Trombose tardia (3 anos e 9 meses) de stent Cypher / Late Stent Thrombosis (3 years and 9 months) after Cypher Implantation

A trombose tardia nos stents revestidos com drogas antiproliferativas é uma realidade a ser enfrentada. Ela ocorre com maior frequência dependendo do critério de trombose, do que em stents convencionais. A trombose pode se dar anos após o implante e mesmo em pacientes usando antiagregante plaquetário. O desfecho clínico pode ser dramático, entretanto, não sabemos ainda se este evento realmente aumenta a mortalidade, quando comparado ao stent convencional. Os autores relatam um caso de trombose de stent Cypher, quase quatro anos após o seu implante.

A trombose tardia nos stents revestidos com drogas antiproliferativas é uma realidade a ser enfrentada. Ela ocorre com maior freqüência, dependendo do critério de trombose, do que em stents convencionais. A trombose pode se dar anos após o implante e mesmo em pacientes usando antiagregante plaquetário. O desfecho clínico pode ser dramático, entretanto, não sabemos ainda se este evento realmente aumenta a mortalidade, quando comparado ao stent convencional. Os autores relatam um caso de trombose de stent Cypher, quase quatro anos após o seu implante.

Stomatal conductance of semi-natural Mediterranean grasslands: implications for the development of ozone critical levels.

Intra-genus and intra-specific variation and the influence of nitrogen enrichment on net assimilation and stomatal conductance of some annual Trifolium species of Mediterranean dehesa grasslands were assessed under experimental conditions. Also gas exchange rates were compared between some Leguminosae and Poaceae species growing in the field in a dehesa ecosystem in central Spain. The results showed that the previously reported different O3 sensitivity of some Trifolium species growing in pots does not seem to be related to different maximum g(s) values. In addition, no clear differences on gas exchange rates could be attributed to Leguminosae and Poaceae families growing in the field, with intra-genus variation being more important than differences found between families. Further studies are needed to increase the database for developing a flux-based approach for setting O3 critical levels for semi-natural Mediterranean species.

Clinical and genetic aspects of two Spanish families with autosomal dominant retinitis pigmentosa (ADRP)

A study was made of two families with autosomal dominant retinitis pigmentosa (ADRP) from Valencia (Spain). One family (ADRP15) was found to have mutation in codon 114 of the rhodopsin gene that led to a substitution of a glycine for an aspartic acid. The second family (ADRP7) substituted an aspartic acid for valine in codon 173 of the peripherin-RDS gene. Rhodopsin is involved in 25% of ADRP cases and many mutations of this gene have been described as causing different forms of the disease, with variable severity and age at onset. ADRP has been classified as RP with a milder symptom evolution, a typical RP fundus pattern, and macular involvement occurring after the second decade of life. Peripherin-RDS gene mutations lead to RP or other retinopathies. Furthermore, two mutations in codon 172 have been described as causing macular dystrophy. In ADRP7, a mutation in neighboring codon 173 produced RP with an atypical fundus pattern and macular involvement within the first decade of life. These observations confirm the established clinical and genetic heterogeneity involved in this form of RP.

[The resident in family and community medicine views his specialization. II]. / El residente de Medicina Familiar y Comunitaria ante su especialización (II).

A questionnaire was submitted to the third year residents of Family and Community Medicine. Its aim was to know their opinion, respecting the different aspects of their specialty. We obtained a high rate of response (49.5%). The majority of residents are male and 37 por 100 had finished their degree before joining the program. The fact of choosing a residence in the Family and Community Medicine program is related to the place obtained in the ranking of Internal Resident Doctors and to the lack of vacancies in fields thought to be more interesting. About a third of those polled state that their main reason for choosing Family and Community Medicine is vocational. If one compared their preference for the specialty before and after the resident period, this increased. Still, the specialty's allure is low. The majority prefer working in Public Medicine and in tasks related to medical care and the urban milieu. We put forward some suggestions that could improve this situation.

[The family and community medicine resident facing his/her specialization (I)]. / El residente de medicina familiar y comunitaria ante su especialización (I).

A questionnaire was sent out to the interns in Family and Community Medicine throughout the country in the last month of training. The objective was to find out the degree of fulfillment and the evaluation of the Official Program of the Specialty as far as courses, rotations and duty periods were concerned. We received 170 questionnaires (response rate: 49.8%). The obligatory courses are overwhelmingly attended, but not so the optional ones. What stands out especially is the incorrect length of rotation among Internal Medicine, Pediatrics, and Primary Health Care. The specializations which draw the most interest due to their eventual use are Internal Medicine, Pediatrics, and Primary Health Care, and the least interesting are Gynaecology, Otorhinolaryngology and Ophthalmics. Roughly half have not had any duty watches in Surgery and Primary Care. With these results in hand, we recommend some changes be made in the specialization programs.