What lessons can be drawn from tuberculosis (TB) control in China in the 1990s? An analysis from a health system perspective

China has made a significant achievement in tackling the TB epidemic over the last decade, due largely to the implementation of directly-observed treatment strategy (DOT). The cure rate of TB cases reached more than 90% for registered TB patients. However, the case detection rate has, unfortunately, been very low (some 30%). Using available information, this paper identifies four main problems facing TB control in China, these are, low case finding, a substantial proportion of TB patients failing to complete standardised treatment, increased proportion of MDR TB patients, and lack of effective TB control among "floating populations". The paper also analyses the possible causes of these problems associated with socio-economic barriers in care seeking, ineffectiveness of TB services, particularly in poor areas, lack of co-operation between health facilities, and weakness of political and financial commitments of local governments to TB control. The paper ends with the discussion of opportunities and challenges facing TB control and makes recommendations for further actions and research.     

Quality of life for patients with gastroesophageal reflux disease 2 years after laparoscopic fundoplication. Evaluation of the results obtained during the initial experience

Background: Health-related quality of life (HRQL) is significantly affected by gastroesophageal reflux disease (GERD), and its evaluation is emerging as a factor important to select treatment options for GERD. Antireflux laparoscopic surgery improves HRQL. The aim of this study was to compare the preoperative and medium-term postoperative HRQL in patients submitted to laparoscopic fundoplication during the initial experience to verify its possible influence on HRQL outcomes. Methods: Clinical assessment, endoscopy, and a previously validated HRQL index were performed before and 2 years after surgery in 32 patients who underwent at the beginning of our experience. Results: The esophageal mucosa returned to normal 2 years after laparoscopic fundoplication in 81% of the patients. Heartburn was absent or occasional in 93%, and 65% were free of antisecretory drugs. All postoperative HRQL items were significantly improved (p <0.0001), with the postoperative curve of HRQL scores superposable to those of healthy Italian subjects (Italian normative sample). Conclusions: The initial phase of learning does not affect the improvement of HRQL observed after laparoscopic antireflux surgery, which is consistent with durable relief of symptoms and endoscopic healing. Evaluation of HRQL should be added to, and probably could replace in most cases, the objective postoperative testing.     

Dysphagia and clinical outcome after laparoscopic Nissen or Rossetti fundoplication: sequential prospective study

Laparoscopic fundoplication represents the most widely used operation in the surgical treatment of gastroesophageal reflux disease (GERD). Besides being operator-dependent, the clinical outcome (efficacy and side-effects) seems also to be dependent on the specific surgical technique. In this prospective trial we compared the results of two groups of patients who were submitted sequentially to the Rossetti or Nissen fundoplication procedure. Dysphagia, other side effects, and clinical outcome were evaluated early after surgery and at 6 and 12 months after the operation. Although both procedures were clinically effective, there was a significant trend toward less postoperative dysphagia in the Nissen group. In these patients the incidence of early dysphagia was significantly lower than that observed in those submitted to the Rossetti fundoplication. In addition, Nissen patients experienced a significantly smaller number of days with dysphagia. One year after surgery, however, the two procedures proved equally successful without any significant difference in dysphagia incidence. Complete fundic mobilization should therefore be advised to reduce the incidence of early troublesome dysphagia.     

SQ 22536, an adenylate-cyclase inhibitor, prevents the antiplatelet effect of dazoxiben, a thromboxane-synthetase inhibitor

This study shows that dazoxiben, a selective inhibitor of thromboxane A2-synthetase in human platelets, inhibited arachidonic acid-induced platelet aggregation in platelet-rich plasma samples from four out of 16 healthy volunteers. In these four "responder" samples, the anti-aggregating effect of dazoxiben was prevented by the compound SQ 22536, a 9-substituted adenine analogue, endowed with an inhibitory activity on adenylate-cyclase. The compound SQ 22536 also counteracted the antiaggregating effect of prostaglandin D2, a known activator of platelet adenylate-cyclase. When platelet thromboxane A2-synthetase was blocked by dazoxiben, a marked increase of prostaglandin D2 was concomitantly observed both in "responder" and "non responder" samples. The compound SQ 22536 blunted the increase in platelet cAMP caused by either dazoxiben and sodium arachidonate or prostaglandin D2. It is suggested that the antiaggregating effect of dazoxiben is mediated by newly synthesized prostaglandin D2. The latter acts by stimulating adenylate-cyclase and increasing cAMP levels. The compound SQ 22536 prevents both phenomena. In "non responder" samples some factors--still to be defined--might counteract similarly to the compound SQ 22536 the antiaggregating activity of PGD2.     

Myocardial infarction caused by a large coronary artery aneurysm

A large coronary aneurysm, originating from a side branch of the right coronary artery, caused recurrent ischemia resulting in myocardial infarction. Successful surgical excision, without concomitant coronary artery bypass grafting, is described.     

Hospitalisationen infolge Hepatitis A, B und C in ?sterreich 1996–1998

Ziel dieser Arbeit ist die Analyse der Hospitalisationsdaten aller Österreicher, die in den Jahren 1996 bis 1998 mit der Hauptdiagnose Virushepatitis (nach ICD 9) stationar aufgenommen waren. Datenquelle ist das Minimum Basic Data Set (MBDS), das an allen-aus öffentlichen Mitteln finanzierten-österreichischen Krankenhäusern von stationären Patienten obligat erhoben wird.Hepatitis A: Die standardisierte Hospitalisationsrate (SHR) erreicht Werte zwischen 2,8/100000 (1996) und 4,7/100000 (1997). Die meisten Hospitalisationen erfolgen in der Altersklasse der Schulkinder (7-13/100000 pro Jahr); in den nachfolgenden Altersklassen nehmen die Hospitalisationen deutlich ab. Im Vergleich mit den österreichischen Bundesländern weist Wien die höchste mittlere SHR auf (6,8/100000 pro Jahr).