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Ependymoblastoma is a rare and devastating tumor of childhood considered by most to be a subtype of primitive neuroectodermal tumors. We present the first detailed MRI description of this entity with a review of the limited pathologic and radiologic literature concerning this tumor.

Retroperitoneal laparoscopy is well known as a surgical technique in adult patients. Its use in pediatric surgery is still-recent but, because of the good results, retroperitoncoscopy indications are getting more acceptance and widening indications. The aim of this work is to analyze our initial experience in retroperitoneal laparoscopy procedures in urological diseases at our centre.From July 2001 to February 2002 retroperitoneal laparoscopy has been used in 6 patients aged 6 months to 14 years. Surgical indications were: pyelolithotomy (lithiasis non-subsidiary to extracorporeal shock wave lithotripsy (n = 1); nephrectomy ofmulticystic dysplastic kidney (n = 4); and nephrectomy of atrophicpelvic kidney (n = 1).Mean operative time in nephrectomy has been 102 minutes, and 230 minutes in conservative surgery. All 5 patients nephrectomized were discharged 24 hours after operation with no postoperatory incidences. The patient operated on for pyelolithiasis (in which a external drainageand a pyelouretheral stent (pig-tail) was placed) remained one week until he could be discharged without drainage. The pig-tail stent was thrown out spontaneously three weeks later through the urethra. Follow up demonstrated no stenosis in this case and no complications in nephrectomy patients.Retroperitoneal laparoscopy is effective and safe in renal surgery and surpasses transperitoneal laparoscopy because its safety in reconstructive surgery avoiding urine leakage risk into the abdomen.

The authors describe pku or phenylketonuria, a congenital type of metabolic alteration which forces those patients who suffer it to follow a dietetic treatment for their entire lives. The authors analyze 1, the biochemical alterations which are produced in the organism and which cause the appearance of them; 2, the genetics involved; 3, the clinical manifestations shown by those who suffer from pku; 4, the diagnosis of this disease; 5, the number of cases in the general public; 6, a bit more extensive section dealing with the nutritional treatment, follow-up and control of this disease; 7, nursing care, fundamentally based on how to educate and counsel patients and their families regarding control methods and problems which commonly occur in dietetic treatment over the course of the various phases in one's life; and 8, the conclusions of this study, whose origin came after intensive contact with the Galician Association of Phenylketonuria and a study of the epidemiological and nutritional situation of sufferers of this disease in Galicia. This study was presented at the Third National "SENC" Congress held in Las Palmas de Gran Canaria.

According to immunostaining and ultrastructural patterns, Rana temporaria tadpole stomach displays a well-differentiated endocrine population comprising, at least, six cellular types: ECL, EC[serotonin], D[somatostatin] – all three of them abundant –, P [bombesin] – less numerous –, CCK-8 [cholecystokinin/gastrin] and A [glucagon/glicentin] – both very scarce. Larval endocrine cells are mainly located in the surface epithelium and show open or closed morphologies. Cellular diversity is similar in tadpoles and frogs, with the exception of immunoreactivity for gastrin-17, found in adults in numerous cells. Larval cells display mature ultrastructural traits, although with smaller secretory granules. The different distribution of endocrine cells, which in adults are preferentially located in the glands, probably refers to different functional requirements. However, the rich vascular plexus present in larval mucosa may be an efficient transport medium of surface hormones to gastric targets. The enhancement in adults of endocrine population and correlative increase in hormonal secretion indicates a more active functional role, probably related to the shift from herbivorous to carnivorous habits. In summary, the tadpole gastric endocrine population, although not as numerous as that of adult frogs, displays histological traits that indicate a relevant (immunoreactive and ultrastructural properties, cellular diversity) and specific (surface location, relative abundance of open-type cells) role of local regulatory factors in amphibian larval gastric function.

Current health reform proposals in most developing countries stress health gain as the chief evaluation criterion. Essential service packages are formulated using cost-effectiveness methods for the selection of interventions without sufficient regard for other factors that are significant for successful implementation and acceptance by the needy. This paper presents the results of research undertaken in Mexico and Central America to test the hypothesis that population groups view health gain as only one among several benefits derived from health systems. The goal at this stage was two-fold: (a) to identify through qualitative methods the range of benefits that are significant for a wide cross-section of social groups and (b) to classify such benefits in types amenable to be used in the development of instruments to measure the benefits intended and actually produced by health systems. Fourteen focus groups were undertaken in Costa Rica, El Salvador, Guatemala, Mexico and Nicaragua representing diverse age, gender, occupation and social conditions. Six major types of health system benefits were identified besides health gain: reassurance/uncertainty reduction, economic security, confidence in health system quality, financial benefits derived from the system, health care process utility and health system fairness. Benefits most often mentioned can be classed under health care process utility and confidence in system quality. They also have the most consensus across social groups. Other benefits mentioned have an affinity with social conditions. Human resource-derived utility stands out by its frequency in the range of benefits mentioned. Health systems and health sector reform proposals must emphasise those aspects of quality related to human resources to be in accord with population expectations.

To make and validate a data base that allows to collect information about clinical characteristics and use of health care services by HIV-infected patients. An additional purpose is to obtain some data about costs of health care services utilization.We have designed an informatic data base that includes: demographic data, clinical data and health care services utilization during the follow up. One hundred and nine patients were selected from 5 different hospitals in Spain and they were followed for 6 months (from January to June 1997). Analytic accounting of one hospital and official tariffs were used to calculate costs of the health care services.The informatic data base designed is useful and appropriate to collect the information of these patients. The annual average cost is 2.5 millions dollars, ranging from 1 million dollars for asymptomatic patients to 3.8 millions for AIDS patients. The comparison of our results with previous studies shows an increased cost of asymptomatic patients.These results give a preliminary information about health care services utilization by HIV-infected patients and confirm the possibility of using the designed instrument in the future. Since HIV-infection presents an uncertain evolution and a variable prognosis, to implant a tracking system is a necessary requirement in order to obtain a fast and accurate information system about the evolution of clinical variables and their economic repercussions.

The annual consumption and costs of the health care resources used by ambulatory Alzheimer's disease patients were estimated. Patients were classified according to the degree of severity of the disease using Folstein's Mini Mental State Examination scale. The sociodemographic characteristics of both patients and their careers were described.Patients with an established diagnosis of Alzheimer's disease according to NINCDS/ADRDA criteria were included in the study. Information on the use of health and non-health care resources consumed during the last 12 months was recorded. The following scales were administered: MMSE, Global Deterioration Scale, Rapid Disability Rating Scale and Hachinski's scale modified by Rosen. Finally, the time dedicated by careers to look after the Alzheimer's disease patients was recorded.A total of 337 patients were considered to be valid for the analysis with an average of 72 (8.4) years and with an average duration of the disease of 48.3 (35.7) months. The average annual cost per patient was 3,194,664 ptas. The average cost per patient in the group with MMSE18 was 2,119,889 ptas; 2,723,159 ptas. in those with MMSE 12-18 and 3,676,707 ptas. in the MMSE12 group.In patients with Alzheimer's disease an increase in cost directly related to functional cognition state was observed. The most important cost component was that imputed to value time dedicated by principal career.

Ever since the introduction of peritoneal dialysis (PD) as a therapy for managing patients with end-stage renal disease, there has been considerable debate about how it compares with outcomes on haemodialysis (HD) especially in terms of survival and quality of life. Whilst earlier results in the 1980s were certainly not comparable, data now emerging show that survival on PD is equivalent to that on HD. Recent registry data from the Canadian Organ Replacement Register show that survival of patients on PD is equivalent to that on HD and may well be better in the first few years of therapy. There have been numerous quality of life studies in patients on PD and HD. Health-related quality of life has been assessed using health profile measurements (both generic and disease-specific instruments) or preference-based measurements. The former approach has been used to analyse 14 different comparative studies. These studies suggest that patients on home HD and CAPD show better quality of life than patients on centre HD. Only a few studies found statistical differences between groups, and only in seven studies were results adjusted for patient differences. There is a need for longitudinal studies with more accurate information on health. Similar data are available for preference-based measurements and studies. Overall, the analysis suggests that PD and HD are equivalent therapies. On this basis, it is hard to explain the wide variation seen in the use of the two therapies.

Since it was defined, SOP has been related to surgery. Before clomifero was introduced, ovarian wedge resection was the only way to stimulate ovulation and gestation in women with this syndrome. Surgical techniques were derelict in favour of less aggressive medical treatments. However, surgery has reduced its side effects due to the incorporation of laparoscopic techniques and other advances. Because of this fact, surgery is being reintroduced in the treatment of polycystic ovarian disease.

In this article, the authors analyze the pathological alterations which women suffer in which menopause is assumed to be a risk factor leading to the outbreak of these pathologies. Taken together, all of these alterations present some clear nutritional considerations; therefore, adequate dietetical care, followed by women during this phase, could help in their prevention and control. These alterations are: osteoporosis, obesity, arterial hypertension, arteriosclerosis and cardiovascular diseases.

A 5-year-old girl with Stevens-Johnson syndrome developed progressive dysphagia secondary to esophageal stenosis. The authors resolved this by treating the patient with balloon dilatation. She has remained symptom-free for 10 months post-treatment.

In the course of metamorphosis of the stomach of Rana temporaria tadpoles there is a marked increase in the amount of active mesenchymal fibroblasts and extracellular matrix underlying the regenerating gastric epithelium. At the onset of metamorphosis, a thick PAS-positive basement membrane is developed around the epithelial component of the mucosa, formed by the apical, degenerating larval epithelium and the basal, regenerative epithelial cords. Under the electron microscope, a folded basement membrane is usually revealed under the apical degenerating epithelium while a compact basement membrane (up to 1–2 μm thick), forming both patches and more extensive areas, is frequently seen around the regenerative glandular cords. Cytoplasmic processes, extending from both the epithelial and mesenchymal fibroblastic cells, cross the basement membrane and make physical contact between the two cellular types. At mid-metamorphosis, areas of thick PAS-positive basement membrane are still observed around the differentiating glandular outlines, before disappearing completely at late metamorphosis. The probable involvement of intertissue interactions between epithelium and connective elements in the morphogenesis, proliferation and differentiation of secondary, definitive frog stomach is discussed. Early contacts between epithelium and phagocytes, probably related to the invasion of epithelium by the phagocytic cells, have also been observed.

Regulation of drugs from the public administration is an activity which is produced in different countries independently from the sanitary model they own. In the field of public financing of drugs there have been several measures to improve the efficiency of their use. However, the analysis of the impact of these measures is complex and this may justify the shortage of objectivable results, especially at long term. The objective of this study is to perform a systematic review of such measures due to the need to have information about the different alternatives before making a decision. The introduction of an isolated measure is in many cases compensated by other changes in other regulating or aiding fields which suggests the creation of an integral strategy which affects different fields (supply/demand of drugs and prescribers). It seems necessary to suggest a social debate taking as a basis the scientific information available at the moment and promote the taking of decisions which lead to a rational use of the available pharmacological resources.

Diabetes mellitus is an important cause of mortality and morbidity in western nations with high costs for both patients and health care systems.Based on the latest epidemiological studies and in combination with Spanish demographic data the direct health care costs of known diabetes mellitus were estimated for the following areas: hospitalisation directly due to the disease, hospitalisation due to certain chronic complications such as acute myocardial infarction, amputations and renal disease (dialysis and transplant), outpatient visits, consumption of anti-diabetic medication, self-control, analyses, additional explorations and camps for diabetic children.In 1994, the total direct costs of diabetes mellitus in Spain were estimated to be more than 90,000 millions pesetas in a population of more than 1,400,000 known diabetic persons. This implies an average annual costs of approximately 63,000 pesetas per patient. If this cost is divided into categories, hospitalisation represents approximately 58% of the global cost, outpatient visits 14%, antidiabetic drugs 13%, self-control 4.7%, analyses 10% and camps a mere 0.04%.The most important component of the costs of diabetes mellitus in Spain in 1994 was hospitalisation due to the disease itself and its chronic complications which would seem to logically imply that resources ought to be targeted at reducing or postponing the development of such complications.

Endocrine cells of the larval intestine of Rana temporaria tadpoles have been identified by argyrophilic, immunocytochemical and electron-microscopical techniques. Scarce endocrine cells have been found in both the short non-absorptive zone immediately following the stomach, and in the rest of the anterior intestine. Endocrine cells are frequently seen to extend a cytoplasmic process towards the lumen. Immunoreactivity for serotonin, somatostatin, bombesin and cholecystokinin-8 has been detected. According to the ultrastructural traits of the endocrine granules, three larval intestinal endocrine populations have been differentiated.

Fertile-aged women are a population group at special risk for developing ferropenia. In the periodic health care examinations, hemogram, among other tests, are included to detect the most advanced state of iron deficity, ferropenic anemia. Likewise, preanemic ferropenia presents a certain morbidity. The aim of this study was to analyze the cost-effectiveness of screening serum ferritin determination in health care examinations of fertile-aged women.An observational transversal study was carried out in 322 women in whom hemogram and serum ferritin were determined. The effects of serum ferritin determination were simulated in a hypothetical cohort of 20-year old women annually examined up to the age of 50 years (mean age of menopause).The prevalence of preanemic ferropenia (serum ferritinor = ng/ml) was 44.1% and that of ferropenic anemica (Hb120 g/l and serum ferritinor = 25 ng/ml) was 3.4%. Hemogram sensitivity for detection of ferropenia was 7.2% (3.6-12.5). By means of the screening program with serum ferritin avoiding of one year with ferropenia costs 2,428 pesetas. Prolonging the program to longer than 35 years largely increases the marginal cost. Cost-effectiveness analysis is specially sensitive to the cost of the diagnostic tests and disease prevalence.Ferropenia in fertile-aged women is a frequent disorder. Avoiding ferropenia by early diagnosis may be performed at a relatively low cost.

Economic evaluation, a comparative analysis of alternative actions in terms of costs and consequences, allows rational decisions to be made concerning the deployment of resources (people, time, equipment, facilities and knowledge). Pharmaceutical policy reflects the various objectives of the many social groups, some of which are conflicting. While new methodologies for evaluation of health care programmes still need to gain wider acceptance, resource limitations for both care providers and decision makers make economic analysis an increasingly important tool.

The cost-effectiveness of hypolipemiant treatment with lovastatine (0.02, 0.04 and 0.08 g/day), cholestyramine (12 and 24 g/day), cholestipol (10 and 20 g/day) and gemfibrocyl (1.2 g/day) was estimated in individuals presenting hypercholesterolemia (200 mg/dl or 5.17 mmol/l) following dietetic treatment.The cost-effectiveness relationship was measured in terms of cost per year of life gained comparing the net cost of the program with its effectiveness for each treatment studied. The net cost of the program was calculated taking the costs associated with hypolipemiant treatment into account and subtracting the estimated reduction of the costs of coronary heart disease attributed to the prevention program. The Framingham equation and the information concerning to the prevalence of cardiovascular risk factors and life expectancy according to age and sex in the Catalonian (Spain) population were used to estimate the effectiveness.The lesser to greater cost per year of life gained is lovastatine-0.02, cholestyramine-12, cholestipol-12, lovastatine-0.04, gemfibrocyl, cholestyramine-24, cholestipol-10, lovastatine-0.08 and cholestipol-20. In males from 45-49 years of age with cholesterol concentration of 300 mg/dl (7.76 mmol/l) the costs per year of life gained were 3.4 millions for lovastatine-0.02, 4.6 for cholestyramine-12, 4.8 for lovastatine-0.04, 5.4 for gemfibrocyl, 6.5 for cholestyramine-24, 7.8 for cholestipol-10, 8.1 for lovastatine 0.08 and 11.6 for cholestipol-20. In women the cost-effectiveness were 11.6, 15.4, 17.7, 21.3, 25.4, 25.9 and 37.1, respectively. The cost-effectiveness for the most effective treatments was less than 5 million of pesetas per year of life gained in males presenting a cholesterol concentration higher than 300 mg/dl (7.76 mmol/l) and those under the age of 65 years. In women the cost-effectiveness was lower than 10 million of pesetas per year of life gained in those presenting more than 340 mg/dl (8.79 mmol/l) under the age of 65 years.The results of this study demonstrate that the administration of lovastatine at 0.02 g/day is the most effective hypolipemiant treatment in preventing coronary heart disease.

PURPOSE: To describe the clinical and radiologic manifestations of juvenile Huntington disease and to determine whether adult imaging criteria for Huntington disease are helpful for pediatric patients. METHODS: Six patients (3 to 18 years of age; mean age, 9.8 +/- 5.6 years; 3 female, 3 male) with juvenile Huntington disease were studied with CT (n = 6) and/or MR (n = 3). CT and MR studies were evaluated for frontal horn distance/intercaudate distance and bicaudate ratios, which were compared with those of 24 age-matched healthy children and 12 age-matched patients with Leigh (n = 9) or Wilson (n = 3) disease. RESULTS: Atrophy of the caudate nuclei was identified in all Huntington patients. The frontal horn distance/intercaudate distance (1.64 +/- 0.39) and bicaudate (0.205 +/- 0.060) ratios of the patients with juvenile Huntington disease were found to be significantly different from those of healthy children and that of those patients with Leigh/Wilson disease. The 3 patients with Huntington disease who underwent MR evaluation were noted to have increased proton density- and T2-weighted signal in the caudate nuclei and putamina. CONCLUSION: As in adult patients, the use of frontal horn distance/intercaudate distance and bicaudate ratios are helpful for the diagnosis of Huntington disease in pediatric patients. On MR, increased proton density- and T2-weighted signal in the atrophic caudate nuclei and putamina are additional features of juvenile Huntington disease.

We report a 12-year-old girl who at presentation had diffuse myxopapillary ependymomatosis of uncertain primary site. The MR appearance and mechanism of metastases of the tumor are discussed.

The histological transformation of amphibian stomach during metamorphosis was studied in the frog Rana temporaria. The earliest metamorphic changes occur shortly before regression of the cloacal piece of tail and appearance of forelegs. Autolysis of primary, larval epithelial cells and activity of phagocytes lead to regression of the apical mucosa, which is shed into the gastric lumen. Histogenesis takes place from the very beginning of metamorphosis in the basal region of the mucosa; undifferentiated, regenerative cells, arranged in small compact cords and surrounded by a thick basement membrane, give rise to secondary lining epithelium and glands. Lining epithelial cells differentiate into a typical mucosecretory epithelium. Oxyntic cells present in larval glands are substituted by both ion- and protein-secreting oxyntic-peptic cells. During metamorphosis, connective and muscular tissues markedly increase, a submucosa, not present in larval tadpoles, gradually develops. A muscularis mucosae is also formed and the muscular propria becomes thicker. At late metamorphosis, folded structures involving both mucosa and submucosa develop, increasing the luminal surface as in adults. Removal of the larval gastric mucosa and its replacement by a new, adult-type definitive one, together with development of peripheral connective and muscular tissues, account for metamorphosis of tadpole stomach.

In a 13-year old girl, an ovarian tumor was suspected of being responsible for causing amenorrhea-galatorrhea. In the absence of any abnormality of the medial umbilical folds, hormonal assessment indicated a high level of prolactin, which was restored to normal after exeresis of the mass. This was an ovarian tumor of the sexual cords with annelated tubules (SCTAT de Scully).

La suplementación de bovinos en autoconsumo puede ser una alternativa válida para disminuir los costos de tiempo y mano de obra asociados al suministro diario de ración. El objetivo fue evaluar la suplementación energética en autoconsumo en el engorde de novillos (326±23 kg) sobre pasturas templadas de alta calidad. Los tratamientos fueron: 1) testigo sin suplementación, 2) suplementación diaria 1% del peso vivo (PV), 3) suplementación restringida en autoconsumo 1% PV con recarga semanal del comedero, 4) suplementación ad libitum en autoconsumo. En los tratamientos con autoconsumo se utilizó ración con 10% de sal para limitar consumo. El consumo de ración en autoconsumo ad-libitum fue 6,7 kg/a/d (1,8% PV), significativamente más alto que el registrado en los tratamientos al 1% PV, ya sea bajo suministro diario (3,6 kg/a/d) o autoconsumo restringido (3,7 kg/a/d). En éste último tratamiento, el comedero quedó desprovisto de ración 2 a 3 días por semana para ajustar el nivel de suplementación a 1% PV. El peso vivo final y la ganancia de peso fue significativamente mayor (p < 0,05) en los animales suplementados (382±29 kg y 1,012±0,546 kg/a/d, respectivamente) comparado con el grupo testigo (329±25 kg y 0,198±0,276 kg/a/d), no existiendo diferencias asociadas al método de entrega de la ración (p > 0,05). La eficiencia de conversión (kg de ración para ganar 1 kg de PV adicional comparado con el grupo testigo) tendió a desmejorar en los tratamientos de autoconsumo (5,2 y 6,9 kg restringido y ad-libitum, respectivamente) comparado con la suplementación diaria (4,7 kg). Los animales suplementados registraron mayor área de ojo de bife y grasa intramuscular y subcutánea que los animales sin suplementación. La suplementación en autoconsumo es una estrategia válida para facilitar operativamente esquemas de suplementación, aunque biológicamente la eficiencia de conversión puede verse afectada por el consumo de ración con alto contenido de sal.

Three cases of rectal carcinoma associated with pregnancy led the authors to review the general literature. The lesion is most often an adenocarcinoma, diagnosed late at an advanced stage of progression in young women. Results of treatment are poor and the outcome fatal.

A six month old infant with dextrocardia, butterfly vertebrae and oesophageal atresia type I is reported. After surgical repair, she developed respiratory distress, needing ventilatory support. The bronchoscopy and bronchography demonstrated segmental tracheal stenosis. A resection of the stenotic segment was performed, and tracheal reconstruction with terminoterminal anastomosis. After a period of clinical improvement, respiratory distress came back and reestenosis was ascertained locating its level on the anastomosis. Three sessions of balloon dilation were ineffective and because that it's decided the introduction of a metallic self-expandable stent. After a transient relief, the patient had a bilateral pneumonia ending with the dead of the patient. In spite of the treatment used, it was not possible to accomplish solution in a middle or a large place. This constitutes a clear exponent of the complexity in the management of the congenital tracheal stenosis.

Primary cardiac lymphomas, defined as those involving only the heart and pericardium, are extremely rare tumors. These tumors are commonly fatal and until recently were rarely diagnosed antemortem. We describe the CT and MR findings in a case of primary lymphoma of the heart currently responding to chemotherapy.

The aim of this study was to determine the cost-efficacy analysis of treatment with antiendotoxin monoclonal antibodies in adult patients admitted to intensive care units for completing the decision making regulating the authorization of registry of drugs in Spain.Two treatment strategies were considered: to treat with antiendotoxin monoclonal antibodies, addition to conventional treatment, to all patients with sepsis or to all those with septic shock versus the alternative of only carrying out conventional treatment. The economic evaluation technique which quantifies costs in pesetas and efficacy in years of life gained by the treatment alternatives was considered.The cost per year of additional life gained from treatment to all patients with sepsis was higher (859, 288 pesetas per year of life gained) than that in patients treated for septic shock (293, 810 pesetas per year of life gained). The result was very sensitive to changes in those expected in survival of the patients treated.In agreement with this cost efficacy analysis the hypothesis to authorize drug registry in Spain for the indication of septic shock is reinforced. The results may vary upon the obtaining of more clinical and epidemiologic information of the treatment.

High blood pressure has a high incidence and produces a high morbidity and mortality due to associated diseases: cerebrovascular disease, ischemic cardiopathy, and cardiac failure. The socioeconomic impact of high blood pressure in Spain was estimated during 1985 in primary, hospitalary and pharmaceutical health care, to provide a framework for decision making and to determine strategies for reducing the costs of this entity.The methodology of analysis of the cost of the disease was followed with the aim of quantifying the socioeconomic consequences of an entity, disease or risk factor with prevalence being the focus of the study.The socioeconomic impact estimated was situated between 95,000 and 124,000 millions of pesetas according to the different hypothesis adopted in the analysis of sensitivity. The direct health care costs represented between 2.6 and 3.9% of the global health care costs for Spain in 1985. Health care funding consumed by high blood pressure in primary health care was higher (between 4.5 and 6.7%) than hospital attendance (between 1.0 and 1.5%) and pharmaceutical care (between 2.3 and 3.5%), with respect to the total costs of each category.The reduction of the costs related with high blood pressure in Spain must be obtained from improvement of efficacy of interventions carried out in health care education and primary health care. The economic evaluation of the primary and secondary prevention programs may aid in determining more cost-effective strategies.

The aim of the study was to economically evaluate the prophylactic use of the recombinant factor of the stimulation of granulocyte colonies (rG-CSF) for the prevention of episodes of febrile neutropenia (EFN) following antineoplasic chemotherapy.The methods of economic evaluation used were those of cost analysis and cost-effectivity analysis. The probability of occurence of EFN was estimated by the application of the Delphi method and the costs were calculated.The costs of EFN for the patients with solid tumors is situated between 236,000-377,000 pesetas according to hospitalary centers. For patients with acute leukemia the value was estimated as between 391,000-667,000 pesetas. The results of the cost analysis indicate that the net cost per patient prophylactically treated is between 4,000-64,000 pesetas. The results of the cost-effectivity analysis indicate that the cost per case of no incidence of EFN is between 20,000-320,000 pesetas.Episodes of febrile neutropenia carry expansive hospital and antibiotic clinical treatment. The prophylactic use of new medication for patients between the first and second cycle of chemotherapy, in agreement with the estimates calculated, does not save health care costs but may improve the quality of life in these patients and permit the continuation of a therapeutic schedule without interruption which may improve the life expectancy of the patient.

The short and thick bowel found in gastroschisis has been attributed to contact with amniotic fluid, among other factors. We designed an original animal model in order to isolate the effect of amniotic fluid on the fetal bowel. We created experimental gastroschisis in fetal rabbits. Extruded bowel was kept out of the amniotic sac in half of the operated fetuses. At term, seven days after surgery, 21 surviving fetuses--12 intra-amniotic (GIA) and nine extra-amniotic (GEA)--and 16 control littermates were harvested for study. Five parameters were measured in each animal: body weight, intestinal weight, intestinal length, bowel diameter and bowel wall thickness. We found no statistically significant difference in body weight, intestinal weight or bowel wall thickness. An enormous difference was found in intestinal length among the three groups. Bowel diameter was significantly different in the extreme groups (GIA and controls), with the intestine being more dilated in GIA than in GEA and controls. Gastroschisis in the absence of amniotic fluid has not been as damaging to the fetal intestine as "natural" intraamniotic gastroschisis.

Tympanometry and otoscopy has been carried out to determine the presence of middle ear disease on patients with cleft palate and the influence of corrective surgery. This explorations have been evaluated preoperatively and at one and six months postoperative follow-up. There is a high incidence of otitis media with effusion in patients with cleft palate, almost 60 per 100 in our study. The influence of cleft palate surgery repair has not revealed as a mayor factor on its resolution, although a visible benefit has been observed in the long term controls. We recommend a otorhinolaryngological follow-up in these patients.

The two concepts included in the title of this paper, intersectorial measures and individual incentives for healthy behaviour, do not form a logical unity; they are rather intended to embrace part of the field of health policy that is not directly involved with the provision and consumption of health care, but with activities of primary prevention and health promotion.