Processes of change assessment in heroin addicts following the Prochaska and DiClemente transtheoretical model

The processes of change dimension of Prochaska and DiClemente's transtheoretical model of change is tested in a sample of opiate addicts for the first time. A self-report (The Processes of Change Inventory for Opiate Addicts, PCI-OA) designed to assess the frequency of processes of change was administered in a sample of 178 heroin addicts in order to study its reliability, validity and discriminative efficiency. An alpha-reliability coefficient of 0.87 was obtained. A principal component analysis of the measure revealed a three-component solution which accounted for 34% of the variance: 'contemplation and preparation processes', 'processes of action', and 'processes of the final part of the action phase and maintenance'. Comparisons between abstinent and non-abstinent subjects revealed significant differences (P < 0.0001) in two of the ten processes considered: counterconditioning and stimulus control. A stepwise discriminant analysis yielded a linear combination of eight processes that correctly identified 78% of the total sample. Theoretical and clinical implications of the results are discussed, suggesting that the PCI-OA can be considered as a useful self-report instrument for identifying which processes of change are being used by a specific opiate-dependent patient.

Fusarin C Production by Fusarium spp. from Spain

From 657 samples of grains and feedstuffs (1991 to 1992 and 1992 to 1993 surveys), collected in two different geographical areas of Spain, 154 isolates of Fusarium spp. were obtained. The isolates were screened for their ability to produce fusarin C in a modified 10% ICI N synthetic liquid medium. The production of fusarin C was verified by means of spectrophotometry, thin layer chromatography, high-performance liquid chromatography, and nuclear magnetic resonance. Results showed that more than 57% of tested isolates were able to produce fusarin C at levels of 0.04 to 200 μg/liter of ICI medium. There were no statistically significant differences (P < 0.05) between levels of fusarin C production and the geographical origin of the Fusarium isolates. The Fusarium isolates that produced fusarin C were identified as F. moniliforme , F. oxysporum , F. sporotrichioides , and F. poae . This is the first report of fusarin C production by F. oxysporum .

[The evaluation of a newborn in a coma]

Coma is differentiated from sleep by the absence of a normal arousal response and from death by the presence of heart beats and the absence of brain death criteria. Most causes of coma are readily diagnosed and treated. Others require a test whose results are not immediately available, transportation or a risky procedure and empirical treatment has to be considered. In addition to treating the cause of coma, treatment of the systemic and neurological causes of secondary brain damage is paramount.

Relationship between the Stages of Development of Fusarium moniliforme ATCC 38932 and Production of Fusarin C

A study of the kinetics of fusarin C production by Fusarium moniliforme ATCC 38932, a known producer of fusarin C, was carried out. This strain was subcultured on an EG medium for an adequate sporulation, and a 4% inoculum was transferred to the 10% ICI N medium. The conditions for the production of fusarin C in this synthetic culture medium were optimized. The time-course study of fusarin C performed over 26 days with this strain showed three different developmental stages in which a maximum production of fusarin C was reached on the 8th day of incubation; thereafter this strain ceased growing exponentially and exhibited a sharp decrease of fusarin C from that moment on.

Angiographic predictors of neointimal thickening after successful coronary wall healing following percutaneous revascularization

This study was undertaken to characterize, by intracoronary ultrasound technique, the neointimal thickening at follow-up of treated coronary segments after successful arterial wall repair and to compare the findings with serial angiographic studies. We selected for study 81 patients with single-vessel coronary disease successfully treated by percutaneous revascularization who were angiographically and ultrasonically reevaluated at a mean follow-up time of 22 +/- 21 months; 23 had been treated by balloon angioplasty, 27 by directional atherectomy, and 31 by elective Palmaz-Schatz stent implantation. The late maximal neointimal thickness varied between 0.1 and 1.5 mm (mean 0.65 +/- 0.31 mm), and the neointimal area ranged between 0.97 and 14.9 mm2 (mean 5.19 +/- 3.14 mm2). The neointimal repair was thinner in patients who obtained a better acute angiographic result immediately after treatment and in stented (3.4 +/- 1.8 mm2) versus dilated (7.8 +/- 4.1 mm2) or resected (5 +/- 1.6 mm2, p < 0.001) segments. On the contrary, the repaired neointimal layer was thicker in those patients who angiographically exhibited less late luminal loss or even expansion and in those evaluated after a longer time since treatment. The acute gain and the time influence resulted in independent predictors of the degree of neointimal thickness. These findings suggest that two reparative mechanisms of the coronary wall may operate in close relation.

Acute administration of the CB1 cannabinoid receptor antagonist SR 141716A induces anxiety-like responses in the rat

Animal models have revealed that psychoactive cannabinoids induce both anxiolytic and anxiety-like reactions which are dose- and context-dependent. In the present study we examined the acute actions of the CB1 cannabinoid receptor antagonist SR 141716A in both the defensive withdrawal test and the elevated plus-maze in rats. Acute administration of SR 141716A (0.1, 1 and 3 mg kg-1) induced defensive responses in both anxiety tests, at a dose of 3 mg kg-1. This dose had no effect on horizontal locomotor activity and did not activate the hypothalamus-pituitary-adrenal axis, although several cannabinoid withdrawal-like behavioural symptoms were observed. These results demonstrate that blockade of the endogenous cannabinoid tone might induce anxiety-like responses in rats.

[Primary stent treatment in the acute phase of myocardial infaction]

INTRODUCTION

Although direct balloon angioplasty has emerged as an alternative to thrombolytic therapy in patients with acute myocardial infarction, reocclusion and restenosis rates are limiting factors. We postulated that these limitations could be partly overcome by primary stenting of the responsible lesion.

MATERIAL AND METHODS

Since January/94 we have studied 59 patients with acute myocardial infarction who were treated in the early phase (3.1 +/- 2 hours since the onset of symptoms) by elective Palmaz-Schatz stent implantation. No adjunctive thrombolytic therapy was associated. Two patients were in cardiogenic shock and were treated under percutaneous cardiopulmonary support. At cardiac catheterization a left ventriculography and coronary angiograms were obtained. Then, mechanical recanalization of the responsible lesion was performed. If the angiographic anatomy was considered suitable, a stent was implanted at the lesion.

RESULTS

The infarct related artery was the left anterior descending in 29 patients, the circumflex in 14 and the right coronary artery in 16. At baseline conditions, 40 patients had a totally occluded artery and 19 showed a TIMI-grande 1 antegrade flow. One patient had an early clinical recurrence 4 days later, which required an additional divided Palmaz-Schatz stent at the distal portion of the lesion, in order to seal a residual dissection. All remaining patients had a favourable clinical course without major complications. Immediately after treatment the minimal lumen diameter was 3.2 +/- 0.4 mm and no residual stenosis was detectable at the treated segment. Six-month angiographic reevaluation was performed in all 29 (49%) eligible patients. Restenosis (> 50% stenosis) was detected in 6 out of the 29 evaluated patients (21%).

CONCLUSIONS

Primary stent implantation in selected patients with an evolving myocardial infarction provides good initial and 6-month results.

Reduction of thrombotic and hemorrhagic complications after stent implantation

This study compared two consecutive antithrombotic strategies after Palmaz-Schatz stent implantation and involved 918 patients. Patients treated between May 1991 and May 1994 (group 1; n = 379) received aspirin, dipyridamole, and intravenous unfractionated heparin until oral anticoagulation was effective, between June 1994 and August 1995, 539 patients (group 2) were treated for 1 month with subcutaneous low-molecular-weight heparin (Fragmin), ticlopidine, and aspirin. There were no differences between the groups in terms of sex, clinical condition, vessel diameter, and severity and location of stenosis. Patients in group 1 were younger than those in group 2 (4% were > 70 years old compared with 12%, respectively; p < 0.01). Group 1 patients had more frequent unplanned stenting (48% vs 18%, respectively; p < 0.01) and fewer endoprostheses in the same artery than those in group 2 (1.1 +/- 0.5 vs 1.2 +/- 0.5, respectively; p < 0.01). Among group 2 patients, there was a significant reduction in thrombotic and hemorrhagic complications compared with group 1 patients. No subacute thrombosis occurred in patients in group 2 in contrast with a 5.8% incidence in patients in group 1 (p < 0.01). In addition, a lower incidence of groin and systemic bleeding was observed in patients in group 2 compared with patients in group 1 (2.6% vs 15%, respectively; p < 0.01). The association of low-molecular-weight heparin and antiplatelets provides a simpler antithrombotic strategy in patients treated with intracoronary stents and reduces the incidence of stent thrombosis and hemorrhagic complications. Our findings suggest that this antithrombotic regimen may prevent or completely avoid stent thrombosis.

Local carboplatin and radiation therapy in the treatment of murine transgenic retinoblastoma

BACKGROUND

Combined modality therapy in the treatment of retinoblastoma may decrease treatment-related morbidity and second tumor-associated mortality, while maintaining excellent tumor control rates.

OBJECTIVE

To evaluate tumor control and potential synergy between intravitreally delivered carboplatin and external beam radiation therapy (EBRT), using a transgenic murine model of spontaneous heritable retinoblastoma.

METHODS

Sixty-six mouse eyes from 4-week-old transgenic mice positive for the simian virus 40 large T antigen were evaluated. Thirty-three mice were treated with 5 intravitreal injections of carboplatin (ranging from 0.1-4.0 micrograms) combined with concurrent bilateral EBRT (ranging from 10-30 Gy) delivered in twice daily 5-Gy fractions. All eyes were followed up for treatment complications. Twelve weeks following final treatment, all eyes were enucleated, serial histologic sections obtained, and the eyes examined for the presence of retinoblastoma.

RESULTS

No eye treated with 0.1 microgram of carboplatin and EBRT exhibited tumor control. Three (75%) of 4 mice receiving 1.0 microgram of carboplatin combined with 10-Gy EBRT had complete tumor control. Four (100%) of 4 mice receiving 1.0 microgram of carboplatin combined with 30-Gy EBRT had complete tumor control. Nine (100%) of 9 mice receiving 4.0 micrograms of carboplatin in combination with EBRT had complete tumor control. The chemotherapeutic enhancement ratio ranged from 1.07 to 3.24.

CONCLUSIONS

Combined administration of intravitreal carboplatin and EBRT enhances local tumor control in murine retinoblastoma. Combining these treatment modalities may allow tumor control in selected patients with retinoblastoma while decreasing treatment-related morbidity and the mutagenic risks associated with radiation and systemic chemotherapy.

Local carboplatin therapy in transgenic murine retinoblastoma

PURPOSE

To determine the efficacy and toxicity associated with intraocular delivery of carboplatin in the treatment of murine transgenic hereditary retinoblastoma.

METHODS

Forty-eight transgenic BLH-SV40 Tag retinoblastoma mice were administered five intravitreal injections of carboplatin in one eye. After 12 weeks, the eyes were examined histopathologically to evaluate tumor burden. Twelve rabbits were administered intravitreal injections of carboplatin in one eye, after which they underwent serial electroretinography. All experimental and control eyes were obtained for histopathology and electron microscopy.

RESULTS

A dose-dependent inhibition of intraocular tumor growth by carboplatin was observed in transgenic retinoblastoma mice. Tumor development was inhibited in 50% of the mouse eyes at doses of 1.4 micrograms. In rabbits, retinal toxicity resulted when intravitreal injections of carboplatin were administered at doses of 10 micrograms or higher.

CONCLUSIONS

Local delivery of carboplatin in serial doses effectively inhibits intraocular tumor growth in a dose-dependent manner in transgenic murine retinoblastoma.

[Directional coronary atherectomy in ostial lesions of the anterior descending coronary artery]

INTRODUCTION AND OBJECTIVES

Coronary stenoses at ostial level, when treated by balloon angioplasty, show a primary success rate much lower than those located in other parts of the coronary tree. Balloon dilation of lesions located at the left anterior descending ostium is associated with a high degree of restenosis, elastic recoil and the possibility of retrograde dissection to the left main coronary artery. Simpson atherectomy may be considered a percutaneous alternative in this particular location, since this technique produces fewer incidents of elastic recoil than balloon dilation. The purpose of the present study is to evaluate directional atherectomy in the treatment of patients with symptoms deriving from severe to stenosis at the origin of the left anterior descending artery.

MATERIAL AND METHODS

From a total number of 302 patients treated by Simpson atherectomy, we have analyzed 45 with severe stenosis at the left anterior descending ostium (less than 3 mm from its origin). The mean age was 54 +/- 12 years. Eighty two percent of the patients were male. The clinical condition was stable in unstable in 34; eleven had had a previous myocardial infarction. Six had multivessel coronary disease, all of them underwent combined balloon angioplasty of other segments. The treated lesion was native in 41 patients and previously dilated by balloon (restenosis) in 4. Two patients needed balloon predilation with 2 and 2.5 mm to facilitate the pass of the atherocatheter. The size of the Simpson atherocatheter was mainly 7F (78%). The weight of the resected arteriosclerotic material was 11 +/- 7 mg.

RESULTS

Primary success (residual stenosis < 40% without major complications) was obtained in 42 out of 45 patients (93%); 3 patients (7%) had major complications (1 death, 1 emergency surgery, and 1 non-Q wave myocardial infarction). A follow-up angiography study was available in 31 patients 7 +/- 8 months later. Restenosis was evidenced in 12 (39%).

CONCLUSIONS

Simpson atherectomy for left anterior descending artery ostial lesions is an effective transluminal alternative in selected patients providing a high rate of primary success (93%) and an acceptable restenosis rate (39%).

[Multidisciplinary assessment of the fetus with hydrocephalus: study protocol and results]

The objective was to make the confirmation-exclusion diagnosis of fetal hydrocephaly, to study its etiology and identify associated anomalies. 67 cases with suspected fetal hydrocephaly were studied at 30 weeks of mean gestational age. Serial studies of ultrasonography, TORCH serology and fetal karyotype were made. Postnatal correlation was made. 14 cases were not confirm and 53 were. 6 cases (11.3%) were classified as isolated hydrocephaly and 47 (88.7%) with associated anomalies. In this group, 15 with only intracranial anomalies and 32 intracranial and extracranial anomalies. All chromosomic anomalies were found in this latter group. Proved in all the cases of hydrocephaly and most of its associated anomalies were documented. Fetal hydrocephaly can be accurately diagnosed with the technology presently available. The diagnosis of associated anomalies is more difficult to obtain, but can be reached using serial studies and multidisciplinary approach.

Influence of water activity and temperature on the production of zearalenone in corn by three Fusarium species

The production of zearalenone in corn by seven isolates of Fusarium belonging to F. graminearum, F. culmorum and F. oxysporum was investigated for different culture conditions (water activity, temperature and incubation time). Two isolates belonging to F. graminearum were the highest producers of zearalenone (5150 and 7100 mg/kg dry weight of culture medium). The culture conditions that gave the highest yields were a(w) = 0.97, 40 days of incubation and temperature conditions including 2 weeks at 28 degrees C followed by incubation at 12 degrees C. These conditions were also optimal for the two isolates of F. oxysporum but for the remaining isolates the maximum levels of zearalenone were obtained at room temperature and 30 days of incubation. The maximum rate of mycotoxin production was observed between day 15 and 30 for all strains tested. At a(w) = 0.95 the maximum yield of zearalenone was 9.3 mg/kg dry weight of culture medium, produced by an isolate of F. graminearum. At 37 degrees C zearalenone was not detectable under any of the conditions assayed.

In situ absorption of aflatoxins in rat small intestine

To evaluate the rate at which the four main aflatoxins (aflatoxins B1, B2, G1 and G2) are able to cross the luminal membrane of the rat small intestine, a study about intestinal absorption kinetics of these mycotoxins has been made. In situ results obtained showed that the absorption of aflatoxins in rat small intestine is a very fast process that follows first-order kinetics, with an absorption rate constant (ka) of 5.84 +/- 0.05 (aflatoxin B1), 4.06 +/- 0.09 (aflatoxin B2), 2.09 +/- 0.03 (aflatoxin G1) and 1.58 +/- 0.04 (aflatoxin G2) h-1, respectively.

[Fibrinolytic treatment in acute myocardial infarction: analysis of delay]

BACKGROUND

The delay time from the onset of symptoms to the initiation of intravenous fibrinolytic treatment in patients with acute myocardial infarction (AMI) is herein described.

METHODS

A study was carried out of the consecutive AMI diagnosed in the Medical Area of the Emergency Department of the Hospital del Mar in Barcelona, Spain, with a 24-hour follow up from 15 May 1993 to 14 January, 1994. All the patients under the age of 80 years with transmural AMI of any localization and evolution of under 6 hours were considered to receive fibrinolytic treatment. The following delay times were analyzed: total delay time, extrahospitalary delay time and intrahospitalary delay time, which included assistance delay time, delay in fibrinolytic treatment indication and delay time in performance of the same.

RESULTS

During the study period 18,316 patients were attended in the Emergency Medical Area, of which 80 corresponded to AMI. Fibrinolytic treatment was initiated with intravenous streptokinase in 33 patients (41.3%). The total delay time was 287.2 +/- 202.6 (mean +/- SD) minutes; the extrahospitalary and intrahospitalary delays were 159.8 +/- 151.7 and 126.8 +/- 161.7 minutes, respectively. The delay time for assistance was 8.5 +/- 12.7 minutes, the delay time in treatment indication was 78.8 +/- 101.8 minutes and in performance it was 39.5 +/- 52.6 minutes. This latter time was analyzed on the basis of the administration site, with statistically significant differences (p < 0.005) if the fibrinolytic treatment was performed in the Emergency Medical Area (12.5 +/- 0.7 minutes), in the observation room (41.4 +/- 50.7 minutes) or in the Intensive Care Unit (61.4 +/- 75.8 minutes).

CONCLUSIONS

Most of the intrahospitalary delay in the administration of fibrinolytic treatment is due to decision delay in regards to carrying out this therapy.

Investigation of rabies virus strains in Mexico with a panel of monoclonal antibodies used to classify Lyssavirus

The purpose of this study was to evaluate the ability of a panel of eight antinucleocapsid monoclonal antibodies developed in Europe to assess rabies virus strains isolated from various animal species in geographically diverse areas of Mexico. Fifty-one rabies-positive brain tissue samples from animals and humans were examined. Material from these samples was used to infect mice, whose brain tissue was subsequently tested by indirect immunofluorescence using the monoclonal antibodies described above. The study did not turn up any strong evidence of Lyssavirus other than rabies virus, but did find four antigenic variants differing from the classic rabies virus serotype. Samples of these latter were sent to the Pasteur Institute in Paris for confirmation. Overall, the antibody panel was deemed useful for rapid typing of rabies virus in Mexico. It also appears possible that autochthonous antigenic variations are now appearing in strains of the virus found in Mexico, which could explain some of the failures observed with certain vaccines. These circumstances appear to create a need for producing antinucleocapsid monoclonal antibodies with strains of rabies virus indigenous to the area.

[Acute pancreatitis and acquired immunodeficiency syndrome]

Viral acute pancreatitis in Human Immunodeficiency Virus (HIV) infected patients has been occasionally described. We studied nine patients with HIV antibodies and acute pancreatitis attributed to Cytomegalovirus and/or Cryptosporidium infection. In four patients the clinical picture was consistent with acute pancreatitis while in five clinical manifestations were unspecific, and diagnosis was based on ultrasonography and/or computed tomography findings. In the HIV infected patient pancreatic evaluation by imaging techniques may disclose acute pancreatitis even in the absence of abdominal pain.

[Toxoplasma gondii: the characterization of an anti-P30 monoclonal antibody]

A specific monoclonal antibody was characterized to Toxoplasma gondii. The hybridoma produced IgG immunoglobulins. The western blot analysis showed that the monoclonal antibody was specific for the antigen of an apparent molecular mass of 30 kd, which was present on the antigen surface. The monoclonal antibody was purified starting from mouse's ascitic fluid and it was matched with sepharose 4B. This immunoabsorbent was used to purify the specific parasitic antigen. The monoclonal antibody studied may be useful for those techniques contributing to the toxoplasmosis diagnosis.

Lipoprotein(a) and vascular access survival in patients on chronic hemodialysis

Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic and cardiovascular complications in the general population and in hemodialysis patients. Increased Lp(a) levels have been also described as a possible predictor of vascular access occlusion in patients on chronic hemodialysis. We have studied prospectively the relationship between vascular access survival and Lp(a) levels in 40 hemodialysis patients. The Lp(a) plasma concentrations were measured by enzyme-linked immunosorbent assay in all patients in April 1993. Throughout the following year, evolution and survival of their vascular accesses were analyzed. Failure of vascular access was established when there were complications requiring surgical repair or transluminal angioplasty. Fourteen patients showed failure of vascular access, and the cumulative survival of vascular accesses after 1 year of follow-up was 63.8%. The Lp(a) levels were higher in patients with failure of vascular access than in the others (35.2 +/- 31 vs. 22.4 +/- 25 md/dl), but this difference did not reach statistical significance (p = 0.064). The vascular access survival in patients with Lp(a) levels > 75th percentile (52.5 mg/dl) was significantly lower than in the remaining patients (40 vs. 72%; p = 0.045). This difference increased when we analyzed the patients with Lp(a) levels > 90th percentile (76 md/dl; 25 vs. 68%; p = 0.002). Our results suggest that patients with the highest levels of Lp(a) are at risk of developing complications in their vascular accesses, and they also have lower vascular access survival.

[The evaluation of a monoclonal antibody panel for Lyssavirus typing in Mexico]

The purpose of this study was to evaluate the ability of a panel of eight antinucleocapsid monoclonal antibodies developed in Europe to identify different strains of rabies virus isolated from a variety of animal species from diverse geographic areas in Mexico. Fifty-one virus-positive samples of brain tissue from various animal species and humans were studied. Material from these samples was used to infect mice, whose brains were later tested by indirect immunofluorescence, using the monoclonal antibodies described above. Strains of the virus that showed antigenic variations were sent to the Pasteur Institute in Paris for confirmation of the results. No mouse brain sample showed a pattern of antigenic reactivity that indicated the presence of a Lyssavirus other than the classic rabies virus. However, four antigenic variations from serotype 1 of classic rabies were found. The panel of antibodies was judged to be useful for the rapid classification of rabies virus in Mexico. It is possible that autochthonous antigenic variations are appearing among strains circulating in that country, a scenario that could explain some of the failures observed with certain vaccines. For this reason, there is a need to produce antinucleocapsid monoclonal antibodies with strains of rabies virus indigenous to the area.

[Acyclovir nephrotoxicity]

We are presenting the case of a seventy-six year old male infected with Herpes zoster of the trigeminal nerve. He had no previous nephropathology, but developed acute renal failure following the administration of an intravenous bolus of Acyclovir. The existing literature was reviewed. Possible pathogenic mechanisms are discussed, and precautions against nephrotoxicity are emphasized.

Osmoregulation in Pseudomonas aeruginosa under hyperosmotic shock

Pseudomonas aeruginosa PAO1 strain was found to be able to tolerate 700 mM NaCl. 0.5 mM of the osmoprotectant betaine restablished the growth of this strain in 1200 mM NaCl. Intracellular K+ and glutamate concentrations of P. aeruginosa PAO1 after an hyperosmotic shock (400 mM NaCl) showed a permanent increase. Adition of betaine (0.5 mM) to the medium with NaCl had an inhibitory effect on the intracellular accumulation of glutamate. The results indicate that P. aeruginosa PAO1 resists high NaCl concentrations, K+ accumulation and glutamate synthesis probably being the first mechanisms involved in adaptation to osmotic stress. Also is is demonstrated that betaine modulates intracellular glutamate levels in osmotically stressed P. aeruginosa PAO1.

[Smoking in Santiago, 1993-94]

The aim of this work was to study smoking habits, alcohol and drug use and living standards in a random sample of 1000 dwellings and 4700 people of Santiago through periodic surveys during 1993 and 1994. Forty nine percent of dwellings had at least one inhabitant that was a daily smoker and 73% had at least one occasional smoker. Thirty seven percent of subjects older than 15 years were smokers (40% of men and 35% of women), 27% were presumably addicted to tobacco and 16% former smokers. Alcohol abuse had a prevalence of 2.3%. The highest prevalence of smoking was noticed in low socioeconomical strata. Smoking was not related to educational level or emotional disturbances. Frequency of alcohol abuse or marihuana use was 8.8 times higher in former smokers and 25 times higher in actual smokers, compared to people that never smoked. Comparing these results with previous population surveys, the prevalence of smoking increased in the period 1971-1986 from 47 to 51% in men and from 26 to 43% in women. On the other hand, during the period 1986-1994 the prevalence decreased from 51 to 40% in men and from 43 to 35% in women.

Follow-up patency of side branches covered by intracoronary Palmaz-Schatz stent

To assess the risk of late side branch occlusion after Palmaz-Schatz stent deployment, we analyzed the angiographic evolution of 62 patients treated by successful stent implantation who had a total of 85 side branches starting from the stented segment. Side branches were considered minor (n = 39) when the diameter was < 1 mm and intermediate (n = 46) when the vessel had > or = 1 mm diameter. One angiographic follow-up study was available in all patients at 8 +/- 5 months. Eight minor branches presented some degree of stenosis at origin before stent deployment (4 totally occluded). After stent deployment, 32 (82%) of 39 remained unchanged and 3 became occluded. Late progression at origin occurred in 4 of 34 (3 occluded). Before stent deployment, 48% of the intermediate branches had some compromise degree at their starting point (1 totally occluded). Eight of 45 intermediate branches became occluded after stent implantation. Late progression at origin happened in 5 of 32 branches (2 occluded). Some degree of follow-up stenosis regression at the origin was observed in 22 (26%) of 85 arteries. Neither clinical nor angiographic factors could be identified as predictors of late side branch occlusion or stenosis progression at its origin. Later occlusion or progression at origin of a side branch covered by a Palmaz-Schatz stent seems to be an uncommon occurrence (7% and 12% respectively) that cannot be predicted by angiographic or clinical factors. On the contrary, regression at follow-up of a side branch-origin stenosis can also come about.

[Medical care in Santiago, 1993]

Results of morbidity and medical care surveys performed in Santiago in 1993-94 are presented in this paper. The study has been done in an aleatory population sample of 4,700 people coming from 1,000 dwellings. Main results are as following: The Health National Fund (FONASA) is the most important financing medical care's agency in Santiago (49% out of total population). A majority of medical services are given in private offices or clinics. Medical care systems show significant differences among the studied city districts. A significant direct correlation between people's income and private practice is noticed. One half of acute diseases had medical care and the other half used self care practices; the proportion of medical care is 29% in the case of chronic disease patients. National Health Service eligible people show a significant higher morbidity rate and medical consultation rate than other groups. Lack of medical care mainly depends on low severity of illness episodes or lack of symptoms in chronic disease conditions. In 12% out of total cases, lack of medical care was due to problems in the medical care systems. The quality of care was judged "good or excellent" by 82% of the people, "fair" by 9%, and "bad or deficient" by the remaining 8%. Personal expenditures due to health care are high, one third depending on medical care and two thirds on dental care. In the case of medical care the reasons for expenditures are linked to chronic diseases (60%), acute diseases (28%), injuries and health examinations (15%). Main activities causing personal disbursements are the purchase of drugs (44%), medical visits (30%), laboratory tests (13%) and hospital charges (7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of body-weight loss and captopril treatment on proteinuria associated with obesity

We have identified 17 obese patients (body mass index, BMI, 37.9 +/- 4.1) with proteinuria > 1 g/day (1.3-6.4 g/24 h, mean 3.1 +/- 1.7). Their age was 34-70 years (48.3 +/- 10); 11 were females and 6 males. Six patients had only one functioning kidney and a sleep apnea syndrome had been diagnosed in 5. Renal biopsies, obtained in 5 cases, showed focal glomerulosclerosis in 2 cases, minimal changes in 2 and mesangial proliferation in 1. Nine patients (group 1) were treated with hypocaloric diets; body weight significantly decreased (BMI 37.1 +/- 3, 34 +/- 3.5 and 32.6 +/- 3.2 at 0, 6 and 12 months, respectively) as well as proteinuria (2.9 +/- 1.7, 1.2 +/- 1 and 0.4 +/- 0.6 g/24 h). There was a significant correlation between body weight loss and decrease in proteinuria (r = 0.69, p < 0.05). Eight patients (group 2) were treated with captopril, without dietary changes. BMI remained stable but proteinuria showed a dramatic decrease, similar to that in group 1 (3.4 +/- 1.7, 1.2 +/- 0.9 and 0.7 +/- 1 g/24 h, respectively). Renal function remained stable in both groups. In summary, both body weight loss and captopril treatment can induce a sharp decrease in obesity-related proteinuria.

[Characteristics and management of morbidity in Santiago 1993]

Results of morbidity and medical care surveys of the Santiago's population are presented in this paper. A random sample of 1,000 dwellings with 4,700 people was selected and studied 3 times, in 1993 and 1994. All health events (acute and chronic morbidity, health examinations, dental care) and main features of medical care were registered in the interviews which covered a 2-week period each time. The population sample had similar characteristics than the results of the last Population and Dwellings Chilean Census. Health events were registered with high frequency: 56% of the families had one or more members with chronic disease; 51% with acute diseases; 46% with emotional troubles; 24% had dental care; 17% health examination and 6% different types of injuries. Frequency of medical care during the fortnight period was 5.6% out of total population of acute diseases; 1.0% of injuries; 4.9% for chronic diseases, 3.9% of health examinations and 5.6% of dental care. Frequency of diseases was significantly higher among women (50%) than in men (33%) and in poor people than in higher socioeconomic levels. Most of the acute disease were respiratory illnesses followed by communicable diseases, skin troubles and rheumatologic disorders. The most important detected chronic diseases were blood hypertension, diabetes mellitus, bronchial asthma and alcoholic addiction.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative study between continuous and bolus subarachnoid administration of 2% lidocaine]

OBJECTIVE

To compare anesthesia with lidocaine 2% by bolus or by continuous perfusion through a subarachnoid catheter.

PATIENTS AND METHODS

Thirty-one patients undergoing surgery on a lower limb were studied prospectively. Patients were divided into two groups: 14 received subarachnoid anesthesia in continuous perfusion (group CP) while 17 were given subarachnoid anesthesia in bolus form (group B). An 18G Tuohy needle was used with a 20 G catheter. An initial bolus of 20 mg (1 ml) was administered in group CP and followed by continuous perfusion at a rate of 16 mg/h (0.8 ml/h). In group B an initial 20 mg bolus was followed by additional ones of 10 mg (0.5 ml). The optimum sensory level was T 10.

RESULTS

The two groups were homogeneous with respect to age, weight, height and medical history. Fewer boluses were needed with continuous perfusion. Seven patients (50%) in group CP required additional boluses. The ratio of total drug dose administered in mg to time of surgery was significantly higher in group CP. The sensory and motor blockade levels obtained were similar in the two groups. One case of hypotension and one of bradycardia were recorded. Two cases of minor headache were recorded in group B. Sedation was used in 7 patients (50%) in group CP and in 13 (76%) in group B.

CONCLUSION

Subarachnoid administration of lidocaine 2% in continuous perfusion affords the same sensory and motor blockade as administration in bolus form and does not reduce the overall amount of lidocaine used.

Different mechanism for insulin induced and contraction induced increases in skeletal muscle glucose uptake

Glucose facilitated diffusion into cells depends on concentration gradients between intracellular and extracellular spaces and can be modified by several factors such as insulin and contractions. Calmodulin participates in the insulin induced recruitment of vesicles containing glucose transporter molecules and its inhibition by trifluoperazine blocks insulin increases in glucose uptake. In the present study we tested if calmodulin inhibition with trifluoperazine blocks hindlimb muscle glucose uptake increase induced by contractions. Trifluoperazine does not inhibit exercise induced increases in glucose uptake; therefore, the mechanisms by which insulin and functional activity increase glucose uptake are different.