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OBJECTIVE: To assess the validity and reliability of bladder ultrasound imaging for noninvasive estimation of urine volume, residual volume after voiding, volume before anesthetic induction and after surgery, and volume on sensing an urge to void. PATIENTS AND METHODS: Study of a prospective series of 47 ASA 1-3 patients aged 18 to 79 years undergoing major outpatient surgical procedures under general anesthesia (n = 24) or regional anesthesia and sedation (n = 23). Urine volume was measured at baseline and on recovery (bladder volume by ultrasound and voided volume in a flask) and at the end of surgery (ultrasound only). The reliability and validity of the ultrasound estimation was calculated. RESULTS: Agreement (intraclass correlation coefficient [ICC]) between 4 ultrasound-image estimations at baseline and the measured amount collected in a flask ranged from 0.70 to 0.86. The inter- and intra-measurement reliability was high, with ICC values greater than 0.80. The median error of estimation by ultrasound, with respect to measurement in the flask, was 23% at baseline and 29% after recovery. The amount in the flask was greater. CONCLUSIONS: Ultrasound monitoring of urine in the bladder is reliable and valid, particularly for small volumes. The procedure is tolerated by patients.

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OBJETIVOS: Evaluar la validez y fiabilidad de la ecografíavesical en la estimación no invasiva del volumende orina y del volumen residual postmiccional, antes dela inducción anestésica, tras la intervención y al sentirnecesidad de orinar.PACIENTES Y MÉTODOS: Serie prospectiva de 47 pacientesASA I-III, de 18 a 79 años de edad, intervenidos enrégimen de cirugía mayor ambulatoria y sometidos aanestesia general (24) o a anestesia regional y sedación(23). Se midió el volumen de orina mediante ecografía yen matraz en los tiempos basal y postquirúgico, medianteecografía en el postquirúrgico inmediato. Se estimaronla fiabilidad y la validez de las mediciones.RESULTADOS: La concordancia entre las cuatro tomasbasales realizadas con el ecógrafo en el primer tiempo yentre cada una de ellas, con las determinaciones delmatraz oscila entre 0,70 y 0,86 (coeficiente de correlaciónintraclase). La fiabilidad inter e intramedida es elevada,con coeficientes de correlación intraclase superiores a0,80. Las medianas de error entre el volumen medido conel ecógrafo y con el matraz, en el momento basal y en lareadaptación, fueron del 23 y el 29% a favor del volumenmedido con el matraz.CONCLUSIONES: La monitorización por ultrasonidos delcontenido vesical es un método fiable y válido, especialmentepara volúmenes pequeños, y aceptado por lospacientes(AU)

OBJECTIVE: To assess the validity and reliability ofbladder ultrasound imaging for noninvasive estimationof urine volume, residual volume after voiding, volumebefore anesthetic induction and after surgery, and volumeon sensing an urge to void.PATIENTS AND METHODS: Study of a prospective series of47 ASA 1-3 patients aged 18 to 79 years undergoing majoroutpatient surgical procedures under general anesthesia (n= 24) or regional anesthesia and sedation (n = 23). Urinevolume was measured at baseline and on recovery (bladdervolume by ultrasound and voided volume in a flask)and at the end of surgery (ultrasound only). The reliabilityand validity of the ultrasound estimation was calculated.RESULTS: Agreement (intraclass correlation coefficient[ICC]) between 4 ultrasound-image estimations at baselineand the measured amount collected in a flask rangedfrom 0.70 to 0.86. The inter- and intra-measurement reliabilitywas high, with ICC values greater than 0.80. Themedian error of estimation by ultrasound, with respect tomeasurement in the flask, was 23% at baseline and 29%after recovery. The amount in the flask was greater.CONCLUSIONS: Ultrasound monitoring of urine in thebladder is reliable and valid, particularly for small volumes.The procedure is tolerated by patients(AU)

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La reforma del sistema de salud implantada por la ley 100 de 1993 provocÓ cambios profundos en todo el sector salud, a la vez que introdujo nuevos actores en el sistema. ¿CÓmo perciben los diversos actores este cambio? ¿cuÁles son sus opiniones? Objetivo: presentar los hallazgos del componente cualitativo de un estudio mayor destinado a evaluar el impacto de los programas de ajuste macroeconÓmico sobre el sector salud en colombia. MetodologÍa: mediante un enfoque cualitativo, se configuraron seis grupos focales y se efectuaron diez entrevistas a informantes claves en dos regiones seleccionadas a propÓsito para maximizar las diferencias esperadas: una, de mayor desarrollo socioeconÓmico (valle del AburrÁ con MedellÍn incluido) y otra, de mÍnimo desarrollo (litoral pacÍfico). Resultados y discusiÓn: dado el tipo de estudio, no presentamos opiniones representativas de la poblaciÓn colombiana, ya que solo pretendemos exponer una gama amplia de opiniones y percepciones de diversos actores. Las percepciones dan cuenta de un cambio importante de caridad a derecho, aumento de recursos del sector y nuevos actores en juego, aumento del grado de institucionalizaciÓn del sistema colombiano, un mayor trabajo intersectorial y una mayor gestiÓn. TambiÉn se perciben problemas como aumento de los costos administrativos y dificultades con los nuevos sistemas de informaciÓn y facturaciÓn. Muchos arguyen que el sistema es demasiado complicado. Los resultados del cambio se perciben en forma diferente

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In vitro regeneration and biolistic transformation procedures were developed for several commercial chrysanthemum Dendranthema grandiflora Tzvelev, syn. Chrysanthemum morifolium Ramat. cultivars using leaf and stem explants. Studies on the effect of several growth regulators and kanamycin on chrysanthemum regeneration were conducted, and a step-wise procedure to optimize kanamycin selection and recovery of transgenic plants was developed. A population of putative transformed chrysanthemum plants cvs. Blush, Dark Bronze Charm, Iridon, and Tara, was obtained after bombardment with tungsten microprojectiles coated with the binary plasmid pBIN19 containing the nucleocapsid (N) gene of tomato spotted wilt virus (TSWV) and the marker gene neomycin phosphotransferase (NPT II). PCR analysis of 82 putative transgenic plants selected on kanamycin indicated that the majority of the lines (89%) were transformed and contained both genes (71%). However, some transgenic lines contained only one of the genes: either the NPT II (15%) or the TSWV (N) gene (14%). Southern blot analysis on selected transgenic lines confirmed the integration of the TSWV (N) gene into the chrysanthemum genome. These results demonstrate the development of an efficient procedure to transfer genetic material into the chrysanthemum genome and selectively regenerate transgenic chrysanthemum plants at frequencies higher than previously reported.

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We have performed 2 implantations of transvenous automatic cardioverter defibrillator in a cardiac laboratory devoted to electrophysiology and pacemaker implantation. This is a preliminary experience with a novel implant strategy. Cardiologists were the primary operators. The automatic cardioverter defibrillator were placed in a subcutaneous pectoral region, with a non-thoracotomy lead system. The automatic cardioverter defibrillator were two Medtronic 7219D PCD Jewel, with a Transvene system. There were no perioperative complications. Acceptable defibrillation threshold were obtained in both patients, 12 and 20 J, respectively. Leads were inserted percutaneously through the left subclavian vein. After 8 months of follow-up the patients continue to tolerate the device satisfactorily. Implantation of automatic cardioverter defibrillator systems by trained cardiologists in an electrophysiology laboratory is safe and feasible. Moreover, its cost-effectiveness is superior, the saving includes the surgeons, and the reduction of stay in unit of intensive care and hospitalization.

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Ten hyperactive children who had failed to respond to methylphenidate were treated with imipramine in a placebo-controlled, crossover design. No significant drug effects were obtained either on parent and teacher ratings of the child's behavior or on the child's performance in a laboratory measure of sustained attention. Findings suggest that imipramine has limited clinical usefulness in the treatment of hyperactive children who fail to respond to methylphenidate.

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The authors report seven cases of electrocardiographic abnormalities occurring in 7- to 10-year-old children receiving imipramine pharmacotherapy for behavior disorders. Three of the children evidenced a first-degree atrioventricular block. The abnormalities were less pronounced in the other four children. Imipramine plasma levels during steady state were not found to be directly related to the extent of the electrocardiographic changes within the obtained plasma values. The authors emphasize the necessity of careful clinical surveillance of children receiving imipramine pharmacotherapy.

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