RESUMEN
BACKGROUND AND OBJECTIVES: This prospective randomized trial compared ultrasound-guided single-injection (SI) and triple-injection (TI) subparaneural popliteal sciatic nerve block. We hypothesized that multiple injections are not required when local anesthetic (LA) is deposited under the paraneurium because the latter entraps LA molecules, ensuring circumferential spread around the nerve. Therefore, in addition to comparable success rates, we also expected similar total anesthesia-related times (sum of performance and onset times) and designed this study as an equivalency trial. METHODS: Ultrasound-guided subparaneural posterior popliteal sciatic nerve block was carried out in 100 patients. In the SI group, LA was deposited at a single location between the tibial and peroneal nerves. In the TI group, LA was injected between the tibial and peroneal divisions, medial to the tibial nerve, and lateral to the common peroneal nerve. The total LA volume (15 mL) and mixture (lidocaine 1%-bupivacaine 0.25%-epinephrine 5 µg/mL) were identical in all subjects. The performance time, number of needle passes, and adverse events (paresthesia, neural edema) were recorded by the (nonblinded) investigator supervising the block. A blinded observer evaluated the success rate (sensorimotor composite score ≥6/8 points at 30 minutes) as well as the onset time and contacted patients 7 days after the surgery to inquire about persistent numbness or motor deficit. RESULTS: Both techniques provided comparable success rates (92%) and total anesthesia-related times (17.1-19.7 minutes). Expectedly, the SI group required fewer needle passes (1 vs 3; P < 0.001) and a shorter needling time (3.0 ± 2.3 minutes vs 4.0 ± 2.3 minutes; P = 0.025). The TI group displayed a shorter onset time (12.5 ± 7.9 minutes vs 15.8 ± 7.9 minutes; P = 0.027). The performance time, procedural discomfort, and incidence of paresthesia (14%-20%) were similar between the 2 groups. Sonographic neural swelling was detected in 2 subjects in the SI group. In both cases, the needle was carefully withdrawn and the injection was completed uneventfully. Follow-up of the 100 subjects 1 week after surgery revealed no residual numbness or motor deficit. CONCLUSIONS: Ultrasound-guided SI and TI subparaneural popliteal sciatic nerve blocks result in comparable success rates and total anesthesia-related times. Expectedly, the SI technique requires fewer needle passes.
Asunto(s)
Anestésicos Combinados/administración & dosificación , Anestésicos Locales/administración & dosificación , Bupivacaína/administración & dosificación , Lidocaína/administración & dosificación , Bloqueo Nervioso/métodos , Nervio Ciático/efectos de los fármacos , Adulto , Anestésicos Combinados/efectos adversos , Anestésicos Locales/efectos adversos , Bupivacaína/efectos adversos , Chile , Combinación de Medicamentos , Epinefrina/administración & dosificación , Femenino , Humanos , Inyecciones , Lidocaína/efectos adversos , Masculino , Persona de Mediana Edad , Bloqueo Nervioso/efectos adversos , Estudios Prospectivos , Quebec , Nervio Ciático/diagnóstico por imagen , Tailandia , Factores de Tiempo , Ultrasonografía IntervencionalRESUMEN
OBJECTIVES: To explore the circumstances and factors that explain the association between private health insurance cover and a high rate of caesarean sections in Chile. DESIGN: Qualitative analysis of audiotaped in-depth interviews with obstetricians and pregnant women; quantitative analysis of data from face to face semistructured interview survey conducted postnatally (with women who had given birth in the previous 24-72 hours), and of a review of medical notes at a public hospital, a university hospital, and a private clinic. SETTING: Santiago, Chile. PARTICIPANTS: Qualitative arm: 22 obstetricians, 21 pregnant women; quantitative arm: 540 postnatal women. MAIN OUTCOME MEASURES: Rates of caesarean section in different types of institutions; consultants' views on private practice; work patterns in private practice; women's reasons for choosing private care; women's preferences on method of delivery. RESULTS: Private health insurance cover requires the primary maternity care provider to be an obstetrician. In the postnatal survey, women with private obstetricians showed consistently higher rates of caesarean section (range 57-83%) than those cared for by midwives or doctors on duty in public or university hospitals (range 27-28%). Only a minority of women receiving private care reported that they had wanted this method of delivery (range 6-32%). With the diversification in the healthcare market, most obstetricians now have demanding peripatetic work schedules. Private maternity patients are a lucrative source of income. The obstetrician is committed to attend these private births in person, and the "programming" (or scheduling) of births is a common time management strategy. The rate of elective caesarean sections was 30-68% in women with private obstetricians and 12-14% in women not attended by private obstetricians. CONCLUSIONS: Policies on healthcare financing can influence maternity care management and outcomes in unforeseen ways. The prevailing business ethos in health care encourages such pragmatism among those doctors who do not have a moral objection to non-medical caesarean section.
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Cesárea/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Sector Privado/estadística & datos numéricos , Actitud del Personal de Salud , Actitud Frente a la Salud , Cesárea/economía , Chile/epidemiología , Femenino , Humanos , Seguro de Salud/economía , Servicios de Salud Materna/economíaRESUMEN
BACKGROUND: Despite indications of high cesarean section rates in various parts of Latin America, relatively few comprehensive studies of national birth intervention trends have been conducted in that continent. Recent national statistics suggest that Chile may now have the highest reported cesarean section rate in the world. This paper examines cesarean birth trends in Chile with reference to changing patterns in health care financing. METHODS: The growth in the national cesarean birth rate is analyzed, with reference to regional patterns, differences according to insurance coverage, and recent shifts in the financing pattern of health care provision, using insurance fund data and hospital reporting systems data for both public and private sector care from the mid-1980s to mid-1990s. RESULTS: Chile had a cesarean birth rate of 37.2 percent for the 301,955 births covered by either the National Health Fund or private health insurance in 1994. This was a one-third increase from the 1986 rate of 27.7 percent. The private health insurance sector revealed consistently far higher cesarean section rates than the National Health Fund sector (59% vs 28.8% in 1994); intrasectoral rates remained fairly stable over the 8-year period. CONCLUSIONS: The overall increase in Chile's cesarean section rate correlates with the growth in the proportion of all births whose care was privately insured during these years (from 7.5% to 24.8%). This change may be partly explained by the doubling (to 32%) of the percentage of women with a personal obstetrician rather than a "duty" practitioner attending the birth of their baby.
Asunto(s)
Tasa de Natalidad/tendencias , Cesárea/estadística & datos numéricos , Cesárea/tendencias , Cesárea/economía , Chile , Femenino , Humanos , Embarazo , Sector Privado , Sector PúblicoRESUMEN
1. We have cloned and characterized a new species of kallikrein cDNA from a human colon cDNA library. The new kallikrein cDNA clone contains a part of intron 2 of the tissue kallikrein gene which is spliced to the remaining exon sequences. It does not contain exons 1 and 2. 2. An in-frame open reading frame is present in the new kallikrein cDNA allowing translation of a 216-amino acid product. The intron-containing kallikrein transcript was detected in salivary glands, pancreas, kidney, colon, prostate gland, testis, spleen, and lung by reverse-transcription/polymerase chain reaction followed by Southern blot analysis using an intron-containing kallikrein-specific oligonucleotide probe. 3. The results indicate that the new species of kallikrein may be processed by alternative splicing or arises from a different transcription initiation site.
Asunto(s)
Colon/enzimología , Calicreínas/aislamiento & purificación , Transcripción Genética , Secuencia de Aminoácidos , Secuencia de Bases , Clonación Molecular , ADN Complementario , Humanos , Intrones , Calicreínas/genética , Datos de Secuencia MolecularRESUMEN
Data gathered among self-identified homosexual men in Guatemala City and Mexico City call into question the intrinsic connection between homosexuality and occupational choice posited by Whitam and Mathy (1986). Concentrations of homosexual men in some occupations can be explained as effects of discrimination and of the normal transmission through personal networks of information about job opportunities, and does not require recourse to any innate drive for homosexual men to be actors, hairdressers or interior decorators.
Asunto(s)
Homosexualidad , Ocupaciones , Guatemala , Humanos , Masculino , México , Prejuicio , Autoimagen , EstereotipoRESUMEN
Over a 3-week period, 20 of 34 (59%) infants in a newborn nursery developed nosocomial viral respiratory tract disease. Either respiratory syncytial virus (seven infants) or parainfluenza virus type 3 (five) or both (two) were demonstrated in respiratory secretions from 14 of the 20 symptomatic patients. Symptoms in the 20 infants included rhinitis (15 infants), cough (14), apnea (eight), pulmonary infiltrates (seven), and fever (six). There were no differences in symptoms between children infected with respiratory syncytial virus alone, with parainfluenza virus alone, or with both viruses concurrently. Patients were clustered in the nursery by agent: infants with the same virus tended to share contiguous bed spaces, supporting the concept that parainfluenza virus as well as respiratory syncytial virus can be transmitted from patient to patient. In addition to this risk for contiguous bed spaces, the presence of a nasogastric tube was associated with risk of illness (P less than 0.05). In the presence of a nursery outbreak of respiratory tract disease, more than one virus may circulate concurrently, and an individual patient may be infected simultaneously by more than one virus.
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Infección Hospitalaria/epidemiología , Brotes de Enfermedades/epidemiología , Salas Cuna en Hospital , Infecciones por Paramyxoviridae/epidemiología , Infecciones por Respirovirus/epidemiología , Boston , Métodos Epidemiológicos , Técnica del Anticuerpo Fluorescente , Hospitales con 300 a 499 Camas , Humanos , Recién Nacido , Intubación/efectos adversos , Nariz/microbiología , Virus de la Parainfluenza 3 Humana/aislamiento & purificación , Infecciones por Paramyxoviridae/complicaciones , Infecciones por Paramyxoviridae/transmisión , Virus Sincitiales Respiratorios/aislamiento & purificación , Infecciones por Respirovirus/complicaciones , Infecciones por Respirovirus/transmisión , Riesgo , Factores de TiempoRESUMEN
The half-life of antipyrine has been estimated from saliva samples in ten subjects by a gas chromatographic method. Half-life, apparent volume of distribution and total body clearance estimated from saliva and plasma concentrations of antipyrine are not significantly different. The concentration of antipyrine in saliva is independent of the flow rate within the range expected in healthy subjects in response to mechanical and sapid stimuli. Antipyrine estimation in saliva could facilitate many areas of pharmacokinetic research limited by the difficulty of obtaining serial plasma samples. (AU)
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Humanos , Adulto , Masculino , Antipirina/metabolismo , Saliva/análisis , Antipirina/análisis , Antipirina/sangre , SemividaAsunto(s)
Linfoma , Adolescente , Negro o Afroamericano , Animales , Linfoma de Burkitt , Niño , Preescolar , Perros , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Población BlancaAsunto(s)
Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Perros , Linfoma de Burkitt , Linfoma , Negro o Afroamericano , JamaicaRESUMEN
2 cases of neoplasms histologically similar to the African lymphoma of children have been found in Jamaica - one in a 12-year-old girl of predominantly African descent, and the other a dog. There was no jaw involvement in these cases. The histology was completely characteristics in the dog, but less so in the child. In Jamaica the leukaemia and lymphoma prevalences resemble those for temperate zones and are unlike those reported equatorial Africa. (AU)