[Liver cirrhosis mortality in Mexico. II. Excess mortality and pulque consumption]

Over the years high cirrhosis mortality rates have been reported in Mexico City and in the surrounding states (Hidalgo, Tlaxcala, Puebla and the State of Mexico); on the contrary, well defined areas, such as the northern states, have shown a considerably lower mortality rate. This situation may indicate that some factors such as the pattern of alcoholic intake and other environmental characteristics could explain this striking difference. To determine the role of alcohol, the availability and consumption of alcohol at regional and state level were compared with cirrhosis mortality rates. A high and statistically significant correlation was found with pulque availability and consumption (r = 72-92%, p less than 0.01) in all periods of time under examination. On the contrary, a statistically significant negative association was observed with beer consumption and a positive, but not significant correlation, with distilled alcoholic beverages. Infectious hepatitis incidence, prevalence of exclusive use of native languages (as an indirect index of ethnic background) and nutritional deficiencies were also studied as possible risk factors. Nutritional deficiencies and the prevalence of exclusive use of náhuatl and otomí languages were positively correlated. These results can be useful to conduct further epidemiological studies still needed to determine the etiologic role of pulque consumption as well as of the other risk factors. Nonetheless, the current data stress the need to implement public health programs to reduce alcohol consumption, especially pulque, and to minimize the impact of these risk factors in high mortality areas.

[Liver cirrhosis mortality in Mexico. I. Relevant epidemiological characteristics]

Previous studies have emphasized the impact of alcoholism on public health, especially on the incidence of liver cirrhosis, which ranks among one of the main causes of death in Mexico. Accordingly, the epidemiologic features of liver cirrhosis mortality (LCM) are examined, highlighting its historical trends, its geographical distribution and other risk factors like age and sex. The data show a consistently high LCM rate over time, male rates moving slightly up and female rates down. Proportional mortality has been increasing. The significant risk increment with age has determined LCM to be the leading cause of death for both sexes in the 30-64 years age group. A particularly interesting finding relates to the continuous excess of LCM seen in Mexico City and four surrounding states; on the contrary, in the northern states, LCM is considerably low. This difference is valid for women too. Comparing all states, a gradient of LCM rates from high to low mortality areas is observed. The social and health implications of LCM regional distribution demand the conduction of epidemiological studies to identify possible explanatory variables related to the pattern of alcohol consumption or other risk factors. Nonetheless, these data alone justify the implementation of an effective action plan in the high-risk areas to deal with this health problem, inherently associated with individual and social behaviors.

[Alcohol and the risk of injuries in 3 emergency services in Acapulco, Mexico]

The present study of 421 cases and controls was conducted in three hospitals in the city of Acapulco, Mexico, over a one-month period to determine whether alcohol consumption constitutes a risk factor in four types of traumatic events: assaults and fights, falls, traffic accidents, and domestic accidents. A total of 274 cases were selected from the population over 15 years of age who presented at the emergency services in the three hospitals for injuries sustained in these occurrences, together with 126 controls from the same age group who consulted the services because of occupational accidents, sports injuries, and animal and insect bites. The amount of alcohol consumed prior to the trauma was measured by blood alcohol concentration (determined by an alcoholometer) and the degree and state of intoxication reported by the patient himself. The relative risk associated with each variable was calculated using the odds ratio (OR) and 95% confidence intervals. Logistic regression was used to control the OR for sex, age, schooling, place of residence, occupation, and time of the week when the injury occurred. The results showed that moderate alcoholemia (10-99 mg/100 ml) constitutes a risk factor for assaults and fights (OR = 12.77; CI = 3.69-44.15) and traffic accidents (OR = 8.96; CI = 2.01-39.96). On the other hand, there was no significant correlation between the four types of injury and alcoholemia over 99 mg/100 ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebral aneurysms: assessment of 377 cases (1956-1982)

A review of 177 patients with cerebral aneurysms is made, out of whom 106 with ruptured aneurysms were examined, whose operational timing and prognostic chances were well documented (group B, 1979-1982) and in part updated to 1984. Furthermore, relevant data of a previous series of 200 cases of cerebral aneurysm, treated between 1956-1978 were used (group A). The patients were graded according to Hunt and Hess, assessing the risks involved. The percentages of recurrent bleeding were in group A 36.5% and 28% in group B. The incidence of vasospasm (as seen in angiography) was in group B 39.6% (42/106 patients). The highest rate of vasospasm in the spasm group division B was found to occur in the second and third week after subarachnoid haemorrhage and amounted to 64.7% and 62.5%. A pre-operatively present vasospasm had no negative effects on the mortality rate, but influenced the outcome for the survivors effectively. The total mortality in group A was 22.5% and in group B 11.7%. Timing of the operation among patients in Hunt and Hess-grades I and II needs to discussion. The surgical position of patients in grade V is also certain. What remains to be discussed and needs attention is grade III and patients in grade IVa. Here the time of operative intervention must be planned individually depending on the course of the neurological status.

Management of giant aneurysms

Technical aspects and anatomical difficulties involved in the management of this entity and the risks associated give giant aneurysms a special place in the treatment of aneurysms as a whole. The direct attack needs careful planning and the right choice of instruments, especially clips. In spite of the progress in recent years, the rate of mortality is still very high. The indirect approach requires in many cases the occlusion of a major cerebral vessel, which in some cases could result in cerebral ischemia. However, by means of extra-intracranial by-pass operation this risk could be reduced. The method of balloon embolisation has progressed recently. This procedure brings the least discomfort to the patient. Results of this method of treatment must be observed critically for future assessment.

[Postneonatal mortality caused by diarrhea: a case-control study]

A matched case-control study was undertaken in Naucalpan de Juárez, Estado de México. The goal of this study was to identify the risk factors for diarrheal disease in children between seven days and one year of age. We identified 63 case and 188 controls. The most important risk factors were: mother's age greater than 36 years with an odds ratis (OR) 3.7, lack of breastfeeding (OR 11.3), breast and bottle feeding (OR 5.4), lack of intradomiciliary sewage (OR 8.3), repeated episoded of disease (OR 8.6) and father's consumption alcoholic beverages (OR 3.6). The main possible paths by which these factors influence mortality are discussed. Specific interventions for some of the factors are proposed.

Development and operation of portable and laboratory electrical stimulation systems for walking in paraplegic subjects

Two new stimulation systems have been designed for use in functional neuromuscular stimulation of paralyzed people; one is portable and one is a nonportable laboratory system. Compared to previous systems, these have greatly enhanced capabilities, especially in terms of memory capacity, expandability, and user interface. They are extensively operator programmable. The laboratory stimulation system was designed to provide quick turnaround time for stimulation pattern or program changes while maintaining complete compatibility with the portable system. The lab system will also accomodate external closed-loop control.

[The prevalence of chronic drinkers in Mexico: an ecologic analysis]

Alcohol consumption is an important element in the epidemiologic profile of Mexico. This can be confirmed observing the increased per capita consumption of certain alcoholic beverages (like beer and wine), alcohol related medical problems (e.g. liver cirrhosis), social problems (i.e. violence) and by the data provided by household surveys of prevalence of alcohol consumption in Mexico since the 60's. The population's consumption of alcoholic beverages has generated concern, as the Simple Distribution Theory (SDT) predicts that an increment in the per capita alcohol consumption is likely to be accompanied by an increment of heavy drinkers. This increment is, then, related to a theoretical increment in alcohol related damages. In order to partially test the SDT data from a series of surveys done in the country, six surveys of the 70's were used. Those surveys were executed in six cities, the capital of five states and the capital of the Republic, with a comparable methodology and definition of alcohol consumption. We used prevalence data of heavy drinkers in those cities as an independent variable for a series of medical and social problems, in a multiple-group comparison study. In general, the results do not support the SDT in the case of mortality by liver cirrhosis, suicide and traffic deaths, or for alcohol related offenses at the Federal Courts. Nevertheless, the results seem to support the SDT for some groups in Common Court offenses and for the rate of traffic accidents. In a comparison with other independent variables (prevalence of abstainers, per capita bars, illiteracy, unemployment, and population density), the prevalence of heavy drinkers and population density were the best. Both obtained the largest number of statistically significant correlations with the problems studied. For the prevalence of heavy drinkers some of those correlations were in the inverse sense as predicted by the SDT.

[Aneurysmal bone cyst of the orbit: report of a case]

The authors report a case of aneurysmatic osseous cyst of the orbit in a 10 year-old girl. The tumor was totally removed and the reconstruction of the orbital roof with acrylic was performed.

[Infratentorial malignant neurinoma: report of a case]

A solitary malignant schwannoma of the foramen jugular, unassociated with von Recklinghausen's disease in a two years and nine months old girl is presented. A partial removal of the tumor was carried out. The low incidence in this age group is emphasized in report to the literature reviewed.