Evolution of quality indicators in acute stroke during the RACECAT Trial: Impact in the general population.

BACKGROUND: Acute ischemic stroke patients not referred directly to a comprehensive stroke center (CSC) have reduced access to endovascular treatment (EVT). The RACECAT trial is a population-based cluster-randomized trial, designed to compare mothership and drip-and-ship strategies in acute ischemic stroke patients outside the catchment area of a CSC. AIMS: To analyze the evolution of performance indicators in the regions that participated in RACECAT. METHODS: This retrospective longitudinal observational study included all stroke alerts evaluated by emergency medical services in Catalonia between February 2016 and February 2020. Cases were classified geographically according to the nearest SC: local SC (Local-SC) and CSC catchment areas. We analyzed the evolution of EVT rates and relevant workflow times in Local-SC versus CSC catchment areas over three study periods: P1 (February 2016 to April 2017: before RACECAT initiation), P2 (May 2017 to September 2018), and P3 (October 2018 to February 2020). RESULTS: We included 20603 stroke alerts, 10,694 (51.9%) of which were activated within Local-SC catchment areas. The proportion of patients receiving EVT within Local-SC catchment areas increased (P1 vs. P3: 7.5% (95% confidence interval (CI), 6.4-8.7) to 22.5% (95% CI, 20.8-24.4) p < 0.001). Inequalities in the odds of receiving EVT were reduced for patients from CSC versus Local-SC catchment areas (P1: odds ratio (OR) 3.9 (95% CI, 3.2-5) vs. P3: OR 1.5 (95% CI, 1.3-1.7) In Local-SC, door-to-image (P1: 24 (interquartile range (IQR) 15-36), P2: 24 (15-35), P3: 21 (13-32) min, p < 0.001) and door-to-needle times (P1: 42 (31-60), P2: 41 (29-58), P3: 35 (25-50) p < 0.001) reduced. Time from Local-SC arrival to groin puncture also decreased over time (P1: 188 [151-229], P2: 190 (157-233), P3: 168 (127-215) min, p < 0.001). CONCLUSION: An increase in EVT rates in Local-SC regions with a significant decrease in workflow times occurred during the period of the RACECAT trial.

Determinants and Trends of the Use of Intravenous Thrombolysis for Minor Stroke: A Population-Based Study, 2016 to 2020.

BACKGROUND: We analyzed the main factors associated with intravenous thrombolysis (IVT) in patients with minor ischemic stroke. METHODS: Data were obtained from a prospective, government-mandated, population-based registry of stroke code patients in Catalonia (6 Comprehensive Stroke Centers, 8 Primary Stroke Centers, and 14 TeleStroke Centers). We selected patients diagnosed with ischemic stroke and National Institutes of Health Stroke Scale (NIHSS) ≤5 at hospital admission from January 2016 to December 2020. We excluded patients with a baseline modified Rankin Scale score of ≥3, absolute contraindication for IVT, unknown stroke onset, or admitted to hospital beyond 4.5 after stroke onset. The main outcome was treatment with IVT. We performed univariable and binary logistic regression analyses to identify the most important factors associated with IVT. RESULTS: We included 2975 code strokes; 1433 (48.2%) received IVT of which 30 (2.1%) had a symptomatic hemorrhagic transformation. Patients treated with IVT as compared to patients who did not receive IVT were more frequently women, had higher NIHSS, arrived earlier to hospital, were admitted to a Comprehensive Stroke Centers, and had large vessel occlusion. After binary logistic regression, NIHSS score 4 to 5 (odds ratio, 40.62 [95% CI, 31.73-57.22]; P<0.001) and large vessel occlusion (odds ratio, 16.39 [95% CI, 7.25-37.04]; P<0.001) were the strongest predictors of IVT. Younger age, female sex, baseline modified Rankin Scale score of 0, earlier arrival to hospital (<120 minutes after stroke onset), and the type of stroke center were also independently associated with IVT. The weight of large vessel occlusion on IVT was higher in patients with lower NIHSS. CONCLUSIONS: Minor stroke female patients, with higher NIHSS, arriving earlier to the hospital, presenting with large vessel occlusion and admitted to a Comprehensive Stroke Centers were more likely to receive intravenous thrombolysis.

Bottlenecks in the Acute Stroke Care System during the COVID-19 Pandemic in Catalonia.

INTRODUCTION: The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system's bottlenecks from a territorial point of view. METHODS: Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15-May 2, 2020) and an immediate prepandemic period (January 26-March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days. RESULTS: Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = -0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05-2.4], p 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4-0.9], p 0.015) during the pandemic period. CONCLUSION: During the COVID-19 pandemic, Catalonia's stroke system's weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system's analysis is crucial to allocate resources appropriately.

Una rareza infradiagnosticada: síndrome de Parsonage-Turner (neuritis braquial aguda) / A rare and seldom diagnosed condition: Parsonage-Turner Syndrome (acute brachial neuritis)

El hombro doloroso es un motivo de consulta frecuente en centros de Atención Primaria y urgencias hospitalarias pediátricas. Establecer un correcto diagnóstico diferencial evitará la iatrogenia sobre el paciente. Presentamos un caso de Síndrome de Parsonage-Turner (también conocido como neuritis braquial aguda) que, aunque es causa infrecuente de hombro doloroso, presenta una clínica muy sugestiva caracterizada por dolor agudo seguido de síntomas neurológicos de instauración tórpida. Como pruebas complementarias (se trata de un diagnóstico de exclusión) son de utilidad el electromiograma y la resonancia magnética. Presenta una evolución favorable con resolución espontánea, aunque está demostrado el beneficio del tratamiento antiinflamatorio y rehabilitador (AU)

The painful shoulder is a common condition for visiting in primary care and hospital emergencies. Establishing a correct differential diagnosis would prevent the iatrogenic patient. Therefore we consider appropriate presenting a case of Parsonage-Turner Syndrome (also known as acute brachial neuritis) which, although it is a rare cause of painful shoulder, it has a very suggestive clinical presentation: acute pain is followed by torpid onset of neurological symptoms. It is an exclusion diagnosis, although electromyogram and magnetic resonance imaging are useful tests. It presents a favourable prognosis with spontaneous resolution although anti-inflammatory treatment and rehabilitation show benefits (AU)

Incremento de la incidencia de los derrames pleurales en el Área de Salud de Albacete: Revisión de 12 años / Increase in the incidence of pleural effusion in the Health Care Area of Albacete: A 12 year review

Introducción. En los últimos años se ha constatado un aumento en la incidencia de derrames pleurales (DP) para-neumónicos. El objetivo del estudio es conocer las características epidemiológicas, clínicas y microbiológicas de los derrames, su incidencia y los cambios producidos desde la introducción de la vacuna antineumocócica. Material y métodos. Estudio retrospectivo y descriptivo de pacientes ingresados por DP en el Servicio de Pediatría del Complejo Hospitalario Universitario de Albacete desde enero de 1996 hasta diciembre de 2007. Resultados. Grupo de estudio: 71 pacientes. La incidencia anual de DP ha aumentado desde el año 2000, con una incidencia máxima de 24 caos por 100.000 niños menores de 14 años del Área de Albacete. El 72,4% de los niños no habían recibido la vacuna antineumocócica. Se practicó 23 (32,3%). Se identificó el microorganismo responsable en 19 casos (26,7%). 13 fueron por Neumococo (18,5%). El 57% de los neumococos fueron sensibles a penicilina. 15 casos (21,1%) precisaron tubo de drenaje pleural y un 22,5% (16 casos) toracoscopia. Conclusiones. Desde el año 2000 observamos un aumento de la incidencia global de los DP y de los derrames por Neumococo. Las características clínicas de nuestros pacientes son similares a las descritas en otras publicaciones. La rentabilidad de los cultivos y la resistencia de Neumococo a la penicilina han sido bajas (AU)

Introduction. An increased incidence of parapneumonic pleural effusions has recently been reported. The aim of this study is to identify the epidemiological, clinical and microbiological characteristics of this illness, to determine the impact of the antipneumococcal vaccine and any changes occurred since its introduction. Material and methods. Retrospective analysis of patients hospitalized due to a pleural effusion in the Department of Paediatrics of the Universitary Hospital of Albacete form January 1996 to December 2007. Results. Study group: 71 patients. The anual incidence of pleural effusions has increased since 2000, with a peak incidence of 24 cases per 100,000 children under 14 years old in the Area of Albacete. 72,4% of children had not received the pneumococcal vaccine. Thoracocentesis was performed in 56,3%. 23 cases fulfilled criteria for empyema (32.3%). The involved microorganism was isolated in 19 case (26.7%), 13 were Pneumococcus (18.5%). 57% of Pneumococci were sensitive to Penicilli. 15 children (21.1%) needed a pleural tube, 16 (22.5%) a thoracoscopy. Conclusins. We observed and increase in the overall incidence of pleural effusions since 200, most of them due to Pneumococcus. The clinical features of our patients are similar to others reported in the literature. The sensitivity of microbiological cultures is low as well as the Pneumococcus resitance to penicillin (AU)

Bandwidth-tunable single-photon source in an ion-trap quantum network.

We report a tunable single-photon source based on a single trapped ion. Employing spontaneous Raman scattering and in-vacuum optics with large numerical aperture, single photons are efficiently created with controlled temporal shape and coherence time. These can be varied between 70 ns and 1.6 micros, as characterized by operating two sources simultaneously in two remote ion traps which reveals mutual and individual coherence through two-photon interference.

Relación entre frecuencia cardíaca y excreción urinaria de albúmina en sujetos normotensos y en hipertensos grados 1-2 nunca tratados / Relationship between heart rate and urinary albumin excretion in normotensives and never treated hypertensive grades 1-2

Fundamento. Algunos estudios previos han observado que tanto el incremento de la frecuencia cardíaca como la microalbuminuria se asocian a un aumento del riesgo cardiovascular.El objetivo de este estudio fue valorar la relación entre elevación de la frecuencia cardíaca y presencia de microalbuminuria en sujetos normotensos y en hipertensos ligeros o moderados nunca tratados. Pacientes y métodos. Se incluyeron 70 sujetos con hipertensión arterial (HTA) grados 1-2 (presión arterial sistólica [PAS] 140-180 mmHg y o presión arterial diastólica [PAD] 90-109 mmHg) nunca tratados y 57 normotensos (presión arterial [PA] < 130/85 mmHg). Se consideró como PA y frecuencia cardíaca (FC) clínica la media de 3 determinaciones en dos días diferentes separados por al menos 4 semanas. Se llevó a cabo un registro ambulatorio de la PA durante 24 horas en todos los sujetos hipertensos y en los sujetos controles mediante un monitor Spacelabs 90202 ó 90207. Se determinó mediante nefelometría la excreción urinaria de albúmina en todos los sujetos en orina de 24 horas. Los sujetos hipertensos se clasificaron como microalbuminúricos cuando la excreción urinaria de albúmina (EUA) fue superior o igual a 30 mg/24 h. Resultados. Se observó microalbuminuria en 15 hipertensos (22,1 por ciento) y tan sólo en un sujeto normotenso (2 por ciento); p = 0,0021.La frecuencia cardíaca clínica fue significativamente más elevada en los hipertensos respecto a los normotensos (74 ñ 9 frente a 69 ñ 11; p = 0,0023). Al analizar la FC medida durante la monitorización ambulatoria de la presión arterial (MAPA) se observó que los hipertensos microalbuminúricos presentaban una FC significativamente mayor que los hipertensos normoalbuminúricos y que los normotensos controles, tanto para la FC-24 h (85 ñ 11, 76 ñ 11 y 75 ñ 8 latidos por minuto [lpm], respectivamente; p= 0,0037) como para la FC diurna (91 ñ13, 80ñ11 y 79ñ9; p=0,0011). Conclusiones. Los sujetos hipertensos con microalbuminuria presentaron una frecuencia cardíaca medida mediante la MAPA significativamente más elevada que los hipertensos normoalbuminúricos y que los normotensos (AU)

Blood pressure reactivity to mental stress task as a determinant of sustained hypertension after 5 years of follow-up.

Previous studies have reported an increased risk of developing sustained hypertension (SH) in borderline or mildly hypertensive subjects showing an exaggerated response of blood pressure (BP) to mental stress. The aim of this study was to assess if the response of BP to mental stress tasks is an independent predictor of SH. A total of 89 patients with grade 1 hypertension, aged 18-64 years, 62% males, were included. The mean of follow-up was 5.3 years (s.d. 2.1 years). SH was defined as the development of grades 2-3 hypertension (Systolic BP>or=160 mmHg or diastolic BP>or=100 mmHg) or to be in antihypertensive treatment after follow-up. Two mental stress tasks: mental arithmetic stress task and a stressful interview (SI) were applied at entry. The subjects were classified as hyper-reactors when BP increase was greater than 35 mmHg for systolic BP or greater than 21 mmHg for diastolic BP, according to the results obtained previously in a normotensive control group. In the univariate analysis, the factors associated with the development of SH were age (P=0.0007), office diastolic BP (P=0.014) and hyper-reactivity of BP during a stressful interview (P=0.003). In the Cox regression model, after adjusting for gender, age, and office BP, the hyper-reactivity of BP during SI was an independent predictor of development of SH. In conclusion, the response of BP to mental stress tasks is useful in predicting SH in young and middle-aged subjects with grade 1 hypertension.

Consumo de alimentos y ayudas ergogénicas en culturistas / Food intake and ergogenic aids in body-builders

Antecedentes: El propósito del estudio fue conocer los hábitos alimentarlos, de consumo de ayudas ergogénicas y de actividad fisica en culturistas. Adicionalmente, valorar su composición corporal y sus niveles de metabolitos en plasma sanguíneo. Material y métodos.- Se diseñó un estudio transversal, descriptivo y analítico, en el que participaron 16 culturistas varones de nivel nacional que entrenaban en la fase de volumen, tres meses antes de la competición. Se aplicaron: un cuestionario de frecuencia de consumo de alimentos, un registro de ingestas de 14 días, una entrevista semi-estructurada para conocer el consumo de ayudas ergogénicas y las características del entrenamiento, un estudio antropométrico y una analítica plasmática de rutina. El análisis de datos se hizo mediante la prueba t-student y regresión lineal simple. Resultados: Los culturistas consumían dos o más anabolizantes androgénicos, uno de los cuales era testosterona y, además, clenbuterol recibiendo dos o más dosis semanales de anabolizante. El consumo medio diario de energía fue de 3.200 K-calorías y de proteínas, 2,5 g/kg. Los sujetos con ingesta proteica superior a 3,0 glkgídía (media 3,6 g/kg/día) presentaron mayor aporte de otros nutrientes (hierro y vitaminas B, B6y B,,) (P<0,05) y niveles plasmáticos elevados de urea (AU)

Ausencia de relación entre insulinemia y afectación orgánica en hipertensos no tratados grados 1-2 / Absence of relationship between insulinemia and organic involvement in non treated hypertensive patients grades 1-2

Antecedentes. Aunque la hiperinsulinemia se comporta como un factor de riesgo independiente de enfermedad coronaria y cerebrovascular, sólo algunos estudios han investigado la relación entre la resistencia a la insulina y la afectación precoz de órganos diana en los sujetos hipertensos. Objetivo. Valorar si el nivel de insulinemia es un determinante independiente de afectación temprana cardíaca o renal en pacientes no tratados con hipertensión arterial grados 1-2.Pacientes y métodos. De la cohorte de pacientes hipertensos del estudio Hospitalet, 125 sujetos aceptaron participar en el estudio de la insulinemia que se determinó mediante radioinmunoensayo. A estos pacientes, formando parte del protocolo básico de la Unidad de Hipertensión Arterial, se les efectuó una determinación de la excreción urinaria de albúmina (EUA) de 24 horas por nefelometría y una ecocardiografía. Se consideró microalbuminuria una EUA entre 30 y 300 mg/24 horas. Se definió como hipertrofia ventricular izquierda un índice de masa ventricular izquierda superior o igual a 125 g/m2. Resultados. Los pacientes incluidos presentaron una edad media de 41,0 años (desviación estándar [DE]: 11,8). El 40,8 por ciento eran mujeres. La presión arterial diagnóstica media fue de 150,1 (DE: 10,5)/95,1 (DE: 5,0) mmHg. Se detectó hiperinsulinemia basal en un 8,8 por ciento de los pacientes, hipertrofia del ventrículo izquierdo en 26 sujetos (23,2 por ciento; IC 95 por ciento: 15,4 por ciento-31,0 por ciento) y microalbuminuria en 12 casos (13,3 por ciento; IC 95 por ciento: 7,1 por ciento-22,1 por ciento). Las determinaciones ecocardiográficas y la EUA no se correlacionaron de forma estadísticamente significativa con el nivel de insulinemia basal ni tras sobrecarga oral de glucosa. Tampoco se observaron diferencias en dichas variables al comparar únicamente a los pacientes en los terciles superior e inferior de los niveles de insulinemia. Conclusión. No se ha observado asociación entre la insuficiencia basal o tras sobrecarga oral de glucosa y la afectación ecocardiográfica o el nivel de excreción urinaria de albúmina en sujetos con hipertensión grados 1-2 no tratados farmacológicamente (AU)

[Relationship in cardiovascular reactivity to mental stress and early involvement of target organs in non-treated mild arterial hypertension. Hospitalet Study]. / Relación entre reactividad cardiovascular al estrés mental y afectación temprana de órganos diana en la hipertensión arterial ligera no tratada. Estudio Hospitalet.

BACKGROUND: It has been previously reported that an exaggerated response of blood pressure to mental stress tasks is associated to an increased cardiovascular risk. The objective of this cross-sectional study, with sequential inclusion of subjects who met the inclusion criteria, was to asses the relationships between the response of blood pressure and heart rate to two different mental stress tasks and early target organ-damage, defined as abnormalities in the echocardiogram and/or an increase of urinary albumin excretion (UAE) or microalbuminuria, in untreated mild hypertensive subjects. SUBJECTS AND METHODS: Two hundred and eleven subjects aged 18 to 65 years (56% males) with mild hypertension (SBP between 140-180 mmHg and/or DBP between 90-105 mmHg) were included in Hospitalet Study. One hundred and thirty seven of them accepted to participate in the study of cardiovascular reactivity. Two different tasks were applied in the same day: a stressful interview (SI) and a mental arithmetic stress tasks (MAST). An echocardiogram of good quality was obtained in 123 cases (89.8%) and 24 h UAE was measured in 108 cases (78.8%). RESULTS: The prevalence of left ventricular hypertrophy was 21.1% (95% CI = 14.3-29.4) and the prevalence of microalbuminuria was 15.7% (95% CI = 9.4-24.4%). After adjusting for the baseline blood pressure, a significant correlation was observed between increase of systolic BP during SI and UAE (r = 0.21; p = 0.03) and between increase of diastolic BP during SI and relative wall thickness (r = 0.32; p < 0.005). When we analyzed the changes of BP during MAST, a significant correlation was observed between increase of diastolic BP (adjusted for baseline diastolic BP) and left atrial size (r = 0.21; p = 0.02). We did not find any significant correlation between the increases of BP (systolic or diastolic) during MAST or increases of heart rate during both tasks and left ventricular mass index or UAE. CONCLUSIONS: A weak correlation was observed between cardiovascular reactivity of blood pressure during mental stress tasks and early target organ damage in mild hypertension. We did not find any relationship between the response to heart rate during the tasks and early target organ damage.

Perceptions about body weight and weight reduction in Spain.

OBJECTIVE: To assess the more prevalent beliefs about body weight and the factors involved in weight changes in the Spanish adult population. DESIGN: A national survey was carried out according to an established protocol on Spanish subjects selected by a multistage procedure following a random route model, which was quota-controlled for several sociodemographic variables. This study was undertaken by the Spanish arm of a pan-European survey and was performed with a validated questionnaire. It contained questions to evaluate some aspects concerning the relationship between obesity, physical activity and health. We also estimated the proportion of self-reported overweight and obesity. SETTING: Spain. SUBJECTS: The sample included 1,000 subjects aged 15 years or older. RESULTS: Eleven per cent of the sample were obese (body mass index, BMI > 30 kg/m-2) and an additional 32% were overweight (BMI > 25 and < 30 kg/m-2). Obesity prevalence was higher among older individuals, those with lower education and socioeconomic levels, and among housewives and retired or unemployed people. Most Spanish people believed that fat intake (51%) and the amount of food consumption (44%) were the major factors involved in weight gain, while physical activity was less mentioned (12%). The method most frequently used to lose weight was diet (9%). Individuals from central and southern regions payed more attention to genetics (20-27%) and physical activity (12-20%) as determinants of weight gain than people living in the north or northwest regions (15-17% and 8-9%, respectively). Normal weight people participated more often in some physical activity during their leisure time. CONCLUSIONS: The Spanish population is not familiar with factors influencing weight gain. Health promotion strategies should emphasize the role of physical activity, especially among older individuals, retired or unemployed subjects, those from lower educational or socioeconomic levels and among people living in the north or northwest of Spain.

[The perceptions of the adult Spanish population of the factors determinative of health]. / Percepciones de la población adulta española sobre factores determinantes de la salud.

OBJECTIVE: To assess which are the most important perceived influential factors on health among the Spanish adult population. This may provide sufficient information to promote primary health care campaigns directed specifically to those that acknowledge that lifestyles are important in spite of not living healthy lifestyles themselves. DESIGN: Observational cross-sectional study. SETTING: Spain (Canary Islands not included). PARTICIPANTS: A representative sample of 1000 Spanish participants over 15 years old selected by a multistage procedure. INTERVENTION: Survey to evaluate the population choosing one of nine known health-related factors (smoking, food, alcohol intake, stress, physical activity, environment, body weight, support from family, genetics) as being one of the two most important factors influencing health through a validated questionnaire. MEASUREMENTS AND RESULTS: The chi-square test for linear trend was used to assess the influence of factors coded on an ordinal scale. The Pearson chi-square test was applied for categorical factors. Smoking was considered the most influential health-related factor by most participants (47.8%). Males, those from lower socioeconomic and educational levels; people living in the south of Spain, and rural regions; those married and individuals who had 3 or more children below 15 years, perceived smoking more often as one of the most important determinants of health. CONCLUSIONS: These data suggest that a large percentage of the Spanish adult population recognizes that life-styles are important determinants of health.

Post-natal changes in biliary lipids in suckling goat kids.

The post-natal composition of biliary lipids in the bile of suckling goat kids has been studied during the first month of life. Samples of hepatic and vesicular bile were obtained from animals fed with milk. Bile flow increased with age and the concentration of bile acids also rose up to 14 days of age. Cholesterol reached maximum values immediately after birth and then decreased. Bile acids conjugated with taurine predominated and this pattern of preferential tauroconjugation persisted at all ages, as has also been found in carnivores and sheep. Comparison of vesicular and hepatic bile composition revealed a poor concentration capacity of the gallbladder in pre-ruminant kids.

[Ischemic colitis as manifestation of Takayasu arteritis]. / Colitis isquémica como manifestación de arteritis de Takayasu.

The case of a 44-years old patient who developed two episodes of ischemic colitis over a three year interval and completely recovering from the same with conservative treatment is presented. The patient was symptomatic only during the acute episodes. Arteriographic study performed during the second episode showed stenosis of the infrarenal aorta reducing the blood flow by more than 50% facilitating to the development of arterial thrombosis at the origin of the inferior mesenteric artery. These arteriographic findings, together with other stenoses in the descending, superior mesenteric, and left subclavian thoracic aorta arteries led to the diagnosis of Takayasu arteritis. Despite the lack of general symptomatology of the disease, the patient was posteriorly administered steroid treatment with the aim of reducing the local inflammatory process and the risk of new thrombotic episodes.

[Evaluation of the information provided by the system of compulsory notification of diseases]. / Evaluación de la información que proporciona el sistema de declaración obligatoria de enfermedades.

In order to assess activities of epidemiological surveillance resulting from the statutory notification system, a total of 17,394 notification records of eight infectious diseases (brucellosis, bacillary dysentery, typhoid fever, viral hepatitis, meningococcal infection, rickettsioses other than exanthematous typhus, pulmonary tuberculosis, and tuberculosis of other organs) together with 10,503 epidemiological surveys submitted to the "Servei Territorial de Salut Pública" of the province of Barcelona between 1982 and 1986 were reviewed. In notification records, data to locate physicians were the most commonly found (between 92.6% and 99.4% according to disease), whereas in epidemiological surveys, clinical and analytical data were the most frequently encountered. The inclusion of data of epidemiological interest ranged from 3.6 to 68.6%. In order to improve efficacy of the statutory notification system a proposal is made to reduce the extension of epidemiological surveys in terms of requesting only necessary data to establish appropriate measures in each case.

Factors affecting the secretion of phosphate in parotid saliva in the sheep and goat.

The relationship between the concentration of phosphate in plasma and parotid saliva was studied in six conscious sheep and a goat, either intact or thyroparathyroidectomized (t.x.p.t.x.), under conditions designed to minimize marked fluctuations in flow rate of saliva. A linear relationship between acutely induced changes in plasma phosphate concentration and the phosphate level in saliva has been demonstrated in both intact and t.x.p.t.x. animals. Dietary phosphorus depletion caused adaptation of salivary phosphate concentration so that less was secreted at a given concentration of plasma phosphate. Attention is drawn to the similarity between this phenomenon and that already described for the proximal renal tubule. Parathyroid hormone (PTH) was shown to reduce the salivary phosphate concentration with little or no effect on phosphataemia. The administration of 1,25-dihydroxycholecalciferol (1,25(OH)2CC) also caused a reduction in salivary phosphate concentration despite hyperphosphataemia and hypercalcaemia. It is suggested that salivary phosphate concentration can be influenced directly by the concurrent level of plasma phosphate but that this relationship can be modified by the circulating concentration of 1,25(OH)2CC and indirectly by PTH via increased production of 1,25(OH)2CC.

Effects of dietary phosphorus and calcium on the intestinal absorption of Ca in sheep.

1. Wether sheep were used, some of which were prepared with a Thiry-Vella loop of jejunum. The long-term use of these loops was ensured by regular perfusion with fresh nutrient solution. 2. The net calcium absorption rate from a Thirty-Vella loop of jejunum increased with increasing intraluminal Ca concentration and was increased by the addition of 1 alpha-hydroxy-cholecalciferol (3 micrograms/l) to the loop fluid. 3. When the diet of sheep was changed from one which was normal in Ca to a diet low in Ca there was an increase in the efficiency of net Ca absorption from the jejunal loop. This dietary change was accompanied by an increase in the circulating concentration of 1,25-dihydroxy-cholecalciferol (1,25(OH)2D3). 4. An intravenous infusion of the Ca chelating agent EDTA increased the efficiency of net Ca absorption from the jejunal loop. The use of 47Ca demonstrated that this reflected an increase in the true absorption rate of Ca. 5. Dietary phosphorus deficiency reduced the efficiency of intestinal Ca absorption and was associated with a reduction in the plasma concentration of 1,25(OH)2D3.