[Inflammatory response associated with Helicobacter pylori infection in gastric mucosa with intestinal metaplasia in a population in high risk for gastric cancer]

Intestinal Metaplasia (IM) and Helicobacter Pylori (HP) infection had been related to gastric carcinogenesis. With the intention to know the relationship among HP infection, IM and inflammatory response of the mucosa in an area of high prevalence of gastric cancer, we studied 800 persons that attended the Gastric Cancer Mass Survey, ongoing in the State Tachira, Venezuela, since 1981. Out of these subjects, 259 had histology diagnosis of IM (32.4%) 52.1% were IM type Y, 19.3% type II and 22.8% type III (sulfomucin secretory). Histology demonstrated with Giemsa stain HP in 94.6% of the cases. Association between HP and inflammation response in gastric mucosa with IM, was statistically significant (p = 0.001). The are heavier bacteria overload in IM type I than in type III although it is not statistically significant. We ponder if gastric mucosa inflammation due to HP, conditions development of IM as a hostile way of the gastric environment to restrain bacterial growth. This phenomenon ally with other oncogeneous factors could induce to premalignant lesions and eventually gastric cancer.

Long-term therapy with a single daily subcutaneous dose of growth hormone releasing hormone (1-29) in prepubertal growth hormone deficient children. Venezuelan Collaborative Study Group

As part of a multicenter study to evaluate the efficacy and safety of one daily subcutaneous dose of 30 micrograms/kg of GHRH, 16 prepubertal GH-deficient children with a mean chronological age of 9.0 +/- 2.3 years were treated for 12 to 24 months. After six months of therapy 11 children (68.7%) were considered good responders in that their growth velocity increased by greater than 2 cm/yr over baseline and were continued on GHRH, while five subjects (31.3%) were regarded as poor responders and switched to recombinant hGH for the following six months. Growth velocity increased significantly in responders from a baseline of 3.4 +/- 0.7 cm/yr (mean +/- SD) to 6.8 +/- 0.1 cm/yr, 6.2 +/- 0.9 cm/yr, 6.6 +/- 1.0 cm/yr and 6.5 +/- 0.7 cm/yr at 6, 12, 18 and 24 months respectively. Bone ages advanced by an amount equivalent to the months of treatment. GHRH antibodies were detected in 4/11 and 6/11 responders at six and 12 months of treatment and in 2/5 non-responders at six months, but seemed not to interfere with growth. No side effects or changes in glucose and lipid levels were noted during therapy. These results suggest that GHRH (1-29) at the dose and schedule used is generally effective in the treatment of GH deficiency.

[Gastric leiomyoblastoma. Histomorphologic and immunologic analysis of 3 cases]

We present three cases of Leiomioblastomas of stomach, diagnosed at the unit of Pathology of the Gastrointestinal Cancer Center "Dr Luis E. Anderson" -San Cristóbal-Táchira State Venezuela. The lesions are analyzed from the clinical, morphological and immunohistological points of view, utilizing Queratine and Vimentin techniques. This neoplasm is not frequent but it is interesting because its biologic behavior not always correspond to its histology-pattern.

[Evaluation of the design and reliability of a questionnaire to identify elderly individuals in need for social and health services]

BACKGROUND

To assess the construction of a short screening questionnaire designed for the detection of elderly people living in the community and in need of social and health care, and to test the reliability of the scores obtained on the scales of Activities of Daily Living (ADL) and mobility through its application.

METHODS

A short screening questionnaire of 11 items was designed to score elderly community dwellings on the scales of ADL and mobility of the International Classification of Impairments, Disabilities and Handicaps of the WHO (ICIDH). A random sample of 1,000 people aged 65 and over from the community of a geographical area of Catalonia (Spain) were interviewed in 1989, either by telephone or in-home personal interview, by non-professional trained interviewers on the basis of the mentioned schedule, and scored on the ICIDH ADL and Mobility scales. The design of the screening questionnaire was evaluated on the construction, content and wording through a 16 opinion statements questionnaire upon which 12 professionals, familiarized with questionnaire construction, expressed agreement or disagreement. To test reliability, each interviewer re-scored, one month apart, 20 subjects based on the information they had registered on the questionnaires, and following the same procedure, a gold standard observer re-scored all 1,000 interviews. In addition, a number of interviews were tape recorded, with previous consent of the subjects, and re-scored by 9 different observers. Interobserver and intraobserver reliability was measured with Cohen's weighted kappa coefficient.

RESULTS

The average time of questionnaire administration was approximately 10 +/- 5 min. Although the instrument was said to be a good tool for the interviewer to score the subjects on the scales, wording of some items of the questionnaire need to be reviewed. Both intraobserver and interobserver reliability were high: kappa coefficients of 0.79-0.97 and > 0.75 respectively.

CONCLUSIONS

The use of a simple and reliable ADL and mobility questionnaire is a practical way to obtain information on the functional status of elderly people living at home, and to select elderly people for a further comprehensive assessment of their social and health care needs for planning the appropriate services in the community.

Laparoscopy in abdominal gunshot wounds

The role of laparoscopy in the evaluation of abdominal trauma continues to evolve. It has been successfully used in blunt and penetrating trauma. We report our experience with diagnostic laparoscopy in 28 patients with abdominal gunshot wounds. We found a 100% accuracy and a 0% morbidity in patients with negative laparoscopy. We report a case in which laparoscopy was used to demonstrate an isolated nonbleeding liver injury due to a gunshot wound to the abdomen. Nontherapeutic laparotomy was avoided.

[The reasons for consultation and active problems. A key for the understanding of information in primary care]

The aim of this work is to assess the major differences found in the information content of the registers in primary care according to whether the registration includes the Reason (s) For Encounter (as ascertained by the professional) or the Active Health Problem (s). The information used is based on an observational study of a representative sample of the consultations to eight general practitioners from the Principate of Andorra. The study was performed during the period of May-June 1989. 547 consultations are analysed. A better specificity and information content is observed when both approaches are registered. Active Health Problems seem to be barely related to Reasons for Encounter and it seems that they could have as much, if no more. Influence in the process of care, than the RFEs it selves.

[Minimum sets of data in primary care: an exploration of their feasibility]

OBJECTIVE

To evaluate the different "costings" of several different strategies for gathering a Minimum Set of Data (MSD) at the Primary Care level.

DESIGN

A simulation study using a hypothetical MSD with 16 items together with the findings on demand and interventions made by General Physicians in an observational study in Andorra. Different gathering strategies were applied using these data and with the MSD register covering visits as the starting-point. Measurement of the "costing" or work-load involved in the gathering and transmission of each of the items was carried out by means of a nominal group. SITE. General and paediatric consulting-rooms.

PATIENTS OR OTHERS PARTICIPANTS

The simulation was carried out among the catchment population of PAMEM and used data on what was done in 1988.

MAIN MEASUREMENTS AND RESULTS

Strategies based on sampling of visits or individuals are those which show a greater reduction in cost (99.3% and 98.1% respectively). Sampling individuals additionally allows for the MSD to be added to during periods of illness. Other options with their respective results are: "gathering information from alternative sources", with a reduction of 22%, "reduction of the number of data to record", with 20% reduction and "separation of stable information" with 18%.

CONCLUSIONS

The systematic collection of data on each visit has important and much more efficient alternatives. The choice of one of them will depend on how feasible it is to introduce, on the available resources and above all on objectives.

Modification of foot-and-mouth disease virus O1 Caseros after serial passages in the presence of antiviral polyclonal sera

Foot-and-mouth disease virus (FMDV) shows a remarkable antigenic variability and, like other RNA viruses, presents a high rate of mutation. It has been proposed that selection exerted by antibodies of the host could play a major role in the rapid evolution of FMDV. The present work reports the selection of FMDV antibody-resistant (Nr) populations after serial passages of a cloned FMDV O1 Caseros strain on secondary monolayers of bovine kidney cells in the presence of subneutralizing antiviral polyclonal sera (APS). After a limited number of passages, i.e., 29, under selective pressure, the virus population showed the following characteristics: (i) increased resistance to neutralization by APS (Nr), (ii) altered electrophoretic mobility of its structural viral proteins (VP1), and (iii) alterations at the RNA nucleotide sequence that codes for the major antigenic site of VP1. These acquired characteristics were detected at passage 15 and remained unmodified throughout successive passages. These results document a rapid selection and fixation of specific mutations in response to immunological pressure. In addition, the findings that (i) mutations not related to APS selection were not detected and (ii) after 29 passages at a high multiplicity of infection without immunological pressure, the RNA sequence that codes for VP1 remained unmodified clearly demonstrated that FMDV O1 Caseros presents in vitro a remarkable unexpected genetic stability.

Hyperthermia-induced seizures alter the levels of methionine-enkephalin in immature rat brain

The effects of hyperthermia induced seizures on the amount of Methionine-enkephalin (Met-E) in 15 day rat pups were examined. Animals exposed to an ambient temperature of 40 degrees C showed a gradual increase in body temperature reaching a maximum of 40.6 +/- 0.2 degrees C; at this time all of the animals had seizures. Elevated brain Met-E concentration was observed immediately after seizures. When the animals were exposed for 30 min to 27 degrees C environment maintained their normal body temperature throughout the experiments and no seizures were observed. The brain Met-E levels in this group were significantly lower than those observed in the animals exposed to 40 degrees C environment. These experiments suggest that enkephalinergic system may play a role in hyperthermia-induced seizures in the rat pups.

Responsiveness patterns and handedness differences in bilateral electrodermal asymmetry

The aim of the present study was to examine the relationship between subjects' handedness and electrodermal asymmetry when subjects were divided according to their electrodermal Responsiveness Patterns, obtained during a stimulus-free period. Skin conductance was bilaterally recorded in a sample of 48 subjects (24 dextrals and 24 sinistrals) during the performance of two tasks (watching a film and listening to neutral tones). Subjects were divided into four groups of 12 subjects each (dextral right-hand responders, dextral left-hand responders, sinistral right-hand responders and sinistral left-hand responders). No differences were found between dextral and sinistral subjects. Orientation of electrodermal asymmetry in each Responsiveness Patterns remained constant throughout the two conditions: right-hand responders showed higher electrodermal activity on their right hand, while left-hand responders showed higher electrodermal activity on their left hand. In addition, left-hand responders showed a slower habituation rate on their left hand than on their right hand, whereas right-hand responders showed no significant differences between hands.

Prevention of hyperthermia-induced convulsions in immature rat by MR-2266, a kappa antagonist

The opioid receptor subtypes involved in hyperthermia-induced convulsions were studied by testing different opioid receptor-selective antagonists in unrestrained 15-day-old rats. Saline-injected animals exposed to an ambient temperature of 40 degrees C showed a gradual increase in body temperature reaching a maximum of 40.4 +/- 0.2 degrees C at 60 min. At this time all rat pups had convulsions and died. Similar results were obtained when the animals were pretreated with beta-funaltrexamine or 1 mg/kg ICI-154129. However, the injection of 10 mg/kg ICI-154129 prevented hyperthermia-induced convulsions (only 20% of the rats showed generalized convulsions at 90 min). Rats treated with the kappa antagonist MR-2266 also showed an increase in rectal temperature. However, none of the animals had convulsions or died. These results suggest that the kappa-opioid receptors are involved in convulsions induced by hyperthermia.

[Minimum data sets in ambulatory care]

A sensible and rational approach is necessary in order to match the growing requirements of information on the ambulatory care sector characterised by a big deal of complexity and variability. This must be applied to any initiative attempting to obtain any degree of harmonization in ambulatory care data sets. This paper summarises a conceptual aspect of the work undertaken by the project Measurement Characterization and Control of Ambulatory Care in Europe (McACE) sponsored by the Commission of the European Communities under the exploratory phase of the Advanced Informatics in Medicine (AIM) programme. Our approach places in the first priority the efficiency when assessing the information needs of the different actors trying to make a balanced approach between the costs of collecting and processing a specific item and its use. For this we performed a conceptual validation of the term Minimum Basic Data Set and its potential application to the Ambulatory Care Sector. It is suggested its substitution by the term Minimum Data Set as a part of a practical tool for promoting the harmonization of the information in ambulatory care.

[Massive pulmonary thromboembolism treated with selective infusion of streptokinase. Report of 2 cases]

We report 2 patients who developed massive pulmonary embolism with greater than 50% occlusion of the pulmonary arterial circulation. Hypotension, syncope and right sided failure were the clinical manifestations. Immediately after diagnostic pulmonary arteriography, 20,000 U of streptokinase (SK) were delivered in the pulmonary artery next to the thrombotic mass. A continuous infusion of SK, 10,000 U/h was maintained for 24 h in one patient and 72 h in the other. Rapid clinical improvement was observed in the following 24 h. Control angiography showed lysis of the embolus with residual obstructions of segmentary branches. The clinical value of this form of treatment for pulmonary embolism is discussed.

Effects of diltiazem on hyperthermia induced seizures in the rat pup

1. We studied the effects of a calcium antagonist diltiazem, as well as diazepam and phenytoin on hyperthermia induced seizures in unrestrained 15 day-old rats. 2. Saline injected animals exposed to an ambient temperature of 40 degrees C showed a gradual increase in body temperature reaching a maximum of 42 +/- 0.1 degree C at 50 min. 3. At this time all rats pups had generalized seizures. 4. Similar results were obtained when the animals were pretreated with phenytoin (100% showed seizures). 5. Animals receiving diltiazem had a temperature of 41.5 +/- 0.1 degree C at 90 min of exposure to 40 degrees C environment. 6. However, diltiazem completely prevented seizures. 7. The rats treated with diazepam showed lower temperature than in saline, diltiazem and phenytoin groups and no seizures were observed in this experimental group.

Sex differences and bilateral electrodermal activity: a replication

The present study was aimed at replicating the results of a previous work on sex differences and electrodermal asymmetry from our laboratory (Román, et al. 1987). Skin conductance was bilaterally recorded in a sample of 44 dextral volunteers (22 males and 22 females) during a stimulus-free period, and the performance of two tasks (verbal and spatial). Subjects were grouped into two groups of right-hand and left-hand dominance in their electrodermal responses (EDRs) in accordance with their laterality coefficient scores at rest. During the tasks subjects appeared clearly differentiated by their lateralization in the magnitude and frequency of EDRs independently of gender: right-hand responders showed higher electrodermal activity on their right hand, while left-hand responders showed higher electrodermal activity on their left hand. Sex differences were not observed within each responsiveness pattern. The orientation of phasic electrodermal changes remained constant throughout the different conditions.