Calidad de vida posterior a reconstrucción de vía biliar / Quality of life of patients who underwent a bile duct reconstruction

BACKGROUND: Bile duct reconstruction (BDR) secondary to bile duct injury during cholecystectomy (BDIC) is a complex surgery, and an important issue is the quality of life (QL) after the procedure. AIM: To compare the QL of a cohort of patients who underwent BDR due to BDIC with a cohort of patients who underwent a cholecystectomy without incidents. MATERIAL AND METHODS: The cohort was composed of 32 patients aged 47 ± 18 years (78% women) who underwent BDR due to BDIC. For purposes of comparison, a cohort of patients who underwent a cholecystectomy without incident was chosen. These cohorts were paired 1:1 by age (± 1 year), gender and type of surgery. The SF-36 quality of life survey was applied in person or by telephone. The score was calculated as proposed by the RAND group. RESULTS: The cohort of BDR patients was comprised of 32 patients, with an average age of 47 ± 17.6 years, with a predominance of women (78%). The mean number of hospitalization days among BDR patients was 20 ± 11.8. The average follow-up was 7 ± 5 years. The mean score of patients undergoing RVB or cholecystectomy without complications was evaluated, without finding differences in the score of the different domains of the SF-36 scale. Conclusions: In the present study no significant differences were found in QL between the patients with BDIC who underwent BDR and patients who underwent a cholecystectomy without complications.

[Quality of life of patients who underwent a bile duct reconstruction]. / Calidad de vida posterior a reconstrucción de vía biliar.

BACKGROUND: Bile duct reconstruction (BDR) secondary to bile duct injury during cholecystectomy (BDIC) is a complex surgery, and an important issue is the quality of life (QL) after the procedure. AIM: To compare the QL of a cohort of patients who underwent BDR due to BDIC with a cohort of patients who underwent a cholecystectomy without incidents. MATERIAL AND METHODS: The cohort was composed of 32 patients aged 47 ± 18 years (78% women) who underwent BDR due to BDIC. For purposes of comparison, a cohort of patients who underwent a cholecystectomy without incident was chosen. These cohorts were paired 1:1 by age (± 1 year), gender and type of surgery. The SF-36 quality of life survey was applied in person or by telephone. The score was calculated as proposed by the RAND group. RESULTS: The cohort of BDR patients was comprised of 32 patients, with an average age of 47 ± 17.6 years, with a predominance of women (78%). The mean number of hospitalization days among BDR patients was 20 ± 11.8. The average follow-up was 7 ± 5 years. The mean score of patients undergoing RVB or cholecystectomy without complications was evaluated, without finding differences in the score of the different domains of the SF-36 scale. CONCLUSIONS: In the present study no significant differences were found in QL between the patients with BDIC who underwent BDR and patients who underwent a cholecystectomy without complications.

Cost-benefit of serum pepsinogen screening for gastric adenocarcinoma in the Mexican population.

INTRODUCTION AND AIM: Helicobacter pylori (H. pylori) is known to be capable of causing chronic inflammation of the gastric mucosa that slowly progresses through the premalignant stages, reaching localized gastric adenocarcinoma (GAC). Its outcome is closely related to the stage at which diagnosis is made. The aim of the present study was to determine cost-benefit by comparing esophagogastroduodenoscopy, serum pepsinogen detection, and no screening at all. MATERIAL AND METHODS: Utilizing Markov chains and Monte Carlo simulation, the costs and effects of various detection modalities were simulated to analyze the cost-benefit of each strategy. For our population, we used the published data of patients with gastric cancer, applicable to the Mexican population. RESULTS: The results were reported as incremental cost-effectiveness ratios. The best strategy was serum pepsinogen determination, followed by the strategy of endoscopic examination with continued monitoring every 3 years. CONCLUSIONS: The performance of serum pepsinogen serology and directed endoscopic examination (and continued monitoring, if necessary) for GAC screening could be a cost-effective intervention in Mexico, despite the low-to-moderate general prevalence of the disease.

Metodología para el estudio ecográfico transperineal del suelo pélvico / Methodology for the transperineal ultrasound imaging of the pelvic floor

Las técnicas de imagen cada vez son más utilizadas dentro de la medicina en general y de la ginecología en particular. La ecografía de suelo pélvico, a diferencia de la aplicación ecográfica en las otras subespecialidades ginecológicas, se encuentra bastante estandarizada y con planos de estudios definidos. Dependiendo del transductor utilizado y del modo de aplicación, se han descrito diferentes métodos ecográficos de valoración del suelo pélvico. De todos estos, el estudio transperineal es el más documentado para el diagnóstico de las disfunciones del suelo pélvico. Por ello, el objetivo de esta revisión es describir el método aplicado para realizar un estudio transperineal 2 D y 3-4D del suelo pélvico, describiendo los planos ecográficos necesarios.(AU)

Imaging techniques are increasingly used within medicine in general, and in gynaecology in particular. Pelvic floor ultrasound, unlike ultrasound application in the other gynaecological subspecialties, is fairly standardised and with defined study plans. Depending on the transducer used, and the mode of application, different ultrasound methods for evaluating the pelvic floor have been described. Of all these methods, the transperineal study is the most documented for the diagnosis of pelvic floor dysfunctions. Therefore, the objective of this review is to describe the method applied to perform a 2 D and 3-4D transperineal study of the pelvic floor, describing the necessary ultrasound planes.(AU)

Cost-benefit of serum pepsinogen screening for gastric adenocarcinoma in the Mexican population. / Costo-beneficio de cribado de adenocarcinoma gástrico por pepsinógeno sérico en la población mexicana.

INTRODUCTION AND AIM: Helicobacter pylori (H. pylori) is known to be capable of causing chronic inflammation of the gastric mucosa that slowly progresses through the premalignant stages, reaching localized gastric adenocarcinoma (GAC). Its outcome is closely related to the stage at which diagnosis is made. The aim of the present study was to determine cost-benefit by comparing esophagogastroduodenoscopy, serum pepsinogen detection, and no screening at all. MATERIAL AND METHODS: Utilizing Markov chains and Monte Carlo simulation, the costs and effects of various detection modalities were simulated to analyze the cost-benefit of each strategy. For our population, we used the published data of patients with gastric cancer, applicable to the Mexican population. RESULTS: The results were reported as incremental cost-effectiveness ratios. The best strategy was serum pepsinogen determination, followed by the strategy of endoscopic examination with continued monitoring every 3 years. CONCLUSIONS: The performance of serum pepsinogen serology and directed endoscopic examination (and continued monitoring, if necessary) for GAC screening could be a cost-effective intervention in Mexico, despite the low-to-moderate general prevalence of the disease.

Threatened Neotropical seasonally dry tropical forest: evidence of biodiversity loss in sap-sucking herbivores over 75 years.

Tropical forests cover 7% of the earth's surface and hold 50% of known terrestrial arthropod species. Alarming insect declines resulting from human activities have recently been documented in temperate and tropical ecosystems worldwide, but reliable data from tropical forests remain sparse. The sap-sucking tribe Athysanini is one herbivore group sensitive to anthropogenic perturbation and the largest within the diverse insect family Cicadellidae distributed in America's tropical forests. To measure the possible effects of deforestation and related activities on leafhopper biodiversity, a survey of 143 historic collecting localities was conducted to determine whether species documented in the Mexican dry tropical forests during the 1920s to 1940s were still present. Biostatistical diversity analysis was performed to compare historical to recent data on species occurrences. A data matrix of 577 geographical records was analysed. In total, 374 Athysanini data records were included representing 115 species of 41 genera. Historically, species richness and diversity were higher than found in the recent survey, despite greater collecting effort in the latter. A strong trend in species decline was observed (-53%) over 75 years in this endangered seasonally dry ecosystem. Species completeness was dissimilar between historic and present data. Endemic taxa were significantly less important and represented in the 1920s-1940s species records. All localities surveyed in the dry tropical forest are disturbed and reduced by modern anthropogenic processes. Mexico harbours highly endemic leafhopper taxa with a large proportion of these inhabiting the dry forest. These findings provide important data for conservation decision making and modelling of distribution patterns of this threatened seasonally dry tropical ecosystem.

Comparative Analysis of the Biosimilar and Innovative G-CSF Modulated Pathways on Umbilical Cord Blood-Derived Mononuclear Cells.

Biosimilars of granulocyte colony-stimulating factor (G-CSF) have been routinely introduced into clinical practice. However, not functional genomics characterization has been performed yet in comparison with the innovator G-CSF. This study aimed to evaluate the transcriptomic changes in an in vitro model of umbilical cord blood cells (UBC) exposed to G-CSF for the identification of their modulated pathways. Umbilical cord blood cells-derived mononuclear cells (MNCs) were treated with biosimilar and innovator G-CSF for further gene expression profiling analysis using a microarray-based platform. Comparative analysis of biosimilar and innovator G-CSF gene expression signatures allowed us to identify the most commonly modulated pathways by both drugs. In brief, we observed predominantly upmodulation of transcripts related to PI3K-Akt, NF-kappaB, and tumor necrosis factor (TNF) signaling pathways as well as transcripts related to negative regulation of apoptotic process among others. In addition, hematopoietic colony-forming cell assays corroborate the G-CSF phenotypic effects over UBC-derived MNCs. In conclusion, our study suggests that G-CSF impacts UBC-derived cells through the modulation of several signaling pathways associated with cell survival, migration, and proliferation. The concordance observed between biosimilar and innovator G-CSF emphasizes their similarity in regards to their specificity and biological responses.

Las células madre, piedra angular de rejuvenecimiento. Aclarando conceptos / Stem cells, corners stone of rejuvenescence. Clarifying concepts

Las células madre tienen tres características comunes: la autorrenovación, la indiferenciación y la derivación a cualquier célula madura, éstas son el patrimonio (en el caso de las célula madre adultas) con el que cuenta un individuo para regenerar las células senescentes a lo largo de la vida. Las células madre pueden regenerar tejidos en individuos compatibles de la misma especie. El termino célula madre en tecnología cosmética hace referencia principalmente a sustancias extraídas de células madre de origen vegetal, ricas en polifenoles tales como el resveratrol, y luteolina o péptidos capaces de activar los genes de las sirtuinas NAD dependientes, que producen de acetilación del ADN que permiten la compactación de la cromatina (AU)

Stem cells has three common characteristics: self-renewal, differentiation and derivation of any mature cell, these are the assets (in the case of adult stem cell) with which an individual has to regenerate senescent cells along life. Stem cells can regenerate tissue compatible individuals of the same species. In Cosmetic technology the term stem cell refers mainly to stem cells extracted from substances of vegetable origin, rich in polyphenols such as resveratrol, and luteolin or peptides able to activate the genes of the NAD-dependent sirtuins, which produce deacetylation that allow the compaction of chromatin (AU)

Cellular and molecular changes associated with somatic embryogenesis induction in Agave tequilana.

In spite of the importance of somatic embryogenesis for basic research in plant embryology as well as for crop improvement and plant propagation, it is still unclear which mechanisms and cell signals are involved in acquiring embryogenic competence by a somatic cell. The aim of this work was to study cellular and molecular changes involved in the induction stage in calli of Agave tequilana Weber cultivar azul in order to gain more information on the initial stages of somatic embryogenesis in this species. Cytochemical and immunocytochemical techniques were used to identify differences between embryogenic and non-embryogenic cells from several genotypes. Presence of granular structures was detected after somatic embryogenesis induction in embryogenic cells; composition of these structures as well as changes in protein and polysaccharide distribution was studied using Coomassie brilliant blue and Periodic Acid-Schiff stains. Distribution of arabinogalactan proteins (AGPs) and pectins was investigated in embryogenic and non-embryogenic cells by immunolabelling using anti-AGP monoclonal antibodies (JIM4, JIM8 and JIM13) as well as an anti-methyl-esterified pectin-antibody (JIM7), in order to evaluate major modifications in cell wall composition in the initial stages of somatic embryogenesis. Our observations pointed out that induction of somatic embryogenesis produced accumulation of proteins and polysaccharides in embryogenic cells. Presence of JIM8, JIM13 and JIM7 epitopes were detected exclusively in embryogenic cells, which supports the idea that specific changes in cell wall are involved in the acquisition of embryogenic competence of A. tequilana.

Use of Dactylopius coccus Costa (Hemiptera: Coccoidea) pigments in the detection of larvae and pupae of Plutella xylostella (L.) (Lepidoptera: Yponomeutidae).

Carmines obtained from the dye of Dactylopius coccus Costa (Hemiptera: Coccoidea) were used for the detection of larvae and pupae of Plutella xylostella (L.) (Lepidoptera: Yponomeutidae) in broccoli inflorescences. Larvae were dyed with carmine II and red cochineal, while the majority of the dyes, with the exception of carmine III and the aqueous extract, were suitable to dye pupae. In the broccoli lumps exposed to the dyes, only the verge of the stems were actually dyed, right in the position where the incision took place, an appropriate characteristic for implementing this technique for commercial use.

Cambios morfométricos peneanos tras prostatectomía radical: revisión de la evidencia / Penile morphometric changes after radical prostatectomy: Evidence-based

Introducción: La prostatectomía radical en cualquiera de sus abordajes representa el tratamiento de elección del cáncer localizado de la próstata y especialmente en pacientes jóvenes sexualmente activos con deseo de mantener su vida sexual. Además de la bien conocida y definida disfunción eréctil postoperatoria, el período de silencio eréctil causa en muchos pacientes (9–71%) cambios estructurales, a veces irreversibles, en la estructura peneana. Estos cambios tisulares derivan en una pérdida de longitud y grosor del pene, que preocupa a los pacientes. Objetivo: Revisar de manera sistemática los datos publicados en la literatura médica hasta el momento en relación con los cambios peneanos tras prostatectomía radical. Material y métodos: Realizamos una búsqueda sistemática en PubMed, EMBASE, Cochrane, SCOPUS y Science Citation Index durante el período de enero de 1990 a septiembre de 2009 para los términos «prostatectomy», «organ size», «fibrosis», «sexual activity», «erectile dysfunction», «penile size», «radical prostatectomy», «prostatic neoplasms», «body weights» y «penis measures».Material y métodosSe seleccionaron 7 series de pacientes para su análisis. Resultados: Se exponen los diferentes métodos de medición peneana y sus potenciales sesgos y diferencias. Asimismo, repasamos las principales teorías fisiopatogénicas para explicar este fenómeno. Finalmente, se detallan los resultados de diferentes series de pacientes comunicadas. Conclusiones: Parece un hecho demostrado que el pene sufre cambios importantes en su longitud y grosor tras prostatectomía radical. Diferentes autores han comunicado los datos de sus series así como las diferentes opciones de tratamiento (inhibidores de la 5-PDE, dispositivos de vacío [DV], extensores del pene, etc.). Las estrategias encaminadas a preservar y a proteger el tejido cavernoso y la túnica albugínea tras el procedimiento así como las que aumenten la oxigenación y permitan recuperar la erección en el menor tiempo posible impactarán positivamente en la calidad de nuestros pacientes (AU)

Introduction: Radical prostatectomy in all its approaches is the treatment of choice for localized prostate cancer and especially in young, sexually active patients with a desire to keep their sex life. In addition to the well-known and defined postoperative erectile dysfunction, erectile silent period causes, in many patients (9–1%), structural changes, in the penile structure, sometimes irreversible. These tissue changes, resulting in a loss of length and girth, that concern patients. Objective: To systematically review to date published data in the literature regarding penile changes after radical prostatectomy. Material and methods: We performed a systematic search in: PubMed, EMBASE, Cochrane, SCOPUS, Science Citation Index period January 1990 to September 2009 for the terms “prostatectomy”, “organ size”, “fibrosis”, “sexual activity”, “erectile dysfunction”, “penile size”, “radical prostatectomy”, “prostatic neoplasms”, “body weights” and “penis measures”. Seven series of patients were selected for analysis. Results: We described the different measurement methods and their potential biases and differences. Also, we reviewed main physiopathogenic theories to explain this phenomenon. Finally, we detail the results of different series of patients reported. Conclusions: It seems to be a proven fact that the penis undergoes major changes in its length and girth after radical prostatectomy. Several authors have communicated the data of their series and the different treatment options (5PDE inhibitors, vacuum devices, penile extenders, etc.). Strategies addressed to preserve and protect cavernous tissue and tunica albuginea after the procedure, as well as to increase oxygenation and allow erection to be recovered in the shortest posible time positive will impact on the quality of life of our patients (AU)

[Penile morphometric changes after radical prostatectomy: Evidence-based]. / Cambios morfométricos peneanos tras prostatectomía radical: revisión de la evidencia.

INTRODUCTION: Radical prostatectomy in all its approaches is the treatment of choice for localized prostate cancer and especially in young, sexually active patients with a desire to keep their sex life. In addition to the well-known and defined postoperative erectile dysfunction, erectile silent period causes, in many patients (9-1%), structural changes, in the penile structure, sometimes irreversible. These tissue changes, resulting in a loss of length and girth, that concern patients. OBJECTIVE: To systematically review to date published data in the literature regarding penile changes after radical prostatectomy. MATERIAL AND METHODS: We performed a systematic search in: PubMed, EMBASE, Cochrane, SCOPUS, Science Citation Index period January 1990 to September 2009 for the terms prostatectomy, organ size, fibrosis, sexual activity, erectile dysfunction, penile size, radical prostatectomy, prostatic neoplasms, body weights and penis measures. Seven series of patients were selected for analysis. RESULTS: We described the different measurement methods and their potential biases and differences. Also, we reviewed main physiopathogenic theories to explain this phenomenon. Finally, we detail the results of different series of patients reported. CONCLUSIONS: It seems to be a proven fact that the penis undergoes major changes in its length and girth after radical prostatectomy. Several authors have communicated the data of their series and the different treatment options (5PDE inhibitors, vacuum devices, penile extenders, etc.). Strategies addressed to preserve and protect cavernous tissue and tunica albuginea after the procedure, as well as to increase oxygenation and allow erection to be recovered in the shortest possible time positive will impact on the quality of life of our patients.

An attempt to study the economic loss arising from Schistosoma japonicum infection and the benefits derived from treatment.

From the northern and southern portions of Leyte Province, which are endemic for schistosomiasis, a total of 801 infected individuals were interviewed, examined, and classified into mild, moderate, severe and very severe forms of disease with an assumed loss of working capacity for each category. The frequency rate or number of spells of illness for the past year under observation were correlated with the degree of incapacity to get the total days lost per person per year. Following a series of computations, of which the disability rate was considered as the most important, a total of 45.4 days lost per infected person per year was arrived at. Treatment of the disease with praziquantel was carried out and the patients were followed up one year after treatment, at which time the same methodology was applied. The results show that the 45.4 days lost prior to treatment went down to 4 days lost. There was an economic gain of 41.4 days as a result of treatment. This can be expressed in terms of financial value if we consider half of the infected cases as breadwinners receiving a minimum wage. It should be noted that a number of assumptions in this study were made. It is, however, hoped that this work will serve as a guide and a starting point for others to carry out related studies on economic loss and subsequent economic benefits to justify budgetary requests/allocations for the implementation of various preventive and control measures.

[Health surveillance of workers exposed to asbestos: an example of cooperation between the occupational prevention system and the national health system]. / La Vigilancia de la Salud de los trabajadores expuestos al amianto: ejemplo de colaboracion entre el sistema de prevencion de riesgos laborales y el sistema nacional de salud.

The Ministry of Health and Consumer Affairs and the Autonomous Governments of Spain have designed and agreed by consensus with the sanitary professionals and major employer's organizations and Unions a Integral Health Surveillance Programme of asbestos-exposed workers, in order to assure appropriate, uniform and harmonized action throughout the national territory with relation to these workers. PROGRAM DESCRIPTION: This initiative started from the Occupational Health Working group of the Interterritorial Council, with inputs from the Asbestos Working Group of the National Occupational Safety and Health Commission. It was agreed with occupational medicine and infirmary professionals and was approved by the Health and Labour authorities. The program is organised in seven main activities. CURRENT PROGRAM STATUS: two years after the Programme approval a total of 5778 workers are included in the Registry of asbestos-exposed workers. 208 workers have COPD, 198 benign pleural disease, 8 lung cancer, 10 mesothelioma and 7 workers have other cancers possibly related to asbestos (gastric, larynx and colon cancer). REMARKS: the agreement and participation reached in this Programme allow achieving much higher coverage of occupational prevention policies than those obtained with a mere law approval, as we could see during the second year of implementation of the Programme in which the number of attended workers has doubled.

La vigilancia de la salud de los trabajadores expuestos al amianto: ejemplo de colaboración entre el sistema de prevención de riesgos laborales y el sistema nacional de salud / Health surveillance of workers exposed to asbestos: an example of co-operation between the occupational prevention system and the national health system

El Ministerio de Sanidad y Consumo y las Comunidades Autónomashan diseñado y consensuado con los profesionales sanitariosy las organizaciones empresariales y sindicales representativas unPlan Integral de Vigilancia de la Salud de los Trabajadores que hanestado expuestos a Amianto, con el objetivo de garantizar una intervenciónadecuada, uniforme y armonizada de estos trabajadores entodo el territorio nacional. La elaboración del Programa partió delGrupo de Trabajo de Salud Laboral del Consejo Interterritorial, seenriqueció con las aportaciones del Grupo de Trabajo Amianto de laComisión Nacional de Seguridad y Salud en el Trabajo, fue consensuadocon los profesionales de la medicina y enfermería del trabajo,y fue aprobado por las autoridades sanitarias y laborales. El Programaconsta de siete grandes bloques de actividades. Dos años despuésde aprobado el Programa, el estado de implantación en las ComunidadesAutónomas es desigual. Las principales dificultades para supuesta en marcha se encuentran en la elaboración del Registro deexpuestos. Un total de 5.778 trabajadores están incluidos en el Registro.208 trabajadores tienen EPOC, 198 alteraciones pleurales benignas,8 cáncer de pulmón, 10 mesotelioma y 7 presentan otros cáncerescon posible relación con el amianto (gástrico, de laringe y colon). El consenso y la participación alcanzados alrededor de este Programaestán permitiendo lograr coberturas de las políticas de prevenciónde riesgos laborales muy superiores a las que se consiguen conla mera actuación institucional y elaboración de normativa, ya que ensólo los dos primeros años de implantación del Programa se ha duplicadoel número de trabajadores atendidos

The Ministry of Health and Consumer Affairs and the AutonomousGovernments of Spain have designed and agreed by consensuswith the sanitary professionals and major employer's organizationsand Unions a Integral Health Surveillance Programme ofasbestos-exposed workers, in order to assure appropriate, uniformand harmonized action throughout the national territory with relationto these workers. Program description: this initiative startedfrom the Occupational Health Working group of the InterterritorialCouncil, with inputs from the Asbestos Working Group of theNational Occupational Safety and Health Commission. It was agreedwith occupational medicine and infirmary professionals and wasapproved by the Health and Labour authorities. The program isorganised in seven main activities. Current Program status: twoyears after the Programme approval a total of 5,778 workers areincluded in the Registry of asbestos-exposed workers. 208 workershave COPD, 198 benign pleural disease, 8 lung cancer, 10 mesotheliomaand 7 workers have other cancers possibly related toasbestos (gastric, larynx and colon cancer). Remarks: the agreementand participation reached in this Programme allow achievingmuch higher coverage of occupational prevention policies than those obtained with a mere law approval, as we could see duringthe second year of implementation of the Programme in which thenumber of attended workers has doubled

Transitory cognitive impairment in epileptic children during a CPT task.

EEGs and behavioral responses were studied in two sex matched groups of 58 epileptic and 20 healthy children between 8 and 12 years of age, during the execution of a go-no go CPT (X; A-X) task to determine transitory cognitive impairment (TCI) incidence. Paroxysmal discharges were found on 87.9% and 5% of the EEGs in the epileptic and control groups respectively, with no differences related to sex. The predominant EEG findings with respect to paroxysmal discharges were the association of two or more types of paroxysms with frequency higher than 5/minute, an average duration less than 0.5 second and topographical distribution over temporal-parietal-occipital areas without significant interhemispheric differences. TCI was detected in 36.2% of epileptic children. The epileptic group showed significantly higher numbers of behavioral errors and longer reaction times (RTs) in relation to the control group. Analyzing RTs on the two blocks of the task, linear discriminant analysis showed an acceptable classification of TCI incidence between groups.

Linkage disequilibrium of HLA-DR3 and HLA-DR4 with HLA-B alleles in Mexican patients with rheumatoid arthritis.

OBJECTIVE: We studied the gene frequencies of classes I, II and III antigens of the Major Histocompatibility Complex (MHC) in 32 Mexican mestizo patients with rheumatoid arthritis (RA) and compared them with those obtained from 110 of their first degree relatives and 100 Mexican mestizo controls. Furthermore, we analyzed the observed and expected frequencies of the haplotypes and calculated the delta values in the three groups. METHODS: The class I and class II MHC antigens were determined by the microlymphocytotoxicity test; class III MHC antigens were obtained by high voltage agarose gel electrophoresis and immunofixation. The significance of differences among the three groups was tested by chi-square analysis; linkage disequilibrium among the different alleles in each haplotype was estimated by computing the delta values (observed vs expected frequencies). RESULTS: Patients showed a significantly increased frequency of HLA-A1 (corrected p = 10(-5)), DR3 (corrected p = 0.04) and DQ2 (corrected p = 10(-4)) and a decreased frequency of A31 (corrected p = 0.003) as compared to the normal controls. First degree relatives compared to patients and controls showed a decreased frequency of HLA-DR4 (corrected p = 0.02 and 0.008 respectively); consequently, DQ3 was also diminished (corrected p = 10(-4)). Analysis of MHC haplotypes within families revealed in the patients seven MHC haplotypes with significant differences between the observed and expected frequencies (statistically significant delta values). These haplotypes were: [HLA-B8; DR3], [HLAB44; FC31], [HLA-B8; SC42], [HLA-DR4; SC31], [HLA-B35; SC32], [HLA-DR7; FC31] and [HLA-DR2; SC31]. On the other hand, the control haplotypes showed significant delta values in only one of these haplotypes ([HLA-DR4; SC31]), whereas first degree relatives showed none. Analysis of all the class I, II and III alleles, either alone or as part of specific haplotypes, showed two B-DR haplotypes with higher relative risks than their alleles alone. These haplotypes were: [B44; DR4] (RR = 6.0, p = 0.005), and [B8; DR3] (RR = 8.3, p = 0.010). CONCLUSION: The results suggest that a specific combination of antigens in the same haplotype (for instance between HLA-B and HLA-DR) could contribute to increasing the genetic susceptibility to develop RA.

[Patients' adherence to therapy and their understanding of hypertension at health centers]. / Adhesión terapéutica y conocimiento en hipertensión de pacientes incluidos en las consultas de enfermería.

OBJECTIVE: The main aim was to find the prevalence of therapy adherence by means of self-reporting, therapy aims and its association to determined variables. Secondary aims were to evaluate the Morisky test and assess the patients' understanding of hypertension. DESIGN: A descriptive crossover study using questionnaires and stratified random sampling. SETTING: Nursing stations (NS) at a rural teaching Health Centre. PATIENTS: A sample of 122 hypertense patients, who were not diabetic, were treated pharmacologically, were over 25 and had attended the NS for at least 6 months. MEASUREMENTS AND MAIN RESULTS: 64.8% prevalence of adherence (CI 0.558 p < = 0.738). 99% were very satisfied with their relationship to the nursing staff, although their understanding of AHT was very low. 12% were wrongly diagnosed or over-prescribed. No statistical significance was found between adherence by self-reporting and the independent variables, but it was between adherence by control and the number of doses: p < 0.05, OR = 0.22, CI 0.8; 0.05. Those patients with three doses had worse control than those with one. Test sensitivity = 0.843; Specificity = 0.16. CONCLUSIONS: A profile of the patient adhering to treatment could not be defined: the adherence rate was situated at the upper limit of other studies. The AHT procedure should have been checked in order to bring into line diagnosis and treatment criteria and to implement special adherence measures in those patients with over two daily doses. There was no evidence that adherence improved in line with time spent at the NS. The test did not predict adherence with accuracy.

Effects of antiepileptic drugs on concentration of serum proteins and immunoglobulins of epileptic patients.

Serum of normal volunteers and serum of epileptic patients receiving either a single drug or combined antiepileptic therapy with Phenytoin (Phen); Carbamazepine (Cbz); Primidone (Prim); Phenobarbital (Phb) were examined and showed: No differences with regard to total proteins, albumins and A/G ratio. The alpha 1-globulin fraction increased to 4.4% with Phen/Cbz (P less than 0.001) and decreased to 1.7% with Phen/Prim = (P less than 0.001). The alpha 2-globulins corresponded to 7.2% (P less than 0.001) with Phen/Prim and 15.5% (P less than 0.001) with Phen/Phb treatments. beta-Globulins decreased to 7.1% (P less than 0.05) when received Phen/Phb treatment. Low concentrations of serum gamma-Globulins were found in Phb (P less than 0.001), Prim (P less than 0.001, Phen (P less than 0.001) treated patients. However, with Cbz, Phen/Phb, Phen/Prim this electrophoretic fraction remained within the upper range of normal. IgA of patients treated with Phen showed a mean of 60 mg/dl. Those patients with Phen serum levels below or above 12-20 micrograms/ml remained normal. Prim and Phb treatment also decreased IgA. IgD was normal in patients treated with Phen/Prim. Alterations of immune humoral responses to all antiepileptic drugs were found.

Endoscopic surgery in distal obstruction of the ejaculatory ducts.

Endoscopic surgery in ejaculatory disorders requires a selection of cases and technical peculiarities, attention to which is drawn in this study. A disorder in the emission stage of the ejaculated product due to distal obstruction of the ejaculatory ducts or veru may be isolated. 9 cases are described. The endoscopic surgery carried out in these 9 cases, was a supramontal arciform incision in 4 cases, longitudinal incision in 2 cases and veru section in 3 cases. This allowed drainage of the ejaculate from the seminal vesicle to the urethra, improving its volume and/or quality, in 5 of the cases.