Three-year follow-up of the Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease (ERACI).

OBJECTIVES: The purpose of this study was to report the 3-year follow-up results of the ERACI trial (Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease). BACKGROUND: Although coronary angioplasty has been used with increased frequency in patients with multivessel coronary artery disease, its value, compared with bypass graft surgery, has not been established. Thus, controlled, randomized clinical trials such as the ERACI are needed. METHODS: In this trial 127 patients who had multivessel coronary artery disease and clinical indication of myocardial revascularization were randomized to undergo coronary angioplasty (n = 63) or bypass surgery (n = 64). The primary end point of this study was event-free survival (survival with freedom from myocardial infarction, angina and new revascularization procedures) for both groups of patients at 1, 3 and 5 years of follow-up. RESULTS: Freedom from combined cardiac events (death, Q-wave myocardial infarction, angina and repeat revascularization procedures) was significantly greater for the bypass surgery group than the coronary angioplasty group (77% vs. 47%; p < 0.001). There were no differences in overall (4.7% vs. 9.5%; p = 0.5) and cardiac (4.7% vs. 4.7%; p = 1) mortality or in the frequency of myocardial infarction (7.8% vs. 7.8%; p = 0.8) between the two groups. However, patients who had bypass surgery were more frequently free of angina (79% vs. 57%; p < 0.001) and required fewer additional reinterventions (6.3% vs. 37%; p < 0.001) than patients who had coronary angioplasty. CONCLUSIONS: 1) Freedom from combined cardiac events at 3-year follow-up was greater in patients who had bypass surgery than in those who had coronary angioplasty. 2) The coronary angioplasty group had a higher incidence of recurrence of angina and the need for repeat revascularization procedures. 3) Cumulative cost at 3-year follow-up was greater for the bypass surgery group than for the coronary angioplasty group.

Mass vaccination campaign against rabies: are dogs correctly protected? The Peruvian experience.

In a mass vaccination campaign conducted in Peru in March 1985, 270,000 dogs (65% of the estimated dog population) were vaccinated over the course of 1 month with an inactivated tissue culture vaccine. Since that time no human rabies cases have been reported; in addition, the number of animal rabies cases has declined to only three from a previous mean of 292 cases per year since 1980. A serologic survey was also done to determine the immune response among randomly selected vaccinated dogs, with titers determined 3, 6, 9, and 12 months after vaccination. Twelve months after vaccination, 97% of the dogs had a rabies neutralizing antibody titer of greater than or equal to 0.5 IU/mL, and 87% had a titer of greater than or equal to 1.0 IU/mL. Thus, this tissue culture rabies vaccine given under field conditions induced antibodies that lasted for at least 1 year in 97% of vaccinated dogs.

La Hidatidosis en el Perú: importancia del inmunodiagnóstico y de los estudios seroepidemiológicos / Hydatidosis in Peru: importance of the inmunodiagnosis and the seroepidemiologycal studies

En el presente estudio se describe la aplicación de pruebas estandarizadas para el diagnóstico inmunológico de la hidatidosis humana en el Instituto de Medicina Tropical "Daniel A. Carrión", Universidad Nacional Mayor de San Marcos, Lima, Perú. Estas se emplearon para obtener la conformación prequirúrgica de la parasitosis en situaciones clínicas, y para la detección de portadores asintomáticos de quistes hidatídicos mediante encuestas. Los resultados se utilizaron como fuente de datos para evaluar la calidad de la información que sobre el número de casos de la afección en distintas áreas ecológicas, se obtiene a partir de los casos hospitalarios notificados a los niveles oficiales. Los resultados demuestran la utilidad que puede brindar la extensión de la cobertura de los servicios para el inmunodiagnóstico de la hidatidosis a las áreas endémicas del país con fines de atención primaria y vigilancia epidemiológica. Esto permitiría obtener mejor información sobre el impacto que la contaminación ambiental por los huevos de Echinococcus granulosus produce en la población humana y medir los cambios que resultarían de la efectiva aplicación de medidas de control.