Response of two populations of holm oak (Quercus rotundifolia Lam.) to sulfur dioxide

Experiments were carried out with seedlings of Quercus rotundifolia Lam., an evergreen schlerophyllous tree typical of the Spanish Mediterranean climate environments. Fruits were collected in two distant (800 km) populations located in the center (southern Spain) and northern border (northern Spain) of the area of distribution of the species. One-month-old potted plants were grown for 130 days in an enriched atmosphere of SO2 (0.23 ppm, 14 h/day) in controlled (growth chamber) conditions. Both northern and southern plants underwent a significant decrease in growth rate as a consequence of the treatment. Even so, plants appear to be quite resistant to SO2 compared with either more temperate or more productive species. The southern population was more sensitive to the treatment, as reflected by the bigger decrease in both growth and photosynthetic rates. Differences in resistance appear to be related to the biogeographic origin of the populations studied, which underlines the importance of biogeographic aspects in studies of resistance to air pollutants.

[Factors involved in the non-compliance of the pharmacologic treatment of dyslipidemia]

OBJECTIVES

To find how much non-compliance with lipid-lowering drug treatment there is, its causes and to describe the profile of non-compliant patients.

DESIGN

Prospective study.

SETTING

Primary Care Centres in the province of Alicante.

PATIENTS

107 patients under drugs treatment for lipaemic disorders and belonging to live General Medical practices.

MEASUREMENTS AND MAIN RESULTS

To evaluate compliance, the method of a surprise count of pills in the patient's home was used. Compliant patients were defined as those with between 80 and 110% compliance. 46.7% were non-compliant (C.I. 37.3-56.2), with 42% under-compliant and 4.7% over. Forgetfulness and unawareness accounted for 68% of the reasons for non-compliance. Associated factors were: moderate to high cardiovascular risk (p = 0.03), stating that the drug treatment was followed badly (p = 0.01), less than a year in regular treatment (p = 0.006), monitoring lipaemia poorly (p = 0.003).

CONCLUSIONS

Non-compliance with pharmacological treatment in patients with lipaemia is high. Its causes are known, as are several factors associated to non-compliance which could be used to identify the non-complier.

Mtd, a novel Bcl-2 family member activates apoptosis in the absence of heterodimerization with Bcl-2 and Bcl-XL

We have identified and characterized Mtd, a novel regulator of apoptosis. Sequence analysis revealed that Mtd is a member of the Bcl-2 family of proteins containing conserved BH1, BH2, BH3, and BH4 regions and a carboxyl-terminal hydrophobic domain. In adult tissues, Mtd mRNA was predominantly detected in the brain, liver, and lymphoid tissues, while in the embryo Mtd mRNA was detected in the liver, thymus, lung, and intestinal epithelium. Expression of Mtd promoted the death of primary sensory neurons, 293T cells and HeLa cells, indicating that Mtd is a proapoptotic protein. Unlike all other known death agonists of the Bcl-2 family, Mtd did not bind significantly to the survival-promoting proteins Bcl-2 or Bcl-XL. Furthermore, apoptosis induced by Mtd was not inhibited by Bcl-2 or Bcl-XL. A Mtd mutant with glutamine substitutions of highly conserved amino acids in the BH3 domain retained its ability to promote apoptosis, further indicating that Mtd does not promote apoptosis by heterodimerizing with Bcl-2 or Bcl-XL. Mtd-induced apoptosis was not blocked by broad range synthetic caspase inhibitors z-VAD-fmk or a viral protein CrmA. Mtd is the first example of a naturally occurring Bcl-2 family member that can activate apoptosis independently of heterodimerization with survival-promoting Bcl-2 and Bcl-XL.

Progressive decrease of CD8high+ CD28+ CD57- cells with ageing

An age-dependent decrease in T cell responsiveness to CD28 costimulation has been described. In order to test the hypothesis that an age-related decrease in CD28 expression by CD8+ T lymphocytes might be involved, we analysed 67 healthy donors ranging in age from 15 to 69 years for their CD8+ T cell expression of CD28 and CD57. We found a statistically significant decrease of CD28 expression through ageing and a significant increase of CD57 expression, both markers being mutually exclusive. Given that cytomegalovirus (CMV) is reported to induce CD57 expression, and since the carrier status for this ubiquitous virus increases with age in the general population, it seemed essential to evaluate whether the phenotypic age-related changes described in CD8high+ cells were not influenced by the CMV carrier status of the individuals. Accordingly, we performed a multivariate analysis to assess the independent association of age and CMV carrier status with CD28 and CD57 expression in CD8high+ cells. Results showed that the progressive decrease in CD8high+ CD28+ CD57- cells was associated only with age, while the expansion of the CD8high+ CD28- CD57+ subset depended both on age and CMV, although mainly on age. We conclude that ageing is accompanied by a progressive loss of CD28 expression in CD8+ T cells and a reciprocal enhancement of CD57 expression, both facts being probably related to the repeated antigenic stimulation occurring throughout life.

Host H-2 haplotype modulates the induction of host-versus-graft disease after the induction of neonatal tolerance to H-2 alloantigens

Mice injected at birth with semiallogeneic spleen cells develop a host-versus-graft disease (HVGD) characterized by the polyclonal activation of donor B cells by alloreactive host CD4+ T cells, the production of autoantibodies (autoAb) and the development of an inmmunocomplex-mediated glomerulonephritis. It has been demonstrated that the recognition of MHC class II, but not class I or non MHC, alloantigens triggers the development of the autoimmune syndrome (AIS). The finding of different expression patterns of Ia molecules in different mouse strains, and a closed restriction of some immune responses to particular H-2 haplotypes, prompted us to analyze whether variations in the expressed MHC class II molecules modify the HVGD. First, newborn BALB/c mice received spleen cells from F1 hybrid mice obtained by mating BALB/c mice with several mouse strains differing in the H-2 haplotype. Second, spleen cells from different F1 mice were neonatally injected in mice of both parental strains. All groups of BALB/c mice injected with different combinations of F1 mice showed an HVGD with a very similar serological course. However, in some instances, duration was different when comparing both parental strains injected with spleen cells from the mutual F1 hybrids. These results suggest that host MHC, but not donor MHC haplotype may modulate the AIS associated with the induction of neonatal tolerance.

Regulation of B cell apoptosis by Bcl-2 and Bcl-XL and its role in the development of autoimmune diseases (Review)

Cell death is a common event during B cell development. The demise of developing B cells is a regulated process that serves to select cell populations bearing functional receptors and to remove cells that are no longer needed or potentially autoreactive. Bcl-2 and Bcl-XL, two members of the bcl-2 gene family of programmed cell death regulators with anti-apoptotic activity, are expressed in a highly regulated pattern during B cell maturation. Overexpression of Bcl-2 in developing B cells of transgenic mice, in the presence of T cell dependent costimulatory signals, results in the generation of a modified B cell repertoire and in the production of pathogenic autoantibodies. While disregulation of programmed cell death in B cells may cause autoimmune manifestations in mice, the involvement of such alterations in the pathogenesis of autoimmune diseases in humans merits further investigation.

[Factors involved in noncompliance with drug treatment in non-insulin dependent diabetes mellitus]

OBJECTIVE

To find the level of non-compliance with treatment with oral hypoglycemics, its causes and the profile of non-compliant patients.

DESIGN

Prospective study.

SETTING

Primary Care Centres in the province of Alicante.

PATIENTS

107 diabetics not dependent on insulin on the lists of five General Medicine practices and all receiving pharmacological treatment.

MEASUREMENTS AND MAIN RESULTS

The method used to value compliance was a surprise count of pills in the patient's home. Patients achieving 80-110% compliance were considered compliant. The level of non-compliance was 51.5% (C.I. 42.1%-61%), 36.5% being hypocompliers and 15% hypercompliers. Forgetting (40.7%) and lack of knowledge (29.5%) were the most frequent reasons for non-compliance. The factors associated with non-compliance were: over four years evolution of the disease (p = 0.02), the diet not properly observed (p = 0.03), over a year in regular treatment (p = 0.006), poor control of the disease valued by HbA1C (p = 0.003).

CONCLUSIONS

A high level of non-compliance with pharmacological treatment was found for patients with Diabetes Mellitus not dependent on insulin. Its causes were identified and factors associated with poor compliance were profiled.

Brucellar prosthetic arthritis in a total knee replacement

The infecting pathogens most commonly implicated in prosthetic joint infections are staphylococci, streptococci, and gram-negative rods. Prosthetic infections caused by Brucella spp. are rarely described in the literature. Treatment of prosthetic infections remains complex and controversial, the most accepted course being antibiotic treatment with removal or retention of prosthetic components. The case of a 60-year-old man who developed Brucella septic arthritis of the right knee in a total knee replacement is reported. Conservative treatment using a three-drug therapy was employed, with excellent results.

[Factors involved in noncompliance with pharmacological treatment in arterial hypertension]

OBJECTIVES

To find the amount of non-compliance with medical treatment for Hypertension and its causes, and to describe the profile of non-compliant patients.

DESIGN

A crossover study performed on two home visits.

SETTING

A rural Health Centre at Calpe, Alicante.

PATIENTS

The sample was obtained from the census of medically treated hypertense patients. 174 of the 200 patients chosen completed the study.

MEASUREMENTS AND MAIN RESULTS

Compliance was evaluated by a surprise count of pills in the patient's home. Patients complying between 80 and 110% were considered compliant. There was 47.7% non-compliance (C.I. 95%: 40.3-55.1), with 31% under-compliers and 16.7% over-compliers. Lack of information (39.8%) and forgetfulness (28.9%) were the most common causes of non-compliance.

CONCLUSIONS

A high amount of non-compliance was shown, including an important number of over-compliers. Its causes were defined along with other reasons predicting non-compliance.

[The relationship between primary and specialized care]

OBJECTIVES

To find the current situation regarding the relationship between Primary Care and specialist doctors. To find the defects in this relationship and to propose actions to improve the situation.

DESIGN

Delphi technique.

SETTING

Area Medical Directors, Medical Coordinators of Primary Care Centres, Hospital Medical Directors, Internal Medicine Service chiefs and Casualty directors from the entire Community of Valencia.

RESULTS

After a qualitative analysis of the replies given in the first and second questionnaires, the 10 most serious problems for the Primary Care/Hospital relationship were extracted, along with 10 possible solutions to improve this relationship.

CONCLUSIONS

The main problems detected between Hospital and Primary Care concerned the professional and organisational areas. The solutions suggested mainly centered on the organisational area. Specific differences were found in the prioritization of the replies, both for problems and solutions, depending on whether the point of view was Primary or Hospital Care.

Serum soluble selectins in patients undergoing cardiopulmonary bypass. Relationship with circulating blood cells and inflammation-related cytokines

BACKGROUND

Membrane-bound selectins mediate the adhesion among leukocytes, platelets and endothelial cells, while circulating (soluble) selectins may function as competitive inhibitors of them. Open heart surgery is known to induce activation of these cells.

METHODS

We studied the acute responses of soluble selectins, circulating blood cells and inflammation-related cytokines in 12 patients undergoing elective open heart surgery with cardiopulmonary bypass. Serial blood samples were withdrawn before, during and after surgery.

RESULTS

Serum soluble E-selectin concentrations did not change significantly during all the perioperative period. In contrast, P-selectin decreased after the initiation of cardiopulmonary bypass and remained low until the end of surgery. L-selectin showed a similar course. A decrease in platelet count and albumin was found during the perioperative period and an increase in leukocyte count was found after cardiopulmonary bypass. Clear elevations in circulating IL (Interleukin)-6, IL-8, and IL-10 were found after the end of surgery, while IL-12 levels remained undetectable.

CONCLUSIONS

While serum inflammatory cytokines clearly rise in response to open heart surgery, soluble selectins do not change (E) or decrease (P and L). Correcting for haemodilution, E-selectin rises postoperatively, but the decrease in P- and L-selectins is not explained by haemodilution.

[The validity of 6 indirect methods for assessing compliance with pharmacological treatment in dyslipidemias]

OBJECTIVE

To validate six indirect methods of identifying patients who do not comply with their treatment with hypolipaemiant drugs.

DESIGN

A prospective study.

SETTING

Primary care centres in the province of Alicante.

PATIENTS

107 lipaemic patients, on the lists of 5 General Medical practices and on drugs treatment.

MEASUREMENTS AND MAIN RESULTS

The most accurate way to assess compliance was the surprise counting of pills in patients' homes. Patients who had between 80 and 110% compliance were defined as compliant. The six indirect methods validated were: Communication of self-compliance (CS), Attendance at appointments (AA), Doctor's judgment (DJ), Information about the illness (II), the Morisky-Green test (MG) and the grade of control (GC). AA, DJ and CS were the methods with highest specificity (91.2%-89.5%). GC and II were the most sensitive (88%-82%). GC obtained the greatest negative predictive value (77.7%), and DJ the greatest positive predictive value (73.6%). The concordance index (kappa) ranged from 0.23 for GC and -0.002 for II.

CONCLUSIONS

GC, DJ and CS are the methods with the best validity indicators and concordance. They could, therefore, be used together in clinical practice to identify patients not complying with their hypolipemiant treatment.

[The validity of 6 indirect methods for assessing drug treatment compliance in arterial hypertension]

OBJECTIVE

To validate six indirect methods, which were simple and easy to apply in clinical practice, of identifying patients who did not comply with drugs treatment for hypertension.

DESIGN

A prospective study based on two visits to patient's home.

SETTING

rural health centre at Calpe, Alicante.

PATIENTS

174 patients (58 men and 116 women) were included. They were chosen at random from the centre's records of hypertense patients.

MEASUREMENTS AND MAIN RESULTS

Compliance was assessed by the method of a surprise counting of pills in the patient's home. Patients who had between 80 and 110% compliance were defined as compliant. The six indirect methods validated were: communication of self-compliance (CS), attendance at appointments (AA), doctor's judgment (DJ), information about the illness (II), hypertension control (HC) and the Morisky-Green test (MG). II was the most sensitive (81.9%). CS reached the highest specificity (93.4%), the best positive predictive value (81.8%) and the best concordance index (kappa, 0.26).

CONCLUSIONS

II and CS are the indirect methods with the best validity indicators and could be used together to assess compliance with drugs treatment for hypertension.

Treatment with anti-LFA-1 alpha monoclonal antibody selectively interferes with the maturation of CD4- 8+ thymocytes

Maturation of T lymphocytes in the thymus is driven by signals provided by soluble factors and by the direct interaction between thymocytes and stromal cells. Although the interaction between T-cell receptor (TCR) and major histocompalibility complex (MHC) molecules on stromal cells is crucial for T-cell development, other accessory molecules seem to play a role in this process. In order to better understand the role of lymphocyte function-associated antigen-1 (LFA-1) and intercellular adhesion molecule-1 (ICAM-1) molecules in thymocyte maturation, mice were treated from birth with saturating doses of non-cytolytic-specific monoclonal antibodies. The effect of this treatment on thymocyte subpopulations and the expression of CD3 and TCR-alpha beta by these cells was investigated by flow cytometry. Our data demonstrated that the effective saturation of LFA-1 alpha chain in the thymus, but not ICAM-I or LFA-I beta chain, selectively interfered with the maturation of CD8+ T cells, as manifested by a marked reduction in the frequency of CD4-8+ thymocytes expressing high levels of CD3 and TCR-alpha beta. This selective reduction was also observed in peripheral blood mononuclear cells and spleen cells. The analysis of the frequencies of various V beta TCR showed that CD4-8+ thymocytes were globally affected by the treatment. These results underline the importance of the interaction between LFA-1 and its ligands in the maturation of CD8+ T cells and document the existence of different molecular requirements for the differentiation of CD4+ and CD8+ T cells.

[The validity of basal blood glucose in the control of non-insulin-dependent diabetic patients]

BACKGROUND

To validate basal glucemia as a control method for non-insulin dependent diabetes mellitus, and to determine the cut-off point that best characterizes good control.

PATIENTS AND METHODS

A transversal, observational study of 256 patients who participated in a diabetes mellitus follow-up program during 1993. In the study, glucemia validity indicators were evaluated after making 2 X 2 tables and ROC (receiver operating characteristic) curves for the different values. Control values of glycated hemoglobin was used as to define a good (< 6.5%) and moderate (< 8%).

RESULTS

The values of glucemia considered to be "good" as regards control (from 80 to 110 mg/dl, 4.4-6.05 mmol/dl) have good sensitivity (from 97.3% to 100%) and negative predictive values (from 85.7% to 100%) but extremely bad specificity (from 3.8% to 22.7%) and only moderate positive predictive values (from 59.5% to 64.1%) in reference to values of glycated hemoglobin of 6.5%. The same occurs for 8% as regards sensitivity (from 98.6% to 100%), negative predictive value (from 96.4% to 100%) and specificity from 2.1% to 14.5%). Positive predictive value worsens (from 27.8% to 30.3%). The most effective and most accurate values of glucemia in the ROC curves are 150 mg/dl (8.25 mmol/l) if the control of glycated hemoglobin is good, and 170 mg/dl (9.35 mmol/l) if it is moderate.

CONCLUSIONS

The glucemia control figures recommended by consensus produce false positives when they are compared to glycated hemoglobin. In the analysis of effectiveness and ROC curves greater accuracy is obtained with glucemia values that are slightly higher than those recommended.

A1 demonstrates restricted tissue distribution during embryonic development and functions to protect against cell death

Members of the bcl-2 gene family are essential regulators of cell survival in a wide range of biological processes. A1, a member of the family, is known to be expressed in certain adult tissues. However, the precise tissue distribution and function of A1 remains poorly understood. We show here that A1 is expressed in multiple tissues during murine embryonic development. In the embryo, A1 was detected first at embryonic day 11.5 in liver, brain, and limbs. At day 13.5 of gestation, A1 expression was observed in the central nervous system, liver, perichondrium, and digital zones of developing limbs in a pattern different from that of bcl-X. In the central nervous system of 15.5-day embryos, A1 was expressed at high levels in the ventricular zone and cortical plate of brain cortex. Significantly, the interdigital zones of limbs and the intermediate region of the developing brain cortex, two sites associated with extensive cell death, were devoid of A1 and bcl-X. The expression of A1 was retained in many adult tissues. To assess the ability of A1 to modulate cell death, stable transfectants expressing different amounts of A1 protein were generated in K562 cells. Expression of A1 was associated with retardation of apoptotic cell death induced by actinomycin D and cycloheximide as well as by okadaic acid. Confocal microscopy showed that the A1 protein was localized to the cytoplasm in a pattern similar to that of Bcl-2. These results demonstrate that the expression of A1 is wider than previously reported in adult tissues. Furthermore, its distribution in multiple tissues of the embryo suggests that A1 plays a role in the regulation of physiological cell death during embryonic development.

[Growth factors and mitogenic activity in experimental hypercholesterolemia]

INTRODUCTION

Hypercholesterolemia is associated with increased platelet reactivity and changes in megakaryopoiesis, which might influence the synthesis of growth factors in the megakaryocyte.

MATERIAL AND METHODS

20 miniature pigs were randomly assigned to received 18 weeks of either regular pig chow feed (control group, n = 10) or a high cholesterol diet (cholesterol group, n = 10). Platelet count, mean platelet volume, platelet distribution width and bleeding time were determined in both groups. Intraplatelet and serum mitogenic activity was quantified by Swiss 3T3 and vascular smooth muscle cells proliferation assays. Insulin-like growth factor I and platelet-derived growth factor (BB isoform) levels were quantified in platelet lysates and in serum in both groups.

RESULTS

Hypercholesterolemia was associated to a significant decrease in mean platelet volume and bleeding time, but it did not affect the proliferative effect of serum and platelet lysates nor its growth factor content.

CONCLUSIONS

Taken together, our results suggest that although hypercholesterolemia affects platelet reactivity, its atherosclerosis-promoting effects cannot be explained by a direct effect on vascular smooth muscle cell proliferation or by changes in serum or intraplatelet growth factor content.

Completely allogeneic spleen cells induced cytolytic neonatal tolerance to alloantigens, but failed to establish allo-helper interactions with host T cells

The injection of spleen cells from F1 mice into-newborns from a parental strain results in the establishment of cytolytic tolerance to donor alloantigens and the development of a lupus-like disease. This syndrome is the consequence of the recognition by alloreactive host CD4+ T cells of discordant major histocompatibility complex (MHC) class II antigens on semi-allogeneic donor B cells. We have analysed whether completely allogeneic spleen cells are as able as semi-allogeneic spleen cells to induce cytolytic tolerance to donor alloantigens and to co-operate with alloreactive T cells for autoantibody production. BALB/c mice were injected at birth with Thy-1-depleted spleen cells from (C57BL/6 x BALB/c)F1 or C57BL/6 mice, either alone or in combination. Cytolytic tolerance was always induced, as manifested by persistence of chimerism and acceptance of skin allografts. However, only F1 semi-allogeneic B cells were activated by alloreactive host T cells to produce anti-DNA IgG antibody. The deficient co-operation between BALB/c CD4+ T cells and completely allogeneic C57BL/6 B cells was confirmed after neonatal injection of (C57BL/ 6 x BALB/c)F1(Igha) spleen cells together with C57BL/6(Ighb) spleen cells. These mice developed anti-DNA antibodies bearing only the Igha allotype. Similar results were observed in experiments of allogeneic interaction in vitro, in which BALB/c CD4+ T cells were cocultured with either (C57BL/6 x BALB/c)F1 or C57BL/6 B cells. The present results demonstrate that completely allogeneic spleen cells efficiently induced cytolytic unresponsiveness to donor alloantigens, but B cells contained in this spleen cell population were unable to establish allo-helper interactions with alloreactive CD4+ T cells, suggesting that cytolytic and helper T-cell interactions involved in alloreactivity may be different.

Effect of hypercholesterolaemia on platelet growth factors

Evidence from several sources suggests that important interactions occur between platelets and low-density lipoproteins. This study was undertaken to find out if diet-induced hypercholesterolaemia affects the growth factor content in circulating platelets. Minipigs were fed either normal diet supplemented with 2% cholesterol (n = 12) or normal diet alone (n = 12). After 4 months, mean platelet volume was significantly lower (P < 0.05) and monocyte count was significantly higher (P < 0.05) in the cholesterol group. Serum and intraplatelet levels of platelet-derived growth factor (BB homodimer) and transforming growth factor beta 1 were statistically unchanged after diet. Hypercholesterolaemia did not affect the proliferative effect of either serum or platelet lysates on porcine vascular smooth muscle cells and Swiss-3T3 cells in culture. A significant positive correlation between Swiss-3T3 and smooth muscle cell proliferation was present in both groups. These results suggest that the atherosclerosis-promoting effect of hypercholesterolaemia cannot be explained by its direct effect on smooth muscle cell proliferation or by changes in serum or intraplatelet concentrations of growth factors.

Characterization of peripheral blood steady-state progenitor cells preserved in liquid culture conditions with or without GM-CSF and IL2

The cellular characteristics of steady-state peripheral blood progenitor cell (PBPC) apheresis, including total number of lymphomononuclear cells, CD34 and CFUs, was evaluated in a group of 26 chemo-radiotherapy patients as well as in a group of 23 surgically resected cancer patients. Three-to seven-day incubation in standard liquid culture conditions with growth factors (IL2, GM-CSF or both) correlated with a statistically significant increase in CD34+ and CD56+ cell populations compared with incubation without growth factors, especially when both GM-CSF and IL2 were used. In addition, an increase in CD33+, CD13+ and HLA-DR+ cell populations was observed after 3-7 days incubation with GM-CSF. The basal culture control exhibited a decrease in CD33+ and CD13+ cell populations while CD34+ and CD56+ cell populations were maintained. These results were similar in the treated and untreated groups of patients. The infusion of GM-CSF and IL2 preincubated PBPC after intensive chemotherapy was associated with a rapid hematological recovery with a median time duration for WBC < 500/uL, WBC < 1.000/uL and platelets < 20.000/uL of 7.9 days, 14.9 days and 10.7 days respectively. We conclude that a short GM-CSF and IL2 preincubation of steady-state PBPC is associated with an increase in cell populations exhibiting the immune and progenitor cell phenotypes and correlates with an early hematological recovery after intensive chemotherapy.

[Quality of drug prescriptions by the Spanish internal medicine services]

Many registered drugs in different countries not always have been tested by clinical assays and their efficacy has no definitively proved. Good clinical practice must assume the prescription of the more efficacy drugs. The aim of this study is to evaluate the quality of the drugs prescribed by spanish general internists. We analyze the treatments prescribed by general internists using their hospital medical records. The records were offered by the Heads of the Internal Medecine Departments of Spanish hospitals with 250 beds or more when required by the Spanish Society of Internal Medecine. A random sample, stratified by the hospital size, was obtained from the whole of the Spanish hospitals. Quality of the drugs was determined using two criteria: A. Their intrinsic value; it was decided it was high if clinical assays showed their efficacy and security, and low of it was not B. The number of different chemical substances in the drug; we considered a high quality criteria if only one chemical substance, or two with proved synergistic efficacy were present, and low if it was more than two, or without proved synergistic efficacy. The sample was 250 clinical records, with 1022 different prescriptions; the records were collected between February and July 1994. We found that 94.06 +/- 1.45 of evaluated treatments have a high intrinsic value, and 96.93 +/- 1.06 have only one chemical component. The drugs without a high intrinsic value were: oral hypoglycaemics, some including several combinations of vit B, drugs acting on the cerebral blood flow and some mucolitics. Spanish general Internists usually prescribed monocomponent drugs with proved efficacy and safety.