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Nephrostomy has been the standard method of urinary diversion for chronic ureteral obstruction or when placement of ureteral stents has failed. We describe the first case of left kidney ileal conduit (Briker's urinary diversion) subcutaneous urinary by-pass. This method made the patient free from a second collecting bag without any significant complications. This method may improve the quality of life of patients with severe ureteral obstruction and ileal conduit.

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Este artículo profundiza en los esfuerzos realizados durante el siglo XVII por catedráticos y estudiantes de Medicina, colegios de boticarios y cirujanos y magistrados municipales de Valencia orientados a la creación y mantenimiento de un huerto destinado al cultivo de plantas medicinales procedentes de diferentes partes del mundo

This article deepens on fue efforts made during fue 17th century by Medicine professors and students, Pharmacist Associations as well as surgeons and magistrates from Valencia directed toward the creation and mantenaince of a garden destinated to the growing of medicinal plants from worldwide

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Use of the Mainz pouch II technique leads to a reduction in the complications frequently observed because of the high pressure associated with ureterosigmoidostomy. A technical variation of the procedure is described in which reimplantation of the left ureter in the rectosigmoid is carried out to avoid the risk of stretching and kinking and the need to fix the pouch to the sacrum. Furthermore, this procedure is easier to perform and less time consuming.

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OBJECTIVE: To perform a modelled economic analysis of the efficacy and tolerability of aceclofenac in comparison with those of other nonsteroidal antiinflammatory drugs (NSAIDs) used in the treatment of common arthritic disorders including osteoarthritis, rheumatoid arthritis and ankylosing spondylitis. DESIGN: A decision analytical model was constructed to represent the clinical and economic consequences of NSAID treatment. Probabilities of noncompliance, lack of efficacy and incidence of adverse events were obtained from comparative randomised double-blind clinical trials. Local unit treatment costs were used and an expert panel was convened to estimate resource use. Both classical foldback analysis and bootstrap methods were used to compute point estimates and 95% confidence limits of costs for NSAID treatment. PATIENTS AND INTERVENTIONS: Data were obtained from 12 randomised double-blind clinical trials included in an earlier meta-analysis. MAIN OUTCOME MEASURES: Total costs to the healthcare provider, including NSAID treatment costs (drug acquisition costs and physician visits for prescription) and iatrogenic costs (substitution treatment costs for patients not achieving clinical efficacy and costs of medical visits, treatment, diagnostic tests and hospital stays associated with adverse events) and the iatrogenic cost factor (ICF) were used as the primary outcome measures. RESULTS: Means and 95% confidence intervals revealed no statistically significant differences in total costs between aceclofenac and other NSAIDs, with the exception of piroxicam, despite substantial differences in drug acquisition costs. The ICF for aceclofenac was lower than that for all other comparators, and differences in ICF between aceclofenac 200 mg/day and diclofenac 150 mg/day, indomethacin 100 mg/day, naproxen 1000 mg/day, tenoxicam 20 mg/day or ketoprofen 150 mg/day were statistically significant. CONCLUSION: These results show that the comparative overall costs of NSAIDs bears little relation to drug acquisition cost, and that the ICF is one of the most important determinants of overall costs.

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OBJECTIVE: To assess the long-term tolerability and safety of a single, oral 12.5-mg dose of almotriptan and its efficacy in alleviating pain associated with consecutive migraine episodes occurring during a 12-month period. BACKGROUND: While sumatriptan appears to be effective for treatment of migraine, the drug has several properties that limit its use. Almotriptan, a new selective 5-HT1B/1D agonist, may be better tolerated over the long term. METHODS: This 1-year study was conducted on 806 adults between the ages of 18 and 65 years suffering from migraine, either with or without aura. The patients met the criteria for study as outlined by the International Headache Society and were instructed on drug use. Oral almotriptan 12.5 mg was used to treat the attack of any pain severity and a second dose was permitted in case of relapse of pain during the first 24 hours. Rescue medication was provided. Efficacy and tolerability were assessed by a combination of patient reporting and clinical visit evaluations. RESULTS: Overall, almotriptan was well tolerated. At 2 hours, 81% of attacks were relieved; 56% of the subjects were entirely free of pain. These efficacy data are similar for the first as well as the last attack studied. At analysis, 534 patients had treated their migraines for at least 6 months. About half of all patients experienced at least one adverse event, with 87% of the events being mild or moderate in nature. The most frequent adverse events were back pain (7.23% of patients), bronchitis (5.76%), and influenzalike symptoms (5.62%). Seventy-one percent of the adverse events were not related to almotriptan use. CONCLUSIONS: Almotriptan at an oral dose of 12.5 mg is safe antimigraine treatment. The safety profile results are similar to those obtained in other controlled triptan clinical studies. Almotriptan is efficacious in moderate-to-severe migraine pain and can be used repeatedly in recurrent episodes. The long-term safety data will be reanalyzed when full data become available.

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AIM OF THE STUDY: We propose some technique devices for treating simple renal cysts with percutaneous puncture (PCN) to reduce recurrences. MATERIALS AND METHODS: Between January 1995 and December 1998, a series of 42 patients, 13 females and 29 males, ranging in age between 49 and 73 were treated for symptomatic kidney cystic disease. The cysts varied between 7.4 and 13.6 cm in diameter and from 100 to 570 cm(3) in volume. This technique consists of echo-guided emptying of the cyst, and slowly inserting a quantity of pure 95% ethanol, equivalent to about 1/3 of the cyst volume, into the cavity. This acts as a sclerosant agent on the cyst walls. The protocol of this technique also includes positioning a curled drainage catheter, for 24-48 h, in suction, to ensure a correct collapse of the cyst walls and to avoid cyst recurrence. RESULTS: Of the 42 patients treated, only 4 did not complete the protocol. In 3 cases, the patients were not able to stand the procedure because of intense pain during cyst filling with alcohol. The other patient had intracystic hemorrhage. The results were evaluated by ultrasonography at 7 days post-operatively and then at 1, 3, 6, 9 and 12 months later. There was a further follow-up lasting from 12 to 36 months. Of 38 patients treated, 29 (76%) did not have any recurrence. 8 patients (21%) developed a small liquid layer of 3-4 cm, which did not enlarge in subsequent check-ups. We observed a recurrence, which spontaneously reduced in volume, only in 1 patient. CONCLUSIONS: This procedure was simple to apply in an out-patient setting and used low-cost materials which are easily obtained. Moreover, the results appear to confirm the validity of this technique.

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The Supreme Board of Health was the first Spanish health institution that took responsibility for health throughout the entire territory of the Crown. Established in 1720 at the behest of Felipe V, the Board was endowed of wide prerogatives from the political and administrative point of view, and was characterized by a rational, centralist stance. In practice, however, its function was limited in essence to the preservation of the Kingdom and the protection of the people's health against catastrophic diseases. It adopted measures of a defensive nature in the face of the various epidemics that occurred within the outside of Spain during the eighteenth century.

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Chromosomal aberrations (CA) were studied in the peripheral blood lymphocytes of 85 healthy male volunteers from Barcelona (Catalonia, Spain). The effect that factors such as age, life style, work exposure and medical treatment had on the cytological endpoints was studied by means of a Poisson regression model. The results obtained indicate a significant positive relationship between the age of the subjects analyzed and the total of chromosome-type aberrations. With respect to the other variables analyzed, a positive association was found between the frequent consumption of analgesics and the incidence of chromatid-type aberrations.

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OBJECTIVE: To improve the understanding of attendance pressure, its evolution over time and its relationship with the indicators of demand, use and age of the resources. DESIGN: Descriptive and retrospective. SETTING: Primary care centres with an appointment system in the Community of Valencia. There were 6,756 valid registers of the monthly attendance pressure (1989-1993) available. MEASUREMENTS AND MAIN RESULTS: Attendance pressure has an extremely dispersed distribution. Behaviour which is constant in its evolution over time does exist, which allows a characteristic curve, repeated every year, to be defined: descent in August, two peaks in October and January and a third "mobile" peak around March and April. Mathematical equality between attendance pressure and the product of three factors has been obtained: duration of use per procedure x intensity of repeated use per procedure x ratio equivalent day. The analysis of the monthly evolution of each one of these three "components" helps understand changes in pressure. These "components" are also modified by the type and age of centre. CONCLUSIONS: The wide dispersion of the results of technical productivity (attendance pressure), and the evidence of its change in composition over time and according to the care model offer important scope for management. It also creates the need for an explanatory model which includes the variables which determine both the attendance pressure and a method for altering it.

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SCE (sister-chromatid exchanges), HFC (high frequency cells) and PRI (proliferative rate index) were studied in the peripheral blood lymphocytes of 154 healthy male volunteers, from Barcelona (Spain). SCE, HFC and PRI variability between and/or within individuals was estimated by means of a mixed linear model. This model allows a determination of the relationship between confounding factors (demographics, life style, work exposure and medical history) and the cytogenetic and cytokinetic parameters analyzed. The results obtained indicate the existence of an important intra-individual heterogeneity in SCE rates, as well as in HFC and PRI values. Although age did not seem to affect either the SCE frequency or the HFC percentage, it showed a significant positive association with the presence of cells with higher SCE frequencies. With respect to the confounding factors, only cigarette smoking increased the SCE rates and the HFC values. On the other hand, PRI mean showed significant differences dependent on age and was inversely correlated with alcohol consumption and X-ray exposure.

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Color Doppler myocardial imaging is a new technique that has been developed specifically to allow color Doppler imaging of myocardial wall motion rather than blood pool imaging. Such a technique has the potential to interrogate velocities, accelerations, and Doppler signal strength within the myocardial wall. Moreover, the concomitant enhancement of the myocardial Doppler signal after an intravenous injection of a transpulmonary echocardiographic contrast agent could permit the noninvasive assessment of regional myocardial perfusion. Thus this new imaging modality could be a valuable adjunct to the ultrasound assessment of myocardial ischemia.

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In a previous collaborative work, we have recently shown that the cytochalasin-B (Cyt-B) concentration used in the human lymphocytes cytokinesis-block micronucleus (CBMN) assay is an important variable in the baseline micronuclei (MN) frequency as well as in the percentage of binucleated cells obtained. Now we have investigated how Cyt-B concentration modulates the MN frequency induced in whole blood human lymphocyte cultures by two clastogens (ethyl methanesulphonate and mitomycin-C) and two aneugens (colchicine and vincristine sulphate). The experimental design includes six donors, two concentrations of Cyt-B (3 and 6 micrograms/ml), two concentrations of the four chemicals tested and the exchange of slides between laboratories. The statistical analysis of the results shows: (i) non-significant differences in the MN frequencies and in the toxicity results between scorers from each laboratory, except for 0.06 microM colchicine at 3 micrograms/ml Cyt-B; (ii) an induction of MN by all genotoxic agents tested, the frequencies being lower with 6 than with 3 micrograms/ml Cyt-B, in control and aneugen-treated cultures; and (iii) significant differences between Cyt-B concentrations in several treatments, obtaining lower MN frequencies and higher values for nuclear division index and % binucleated cells when 6 micrograms/ml Cyt-B was used. Bearing in mind these results as well as the toxicity data showing that 6 micrograms/ml Cyt-B is much more effective in blocking cytokinesis, we can conclude that the use of 3 micrograms/ml Cyt-B may overestimate the induced frequency of MN.

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