A phenomenologically grounded specification of varieties of adolescent depression.

Researchers are increasingly acknowledging that psychopathological conditions usually grouped together under the generic label "depression" are highly diverse. However, no differential therapeutic approach currently exists that is sensitive to the varieties of depression afflicting young people. In fact, the discussion is missing something much more fundamental: a specification of the types of adolescent depression. Recent research that has aimed to classify different kinds of depression has mainly studied adult populations and predominantly used technically complicated measurements of biological markers. The neglect of the potential particularities of dysphoric disorders affecting youths is unfortunate, and the exclusive focus on biological parameters unnecessarily restrictive. Moreover, this one-sidedness obfuscates more directly available sources of clinically relevant data that could orient conceptualization efforts in child and adolescent psychiatry. Particularly, clues for discriminating different types of adolescent depression may be obtained by analyzing personally articulated accounts of how affected young people experience changes in their relation to the world and to themselves. Thus, here we present and discuss the findings of a study that explored the possibility of specifying types of adolescent depression in a phenomenological way. The study investigated the association between these types and the vicissitudes of personality development. In accounts given by youths diagnosed with depression during semi-structured interviews, we identified themes and examined their phenomenological centrality. Specifically, our qualitative analyses aimed to determine the relative importance of certain themes with respect to the overall intelligibility of the described changes to the relational space. Based on the findings of these analyses, we differentiate three specifiers of adolescent depression and suggest an association between particular types of experiences and the trajectory of affected adolescents' personality development. To our knowledge, this is the first phenomenologically grounded specification of types of adolescent depression with potential therapeutic significance. Thus, based on this contribution, we propose that modes of scientific exploration that are close to phenomenological philosophy-which have been ignored in the context of developmental psychopathology-could offer a foundation to theories developed in the field of child and adolescent psychiatry.

[The Requirement of a Situated Approach in the Treatment of Preschool Children with a Refugee Background: Discussion of a Case Study]. / Die Notwendigkeit eines situierten Ansatzes bei der Behandlung von Vorschulkindern mit Fluchthintergrund: Diskussion eines Fallbeispiels.

In recent years, increasingly more German-born preschool children of refugee parents have been referred to the 'specialized consultation service for refugee minors' of the Department of Child and Adolescent Psychiatry at the University Hospital Münster. This 'change' in the use of the above-mentioned consultation service could be understood as a 'natural' consequence of the family life cycle of forced migrants who some years ago came to Germany as adolescents or young adults and started here a family. The treatment of 'preschoolers with a refugee background', as we may call this group of patients, confronts mental health practitioners with particular challenges. In this contribution, we specify some of these challenges and argue that, due to the deep intertwinement of different aspects of these patients' condition, a 'situated approach' is required when treating this population.When planning therapeutic interventions for preschoolers with refugee background, their families should be conceived as unified systems which in their social and transcultural embeddedness exhibit trans-individual vulnerabilities and resources. By discussing a case study, we illustrate how an extremely challenging child psychiatric treatment could succeed only on the condition that we focused on the interconnectedness of various factors determining not merely the patient's symptomatic behavior but, furthermore, the behavior of the family, i. e., on the condition of focusing on the situated nature of the problematic.

The Mexican consensus on the diagnosis, treatment, and prevention of NSAID-induced gastropathy and enteropathy. / Consenso mexicano sobre diagnóstico, prevención y tratamiento de la gastropatía y enteropatía por antiinflamatorios no esteroideos.

More than 30 million persons worldwide take nonsteroidal anti-inflammatory drugs (NSAIDs) on a daily basis, and annual consumption is increasing. In addition to their analgesic and anti-inflammatory properties, NSAIDs also produce well-known gastrointestinal adverse events. There is no consensus in Mexico on the diagnosis, treatment, and prevention of NSAID-induced gastropathy and enteropathy, and so the Asociación Mexicana de Gastroenterología brought together a group of experts to establish useful recommendations for the medical community. Thirty-three recommendations were formulated in the present consensus, highlighting the fact that the risk for NSAID-induced gastrointestinal toxicity varies according to the drug employed and its pharmacokinetics, which should be taken into account at the time of prescription. The risk factors for gastroduodenal complications due to NSAIDs are: a history of peptic ulcer, age above 65 years, high doses of NSAIDs, Helicobacter pylori infection, and the presence of severe comorbidities. The symptoms and gastroduodenal damage induced by NSAIDs vary, ranging from an asymptomatic course to the presentation of iron-deficiency anemia, bleeding, stricture, and perforation. Capsule endoscopy and enteroscopy are direct diagnostic methods in NSAID enteropathy. Regarding prevention, the minimum dose of an NSAID needed to achieve the desired effect, administered for the shortest period of time, is the recommendation. Finally, proton pump inhibitors are the gold standard for the prophylaxis and treatment of gastroduodenal effects, but they are not useful in enteropathy.

Leishmania mexicana: promastigotes and amastigotes secrete protein phosphatases and this correlates with the production of inflammatory cytokines in macrophages.

Phosphatase activity of Leishmania spp. has been shown to deregulate the signalling pathways of the host cell. We here show that Leishmania mexicana promastigotes and amastigotes secrete proteins with phosphatase activity to the culture medium, which was higher in the Promastigote Secretion Medium (PSM) as compared with the Amastigote Secretion Medium (ASM) and was not due to cell lysis, since parasite viability was not affected by the secretion process. The biochemical characterization showed that the phosphatase activity present in PSM was higher in dephosphorylating the peptide END (pY) INASL as compared with the peptide RRA (pT)VA. In contrast, the phosphatase activity in ASM showed little dephosphorylating capacity for both peptides. Inhibition assays demonstrated that the phosphatase activity of both PSM and ASM was sensible only to protein tyrosine phosphatases inhibitors. An antibody against a protein phosphatase 2C (PP2C) of Leishmania major cross-reacted with a 44·9 kDa molecule in different cellular fractions of L. mexicana promastigotes and amastigotes, however, in PSM and ASM, the antibody recognized a protein about 70 kDa. By electron microscopy, the PP2C was localized in the flagellar pocket of amastigotes. PSM and ASM induced the production of tumor necrosis factor alpha, IL-1ß, IL-12p70 and IL-10 in human macrophages.

[Mexican consensus on portal hypertension]. / Consenso Mexicano de Hipertensión Portal.

The aim of the Mexican Consensus on Portal Hypertension was to develop documented guidelines to facilitate clinical practice when dealing with key events of the patient presenting with portal hypertension and variceal bleeding. The panel of experts was made up of Mexican gastroenterologists, hepatologists, and endoscopists, all distinguished professionals. The document analyzes themes of interest in the following modules: preprimary and primary prophylaxis, acute variceal hemorrhage, and secondary prophylaxis. The management of variceal bleeding has improved considerably in recent years. Current information indicates that the general management of the cirrhotic patient presenting with variceal bleeding should be carried out by a multidisciplinary team, with such an approach playing a major role in the final outcome. The combination of drug and endoscopic therapies is recommended for initial management; vasoactive drugs should be started as soon as variceal bleeding is suspected and maintained for 5 days. After the patient is stabilized, urgent diagnostic endoscopy should be carried out by a qualified endoscopist, who then performs the corresponding endoscopic variceal treatment. Antibiotic prophylaxis should be regarded as an integral part of treatment, started upon hospital admittance and continued for 5 days. If there is treatment failure, rescue therapies should be carried out immediately, taking into account that interventional radiology therapies are very effective in controlling refractory variceal bleeding. These guidelines have been developed for the purpose of achieving greater clinical efficacy and are based on the best evidence of portal hypertension that is presently available.

Reproductive biology of freshwater fishes from the Venezuelan floodplains.

This review describes the endocrine changes that occur during the annual reproductive cycle of Pygocentrus cariba, Pimelodus blochii, and Oxydoras sifontesi and their relationships with the environmental characteristics of Venezuelan floodplains. Most reproductive studies of teleosts have focused on changes that occur during annual cycles in temperate species but, in tropical fish, this has been examined less frequently. P. cariba, P. blochii, and O. sifontesi are seasonal breeders widely distributed along the Orinoco River. Under natural conditions they have an annual gonadal cycle closely related to changes in the annual hydrology cycle of the Orinoco River which defines two seasons on the floodplain: inundation and isolation. The reproductive cycle of these species seems to be controlled by cues from the external environment. Relevant data about gonadal maturation, for example gonadosomatic index and sexual hormones secretion, are contrasted. The role of catecholamines in neuroendocrine control of the reproductive axis is also considered in this work.

Neumotórax en el recién nacido: experiencia de un servicio de cirugía de tórax / Pneumothorax in the newborn: experience of a thoracic surgery department

Objetivos: Evaluar la experiencia del Servicio de Cirugía de Tórax del Hospital Universitario de Maracaibo en el diagnóstico y tratamiento del neumotórax en el recién nacido. Métodos: 23 recién nacidos con neumotórax fueron evaluados por el Servicio de Cirugía de Tórax en la Emergencia Pediátrica, Unidad de Cuidados Intensivos Pediátricos y en el Servicio de Neonatología entre los años 2000–2004. Se recolectaron los datos relacionados con: la duración de la gestación, complicaciones maternas durante el embarazo, examen físico, estudios diagnósticos, tratamiento yevolución de los pacientes. Resultados: 13(56.52%) delos recién nacidos eran varones y la edad gestacional promedio fue de 35.25 +/- 2.49 semanas. 12(52.17%) nacieron por cesárea y 10(43.47%) tenían antecedentes de maniobras de reanimación al nacer. El neumotórax se localizó en el hemitórax izquierdo en 8 recién nacidos (34.78%), hemitórax derecho en 14 recién nacidos (60.86%) y en ambos hemitórax en 1 recién nacido (4.47%). 22 (95.65%) presentaron dificultad respiratoria El tratamiento incluyó una conducta expectante en 2 recién nacidos con neumotórax menor de 25%, y la colocación de tubo de toracostomía en 21 recién nacidos (91.30%) con neumotórax mayor de 25% Conclusión: el neumotórax es una complicación que se observa principalmente en el recién nacido con Apgar bajo al nacer o querequieren maniobras de reanimación y se presenta con dificultad respiratoria. Los neumotorax menores de 25% pueden manejarse con observación y radiología seriada, pero aquellos mayores de 25% requerirán colocación de tubo de toracostomía.

Objectives: To evaluate the experience of Thoracic Surgery Service in the diagnosis and treatment of pneumothorax in newborn at theHospital Universitario de Maracaibo.Methods: 23 newborn with pneumothorax were evaluated by the Thoracic Surgery Service in the Pediatric Emergency Unit, PediatricIntensive Care Unit and Neonatology Service between the years 2000-2004. Data was collected regarding gestational age, complications during the pregnancy, physical exam, diagnostic studies, treatment and evolution of the patients. Results: 13 (56.52%) were males, with mean gestational age of 35 +/- 2.5 weeks. 12 (52.17%) were born by caesarean section and 11(47.82%) by vaginal delivery. 10 newborns had history of resuscitation manoeuvres (43.47%). Pneumothorax was located in lefthemithorax in 8 newborn (34.78%), right hemithorax in 14 newborn (60.86%) and both hemithorax in 1 newborn (4.47%). 22 (95.65%)presented respiratory distress. Treatment included observation in 2 newborns with pneumothorax < 25%, and tube thoracostomy in 21 (91.30%) with pneumothorax > 25%. Conclusion: Pneumothorax is a complication seen mainly in newborns with low Apgar score and those who required resuscitation manoeuvres and almost always presents with respiratory distress. Pneumothorax < 25% can be treated with observation and serialradiology but those > 25%.will require tube thoracostomy.

[Importance of the time for stopping the combined use of aspirin and clopidogrel in patients undergoing coronary artery by-pass graft surgery]. / Importancia del tiempo de suspensión del uso combinado de aspirina y clopidogrel en pacientes sometidos a cirugía de revascularización coronaria.

The combined use of aspirin and clopidogrel is the standard of care for patients with acute coronary syndromes. The risk for perioperative bleeding is considerably increased after coronary artery by-pass graft surgery (CABG). This study was designed to evaluate the effect of antiplatelet therapy on perioperative CABG outcome. We studied 49 consecutive patients undergoing first time CABG, and compared two groups: Group A, patients who stopped antiplatelet treatment at least 6 days before surgery, and group B, those who received antiplatelet therapy within 5 days before surgery or did not suspended therapy. The groups were comparable in their demographic characteristics, manifestations of disease, perioperative medication use and the characteristics of surgery. There was a non significant tendency for more cardiovascular complications (primary cardiovascular endpoint) in the group that stopped antiplatelet therapy 6 or more days before surgery (Group A 12%, group B 8%; p = 0.923). The bleeding endpoint was significantly higher in group B, that remained on antiplatelet therapy within 5 days before surgery (Group A 4%, group B 29%; p = 0.023), as well as the need for transfusion. We concluded that the combined use of aspirin and clopidogrel before CABG increases postoperative bleeding and morbidity; there was no definitive difference in the cardiovascular outcome.

Importancia del tiempo de suspensión del uso combinado de aspirina y clopidogrel en pacientes sometidos a cirugía de revascularización coronaria / Importance of the time for stopping the combined use of aspirin and clopidogrel in patients undergoing coronary artery by-pass graft surgery

The combined use of aspirin and clopidogrel is the standard of care for patients with acute coronary syndromes. The risk for perioperative bleeding is considerably increased after coronary artery by-pass graft surgery (CABG). This study was designed to evaluate the effect of antiplatelet therapy on perioperative CABG outcome. We studied 49 consecutive patients undergoing first time CABG, and compared two groups: Group A, patients who stopped antiplatelet treatment at least 6 days before surgery, and group B, those who received antiplatelet therapy within 5 days before surgery or did not suspended therapy. The groups were comparable in their demographic characteristics, manifestations of disease, perioperative medication use and the characteristics of surgery. There was a non significant tendency for more cardiovascular complications (primary cardiovascular endpoint) in the group that stopped antiplatelet therapy 6 or more days before surgery (Group A 12%, group B 8%; p = 0.923). The bleeding endpoint was significantly higher in group B, that remained on antiplatelet therapy within 5 days before surgery (Group A 4%, group B 29%; p = 0.023), as well as the need for transfusion. We concluded that the combined use of aspirin and clopidogrel before CABG increases postoperative bleeding and morbidity; there was no definitive difference in the cardiovascular outcome.

Magnetostriction measuring device based on an optical fiber sensor with an annular photodiode.

A new simple and sensitive dilatometer to measure magnetostriction of ribbons has been developed, based on an optical fiber sensor using an annular photodiode. The optical fiber is used bidirectionally, both for emission and detection of light, simplifying the access to the ribbon under test. The working principle is based on the measurement by reflection of the longitudinal displacement of the ribbon end. For a Vitroperm amorphous ribbon of 100 mm length, 21 microm thickness, and 8.3 mm width, a displacement of 2.571 microm with a maximum uncertainty of 8 nm has been obtained.

Evaluación de la broncofibroscopía flexible en el Hospital Nacional Daniel Alcides Carrión Callao junio-octubre 2000 / Evaluation of the flexible broncofibroscopy in the Hospital Nacional

Se realizó estudio descriptivo prospectivo para evaluar la utilidad de la broncofibroscopia en el diagnóstico de las enfermedades neumológicas prevalentes en nuestro medio. Se realizaron 141 broncofibroscopias. Resultados bacteriológicos: de 84 pacientes (con sospecha de TBC) resultaron 20 pacientes (23.8 por ciento) con baciloscopias positivas; de 48 muestras para cultivo de gérmenes comunes se identificaron: pseudomonas 20 muestras (46.5 por ciento), estreptococos 08 muestras (18.6 por ciento), estafilococos 04 muestras (9.3 por ciento), Neisseria 03 muestras (7 por ciento), y 08 muestras (18.4 por ciento) de otros gérmenes y en examen para hongos, de 71 muestras se obtuvo 04 (5.6 por ciento) cultivos positivos (3:candida albicans, 1:aspergillus fumigatus). Resultados citológicos: En 36 pacientes se realizó papanicolao (PAP) en 5 (13.9 por ciento) se evidenciaron células sospechosas de neoplasia. Resultados histológicos: En 86 pacientes se realizaron biopsias; los resultados fueron bronquitis crónica 43 (46.7 por ciento), Inflamación crónica 15 (16 por ciento), bronquitis aguda 07 (7.6 por ciento), metaplasia epidermoide 07 (7.6 por ciento, granuloma tuberculosos 02 (2.2 por ciento) y otros más. Conclusiones: Se demostró la importancia del uso de la broncofibroscopia flexible en el diagnóstico de enfermedades infecciosas en nuestro medio, siendo el mayor aporte en la detección precoz de la TBC posibilitando su tratamiento con los mas importantes beneficios epidemiológicos, sin dejar de mostrar su aporte importante en el diagnóstico de neoplasias pulmonares.

Analysis of restriction profiles of mitochondrial DNA from Sporothrix schenckii.

Mitochondrial DNA (mtDNA) diversity was analyzed in 42 clinical isolates of Sporothrix schenckii from Mexico (n = 29), Guatemala (n = 4) and Colombia (n = 9). Based on HaeIII restriction digestion profiles, the isolates were classified into eight types. In addition to 24 mtDNA types previously reported in another study, 6 new types were found in this study. Most of the strains belong to type 14 and type 30, the former restricted to Mexico, whereas the latter was distributed in Mexico, Guatemala and Colombia. The new types (25-30) were identified in Mexico, Guatemala and Colombia. Restriction-fragment length polymorphism in mtDNA of S. schenckii revealed high levels of genetic variation attributable to differences in restriction sites as well as in mtDNA size. Based on genetic distances S. schenckii types were clustered into two main groups.

Photic regulation of mt(1) melatonin receptors and 2-iodomelatonin binding in the rat and Siberian hamster.

We have investigated the photic regulation of melatonin receptors both at the level of binding capacity and mt(1) mRNA expression in the suprachiasmatic nucleus (SCN) and the pars tuberalis (PT) of the pituitary of two species: a highly photoperiodic one, the Siberian hamster, and a nonphotoperiodic one, the Wistar rat. This study has been performed by looking at the effect of a light pulse applied during the night on the two receptor parameters. The results show that the photic regulations of mt(1) mRNA expression and receptor density are distinct from each other in both the SCN and PT of the two species studied. They also show that, depending on the species and the structure, this regulation may implicate either the circadian clock or melatonin.

Biosynthesis and functions of melanin in Sporothrix schenckii.

Sporothrix schenckii is a human pathogen that causes sporotrichosis, an important cutaneous mycosis with a worldwide distribution. It produces dark-brown conidia, which infect the host. We found that S. schenckii synthesizes melanin via the 1,8-dihydroxynaphthalene pentaketide pathway. Melanin biosynthesis in the wild type was inhibited by tricyclazole, and colonies of the fungus were reddish brown instead of black on tricyclazole-amended medium. Two melanin-deficient mutant strains were analyzed in this study: an albino that produced normal-appearing melanin on scytalone-amended medium and a reddish brown mutant that accumulated and extruded melanin metabolites into its medium. Scytalone and flaviolin obtained from cultures of the reddish brown mutant were identified by thin-layer chromatography, high-performance liquid chromatography, and UV spectra. Transmission electron microscopy showed an electron-dense granular material believed to be melanin in wild-type conidial cell walls, and this was absent in conidial walls of the albino mutant unless the albino was grown on a scytalone-amended medium. Melanized cells of wild-type S. schenckii and the albino grown on scytalone-amended medium were less susceptible to killing by chemically generated oxygen- and nitrogen-derived radicals and by UV light than were conidia of the mutant strains. Melanized conidia of the wild type and the scytalone-treated albino were also more resistant to phagocytosis and killing by human monocytes and murine macrophages than were unmelanized conidia of the two mutants. These results demonstrate that melanin protects S. schenckii against certain oxidative antimicrobial compounds and against attack by macrophages.

Melatonin regulates the mRNA expression of the mt(1) melatonin receptor in the rat Pars tuberalis.

The pars tuberalis (PT) of the pituitary is a major neuroendocrine target site for melatonin as it contains a large number of high-affinity melatonin receptors. We have previously shown that melatonin autoregulates the density of its own receptors in the PT. However, whether melatonin regulation includes mRNA expression in vivo is unclear. In the present study we have used quantitative in situ hybridization to (1) follow the daily profile of mt(1) mRNA expression in the rat PT and (2) investigate whether mt(1) mRNA expression could be regulated in vivo by melatonin. We found clear diurnal variations of mt(1) mRNA expression that persist in constant darkness. We also showed, on pinealectomized animals, that the rhythmic pineal melatonin secretion is necessary for the expression of these daily variations. In a second step, we studied the effect of an acute suppression of endogenous melatonin synthesis on mt(1) melatonin receptors by applying a 1-hour light pulse during the night. We found that light induced a dramatic increase in mt(1) mRNA which was totally prevented by a melatonin injection showing that the acute effect of melatonin on the receptor mRNA is strongly inhibitory. A light pulse applied to animals with a chronic absence of melatonin was ineffective showing that light only affects melatonin receptors via the light-induced plasma melatonin suppression. Altogether our results show that melatonin regulates mt(1) melatonin receptor mRNA expression. However, this regulation seems to be complex: acute changes in plasma melatonin concentration regulate negatively the gene transcription, even if the daily endogenous nocturnal melatonin peak seems a prerequisite for variations in its receptor expression.

Photic regulation of mt1 melatonin receptors in the Siberian hamster pars tuberalis and suprachiasmatic nuclei: involvement of the circadian clock and intergeniculate leaflet.

In the Siberian hamster suprachiasmatic nuclei and pars tuberalis of the pituitary, high affinity mt1 melatonin receptors are present. We have previously shown that night applied light pulse induced an increase in mt1 mRNA expression in the suprachiasmatic nuclei of this species, independently of the endogenous melatonin. Here, we report the photic regulation of melatonin receptor density and mRNA expression in the suprachiasmatic nuclei and pars tuberalis of pinealectomized Siberian hamsters and the implication in this control of either the circadian clock or the intergeniculate leaflet. The results show that: (1) A 1-h light pulse, delivered during the night, induces a transitory increase in mt1 mRNA expression in the suprachiasmatic nuclei and pars tuberalis. After 3 h this increase has totally disappeared (suprachiasmatic nuclei) or is greatly reduced (pars tuberalis). (2) The melatonin receptor density, in the suprachiasmatic nuclei, is not affected by 1 or 3 h of light, while it is strongly increased in the pars tuberalis. (3) In hamsters kept in constant darkness, the mt1 mRNA rise is gated to the subjective night in the suprachiasmatic nuclei and pars tuberalis. In contrast, the light-induced increase in melatonin binding is also observed in the subjective day in the pars tuberalis. (4) intergeniculate leaflet lesion totally inhibits the mt1 mRNA expression rise in the suprachiasmatic nuclei, while it has no effect on the light-induced increase in mt1 mRNA in the pars tuberalis. However, the light-induced increase in melatonin receptor density is totally prevented by the intergeniculate leaflet lesion in the pars tuberalis. These results show that: (1) the photic regulations of mt1 mRNA expression and receptor density are independent of each other in both the suprachiasmatic nuclei and pars tuberalis; and (2) the circadian clock and the intergeniculate leaflet are implicated in the photic regulation of melatonin receptors but their level of action differs totally between the suprachiasmatic nuclei and pars tuberalis.

Ploidy study in sporothrix schenkii

Sporothrix schenckii is a dimorphic fungus that is pathogenic for humans. No sexual cycle has been reported for this fungus and little is known of its genetic constitution. To inquire into the ploidy state of Sporothrix schenckii, different approaches were followed: DNA content during transition from conidia to yeast, survival to ultraviolet irradiation, chemical mutagenesis, and induction of mitotic recombination. No change in ploidy was detected between the conidia and yeast phases of the fungi. Resistance to cell inactivation by UV irradiation was higher in S. schenckii and in Sacharomyces cerevisiae in its diploid state than in isogenic haploids a and alpha from S. cerevisiae that were inactivated at lower doses. Two mutant phenotypes, auxotrophy and albinism, were screened after chemical mutagenesis. One-step mutagenesis with either nitrous acid or ultraviolet light was unsuccessful in inducing auxotrophy but was sufficient to induce albino colonies. Two-step mutagenesis with nitrous acid in combination with UV light was necessary to attain two auxotrophic requirements: adenine and methionine. Prototrophic and pigmented revertants behaved as heterozygotes; after exposure to UV light they gave rise to derivatives which resemble the original mutation. The experiments presented in this work suggest that S. schenckii is a diploid, although aneuploidy cannot be excluded. Copyright 1999 Academic Press.

Prevalencia de displasia en casos de metaplasia gástrica. Estudio retrospectivo de 89 casos / Gastric dysplasia in gastric intestinal metaplasia

La tinción histológica de rutina: la hematoxilina eosina, continúa siendo la herramienta básica que evalúa los precursores de cáncer gástrico. Se le considera el estándar de oro vs. cualquier otro marcador debe compararse. En nuestro hospital recibimos anualmente 54 casos nuevos de cáncer gástrico, todos ellos en etapa avanzada al momento del diagnóstico y sólo con esperanza de paliación de la enfermedad. En un intento por reconocer marcadores preneoplásicos separamos los casos de metaplasia intestinal de cualquier índole en búsqueda de displasia. Entre 2160 biopsias gástricas de adultos recuperamos las preparaciones histológicas de 89 en quienes se hizo originalmente el diagnóstico de metaplasia. Se revisaron los casos por dos patólogos individualmente y se tabularon los diagnósticos. Encontramos 30 casos con evidencia de algún grado de displasia según los criterios de Morson. 14 correspondieron a displasia leve, 12 a moderada y cuatro a intensa. Los promedios de edad fueron de 59, 64 y 72 años respectivamente. En 21 casos el diagnóstico de ambos patólogos fue semejante. En los nueve restantes el diagnóstico difirió más de un grado, por lo que se decidió realizar la revisión simultánea de las preparaciones histológicas y el diagnóstico fue de común acuerdo. Concluimos que: 1) la aplicación simultánea de los criterios de Morson son evidentemente reproducibles y obligan al patólogo a asignar un grado de confianza, 2) Uno de cada tres casos de metaplasia en nuestro material cursa con displasia de algún grado, 3) De entre los casos de displasia más de la mitad (16/30) ameritarían seguimiento cuidadoso en búsqueda de neoplasia sincrónica o metacrónica

Effectiveness and cost-effectiveness of linking the special supplemental program for women, infants, and children (WIC) and immunization activities.

OBJECTIVE: To raise immunization coverage among children at risk for underimmunization, we evaluated the effectiveness and cost-effectiveness of immunization activities in the Special Supplemental Program for Women, Infants and Children (WIC). METHOD: A controlled intervention trial was conducted in seven WIC sites in Chicago between October 1990 and March 1994. At intervention sites, staff screened children for vaccination status at every visit, referred vaccine-eligible children to either an on-site WIC nurse, on-site clinic, or off-site community provider, and issued either a 3-month supply of food vouchers to up-to-date children or a 1-month supply to children not up-to-date--a usual practice for high-risk WIC children. Our primary measure of effectiveness was the change in the baseline percentage of up-to-date children at the second birthday; cost-effectiveness was approximated for each of the three referral interventions. RESULTS: After one year, up-to-date vaccination coverage increased 23% above baseline for intervention groups and decreased 9% in the control group. After the second year, up-to-date vaccination further increased to 38% above baseline in intervention groups and did not change in the control group. The total cost per additional up-to-date child ranged from $30 for sites referring children off-site to $73 for sites referring children on-site to a nurse. CONCLUSION: This controlled intervention trial of screening, referral, and a voucher incentive in the WIC program demonstrated a substantial increase in immunization coverage at a low cost. Continuing to design linkages between WIC and immunization programs by building on WIC's access to at-risk populations is worth the investment.