Small-intestine absorption during continuous intraduodenal infusion of nutrients in dogs.

Motility and exocrine and endocrine secretions of the gastrointestinal tract are modified during postprandial periods. Experimental evidence suggests that nutrients stimulate small-intestine absorption, but the mechanisms involved are uncertain. Further, the effects of mixing nutrients with different physicochemical compositions on absorption and motility are not completely elucidated. With the use of a canine model, we investigated the effects of a mixture of different lipids and proteins on small-intestine motility and absorption. Two cannulae, one in the proximal duodenum and one in the distal ileum, were implanted in the dogs. Absorption of a continuous duodenal infusion of eight test mixtures consisting of long- and medium-chain fatty-acid triacylglycerols, soy protein and its hydrolysate, casein and its hydrolysate, and variable amounts of glucose, and glucose polymer were analyzed by measuring the volume, concentration, and total amount of triacylglycerols, nitrogen, and glucose recovered from the ileal cannula. Significant differences in absorption were observed across test mixtures. Significantly lower absorption of H(2)O and nutrients was observed with test mixtures prepared with medium-chain fatty-acid triacylglycerols and soy protein compared with test mixtures prepared with corn oil, casein, and hydrolysates of both proteins. We concluded that the physicochemical characteristics of nutrients in elemental diets continuously infused into the duodenum are important for determining small-intestine absorption.

Exploring child maltreatment and its relationship to alcohol and cannabis use in selected Latin American and Caribbean countries.

OBJECTIVES: Research from developed countries shows that child maltreatment increases the risk for substance use and problems. However, little evidence on this relationship is available from developing countries, and recognition of this relationship may have important implications for substance demand reduction strategies, including efforts to prevent and treat substance use and related problems. Latin America and the Caribbean is a rich and diverse region of the world with a large range of social and cultural influences. A working group constituted by the Inter-American Drug Abuse Control Commission and the Center for Addiction and Mental Health in June, 2010 identified research on this relationship as a priority area for a multinational research partnership. METHODS: This paper examines the association between self-reported child maltreatment and use in the past 12 months of alcohol and cannabis in 2294 university students in seven participating universities in six participating countries: Colombia, El Salvador, Jamaica, Nicaragua, Panama and Uruguay. The research also considers the possible impact of religiosity and minimal psychological distress as factors contributing to resiliency in these samples. RESULTS: The results showed that experience of maltreatment was associated with increased use of alcohol and cannabis. However, the effects differed depending on the type of maltreatment experienced. Higher levels of religiosity were consistently associated with lower levels of alcohol and cannabis use, but we found no evidence of an impact of minimal psychological distress on these measures. CONCLUSIONS: This preliminary study shows that the experience of maltreatment may increase the risk of alcohol and cannabis use among university students in Latin American and Caribbean countries, but that higher levels of religiosity may reduce that risk. More work to determine the nature and significance of these relationships is needed.

Predictive factors for pressure ulcers in the ambulatory stage of spinal cord injury patients.

STUDY DESIGN: Case control study. OBJECTIVE: To determine the main risk factors for pressure ulcer (PU) in ambulatory spinal cord injury (SCI) patients. SETTING: Hospital del Trabajador, Santiago, (ACHS (Chilean Security Association), Chile. METHODS: We studied 41 patients for traumatic SCI, from Santiago, Chile, cared for in our hospital. The clinical histories were reviewed from first discharge to 1996. The patients were categorized into two groups: 18 cases with a previous history of PU, and 23 patients with no history of PU were considered as controls. Univariate analysis was performed, 18 variables per case, 10 of which were psychosocial factors. RESULTS: There were 37 men and four women. Average age was 41.7 years. Duration of SCI on average was 6.7 years. The distribution was complete paraplegia (CPP) 22 patients (54%), complete tetraplegia three patients (7%), incomplete paraplegia 11 patients (27%) and incomplete tetraplegia, five patients (12%). Four variables of the univariate analysis were significant: duration of cord injury (SCI time) >5 years, completeness of cord injury, paraplegia and not able to practice regular standing. There was a significant association in body morphology (endo or ectomorphic), being able to practice regular standing and personality disorder in CPP. CONCLUSIONS: The risk for developing PU was 4.3 times greater in CPP patients than is any other type of SCI. CPP patients who do not practice standing periodically, who have a personality disorder and have an ecto/endomorphic corporal morphology have a greater risk of suffering PU.

[Dichotomization of continuous variables in logistic regression models]. / Dicotomización de variables continuas en modelos de regresión logística.

It is highly to observe in the biomedical literature, that the continuous variables such as systolic blood pressure and cholesterol, are dichotomized and used in such manner in a given statistical analysis. The consequences of such transformation can be very varied. In this article, how the dichotomization of a continuous exposure variable affects the quality of the prediction of a response using the logistic regression is examined. One can conclude that, in almost all the studied stimulation, the percentages of misclassification can increase drastically, reaching over there times the probability of misclassification of the ones using the original variable. Therefore, we recommend to avoid dichotomization.

Relationship between small intestinal fasting motility and vomiting in dogs.

Preceding vomiting, several changes in small intestinal motility have been described. They consist mainly of high-amplitude retrograde contractions and inhibition of motility before and after these contractions. The recordings of 94 episodes of emesis occurring spontaneously, during manometric studies of intestinal motility by means of infused catheters in dogs with gastric and duodenal cannulae, showed that 95.7% of all episodes developed during phase II of the migratory motor complex. In order to establish whether different phases of the fasting cyclic activity are associated with a different sensitivity to emetic stimulus, two agents, apomorphine, a centrally acting drug and copper sulfate, a peripherally acting agent, were administered at the beginning of phases I and II of the migratory motor complex. Coincident with spontaneously occurring vomiting, a statistically significative greater number of responses to both emetic agents was observed during phase II as compared to phase I. This finding suggests that cyclic changes of the small bowel motility are related to changes in the threshold of the vomiting center.

Influence of vertical dimension on masseter muscle electromyographic activity in patients with mandibular dysfunction.

Occlusal splints were adjusted to different vertical heights and used to single out the influence of vertical dimension of occlusion in increments on BT-EMG activity of the masseter muscle in patients with mandibular dysfunction. The vertical dimension of least EMG activity was determined for each of 60 patients, who were randomly divided into three groups according to the vertical dimension at which the occlusal splint was adjusted: group No. 1, 1 mm from occlusal vertical dimension; group No. 2, mean vertical dimension, 4.25 mm; group No. 3, mean vertical dimension, 8.25 mm. Results showed a significant reduction of masseter BT-EMG activity (series A and B) at the end of the 3-week treatment period for patients in group Nos. 2 and 3 in comparison with group No. 1. Furthermore, the short-term use of occlusal splints with a vertical height that exceeded the so-called physiologic interocclusal distance did not result in an increase in masseter BT-EMG activity. This study suggests that an increase of vertical dimension of occlusion to or near the vertical dimension of least EMG activity by means of occlusal splints can be an effective way to obtain a reduction in masseteric muscle activity.

[Categorizing variables in the statistical analysis of data: consequences for interpreting the results]. / Categorización de variables en el análisis estadístico de datos: consecuencias sobre la interpretación de resultados.

Frequently during the process of data analysis in epidemiological studies, the scale of one or more continuous variables is changed. The objective of this paper was to assess the consequences of categorizing variables during data analysis. We studied three situations with different scenarios for statistical analysis with regression models. The results show that dichotomizing continuous variables can substantially modify the relationships between dependent and independent variables. Thus, for example, in epidemiological studies trying to evaluate the effect of an exposure on a response, the magnitude and/or the direction of this effect can be biased by dichotomizing a variable. We therefore recommend avoiding, as much as possible, the categorization of variables when doing analyses.

Altered small bowel motility in patients with liver cirrhosis depends on severity of liver disease.

Abnormal small bowel motility has been described in patients with liver cirrhosis but the mechanisms involved are unknown. The aim was to investigate a possible relationship between the severity of liver failure and the intensity of small intestinal abnormalities. Motility was studied during fasting, by means of perfused catheters and external transducers, on 33 cirrhotics with different etiologies; 8 were at Child-Pugh stage A, 12 stage B, and 13 stage C. Both abnormalities of MMC and increased clustered activity were recorded. Absence of cycling activity was most frequently observed in Child-Pugh stage C patients compared to Child-Pugh stage A cirrhotics. A significant increase in clustered contractions from 4.7 +/- 0.4/hr in stage A patients to 11.3 +/- 1.1 in stage C was recorded. The frequency and amplitude of contractions was also increased from Child-Pugh stage A to stage C. Our findings might be related to a delayed transit time observed in these patients and a higher prevalence of bacterial overgrowth in cirrhotics with more advanced liver disease.

[Assessment of the use of statistical methods in health research]. / Evaluación de utilización de los métodos estadísticos en la investigación en salud.

BACKGROUND: Computer use has lead to a great development of statistical methods. AIM: To assess the use of statistical methods in Chilean medical literature. METHODS: Two hundred sixty four papers appeared in Revista Médica de Chile and Revista Chilena de Pediatría between 1983 and 1993 were reviewed. RESULTS: Student's "t", Fisher's, and chi 2 test are the most frequently used statistical methods in 67% of papers. Correlation coefficients are used in 10% of papers. Multivariate methods are seldom used. CONCLUSIONS: Statistical analysis of papers published in Chilean medical journals is restricted to very few methods.

[Medical care in 12 Chilean cities]. / Atención médica en doce ciudades Chilenas.

Frequency of diseases and accidents and the main aspects of medical care were studied in 12 larger Chilean cities, excluding the metropolitan area of Santiago. A survey of 4,737 individuals was performed in a random sample of homes and medical problems observed during a 2 week period were analyzed. A mean of 4.17 disease episodes per person-year was registered, 47% of them receiving medical care. This rate was higher for acute conditions (69%) than for chronic diseases (32%). The sum of consults for disease and health controls gave a total assistance of 3.42 per person-year. 70% of visits took place in outpatient hospital clinics and 30% in private practice facilities. Two thirds of the visits were done in National Health Service's outpatient clinics. The quality of medical care was rated by patients as good or very good in 81% of cases, fair in 13% and deficient in 6%. Main reasons given by patients for not seeking medical care (31% in acute episodes and 68% in chronic patients) were the short course of disease in acute conditions or a feeling that control was not needed in chronic diseases. Problems linked to the medical care system, including financial reasons, explained lack of care in 28% of cases. The medical care situation in these 12 larger cities is similar to that observed in Santiago, using the same type of survey.

[Consumption of licit and illicit drugs in Chile: results of the 1998 study and comparison with the 1994 and 1996 studies]. / Consumo de drogas lícitas e ilícitas en Chile: resultados del estudio de 1998 y comparación con los estudios de 1994 y 1996.

The principal results are presented here from the Third National Study of the Consumption of Drugs, which was carried out in Chile by the National Board for Narcotics Control between 1 September 1998 and 15 January 1999. The 1998 study used the same methodological design as the first and second studies, which were done in 1994 and 1996. The 1998 study expanded the sample to 31,665 individuals, who were representative of a population of 6,940,727 people from 12 to 64 years old, both sexes, and five socioeconomic levels and who were residents of urban areas in 62 commune administrative divisions of the 13 regions of the country. Results from the 1998 study are compared with those from 1996 and 1994. The 1998 study shows that 17.5% of Chileans have at some time in their life used one of the three illicit drugs most popular in the country: marijuana (16.8%), coca paste (2.3%), and cocaine hydrochloride (4.0%). The prevalence of use of any of the three drugs, mainly marijuana, during the preceding year was 5.3% and during the preceding month 2.2%. With respect to licit drugs, 28.4% of Chileans have at some time in their lives used antianxiety drugs, 84.4% of them have consumed alcohol, and 71.9% have used tobacco. Most of the people who once used illegal drugs have stopped doing so: 71.6% in the case of marijuana, 64.1% with coca paste, and 66.8% with cocaine hydrochloride. For legal drugs, the percentages were lower: 55.5% for anxiolytics, 16.0% for alcohol, and 34.5% for tobacco. The consumption of licit and illicit drugs was several times greater among men than among women, except for anxiolytics, whose use was three times greater among women. Drug use was more frequent among persons between 19 and 25 years old. Consumption of illegal drugs was more frequent at higher socioeconomic levels, and use of licit drugs was more common in the lower socioeconomic levels. The 50th percentile of the age of initiating drug use was 17 years for alcohol, 15 for tobacco, 30 for antianxiety agents, 17 for marijuana, 20 for coca paste, and 21 for cocaine hydrochloride. Comparing the results of the three studies shows that, after an increase in the use of licit drugs between 1994 and 1996, there was a stabilization in 1998. With illegal drugs there was a modest increase in consumption between 1996 and 1998, following a small reduction between 1994 and 1996.

[Prostitutes of the east sector of Santiago: characteristics and pathology of sexual transmission]. / Las prostitutas del sector oriente de Santiago: características y patología de trasmision sexual.

We studied the frequency of venereal disease in 329 prostitutes working at massage parlours in Santiago. The mean age was 24 years and half of them had high school or university studies. In spite of frequent sexual contacts averaging 2.8 per day, the prevalence of significant venereal disease was not high in this group. Notably, AIDS infection was not detected. Vaginitis due to Trichomonas or Candida infection was the commonest problem and this was half as frequent among gum preservative users. Marital condition, age, obstetrical history and other variables were not related to genital infection.

PIP: A sample of 329 prostitutes from the eastern area of Santiago, Chile, who attended the Dermatology Service of the Salvador Hospital in January-February 1988 were studied to determine the current incidence of sexually transmitted disease among prostitutes. Approximately 600 prostitutes attend the service for required monthly health examinations. The 329 women worked in established locales such as saunas, massage parlors, and nightclubs. None were uncontrolled street prostitutes. The average age was 24.3 years. 68% were single, 17% were separated, and 15% were married. Only 14% had no more than primary education, and half had high school or college educations. The average parity was 1.52. 83% used contraception. 31% used oral contraceptives (OCs), 21% used injectables, 24% used IUDs, and 7% used other methods. The average number of sexual contacts per day was 2.87. 54% always used condoms, 36% occasionally did so, and 10% never did so. The estimated number of monthly sexual contracts/woman was 65. 22% of the women had some sort of genital pathology. No cases of HIV infection were seen. 9.7% were diagnosed with trichomonas, 4.6% with unspecified vulvovaginitis, 3.3% with candidiasis, 1.8% with syphilis, 1.5% with gonorrhea, .9% with condyloma acuminata, and .3% with active herpes. The frequency of vaginitis did no appear to be associated with the number of sexual contacts, but other pathologies were more common in women with more partners. Women who always used condoms were only half as likely to have genital pathologies or vaginitis as women who never used condoms.

[Changes in ethical attitudes during medical studies]. / Cambios de actitudes éticas a lo largo de los estudios de medicina.

The aim of this work was to explore the attitude changes towards ethico-medical issues in medical students as they went through medical school. A personal standardized questionnaire containing 14 closed and direct questions was applied to 27 freshmen, 38 interns and 14 post graduates. The most outstanding differences in ethical attitudes occurred between first year students and the older groups. The younger students adhered to ethical principles, valued justice towards patients and moral integrity in physicians. The older students and post graduates emphasized the professional role of physicians and preferred institutional ethical regulations over public control. They also considered more valuable therapeutic efficiency and paternal attitudes towards patients as well as social prestige and economical rewards. We conclude that there is a progressive erosion of humanistic principles along the medical studies, that are substituted by a model of professional competence, social recognition and internal ethical control.

[Acute myocardial infarction in Chile: differences between men and women in its evolution and prognosis. Multicenter Study Group on Infarction] (GEMI)]. / Infarto agudo del miocardio en Chile: diferencias entre hombres y mujeres en su evolución y pronóstico. Grupo de Estudios Multicéntrico de Infarto (GEMI).

BACKGROUND: Gender may be a prognostic factor for the evolution of acute myocardial infarction and women may have higher mortality and complication rates. AIM: To study if there are differences in the evolution of acute myocardial infarction between men and women. PATIENT AND METHODS: We have recorded information on risk factors, clinical evolution, treatment and complications of 2,052 patients hospitalized for acute myocardial infarction in 36 Chilean hospitals. The odds ratio for female sex and mortality was calculated using a logistic regression analysis adjusted for risk factors, treatment, invasive procedures and complications. RESULTS: Twenty six percent of analyzed patients were female. Mortality rates among females and males were 11.8 and 20.2% respectively (p < 0.01). Women had higher frequency of smoking, diabetes, obesity and hypertension. Blood lipid levels were similar in both sexes. Compared to men, a lesser proportion of women were treated with thrombolytic agents (25 and 35% respectively), intravenous heparin (54 and 61% respectively), beta blockers (31 and 42% respectively) and intravenous nitrates (53 and 61% respectively). Also, women were subjected to less invasive procedures. The odds ratio for mortality and sex was 1.72 (confidence interval from 1.13 to 2.62). CONCLUSIONS: Female sex is an independent risk factor for acute myocardial infarction mortality.

Uterine artery blood flow velocity waveforms in pregnant women with müllerian duct anomaly: a biologic model for uteroplacental insufficiency.

OBJECTIVE: The purpose of this study was to determine whether there are demonstrable alterations in uterine artery blood flow in pregnant women with müllerian duct anomaly. STUDY DESIGN: Flow velocity waveforms obtained from the placental and nonplacental uterine arteries were studied at 18 to 24 weeks' gestational age in 15 pregnant women with müllerian duct anomaly and in 30 controls. The systolic/diastolic ratios were compared and correlated with the degree of placental laterality and perinatal outcome. RESULTS: Systolic/diastolic ratio in the uterine artery was abnormal in 80% of the cases and in 10% of controls (p < 0.0001). A completely lateral placenta was found in 10 of 15 women of the study group and only in 1 of the 30 controls (p < 0.0001). Women with müllerian duct anomaly had higher systolic/diastolic ratios in the nonplacental uterine artery than those with a normal uterus (median 4.3, range 2.0 to 7.4 vs median 2.8, range 2.0 to 4.0; p < 0.001). Twelve of 15 women of the study group had poor perinatal outcome compared with 4 of the 30 controls (p < 0.001). Among those women with poor perinatal outcome, 11 of 12 (92%) in the study group and only 1 of the 4 (25%) in the control group had an abnormal systolic/diastolic ratio in the uterine arteries (p < 0.05). CONCLUSION: There is a clear association between placental laterality and high systolic/diastolic ratio in the nonplacental uterine artery in pregnant women with müllerian duct anomaly who had poor perinatal outcome. This finding suggests that unilateral placental implantation could lead to functional exclusion of one uterine artery from the uteroplacental circulation and could explain pregnancy complications in women with developmental fusion defects of the uterus.

Discordant uterine artery velocity waveforms as a predictor of subsequent miscarriage in early viable pregnancies.

OBJECTIVE: Our purpose was to determine whether an abnormal uterine perfusion pattern was associated with subsequent pregnancy loss after fetal cardiac activity was documented. STUDY DESIGN: Pulsatility indexes of both the right and left uterine arteries were obtained by transvaginal color Doppler ultrasonography in 318 consecutive viable pregnancies between 6 and 12 weeks' gestation. The Delta uterine artery pulsatility index value, expressed as the highest uterine artery pulsatility index value minus the lowest value, was calculated for each pregnancy. Women were subsequently classified as having continuing pregnancies or pregnancy loss before 20 weeks' gestation. To predict subsequent pregnancy loss, Doppler findings were adjusted for maternal age, history of previous abortion, presence of subchorionic hematoma, embryonic bradycardia, and gestational age by means of multivariate logistic regression analysis. RESULTS: Twenty-four pregnancies (8%) were spontaneously aborted before 20 weeks' gestation. Both Delta uterine artery pulsatility index (odds ratio 2.9, 95% confidence interval 1.5-5.8) and history of previous abortion (odds ratio 3.1, 95% confidence interval 1.2-8.2) were significantly associated with pregnancy loss in the multivariate logistic regression analysis. The sensitivity and specificity of the multivariate logistic regression model to predict abortion were 75% and 85%, respectively, significantly higher than the diagnostic performances of qualitative and quantitative variables considered individually. CONCLUSION: Discordant uterine artery pulsatility indexes in the first trimester were strongly associated with subsequent pregnancy loss. This suggests that uterine ischemia may be implicated in certain cases of early pregnancy loss after documentation of fetal cardiac activity during the first trimester.

[Morbidity and mortality of essential arterial hypertension treated in Chile: a 15 years' follow-up study]. / Morbimortalidad de la hipertensión arterial esencial tratada en Chile: seguimiento a 15 años.

In order to establish morbidity and mortality in treated patients with essential hypertension, a prospective study was started in 1974. 714 patients were followed for 15 years. Admission criteria included diastolic blood pressure over 95 mmHg during one month on placebo, absence of malignant or accelerated hypertension and no recent (6 month) cardiovascular complication. According to target organ damage, 51% of patients were in WHO stage I, 35% in stage II and 14% in stage III. There were 342 males and 372 females, with mean age 58.7 +/- 9.8 years. Mean initial blood pressure was 181/110 +/- 12/8.9 mmHg. Treatment schedules included diuretics alone (23%), beta blockers alone (32%), diuretic and betablocker (38%), combined therapy with vasodilators (9%) and other forms of therapy (5%). 75 subjects failed to comply with therapy but were maintained in the analysis (intention to treat). A significant reduction in blood pressure was observed in the group as a whole (154/93 +/- 7/9 mmHg). Sustained normalization of BP (< 90 mmHg) was obtained in 40.2% of patients, reductions to between 91 and 100 mmHg in 37.2% and reductions to over 101 mmHg in 22.5% 47 patients died from cerebro vascular complications (15-year cumulative death rate of 12.3%). Total morbidity rate was 40.1% (232 events) with 61 coronary events (13.3%), 43 cerebrovascular events (8.7%), 30 cases of heart failure (12.9%) and 21 cases of renal failure (4.3%). These figures are in agreement with internationally reported ones with the exception of coronary morbidity which appears lower in this study.

[Comparative study of the efficacy of two types of BCG vaccines administered in different doses]. / Estudio comparativo de la eficacia de dos tipos de vacunas BCG administradas en dosis diferentes.

BACKGROUND: In 1993, WHO and UNICEF recommended the administration of 0.05 ml doses of BCG, instead of 0.1 ml, to newborns. This recommendation was adopted by the Chilean Ministry of Health, using the Mérieux vaccine. Subsequently, different Health Services detected a high percentage of children without BCG scar at the time of their growth and development control. AIM: To assess the efficacy of BCG vaccination in a double blind randomized fashion, using two vaccine types and different doses. PATIENTS AND METHODS: Newborns of two public hospitals of Santiago were randomly assigned to receive the Tokio or Mérieux BCG strains in doses of 0.05 or 0.1 ml. Ninety five to 125 days after vaccination, vaccine scar was measured and inmunogenicity was assessed using the tuberculin test. RESULTS: Six hundred newborns (150 in each group) were included in the protocol and results were assessed in 408. The percentage of children with a PPD reaction of 0 mm was 9.3, 3.7, 7.8 and 0% with the Mérieux vaccine in doses of 0.1 ml, Tokio vaccines in doses of 0.1 ml, Mérieux vaccine in doses of 0.05 ml and Tokio vaccine in doses of 0.05 ml, respectively. In the same groups the scar diameters were 6.4 +/- 3.4, 7.3 +/- 2.7, 5.6 +/- 2.8 and 7.3 +/- 2.9 mm. The observed differences for each group are significant, depending on the type of strain and dose, but favoring the Tokio type of vaccine. CONCLUSIONS: The BCG scar diameters obtained in this study are similar to those obtained in previous works in 1984 and 1986. This scar is the evidence of vaccination that nurses detect in health controls. Therefore the use of 0.1 doses for vaccination, that result in better scars and PPD response, is recommended.

Bedside markers of coronary artery patency and short-term prognosis of patients with acute myocardial infarction and thrombolysis.

BACKGROUND: In this study we have evaluated the prognostic power of noninvasive markers of coronary artery reperfusion in patients with acute myocardial infarction who were treated with intravenous streptokinase. METHODS: In 967 consecutive patients with acute myocardial infarction who were treated within 6 hours of symptoms, we analyzed the prognostic power of resolution of chest pain and ST-segment elevation >50% at 90 minutes, abrupt creatine kinase rise before 12 hours, and T-wave inversion in infarct-related electrocardiographic leads within the first 24 hours after thrombolysis. RESULTS: Global in-hospital mortality rate was 12.0%. Each reperfusion marker was associated with improved outcome. Multivariate logistic regression analysis showed that 3 of the 4 markers of coronary artery reperfusion were significantly and independently associated to low in-hospital mortality rate. The presence of early T-wave inversion was associated with the lowest in-hospital mortality rate (odds ratio 0.25, confidence interval 0. 10-0.56). When all markers of coronary artery reperfusion were included in the regression model, T-wave inversion (odds ratio 0.29, confidence interval 0.11-0.68) and abrupt creatine kinase rise (odds ratio 0.36, confidence interval 0.16-0.77) continued to be significantly associated with better outcome. CONCLUSION: A systemic analysis of noninvasive markers of coronary artery reperfusion can provide the clinician with an excellent tool to predict clinical outcomes when treating myocardial infarction.

Long-Term treatment with cisapride and antibiotics in liver cirrhosis: effect on small intestinal motility, bacterial overgrowth, and liver function.

OBJECTIVES: Altered small-bowel motility, lengthening of the orocecal transit time, and small-intestinal bacterial overgrowth have been described in patients with liver cirrhosis. These changes might be related to the progressive course and poor prognosis of the disease. We investigated the effect of a long-term treatment with cisapride and an antibiotic regimen on small-intestinal motor activity, orocecal transit time, bacterial overgrowth, and some parameters of liver function. METHODS: Thirty-four patients with liver cirrhosis of different etiology entered in the study. They were randomly allocated to receive cisapride (12), an alternating regimen of norfloxacin and neomycin (12), or placebo (10) during a period of 6 months. At entry and at 3 and 6 months, a stationary small-intestinal manometry was performed, and orocecal transit time and small-intestinal bacterial overgrowth were also investigated using the H2 breath test. Liver function was estimated with clinical and laboratory measurements (Child-Pugh score). RESULTS: After 6 months, both cisapride and antibiotics significantly improved fasting cyclic activity, reduced the duration of orocecal transit time, and decreased small-intestinal bacterial overgrowth. Cisapride administration was followed also by an increase in the amplitude of contractions. No statistically significant variations in these parameters were observed with placebo. An improvement of liver function was observed at 3 and 6 months with both cisapride and antibiotics. CONCLUSIONS: Long-term treatment with cisapride or antibiotics reversed altered small-intestinal motility and bacterial overgrowth in patients with liver cirrhosis. These findings suggest a possible role for prokinetics and antibiotics as a modality of treatment in selected cases of decompensated cirrhosis.