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The aim of the study was to describe the impact of hepatitis B vaccination and disease incidence in adolescents and young people 12 years after the launching of a mass hepatitis B vaccination of pre-adolescents in schools. Vaccination coverage was assessed using administrative and serological data. Infection trends were evaluated by means of seroepidemiological surveys. High levels of vaccination coverage and vaccine-induced immunity were achieved. The resulting low proportions of susceptible adolescents and young people have undoubtedly contributed to the substantial reduction in the prevalence of hepatitis B infection in the 15-24 years age group (0.9 per 100 in 2001 versus 9.3 per 100 in 1986) and in the reported incidence of hepatitis B cases (80% reduction). Over the last 3 years, the declining trend seems to have been halted, although 35% of cases reported during this period corresponded to immigrants.

There are a lot of controversies related to the diagnostic and therapeutic management of Whipple s disease.We present 4 cases of Whipple's disease, collected from the Gastroenterology Service of the Hospital Ramon y Cajal, from Madrid.The average age was 69. The first symptoms were in order of frequency, arthralgias, loss of weight, arthritis, diarrhoea, fever, epigastric pain and neurologic symptoms. Three were treated with trimethoprim-sulphamethoxazol and one with cefixime. There were no recurrences.The endoscopic appearance of the duodenum is fundamental for the suspicion of the disease. The initial parenteral treatment may consist of ceftriaxone and try to avoid using streptomycine because of its toxicity, followed by oral trimethoprim-sulphamethoxazol. As an alternative to the latter, cefixime is usually effective. The typical findings of the duodenum biopsy can persist several months or years after finishing the treatment, decreasing the value of endoscopic pursuit after treatment.

Fundamento: Existen muchas controversias relacionadas con el manejo diagnóstico y terapéutico de la enfermedad de Whipple. Pacientes: Se presentan cuatro casos de enfermedad de Whipple, recogidos del Servicio de Gastroenterología del Hospital Ramón y Cajal de Madrid. La edad media fue 69 años. Los síntomas de presentación fueron en orden de frecuencia artralgias, pérdida de peso, artritis, diarrea, fiebre, dolor epigástrico y síntomas neurológicos. Tres fueron tratados con trimetroprim-sulfametoxazol y uno con cefixima. No hubo recidivas. Conclusiones: El aspecto endoscópico del duodeno es decisivo para la sospecha de la enfermedad. El tratamiento inicial parenteral de la enfermedad debe realizarse con ceftriaxona e intentar evitar la estreptomicina por su toxicidad, seguido del trimetroprim-sulfametoxazol oral. Como alternativa la cefixima parece eficaz. Los hallazgos típicos de la biopsia pueden persistir meses y años después de finalizado el tratamiento, lo cual resta valor al seguimiento endoscópico de los pacientes tras el tratamiento.

The executive function is a collection of cognitive abilities that allow the anticipation and establishment of goals, the formation of plans and programs, the beginning of activities and mental operations, the auto regulation of tasks, and the ability to carry on them efficiently. Both psychopathy and disexecutive syndrome have been considered as prototypes of frontal lobe damage, although they have been related very recently.Psychopathy construct is not clear defined in the international classifications of mental disorders. They have focused only in the antisocial disorder of personality. A clear conceptual delimitation of psychopathy is necessary. The typical behaviours of psychopaths could be related with structural and functional brain alterations showed by the neuroimaging techniques and neuropsychological tests. These deficits are the neurological support of the inability of psychopaths to the integration of reasoning process with emotions, and specifically, of the presence of symptoms as impulsivity, inattention, context dependency, pathological perseverations and metacognitive alteration.The relevant conclusion of this study is the close relationship between reasoning and emotion. Executive function could be the explaining nexus of this connection.

Online cultural archives represent vast amounts of interesting and useful information. During the last decades huge amounts of literature works have been scanned to provide better access to Humanities researchers and teachers. Was the problem 20 years ago one of scarceness of information (precious originals only to consult in major libraries), today’s problem is that of information overload: many databases online and many CD collections are available; each with their own search forms and attributes. This makes it cumbersome for users to find relevant information. In this paper, we describe a case study of how Semantic Web Technologies can be used to disclose cultural heritage information in a scalable way. We present an ontology of Humanities, a semi-automatic tool for annotation, and an application to exploit the annotated content. This tool, positioned somewhere in the middle, between a basic editor and a fully automatic wrapper, helps annotators performing heavy knowledge acquisition tasks in a more efficient and secure way.

Transrectal prostate biopsy is the most accurate method for prostate cancer diagnosis. Although an antimicrobial prophylaxis is employed in most cases, infectious complications are among the most severe. We present a case of E. coli multirresistant meningitis after transrectal prostate biopsy despite quinolone prophylaxis.

We assessed by flow-cytometry the Th1/Th2 profiles in peripheral blood lymphocytes (PBL) from patients with active tuberculosis (TB), before and after antituberculous therapy, and from healthy tuberculin-positive and -negative reactors. PBL from patients showed a reduced potential for Th1-cytokine (notably IFN- γ ) production after culture with a policlonal stimulus. When these PBL from patients were cultured with a M. tuberculosis (MTB)-specific antigen such as PPD (l0 μ g/ml), there was no detectable production of Th1 cytokines. Only the Th2 cytokine IL10 was detected in PBL from patients but not from controls. However, at the site of the tuberculosis disease, T lymphocytes from bronchoalveolar lavage, after culture with PPD, produced IFN- γ . After completion of tuberculosis therapy, PBL did not produce IL10. These data indicate that the immunosuppression observed in PBL during active tuberculosis infection may be related to IL10 production, and to the compartmentalization of the antigen-Th1 response to sites of active MTB infection.

For Tb(0001), a surface core-level shift of the 4${\mathit{f}}^{7}$ photoemission multiplet of ${\mathrm{\ensuremath{\delta}}}_{\mathit{s}}$=0.26\ifmmode\pm\else\textpm\fi{}0.03 eV is determined. This value is by more than a factor of 2 smaller than the result of a recent self-consistent SLAB calculation, but agrees with the prediction of a thermochemical model. It is demonstrated that the larger values of ${\mathrm{\ensuremath{\delta}}}_{\mathit{s}}$ reported previously for polycrystalline samples originate from contributions of low-coordinated surface sites. Implications of the present findings for an improved understanding of the surface electronic structure of rare-earth metals are briefly discussed.

Extraocular muscle biopsies were obtained during enucleation because of advanced intraocular retinoblastoma in four patients admitted to the Service of Ophthalmology at the Caracas University Hospital. Slight limitations of ocular movements and strabismus were present in all cases. The electron microscopical analysis showed muscle fibres with slight to severe atrophy exhibiting myopathic structures as nemaline, filamentous and zebra bodies. Fibre necrosis was also observed characterized by sarcomeric hypercontraction, autophagia, sarcolemmal disruption, and mitochondrial swelling. Capillary alterations included endothelial proliferation with intraluminal infoldings and, in some cases, capillary degeneration and necrosis. A mononuclear cell infiltration formed by macrophages and scarce mast cells located next to atrophic fibres and altered capillaries was observed. Additionally, neutrophils were found around capillaries and in their wall. Cancer cells invading muscle tissue were not seen. Two different ethiopathogenic mechanisms for muscle damages seem to be present. Because of the similarity between the microvascular changes we observed and those found in the muscle compromise of several autoimmune diseases, an autoimmune component in the ethiopathogenesis of the observed capillary alterations is proposed. On the other hand, abnormalities observed in muscle fibres are very similar to those in neurogenic atrophy. This study represents the first report on an extraocular muscle paraneoplastic phenomenon associated with orbital tumours.

To identify risk factors for transmission of multidrug-resistant tuberculosis (MDR-TB) among hospitalized human immunodeficiency virus (HIV) infected patients exposed during a nosocomial outbreak.Case control study. Cases were HIV-infected patients with MDR-TB due to Mycobacterium bovis (MDR-TBMb) who acquired the disease after exposure to an MDR-TBMb patient in an hospital ward. Controls were HIV-infected patients exposed to a case of MDR-TBMb in an hospital ward but who did not develop MDR-TBMb during the follow-up.Nineteen cases and 31 controls were included. CD4 cell counts were significantly lower among cases. Exposure in the infectious diseases ward or exposure to the index patient were associated with development of MDR-TBMb, while exposure during a single-room hospital stay and exposure in the respiratory isolation ward were associated with non-development of MDR-TBMb. A multiple regression logistic model showed that only a CD4 cell count below 50/microL and exposure to the index patient increased the risk of developing MDR-TBMb (P0.05). Hospitalization in a single room seemed to protect HIV-infected patients from developing nosocomial MDR-TBMb (P = 0.052).Over classic risk factors, such as length of exposure or sharing a room with a case, severe immunosuppression independently increases the risk of MDR-TB transmission in the context of a nosocomial MDR-TB outbreak among HIV-infected patients. This information must be considered in the management of tuberculosis outbreaks. Patients with CD4 cell counts below 50/microL should be the principal group targeted for prevention strategies in nosocomial outbreaks.

Invasive aspergillosis (IA) is an important cause of mortality in liver transplant patients. Clinical and microbiological diagnosis is difficult, and it is frequently achieved only after autopsy. Early diagnosis and antifungal therapy could improve the survival of these patients.A retrospective case-control study of IA in liver transplant recipients (OLT) was performed to determine the value of the detection of galactomannan Aspergillus antigen in serum using a sandwich-ELISA test (Platelia, Sanofi Diagnostic Pasteur). Stored frozen serum specimens obtained during the posttransplantation period were used.Fourteen cases of IA were diagnosed in 240 OLT recipients (IA incidence: 5.8%) during 5 years with 13 deaths (mortality: 93%). Nine case patients and 33 control patients met the criteria required for being considered "valid" for antigenemia analysis. In five of the nine case patients, a serum sample was positive for Aspergillus antigenemia detection. The median value was 5.7 ng/ml (range: 1.6-6.6). Sensitivity of the test was 55.6%, specificity was 93.9%, the positive predictive value was 71.4%, and the negative predictive value was 88.6%. The likelihood ratio of a positive test was 9.2.Galactomannan detection in serum could be useful for an early diagnosis of IA in OLT recipients.

Improving plant efficiency for fertiliser use is important to reduce costs of crop production in Colombia, and N is one of the most costly inputs for sorghum production. Field experiments were conducted on an Inceptisol in the Eastern Piedmont of Colombia to determine yield response to nitrogen supply, N use efficiency (NUE) and Apparent Nutrient Recovery (ANR) for sorghum genotypes with contrasting genetic backgrounds. ICI 770 had highest grain yields (4373 kg ha−1) with applications of 200 kg N ha−1, and no significant differences in grain yields were noted between SBL 102 and ICI 770 when grown with 50 and 100 kg N ha−1. At low levels of N (50 kg N ha−1) the improved genotype (SBL 102) had the highest NUE and the commercial hybrid (ICI 770) the lowest NUE. However, at high levels of N (200 kg N ha−1) the commercial hybrid showed the highest NUE and the Al tolerant cultivar (Sorghica Real 40) and the improved cultivar had the lowest NUE. SBL 102 had the highest ANR value (21%) compared to lowest for ICI 770 (15%) when grown with 100 kg N ha−1, and Sorghica Real 40 had the highest ANR (37%) compared to ICI 770 (23%). The results from the study indicate that simultaneous improvement of yield and N utilization efficiency should be possible in sorghum.

To identify risk factors for colonization and bacteremia among patients with non-tunnelled central venous catheters.A prospective study was conducted of a cohort of patients carrying non-tunnelled central venous catheters. Different parameters were obtained and the degree of its association with colonization of the distal portion of the catheter or with bacteremia associated with colonization was estimated. The CDC (centers for Disease Control) diagnostic criteria of colonization and catheter-related bacteremia were used.A total of 118 catheters were eventually analyzed, corresponding to 114 patients, with a catheterization mean time of 14 +/- 8 days (mean +/- SD); out of these 114 patients, 51 were colonized and in 22 the presence of associated bacteremia was confirmed. The parameters associated with a higher risk for catheter colonization included length of colonization, femoral location, number of lumina and a vital prognosis lower than one month. All these factors, with the exception of the increase in the number of lumina, showed an independent association with colonization on the multivariate analysis [catheterization length (in weeks): OR 1.46; 95% CI: 1.0-2.11; femoral location: OR 3.73; 95% CI: 1.16-11.9; vital prognosis lower than one month: OR 12.7; 95% CI: 1.4-112.7]. As for risk for catheter-related bacteremia, the univariate analysis showed an association with catheterization length and a vital prognosis lower than one month; the latter was the only factor that maintained an independent association in the multivariate analysis (OR 5.75; 95% CI: 1.17-28.27).The present study documents the relevance of prolonged catheterization as a consistent risk for colonization of non-tunnelled central venous catheters. This risk increases independently in canalization at femoral site and particularly among severely ill patients. The presence of these factors allows the identification of a high risk population for the development of catheter related bacteremia.

To measure and assess changes in plasma concentrations of alpha glutathione S-transferase (alpha-GST) during and after anesthesia with isoflurane, desflurane and propofol.Study of 90 ASA I and II patients scheduled for lumbar back surgery under general anesthesia assigned randomly to one of three groups to receive anesthetic maintenance with isoflurane, desflurane or propofol. We measured plasma levels of alpha-GST, aspartate aminotransferase aspartate, alanine aminotransferase, alkaline phosphatase, pseudocholinesterase, gamma glutamyltransferase and total bilirubin at baseline and several times during and after surgery.Changes in plasma levels of alpha-GST were detected in all three groups, the tendency to increase reaching its peak with the sample taken at the end of anesthesia. The ranges considered normal were not exceeded in any of the patients studied.By measuring alpha-GST changes in plasma, we have detected signs of disturbance in hepatocellular integrity after anesthesia with all three maintenance agents used. However, the slight and transitory nature of the events confirms the scarce hepatotoxic potential of isoflurane, desflurane and propofol.

The aim of the present was to study the clinical characteristics, the diagnostic methods, response to treatment and the evolution of cryptococcosis not associated with AIDS.Seven cases studied in the Hospital Ramon y Cajal of Madrid, Spain over a 19-year period (1980-1998). Diagnosis was determined by LCR culture, blood or other clinical samples.Four patients were males with a mean age of 45.1 years (range: 23-69 years). All except one case presented a predisposing disease and three received corticoids and/or immunosuppressive drugs. Six patients presented meningitis and one pneumonia. The meningitis showed a subacute course with pleocytosis, hypoglycorrhachia and hyperproteinorrhachia in most of the patients. Chinese ink staining, culture and the cryptococcic antigen of LCR were positive in all the cases of meningitis evaluated. All the patients were initially treated with amphotericin and fluorocytosin. This schedule was substituted in two cases by amphotericin lipid formulas because of adverse effects and by fluconazol as an elective choice in one case. The evaluation was favorable in all the patients. One patient presented meningeal and cutaneous recurrence. Three patients died, although none did so during the acute episode or as a consequence of the infection.Cryptococcosis not associated with AIDS is rare in Sapin. It usually evolves with subacute hypoglucorrhachic meningitis and the conventional diagnostic techniques (Chinese ink staining, cryptococcic antigen and culture) provide adequate profitability. Response to treatment with amphotericin and fluorocytosis is usually favorable, although there are therapeutic alternatives which are adequate for selected cases.

Seroepidemiologic studies carried out in different European countries have shown the existence of low levels of protection against diphtheria. In this study the prevalence of antidiphtheria antibodies in the adult population of Catalonia, Spain, during 1995 has been studied.The prevalence of the seroprotection against diphtheria was investigated in a representative sample (n = 1,248) of the adult population of Catalonia aged 15 or older. The antibody levels were determined by means of the in vitro Vero-cell neutralization technique. Two protection levels were considered: 0.01-0.09 U/ml (partial immunity) andor = 0.1 U/ml (total immunity).The prevalence of absolute seroprotection was 12.4% (CI 95%: 10.5-14.3%) and that of partial and absolute seroprotection was 26.0% (CI 95%: 23.6-28.4%). The prevalence of antibodies is higher in men than in women (29.2% versus 23.1%; p0.05), and in urban than in rural environments (27.2% versus 19.9%: p0.05). The odds ratios adjusted by multiple logistic regression analysis were 1.43 (1.11-1.85) and 1.56 (1.05-2.29), respectively.The prevalence of antidiphtheria antibodies in the adult population of Catalonia, Spain, is low. The results suggest the need to develop antidiphtheria vaccination programmes in the adult population.

The mode of hepatitis C virus (HCV) transmission in patients who deny parenteral exposure is still not understood. Seroprevalence studies of anti-HCV in sexually promiscuous populations and in spouses of infected patients have given contradictory results. We investigated the role of sexual transmission of HCV in a case-control study of risk factors for infection in a series of 43 anti-HCV positive pregnant women and 172 matched controls (4 for each case). In the univariate analysis, the following factors were associated significantly with anti-HCV seropositivity: low social class, unmarried, history of abortion, wounds which were sutured, tattooes, sharing toiletries with the partner, sexual contact outside the partnership without condom use, blood transfusion, and intravenous drug abuse, but only the last 3 factors remained significantly associated with HCV infection in multiple logistic regression analysis. The relative risk of HCV infection increased according to the increased number of sexual partners. Thus sexual transmission must be considered a possible mode of infection in HCV infected persons without parenteral exposures. J. Med. Virol. 52:164–167, 1997. © 1997 Wiley-Liss, Inc.

To compare hormone response to stress caused by surgery performed under balanced general anesthesia and total intravenous anesthesia.Two randomly formed groups of 24 patients each were studied. All patients were scheduled for lumbar laminectomy to correct disc hernias, with one group receiving balanced anesthesia with isoflurane (expiratory fraction between 0.5% and 0.6%), and the second group receiving total intravenous anesthesia (TIVA) (propofol infusion changed every 10 min from 12 to 6 mg/kg/h). Analgesics and relaxants were given by continuous infusion at preestablished doses (fentanyl 2 micrograms/kg/h; vecuronium 0.05 mg/kg/h). Cortisol and catecholamine (adrenalin, noradrenaline and dopamine) levels were determined at the following times: the morning of surgery (baseline), 5 min after intubation, 5 min after incision, 30 and 60 min after intubation; 5 min after tube removal and upon admission to the recovery unit.Cortisol levels decreased from baseline (14 +/- 3 pg/ml) until 30 min after intubation (4 +/- 2 pg/ml; p0.05) in the balanced anesthesia group. Adrenaline levels followed the same pattern (baseline 77 +/- 7 versus 57 +/- 10 pg/ml 30 min after intubation). Dopamine levels were statistically different (p0.05) at baseline (42 +/- 3 pg/ml), after intubation (38 +/- 2 pg/ml) and after incision (35 +/- 3 pg/ml), but the difference disappeared 30 minutes after intubation (38 +/- 8 pg/ml). Noradrenaline levels after incision (425 +/- 116 pg/ml) were significantly different from those at baseline (671 +/- 124 pg/ml), and the difference was evident until 60 min after incision. In the TIVA group we found significantly higher cortisol levels after intubation (21 +/- 0 pg/ml) than after baseline (14 +/- 2 pg/ml); this level decreased after extubation (7 +/- 0 pg/ml; p0.05). Adrenaline levels were significantly higher than at baseline (64 +/- 11 pg/ml) at times corresponding to intubation (76 +/- 5 pg/ml) and extubation (48 +/- 5 pg/ml). Noradrenaline increased significantly over baseline (497 +/- 99 pg/ml) after incision (597 +/- 90 pg/ml) and decreased significantly after 30 min. The increases in cortisol were significantly greater in the TIVA group than in the control group after intubation (21 +/- 0 versus 8 +/- 3 pg/ml, respectively) after intubation, after incision (18 +/- 2 versus 6 +/- 3 pg/ml) and 30 minutes after intubation (15 +/- 2 versus 4 +/- 2 pg/ml). Similar differences were found for dopamine after intubation (49 +/- 2 versus 38 +/- 2 pg/ml) and after incision (45 +/- 5 versus 35 +/- 3 pg/ml).Hormone levels are significantly higher during intravenous anesthesia than during balanced anesthesia, and the difference is evident from the earliest measurement performed.

The aim of the study was to assess all patients with ENT symptoms whose histologic and/or microbiologic diagnosis confirmed tuberculosis.All the anatomopathologic studies performed in the ENT unit in the authors' hospital in which the presence of acid-alcohol resistant bacilli were observed. All cases of cervical adenitis were not included.Eighteen patients with the following localizations were studied: 14 laryngeal tuberculosis and 4 extra-laryngeal tuberculosis (2 oropharyngeal, 1 otic and 1 sinusal). In the laryngeal forms, all patients were male except for one, and all were smokers. The duration of the symptoms was greater than 3 months in all the cases. Unilateral cord involvement was most commonly found, and in 2 cases this was associated with carcinoma of the vocal cord. Twenty-nine percent did not present with coincident pulmonary tuberculosis. None of the extra-laryngeal forms showed pulmonary involvement. All the patients were women and only 1 was smoker, the symptomatology was greater than 3 months in all cases and all required biopsy for achieving diagnosis. The evolution with medical treatment was favorable in all cases. During the same time period, 2300 cases of pulmonary tuberculosis were diagnosed in the authors' hospital.Tuberculosis of the upper respiratory tract is infrequent. Pulmonary involvement is common, although in this series this was only found in 71% of all laryngeal forms. Diagnosis is difficult, except in cases of coinciding pulmonary involvement and usually requires surgery for biopsy. Response to medical treatment is usually good.

Recent seroepidemiologic studies have demonstrated a decrease in the prevalence of hepatitis A virus infection (HAV) in relation with an improvement in hygienic conditions. The prevalence of anti-HAV in a group of health care students was studied and a vaccination program initiated in this collective.Serum anti-HAV determination was performed by an enzymoimmunoanalysis method. A inactivated hepatitis A vaccine was administered.Only 18.5% of the subjects between 17-23 years-old presented anti-HAV antibodies. The prevalence of anti-HAV was related with age and the number of partners. All of the 129 immunized individuals responded to the HAV vaccine with protector antibody titles.The present study demonstrates the decrease in HAV infection among youths as well as the immunogenicity of the anti-hepatitis A vaccine.

This study has researched the cost-effectiveness of Early Diagnosis of Breast Cancer in Catalonian women in the 50-64 age group.The cost-effectiveness ratio was obtained by comparing the costs of a program for 100,000 women with results achieved. The program consisted of a twice yearly mammography on all of the women over a 10 year period. The study assumed a participation level of 70%, detection rate of 0.36%, 92% sensitivity and specificity of 94%.A cost-effectiveness ratio of 1,413.648 pesetas was determined per case of cancer detected. 705,489 per year of extended life and 783,982 per year of extended life adjusted according to quality. Cost-effectiveness of the test in the first year was 842,400 per case of cancer detected. 383,183 per year of extended life and 425,418 per year of extended life adjusted according to quality.The results of the study are consistent with those obtained by other evaluations and show that early diagnosis of breast cancer is associated with a favourable cost-effectiveness ratio.

Three hundred and three patients undergoing elective surgery were studied prospectively. Patient data and results of serial blood cell counts were recorded before and after surgery and used to evaluate the criteria used to reserve and transfuse blood and blood products, as well as to assess the outcome of transfusions performed. Six hundred and ninety-nine units were reserved, indicating a reservation-to-transfusion ratio of 1.8. The most often cited reasons for reserving blood were surgical technique, nature of disease and prolonged surgery. A high number of reservations were called for from the ward by the surgeons themselves. A total of 180 patients were given transfusions, the main reason being the anesthesiologist's judgement that the Hb count was low (in 26% of cases). Transfusions because of slight bleeding during surgery and prolonged surgery gave rise to the highest Hb counts. The lowest post-transfusion Hb counts recorded occurred when the reason cited was presence of signs of anemia. We conclude that the ratio of reservations to transfusions in our study was acceptable, as were the reasons justifying reserves. There is an overall tendency to achieve excessively high Hb counts (10-11 g/dl) in the early postoperative period. The best criterion for performing transfusion is the presence of signs of anemia.

The convenience of carrying out prevaccination detection studies of hepatitis A virus (HAV) markers depends on the relative costs of the detection and vaccination, as well as the prevalence of susceptible subjects in each population group to be vaccinated. The aim of this study was to analyze the efficacy of the systematic prevaccination detection of anti-HAV antibodies in Catalonia, Spain.The following formula was applied: Unit cost of detection + (1-X) x Unit cost of vaccination of anti-HAV negative subjects = group vaccination cost, with X being the threshold of prevalence of marker under which detection no longer remains efficient. This prevalence was compared with the findings of a seroepidemiologic survey carried out in international travellers and food handlers.The unit cost of the detection of anti-HAV was calculated as 2,733 pesetas, and the unit cost of the vaccination as 9,963 pesetas obtaining a prevalence anti-HAV threshold of 27%. This prevalence corresponds to travellers under the age of 30 years and food handlers under the age of 25 years.The systematic detection of anti-HAV is only recommended in population groups in which prevalences higher than 27% may be expected. The vaccination is more efficient without a previous marker study under this threshold. According to this study, direct vaccination of food handlers under the age of 25 years (born after 1969) is recommended as is that of international travellers under the age of 30 years (born after 1964). In those over the age of these collectives, the prevaccination study is more efficient.

The cost-effectiveness of the following methods of cessation of smoking were calculated in this study: 1) medical advice, 2) medical advice and nicotine chiclets, and 3) medical advice and nicotine patches.The costs and effectiveness of the methods of cessation of smoking compared in terms of cost per year of life gained, deducing the costs and benefits at 5%.The cost per year of life gained was found to be 260,000 to 434,000 pesetas in males and 441,000 to 637,000 in women for medical advice, 287,000 to 479,000 in males and 486,000 to 703,000 in females for advice and nicotine chiclets and 329,000 to 549,000 in males and 557,000 to 805,000 in females for advice and nicotine patches. Maximum efficacy was achieved with the three methods in the age group from 45-59 years in males and from 50-54 years in females. On comparison of cost and effectiveness of the methods of nicotine substitution with those calculated for medical advice the increase in cost-effectiveness was shown to be 395,000 to 658,000 in males and 668,000 to 966,000 in females for advice and chiclets and from 467,000 to 779,000 in males and 791,000 to 1,142,000 in females for advice and patches. The increase in cost-effectiveness for advice and patches versus advice and chiclets was from 539,000 to 899,000 in males and 913,000 to 1,318,000 in females.The efficiency of achieving the cessation of smoking is very similar for medical advice and medical advice plus nicotine chiclets and is somewhat less for medical advice and nicotine patches. The results of this study place the methods of smoking cessation among the most effective health care procedures.

Magneto-optical Kerr effect and Faraday effect provide the basis of established methods for studying the magnetic properties of matter by polarized light in the visible spectral range. It was only quite recently that an analogous effect in the x-ray region, magnetic circular dichroism in x-ray absorption, was first observed by Gisela Schutz et al. for the near-edge fine structure at the K edge of ferromagnetic iron.1 Later on, magnetic circular x-ray dichroism (MCXD) was also observed at the LII,III thresholds of rare-earths2 and 3d transition metals,3 opening up the possibility for element-specific analyses of magnetic moments in compound magnets and multilayers. Today MCXD is mainly used as a tool at the LII,III x-ray absorption thresholds of 3d transition metals, where relatively large MCD asymmetries in the white lines upon reversal of either sample magnetization or circular polarization (photon spin) of the absorbed light are observed. MCXD can be understood in the simplest way in a one-electron picture by taking the spin polarization of the excited electron due to the inner-shell spin-orbit coupling (Fano effect4) into account as well as the spin-split density of final states at and above the Fermi level.5 More rigorous theoretical treatments have been given,6,7,8 which allow to recognize the three important ingredients for magnetic circular dichroism: (i) Exchange interaction as the driving force for long-range spin order; (ii) use of circularly polarized light with preferential propagation along the magnetic quantization axis; (iii) spin-orbit interaction providing the mechanism for an effective coupling between the angular momentum of the circularly polarized photon and the magnetically ordered electron spins.

To determine plasma catecholamine levels during the use of propofol for maintenance of anesthesia. We studied 20 randomly chosen patients undergoing elective orthopedic surgery under general intravenous anesthesia with propofol as the agent of maintenance along with pancuronium and fentanyl. Plasma concentrations of dopamine, noradrenalin and adrenalin were measured at the following times: baseline, after intubation and every 15 min during surgery. The levels obtained for the different samples were compared with baseline levels. At the doses used in our study, there were no significant differences in the way dopamine plasma levels varied. This was not the case with the other two hormones, however. Adrenalin levels were significantly higher at the first 3 extractions (post-intubation, 15 min and 30 min), and noradrenalin was significantly higher (p0.05) at all extraction times. Total intravenous anesthesia with propofol is associated with a significant increase in plasma concentrations of adrenalin and noradrenalin. Adrenalin returns to baseline levels 45 min after induction.

The aim of this study was to investigate the prevalence of hepatitis C virus (HCV) infection in a population of pregnant women in Catalonia and the sociodemographic variables and risk factors associated to this prevalence.A representative sample of the pregnant women in Catalonia (n = 4,551) randomly selected by clusters (hospitals with maternity clinics) was studied. Detection of antiHCV antibodies was performed by the third generation ELISA test. Reactive cases were confirmed with RIBA 3 and MATRIX.The prevalence of antiHCV was found to be 1% and was not significantly associated with any of the sociodemographic variables studied (age, social and cultural level, origin and residence). A history of blood transfusion, intravenous drug consumption and hepatitis in the sexual partner were the only risk factors associated with the prevalence of infection found on univariate analysis although these were only present in 47% of the antiHCV positive cases detected. The association between the positivity of antiHCV and the history of hepatitis in the partner was lost on stratification of the cases according to the possible existence of history of drug addiction.A high proportion of young asymptomatic people (1%) were found to have hepatitis C virus infection with the possible mode of infection not being detected in approximately half of these subjects. In the other half of these cases the infection was found to have been acquired by an intravenous mechanism: blood transfusion or drug use.

Tuberculosis in HIV infected patients does not carry a worse therapeutic response rate. Treatment failure is usually due to incomplete schedule, with development of acquired resistance. Two patients with HIV infection and disseminated tuberculosis who developed fatal meningitis are presented.In vitro studies of sensitivity to anti-tuberculous drugs were carried out, using the proportions method.Following a good initial evolution, both patients were readmitted with tuberculous meningitis resistant to isoniazide in both and to rifampicin in one of the patients. In one patient, the original strain (which was sensitive) was available. In this patient, changes in the treatment were performed in the initial phase.The importance of anti-tuberculous multiple therapy, particularly in the initial phases, for HIV positive patients is crucial. The lengthen of admission when good patient's compliance is in question, but also to avoid, whenever possible, changes in treatment are important measures in this stage. Meningitis may occur as a form of therapeutic failure and its cure may be difficult if the strains are resistant.

The aim of this study was to analyze the electroencephalographic alterations produced by minimum doses of midazolam and look for a theoretic base for these changes in the benzodiazepinic receptor. To do so, the possible abnormal responses provoked by midazolam on the EEG of patients with ischemic cerebral infarctions were studied. Sub-hypnotic infusions of midazolam (0.15 mg kg/min) were administered prior to anesthetic induction in three groups of patients: control group, patients with tumoral cerebral pathology group, and ischemic cerebral infarctions group. In addition to the known modifications obtained in the patients of the control group, those presenting bioelectric activity alterations due to tumoral pathology did not show modifications. In the group of patients with ischemic infarctions, the intravenous perfusion of midazolam induced moderate increase in the localized theta and delta frequency and a lower representation of the beta rhythm which was also of lower amplitude. Midazolam is capable of making slow rhythms on the EEG, following it administration at low doses, in ischemic zones of the brain.

MR showed a small, acute hemorrhage adjacent to an area of infarction in the parieto-occipital lobe in a man with acute malaria.

We report on strong magnetic circular dichroism (MCD) in 4f photoemission (PE) from Magnetized Gd(0001)/W(110) films. The shape of the 4f6–7FJ final-state PE Multiplet depends on the relative orientation between photon spin and sample magnetization and can be described within an atomic Model. The spectra rule out antiferromagnetic alignment of the (0001) surface layer and the bulk of Gd. This MCD in 4f-PE from rare-earth materials opens new perspectives in the analysis of surface and thin-film magnetism and as a sensor for circular polarization of soft x-rays.

The electronic structure of high-temperature superconductors near the Fermi level which is of primary interest for the understanding of the mechanism of superconductivity, is not yet well understood. Most theoretical investigations deal with Cu3dx−y and O2px,y orbitals at EF, but whether or not O2pz and Cu3d3z−r orbitals contribute to states at EF, is still under discussion. The contribution of states with out-of-plane orbital character has been investigated by polarized x-ray absorption spectroscopy (XAS) on HTSC single crystals. For La2−xSrxCuO4 a small contribution from O2pz orbitals (8% of holes in O2p valence band states) was observed which increased to about 13% on 30% Sr doping. In n-type doped HTSC there is no clear evidence for O2pz orbitals at EF, but states are observed slightly above EF with O2pz character depending on the doping and annealing conditions. An observed admixture of Cu 3d3z−r states to the predominant 3dx hole states at EF of a few percent did not significantly exceed the expermental error limits.

To study the usefulness of several omeprazole regimens on gastric fluid volume and pH in patients undergoing elective surgery.We analyzed 105 patients undergoing to elective surgery who received prophylactic treatment for the acid aspiration syndrome. They were randomly allocated into 7 homogeneous groups according to the therapeutic regime. Placebo (group 1), oral omeprazole (20 mg) the night prior to surgery (group 2), oral ranitidine (150 mg) the night before (group 6), two doses (the previous night and before surgery) in the remaining three groups: 20 mg of omeprazole (group 4), 40 mg of omeprazole (group 5) or 150 mg of ranitidine (group 7). In all patients we measured pH and volume of the gastric content after induction of anesthesia and one hour thereafter.There were no statistically significant differences in mean pH values and gastric volume content among groups 1.2,3, and 6 (2.1 (pH) and 27 ml (gastric volume) in group 1, 2.1 and 23 ml in group 2, 2.6 and 19 ml in group 3, and 2.2 and 32 ml in group 6). With repeated doses of 40 mg omeprazol (group 5), mean pH values were comparable to those found with the two doses of ranitidine (4.1 +/- 1.8 vs 4.1 +/- 3.6) although gastric volumes were significantly less (12 +/- 2.6 ml vs 20 +/- 4.8 ml). These two groups showed significantly greater mean pH values and less gastric volumes than the remaining patients.The incidence of patients with gastric content deemed at risk for acid aspiration (pH less than 2.5 and gastric volume greater than 25 ml) was less after premedication with two oral doses of omeprazole (40 mg) than either two doses of ranitidine (150 mg) or smaller doses of both drugs.

We report 2 patients programmed for elective surgery who were considered susceptible to develop the malignant hyperthermia syndrome. The first patient had two familiarly antecedents of death produced by postanesthetic malignant hyperthermia, whereas the second patient suffered a clinical picture compatible with this syndrome during tonsillectomy, although followed a favourable recovery. The preoperative study including measurement of muscular enzymes, isoenzymes, and muscular biopsy was normal. In both patients an intravenous prophylactic treatment with dantrolene 2.5 mg.kg1 was undertaken before surgery. The first patient underwent hysterectomy under intradural anesthesia with bupivacaine 0.5%. The second patient had a maxillary fracture which was treated with osteosynthesis under general anesthesia. During the intervention and the postoperative follow-up, both patients were free of signs related to malignant hyperthermia. We conclude that prophylaxis with dantrolene is necessary in patients susceptible to develop the syndrome of malignant hyperthermia.

We describe the guidelines used and the clinical and epidemiological data of a varicella outbreak seen in our service. The index case was a male drug addict, seropositive for HIV, with disseminated varicella. A total of 40 health care workers were in contact with the patient. Of them, 37 were considered not to be susceptible of having the disease. The remaining three health care workers developed varicella, and one had been also in contact with other hospitalized patients during the exposure period. Serological test for varicella (FAMA) of all 20 exposed patients (all HIV positive) showed that only four were susceptible. Those were put on isolation and immunoglobulin against zoster-varicella (VZIG) was used. Only one developed varicella. We recommend: a) the index case has to bep put under strict isolation precautions or discharged; b) acyclovir should be given to all immunosuppressed patients; c) immunoglobulin (VZIG) should be used in immunosuppressed patients susceptible to varicella and exposed to index case, and d) live, attenuated vaccine should be used in non immunosuppressed susceptible patients.

Antituberculous chemoprophylaxis with isoniazide during a period of one year is very useful although it is not readily accepted. A community trial is designed in order to test if three health education interventions increase patients compliance with such treatment in case of tuberculin positive children who are not ill. The two interventions performed by nurses, one by phone, and the second one by a home visit, resulted in statistically significant difference when compared to the control group. This did not occur, however, with the intervention performed by the doctor in his office. A cost-effectiveness study demonstrates that the most efficient intervention has been the phone call.

Introduccion. La funcion ejecutiva es un conjunto de habilidades cognitivas que permiten la anticipacion y el establecimiento de metas, la formacion de planes y programas, el inicio de actividades y operaciones mentales, la autorregulacion y monitorizacion de las tareas y las aptitudes para llevar estas a cabo de forma eficaz. Tanto la psicopatia como el sindrome disejecutivo se han considerado prototipos de dano en el lobulo frontal aunque, hasta hace relativamente pocos anos, no se habian puesto en relacion. Desarrollo. El constructo psicopatia no esta definido claramente en las clasificaciones internacionales; se centra unica y exclusivamente, en el trastorno antisocial de la personalidad. Es necesaria una clara delimitacion conceptual de la psicopatia. Las conductas tipicas del psicopata pueden ponerse en relacion con determinados deficit cerebrales estructurales y funcionales apreciables en las tecnicas de neuroimagen y en tests neuropsicologicos. Estos deficit constituyen el soporte neurologico de la incapacidad de los psicopatas para la integracion de los procesos de razonamiento con las emociones y, mas concretamente, para la aparicion de sintomas como la impulsividad, inatencion, dependencia ambiental, perseverancia patologica y deficit en la autorregulacion, que son caracteristicos del sindrome disejecutivo. Conclusion. La conclusion mas relevante es la estrecha relacion que existe entre el razonamiento y la emocion; es imposible la comprension de uno sin la otra o viceversa. La FE es el nexo explicativo de la relacion entre ambos.