Placental concentrations of heavy metals in a mother-child cohort.

Heavy metals are environmental contaminants with properties known to be toxic for wildlife and humans. Despite strong concerns about their harmful effects, little information is available on intrauterine exposure in humans. The aim of this study was to evaluate prenatal exposure to As, Cd, Cr, Hg, Mn, and Pb and its association with maternal factors in a population-based mother-child cohort in Southern Spain. Between 2000 and 2002, 700 pregnant women were recruited and 137 placentas from the cohort were randomly selected and analyzed for the selected metals by atomic absorption. Maternal sociodemographic and lifestyle factors were obtained by questionnaire after delivery. Bivariate analysis and multivariate linear regression were performed. Cd and Mn concentrations were detected in all placentas, while Cr, Pb, and Hg were found in 98.5%, 35.0%, and 30.7% of samples, respectively. The highest concentrations were observed for Pb (mean: 94.80 ng/g wet weight of placenta), followed by Mn (63.80 ng/g), Cr (63.70 ng/g), Cd (3.45 ng/g), and Hg (0.024 ng/g). Arsenic was not detected in any sample. Gestational age and smoking during pregnancy were associated with placental Cd concentrations, while no factor appeared to influence concentrations of Cr, Hg, Mn, or Pb. In comparison to results of European studies, these concentrations are in a low-intermediate position. Studies are required to investigate the factors contributing to early exposure to heavy metals and to determine how placental transfer of these toxic compounds may affect children's health.

Selenium and impaired physical function in US and Spanish older adults.

BACKGROUND: Selenium (Se) is a trace element with a narrow safety margin. OBJECTIVES: To evaluate the cross-sectional and longitudinal dose-response association between Se exposure and measures of impaired physical function and disability in older adults. DESIGN: NHANES 2011-2014 cross-sectional (US, n = 1733, age ≥60 years) and Seniors-ENRICA-2 2017-2019 cross-sectional and longitudinal (Spain, n = 2548 and 1741, respectively, age ≥65 years) data were analyzed. Whole blood and serum Se levels were measured using inductively coupled plasma-mass spectrometry. Lower-extremity performance was assessed with the Short Physical Performance Battery, and muscle weakness with a dynamometer. Incident mobility and agility limitations, and disability in instrumental activities of daily living (IADL) were ascertained with standardized questionnaires. Analyses were adjusted for relevant confounders, including physical activity. Results across studies were pooled using random-effects meta-analysis. RESULTS: Meta-analyzed odds ratios (95% confidence interval) per log2 increase in whole blood Se were 0.54 (0.32; 0.76) for weakness, 0.59 (0.34; 0.83) for impaired lower-extremity performance, 0.48 (0.31; 0.68) for mobility limitations, 0.71 (0.45; 0.97) for agility limitations, and 0.34 (0.12; 0.56) for disability in at least one IADL. Analyses for serum Se in NHANES showed similar results. Findings suggest the inverse association with grip strength is progressive below 140 µg/L (p-value for non-linear trend in the Seniors-ENRICA-2 study = 0.13), and above 140 µg/L (p-value for non-linear trend in NHANES = 0.11). In the Seniors-ENRICA-2 cohort, with a 2.2 year follow-up period, a doubling in baseline Se levels were associated with a lower incidence of weakness [odds ratio (95% confidence interval): 0.45 (0.22; 0.91)], impaired lower-extremity performance [0.63 (0.32; 1.23)], mobility [0.43 (0.21; 0.91)] and agility [0.38 (0.18; 0.78)] limitations. DISCUSSION: In US and Spanish older adults, Se concentrations were inversely associated with physical function limitations. Further studies are needed to elucidate underlying mechanisms.

Power Doppler can detect the presence of 7-8 day conceptuses prior to flushing in an equine embryo transfer program.

In order to determine whether differences in uterine blood flow between pregnant and non-pregnant mares can be used to predict the presence of the equine embryo prior to flushing in an embryo transfer program, power Doppler ultrasonography was used on a total of 52 mares on days 7 or 8 post-ovulation. Computer analysis of Doppler images was subsequently performed using ImageJ v1.48 software. Vascular perfusion of the endometrium was analyzed using spot meter techniques, measuring mean pixel intensity and area of blood flow. Mares with positive flushings presented a higher uterine blood flow area (one embryo: 54.01 ± 2.27 mm2 or two embryos: 61.01 ± 6.73 mm2) prior to embryo recovery compared to barren mares (21.77 ± 2.22 mm2) (p≤0.05). However, significant differences in vascular perfusion were not detected between single or twin pregnancies. Blood flow area appears to be a good predictor for differentiation between pregnant and non-pregnant mares with an AUC: 0.869; p≤0.001 and an optimal cut-off value of 37.21 mm2. Both the mare's age and day of embryo recovery caused effects on uterine vascular perfusion. According to Youden's J statistics the uterine blood flow area of young pregnant mares was greater than 25.4 mm2 on day 7 (with a sensitivity of 75% and a specificity of 87.5%) and greater than 21.02 mm2 on day 8 post-ovulation (with a sensitivity of 93.8% and a specificity of 100%). The uterine blood flow area in adult pregnant mares was greater than 41.4 mm2 on day 7 (with a sensitivity of 80% and a specificity of 85.5%) and greater than 35.55 mm2 on day 8 after ovulation (with a sensitivity of 97.2% and a specificity of 85.7%). Evaluation on day 8 is therefore considered to be more reliable. Older and middle aged pregnant mares (5-18 years old) had increased uterine vascularization compared to young pregnant mares (2-5 years old) (p≤0.001). Conversely, older barren mares showed higher endometrial vascularity (35.06 ± 2.56 mm2) than young (17.21 ± 1.26 mm2) and middle aged non-pregnant mares (23.84 ± 1.50 mm2) (p≤0.05). We hypothesized that the higher blood flow area seen in older barren mares may be a consequence of a subclinical endometritis due to repeated flushing for embryo recovery. The results of the present study indicate that power Doppler ultrasound combined with computer assisted analysis of images are reliable techniques to detect early pregnancy prior to embryo recovery.

Adipose tissue concentrations of non-persistent environmental phenols and local redox balance in adults from Southern Spain.

The aim was to evaluate the associations of environmental phenol and paraben concentrations with the oxidative microenvironment in adipose tissue. This study was conducted in a subsample (n = 144) of the GraMo cohort (Southern Spain). Concentrations of 9 phenols and 7 parabens, and levels of oxidative stress biomarkers were quantified in adipose tissue. Associations were estimated using multivariable linear regression analyses adjusted for potential confounders. Benzophenone-3 (BP-3) concentration was borderline associated with enhanced glutathione peroxidase (GPx) activity [exp(ß) = 1.20, p = 0.060] and decreased levels of reduced glutathione (GSH) [exp(ß) = 0.55, p = 0.070]. Concentrations of bisphenol A (BPA) and methylparaben (MeP) were associated to lower glutathione reductase (GRd) activity [exp(ß) = 0.83, exp(ß) = 0.72, respectively], and BPA was borderline associated to increased levels of oxidized glutathione (GSSG) [exp(ß) = 1.73, p-value = 0.062]. MeP was inversely associated to both hemeoxygenase-1 (HO-1) and superoxide dismustase (SOD) activity, as well as to the levels of thiobarbituric acid reactive substances (TBARS) [0.75 < exp(ß) < 0.79]. Our results suggest that some specific non-persistent pollutants may be associated with a disruption of the activity of relevant antioxidant enzymes, in addition to the depletion of the glutathione stock. They might act as a tissue-specific source of free radicals, contributing to the oxidative microenvironment in the adipose tissue.

Environmental phenols and parabens in adipose tissue from hospitalized adults in Southern Spain.

Urinary concentrations of non-persistent environmental pollutants (npEPs) are widely assessed in biomonitoring studies under the assumption that they are metabolised and eliminated in urine. However, some of these chemicals are moderately lipophilic, and their presence in other biological matrices should also be evaluated to estimate mid/long-term exposure to npEPs and its impact on human health. The present study aims to explore concentrations and potential determinants of npEPs in adipose tissue from a hospital-based adult cohort (GraMo cohort, Southern Spain). Concentrations of bisphenol-A (BPA), benzophenone-3 (BP-3), triclosan (TCS), three chlorophenols (2,4-DCP, 2,5-DCP and 2,4,5-TCP) and two phenylphenols (2-PP and 4-PP), triclocarban (TCCB) and parabens [methyl- (MeP), ethyl- (EtP), propyl- (n-PrP and i-PrP), butyl- (n-BuP and i-BuP) and benzyl-paraben (BzP)] were analysed in adipose tissue samples from a subcohort of 144 participants. Spearman correlation tests were performed, followed by stepwise multivariable linear regression analyses to assess determinants of the exposure. Detection frequencies and median concentrations were: BPA (86.8%, 0.54 ng/g tissue), BP-3 (79.2%, 0.60 ng/g tissue), TCS (45.8%,

[Postoperative analgesia in cardiac surgery: spinal versus intravenous morphine]. / Analgesia postoperatoria en cirugía cardiaca: comparación de morfina intratecal versus morfina intravenosa.

OBJECTIVE: To compare the effects of spinal and intravenous administration of morphine to supplement anesthesia with remifentanil in terms of analgesia during early postoperative recovery and considering time until extubation. MATERIAL AND METHODS: This prospective, randomized, blinded trial enrolled 59 patients scheduled for cardiac surgery. The patients were assigned to receive either a spinal infusion of morphine (15 microg x Kg(-1)) or an intravenous infusion (0.3 mg x Kg(-1)). Anesthesia was maintained with 0.15 to 0.50 microg x Kg(-1) x min(-1) of remifentanil and 2 to 4 mg x Kg(-1) x h(-1) of propofol in perfusion. After the period of extracorporeal circulation, all patients were given an intravenous infusion of 30 mg of ketorolac. Later intravenous ketorolac was ministered at a dose of 30 mg per 8 hours; intravenous morphine (bolus dose of 3 mg) was also administered until pain was relieved. RESULTS: The same quality of postoperative analgesia and anesthetic recovery was achieved with both spinal and intravenous administration. The incidence of side effects was also similar. Likewise, the extubation times were similar in the 2 groups (spinal infusion group: 294.5 [SD, 150.5] minutes; intravenous group: 325.0 [139.9] minutes; P>0.05). Less postoperative intravenous morphine was administered in the first 24 hours to patients in the spinal morphine group (P<0.05) and fewer patients in that group required intravenous morphine boluses (P<0.05). CONCLUSIONS: Our study suggests that spinal morphine does not offer advantages over intravenous morphine with regard to postoperative analgesia, hemodynamic stability and respiratory parameters, time until extubation, or adverse effects.

[Comparison of two models of education for asthmatic patients]. / Comparación de dos modelos de educación para pacientes asmáticos.

BACKGROUND: The education programs have demonstrated to be an important point in the management of asthmatic patients. The aim of the present study was to assess if an intensive group asthma education program was able to improve a simplified and individual asthma education program, both with a self-management plan included. PATIENTS AND METHOD: A prospective randomised controlled trial was conducted over 12 months and 73 moderate-severe asthmatic patients were included. Patients were randomly assigned to control or study group. Patients in control group received individual and simplified education with a self-management plan and patients in study group attended an <> in small groups where they received a three hours education program in three weeks.The outcome measures were: number of hospital admissions, observation unit admissions, emergency visits and unscheduled general practice consultations. Knowledge, adherence to treatment, ability with inhaler devices, airway function, environmental control measures and quality of life. They were assessed at the beginning and the end of the study. RESULTS: At the end of the study period the outcome of morbidity had improved in both groups but the number of observation unit admissions (p = 0.028) and unscheduled general practice consultations (p = 0.022) was substantially lower in study group. This group also demonstrated improvement in environmental control measures and better inhaler technique and knowledge (p = 0.007). In adherence, lung function or quality of life there were no differences between groups. CONCLUSIONS: In patients with asthma better results can be obtained with an intensive group asthma education program than with the individual and simplified program.

Determination of essential elements (copper, manganese, selenium and zinc) in fish and shellfish samples. Risk and nutritional assessment and mercury-selenium balance.

Fish and shellfish are an important source not only of toxic heavy metals, but also of essential elements in the diet. In this study, levels of Cu, Mn, Se and Zn have been determined in fresh, canned and frozen fish and shellfish products. A total of 485 samples of the 43 most frequently consumed fish and shellfish species in Andalusia (Southern Spain) were analyzed for essential elements content. The potential human health risks for the consumers and the nutritional value of the products analyzed were assessed. Furthermore, the mercury-selenium ratios and the selenium health benefit value (Se-HBVs) were calculated. The highest concentrations of Cu were found in crustaceans species (shrimp and prawn) as they have hemocyanin (a copper-containing protein) that functions as an oxygen-transport molecule. Mn levels were higher in canned bivalve molluscs, such as cockle and clam, and in fresh common sole. Concerning Se, two fresh predatory fish species (tuna and swordfish) presented the most remarkable concentrations of this element. The highest concentration of the essential metals analysed was found for Zn, especially in fresh and canned mussels. All the species analyzed showed beneficial Hg:Se ratios and Se-HBVs, except for the shark species (blue shark and cat shark) and gilt-head bream because of their high Hg levels and low Se content, respectively. Nevertheless, the biomagnification usually observed in hazardous metals such as Hg would not occur for the essential elements measured in predatory species. The estimated daily intakes of the elements studied represented very low percentages of their reference values, ranging from 0.1% (Se) to 3.9% (Cu) for person weighting 60 kg, so the intake of these elements through fish and shellfish would not pose any risk for the average consumer. Moreover, the contribution of fish and shellfish products to the recommended daily allowances and adequate intakes of these mineral elements ranges from 2.5% (Mn) to 25.4% (Se).

Determination of toxic elements (mercury, cadmium, lead, tin and arsenic) in fish and shellfish samples. Risk assessment for the consumers.

Although fish intake has potential health benefits, the presence of metal contamination in seafood has raised public health concerns. In this study, levels of mercury, cadmium, lead, tin and arsenic have been determined in fresh, canned and frozen fish and shellfish products and compared with the maximum levels currently in force. In a further step, potential human health risks for the consumers were assessed. A total of 485 samples of the 43 most frequently consumed fish and shellfish species in Andalusia (Southern Spain) were analyzed for their toxic elements content. High mercury concentrations were found in some predatory species (blue shark, cat shark, swordfish and tuna), although they were below the regulatory maximum levels. In the case of cadmium, bivalve mollusks such as canned clams and mussels presented higher concentrations than fish, but almost none of the samples analyzed exceeded the maximum levels. Lead concentrations were almost negligible with the exception of frozen common sole, which showed median levels above the legal limit. Tin levels in canned products were far below the maximum regulatory limit, indicating that no significant tin was transferred from the can. Arsenic concentrations were higher in crustaceans such as fresh and frozen shrimps. The risk assessment performed indicated that fish and shellfish products were safe for the average consumer, although a potential risk cannot be dismissed for regular or excessive consumers of particular fish species, such as tuna, swordfish, blue shark and cat shark (for mercury) and common sole (for lead).

Assessing the public health impacts of urban air pollution in 25 European cities: results of the Aphekom project.

INTRODUCTION: The Aphekom project aimed to provide new, clear, and meaningful information on the health effects of air pollution in Europe. Among others, it assessed the health and monetary benefits of reducing short and long-term exposure to particulate matter (PM) and ozone in 25 European cities. METHOD: Health impact assessments were performed using routine health and air quality data, and a common methodology. Two scenarios were considered: a decrease of the air pollutant levels by a fixed amount and a decrease to the World Health Organization (WHO) air quality guidelines. Results were economically valued by using a willingness to pay approach for mortality and a cost of illness approach for morbidity. RESULTS: In the 25 cities, the largest health burden was attributable to the impacts of chronic exposure to PM2.5. Complying with the WHO guideline of 10 µg/m(3) in annual mean would add up to 22 months of life expectancy at age 30, depending on the city, corresponding to a total of 19,000 deaths delayed. The associated monetary gain would total some €31 billion annually, including savings on health expenditures, absenteeism and intangible costs such as well-being, life expectancy and quality of life. CONCLUSION: European citizens are still exposed to concentrations exceeding the WHO recommendations. Aphekom provided robust estimates confirming that reducing urban air pollution would result in significant health and monetary gains in Europe. This work is particularly relevant now when the current EU legislation is being revised for an update in 2013.

Predictors of the total effective xenoestrogen burden (TEXB) in human adipose tissue. A pilot study.

The estrogenicity of biological extracts tested by appropriate bioassay is a standard method to evaluate the total effective xenoestrogen burden (TEXB). Information has been published on the combined effect of xenoestrogens after removing endogenous hormones. The main goal of the present study was to investigate the combined estrogenicity of endogenous and xenoestrogens in human adipose tissue samples with and without HPLC fractionation. The results suggest that both approaches may be useful to study interaction between xenoestrogens and endogenous hormones. TEXB of the whole extract provides information about the overall estrogenicity to which humans are exposed, useful to assess the potential contribution to health outcomes. Additionally, it is possible to identify the source and potency of the estrogenicity by using the method with fractionation, distinguishing the effect of organohalogenated chemicals (alpha-fraction) from that of endogenous hormones and more polar xenoestrogens (beta-fraction). Both methods are an integrative measure of internal estrogen load.

Validation of a method to quantify chromium, cadmium, manganese, nickel and lead in human whole blood, urine, saliva and hair samples by electrothermal atomic absorption spectrometry.

For biological monitoring of heavy metal exposure in occupational toxicology, usually whole blood and urine samples are the most widely used and accepted matrix to assess internal xenobiotic exposure. Hair samples and saliva are also of interest in occupational and environmental health surveys but procedures for the determination of metals in saliva and hair are very scarce and to our knowledge there is no validation of a method to quantify Cr, Cd, Mn, Ni and Pb in four different human biological materials (whole blood, urine, saliva and axilary hair) by electrothermal atomization atomic absorption spectrometry (ETAAS). In the present study, quantification methods for the determination of Cr, Cd, Mn, Ni and Pb in whole blood, urine, saliva and axilary hair were validated according to the EU common standards. Pyrolisis and atomization temperatures have been determined. The main parameters evaluated were: detection and quantification limits, linearity range, repeatability, reproducibility, recovery and uncertainty. Accuracy of the methods was tested with the whole blood, urine and hair certified reference materials and recoveries of the spiked samples were acceptable ranged from 96.3 to 107.8%.

Hipoglicemia en el paciente diabético hospitalizado / Hypoglycemia in hospitalized diabetic patiens

Introduction: Hypoglycaemia occurs frequently in hospitalized diabetic patients and increases inpatient morbidity and mortality. In 60 percent of cases, it isn’t managed properly. The goal of this study was to determine prevalence, treatment, complications and length of hospital stay related to hypoglycaemia with local patients. Patients and Methods: This study was designed as a prospective series of cases with diabetic patients, hospitalized in internal medicine and surgical services. Results: 105 cases of hypoglycaemia presented in 47 patients, with a mean of 2,21 +/- 1,68 episodes per patient. 53,32 percent of hypoglycaemic episodes presented in surgical patients. The cause was not determined in 49,52 percent (n = 52) of the episodes, and 41,9 percent (n = 44) of them were asymptomatic. 59,57 percent (n = 28) of patients presented complications during their hospital stay, mainly infectious, with no difference between surgical and medical services. Median inpatient stay in the surgical service was of 28 days (RIQ 19-45), and of 16 days (RIQ 11-28) in the internal medicine service. Treatments were modified in 57,45 percent (n = 27)of patients after their first hypoglycaemic episode occurred, 17 in internal medicine service, and 10 in surgical service (p = 0,003). Conclusions: the majority of patients presented at least two hypoglycaemic events, and only in half of were treatments modified in order to prevent another episode, which is more that reported in literature, particularly in internal medicine service, where diabetologists work. Highlighting the large number of undetermined causes of hypoglycaemia, caused mainly by lack of registry, can lead to the creation of a registry form for these kinds of occurrences in order to successfully prevent more episodes and decrease inpatient stay and complications.

Predictors of concentrations of hexachlorobenzene in human adipose tissue: a multivariate analysis by gender in Southern Spain.

Hexachlorobenzene (HCB) was measured in adipose tissue intraoperatively collected from 387 subjects over 16 years old undergoing surgery in two hospitals in Granada (Southern Spain). HCB was quantified in 90.7% of subjects. The concentrations and frequencies of HCB were similar to those reported in adipose tissue samples in other recent European studies. Exposure patterns differed between females and males: higher HCB concentrations were found in females than in males (geometric mean 18.3 vs. 6.8 ng/g, p<0.001). The relationship between HCB concentrations and exposure risk factors was assessed by multivariate analysis stratifying by gender. In men, HCB concentrations were predicted (r(2)=0.45) by age, body mass index (BMI), place of residence, smoking, consumption of fish, chicken and cheese, occupation related to agriculture, and family involvement in construction activities. In women, HCB concentrations were predicted (r(2)=0.50) by age, BMI, consumption of milk and cheese, and occupation related to industry. The finding that women had three-fold higher levels of HCB than the men deserves further investigation.

Sobrevida de pacientes con cáncer de mama y metástasis ósea / Survival of patients with breast cancer and bone metastasis

Introduction: Breast cancer is an important cause of death among female cancer in Chile. It metastasizes to any part of the body, being bone the first area of dissemination in 26-50 percent of cases and being found in 75 percent of patients dead from this cause. A median survival of 18 to 24 months is reported, and a probability of surviving 5 years of 20 percent. Therefore the objective of this study is to determine the difference of median survival depending on the presence of bone metastasis. Methods: A retrospective cohort study was conducted with 822 patients diagnosed with breast cancer between 2003 and 2010. The exposed cohort had scintigraphicly diagnosed bone metastasis, and the control group had no bone metastasis. Results: 8.88 percent of 822 patients, had bone metastasis. Those with bone metastasis had a mortality of 74 percent, and in the group with no bone metastasis, 16.69 percent died (p < 0.01). The median survival of patients with no metastasis was 44.3 months (IQR 35-83), and with metastasis was of 35 (IQR 18.6-46.1) (p < 0.01). With bone metastasis, over 48 months survival was 30.6 percent; and over 84 months 14.8 percent. Without bone metastasis, above 84 months, 78.51 percent survived (p < 0.01). Discussion and Conclusions: The difference between the two groups, considering global survival, is significant and implies an important decrease in survival and quality of life; the result obtained also differs from those reported in literature and it makes us reflect on the importance to consider bone metastasis not as a terminal event...

Introducción: El cáncer de mama es una importante causa de muerte por cáncer en las mujeres chilenas. Metastatiza a cualquier parte del cuerpo, siendo hueso la primera zona de diseminación en 26-50 por ciento de los casos, encontrándose un 75 por ciento de los pacientes que fallecen por esta causa. Se reporta una sobrevida de 18-24 meses, y una supervivencia a los 5 años del 20 por ciento. El objetivo del siguiente trabajo es determinar la sobrevida ante presencia de metástasis óseas. Pacientes y Método: Se realizó un estudio de cohortes retrospectivas con 822 pacientes diagnosticadas con cáncer de mama entre los años 2003 y 2010. La cohorte expuesta tiene diagnóstico cintigráfico de metástasis ósea, y la de control no tiene metástasis óseas. Resultados: 8,88 por ciento del total de 822 pacientes, presentó metástasis ósea. Con metástasis ósea existió una mortalidad del 74 por ciento, mientras que sin metástasis fue 16,69 por ciento (p < 0,01). La mediana de sobrevida sin metástasis ósea fue 44,3 meses (RIQ 35-83), en cambio, ante metástasis ósea fue 35 meses (RIQ 18,6-46,1) (p < 0,01). A los 48 meses, la supervivencia fue del 30,6 por ciento, para los pacientes con metástasis ósea y a los 84 meses, 14,8 por ciento, mientras que en los pacientes sin metástasis, la sobrevida a los 84 meses fue de 78,51 por ciento (p < 0,01). Discusión y Conclusiones: La diferencia de sobrevida entre pacientes con y sin metástasis ósea es significativa, implica una disminución en la supervivencia y la calidad de vida; difiere poco de lo reportado en la literatura, pero no debe hacernos considerar la metástasis ósea como un evento terminal de la enfermedad...

[Evaluation of theory-practice knowledge on inhalation systems in primary care physicians, post-graduates in training and undergraduates]. / Evaluación del conocimiento teórico-práctico de los sistemas de inhalación en médicos de atención primaria, posgrados en formación y pregrado.

OBJECTIVE: To find the theoretical and practical knowledge concerning inhalation systems of primary care doctors, postgraduates in training--family & community medicine (FCM) residents--and undergraduates who had passed their course in pneumology. DESIGN: Crossover, descriptive study. SETTING: FCM teaching unit of the Puerta del Mar Hospital (Cadiz), the Cadiz Faculty of Medicine and seven primary care centres on the Bay of Cadiz. PARTICIPANTS: 31 practising primary care doctors, 25 third-year FCM residents and 31 medical students were evaluated. MEASUREMENTS AND MAIN RESULTS: A thirteen-point questionnaire was used to evaluate the subjects theoretical knowledge of inhalation systems. The percentage of correct replies was used to establish reply levels. Their techniques of handling different systems of inhalation (pressurised cartridge, pressurised cartridge with spacing chamber, Turbuhaler and Accuhaler) were assessed according to the guidelines of the SEPAR (Spanish Society of Pneumology and Thoracic Surgery). 26% of the practising doctors and residents answered over 75% of the questionnaire correctly, with no significant differences between the two groups (p > 0.66). No undergraduate reached 75% of correct answers. After exclusion of asthmatic participants, three of the practising doctors (9.7%) and one of the residents (4.8%) performed the technique correctly with the four systems: there were no differences between the two groups (p > 0.87). No undergraduate performed them satisfactorily. CONCLUSIONS: Specific training for primary care doctors in handling inhalation therapy is recommended.

Experiencia quirurgica en coartación de aorta

La coartacion de la aorta es una defecto obstructivoque constituye el 8 por ciento del total de pacientes portadores de malformaciones cardiacas. En el presente trabajo se estudiaron 42 pacientes sometidos a cirugía por coartación de aorta desde enero de 1986 a noviembre de 1992, comprendidos entre 1 mes y 29 años , 33 hombres (78.5 por ciento) y 9 mujeres (21.5 por ciento), proporción de 3.7:1.0. Anatomicamente se encontró coartación yuxtaductal en 22 pacientes (52.3 por ciento), preductal3 (7.2 por ciento) de itsmo 12 (28.5 por ciento), con hipoplasia de arco 2 (4.8 por ciento), mixta 3 (7.2 por ciento) y coartación de aorta con otros defectos en 29 casos. Se utilizaron como técnicas quirurgicas: La anastomosis en 14 casos(33.4 por ciento), colocación de tubo en 3 (7.1 por ciento), Telles 14 (33.4 por ciento), aortoplasia 11(26.1 por ciento). De todos los pacientes estudiados, únicamente 8 presentaron compliaciones tempranas, 7 con crisis hipertensiva (16.6 por ciento) y 1 sección de conducto toraxico (2.3 por ciento), no se presentaron complicaciones tardias. Se plantea la utilidad de un diagnostico a menor edad e intervención quirurgica temprana.