Environmental and economic analysis of power generation in a thermophilic biogas plant.

This paper investigates the environmental and economic performance of the power production from biogas using Life Cycle Assessment, Life Cycle Costing and Cost Benefit Analysis methodologies. The analysis is based on a commercial thermophilic biogas plant located in Spain where is installed a Combined Heat and Power system that produces electricity that is sold to the grid. Power generation has been assumed as the only function of the biogas system, expanding the system boundaries to include the additional function related to the end-of-life management of the biowastes. Thus environmental burdens from the conventional management of residues were calculated separately and subtracted. The base scenario involves using agri-food waste, sewage sludge and pig/cow manure as substrates. This situation is compared against an alternative scenario where the production of synthetic fertilizer is surrogated by the digestate. The results have shown that the most impacting activities in all impacts categories of power production are primarily attributable to the operation and maintenance of the biogas plant except for water resource depletion and climate change. The avoided emissions associated with the conventional management of pig/cow manure more than offset GHG emissions of the biogas system resulting in a negative impact value of -73.9gCO2eq/kWh in the base case scenario. The normalized results show that local impact categories such as primarily human toxicity, fresh water ecotoxicity and particulate matter are the most significantly affected by the biogas system while global impact categories as climate change and ozone depletion are less severely affected. The operation and maintenance phase is also shown to be the largest contributor after the life cycle cost analysis, followed by the construction and dismantling of the biogas plant and the profitability of the project is primarily related to the income obtained from the management of the biowastes used as substrates.

Assessment of sexuality among middle-aged women using the Female Sexual Function Index.

OBJECTIVE: The purpose of the present investigation was to assess sexual function among middle-aged women and determine related risk factors (personal and partner) for sexual dysfunction. METHODS: In this cross-sectional study, women aged 40-59 years were requested to fill out the Female Sexual Function Index (FSFI) and a general demographic questionnaire containing personal and partner data. RESULTS: A total of 409 women with a mean age of 47 +/- 5.3 years were surveyed. Of these, 42.1% were premenopausal, 24.4% perimenopausal and 33.5% postmenopausal. At the time of survey, 10.5% of women were hysterectomized, 1.5% used psychotropic drugs, and 9.8% were on hormone therapy (HT) for the menopause; 28.1% had less than 12 years of schooling and 80.4% had only one partner at the moment of survey. Among their male partners, 7.3% abused alcohol, 10.3% had erectile dysfunction, 11.2% premature ejaculation and 63.83% were faithful partners. Mean (+/- standard deviation) scores for the FSFI domains were: desire (3.7 +/- 1.2), arousal (3.1 +/- 2.5), lubrication (3.3 +/- 2.6), orgasm (2.6 +/- 2.3), satisfaction (4 +/- 1.7), and pain/dyspareunia (3.2 +/- 2.6). The mean total FSFI score was 20.1 +/- 12.4 (median 24.7). In this series, the prevalence of female sexual dysfunction (FSFI score

[Colitis cystica profunda]. / Colitis quística profunda.

Colitis cystica profunda is a rare benign disease, characterized by the presence of mucin-filled cysts in the submucosa layer of colon, which forms polypoid lesions. The most habitual type of clinical presentation is localized, at distal colon or in the rectum, and more rarely appears like a diffuse afectation of colon. We present a case of colitis cystica profunda with diffuse afectation of whole colon, which definitive diagnosis was for the histological finds of the endoscopy macrobiopsys realized to colon's polypoid lesions.

Colitis quística profunda / No disponible

La colitis quística profunda es una enfermedad rara y benignaque se caracteriza por la presencia de quistes llenos de moco en lacapa submucosa del colon, que forman lesiones polipoideas. Eltipo de presentación clínica más habitual es localizada, en el colondistal o en el recto, y más raramente aparece como una afectacióndifusa del colon. Presentamos un caso de colitis quística profundacon afectación difusa de todo el colon, cuyo diagnóstico definitivofue por los hallazgos histológicos de las macrobiopsiasendoscópicas realizadas a las lesiones polipoideas del colon

Colitis cystica profunda is a rare benign disease, characterized bythe presence of mucin-filled cysts in the submucosa layer of colon,which forms polypoid lesions. The most habitual type of clinicalpresentation is localized, at distal colon or in the rectum, and morerarely appears like a diffuse afectation of colon. We present a caseof colitis cystica profunda with diffuse afectation of whole colon,which definitive diagnosis was for the histological finds of the endoscopymacrobiopsys realized to colon’s polypoid lesions

[Influence of neostigmine on the course of neuromuscular blockade with rocuronium or cisatracurium: a randomized, double-blind trial]. / Influencia de la neostigmina en la evolución clínica del bloqueo neuromuscular de rocuronio y cisatracurio. Estudio aleatorizado doble ciego.

OBJECTIVES: To compare the time-course of neuromuscular blockade with rocuronium or cisatracurium during intravenous anesthesia, in terms of both the time to spontaneous recovery or time to reversal after administration of neostigmine. MATERIAL AND METHODS: Patients classified as ASA 1-2 were randomized to receive blinded administration of a single injection of twice the 95% effective dose of rocuronium or cisatracurium for general anesthesia, and then neostigmine plus atropine at recovery of the first train-of-4 (TOF) twitch at 5% or 25%, or normal saline solution as placebo at recovery of the first TOF twitch at 25%. The neuromuscular blockade was monitored by acceleromyography. Intergroup comparisons were carried out by Student t test and analysis of variance. RESULTS: Sixty patients were enrolled. Mean (SD) time to onset was faster with rocuronium at (1.04 [0.32] minutes) compared with cisatracurium at (2.58 [0.81] minutes) and duration was shorter: time to the first twich at 5% was 30 (6.4) minutes with rocuronium and 38.1 (9.7) minutes with cisatracurium. The total duration of blockade (time to the 80% TOF ratio) was also shorter with rocuronium when the neuromuscular blockade was reversed, but there were no differences in the time to block reversal when neostigmine was not used: 62 (18.9) minutes to recovery from the rocuronium blockade vs 66.96 (15.9) minutes to recover from a cisatracurium blockade. A high percentage of patients had less than an 80% TOF ratio at 60 and 90 minutes of administration of the neuromuscular blockerswhen reversal was not used (patients receiving rocuronium, 60% at 60 minutes, and 20% at 90 minutes; patients receiving cisatracurium, 80% at 60 minutes, and 40% at 90 minutes). CONCLUSION: Not antagonizing a rocuronium- or cisatracurium-induced neuromuscular blockade in surgical procedures lasting less than 90 minutes can lead to a high percentaje of residual blockade (TOF ratio <80%).

Influencia de la neostigmina en la evolución clínica del bloqueo neuromuscular de rocuronio y cisatracurio. Estudio aleatorizado doble ciego / Influence of neostigmine on the course of neuromuscular blockade with rocuronium or cisatracurium: a randomized, double-blind trial

OBJETIVOS: Comparar la evolución y la recuperación,tanto espontánea como tras reversión con neostigmina,del bloqueo neuromuscular (BNM) de rocuronio y cisatracuriodurante una anestesia intravenosa.MATERIAL Y MÉTODO: Pacientes ASA 1-2 fueron randomizadosde forma ciega para recibir una dosis única2ED95% de rocuronio o de cisatracurio durante una anestesiageneral intravenosa, y recibir neostigmina más atropinaa la recuperación de la primera respuesta del TOF(T1) del 5% o del 25%, o recibir placebo (suero fisiológico)a T1 25%. La monitorización del BNM se llevó a cabomediante aceleromiografía. La comparación entre gruposse realizó mediante las pruebas T student y ANOVA.RESULTADOS: Se incluyeron 60 pacientes en el estudio.Rocuronio presentó unos tiempos de instauración(1,04±0,32 vs 2,58±0,81 min) y duración Dosis-T1 5%(30±6,4 vs 38,1±9,7 min) significativamente inferiores acisatracurio. La duración total del bloqueo (Dosis-TOFratio 80%) también fue inferior para rocuroniocuando se usó reversión del BNM, pero no observamosdiferencias cuando no se utilizó reversión con neostigmina(62 ±18,9 min rocuronio vs 66,96±15,9 min cisatracurio).Para ambos fármacos, cuando no se utilizó reversióndel BNM, un alto porcentaje de pacientes mantuvoun TOFratio<80% a los 60 y 90 min de administrado elbloqueante (Rocuronio TOFratio<80%: 60% 60 min,20% 90 min; Cisatracurio TOFratio<80%: 80% 60 min,40% 90 min).CONCLUSIÓN: No revertir el BNM de rocuronio o cisatracurioen procesos anestésico-quirúrgicos inferiores a90 min puede llevarnos a un alto porcentaje de pacientescon BNM residual (TOFratio<80%) (AU)

OBJECTIVES: To compare the time-course of neuromuscular blockade with rocuronium or cisatracurium during intravenous anesthesia, in terms of both the time to spontaneous recovery or time to reversal after administration of neostigmine. MATERIAL AND METHODS: Patients classified as ASA 1-2 were randomized to receive blinded administration of a single injection of twice the 95% effective dose of rocuronium or cisatracurium for general anesthesia, and then neostigmine plus atropine at recovery of the first train-of-4 (TOF) twitch at 5% or 25% or normal saline solution as placebo at recovery of the first TOF twitch at 25%. The neuromuscular blockade was monitored by acceleromyography. Intergroup comparisons were carried out by Student t test and analysis of variance. RESULTS: Sixty patients were enrolled. Mean (SD) time to onset was faster with rocuronium at (1.04-0.32 minutes) compared with cisatracurium at (2.58-0.81 minutes) and duration was shorter: time to the first twich at 5% was 30 (6.4) minutes with rocuronium and 38.1 (9.7) minutes with cisatracurium. The total duration of blockade (time to the 80% TOF ratio) was also shorter with rocuronium when the neuromuscular blockade was reversed, but there were no differences in the time to block reversal when neostigmine was not used: 62 (18.9) minutes to recovery from the rocuronium blockade vs 66.96 (15.9) minutes to recover from a cisatracurium blockade. A high percentage of patients had less than an 80% TOF ratio at 60 and 90 minutes of administration of the neuromuscular blockerswhen reversal was not used (patients receiving rocuronium, 60% at 60 minutes, and 20% at 90 minutes; patients receiving cisatracurium, 80% at 60 minutes, and 40% at 90 minutes). CONCLUSION: Not antagonizing a rocuronium- or cisatracurium-induced neuromuscular blockade in surgical procedures lasting less than 90 minutes can lead to a high percentaje of residual blockade (TOF ratio <80%) (AU)

[Clinical effect of mivacurium in morbidly obese patients]. / Efecto clínico del mivacurio en pacientes con obesidad mórbida.

OBJECTIVES: To compare the clinical effect of mivacurium in morbidly obese and normal-weight patients. PATIENTS AND METHODS: Ten morbidly obese patients (body mass index >40) and 10 normal-weight patients (body mass index, 21-24) with normal plasma cholinesterase levels. Anesthesia was provided with propofol and remifentanil in continuous infusion and a mixture of oxygen and nitrous oxide. Mivacurium was administered at a dose based on the patient's weight (0.15 mg x kg(-1)). The neuromuscular block was monitored by train-of-four (TOF) acceleromyography after stimulation of the cubital nerve at the forearm. We measured the onset time (time from administration of the muscle relaxant to 95% twitch depression), duration of block (times from dosing to 5% recovery after the first twitch [T1] of a TOF stimulus and to a TOF ratio of 80%), and the recovery indices (time between 25% and 75% recovery after T1 and between recovery of TOF ratios of 25% and 80%). Groups were compared with the Student t test. RESULTS: Mean (SD) onset time was similar in the 2 groups (normal weight 2.73 [1] minutes vs morbidly obese 1.91 [0.6] minutes). Other measures of duration and recovery were also similar in the 2 groups, respectively: duration of dose-T1 5%, 12.23 (2.1) vs 11.45 (3) minutes; dose-TOF ratio 80%, 24.71 (4.6) vs 24.81 (5) minutes); recovery index T1 25%-75%, 6.45 (2) vs 5.56 (1) minutes; recovery of TOF ratio T1 25%-80%, 9 (2) vs 10.11 (2) minutes. CONCLUSION: We found no differences in the clinical effect of mivacurium between morbidly obese and normal-weight patients when doses were based on real weight.

Efecto clínico del mivacurio en pacientes con obesidad mórbida / Clinical effect of mivacurium in morbidly obese patients

OBJETIVOS: Comparar el efecto clínico del mivacurioen pacientes con obesidad mórbida y pacientes con normo-peso.PACIENTES Y MÉTODOS: Se estudiaron 10 pacientescon obesidad mórbida (Índice de masa corporal(IMC)>40) y 10 pacientes con normo-peso (IMC 21-24)con actividad de colinesterasa plasmática normal. Laanestesia se realizó con propofol y remifentanilo eninfusión continua y mezcla de O2/N2O. Se administró0,15 mg Kg-1 de mivacurio en base al peso real delpaciente. El bloqueo neuromuscular se monitorizó poraceleromiografía tras estimulación del nervio cubital anivel del antebrazo. Se registró la instauración del bloqueo(tiempo desde la dosis a la depresión de la respuestadel estímulo simple del 95%), duración del bloqueo(tiempos desde la dosis hasta la recuperación de laprimera respuesta del TOF (T1) del 5% y del TOF ratio(TOFr) del 80% y los índices de recuperación T1 25-75% y T1 25%-TOFr 80%. Los grupos se compararoncon la prueba t-Student.RESULTADOS: Los grupos fueron similares en la instauracióndel bloqueo (normo-peso 2,73±1 min vs obesidadmórbida 1,91±0,6 min), en su duración (Dosis-T1 5%:12,23±2,1 vs 11,45±3 min; Dosis-TOFr 80%: 24,71±4,6 vs24,81±5 min) y en los parámetros de recuperación (T1 25-75%: 6,45±2 vs 5,56 ± 1 min; T1 25%-TOFr 80%: 9±2 vs10,11±2 min).CONCLUSIÓN: No encontramos diferencias en el efectoclínico del mivacurio entre pacientes con obesidad mórbiday pacientes con normo-peso cuando se dosifica enfunción del peso real

OBJECTIVES: To compare the clinical effect of mivacuriumin morbidly obese and normal-weight patients.PATIENTS AND METHODS: Ten morbidly obese patients(body mass index >40) and 10 normal-weight patients(body mass index, 21-24) with normal plasma cholinesteraselevels. Anesthesia was provided with propofol andremifentanil in continuous infusion and a mixture ofoxygen and nitrous oxide. Mivacurium was administeredat a dose based on the patient's weight (0.15 mg·kg-1).The neuromuscular block was monitored by train-offour(TOF) acceleromyography after stimulation of thecubital nerve at the forearm. We measured the onsettime (time from administration of the muscle relaxant to95% twitch depression), duration of block (times fromdosing to 5% recovery after the first twitch [T1] of aTOF stimulus and to a TOF ratio of 80%), and the recoveryindices (time between 25% and 75% recovery afterT1 and between recovery of TOF ratios of 25% and80%). Groups were compared with the Student t test.RESULTS: Mean (SD) onset time was similar in the 2groups (normal weight 2.73 [1] minutes vs morbidly obese1.91 [0.6] minutes). Other measures of duration and recoverywere also similar in the 2 groups, respectively: durationof dose-T1 5%, 12.23 (2.1) vs 11.45 (3) minutes; dose-TOF ratio 80%, 24.71 (4.6) vs 24.81 (5) minutes); recoveryindex T1 25%-75%, 6.45 (2) vs 5.56 (1) minutes; recoveryof TOF ratio T1 25%-80%, 9 (2) vs 10.11 (2) minutes.CONCLUSION: We found no differences in the clinicaleffect of mivacurium between morbidly obese and normalweightpatients when doses were based on real weight

The leaching of inorganic species from activated carbons produced from waste tyre rubber.

Waste tyre rubber can be used as a precursor for the production of high quality activated carbons. However, there is concern that inorganic impurities present in the rubber feed may restrict their use in liquid phase applications with high purity requirements. This paper presents an investigation of the presence and the leaching of inorganic species from activated carbons derived from waste tyre rubber. For the purpose of this work, a number of carbons were produced, characterised for their BET surface area and analysed for their inorganic composition. Subsequently, a number of tests were performed to evaluate the leaching of different inorganic species into solution at various pH values and carbon doses. Results showed that rubber-derived carbons contained elevated concentrations of sulphur and zinc, as well as traces of other metals such as lead, cadmium, chromium and molybdenum. Inorganic levels were significantly affected by production conditions, particularly degree of carbon activation and the nature of the gasification agent. However, leaching tests showed that the availability of these species in neutral pH conditions was very limited. Results demonstrated that, when using carbons doses comparable to those employed in water treatment works, only sulphur levels exceeded, in some occasions, health based quality standards proposed for drinking water.

Atrial natriuretic hormone, vessel dilator, long acting natriuretic hormone, and kaliuretic hormone decrease circulating prolactin concentrations.

The present investigation was designed to test whether four cardiac hormones--long acting natriuretic hormone, vessel dilator, kaliuretic hormone and atrial natriuretic hormone--decrease the circulating concentration of prolactin in humans (n = 30). Vessel dilator, kaliuretic hormone, long acting natriuretic hormone and atrial natriuretic hormone decreased the circulating concentration of prolactin to 3 %, 31 %, 27 %, and 23 % of control values, respectively, at the end of their infusions when infused at concentrations of 100 ng/kg body weight per minute for 60 minutes (p < 0.001 for each). Vessel dilator, kaliuretic hormone, long acting natriuretic hormone and atrial natriuretic hormone had sustained effects on modulating prolactin's concentrations, with circulating concentrations of 1 %, 64 %, 28 %, and 2 % of control values (p < 0.001) 3 hours after stopping their respective infusions. These results suggest that there are four circulating prolactin-inhibitory hormones in addition to the hypothalamic mediators, dopamine and corticotropin-releasing hormone, which modulate prolactin release. These peptide hormones' ability to decrease circulating prolactin concentrations may be mediated in part by dopamine and in part by their demonstrated ability to decrease corticotropin-releasing hormone concentrations, which stimulate prolactin release.

Thermal regeneration of granular activated carbons using inert atmospheric conditions.

Thermal regeneration is increasingly being used for the recovery of field-spent granular activated carbons (GAC) generated by the water treatment industry. Despite its commercial success, conventional methods using oxidising conditions (usually steam) are known to damage the porosity of the regenerated carbons, thus reducing their adsorption capacity and economic value. This paper presents a comparative investigation into the benefits of using inert conditions for the regeneration of field-spent GAC. For the purpose of this work, a sample of spent carbon was regenerated in nitrogen and in steam to different degrees of burn off. The resulting samples were analysed for their porosity and surface area characteristics using nitrogen gas adsorption, and for their aqueous adsorption capacities using phenol and methylene blue. Experimental results showed that steam was sightly more effective than nitrogen at regenerating the total micropore volume and BET surface area of the carbons. However, these benefits were largely counteracted by greater losses in the carbon yield and damage to the narrow microporosity. Carbons regenerated in nitrogen exhibited greater adsorption capacities for the adsorption of small molecular size compounds (phenol) from solution, while carbons regenerated in steam adsorbed larger molecular size compounds (methylene blue) more effectively. However, when product yields were taken into consideration, inert regeneration was found to produce significantly better results than steam regeneration. An optimum process temperature was determined to be 950 degrees C.

Prenatal diagnosis of Cantrell's pentalogy with conventional and three-dimensional sonography.

Omphaloceles and gastroschisis are the most common defects of the fetal anterior abdominal wall. The association of an omphalocele with an anterior thoracic wall defect could result from a variety of congenital syndromes of which Cantrell's pentalogy is the most common. For proper surgical scheduling of the neonate, early diagnosis of each of the components of this syndrome is important. The presence of a congenital intracardiac anomaly is the best predictor of neonatal mortality. We present a case of Cantrell's pentalogy diagnosed prenatally with conventional and three-dimensional sonographic imaging, and confirmed at birth. We discuss this case and the reports in the world literature.

Atrial natriuretic hormone, vessel dilator, long-acting natriuretic hormone, and kaliuretic hormone decrease the circulating concentrations of total and tree T4 and free T3 with reciprocal increase in TSH.

The present investigation was designed to determine whether atrial natriuretic peptides (ANPs) consisting of amino acids 1-30 [i.e. long-acting natriuretic hormone (LANH)], 31-67 (vessel dilator), 79-98 (kaliuretic hormone), and 99-126 (atrial natriuretic hormone [ANH]) of the 126-amino acid ANH prohormone decrease the circulating concentrations of total and free T4 and/or free T3 in healthy humans (n = 30). Vessel dilator, kaliuretic hormone, LANH, and ANH decreased the circulating concentrations of total T4 by 61%, 58%, 47%, and 55% and of free T4 by 60%, 67%, 79%, and 79%, whereas free T3 decreased 72%, 67%, 71%, and 67% (P < 0.05 for each), respectively, when infused at 100 ng/kg BW x min for 60 min. Vessel dilator, kaliuretic hormone, LANH, and ANH simultaneously increased circulating TSH concentrations 4- to 12.5-fold (P < 0.004). The decreases in T4 and T3 with reciprocal increases in TSH lasted 2-3 h after cessation of the respective ANP infusions. The reciprocal increase in TSH with the decreases in T4 and T3 suggests that their modulation of T4 and T3 concentrations occurs in the thyroid rather than in the pituitary or hypothalamus, because TSH would be decreased in the circulation if their inhibitory effects were in either the hypothalamus or pituitary.

A study of the influence of the hydrophobic core residues of yeast iso-2-cytochrome c on phosphate binding: a probe of the hydrophobic core-surface charge interactions.

To gain insight into the role of hydrophobic core-surface charge interactions in stabilizing cytochrome c, we investigated the influence of hydrophobic core residues on phosphate binding by mutating residues in yeast iso-2-cytochrome c to those corresponding to iso-l-cytochrome c in various combinations. Heat transition of ultraviolet CD was followed as a function of pH in the presence and absence of phosphate. Thermodynamic parameters were deduced. It was found that the I20V/V43A/M98L mutation in the hydrophobic core, whose locations are remote from the putative phosphate sites, modulates phosphate interactions. The modulation is pH dependent. The I20V/ M98L and V43A mutation effects are nonadditive. The results lead to a model analogous to that of Tsao, Evans, and Wennerstrom, where a domain associated with the ordered hydrophobic core is sensitive to the fields generated by the surface charges. Such an explanation would be in accord with the observed difference in thermal stability between iso-2 and horse cytochromes c.

Atrial natriuretic hormone, vessel dilator, long-acting natriuretic hormone, and kaliuretic hormone decrease the circulating concentrations of CRH, corticotropin, and cortisol.

The present investigation was designed to determine whether atrial natriuretic peptides consisting of amino acids 1-30 (i.e. long-acting natriuretic hormone), 31-67 (vessel dilator), 79-98 (kaliuretic hormone), and 99-126 (atrial natriuretic hormone) of the 126 amino acid atrial natriuretic hormone prohormone decrease CRH, ACTH, and/or cortisol in healthy humans (n = 30). Vessel dilator, kaliuretic hormone, long-acting natriuretic hormone, and atrial natriuretic hormone decreased the circulating concentration of CRH 84%, 74%, 67%, and 62% (P < 0.001 for each), respectively, when infused at 100 ng/kg body weight.min for 60 min. Vessel dilator, kaliuretic hormone, long-acting natriuretic hormone, and atrial natriuretic hormone decreased circulating ACTH concentrations 58%, 80%, 81%, and 70% (P < 0.001) and the circulating concentration of cortisol 73%, 72%, 73%, and 67% (P < 0.001), respectively. The decreases in CRH, ACTH, and cortisol lasted 11/2 to 3 h after cessation of the respective atrial natriuretic peptide infusions. These data, along with the knowledge that cortisol upregulates atrial natriuretic peptides' gene expression and CRH and ACTH stimulate atrial natriuretic peptides' release, suggest that these four atrial natriuretic peptides may be part of an intricate feedback system to help regulate cortisol concentrations via their ability to decrease the circulating concentration of CRH which, in turn, results in a decrease in ACTH and cortisol.

Effects of kaliuretic peptide on sodium and water excretion in persons with congestive heart failure.

Kaliuretic peptide, a 20-amino acid peptide hormone synthesized in the heart, enhances urine flow twofold, whereas atrial natriuretic peptide (ANP) enhances urine flow four- to 11-fold in healthy persons. The present investigation was designed to (1) determine whether kaliuretic peptide may have beneficial diuretic effects in persons with congestive heart failure (CHF), and (2) compare its beneficial effects with ANP in the treatment of CHF. Kaliuretic peptide (100 ng/kg body weight/min) given intravenously for 60 minutes to subjects with New York Heart Association class III CHF increased urine flow fourfold (p <0.001), which was maximal 212 hours after its infusion was stopped. Kaliuretic peptide enhanced sodium excretion threefold in subjects with CHF (p <0.01). Kaliuretic peptide increased the urinary excretion rate of potassium ion and fractional excretion of potassium 3.5- and twofold (p <0.05), respectively. ANP (same concentration) did not significantly enhance urine flow. ANP enhanced sodium excretion two- to sixfold in half of the CHF subjects, whereas it had no effect on sodium excretion in the other half. ANP did not significantly increase fractional excretion of sodium but did increase fractional excretion of potassium (p <0.05) during the first 20 minutes of its infusion. ANP-infused patients with CHF became hypotensive. None became hypotensive secondary to kaliuretic peptide. These data indicate that the diuretic properties of kaliuretic peptide in persons with CHF, as opposed to those of ANP, are not diminished (but rather are increased) compared with their effects in healthy persons. In patients with CHF, kaliuretic peptide causes a natriuresis-a feature not observed in those without sodium retention.

[Why are not all patients with chronic liver disease associated with hepatitis C virus treated?]. / ¿Por qué no reciben tratamiento todos los pacientes con una hepatopatía crónica relacionada con el virus de la hepatitis C?

AIMS: To analyze the prevalence of patients with chronic liver disease associated with hepatitis C virus (HCV) not undergoing antiviral treatment and the reasons for which this treatment was not indicated. PATIENTS AND METHODS: 718 patients with HCV infection referred for therapeutic evaluation between January 1990 and January 1998. Demographic, clinical, biological and histological variables were prospectively analyzed. The patients were divided into two groups: treated and untreated. RESULTS: 393 patients were treated and in 325 patients antiviral treatment was not considered to be indicated. The most frequent reasons for not starting therapy were advanced age, the presence of decompensated cirrhosis and the patients' refusal to undergo antiviral treatment. CONCLUSIONS: A broad subgroup of patients with chronic liver disease associated with HCV do not receive antiviral treatment. This is related with: a) patients' advanced age at diagnosis, b) diagnosis at the advanced stages of the disease, and c) patients' refusal to undergo such treatment after being informed of its potential risks and benefits.