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Background: It has been shown that tobacco is a significant risk factor for periodontal disease; however, there have been few studies on young populations where problems of general health can be discounted. The purpose of this study was to examine the influence of tobacco consumption on the periodontal condition of a young, healthy population., Methods: The study population consisted of 304 young Caucasian males (average age 19.38 +/- 0.72 years) entering the Armed Forces. All the subjects completed a self-administered questionnaire on age, oral hygiene habits, previous dental examinations, and quantity and length of tobacco use. The periodontal examination consisted of the plaque index (PI); periodontal bleeding index (PBI); probing depth (PD); and clinical attachment level (CAL). One- and 2-way ANOVA was used to compare data recorded between smokers and non-smokers., Results: Forty-six percent of subjects reported that they brushed their teeth at least once a day, but only 13% visited a dentist at least once a year. Over half (53%) were habitual smokers, 43% smoking between 5 and 20 cigarettes per day; 39% of the smokers had been smoking for less than 5 years. Mean PI was 31.24 +/- 14.88 (27.19 +/- 15.93 for smokers and 35.78 +/- 12.17 for non-smokers), with significant differences between non-smokers and those who smoked 5 to 20 cigarettes per day (26.85 +/- 16.11, P<0.0001). Mean PBI was 42.29 +/- 8.43 (non-smokers 44.67 +/- 6.53 and smokers 40.17 +/- 9.46). Significant differences were found between the PBI of the non-smokers and of those who smoked 5 to 20 cigarettes per day (39.90 +/- 9.64, P <0.0001). There were also differences in the PBI between those who brushed their teeth once (40.53 +/- 9.61) and twice (44.86 +/- 5.9) a day (P<0.0001). Mean PD was 1.62 +/- 0.43 mm (non-smokers 1.56 +/- 0.36 and smokers 1.68 +/- 0.49). Deeper probing depths were recorded among smokers than among non-smokers, with statistically significant differences (P<0.049); statistically significant differences were also found between those who attended (1.49 +/- 0.50) and those who did not attend (1.65 +/- 0.42) regular dental check-ups (P<0.031). Mean CAL 1.75 +/- 0.41 (non-smokers 1.64 +/- 0.32 and smokers 1.82 +/- 0.44)., Conclusions: It may be concluded that, even at such an early age, tobacco consumption affects the periodontal health. It is necessary to inform young smokers of the risk of tobacco use regarding periodontal health.

Background: There has been speculation as to whether hormonal changes during pregnancy or pre-existing conditions of general, oral, and dental health and socio-cultural background have a greater impact on the development of periodontal disease during pregnancy., Methods: This study evaluates the periodontal status of 130 pregnant women (plaque index, bleeding index, probing depth, and clinical attachment level) and its relationship to demographic (age, professional level, education, and urban or rural residence) and clinical variables (gestation period, previous pregnancy, health status, previous live births, previous periodontal maintenance). The hospital in which the study was conducted was selected during a prior pilot study. All records were compiled by the same trained examiner with a calibrated manual probe. Statistical tests used were ANOVA and ANCOVA., Results: Results showed a mean plaque index of 58.7+/-2.79%, which increased with statistical significance when the professional level was lower (P <0.014), education was lower (P <0.01), previous periodontal maintenance was less frequent (P <0.00001) and patients lived in rural areas (P <0.0003). The mean bleeding index was 68.8+/-2.44% and was significant in relation to lower professional level (P <0.025), less frequent previous periodontal maintenance (P <0.029), and an urban residence (P <0.0011). A mean clinical attachment level of 0.84+/-0.65 mm was observed and was related significantly with age (26 to 30 years) (P <0.001) and the third trimester of gestation period (P <0.0025). The mean probing depth was 1.71+/-0.3 mm, which related significantly with age (36 to 42 years) (P <0.0002), lower professional level (P <0.0013), rural residence (P <0.0025), 2 or more previous live births (P <0.0001), and non-attendance for previous periodontal maintenance (P <0.0023). Using ANCOVA testing and adjusting by age, the differences relating to previous live births disappeared., Conclusions: Gingivitis due to accumulation of plaque was the most characteristic periodontal condition in this sample and was related to professional level, level of education, and previous periodontal maintenance. These results illustrate the importance of establishing periodontal preventive measures for pregnant women, even though their demographic and clinical characteristics do not differ from those of the general population.

Teratocarcinoma is a mixed germ cell tumor histologically composed of embryonal carcinoma cells and embryonic and extraembryonic tissues. In the present work we have used the CE44 teratocarcinoma, which is a tumor cell line derived from the OTT6050 experimental tumor, to appreciate the influence the microenvironment has on the modulation of tumoral differentiation. For this, we have studied the development of CE44 teratocarcinoma in primary tumors (subcutaneous and intrasplenic) and in experimental metastases (hepatic and pulmonary). CE44 teratocarcinoma shows variations in its capacity for differentiation in so far as development is concerned and, in hepatic metastases, we noticed a reparative process of the intratumoral necrotic areas which in the same cases were substituted by loose connective tissue. Our results clearly suggest that the microenvironment is decisive in the biological behaviour of the teratocarcinoma cells and that epigenetic factors influence the capacity for differentiation of the undifferentiated tumoral cells.

Background: When faced with a therapeutic issue, the practice of evidence-based medicine requires efficient access to information derived from controlled clinical trials. The objectives of the study were to locate, with the greatest possible exhaustivity, all controlled clinical trials published in Spanish journals of general medicine, between 1971 and 1995 (25 years), to characterize them, and to incorporate them into the worldwide database of clinical trials maintained by the Cochrane Collaboration., Methods: The controlled clinical trials have been identified by a systematic, manual review of all the Spanish journals of general and internal medicine. The results obtained have been compared with an exclusive electronic search in MEDLINE. A descriptive analysis of the characteristics of the localized controlled clinical trials was done., Results: 68 journals of general and internal medicine have been identified, only 6 being indexed in MEDLINE. A search carried out exclusively using MEDLINE would imply the loss of one third of all controlled clinical trials. About 16 controlled clinical trials per year have been published in Spain in the area of general and internal medicine, most of them with important missing information., Conclusions: The limitations of searching only in MEDLINE have been shown once again. There are few controlled clinical trials published in Spain in the area of general and internal medicine, and in order to improve their quality and their diffusion is recommended that authors and editors adhered to the international consensus initiatives that are under way.

Background: The aim of this study was to determine the effect of ciprofloxacin at subinhibitory concentrations on the expression of P fimbriae of uropathogenic Escherichia coli. Thirty-nine strains of Escherichia coli isolated from out patients with urinary tract infection were studied. Thirty-nine of these strains had been previously characterized as P-fimbriated and the remaining non fimbriated strain was used as a negative control., Methods: Fimbriation was quantitatively studied by electron microscope observation of the strains before and after treatment. To determine possible qualitative variations in the fimbrial proteins and in the external membrane (OMPs), extraction and electrophoretic separation was performed in polyacrylamide gels., Results: No qualitative differences were observed in the OMPs profile and fimbrial proteins induced by ciprofloxacin in any of the strains studied. However, electron microscopic observation generally showed a decrease in the percentage fimbriated bacterial cells by the antimicrobial effect., Conclusions: The mechanism of action of ciprofloxacin at subinhibitory doses may correspond to a process of fimbrial protein synthesis inhibition secondary to the initiation of general repair mechanism of the cell exposed to the antimicrobial and not to a process of specific mutations which qualitatively affect fimbrial protein composition.

Gingival overgrowth induced by nifedipine has been extensively reported. This finding, however, does not apply to gingival size changes caused by other calcium antagonists such as diltiazem. We studied the gingiva of 13 subjects with ischemic cardiopathy who had been treated with diltiazem and established two control groups: (1) a healthy group of 12 patients and (2) a group of 10 patients with ischemic cardiopathy and concomitant treatment similar to that applied to the diltiazem group except that they had not been administered any type of calcium antagonists. The size of the gingiva around the six anterior teeth was measured on plaster models of the upper and lower jaws. Significantly higher scores of the size of the gingiva were found when patients treated with diltiazem were compared with the patients in the other two groups (p < 0.05) gingiva were found when patients treated with diltiazem were compared with the patients in the other two groups (p < 0.05) and also when interproximal (p < 0.05) and vestibular (p < 0.05) sites were considered. We did not observe any significant difference in the plaque index of each group (p < 0.05); only bleeding after probing was found statistically different between the diltiazem and the nondiltiazem groups.

Of 197 consecutive patients with cirrhosis admitted because of bleeding from esophageal varices, 133 were included in a prospective study of elective sclerotherapy. We evaluated the incidence of extensive rebleeding and mortality rate. The period of study was 54 months and the mean follow-up period was 21 months. Forty-one patients had severe rebleeding and a majority of the episodes occurred during the first year. Only four patients had more than five sessions of sclerosis when rebleeding occurred. The probability rate for patients to be free of severe rebleeding after 48 months, according to Pugh's classification, was 88 per cent for those with grade A, 50 percent for grade B and 43 percent for grade C. The over-all mortality rate was 38.8 per cent (53 patients), with the highest rate noted during the first year. The mortality rate of patients with severe rebleeding was much higher than that of those who did not rebleed. Kaplan-Meier survival analysis at four years was 52 per cent, and survival rates in relation to Pugh's classification were 73 per cent for A, 53 per cent for B and 34 per cent for C. Differences between the three groups were statistically significant. Therefore, because of the high mortality rate associated with patients with cirrhosis and extensive rebleeding during the first year, it is important to achieve, as soon as possible, eradication of esophageal varices.

The results of a survey of primary health care physicians in order to know which factors are associated with the efficacy in the detection and treatment of patients with alcohol-related problems are analyzed in this article. The number of diagnosed patients is related with previous formal education on alcohol-related problems of primary health care physicians. Primary health care physicians are very interested in this issue, but they don't feel satisfied nor gratified with their work with this type of patients. Gratifying feelings are directly related to previous formal education, and those who feel gratified diagnose more patients. Needs for formal education must be accompanied by profound organizational changes in the coordination of actions between primary health care, specialized services and social care.

An analysis of 369 patients operated on for massive upper gastrointestinal bleeding is presented. Gastroscopy was performed in all patients. Duodenal ulcer remains the most common cause of such bleeding (45.4 percent of cases). The type of treatment that should be used is the most controversial in patients with bleeding esophageal varices. It is concluded that the procedure that corrects the patient's primary disease is also the most suitable one for treating massive bleeding.

Using a technique of end-to-end intestinal anastomosis, based upon a 90 degree axial rotation, the conjunction of both mesenteric edges without peritoneal serosa is avoided; theoretically, this would be the weakest area of such an anastomosis. This theory was experimentally tested in the colon of rabbits and the technique compared with the usual, so-called exact facing technique, justifying its clinical use in the hope of improving the results of gastrointestinal operations.

In a multicenter prospective, randomized study, the efficacy of a single preoperative dose of 1 g of cefotaxime for avoiding wound infections was compared with four 2-g doses of cefoxitin. In the study, 1,451 patients with infection risk factors who underwent gastroduodenal or biliary surgery were included, of whom 722 received cefotaxime and 729 cefoxitin. The characteristics of both groups were comparable. The frequency of wound infections in the cefotaxime group was 3.3 percent and in the cefoxitin group, 7.6 percent. The difference was statistically significant. The lowest rate of wound infection (0.63 percent) was achieved when cefotaxime was administered during the last hour before surgery. In both groups, the frequency of infections was directly related to the duration of operation. Hospital stay was, on average, 3 days longer in patients with wound infections. After cost-benefit analysis, we have concluded that cefotaxime treatment results in substantial reduction of costs derived from antibiotic prophylaxis.

Bezoars are conglomerates of undigested material in the stomach, which appear as a late complication of gastric surgery and are presumably related to secondary motility changes. We studied the gastric emptying of a technetium-99m-(Tc 99m) labelled solid meal in 10 patients who presented with a bezoar 1 to 20 years after vagotomy and pyloroplasty, vagotomy and antrectomy, vagotomy and gastrojejunostomy, or hemigastrectomy. The results were compared with the emptying data of operated patients without bezoars. The gastric retention of Tc 99m-labelled solids at 45, 75, and 105 minutes was 85 +/- 15 percent (mean +/- SD), 79 +/- 17 percent, and 65 +/- 24 percent, respectively. No differences were found when results were compared with those of operated patients without bezoars. We concluded that factors other than the gastric digestive phase are the main contributors to bezoar formation.