Comparison of response to serotonin of radial artery grafts and internal mammary grafts to native coronary arteries and the effect of diltiazem.

We studied the response of radial artery (RA) or left internal mammary artery grafts to the intraluminal infusion of serotonin in 22 consecutive patients 1 year after the operation, subsequently evaluating the effect of diltiazem in 9 patients. Serotonin causes a significant vasoconstriction of the RA grafts, but not of the left internal mammary artery grafts, whereas oral diltiazem treatment does not prevent the effect of the higher dose of serotonin on RA grafts.

Elevated levels of C-reactive protein before coronary artery bypass grafting predict recurrence of ischemic events.

C-reactive protein was measured in 86 patients undergoing coronary artery bypass graft surgery. Patients were followed up for 3.2 years (range 1 to 6). Patients with C-reactive protein > or = 3 mg/L had significantly increased risk of recurrent ischemia at 1 to 6 years after intervention.

Composite lengthened arterial conduits: long-term angiographic results of an uncommon surgical strategy.

BACKGROUND: We sought to evaluate the long-term patency rate of composite lengthened conduits. METHODS AND RESULTS: From December 1991 to April 2000, 43 patients had a composite lengthened arterial conduit. There was a mean of 2.83 +/- 1.23 anastomoses per patient. No 30-day mortality occurred. Five patients died from 3 to 84 months after the operation (mean, 38.6 +/- 34.6 months). After a mean follow-up of 57.0 +/- 32.3 months (range, 3-99 months), all the survivors are asymptomatic. The only cardiac major events recorded were 2 (4.6%) late acute myocardial infarctions in the patients who died. Eight-year survival and event-free survival were both 80.4% +/- 9.1% (range, 3%-93%). In the early period (13.5 +/- 4.8 days) in 26 patients, 26 arterial composite lengthened conduits and 37 distal anastomoses had postoperative angiographic control; all the anastomoses were rates as grade A, according to Fitzgibbon classification. In the late period (29 +/- 30 months) in 23 patients, 23 arterial composite lengthened conduits and 34 distal anastomoses were checked; the patency rate was 22 (95.6%) of 23 for the composite lengthened conduits and 33 (97%) of 34 for the distal anastomoses. CONCLUSIONS: In particular situations, when the length of an arterial conduit is not enough to allow a correct use of the graft, lengthening of an arterial conduit can be a safe and effective technique.

Midterm clinical and angiographic results of radial artery grafts used for myocardial revascularization.

OBJECTIVE: To evaluate the midterm angiographic results of the use of radial artery grafts for myocardial revascularization. METHODS: The first 68 consecutive surviving patients who received a radial artery graft proximally anastomosed to the aorta at our institution were studied again at 5 years (mean 59 +/- 6.5 months) of follow-up; 48 of these patients had previously undergone an early angiographic examination. The response of the radial artery to the endovascular infusion of serotonin was evaluated 1 and 5 years after the operation, and the midterm status of the radial artery graft was correlated with the degree of preoperative stenosis of the target vessel and with calcium-channel blocker therapy. RESULTS: The patency and perfect patency rates of the radial artery grafts 5 years after the operation were 91.9% and 87.0%, respectively. All radial artery grafts that were patent early after the operation remained patent at midterm follow-up, and early parietal irregularities in 7 patients were seen to have disappeared after 5 years. The early propensity toward graft spasm after serotonin challenge was markedly decreased at midterm follow-up. The continued use of calcium-channel antagonists after the first postoperative year did not influence the radial artery graft status, whereas the preoperative severity of the target-vessel stenosis markedly influenced the angiographic results. CONCLUSIONS: The midterm angiographic results of radial artery grafts used for myocardial revascularization are excellent. The correct surgical indication is essential. Continued therapy with calcium-channel antagonists after the first year does not influence the midterm angiographic results.

Repair of an ascending aorta pseudoaneurysm by way of superior ministernotomy.

A wide ascending aorta pseudoaneurysm occurring 10 years after uncomplicated aortic valve replacement was successfully repaired using a superior ministernotomy and femoral-femoral cannulation. In this setting, a limited sternal incision minimized the risk of pseudoaneurysm rupture during dissection and allowed safe isolation of the target cardiac structures.

Reversed-J inferior sternotomy for beating heart coronary surgery.

Median sternotomy or combined multiple minimally invasive approaches are currently used to revascularize patients with multivessel coronary artery disease on the beating heart. We present here a new alternative approach for minimally invasive coronary surgery on the beating heart: the reversed-J inferior sternotomy. Through this approach, the left anterior descending, diagonal, and right coronary arteries can be revascularized via a single minimally invasive approach.

Use of the radial artery for myocardial revascularization.

BACKGROUND: The radial artery was first used as a coronary graft by Carpentier and associates in 1973 but, due to the disappointing results, it was abandoned. In 1992 its revival coincided with the widespread use of calcium-channel blockers in cardiovascular surgery, in the belief they could prevent spasm. METHODS: From January 1993 to October 1995 we operated on 109 patients for myocardial revascularization employing the radial artery with two different surgical techniques: in 95 patients (group 1) it was "pretreated" by opening its fascia after a gentle hydrostatic dilation and then anastomosed to the aorta; in 14 patients (group 2) it was branched to another conduit. We had two operative deaths (1.82%). RESULTS: At a mean interval of 532.42 days 105 patients are still alive, 2 (1.86%) having died of abdominal tumors. Fifty-six patients (52.33%) underwent angiography at a mean interval of 334.42 days: the patency of the radial artery was 88.88% in group 1 and 62.50% in group 2. Indications and contraindications are discussed. CONCLUSIONS: The radial artery is an easily manageable conduit whose early patency is very promising, although a longer follow-up is mandatory.

Why do workers behave unsafely at work? Determinants of safe work practices in industrial workers.

AIMS: To explore the relation between safety climate (workers' perceptions regarding management's attitudes towards occupational safety and health) and workers' behaviour at work. METHODS: Cross sectional survey of workers at the pottery industry in Castellon, Spain. Sampling was stratified by plant size and workers' gender, according to data on the working population at this setting. A total of 734 production workers were interviewed. Information was collected on safety climate and workers' behaviour towards occupational risks with a specific questionnaire. A safety climate index (SCI, scale 0-100) was constructed adding scores for each item measuring safety climate in the questionnaire. Workers' unsafe behaviour was analysed for the different safety climate index levels. RESULTS: Mean score for SCI was 71.90 (SD 19.19). There were no differences in SCI scores according to age, gender, education, children at charge, seniority at work, or type of employment. Small workplaces (<50 workers) showed significantly worse SCI (mean 67.23, SD 19.73) than the largest factories (>200 workers). Lower levels of SCI (SCI <50) were related to workers' unsafe behaviours (full/high accord with the statement "I excessively expose myself to hazards in my work", adjusted odds ratio ORa 2.79, 95% CI 1.60 to 4.88), and to lack of compliance with safety rules (ORa 12.83, 95% CI 5.92 to 27.80). CONCLUSIONS: Safety climate measures workers' perception of organisational factors related to occupational health and safety (for example, management commitment to risk prevention or priorities of safety versus production). In this study these factors are strongly associated with workers' attitudes towards safety at work. Longitudinal studies can further clarify the relation between safety climate and workers' behaviour regarding occupational safety and health.

[Reintervention of myocardial revascularization by left thoracotomy in deep hypothermia. A clinical case]. / Reintervento di rivascolarizzazione miocardica per toracotomia sinistra in ipotermia profonda. Caso clinico.

Herewith we report a case of redo coronary-surgery which was approached through a left thoracotomy and in hypothermic arrest so as to avoid either a demanding dissection with its potential consequences over the functioning grafts and aortic cross-clamping thus making unnecessary any cardioplegia delivery. We describe the surgical procedure and analyze its advantages with respect to the usual median sternotomy approach.

Epidemiology of HIV infection in children in Europe.

In Europe the Human Immunodeficiency Virus (HIV) epidemic in children is an important public health problem. Reliable epidemiological information varies widely among countries, and there is no standard method to document the pandemia. By September 1992, a total of 81,849 AIDS cases were identified. France had 21,487, Spain 15,678 and Italy 14,784 (63% of all cases). The highest rate per 100,000 inhabitants occurred in Spain (88.9), France had 70.6 and Italy 63.5. The numbers of HIV+ newborns (NB) in Spain were 4673, in Italy 2,693, in Belgium 368, in Scotland 79 and in Holland 11. The highest rate of HIV+ NBs per 100,000 inhabitants occurred in Spain (120.1), the lowest in Holland (0.73). In Western Europe, 82% of all cases were due to vertical transmission. Mothers' venous drug use was the most common form of HIV transmission.

Anonymous testing of newborn infants for HIV antibodies as a basis for estimating prevalence of HIV in childbearing women: the 1991-1994 study in Spain.

During 1991-1994, anonymous screening of newborn infants for maternal antibody to human immunodeficiency virus (HIV) was carried out in three regions of Spain: Valencia, Galicia and Sevilla. The newborn infants whose heel-stick blood eluates were satisfactory for HIV antibody tests were a consecutive series of 104 876, representing 99.3% of all newborn infants undergoing routine metabolic screening and estimated as comprising at least 98% of all births in the three regions. Enzyme immunoassay (EIA) positives were confirmed by immunoblot, yielding 246 confirmations: a rate of 2.3 per 1000. Seropositivity rates ranged from 1.4 per 1000 in Galicia to 2.1 in Sevilla and 3.1 in Valencia, and remained relatively stable in each region during the years of the study. Within socioeconomically defined subgroups of birth hospitals in Valencia and Galicia, all subgroups contained seropositives, even though there was a twofold to fivefold over-representation in the "inner city" public hospitals. To estimate the proportion of HIV-1-seropositive newborn infants who were positive for HIV-1 DNA, polymerase chain reaction (PCR) assays were performed on 165 dried blood spots that had been retained following positive immunoblot assays. Fifteen (9%) were PCR positive, and when this proportion is adjusted for the age-specific sensitivity of the method, it translates into an estimated HIV-1 transmission rate of 24% (range 18-36%). For 94,906 of the 104,876 newborn infants screened, the EIA used could detect antibodies that react with epitopes of HIV-1 and HIV-2. There were 30 newborn infants whose blood eluate was positive by this combined HIV-1/HIV-2 antibody screen and whose secondary screening with monovalent HIV-2 and HIV-1 EIA indicated that the HIV-2 reactivity was above the cut-off whereas the HIV-1 was not. Ranking these 30 results according to absolute HIV-2 reactivity and relative reactivity with respect to HIV-1 indicated that four infants were probable true HIV-2 seropositives and a total of 12 were possible HIV-2 seropositives, a prevalence of the order of 1:10000 to 1:20000 newborn infants. These anonymous population-based serological studies provide "leading-indicator" data to complement traditional AIDS surveillance for epidemiological and planning purposes.

HIV infection in children.

PIP: Various studies have reported rates of human immunodeficiency virus (HIV) transmission from mother to child of 13-40%. Vertical transmission occurs in utero, during delivery, or, in a small number of cases, through breast milk. Whether mothers at various stages of HIV infection experience different rates of transmission remains unknown. Maternal antibodies cross the placenta and are present from birth up to 18 months of age. The offspring of HIV-positive mothers tend to be low birthweight, under 37 weeks' gestation, and at high risk of perinatal mortality. It is likely, however, that this profile is indicative of the low socioeconomic status of most women with HIV rather than a result of infection. Also emerging is a psychosocial profile of the HIV child. These children are isolated, neglected, battered, frequently abandoned, and exhibit various degrees of mental retardation. Also common are delayed psychomotor development, loss of developmental milestones, limited attention span, poor language development, and abnormal reflexes. These features result from the interaction of low socioeconomic status, a lack of psychosocial stimulation, nutritional deficiencies, and central nervous system infections. Since HIV-infected children tend to be the offspring of drug addicts, bisexuals, and prostitutes, they are not awarded the same compassion as children afflicted with other terminal illnesses. Moreover, these children are generally neglected by groups formed to provide support to AIDS patients. Thus, it is up to the general public, the mass media, and the health care system to advocate for the needs of these neglected children.^ieng

[Sociocultural factors and nutrition (author's transl)]. / Nutrición y factores socioculturales.

A schematic review of some of the most significant sociocultural factors related to food intake throught life, either in developing or developed societies is presented. In both societies, sociocultural factors are of fundamental importance on the determination of feeding practices, thus its excess or deficit are of great relevance to physical growth, possibly mental development as well as on morbidty and mortality. In developing societies low social class and poor education are sinonimous of poor nutrition. However, if the whole population in developed societies are studied, it is proven once again that nutritional deficiencies do also exist among marginal groups of people, which are mainly produced by poor education, erroneous feeding practices, nutritional taboos during health and disease, byas and prejudices. It must follows that in these societies, relative large group of children are poorly fed during the critical periods of growth and development due to sociocultural factors. Only through the appropiate and enforced nutrition educational programs at all learning levels, primarw and higher education, as well as better and more complete nutritional curriculum at Medical and Public Health Schools could perhaps solve, the problem, or at least significant alleviated it. This is the hope.

Microelectrode studies of dog's gastric mucosa.

In anesthetized dogs, the potentials in the mucous coat and gastic cells were measured with microelectrodes. In the secreting stomach, with isotonic saline in contact with the mucosal surface, the orientation of the initial change in potential difference (PD) was often the same as that of the liquid junction potential between gastric juice and saline (the microelectrode became negative to a reference electrode in the saline) but the magnitude of the change was never more than 11 mv. On the basis of this finding an explanation is offered for the observation that in the secreting stomach replacing isotonic saline with isotonic HCl as the bathing fluid on the mucosal surface, results in a change in the serosal to mucosal PD of only 19 mv, which is 40% less than the liquid junction potential between gastric juice and saline. In the surface epithelial cells of both resting and secreting stomach, multiple levels of potentials were found. For the secreting stomach, the resistance between the interstitial fluid of the pit region and the fluid on the mucosal surface was 55 ohm cm(2), determined as the change in PD per unit of applied current across stomach. The implications of these findings are discussed with reference to the separate site theory of HCl formation.

Acute infectious hepatitis. Clinical and epidemiological study.

A retrospective study of 120 children from birth to seven years of age suffering from acute infectious hepatitis was carried out from 1971 to 1974 at the Children's Hospital "La Fe". Only the most serious cases from the region were admitted to the Hospital and were classified and analyzed according to HBAg+ and HBAg- groups. Clinical and biochemical evaluations were done at admission, and again after 15 and 30 days. The main findings were as follows: hospital incidence was 5%; seasonal distribution did not follow the expected epidemiological pattern; the disease was more common among malnourished children; HBAg+ and HBAg- cases were not randomly distributed among the various blood groups: A+ children were four times more susceptible to HBAg- than to HBAg+, and 0+ children were more than twice more susceptible to HBAg+ than to HBAg-; clinical and biochemical recovery occurred within 30 days after hospital admission; mortality was 2.5%. Steroid therapy was reserved for the most serious cases; however, it was not possible to evaluate in this study its contribution to the course of the disease.

[Spanish Pediatric Association. Madrid. Human immunodeficiency virus infection. Spanish multicenter study]. / Asociación Española de Pediatría. Madrid. Infección por el virus de la immunodeficiencia humana. Encuesta multicéntrica española.

The results of an epidemiological survey in Spain organized by the "Spanish Pediatric Association" of children born to HIV+ mothers from 1981-1989 are presented. The objectives were, a) to document in the different parts of Spain the number of HIV+ children born to HIV+ mothers, and b) to identify the risk factors involved in the HIV infection. Only in public hospitals, a total of 1938 HIV+ children born to HIV+ mothers were identified. A systematic yearly increase of HIV+ newborns was evident since 1985. Madrid, Catalonia, Valencia, Basq and Andalucia communities incorporated 85% of all cases. 93% of mothers were IVDU and 51% of them were married. Prematurity occurred in 27% of cases and low birth weight in 33% of NB's. The rate of transmission in children over 18 months of age was 25.6% Breast feeding could be a risk factor in the transmission of HIV infection observed in children over 18 months of age. No other maternal risk factors responsible for the HIV transmission were identified. 12% of children died with AIDS. Clinical classification and evolution of HIV infection did not significantly differ from similar studies in other parts of the world. In spite of only public hospitals being involved, Spain has more identified HIV+ children than Italy, Switzerland, Federal Republic of Germany, United Kingdom, Sweden and Belgium combined. The pediatric centres with large number of cases require interdisciplinary pediatric specialized units to cope with the increase demand of medical services, now inadequate and insufficient. To fight drug use and HIV infection in Spain, health education and family support, are indispensable in trying to arrest the continuous spread the HIV infection.