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Introduction and Objectives: In Columbia the epidemiology of cerebrovascular illness (ECV) is unknown. For this reason a study was made to determine the prevalence, incidence and annual mortality, and to identify the different types of ECV and the demographic characteristics of the population., Material and Methods: In the urban area of Sabaneta, Columbia 13,588 door to door interviews were carried out among the inhabitants. A cutoff study carried out between April and June 1992 showed the prevalence of ECV. One year follow-up of persons without ECV between June 1992 and June 1993, enabled the incidence and annual mortality to be evaluated. A structured interview was used to identify the demographic characteristics of the population and classify people as healthy or as possibly having ECV. The latter were examined by neurologists to confirm or rule out the presence of ECV and to determine the type of ECV involved. Of the total urban population, 76.9% agreed to participate in the study. During the follow-up year, 8.4% were lost trace of., Results and Conclusions: The prevalence of ECV was 559.3/ 100,000 inhabitants, increasing with age (15). In the 15-40 year old group, the incidence of ECV was 44 times higher in women than in men. The annual incidence rate was 88.9/100,000 inhabitants: thromboembolic disease was the most frequent. Of a total of 87 cases of ECV, 12 (13.98%) died of various causes during the year in which they were being observed. The annual mortality rate for ECV was 16.2/100,000 inhabitants, all being primary cases.

Unlabelled: The aim of the study which we present is to analyze the incidence of late complications, clinical and sub-clinical, of venous reservoirs implanted through two access routes, subclavian (group A), and brachial (group B). It is a multi-centric clinical study, initiated in 1992, in which the general surgery departments of three general hospitals of the Valencian Community were involved. It is made up of 87 patients, 48 men and 39 women, with a mean age (SD) of 57.1 (12.6) years, of whom we made a late review of 41 patients (29 from group A and 12 from group B). They were subjected to a physical examination, bacterial cultures of the entrance, and phlebograms of the upper extremities through the dorsal veins of the hands., Results: The incidence of clinical complications was 39% in group A and 77% in group B (p = 0.0507). The main clinical complications were minimally symptomatic venous thrombosis, catheter thrombosis, infection, and miscellaneous (migration, paresthesias, articular movement alterations, etc.). And the prevalence of phlebographic venous thrombosis was 18% in group A and 40% in group B (p = 0.051)., Conclusions: The subclavian access for the implantation of venous reservoirs has a lower incidence (with a tendency towards clinical significance) of clinical complications and subclinical venous thrombosis (Phlebogram) than the brachial access.

Unlabelled: A multicentric clinical trial was performed to evaluate two routes of access for implantable subcutaneous central venous devices: by way of the subclavian vein (group A) and peripheral access by way of the veins of the flexion side of the elbow (group B). The indications for implantation were: antineoplastic treatment of solid tumors, myelo- and lymphoproliferative syndromes, antiviral treatment, and parenteral nutrition at home. The study was composed of 87 patients, 48 men and 39 women, with a mean age of 57.1 years (SD = 12.6). Group A was made up of 48 patients, and group B of 39., Results: Implantation failure was 8.3% in group A and 5.1% in group B (p = n.s.). Complications of implantation were 23.4% in group A and 15.4% in group B (p = n.s.). The complications of permanence were diagnosed at 27.6% in group A and at 15.4% in group B (p = n.s.)., Conclusions: We have not been able to find significant differences between the two groups, probably due to the fact that the series is still short. Nevertheless, the manageability, comfort for the nursing staff and for the patients, appears to be greater with the devices implanted in the infraclavicular region, by means of a subclavian vein puncture.

Computerised tomography (CT) was used in a study of liver and spleen hydatids in two patients. CT is of primary importance, even when such cysts occur in unusual sites, i.e. the spleen, because it clinches the diagnosis in all cases where daughter cysts are present. Scintigraphy, angiography, and conventional radiology may be regarded as of secondary importance. Even when CT is not specific due to the absence of daughter cysts, it offers a panorama of the hydatid territory, its boundaries, and the displacement and compression it imposes on neighbouring organs. It immediately defines the liquid content. In addition, the diagnostic values of CT goes beyond that of ultrasonography, which may be impeded by meteorism and surgical sequelae, such as adhesions and scars.

We present a review of 175 cases of carcinoma of the colon out of 270 cases of colorectal cancer operated in our service during the period 1980-1986. It is noteworthy that 46.8% of the patients underwent emergency surgery for occlusion and/or diastasic tumoral perforation, and that they presented an advanced average age (48.5% were over 70 years). In emergency surgery there was a predominance of bypass operations (73%) versus tumoral resection (27%). In programmed surgery the index of resectability was 83%. The global operative mortality was 12.5%, but separately it was greater for emergency surgery (18%) than for elective surgery (7.5%). Wound infection occurred in 35% of emergency operations and in 11.8% of programmed operations. An anastomotic fistula appeared in 6.9% of cases, with a similar incidence for mechanical and manual anastomoses. It is concluded that early detection of the disease is necessary to reduce the percentage of urgent operations, and consequently the rates of operative morbi-mortality, and improve long-term survival.

A collaborative effort to describe patients at admission led to the development of the Central Data Set, a 32-item profile of demographic and clinical variables which was used to sample 1,302 admissions across 10 hospitals in 1982. Weighted estimates indicated that this group of adult patients admitted to CNPHA-member hospitals were younger than those admitted to other private psychiatric hospitals, almost half had more than one previous psychiatric hospitalization, about one-fourth had made a previous suicide attempt, and two-thirds had engaged in psychotherapy or counseling prior to his admission. Most common diagnoses at admission were major affective disorders (36%), personality disorders (36%), substance abuse (30%), schizophrenic disorders (13%), and depressive neuroses (13%).

The effects of portacaval anastomosis on the biodynamics of cholesterol in male adult rats of a genetically hypercholesterolemic strain (Rico) were studied using an isotopic equilibrium method. Animals received a sucrose-rich semipurified diet. In both hypercholesterolemic rats and controls, portacaval anastomosis decreased plasma cholesterol levels (27%), liver weight (35-43%) and total cholesterol content in liver and body pools. Rico rats were characterized by (1) a high input rate of newly synthesized cholesterol (internal secretion) (25.3 +/- 1.9 vs. 16.2 +/- 1.5 mg/day/rat in controls) related to increased hepatic cholesterogenesis, and (2) a high rate of cholesterol transformation into bile acids, while other parameters remained unchanged. Portacaval anastomosis decreased the internal secretion of cholesterol in Rico rats (20.1 +/- 2.0 mg/day/rat). Since the activity of the gut for cholesterol synthesis as shown by the fecal external secretion (cholesterol biosynthesized by the gut and directly eliminated in the gut and feces) was not modified, it is assumed that the reduction of internal secretion induced by portacaval anastomosis results from decreased hepatic cholesterogenesis.

The results of a clinical study to evaluate the use of glucose-1-phosphate for phosphate supplementation to a group of 8 surgical patients receiving standardized total parenteral nutrition are presented. Average phosphate (p + 0.001), calcium (NS) and magnesium (NS) plasma concentrations increased during total parenteral nutrition. Positive average daily balances were obtained: 8.1 + 14.8, 4.5 + 4.3 and 1.8 + 3.3 mmol/day for phosphate, calcium and magnesium respectively. These findings support the hypothesis of higher bioavailability of glucose-1-phosphate with respect to inorganic phosphate. On the other hand, hyperphosphatemia was a frequent situation (45.8%); this fact suggests the need for reviewing phosphate daily requirements when supplied in the form of glucose-1-phosphate.