A hemodynamic, metabolic and histopathological study of a heterotopic auxiliary swine liver graft with portal vein arterialization.

BACKGROUND: Auxiliary heterotopic liver transplantation with portal vein arterialization (AHLT-PVA) is a model that has been hardly studied, despite its therapeutic potential. METHODS: Hemodynamic and biochemical characterization was carried out during graft implantation, in a pig-to-pig model (n=15 AHLT-PVA). Furthermore a histopathological study was performed to establish microscopic alterations due to PVA. RESULTS: Reperfusion of the arterialized graft produced an increase in heart rate (HR) vs. baseline (P=.004) and vs. inferior vena cava clamping phase (P=.004); and a decrease in systemic vascular resistance vs. cava clamping phase (P=.021). At the end of implantation, cardiac output remained elevated (P=.001), likewise HR remained increased vs. baseline phase (P=.002). Mean arterial pressure decreased with cava clamping, but was not affected by the reperfusion of the graft, nor the skin closure. The histopathological study at 3, 10, and 21 days post-PVA revealed that functional liver structure was maintained although it is common to find foci of perilobular necrosis on day 3 (P=.049), and perilobular connective tissue proliferation at day 10 (P=.007), vs. native liver. CONCLUSIONS: The described arterialized liver graft model minimizes the number of vascular anastomoses vs. previously described models. It is hemodynamically and metabolically well tolerated and the double arterial vascularization of the graft does not cause significant changes in liver histology.

[Variability in primary care drug prescription in 2003 in Castile-la Mancha, Spain]. / Variabilidad en la prescripción farmacéutica de atención primaria de Castilla la Mancha durante 2003.

BACKGROUND: Detecting variability in clinical practice is important, given that it may entail the underuse or overuse of resources. This study was aimed at studying the variability of drug prescription in Primary Care in Castile-La Mancha in terms of certain sociosanitary characteristics of each health district. METHODS: The prescribing of various therapeutic groups in 2003 was reviewed in 180 health districts, the following variables having been gathered: number of packages having been prescribed per 100 inhabitants, percentage of inhabitants over age 65 in the district, visit rate (visits/1,000 inhabitants), physicians/1,000 inhabitants and distance to the reference hospital. RESULTS: The greatest degree of drug-prescribing variability was found regarding fibrates (42.95% variance factor) and H2-blockers (38.61%). The group showing the closest correlation between its prescription rate and the variables analyzed was that of the angiotensin-converting enzyme inhibitors (mean Spearman p: 0.719); antidepressants however showing a weak correlation (0.324). The percentage of inhabitants over age 65 and the visit rate are the variables arising more significantly in the multiple regression models constructed for each treatment group. The highest determination coefficient was found in the angiotensin enzyme-converting inhibitors (R2=0.761). The mean determination coefficient for all of the groups, weighted on the basis of the prescribing volume, was 0.492. CONCLUSIONS: A high degree of drug-prescribing variability was found to exist according to the different districts. Generally speaking, the variables analyzed explain part of this variability.

[Educational intervention for preventing unwanted pregnancies and sexually-transmitted diseases among teenagers in the city of Toledo, Spain]. / Intervención educativa para la prevención de embarazos no deseados y enfermedades de transmisión sexual en adolescentes de la ciudad de toledo.

BACKGROUND: No-one doubts the need of effectively providing teenagers with information about birth control and sexually-transmitted diseases. This study is aimed at evaluating the results of an educational intervention related to these matters. METHODS: Before-and-after study of an educational intervention (based on lectures and handing out documentation) without a control group. A questionnaire was passed out before and after the intervention to assess changes in knowledge and attitudes of the 4th-year Compulsory Secondary Education students at five schools in Toledo. RESULTS: The questionnaire was answered by 238 of the 268 students. The average age was 15.59. A total of 54.66% were females. In all, 24.03% had had some sexual relation. The birth control method used most often was the condom (98.24%). The girls more refuse more unprotected relations (76.5% vs. 48.6%; p<0.001) and share the same classroom with a student having AIDS (80.47% vs. 60.38%; p<0.001). Six months following the start of the intervention, a total of 197 students answered the second questionnaire. Proper condom use rose from 62.13% to 73.46%. CONCLUSIONS: Following the intervention, an improvement has been noted in the degree of knowledge related to birth control methods and AIDS transmission and a more positive attitude regarding HIV.

[Knowledge and attitudes of the population about the living wills]. / Conocimientos y actitudes de la población ante el documento de voluntades anticipadas.

OBJECTIVE: To evaluate knowledge of living wills and attitudes to these documents in the populations of two basic health areas in Toledo (Spain). METHOD: We performed a descriptive, cross-sectional study in primary care centers. Participants consisted of the populations of two basic health areas selected by systematic stratified sampling. Inclusion criteria comprised age between 18 and 80 years, and absence of mental or terminal illnesses. The participants were contacted by telephone before a personal interview was carried out. Data on demographic variables and knowledge of living wills and attitudes to these documents were recorded. RESULTS: A total of 395 participants were interviewed (58% women) with a mean age of 46.22 years (SD: 17.13). The vast majority (88.6%) were unaware of living wills, with no significant differences in sex or religious beliefs. Most (67.8%) would sign a living will in the case of terminal illness whereas 56.3% would sign at the present moment, with no significant differences in sex or religious beliefs. More than half of the men (57.5%) would agree to modify the living will if requested by relatives versus 42.6% of the women. More than three-quarters (76.2%) believed that information on living wills was insufficient. One-third (34.5%) would allow a relative's organs to be donated even without the relative leaving express wishes, while 49.2% would donate their own organs. CONCLUSION: There was a huge lack of awareness on living wills in our population, which nevertheless proved to be highly receptive to, and in agreement with, the implications of these documents after receiving information on the topic.