[A version of DSM-IV criteria adapted for adolescents and applied to young smokers]. / Aplicación en jóvenes fumadores de una versión de los criterios nosológicos DSM-IV adaptada para adolescentes.

OBJECTIVES: To evaluate nicotine dependence in adolescent smokers using a version of DSM-IV criteria for nicotine dependence adapted for adolescents (DSM-IVa). To establish its usefulness and the most relevant items for diagnosing adolescent smokers. POPULATION AND METHODS: Two thousand six hundred forty-seven schoolchildren between 10 and 17 years old were surveyed. A sample size was calculated for each year of age, using the finite population equation with the addition of 10% so that the absolute error would not increase at the end of the study if questionnaires were withdrawn. The sample was stratified by sex and type of school for each age group, with allocation to each stratum proportional to the number of individuals. Schools and students were selected using random number tables. The questionnaire collected the most significant personal data and information related to DSM-IVa criteria. RESULTS: Smokers made up 23.1% of the sample, and 63.5% of them smoked daily. According to the DSM-IVa criteria, 70.7% of the smokers were nicotine dependent. The DSM-IVa had a kappa value of 1 and internal consistency was good (Cronbach's alpha: 0.5598). CONCLUSIONS: The DSM-IVa is useful in the studied population, although not perfect. According to the criteria, 70.7% of those interviewed were already nicotine dependent. The key questions were those that referred to the presence of nicotine withdrawal syndrome symptoms and the need to spend a large amount of free time obtaining or smoking cigarettes.

Aplicación en jóvenes fumadores de una versiónde los criterios nosológicos DSM-IV adaptadapara adolescentes / A version of DSM-IV criteria adapted for adolescents and applied to young smokers

OBJETIVOS: Valorar la dependencia nicotínica en jóvenes fumadores a través de una versión adaptada para adolescentes de los criterios nosológicos DSM-IV para la dependencia a la nicotina (DSM-IVa). Determinar su utilidad y los ítems más importantes del mismo en adolescentes fumadores. POBLACIÓN Y MÉTODOS: Se entrevistó a 2.647 escolares de entre 10 y 17 años. Se calculó un tamaño muestral para cada edad, en años, mediante la ecuación de poblaciones finitas, añadiendo un 10 por ciento para que en el caso de existir mermas no aumentasen el error absoluto final. Para cada edad el muestreo fue estratificado por sexo y tipo de centro, con afijación en cada estrato proporcional al número de individuos. La elección de centros y alumnos se hizo mediante tabla de números aleatorios. La encuesta, además de recoger los principales datos personales, comprendía una versión adaptada a adolescentes de los criterios nosológicos DSM-IV para la dependencia a la nicotina. RESULTADOS: El 23,1 por ciento eran fumadores, y de ellos el 63,5 por ciento eran fumadores diarios. Según el DSM-IVa, el 70,7 por ciento de los fumadores eran dependientes de la nicotina. El DSMIVa obtuvo un índice kappa de 1 y una buena consistencia interna (coeficiente alfa de Cronbach = 0,5598). CONCLUSIONES: El DSM-IVa es útil en dicha población, aunque no perfecto. Según sus criterios, el 70,7 por ciento de los entrevistados ya se habían vuelto dependientes de la nicotina, siendo las preguntas clave las referentes a la presencia de síntomas del síndrome de abstinencia nicotínica y a la necesidad de emplear gran parte del tiempo libre en conseguir o consumir tabaco (AU)

Prescripción facultativa o consejo médico antitabaco en atención primaria: opiniones desde el otro lado de la mesa / Specialist medical prescription or medical counseling in primary care: opinions from the other side of the table

OBJETIVOS: Conocer la frecuencia, las características y el seguimiento de la prescripción sanitaria antitabaco en los pacientes que acuden a las consultas de atención primaria (AP); valorar la opinión de los pacientes sobre el consejo sanitario antitabaco recibido. MATERIAL Y MÉTODOS: Estudio descriptivo transversal realizado en AP. Sujetos: muestra aleatoria de 330 pacientes entre 15 y 75 años que acudieron a las consultas de AP durante los meses de marzo y abril de 2000. Mediciones: encuesta confidencial autoadministrada sobre hábito tabáquico, enfermedades crónicas relacionadas con el tabaco, prescripción sanitaria antitabaco recibida y opinión sobre el consejo sanitario antitabaco. RESULTADOS: La prevalencia de fumadores era del 31,9 por ciento (100). Considerando el conjunto de fumadores y ex fumadores (162), el 29,2 por ciento (47) recibió consejo antitabaco del médico de AP, 11,8 por ciento (19) del especialista, el 8,7 por ciento (14) del personal de enfermería, el 3,1 por ciento (5) del farmacéutico y el 21,1 por ciento (34) de la familia. No se encontró una relación estadísticamente significativa entre la prescripción sanitaria antitabaco y el sexo o la edad, pero sí con la presencia de una enfermedad crónica. El 65 por ciento (54) de las personas que habían recibido consejo antitabaco consideraron que el tiempo empleado en dicho consejo fue adecuado. En el 12 por ciento (10) de las ocasiones, además del consejo, se entregó un folleto informativo. El 40 por ciento de los fumadores refiere que dejaría de fumar si su médico se lo aconsejase, y el 45 por ciento lo haría si tuviese una enfermedad relacionada con el tabaco. El 33 por ciento de los fumadores opina que debe recibir prescripción sanitaria antitabaco en todas las consultas, mientras que el 38 por ciento sólo si tuviera una enfermedad relacionada con el tabaco. CONCLUSIONES: La prevalencia de fumadores que acuden a las consultas de AP es elevada. La prescripción sanitaria antitabaco es baja, su recuerdo y seguimiento son mínimos. Tras averiguar el hábito del paciente y estudiarlo, siempre efectuaremos una prescripción facultativa antitabaco, asesorando y realizando el seguimiento oportuno (AU)

Evaluación de la calidad de comunicación entre niveles asistenciales mediante el documento interconsulta / Evaluation of the quality of communication between care levels through the inter-consultation document

Objetivos. Evaluar la calidad y mejora de cumplimentación de los documentos de interconsulta en el equipo de atención primaria (EAP). Diseño. Ciclo completo de calidad. Emplazamiento. Atención primaria (AP).Componentes de la evaluación. Dimensión estudiada: calidad científico-técnica. Sujetos: todos los documentos de interconsulta (DI-1) dirigidos por los médicos de AP del centro de salud de Irún Centro a atención especializada durante 15 días, 223 DI-1 para la evaluación en abril de 1998 y 287 para la reevaluación en octubre 1998. Tipo de evaluación: retrospectiva. Fuente de datos: documentos interconsulta e historias clínicas. Criterios: explícitos y normativos. Medidas correctoras: educativas (discusión de resultados en reunión del EAP).Resultados. En la reevaluación se observó una mejoría estadísticamente significativa: datos de filiación (91,5-96,8 por ciento), legibilidad (86-92,7 por ciento), antecedentes y/o medicación habitual (35,9-50 por ciento) y sintomatología (77,8-87,2 por ciento). Por niveles de calidad se ha pasado en los buenos del 20,6 al 42,5 por ciento y en los malos del 40,8 al 33,4 por ciento. Obtuvimos respuesta en un 22,2 por ciento de nuestras derivaciones. La falta de respuesta se produce en un 34 por ciento por no haber informe del especialista, un 47,8 por ciento se atribuyen al paciente o al circuito y el 18 por ciento de los pacientes está pendiente de pruebas. Conclusiones. La información proporcionada en los DI-1 ha mejorado significativamente después del ciclo de calidad. Conocer nuestra práctica habitual de trabajo sirve como estimulo de mejora. Los criterios que peor cumplimos son: referencia a antecedentes personales y/o medicación habitual, exploración física y medidas terapéuticas empleadas. Gran perdida de información en la respuesta a nuestras derivaciones (AU)

[Experience with ventriculitis at a neonatology department]. / Ventriculitis: experiencia en un servicio de neonatología.

OBJECTIVE: To study the characteristics, treatment and follow-up of patients with ventriculitis in our neonatal unit. PATIENTS AND METHODS: Retrospective study of patients diagnosed with ventriculitis from January 1990 to December 1997. Diagnostic criteria were the identification of any bacteria in the ventricular fluid and pleocytosis (> or = 100 leukocytes per microl). Personal history, clinical and analytical findings and evolution after diagnosis were studied. RESULTS: We recorded ten cases of ventriculitis in nine patients. Six of them occurred as a complication of previous meningitis and four occurred after neurosurgical treatment. The mean age at diagnosis was of 38.8 days (range 8-130), and mean gestational age was 29.4 weeks (range 25-38). Clinical and ventricular fluid anomalies were seen in six cases and in four the diagnosis was made at autopsy. Treatment was systemic antibiotics. In two cases intraventricular antibiotics were added. Six patients died, ventriculitis being the direct cause of death in five. Of the three survivors, one had mental retardation and cerebral palsy and the other two had minor disabilities. CONCLUSIONS: During the neonatal period, a high degree of clinical suspicion and techniques for an early diagnosis and treatment are needed for ventriculitis.

[Evaluation of the quality of communication between levels of care through the inter-consultation document]. / Evaluación de la calidad de comunicación entre niveles asistenciales mediante el documento interconsulta.

OBJECTIVES: To evaluate the quality and improvement of compliance in the inter-consultation documents of the primary care team (PCT). DESIGN: Entire care cycle. SETTING: Primary care (PC). MEASUREMENTS: Dimension studied: scientific-technical quality. SUBJECTS: all the inter-consultation documents (ID-1) sent by PC doctors from Irun Health Centre to specialist clinics over a 15-day period. 223 ID-1 for evaluation in April 1998, and 287 for re-evaluation in October 1998. Type of evaluation: retrospective. SOURCE OF DATA: inter-consultation documents and clinical records. CRITERIA: explicit and standard. Corrective measures: educational (discussion of results in meeting of the PCT). RESULTS: A statistically significant improvement was found at the re-evaluation: basic personal details (91.5%-96.8%), legibility (86%-92.7%), medical history and/or customary medication (35.9%-50%) and symptoms (77.8%-87.2%). Good quality levels rose from 20.6% to 42.5%; and bad quality levels fell from 40.8% to 33.4%. 22.2% of our referrals received a reply. 34% of the lack of replies was because of no report from the specialist, 47.8% were attributed to the patient or circuit, and 18% of the patients were awaiting test results. CONCLUSIONS: The information supplied in the ID-1 improved significantly after the quality cycle. Knowing our habitual working practice can serve to stimulate improvement. The criteria we complied with least were: reference to personal antecedents and/or habitual medication, physical examination, and therapeutic measures employed. There was a huge loss of information in the replies to our referrals.

Immunoperoxidase study of uncommon parathyroid tumors. Report of two cases of nonfunctioning parathyroid carcinoma and one intrathyroid parathyroid tumor-producing amyloid.

Nonfunctioning carcinomas of the parathyroid gland are rare and difficult to diagnose. They are often confused with thyroid tumors or with metastasis from other sites. We report two cases of nonfunctioning parathyroid carcinomas; one was originally diagnosed as follicular carcinoma of the thyroid gland. The immunohistochemical demonstration of parathormone in the tumor cells established the parathyroid origin of these neoplasms. An intrathyroid parathyroid tumor, associated with large amounts of interstitial amyloid, mimicking medullary carcinoma of the thyroid, in a patient with primary hyperparathyroidism is also reported. Positive immunoreaction in the tumor cells for parathormone, negative staining for calcitonin, and the return of patients' serum calcium levels to normal after tumor resection, confirmed the parathyroid nature of this neoplasm. Immunohistochemistry studies proved to be extremely helpful in establishing the diagnoses of these unusual parathyroid tumors.

Impact of therapy for differentiated carcinoma of the thyroid: an analysis of 706 cases.

A retrospective analysis of clinical and pathological data was conducted on 706 patients (514 females and 192 males) treated for differentiated thyroid carcinoma at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston from 1951 to 1975 and followed to 1981. The histological diagnoses were mixed papillary/follicular carcinoma (66.7%), papillary carcinoma (14.6%), follicular carcinoma (15.3%), or Hurthle cell carcinoma (3.4%). Patients diagnosed before the age of 40 yr lived significantly longer than those diagnosed over the age of 40 yr, and females lived longer than males. According to survival analyses and disease-free intervals, the order of increasing aggressiveness of the tumors was papillary, mixed, follicular, and Hurthle cell. Total thyroidectomy was associated with longer disease-free intervals and fewer recurrences. The 136 patients who received ablative 131I after surgery had fewer recurrences than a matched group who did not, but the disease-free interval and survival rate showed no significant difference. Further classification showed that patients with follicular and mixed tumors, and those who underwent total thyroidectomy benefited from 131I. There were 78 deaths attributed to thyroid cancer in the whole group. Approximately two thirds occurred in the first 10 yr after diagnosis. In conclusion, total thyroidectomy is recommended, when feasible, for differentiated thyroid cancer, followed by ablative 131I therapy, at least for follicular and mixed varieties.

Clear cell islet cell tumor.

A patient with an islet cell tumor presented initially with a supra-renal mass that histologically had an extensive clear cell component. Electron microscopic and immunocytochemical findings were essential to prove that the extrapancreatic mass with clear cells was an unusual metastatic manifestation of an islet cell tumor. Both the pancreatic and extrapancreatic tumor cells contained neurosecretory granules and produced vasoactive intestinal polypeptide and substance P. The clear cell morphology was due to the accumulation of lipid and glycogen and cytoplasmic swelling.

Ectopic parathyroid hormone production by a squamous carcinoma of the tonsil.

A patient with recurrent squamous carcinoma of the neck showed hypercalcemia with the immunoreactive parathyroid hormone (PTH) level within the upper limits of normal range, this being inappropriate for the degree of hypercalcemia. An immunoreactive peak of PTH was found in the tumor tissue extract, which appeared on column chromatography to be in the region of elution of pure bovine PTH. The tumor tissue showed positive immunoperoxidase reaction for PTH compared with negative reaction when the patient had normocalcemia. These findings are strong evidence that the tumor produced a PTHlike substance.

Functioning oxyphil cell adenomas of parathyroid gland: immunoperoxidase evidence of hormonal activity in oxyphil cells.

Functional oxyphil adenomas of parathyroid gland are rare. Several studies have suggested that these tumors consist of a mixed cell population and that the transitional oxyphil cells and/or chief cells are the main source of parathormone, while the fully developed oxyphil cells have minimal or no hormonal activity. This report describes light, ultrastructural, and immunocytochemical features of six parathyroid adenomas, and confirms that these neoplasms are composed of a mixed cell population. It also demonstrates that the oxyphil cells have strong hormonal activity and therefore can play a significant role in the pathogenesis of hyperparathyroidism.

Parathyroid carcinoma: a clinical study of seven cases of functioning and two cases of nonfunctioning parathyroid cancer.

Seven cases of functioning and two cases of nonfunctioning parathyroid carcinoma are presented together with a general discussion of this disease. Functioning parathyroid carcinoma may be associated with prolonged survival. The morbidity and mortality from this disease are generally related to the prolonged hypercalcemia that occurs. The hypercalcemia is best treated with excision of local recurrences; however, this surgery is most often palliative and seldom curative. The best operative results were obtained when the disease could be localized preoperatively. Neck and mediastinal exploration in the absence of physical or radiographic evidence of recurrence failed to affect serum calcium levels. Two patients with nonfunctioning parathyroid cancer did poorly compared with those with functioning parathyroid carcinoma. The few cases reported in the literature are also suggestive of a more aggressive disease. The failure of this tumor to produce parathyroid hormone may allow it to escape clinical attention until it has achieved an advanced state.

MIF-I suppresses deprivation-induced fluid consumption in rats.

Rats were injected IP with a 0.1 mg/kg dose of MIF-I, naloxone, dynorphin, [D-Phe4]-Met-enkephalin, [D-Ala2, F5Phe4]-Met-enkephalin-NH2, or the diluent vehicle, placed in their home cages for ten minutes, and then given ad lib access to either 20% sucrose, 10% sucrose, water, 0.01% quinine, or 0.02% quinine in a repeated measures design with solutions counter-balanced over five days. Fluid consumption was measured very hour for 4 hours. A mixed analysis of variance yielded significant results for all main effects and the peptides by fluid and hours by fluid interactions. For the 4-hr test period, naloxone and [D-Phe4]-Met-enkephalin produced reliable increased in consumption while MIF-I produced a reliable decrease. Differences were obtained only with sucrose solutions, and the results clearly suggest that peptides modulate fluid consumption at positive levels of incentive motivation. To reconcile the findings of increased consumption after naloxone with the many studies suggesting a decrease in such paradigms, 0.1, 1.0, and 10.0 mg/kg of naloxone and MIF-I were administered as before but to independent groups of rats and intake was measured every 30 min. These results replicate and extend the above findings by showing that during the first 30-min period, both naloxone and MIF-I suppressed intake in a dose-dependent fashion, with MIF-I being more effective at each dose. The 0.1 mg/kg naloxone group, however, increased consumption over time and achieved a total consumption greater than control animals but comparable to that observed in the first study. It appears that at very low doses naloxone increases consumption over time, but at more commonly tested higher doses it has a suppressant effect. The results support the concept that in many situations MIF-I can produce the same effects as naloxone.

A comparative study of 14 cases of familial and nonfamilial pheochromocytomas.

A comparison is made between epidemiological features found in a group of 14 patients with familial and nonfamilial pheochromocytomas at M. D. Anderson Hospital and Tumor Institute. The Sipple syndrome (familial) group comprised eitht patients from three different families, and the nonfamilial group consisted of six nonrelated patients. The main differences were noted in the age of onset, sex ratio, bilaterality, malignant behavior, and occurrence of a second nonendocrine primary tumor. An attempt was made by light microscopy to define features that would indicate malignant behavior. No such features could be delineated. Survival time was unrelated to the presence of pheochromocytoma except in operative and investigative procedures.

Hyperparathyroidism and carcinoid tumor.

Three patients with carcinoid tumor associated with hyperparathyroidism are described. All patients showed a high circulating immunoreactive calcitonin level with no differential increase in the neck venous catheterization specimens, suggesting that the high concentrations of circulating immunoreactive calcitonin may have come from the carcinoid tumor. We think that the hyperparathyroidism in these patients was primary and that the association with carcinoid tumor represents another form of multiple endocrine tumor formation. Hyperparathyroidism should be investigated in patients with carcinoid tumor.