Gyneco-obstetrical morbidity in the population of Santiago

1607 women were interviewed about their gyneco-obstetrical health in a survey of 469 randomly selected households in the province of Santiago, Chile. The dependent variables correspond to the frequency of gynecologic or obstetrical morbidity and demand for medical attention in 2 weeks of April, 1987. Independent variables were age, educational status, and health insurance coverage. 125 of the households were headed by uninsured persons. The average woman was 34.4 years old. 43.1% had 8 years or less of education, 42.6% had 9.12 years, and 14.2% had 13 or more years. 21 new cases of acute obstetrical or gynecological disorders were reported, including 15 of vulvovaginitis, 3 abortions, 1 bartholinitis, 1 intrahepatic cholestasis of pregnancy, and 1 urinary tract infection. There were 55 cases of chronic disorders, including 12 benign ovarian lesions, 8 dysmenorrheas, 8 uterine dystropias, 10 cases of menstrual disturbances, 1 of infertility, 4 benign cervical lesions, 5 benign uterine lesions, 2 pelvic inflammations, 2 cervical cancers, 2 breast cancers, and 1 ovarian cancer. Among the 1607 women, 11 had consulted for family planning in the 2 weeks, 25 for pregnancy, 22 for gynecological conditions, and 9 for postpartum care. 58.3% of the women aged 15-49 used a contraceptive method. The proportions of users of oral contraceptives and IUDs respectively were 62.5% and 37.5% for women under 20, 60% and 40% for women 20-29, 27% and 61% for women 30-39, and 15.1% and 60.6% for women 40-49. 28.2% of women over 15 had had a Pap test in the past year. The proportions of different age groups having Pap tests ranged from 2.0% for women under 20 to 46.7% for women aged 30-39. 3 women in the sample households had died in the past year of gyneco-obstetric causes, 1 of complications of childbirth and 2 of cervical cancer.     

Exenteration in benign orbital pathology: report of a case

PURPOSE, MATERIAL AND METHOD: Orbitary exenteration is an indicated treatment for malignant and benign processes where special incidence of extension, uncontrollable pain, unrecoverable visual loss, cosmetic disfiguration, tendency to diffuse or persistent infiltration and malignancy potential have been observed. We report a case of a 22 year-old male from Senegal, presenting an isolated neurofibroma of the orbit of long evolution and great size. RESULTS/CONCLUSIONS: Treatment of this tumor is complete local resection. In this case an orbitary exenteration was performed due to size of the tumor and visual loss. We emphasize the need to treat these patients as soon as possible.     

Health interventions for the metal working industry: which is the most cost-effective? A study from a developing country

This study ranked the cost-effectiveness of health interventions in the metal working industry in a developing country. Data were based on 82 034 workers of the Northern region of Mexico. Effectiveness was measured through 'healthy life years' (HeaLYs) gained. Costs were estimated per worker according to type and appropriate inputs from selected health interventions. 'Hand' was the anatomical region that yielded the most gain of HeaLYs and amputation was the injury that yielded the most gain of HeaLYs. The most effective health intervention corresponded to training, followed by medical care, education, helmets, safety shoes, lumbar supports, safety goggles, gloves and safety aprons. In dollar terms, education presented the best cost-effectiveness ratio (US$637) and safety aprons presented the worst cost-effectiveness ratio (US$1 147 770). Training proved to be a very expensive intervention, but presented the best effectiveness outcome and the second best cost-effectiveness ratio (US$2084). Cost-effectiveness analyses in developing countries are critical. Corporations might not have the same funds and technology as those in developed countries or multinational companies.     

Lignosulfonic acid blocks in vitro fertilization of macaque oocytes when sperm are treated either before or after capacitation

Lignin-derived macromolecules (LDMs) are biologically active compounds that affect a variety of cell-to-cell interactions including the inhibition of fertilization and embryo development in a number of nonmammalian species. The effect of ligno-sulfonic acid (LSA), a highly sulfonated LDM, on cynomolgus macaque sperm-oocyte interaction was evaluated with a zona pellucida binding assay and by in vitro fertilization (IVF). Sperm were treated with LSA (1.5 mg/mL) either before washing or after capacitation. Capacitation included centrifugation through 80% Percoll followed by 2 consecutive washes with medium, overnight incubation, and activation with dibutyryl cyclic adenosine monophosphate and caffeine. The zona binding assay was performed using immature oocytes that had adhered to the center of glass "binding chambers." The number of capacitated sperm that attached to the zona over a 3-minute period was recorded. Sperm attachment was significantly inhibited by LSA as compared to controls whether treatment occurred after capacitation (92.5%; P <.001) or before washing (82.5%; P <.001). When sperm were treated similarly with fucoidin, a sulfated polysaccharide known to inhibit sperm-oocyte interaction, sperm-zona binding was significantly inhibited by postcapacitation treatment but not by prewash treatment. Treatment of sperm with LSA consistently blocked fertilization over 4 IVF cycles both before washing and after capacitation. Fertilization rate for controls was 65% +/- 17%. No LSA-treated sperm were observed on the surface of lightly rinsed oocytes after 4 hours of coincubation. Localization of biotinylated LSA showed labeling over the entire sperm surface with the greatest intensity observed over the head and midpiece. LSA treatment had no effect on the percentage of motile sperm or quality of sperm motility. Due to the antifertility properties of this nontoxic molecule, LSA appears to have potential as a vaginal contraceptive.     

Fiblast (trafermin) in acute stroke: results of the European-Australian phase II/III safety and efficacy trial

BACKGROUND: Trafermin (basic fibroblast growth factor) has been shown to reduce infarct volume in acute ischemic stroke models, and to promote functional recovery and new synapse formation when given to animals with completed cerebral infarction. A previous study in acute stroke patients suggested that trafermin was safe and well tolerated when given over a 3-hour period over a wide dose range. METHODS AND RESULTS: Double-blind, parallel group, placebo-controlled trial of a single 24-hour intravenous infusion of trafermin. Patients having onset of stroke symptoms within 6 h and a baseline score of >/=7 on the NIH Stroke Scale (>/=2 motor) were randomized to receive 5 or 10 mg of trafermin or placebo intravenously infused over 24 h. The primary efficacy outcome was a categorized combination of the Barthel and Rankin scales assessed at 90 days. A total of 286 patients had been enrolled at 55 sites in 11 countries when the sponsor directed that enrollment be stopped because an interim analysis of efficacy data predicted too small a chance of demonstrating a statistically significant benefit after recruitment of the planned 900 patients. The 5-mg group showed a slight but nonsignificant advantage over placebo (OR 1.2, 95% CI 0.72-2.00, p = 0.48); the 10-mg group showed a nonsignificant disadvantage (OR 0.74, 95% CI 0.44-1.22, p = 0.24). Mortality rates at 90 days were 17% in the 5-mg group, 24% in the 10-mg group and 18% in the placebo group. Treatment with trafermin was associated with an increased leukocytosis and a decrease in blood pressure: mean decrease in systolic blood pressure from baseline was 19 mm Hg in the 5-mg group, 22 mm Hg in the 10-mg group and 8 mm Hg in the placebo group. In a post hoc subgroup analysis, patients in the 5-mg group treated more than 5 h after the onset of symptoms showed an apparent advantage over placebo (OR 2.1, 95% CI 1.00-4.41, p = 0.044; after age adjustment: OR 1.9, 95% CI 0.91-4.13, p = 0.08). CONCLUSIONS: With the proper treatment regimen, trafermin can likely be given safely to stroke patients. The 5-mg dose showed a trend toward a treatment advantage. The ideal time window for this agent may exceed 5 h. This may open new avenues for acute stroke therapy, aiming at enhancing recovery mechanisms rather than immediate neuroprotection.     

Musculoskeletal hydatid disease: a report of 13 cases

This is a retrospective study of 13 patients with muscular hydatidosis--i.e., 4% of the 309 cases of hydatid disease treated in our department during 1983-1999. The commonest clinical finding was an asymptomatic and slowly growing mass (7). Puncture or incision of the mass was followed by an infection of the cystic cavity with fistulization in 2 patients. The immunological findings were false negative in 4 patients. MR images were obtained in 4 patients before diagnosis, and were highly suggetive of hydatid disease. The cystic cavities in all 9 patients subjected to radical surgery healed without chemotherapy. Radical surgery was not possible in 4 cases, in 3 of whom the sacrum was involved. Medical treatment of these patients did not eliminate the disease and new operations were necessary.     

Limitations of the diagnostic criteria for type 2 diabetes and glucose intolerance

Conflicting results have been published during the past three decades regarding the cut points for the diagnosis of diabetes and glucose intolerance. Two major consensus changed the diagnostic values; the last revision occurred in 1997. After the publication of the new criteria, the controversy grew. New evidence was published demonstrating that the new cut points were inappropriate. The purpose of this review paper is to summarize the currently available information useful to evaluate the sensibility and specificity of the diagnostic criteria and to discuss the difficulties to define properly the cut-points for the diagnosis of diabetes and glucose intolerance.