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Two compounds having six metal-metal bonded Mo(2)(4+) and Rh(2)(4+) units, the midpoints of which occupy the vertexes of an octahedron, are described here. Each of the M(2)(4+) units is also bridged by two mutually cis formamidinate groups of the type DAniF = N,N'-di-p-anisylformamidinate. These units are linked to each other by four tricarboxylate anions from trimesic acid, the centers of which form a tetrahedron that is encapsulated by the octahedron of dimetal units. Each of the neutral cages has a clathrated solvent molecule, CH(2)Cl(2) when the metal M is Mo and CH(3)CN when it is Rh. For the latter, there are CH(3)CN molecules occupying (2)/(3) of the axial sites on the Rh(2) units in a way that reduces the symmetry. These symmetrical structures appear to persist in solution as shown by the (1)H NMR spectra. The compounds [M(2)(cis-DAniF)(2)](6)[1,3,5-C(6)H(3)(CO(2))(3)](4), 1 for M = Mo and 2 for M = Rh, were crystallized as 1.22.1CH(3)CN.2.3CH(2)Cl(2) and 2.13.9CH(3)CN, respectively. In 1 there are four crystallographically independent quadruply bonded Mo-Mo distances in the narrow range 2.098-2.104 A. For 2, the six independent singly bonded Rh-Rh distances are in the range 2.428-2.438 A.

Reaction of the molecular loop [Rh(2)(cis-DAniF)(2)(CH(3)CN)](2)(malonato)(2), DAniF = N,N'-di-p-anisylformamidinate, with 2 equiv of 2,2',3,3',5,5',6,6'-octafluoro-4,4'-biphenyldinitrile gives a linear tubular structure with Rh-Rh distances of 2.435(1) A. A comparison of the structures obtained with this molecular loop but employing other linkers support the idea that longer linkers favor one-dimensional structures while shorter linkers favor two-dimensional structures because of the increased clashing between the large p-anisyl groups. Crystallographic data at 213(2) K for [[Rh(2)(cis-DAniF)(2)](2)(O(2)CCH(2)CO(2))(2)(NCC(6)F(4)C(6)F(4)CN)(2)] x 6.8nCH(2)Cl(2) are: monoclinic, P2(1)/m, a = 11.802(1), b = 28.303(2), c = 18.820(2) A, beta = 95.673(2) degrees, and Z = 2.

The monoanion of 2,6-bis(phenylamino)pyridine (HBPAP(-)) has been found to support quadruply bonded Cr(2)(4+) and Mo(2)(4+) units in Cr(2)(HBPAP)(4) (1) and Mo(2)(HBPAP)(4) (2). The corresponding dianion BPAP(2)(-) was able to stabilize the trinuclear complexes, (TBA)(2)Cr(3)(BPAP)(4) (3) and (TBA)(2)Ni(3)(BPAP)(4) (4), where TBA is the tetrabutylammonium cation. The dinuclear complexes have the typical paddlewheel configuration with Cr-Cr distances of about 1.87 A and a Mo-Mo distance of 2.0813(5) A and exhibit a high-field displacement of the corresponding N-H signals caused by the magnetic anisotropy of the quadruple bonds. For the trinuclear complexes, 3 has a linear chain of three chromium atoms arranged in an unsymmetrical fashion with two chromium atoms paired to give a quadruply bonded unit (Cr-Cr distance: 1.904(3) A) and an isolated, square planar Cr(II) unit at 2.589(3) A from the dimetal unit. On the other hand, the three nickel atoms in 4 are evenly spaced, having Ni.Ni distances of 2.3682(8) A. The trinuclear compounds show a twisted conformation with an overall torsion angle of about 30 degrees.

Three compounds containing two quadruply bonded Mo(2)(DAniF)(3) (DAniF = N,N'-di-p-anisylformamidinate) units linked by tetrahedral EO(4)(2-) anions (E = S, Mo, W) have been prepared and characterized by crystallography and NMR. The linkers in these [Mo(2)(DAniF)(3)](2)(mu-EO(4)) compounds hold the Mo(2) units in an approximately perpendicular orientation and mediate strong electrochemical communication between them. Each of the three compounds shows two quasireversible (mu-SO(4)) or fully reversible (mu-MoO(4), mu-WO(4)) features in its cyclic voltammogram corresponding to successive oxidation of each of its Mo(2) units. The DeltaE(1/2) values are the largest thus far measured for Mo(2)-X-Mo(2) bridged complexes and may be sufficiently large to permit isolation of the singly oxidized species.

Sixteen crystal structures have been determined for the Co3(dpa)(4)Cl2 (1) molecule in the following five crystalline solvates: 1.0.85(C2H5)(2)O.0.15CH2Cl2 (at 120, 213, 296 K); 1.C(4)H(8)O (at 120, 295 K); 1.C(6)H(6) (at 170, 213, 260, 316 K); 1.C(6)H(12) (at 120, 213, 295 K); and 1.1.75C(7)H(8).0.5C(6)H(14) (at 90, 110, 170, 298 K). For 1.0.85(C(2)H(5))(2)O.0.15CH2Cl2 the molecule of 1 is almost symmetrical at 120 K (Co-Co distances of 2.3191(3) and 2.3304(3) A) and remains so at 296 K (2.2320(3) and 2.3667(4) A). For 1.C(4)H(8)O the Co(3) chain is precisely symmetric at both 120 and 295 K though the Co-Co distances increase from 2.3111(4) to 2.3484(4) A as the temperature rises. Compound 1.C(6)H(6) is isomorphous with 1.C(4)H(8)O at 213 and 295 K and has rigorously symmetrical molecules at these two temperatures. Between 213 and 120 K the space group changes from Pccn to P2(1)/c, so that a symmetrical arrangement is no longer required and the two Co-Co distances then differ slightly (by 0.013 A). For 1.C(6)H(6) there is a phase change between 316 K (Pca2(1)) and 260 K (Pna2(1)). At all four temperatures, however, the molecule is almost symmetrical, with the two independent Co-Co distances never differing by more than 0.026 A. 1.1.75C(7)H(8).0.5C(6)H(14) contains, at all temperatures between 90 and 298 K, two crystallographically independent molecules, each of which is distinctly unsymmetrical at 298 K (Co-Co distances of 2.312(2) and 2.442(2) A for one and 2.310(2) and 2.471(2) for the other). In the first of these the distances converge to a much smaller separation (0.056 A) at 90 K while in the second the difference decreases to only 0.006 A at 90 K. Magnetic susceptibility measurements from 1.8 to 350 K indicate in each case that a gradual spin crossover, from a doublet to a quartet state, occurs over this temperature range.

Twelve compounds containing two quadruply bonded Mo(2)(DAniF)(3) (DAniF = N,N'-di-p-anisylformamidinate) units linked by dicarboxylate anions have been prepared in high purity and good yields. All of these compounds have been characterized by crystallography and NMR. The dinuclear pairs display electrochemical behavior which is controlled by the nature of the bridging dicarboxylate group. As described by the linkers, the compounds are oxalate, 1; acetylene dicarboxylate, 2; fumarate, 3; tetrafluorophthalate, 4; carborane dicarboxylate, 5; ferrocene dicarboxylate, 6; malonate, 7; succinate, 8; propane-1,3-dicarboxylate, 9; tetrafluorosuccinate, 10; bicyclo[1.1.1]pentane-1,3-dicarboxylate, 11; and trans-1,4-cyclohexanedicarboxylate, 12.

Three new linear compounds of the type Co(3)(dpa)(4)X(2), where dpa is the anion of di(2-pyridyl)amine and X is NCS(-) (5), CN(-) (6), and N(CN)(2)(-) (7), have been prepared, and their structures and magnetic behavior have been studied. In all of them, including three different solvates of 5, the Co(3) chains are symmetrical with Co-Co distances of ca. 2.31-2.32 A. The appearance of four lines in the (1)H NMR spectra of the three compounds is also consistent with a symmetrical structure in solution. For all compounds, the magnetic behavior is quite similar with mu(eff) of ca. 1.9-2.0 micro(B) at temperatures between 1.8 and 200 K. As the temperature increases, the effective moments increase gradually, but since saturation is not reached, even at 400 K, the high-spin state cannot be assigned.

Four compounds consisting of molecular loops formed from two quadruply bonded Mo2(DAniF)2 (DAniF = N,N'-di-p-anisylformamidinate) units linked by two dicarboxylate anions have been prepared in high purity and essentially quantitative yields. These compounds have been characterized by crystallography and NMR spectroscopy and display electrochemical behavior dependent on the nature of the dicarboxylate anion. However, the electronic communication between the two Mo2(4+) units is not strong. As denoted by the dicarboxylate linkers, the compounds are malonate, 1, 1,4-phenylendiacetate, 2, homophthalate, 3, and trans-cyclopentane-1,2-dicarboxylate, 4.

Seven complexes obtained by reacting the quadruply bonded complex [Mo2(cis-DAniF)2(CH3CN)4](BF4)2 (DAniF = N,N'-di-p-anisylformamidinate) and (Bun4N+)2(Carb2-), where Carb2- is a dicarboxylate anion, have been found to have a ratio of dimetal unit to dicarboxylate of 1:1. As noted by the carboxylate linker, the compounds are oxalate, 1, fumarate, 2, ferrocene dicarboxylate, 3, 4,4'-biphenyldicarboxylate, 4, acetylenedicarboxylate, 5, tetrafluorophthalate, 6, and carborane dicarboxylate, 7. Structural characterization of 1-4 revealed a square of dimolybdenum units linked by the dicarboxylate anions, each having an interstice capable of accommodating specific solvent molecules. Results of NMR studies of all seven compounds are consistent with the presence of a highly symmetrical structure. These compounds display a rich electrochemical behavior that is affected by the nature of the carboxylate group.

The quadruply bonded compound Mo2(DpyF)4 (1), where DpyF- is the anion of N,N'-di(2-pyridyl)formamidine, has been prepared by ligand substitution reactions of Mo2(OOCCF3)4 and either the neutral ligand, HDpyF, at ambient temperature or its lithium salt, LiDpyF, under refluxing conditions. An X-ray structural analysis shows that 1 has a paddlewheel structure with a [symbol: see text] distance of 2.1108(6) A. Reaction of 1 with CoCl2 in methanol produces the paramagnetic compound [Mo2Co(DpyF)4][CoCl4].2MeOH (2). The Co(II) atom in the cation [Mo2Co(DpyF)4]2+ resides on a low-spin hexacoordinate environment (S = 1/2) with a Co...Mo separation of 2.979(6) A, suggesting there is no direct bonding interaction between the Co and Mo atoms. The Mo-Mo distance of 2.1096(5) A is similar to that in 1. Reaction of 1 and CuCl in methanol yields [Mo2Cu4(DpyF)4Cl2][CuCl2]2.2MeOHxEt2O (3). In the cation there are two copper atoms on each side of the Mo2 core. Each is coordinated to two pyridyl nitrogen atoms of the cis DpyF- ligands and loosely bridged to the other by a chloride ion. As a result, the Cu(I) atoms are not aligned with the Mo2 unit. The Cu to Mo separations are in the range 3.003(1)-3.015(1) A, and the Mo-Mo distance of 2.127(1) A is comparable to those in 1 and 2.

Two compounds containing the cations Mo2(DPhIP)4n+, n = 1 or 2 and DPhIP = the anion of 2,6-diphenyliminopiperidine, have been obtained by oxidation of the quadruply-bonded Mo2(DPhIP)4 species. The first oxidation process conserves the structure but results in a slight increase of the Mo-Mo distance from 2.114(1) to 2.136(2) A in [Mo2(DPhIP)4](PF6).2CH2Cl2 (1.2CH2Cl2). However, the second oxidation process breaks the dimolybdenum bond, giving a bioctahedral complex, [Mo2(DPhIP)4](BF4)2.5CH3CN.Et2O (2.5CH3CN.Et2O), with Mo...Mo separation of 2.9954(7) A. Crystallographic data for 1.2CH2Cl2 are space group C2/c, a = 17.1891(9) A, b = 17.807(1) A, c = 24.210(2) A, beta = 106.403(4) degrees, Z = 4; for 2.5CH3CN.Et2O, space group P2(1)/n, a = 16.523(5) A, b = 27.418(5) A, c = 18.163(3) A, beta = 93.48(2) degrees, Z = 4.

The anion of 2,6-di(phenylimino)piperidine (DPhIP) has been found to support linear chains of three metal atoms. Three new compounds, [Cr3(DPhIP)4Cl]Cl.(1).5CH2Cl2.0.5H2O (1.1.5CH2Cl2.0.5H2O), [Cr3(DPhIP)4(CH3CN)]- (PF6)2.H2O.4CH3CN (2.H2O.4CH3CN), and [Cr3(DPhIP)4(F)(CH3CN)](BF4)2.5CH3CN (3.5CH3CN), have been synthesized and characterized by X-ray crystallography. Compound 1 has a linear chain of three chromium atoms arranged in an unsymmetrical fashion, with two of them forming a quadruply bonded unit (Cr-Cr distance 1.932(2) A) and the third being a non-metal-metal-bound 5-coordinate unit (Cr...Cr distance 2.659(2) A). The fifth coordination site is occupied by a chloride ion, and another chloride ion is located in the interstices of the crystal. The trimetal unit in compound 2 is structurally similar to that in compound 1 except that the axial ligand in 2 is a CH3CN molecule. Compound 3 is an oxidation product prepared by reaction of 1 with AgBF4. Here, a square pyramidal CrIII unit, FCrN4, and a Cr-Cr quadruply bonded (Cr-Cr distance 1.968(2) A) unit, with an axially coordinated acetonitrile molecule, form the trichromium chain. The CrIII...CrII separation of 2.594(2) A in 3 is too long to be considered a bonding interaction.

Reaction of the linear tricobalt compound Co3(dpa)4Cl2 (1) (dpa = di(2-pyridyl)amide) with silver hexafluorophosphate in acetonitrile yields [Co3(dpa)4(CH3CN)2][PF6]2 (2). Two crystalline forms are obtained from the same solution, namely, a monoclinic (P2(1)) form 2xCH3CNx2Et2O and a triclinic (P1) form, 2x3CH3CN. The tricobalt units in both crystals are essentially symmetrical, though this is not required by crystal symmetry, with Co-Co distances in the range 2298-2304 A. Each of the two terminal Co atoms is coordinated to an acetonitrile molecule with Co-N distances in the range 2068-2111 A at 213 K. The spiral arrangement of ligands gives an overall idealized D4 point group symmetry for the cation [Co3(dpa)4(CH3CN)2]2+ . Chiral crystals of both delta and lambda configurations in the P2(1) form have been isolated. The absolute configurations were determined by X-ray crystallography and their mirror-image circular dichroism spectra measured. The D4 symmetry of the cation appears to be preserved in solution as judged by the presence of only five proton resonance signals in the 1H NMR spectrum. Magnetic susceptibility measurements in the solid state indicates that 2 has a doublet ground state and exhibits an increase of the effective moment at high temperature (approximately 160 K) due to a spin crossover process.

The series of M2(hpp)4Cl2 complexes (hpp is the anion of 1,3,4,6,7,8-hexahydro-2H-pyrimido[1,2-a]pyrimidine) from M = W to M = Pt has been completed by the preparation and characterization of those with M = W, Os, and Pt. W(hpp)4Cl2 (1) has a W-W distance of 2.250(2) A, is diamagnetic, and can be assigned a W-W triple bond based on a sigma 2 pi 4 electron configuration. Os2(hpp)4Cl2 (2) has an Os-Os distance of 2.379(2) A and displays a temperature-independent paramagnetism. It can be assigned a sigma 2 pi 4 delta 2 delta*2 configuration. Pt2(hpp)4Cl2 has a Pt-Pt distance of 2.440(1) A and is diamagnetic. A bond order of 1, based on a configuration in which only the sigma* orbital is empty, is consistent with these data.

Background: Sigmoid volvulus is an exceptionally rare and potentially life-threatening condition in the pediatric age group., Study Design: We report our experience with three children treated for sigmoid volvulus and review the cases reported in the medical literature since 1940., Results: Since 1940, 63 cases of sigmoid volvulus in children (including this series) have been reported. The median age was 7 years and the male to female ratio was 3.5:1. Two distinct presentations (acute and recurrent) were identified. Abdominal symptoms dominated the clinical picture. Barium enemas either confirmed or were highly suggestive of sigmoid volvulus. Reduction by barium enema was successful in 77% (10 of 13) of the attempts. Forty-nine patients underwent operative treatment, with sigmoidectomy (with or without primary anastomosis) being the most common. The overall mortality rate was 6%, operative mortality was 8.1%, and neonatal mortality was 14%. Associated conditions were frequent. Particular emphasis should be placed on ruling out Hirschsprung's disease (present in 11 of 63 patients)., Conclusions: Sigmoid volvulus remains a rare occurrence in children, but it should be included in the differential diagnosis of pain in children when colonic distention is present. An algorithm for treatment is proposed.

It is shown that the M2(DPhIP)4 molecules (M = Cr, Mo; HDPhIP = 2,6-di(phenylimino)piperidine) can each capture two CuI atoms to form molecules with linear Cu...M[symbol: see text] M...Cu chains. In these chains the CuI atoms have only weak interactions with the M atoms (Cr...Cu = 2.628 A; Mo...Cu = 2.615 A) even though their introduction causes marked decreases in the M[symbol: see text]M distances (from 2.265 to 1.906 A for Cr and from 2.114 to 2.078 A for Mo). These seemingly contradictory facts are explained by noting that in the M2(DPhIP)4 molecules there are strong destabilizing (to the M[symbol: see text]M bonds) donor interactions of the dangling nitrogen atoms with the pi* orbitals. When these are eliminated by the introduction of the CuI atoms, the M[symbol: see text]M bonds become stronger and shorter.

Seven compounds having in common a Cr3(dpa)4(3+) core (dpa = di(2-pyridyl)amide ion) have been prepared and all shown to have an unsymmetrical chain of three Cr atoms. This chain can be described as a pair of quadruply bonded Cr(II) atoms to which a Cr(III) atom is attached. No symmetrical chain has been found, contrary to a previous preliminary report. The seven compounds have been well characterized crystallographically, and their short and long Cr to Cr distances (A, in parentheses) are: 1 [Cr3(dpa)4Cl2]Cl.2CH2Cl2.THF (2.12, 2.47), 2 [Cr3(dpa)4Cl2]AlCl4.CH2Cl2 (2.011, 2.555), 3 [Cr3(dpa)4Cl2]FeCl4.CH2Cl2 (2.009, 2.562), 4 [Cr3(dpa)4Cl2]I3.THF.2H2O (2.08, 2.49), 5 [Cr3(dpa)4Cl2]PF6.2CH2Cl2 (2.08, 2.48), 6 [Cr3(dpa)4(BF4)F]BF4.2CH2Cl2 (1.900, 2.595), 7 [Cr3(dpa)4ClF]BF4.CH2Cl2.C6H14 (2.039, 2.507). Magnetic susceptibility measurements on 1 and 2 reveal mueff = 3.85 +/- 0.05 muB from 10 to 300 K.

The preparation and structures of seven compounds that contain the Cr3(dpa)4(2+) core (dpa = the anion di(2-pyridyl)amide) are reported. The magnetic properties of several have been measured. In each case there are anionic ligands at each end of the Cr3(6+) chain, sometimes identical (2Cl-, 2CCPh-), sometimes different (Cl-, BF4-; Cl-, PF6-). Several of these compounds have a symmetrical arrangement of the three Cr atoms, with the two Cr-Cr distances equal at ca. 2.36 A, while others have an unsymmetrical arrangement. In the most extreme case the two Cr-Cr distances are 2.00 and 2.64 A. The electronic structures and the remarkable flexibility of the Cr3 arrangement are discussed.

The occurrence of an amebic liver abscess (ALA) rupturing into the stomach is reported. ALAs in children can have atypical presentations, resulting in delayed diagnosis and increased morbidity and mortality. Timely treatment is usually followed by complete recovery.

The management of a critical airway in infants and toddlers with congenital tracheal stenosis (CTS) continues to be an enormous challenge to the surgeon. Until recently, this condition often proved fatal. Improvements in surgical techniques, anesthetic management, and postoperative critical care have resulted in successful outcomes in children not long ago considered untreatable. However, issues such as the best operative approach and the optimal perioperative management are still unresolved. The diagnosis of CTS, often delayed, must be considered in any infant with stridor, wheezing, cyanosis, or recurrent episodes of pneumonia. Associated anomalies are the rule, including frequently vascular rings and rarely pulmonary agenesis. These defects can be repaired with conventional ventilatory support under cardiopulmonary bypass, or using extracorporeal membrane oxygenation (ECMO). We report our experience in which ECMO was used to support two patients with CTS during the perioperative period. ECMO proved to be both safe and practical, allowing unrushed, precise repair of the tracheal stenosis and providing brief postoperative support. Perioperative outcomes were excellent, although one of our patients died months after the repair. A review of the literature and our experience in which ECMO was used to provide cardiopulmonary support during repair of CTS showed uniformly successful perioperative outcomes.

Objective: To find certain personal and social factors relating to the attitudes to food and the nutritional habits of young people., Design: Observational, crossover study with randomised distribution., Setting: Txantrea, a quarter of Pamplona with 20,578 inhabitants and with 1739 14 to 19-year olds in school., Participants: Sample of 465 people between 14 and 19, randomised and stratified for age., Results: Under the life-style heading, 69% (64.3-73) tried to eat a varied diet; 56% (51.3-60.5) took part in the choice of family meals; and 52% (47, 3-56.3) ate snacks. On personal questions, 67% (62.3-71.1) said they had quite a lot or a lot of interest in diet; 50% (45.3-54.5) said they were quite concerned or very concerned about their diet; 22% (18.3-25.9) thought themselves obese or slightly obese, whereas 8% (5.7-10.9) were in fact obese. 71% (66.7-74.9) were satisfied with their physique. 28% (24.1-32.2) had been on a diet. 81% (76.7-84.6) thought that young people gave a lot or quite a lot of importance to their physique. 78% (73.9-81.4) thought that the communication media had a lot or quite a lot of influence on the life-styles of young people. On education and information, 33% (28.7-37.3) thought they were well-informed on dietary questions, basically by the family. 38% (33.5-42.3) thought they were good or very good at cooking. 58% (53.3-62.3) said they were available for training in nutrition. The people with more interest in nutritional questions were more concerned and better informed. Being female was associated with: more interest and concern, having followed a diet, the view that the media had a big influence, feeling pressured by the family to eat more and availability for education. Being male was associated with: satisfaction with their physique, and thinking they were very thin, thin or balanced., Conclusions: Critical attitudes to the influence of the media were seen. There was a lot of concern about, and interest, in, nutrition. There was also quite a lot of not very healthy behaviour.

Sacrococcygeal teratomas (SCT) are the most common neoplasms in newborns with a reported occurrence of 1 in 35,000 live births. Highly vascularized tumors in which the ratio of tumor weight to patient weight approaches 1:1 are frequently associated with hyperdynamic states, prenatal hydrops, placentamegaly, postnatal high-output cardiac failure, and carry a high perinatal mortality rate. Operative management of giant, highly-vascular sacrococcygeal teratomas in neonates can be complicated by life-threatening hemorrhage. Laparotomy, control of the aorta, and the arterial blood supply to these tumors before resection has been advocated as a safer alternative. The authors report their experience with three infants successfully treated using this approach. Hemodynamic stability was maintained during the operations. All tumors were resected successfully. The patients are alive without evidence of recurrence, 8.5 months to 18 months (average, 14.3 months) after the operation. Alpha-fetoprotein levels dropped to normal range after the removal of SCT and have remained normal in follow-up. Vascular control before excision of giant, highly-vascular SCT in neonates is safe, decreases intraoperative blood loss, and postoperative morbidity.

Objective: To analyse the urgent consultations sent by doctors to a Dermatology Department for origin, reason for referral, clinical compliance, suspected diagnosis, concordance with the dermatologist's diagnosis and justification of the urgent referral., Design: Descriptive study., Setting: The information was gathered in the tertiary specialist Dermatology service of Navarra, which covers the whole population., Participants: Of the total (595) number of urgent forms received by the service in 1995, 505 were analysed and contrasted with the dermatological clinical history. Each patient corresponded to a form., Measurements and Main Results: The following was analysed: age, sex, origin of referral, reason for referral, clinical compliance, suspected diagnosis, concordance with the dermatologist's diagnosis and justification of the urgent referral. Most letters came from Health Centres (48.5%). The most commonly alleged reason for referral was diagnostic help (51.2%). There was good clinical compliance only in the notes coming from hospital Casualty Departments (78.7%)., Conclusions: There were major deficiencies in all the points under analysis, with no significant differences as to origin, except for hospital Casualty, which had better clinical compliance and whose referrals were more justified.

Shear-induced aggregation requires the platelet glycoprotein complexes (Gp), the von Willebrand factor (vWf) and ADP. The Bernard Soulier syndrome (BS) and the gray platelet syndrome (GPS) are platelet function defects characterized by absence of GP Ib/IX and alpha granules, respectively, with mucocutaneous hemorrhages, prolonged bleeding time (BT) and moderate thrombocytopenia in both syndromes. There are reports that desmopressin (DDAVP) shortens the BT in some patients with platelet dysfunction. The purpose of this study was to evaluate the response t(DDAVP) in four female patients (2 with GPS plus Marfan's disease and 2 BS). All had bleeding episodes, BTs > 10 minutes, platelet counts (PC) between 40-88 x 10(9)/L and defects in platelet aggregation. The DDAVP was administered at a dose of 0.3 microgram/kg in 15 to 30 mL of isotonic saline given by slow intravenous drip in 30 to 45 min. All patients were studied before and after DDAVP administration (BT, PC, platelet factor, mean platelet volume, factors F.VIII:C, FvW:Ag, FvW:RiC of, and platelet aggregation). After DDAVP infusion the patients had a BT < 6 min, and increased levels of F. VIII:C, FvW:Ag and FvW:RiC of (> 100 Ul/dL), and the bleeding disappeared. We conclude that there was a good response to DDAVP probably associated with improved platelet adhesion, and increases in the multimers of the von Willebrand factor.

In this study, cimetidine was used to treat patients with hemophilia A and inhibitors to factor VIII who presented with acute hemorrhages (Group A) and those without hemorrhages (Group B). The dose of cimetidine was 15 mg/kg/day. Group A consisted of five patients with inhibitors between 156 and > 10,000 Bethesda Units (BU), all with serious hemorrhagic problems. The control of hemorrhaging was effective in 100% of these patients, although inhibitor levels remained high (25-380 BU). Group B consisted of seven patients who did not have hemorrhages, whose inhibitor levels were 41-358 BU. Five of these patients no longer had anamnestic responses to Factor VIII after several months of treatment with cimetidine. No difference in the response to cimetidine was seen between HIV positive and HIV negative patients. The results suggest that cimetidine is useful to suppress inhibitors to Factor VIII in patients with hemophilia A.

Objective: Description of our results with autologous buccal mucosa as a substitute for urethral epithelium in 8 patients with severe urethral strictures., Methods: Patients were selected according to the intrinsic complexity or due to recurrence following previous surgery. Buccal mucosa was harvested from the lower lip, and no suture was used to close the wound. A full thickness mucosal graft measuring up to 8 cm was excised., Results: The clinical results are satisfactory in 7 cases. No urethral fistulas were observed., Conclusion: Buccal mucosa offers an excellent option for repair of complicated urethral strictures.

We report three patients with acquired inhibitors against F VIII:C/F vW:Ag complex. Two patients had acquired hemophilia A. The three patients presented with bleeding diathesis. Case 1 was a 19 years old woman with Graves-Basedow disease; case 2 was a 40 years old woman with systemic lupus erythematosus of four years; and case 3 a 38 years old woman who had had rheumatoid arthritis for five years and was in her 3d month postpartum. The F VIII:C level was below 8 U/dL in all cases. The F vW:Ag, ristocetin cofactor and platelet aggregation with ristocetin were diminished in the two cases with von Willebrand. Inhibitor to F VIII:C was 50, 38 and 20 Bethesda units, respectively, for cases 1, 2 and 3. The three patients showed clinical response to DDAVP and cryoprecipitates with partial response in laboratory tests. All patients responded to corticosteroid treatment, but immunosuppressive treatment was necessary in case 3.

Grey-platelet syndrome is a rare familial platelet impairment characterised by lack of alpha granules and giant vacuolated platelets. A Mexican family with grey-platelet syndrome associated to Marfan disease is presented. The family was comprised of 22 members, of whom 3 (the propositus and two of his nephews) could be studied. Two of them, with haemorrhagic symptoms since childhood, had moderate prolongation of the Ivy bleeding time which improved after DDAVP administration, plus moderate thrombocytopenia, giant platelets and abnormal platelet aggregation induced by adrenalin, ADP and collagen. Platelet factor 4 was normal. Electron microscope examination of platelets showed lack of alpha granules and increased dense bodies. The rarity of the casual association of two low-frequency genetic diseases, namely Marfan disease and the grey-platelet syndrome, is commented, along with the response attained with DDAVP in the two affected individuals.

In this work we discuss several procedures of evaluation of time series models and analyze practical aspects of the management of a data base relative to a health information system devoted to the epidemiological surveillance and the detection of unusual values that could correspond to epidemic events. The analyzed statistical information corresponds to the time series of the number of emergency room admissions for asthma in several hospitals of Barcelona city, between the first of January of 1985 and the seventh of september of 1987. Among the three analyzed methods, the one based on the correlations of the one-step-ahead residuals (the second one) is the most specific and, furthermore, it doesn't require the previous definition of an epidemic day. In addition, this second procedure has less analytical and computational difficulty.

The pattern of use of alcoholic beverages and factors influencing it among Barcelona schoolchildren were studied; 2,255 fifth and eighth grade students from 71 schools completed a self-administered questionnaire. Between fifth-eighth grades, important changes take place in attitudes--strongly opposed to alcohol among the younger, much more moderate among the older. Family celebrations such as Christmas or birthdays are the earliest source of exposure to alcohol, at which one-third of fifth grade students and two-thirds of eighth grade students drink. In eighth grade, though daily consumption is relatively rare (4.4% for boys), a considerable proportion have been drunk at least once (16% of girls and 19% of boys) or have had four or more drinks in a row, while a small but significant proportion (2.5%) have been drunk two or more times in the last six months. A discriminant analysis uncovered some features predicting this "higher risk" use of alcohol: age and gender (being a boy in eighth grade), lower socioeconomic status, higher weekly allowance available for personal expenses, a pattern of usual consumption by both the father and friends, smoking regularly, and having a moderate or high physical activity level, as well as holding opinions in favor of drinking.