Benzodiazepine use in Chile: impact of availability on use, abuse, and dependence

This study tested the hypothesis whether over-the-counter benzodiazepine availability influenced patterns of benzodiazepine use, abuse, and dependence in Chile. If over-the-counter availability represents a major risk factor leading to benzodiazepine substance use disorders, rates of abuse, and dependence would be significantly higher among over-the-counter benzodiazepine users than among prescription drug users. The study was a household survey of a stratified sample (N = 1,500) of the Santiago (Chile) population performed by trained interviewers. Data were collected by structured questionnaires on demographic characteristics, drug use, psychoactive substance use disorders, and other psychosocial variables. Past-year prevalence of benzodiazepine use was 31.4%, daily use of benzodiazepines for > or = 12 months, 5.9%, and subjects who met DSM-III-R criteria for dependence, 3.3%. Seventy-four percent of subjects obtained the benzodiazepine over-the-counter (always 45%; sometimes 29%). No subject acknowledged recreational benzodiazepine use or met criteria for benzodiazepine abuse. Use, long-term use, and dependence occurred equally frequently among both over-the-counter and prescription benzodiazepine users. Results suggest that although over-the-counter availability increases benzodiazepine use, it is not a major risk factor that leads to benzodiazepine abuse and/or dependence.

[Digestive cytomegalovirus disease in AIDS patients]

BACKGROUND

In this paper we study the digestive manifestations of cytomegalovirus (CMV) in AIDS patients. Also, we evaluate the antiviral treatment and the necessity of maintenance therapy.

METHODS

Retrospective review of medical charts of all patients with AIDS and digestive CMV disease diagnosed and followed-up since 1983 to december 1993.

RESULTS

Of 720 AIDS patients, 96 presented a CMV disease. Among them, 30 patients (31%) complained digestive manifestations. These were 26 males and 4 females, mean age: 37.4 y-old. Risk factors for HIV were: 13 homosex and 12 intravenous drug abusers. Average of time between AIDS diagnosis and digestive CMV disease: 13.4 months. Fourteen patients had esophagitis, 9 proctocolitis, 3 hepatitis, 3 pancreatitis, 2 gastric ulcerations, one small bowel disease and other an oral ulceration. Two patients had a concomitant CMV chorioretinitis. CD4 lymphocytes were below 0.05 x 10(9)/l in 29 patients. Twenty-four patients received antiviral treatment during the acute disease period, with a clinical curation rate of 60%. Seven patients received maintenance therapy and remained free of CMV disease until death. Eleven patients didn't received maintenance treatment. Of them, one patient presented a digestive relapse and two developed a CMV chorioretinitis. Mortality in the first month from diagnosis was 23% and the median of survival time for patients who cured and initial episode of digestive CMV disease was 208 days, wether or not the patient received maintenance therapy or not.

CONCLUSIONS

One third of ours patients with AIDS and CMV infection have a digestive disease. This CMV digestive disease appears in patients with a severe immunosuppression. Acute phase mortality was 23%. The median survival was 7 months, independently or receiving maintenance treatment or not.

[Pleural cryptococcosis in patients with human immunodeficiency virus infection]

Four cases of pleural cryptococcosis as the form of onset of cryptococcosis in patients with human immunodeficiency virus (HIV) infection are reported. In two out of the four cases cryptococci were simultaneously isolated in other localizations (blood and meninges). In the two remaining patients the pleura was the only site of the disease, with serum determination of the cryptococci antigen being negative in one. The four patients evolved favourably, with three being exclusively treated with fluconazol. Pleuritis is an infrequent manifestation in cryptococcosis although it may be the form of onset and the only localization of the disease. Only 10 cases have been reported in patients with HIV infection. The present four cases represent 11% of the authors' series of cryptococcosis in AIDS patients. The diagnostic possibility of cryptococcosis should be considered in patients with human immunodeficiency virus infection presenting pleural effusion.

Prevalence of antibiotics to hepatitis C in a population of intravenous drug users in Valencia, Spain, 1990-1992

BACKGROUND

Hepatitis C has been related to other viral diseases such as the human immunodeficiency virus infection (HIV) or hepatitis B (HBV). The objective of this study was to estimate the prevalence and determinants of antibodies to hepatitis C virus (HCV) in intravenous drug users (IVDU) in Valencia (Spain) and to compare the seroprevalence between the HCV, HIV and HBV in this high risk group.

METHODS

A cross-sectional study was conducted in a sample of 1056 current IVDU from the Valencia area who attended the city's AIDS Information Centre between January 1990 and December 1992. Information on sociodemographic, sexual behaviour, and drug use variables was collected by means of a structured questionnaire. Antibodies to HCV, HIV and HBV were assayed by ELISA test.

RESULTS

The seroprevalence of HCV for the whole period was 85.5% (95% confidence interval [CI]: 83.2-87.5%), ranging from 76.5% in 1990 (95% CI: 71.9-81.1%) to 87.8% in 1992 (95% CI: 82.5-93.1%). Year of testing and prevalence of HBV markers showed an independent association with HCV seroprevalence. When only IVDU aged < 25 years were analysed, sharing of needles also appeared as an independent dominant. Of those IVDU with less than one year of addiction, 69% were HCV seropositive compared with 41% for HBV and 14% for HIV.

CONCLUSIONS

Intravenous drug users in Valencia showed one of the highest reported hepatitis C seroprevalences (85.5%). A more efficient parenteral transmission of hepatitis C virus than HBV or HIV is suggested.

The morphology of Laemobothrion (Laemobothrion) maximum (Phthiraptera: Laemobothriidae)

Adult specimens of Laemobothrion (L.) maximum (Scopoli, 1763), a buzzard louse species, were studied using scanning electron microscopy and paying special attention to sensitive structures, mainly those located on the head, mouthparts, abdomen and legs. Data on shape and size of palpl and antennal sensilla, as well as post-spiracular ones, were obtained. Some modifications of the mouthparts were observed.

Trends in incidence and prevalence of HIV-1 infection in intravenous drug users in Valencia, Spain

Our objective was to describe and compare the trends of incidence and prevalence of HIV-1 infection in intravenous drug users (IDUs) in Valencia, Spain in 1987-1992. A cohort study was carried out in AIDS Information Centers located in the Valencia Region (Spain). Point seroprevalence was calculated for in each year according to HIV status at the first contact. Incidence annual rates were calculated from those IDUs identified as seronegative in their first visit and who returned for a new testing. From a total of 4,207 IDUs who contacted these centers, 4,131 (98.2%) asked voluntarily for HIV-1 testing. The seroprevalence for the whole period was 48.4% (95% C.I., 46.88, 49.92). Follow-up information was available for 604 subjects of the total 2,130 subjects who were seronegative in their first visit. The incidence rate for the 1988-1992 period was 12.02/100 person-years (95% C.I., 9.62, 14.41). Prevalence showed an overall decreasing pattern with a minimum corresponding to the year 1992 (43.6%). Incidence rates increased mildly until 1990 (13.93 per 100 person-years), to stabilize beyond at approximately 10 per 100 person-years. Our incidence rates are very high regardless of the decline of prevalence. Effective risk reduction programs among IDUs have been almost nonexistent in Spain up to now and should become an immediate priority.

ABO-haemolytic disease of the newborn (ABO-HDN): factors influencing its severity and incidence in Venezuela

The objective of this study was to determine the incidence of the Haemolytic Disease of the Newborn due to ABO blood group incompatibility (ABO-HDN) in the population of Caracas attending the Maternity Hospital 'Concepción Palacios'. The relationship between A and B antigens density of cord blood erythrocytes and the cytotoxic activity of antibodies in mothers' sera with the severity of the haemolytic disease, was also studied. From a sample of 245 blood group 'O' mothers, 68 gave birth to full term 'A' or 'B' blood group infants. The evolution of serum bilirubin and the routine haematological values, were followed in all the babies during 72 h after birth, allowing the diagnosis of ABO-HDN in 21 infants. Taking into account that in Venezuela the frequency of blood group 'O' is 59 per cent, it was concluded that in the general population of newborns, 16 per cent present foeto-maternal ABO incompatibility, and the incidence of ABO-HDN was near to 5 per cent. The density of the 'A' and 'B' antigens in cord red cells was studied using an immunoenzymatic assay. No statistically significant association between antigen maturity and severity of the ABO-HDN could be shown. A positive association was found between cytotoxic capacity of mothers' sera and development of ABO-HDN (P < 0.05). Twenty ABO incompatibles children presented moderate late anaemia at 3 weeks of age.

Tenotomy of the tibial insertion of the semitendinosus muscle of two horses with fibrotic myopathy

Two horses with fibrotic myopathy of the semitendinosus muscle are described. The report deals with the aetiology, clinical signs and diagnosis of the condition, and discusses the different surgical techniques described in the literature. Tenotomies were performed on both horses. Excellent results were obtained in the horse in which only the semitendinosus muscle was affected, but in the horse in which the semimembranosus and gracilis muscles were also involved the results were less satisfactory.

Sharing of injection equipment among 3755 intravenous drug users in Valencia, Spain, 1987-1992

BACKGROUND

In order to identify, in a sample of heroin intravenous drug users (IVDU), those factors associated with the predominant risk behaviour related to the transmission of HIV-1 infection--sharing of injection equipment--a cross-sectional survey was carried out in Valencia, Spain from 1987 to 1992.

METHODS

Informed consent and pertinent data were obtained from 3755 heroin IVDU recruited at two public AIDS Information Centres in two cities in the region of Valencia. Data were gathered on sociodemographic variables, and sexual and drug use behaviour by interview. The subjects were subsequently tested for HIV-1 antibody. A univariate analysis was carried out to identify variables that were significantly associated with sharing injection equipment. A logistic regression model was used to control for possible confounders.

RESULTS

The IVDU who were teenagers, prostitutes (OR = 1.95), who had antibodies to HIV-1 (OR = 1.30) or who had an IVDU steady partner were at significantly higher risk for sharing of injection equipment. Higher levels of education, condom use (OR = 0.65) and living in the smaller city (OR = 0.75) were inversely related to sharing injection equipment.

CONCLUSIONS

Our results suggest that different subgroups of IVDU have different characteristics that place them at different risk for HIV-1 infection. These characteristics should guide the design and intensity of specific preventive interventions. Teenagers and IVDU with low educational levels should be targetted for special attention by health authorities.

[Factors associated with the use of gynecology services by climacteric women: a case-control study]

BACKGROUND

The data and concepts described in the literature on menopausic women are based on observations and studies carried out in menopausic women attending medical or gynecological consultations and contrast greatly with the results obtained in women from a general population.

METHODS

In a case-control study 505 women between 45-55 years of age, 142 having attended a gynecological consultation (cases) and 363 taken from a randomized sample of the general population (controls) were evaluated. Information concerning sociodemography, climacteric phase, psychic morbidity and psychosocial factors as stressing events, social support and adjustment and satisfaction with roles was collected in a personal interview. The odds ratio (OR) was used as the means of association and multiple regression analysis was performed to control possible confusing factors.

RESULTS

The cases were fundamentally young women in a premenopausic phase of a high social class belonging principally to a group of widows, separated or divorcees and a group of married women with high levels of association (OR = 14.7; OR 12.14). The women attending a gynecological consultation were characterized by having greater risk of lacking social support (OR = 8.94), presenting a greater frequency of vital severely stressing events over the previous year (OR = 2.55), and demonstrating greater insatisfaction in social adjustment (OR = 2.42) particularly in their sexual and matrimonial relations.

CONCLUSIONS

Women attending medical, specially gynecological, consultations during climacteric years are not representative of the population of women in these years as a whole. Purely pharmacologic management, principally substitutive hormonal therapy, was the most wide-spread treatment of preventive character should be reestablished in accordance with the results with the most manifold and multifactorial orientations and foci.

[The incidence of human immunodeficiency virus type-1 (HIV-1) infection in parenteral drug users]

BACKGROUND

Cohort studies estimating rates of incidence are scarce despite they are the most appropriate for following the epidemics of HIV-1 and evaluating the effectiveness of preventive interventions. The rate of incidence of infection by HIV-1 in intravenous drug users (IVDU) and the determining factors for such infection are estimated in the present study.

METHODS

3,693 IVDU attended in two centers for information and prevention of AIDS from 1987-1992, were included in the study. Out of 1,868 seronegative subjects, 579 attended a second visit in which a new serologic test was performed against HIV-1. The rates of incidence and 95% confidence intervals were calculated with a Poisson regression model being adjusted in order to control the confounding factors.

RESULTS

The estimated global incidence was 11.7/100 people/year (CI 95%: 9.6; 14.46). Those highest rates were observed in IVDU who exchanged syringes (23.5/100 people/year), in those who had more than one sexual partner in the previous month (21.2/100 people/year), in those referring a history of prostitution (22.6/100 people/year), in carriers of hepatitis B antigens (25.6/100 people/year) and in the IVDU younger than 20 years of age (16.5/100 people/year). The variables which independently predicted the rates of incidence were: the exchange of syringes (RR = 6.85; CI 95%: 3.99; 11.75), having more than one different sexual partner in the previous month (RR = 3.51; CI 95%: 1.70; 7.20) and age, with lower risk in those under the age of 20 (RR = 0.49; CI 95%: 0.25; 0.95).

CONCLUSIONS

The incidence of infection by type-1 human immunodeficiency virus observed in intravenous drug users is the highest described in Western countries. Preventive measures in general must be intensified particularly in subgroups of intravenous drug users with the greatest risk of seroconversion.

Pharyngeal bot flies (Oestridae) from sympatric wild cervids in southern Spain

The prevalence of 2 species of pharyngeal bot flies parasitizing sympatric wild ungulates from southern Spain is given. Pharyngomyia picta was found in all red deer and fallow deer whereas Cephenemyia auribarbis was found in 59% of fallow deer and 81% of red deer examined. The mean number of P. picta larvae was 3-6 times more than that of C. auribarbis larvae. These data suggest that red deer are more heavily parasitized than fallow deer and that they are predominantly infested with P. picta larvae.

Social functioning as a significant factor in women's help-seeking behaviour during the climacteric period

In order to identify the psychosocial factors that lead to the demand for medical care related to the menopause, we carried out a case/control study. A case was defined as a woman who sought gynaecological care due to "menopausal complaints" (n = 85) and a control referred to a woman drawn at random from the general population. The cases showed greater psychiatric morbidity and social dissatisfaction, a lower level of diffused social support and a higher frequency of severe life events and the controls showed greater social maladjustment in objective conditions. The multivariate analysis (logistic regression) carried out after adjusting all the relevant variables, indicated that the demand for medical care due to menopausal complaints was not only determined by the menopausal status itself but also by a set of social and demographic variables, especially dissatisfaction and a lack of social support.

Comparative study on benzodiazepine use in Canada and Chile

Benzodiazepines are the most prescribed psychotropic drugs in the world. Comparative international data on benzodiazepine use, specifically among developed and developing countries, are unavailable. To determine the different patterns of benzodiazepine use in two representative countries, use of benzodiazepines in Chile (a developing country) and Canada (a developed country) was undertaken. Wholesale data as provided by the Intercontinental Medical statistics and drug import data were used as databases. Data on trends of benzodiazepine use was determined for 5 years using the methodology recommended by the WHO for drug use research, the defined daily dose/1000 inhabitants/day. Total benzodiazepine use was similar in both countries, but Canadian use had increased slowly. Patterns of use, however, differ widely among the two countries. A linear increase of rapidly eliminated benzodiazepines was observed in Canada, whereas the reverse occurs in Chile: the slowly eliminated benzodiazepines are the ones that have increased use. Hypnotic benzodiazepines are used twice as frequently in Canada than in Chile. Striking differences in the use of individual benzodiazepines are observed. Differences in healthcare systems determine wide differences in the way these drugs are prescribed. Demographic characteristics of the two countries also may account for the differences in benzodiazepine use. The authors conclude that, although total benzodiazepine consumption is similar in the two countries, patterns of benzodiazepine use vary widely. The different patterns of use may determine differences in the morbidity rates associated with the use of these drugs.

The influence of family expressed emotion on the course of schizophrenia in a sample of Spanish patients. A two-year follow-up study

A sample of 60 Spanish schizophrenic patients was studied to ascertain the relationship between their relatives' expressed emotion (EE) and relapse at follow-up. The relatives' EE and patients' relapse were operationalised following Leff & Vaughn's criteria. At nine months a significant association was not found between the relatives' EE and relapse, but this association became significant on reclassifying the relatives' EE scores after decreasing to four points the cut-off point for critical comments. At 24 months no association was found between EE and relapse. There was a tendency for patients who interrupted their medication or who did not work to relapse more frequently, particularly among the high-EE group.

Diagnostic value of ascites gamma interferon levels in tuberculous peritonitis. Comparison with adenosine deaminase activity

The value of ascites gamma interferon concentration and ascites adenosine deaminase activity in distinguishing tuberculosis from other causes of ascites was examined in a prospective study of 86 patients with ascites, including 16 with tuberculous peritonitis. Gamma interferon concentration was higher in tuberculous peritonitis than in the other causes of ascites (p less than 0.0001), and a cut-off between 3 and 9 u/ml reached a sensitivity and a specificity of 100%. The mean (+/- SD) gamma interferon level in tuberculous ascites was 39.3 +/- 18.3 u/ml in patients seronegative for HIV and 14.2 +/- 4.7 u/ml in patients with AIDS (p = 0.01). Adenosine deaminase activity in tuberculous ascites was also higher than in the other causes of ascites (p less than 0.0001), and a cut-off of 40 u/l reached a sensitivity of 100% and a specificity of 97%. The two false positives for adenosine deaminase test were true negatives for the gamma interferon test. There was no significant correlation between gamma interferon concentration and adenosine deaminase activity either in tuberculous ascitis or in any other group. This study suggests that ascites gamma interferon determination may be very useful in the screening of tuberculous peritonitis, but its cost makes it advisable to use adenosine deaminase activity as a routine test, at least in areas where tuberculosis is endemic.

[The experimental production of abdominal wall defects in the chick embryo]

We have developed experimental models of gastroschisis and celosomias (omphalocele and Cantrell's pentalogy) in the chick embryo. They were obtained by operation "in ovo" and early aspiration of 5 ml of egg albumin respectively. We have observed 42 gastroschisis out of 184 operated embryos and 12 exomphalos and 20 pentalogies out of 528 aspirated embryos. These models enable us to study the biology of malformed fetuses.

[Laparoscopic findings in liver fascioliasis. Study of 13 cases]

The laparoscopic findings in 13 patients with liver fasciolasis are described. Diagnosis was made in three cases in base of the presence of ova Fasciola Hepatica in the patient's faeces and in 10 cases, because they fulfilled the following conditions: ingestion of fresh watercress, eosinophilic count exceeding 30%, positive serologic tests, eosinophilic granulomas with Charcot-Leyden crystals in liver biopsy and good response to treatment with dihidroemetine or bithionol. Nine cases (68.2%) showed hepatomegaly. In 12 of 13 (92.3%) lesions suggestive of hepatic distomatosis were found. Hepatic nodules of different sizes and shapes could be seen in 10 patients (76.9%), Glisson capsule was involved in five cases (38.4%) and peritoneum in three (23%). The latter was always affected with the liver but, on the other hand, liver capsule was found affected alone in two cases. In our experience, laparoscopy with liver biopsy is an important method for diagnosis of abdominal fasciolasis.

Spina bifida: a chick embryo experimental model

Neural Tube Defects (NTD) can be induced in the chick embryo with relative ease in order to provide an experimental tool for investigation of such disabling malformations. Domestic hen (Gallus gallus) eggs were incubated at 37.5 degrees C and 80% humidity for 24 h. At that moment, 5 ml of albumen were aspirated by sterile puncture of the shell, and the incubation was resumed. The embryos were recovered and studied at the 8th, 10th and 14th days. Almost half (45%) of the 602 treated embryos survived and 73 of them (12%) had various malformations. Thirty-six (6%) suffered NTD of which 30 were open myelomeningocele, 2 meningocele and 4 encephalocele. The anatomy of the defects was astonishingly similar to that of the human malformation. Whether these experimental NTD are induced by mechanical or nutritional modifications of the internal environment of the egg is unknown, but the similarity of the lesion with those in humans make them suitable for further investigation of these issues. We believe that this relatively simple and inexpensive model is a suitable tool for research on spina bifida.

[Bacteremia and fungemia in patients with AIDS. Study of 56 episodes]

We report 56 episodes of bacteremia and fungemia in 45 patients (23%) out of overall 193 cases of AIDS. 41% of the isolates were gram-negative bacilli, with a predominance of Salmonella enteritidis (30%), most of them community-acquired. Gram-positive cocci (18 episodes) were hospital-acquired in 61%, with a predominance of Staphylococcus sp (10 cases). Mycobacteria and Cryptococcus neoformans were isolated in 8 patients. 88.8% of our patients with cryptococcosis (8/9) had positive blood cultures. 76% of the episodes (43/56) were community-acquired, with a high incidence of primary bacteremias (59%). 48% of the patients were cured, whereas 27% died from causes related with the bacteremia.

Body composition of goat kids during sucking. Voluntary feed intake

The body composition of thirty-eight Granadina goat kids was measured. Six animals were slaughtered at birth while the remainder were kept individually at an environmental temperature of 24 +/- 2 degrees and a relative humidity of 60 +/- 5%. They were given goat's milk or a milk-substitute at two planes of nutrition until 15 or 30 d of age and then slaughtered. The goat's milk and milk-substitute contained 260.4 and 222.0 g digestible protein/kg and 23.23 and 20.85 MJ metabolizable energy/kg respectively. Voluntary feed intake as metabolizable energy was a function of metabolic body-weight (kg W0.75), equivalent to 2.42 and 2.44 times the energy requirement for maintenance for goat's milk- and milk-substitute-fed animals respectively. There was a high degree of correlation between the empty-body concentration of dry matter, fat and energy and empty-body-weight (P less than 0.001) or animal age (P less than 0.001), and between body-weight and animal age (P less than 0.001). The relationships between empty-body composition and empty-body-weight were independent of type of milk or plane of nutrition. In contrast relationships between empty-body composition or empty-body-weight and animal age were affected by the type of milk and, over all, by the plane of nutrition. All these results show that in these animals any body-weight will have a similar composition, but it will be reached earlier or later depending on dietary regimen and always with the limitation of voluntary intake.

[Emotional expressiveness and development of schizophrenia: a reply to the work of Vaughn]

The influence of family climate in the course of schizophrenia has been empirically established. However research has been so far limited to the Anglo-American culture and there are reasons to think that straight forward extrapolation to own our culture may not be totally justified. Consecqently a replication of Vaughn's (Vaughn et al, 1984) has been carried out with a sample of 60 schizophrenic patients in Valencia. Relapse rate was not predicted by EE status or by any EE scale-score according to British original criteria. As the cut-off point was changed from six or more critical remarks to four or more, then the relapse rate was significantly different between high and low EE groups. The study confirms the link between EE-status and relapse rates over nine months but is also underlines the need to take into account cultural differences when it comes to establish cut-off scores.

Intermediate filament and carcinoembryonic antigen expression in salivary gland pleomorphic adenoma

In recent years immunohistochemical studies have become of relevance in the discovery of significant antigenic structures in human cells. Filamentous protein structures with a diameter between that of microtubules and microfilaments have recently been described with the name of intermediate filaments. These structures play an important role in certain cellular functions such as cytokinesis and chromosome movements during cell division. The immunohistochemical expression of these filaments in tumoral disease is identical to that seen in normal cells of the type the tumor arises in. We describe the expression of some of these filaments and of carcinoembryonic antigen in an attempt to clarify the complex origin of pleomorphic adenoma of the salivary glands.

[Primary surgical pathology of the epiploon]

In the last nine years we have operated upon six children (eight males and two females) with primary omental pathology. The age of our patients ranged from five to eleven years with the exception of a newborn prenatally diagnosed of lymphangioma. All the remaining children had abdominal pain and right iliac tenderness for an average of two days. All had leukocytosis and left shift. Vomiting and fever were present only in one instance. In no case the mass was palpated preoperatively. The initial diagnosis was acute appendicitis in all cases. A patient suffered, one year after operation, a second acute clinical picture and the omental mass could be revealed [correction of decealed] preoperatively. At operation there was free intraperitoneal fluid in six instances (three times bloody, two times clear and one purulent). Surgical findings (nine operations) were: three omental segmental infarctions (primary in two cases and secondary to torsion in one), three segmental epiploitis in two patients (one acute, one chronic, one secondary to foreign body), two cystic lesions (one lymphangioma, one hydatic cyst) and one benign tumor (fibromatosis).

[Gamma interferon and adenosine deaminase in pleuritis]

The concentration of gamma interferon (IFN gamma) and adenosine deaminase (ADA) activity were measured in the pleural fluid of 162 patients to compare their diagnostic significance and to establish a possible correlation between both tests. The IFN gamma levels in tuberculous pleural effusions were quite variable, with a mean of 93 U/ml and a median of 48 U/ml. They were higher than 2 U/ml in all cases, whereas no case of nontuberculous effusion showed higher values. ADA activity was higher than 43 U/l in all tuberculous effusions, with a mean value of 80 U/l, higher than in any other group except lymphoma. In three pleural effusions associated with lymphoma, one with mesothelioma, one with adenocarcinoma and four with empyema, ADA activity was higher than 43 U/l. In these patients, IFN gamma levels were low. There was no correlation in the whole series or in any group between IFN and ADA. Both parameters can be very useful for the diagnosis of tuberculous pleuritis. The measurement of IFN gamma is more specific, although the experience with this test is more limited than with ADA. It has the additional shortcoming of a high cost and it requires facilities for radionuclide use. Therefore, we think that ADA measurement should be considered as a routine test while IFN gamma measurement should be reserved for reference institutions.

Immunohistochemical location of S-100 and glial fibrillary acidic proteins in salivary gland pleomorphic adenomas

The S-100 protein is a low molecular weight protein which has been isolated mainly in mammalian brain cells. Glial fibrillary acidic protein is one of the five types of intermediate filaments described to date. We used immunohistochemical methods to study the expression in this patterns of expression of these two proteins in pleomorphic adenoma of the salivary glands, in an attempt to explain their tumor and to elucidate the origin of this complex neoplasm of the salivary glands.

Adenosine deaminase in body fluids: a useful diagnostic tool in tuberculosis

The performance of a colorimetric ADA determination in body fluids other than serum in the diagnosis of tuberculosis was assessed in 1063 patients from whom pleural (600), peritoneal (136), pericardial (77), or cerebrospinal (250) fluids were obtained. In exudative pleuroperitoneal and pericardial effusions, an ADA decision level of 0.71 mu kat/L displayed a sensitivity of 1.00, and was higher than those of histologic (0.83) and bacteriologic (0.62) studies. At this level, ADA reached a specificity of 0.92 and efficiency of 0.94. In cerebrospinal fluid, an ADA catalytic concentration above 0.15 mu kat/L strongly suggests tuberculous meningitis in patients older than 7 years (sensitivity 1.00, specificity 0.99 and efficiency 0.99). ADA results obtained with a UV-method were closely correlated with those of the colorimetric method in pleuroperitoneal effusions (r = 0.989) and in cerebrospinal fluids (r = 0.905). Sample blanks should be processed, otherwise false positive results may be found in non-tuberculous cerebrospinal fluids (5.3%) and pleuroperitoneal effusions (3.8%).

[Use of antimicribials at a University Hospital (1983-1987)]

We studied total utilization of antimicrobials from 1983 to 1987 at the Clinical Hospital, University of Chile. The method of defined daily doses suggested by the WHO was used for analysis. The peak value occurred in 1984 (28.3 DDD/1000 patient-days), the lowest in 1987 (19.9). Penicillins were the most frequently used drugs, followed by aminoglycosides and cephalosporins. The latter group was mainly used at the Intensive Care Unit (37.5% of total cephalosporin use) and by the Intermediate Surgical Unit (35.1%). Use of antimicrobials at the Neurology and Dermatology services represented 5.3 and 4.9% of total utilization, respectively (excluding cephalosporins). These methods may be employed for comparisons of antimicrobials use among Chilean hospitals.

Utilization of benzodiazepines in Chile during 1982-1986

The consumption of benzodiazepine drugs (BDZ) in Chile in the period 1982-1986 has been studied by the DDD method. National use was assessed using drug import forms as a source of information, assuming that the total amount imported was manufactured and consumed in the same year. The utilization did not show a constant pattern, being 32.7, 33.6, 50.2, 34.9, and 31.3 DDD 1000 per inhabitants per day in 1982, 1983, 1984, 1985 and 1986, respectively. During the study period, diazepam was the most commonly used agent amongst anxiolytic BDZ, reaching a peak of 27.1 DDD per 1000 inhabitants per day in 1984, and flunitrazepam was the most popular hypnotic, attaining its maximum in 1986 (6.4 DDD per 1000 inhabitants per day). The use of BDZ at community pharmacy level was also evaluated, employing the International Marketing System (IMS) as the source of information. At that level the pattern of utilization showed a constant increase during the study period, being 14.9 and 25.8 DDD/1000 inhabitants/per day in 1982 and 1986, respectively. In community pharmacies the anxiolytic BDZ most often consumed was diazepam (maximum 9.1 DDD per 1000 inhabitants per day in 1985), and the commonest hypnotic was flunitrazepam (peak 6.0 DDD per 1000 inhabitants per day in 1986). National consumption of BDZ appeared higher and more variable than use at the community pharmacy level, but in both there was greater usage of anxiolytic than of hypnotic BDZ, and diazepam and flunitrazepam were the most popular agents.

Adenosine deaminase activity in rheumatoid pleural effusion

The activity of adenosine deaminase was studied in nine cases of rheumatoid pleural effusion, showing an increase in enzyme activity in all. Rheumatoid arthritis seems unique, however, as it cannot be differentiated from pleural tuberculosis on the basis of this test. Selective increase of adenosine deaminase in both conditions is attributed to stimulation of T lymphocytes in the pleural fluid.

Disposition kinetics of dibekacin in normal subjects and in patients with renal failure

Dibekacin pharmacokinetics was studied in ten healthy volunteers and six patients with renal failure presenting Clcr less than 10 ml X min-1 per 1.73 m2 of body surface, given as a slow intravenous bolus to the volunteers and as a 30-minute intravenous infusion to the patients. The antibiotic was assayed in plasma and urine by means of a microbiological method using Bacillus subtilis. A two-compartment kinetic model was used to describe the bi-phasic decline of the plasma concentration thus establishing the different pharmacokinetic parameters. Elimination parameters beta, k10 and total body clearance were markedly diminished in renal patients (p less than 0.001): t1/2 beta was 2.0 h, k10 = 0.016 min-1 and Cl = 0.87 ml X min-1 kg body weight in normal subjects and t1/2 beta = 21.4 h, k10 = 0.0011 min-1 and Cl = 0.131 ml X min-1 per kg in the patients. Other kinetic parameters, as distribution (alpha) and transfer (k12, k21) constants were lower in patients than in volunteers. Also the different terms of volume of distribution of the two-compartment model (V1, Vdss, Vdarea) were significantly higher in patients than in normal subjects (p less than 0.05). A good correlation (r = 0.987) between patients' beta constant and creatinine clearance was found. A similar relationship between serum creatinine levels and disposition half-life was found (r = 0.955). Urinary recovery at 24 h was 89.0% of the dose given to normals and 15.8% of the dose given to patients.

Adverse drug reactions (ADRs) in patients with heart diseases. Comparison between patients without and with heart failure

Adverse drug reactions (ADRs) may be more frequent in patients who present some diseases. By means of an intensive prospective drug surveillance work, 492 patients with heart diseases, hospitalized at the Department of Medicine of the Clinical Hospital of the University of Chile, were studied in order to determine the frequency and characteristics of ADRs. ADRs were significantly more frequent in patients with heart failure (HF) (30.0%) than in those without HF (22.7%)(p less than 0.05). Patients presenting HF developed more metabolic disturbances than patients not presenting HF (p less than 0.001). Furosemide was the most frequently used drug in both groups, but treatment with it was longer in patients with HF who presented a significantly higher frequency of adverse reactions to this diuretic (p less than 0.05). 89.9% of ADRs in patients without HF and 93.8% of ADRs in those with HF, were dose-related effects. Analyses of some predisposing factors to ADRs, such as age, number of drugs administered, duration of hospitalization, ADR or allergy histories and presence of a renal failure, did not explain differences found between ADRs in patients without and with HF. These findings suggest that heart failure may be a determinant of frequency and characteristics of ADRs.