[The performance and perception of informed consent in a health-care section of Catalonia]. / Cumplimiento y percepción del consentimiento informado en un sector sanitario de Cataluña.

BACKGROUND: Informed consent entails a process which involves more than signing a form to give one's consent. This process involves the mutual exchange of information, understanding, trust and consent between physician and patient. The purpose of this study is that of ascertaining the degree to which those consumers who have gone through the informed consent process in a health care district in Catalonia have filled out and fully understood this form. METHODS: Telephone survey conducted among 314 former surgery patients at hospitals in a given district, ages 18-75, who had undergone surgery within the three months immediately prior to the date on which the survey was conducted for the purpose of ascertaining the opinion of these consumers regarding the consent process. A review of the clinical records of 30% of these individuals was conducted for the purpose of ascertaining the degree of compliance with the consent form process. RESULTS: Sixty-one percent (61%) of the patients surveyed remembered having signed the consent form, 59.2% recalling explanations regarding risks or complications of the surgery they were to undergo. Nine percent (9%) did not understand well enough what was going to be done to them during the surgery, and 36% were of the understanding that the consent form released the health care professionals from liability. A statistically significant relationship was found to exist among the age group, educational level and admissions channel. Seventy-eight percent (78%) of the clinical records reviewed included informed consent forms. The diagnosis was stated on 14.9% of these forms, and 48.9% had been signed by the attending physician. A statistically significant relationship was found between the channels through which patients were admitted to the hospital. CONCLUSIONS: The informed consent process is not being implemented correctly at the two hospitals analyzed. Physicians are not totally involved in the process.

Epidemiologic evidence of transmission of donor-related bacterial infection through a transplanted heart.

This study describes a patient who had fulminant infectious myocarditis as a result of methicillin-resistant Staphylococcus aureus after receiving a heart transplant from an infected donor. There was complete concordance of typing results between donor and recipient strains that were different from the 20 isolates with which they were compared. Molecular epidemiologic study provided compelling evidence that a transplanted organ can transmit a bacterial infection from the donor to the recipient.

Spectrum of alcohol-induced myocardial damage detected by indium-111-labeled monoclonal antimyosin antibodies.

OBJECTIVES: We sought to determine the prevalence, intensity and evolving changes of myocardial damage detected by myocardial uptake of antimyosin antibodies in patients with alcohol-induced dilated cardiomyopathy, alcohol addicts attending a detoxification unit and healthy subjects with short-term alcohol consumption. BACKGROUND: Evidence of alcohol-induced myocardial damage may be provided by myocardial uptake of indium-111-labeled monoclonal antimyosin antibodies. The spectrum of such damage in patients who are heavy drinkers (> 100 g for > 10 years), with or without cardiomyopathy, and the impact of short-term alcohol ingestion on antimyosin antibody uptake have not been adequately explored. METHODS: One hundred twenty antimyosin studies were performed in 56 patients with dilated cardiomyopathy (group I), 15 alcohol addicts attending a detoxification unit (group II) and 6 volunteers for short-term alcohol ingestion (group III). Estimation of antibody uptake was calculated through a heart/lung ratio (HLR) (normal < 1.55). RESULTS: The 56 patients in group I (54 men, 2 women; mean [+/-SD] age 46 +/- 11 years) had consumed 123 +/- 60 g/day of alcohol for 21 +/- 9 years, for a cumulative intake of 914 +/- 478 kg. Mean duration of symptoms was 46 +/- 49 months. Mean left ventricular end-diastolic diameter was 71 +/- 10 mm, and mean ejection fraction was 28 +/- 12%. No differences in New York Heart Association functional class, ventricular size or ejection fraction were noted between 28 active and 28 past consumers, except for the prevalence and intensity of antibody uptake (75% vs. 32%, p < 0.001) and HLR (1.75 +/- 0.26 vs. 1.49 +/- 0.17, p = 0.0001). In 19 patients in the active group restudied after alcohol withdrawal, antibody uptake decreased (from 1.76 +/- 0.17 to 1.55 +/- 0.19, p < 0.001), and ejection fraction improved (from 30 +/- 12% to 43 +/- 16%, (p < 0.001). No changes occurred in the 15 past consumers restudied. The 15 male patients in group II (mean age 36 +/- 4 years) had consumed 156 +/- 59 g/day for 17 +/- 5 years, for a cumulative alcohol intake of 978 +/- 537 kg, an amount similar to that in patients in group I, but antimyosin antibody uptake was detected in only 3 (20%) of 15 patients. None of six group III subjects developed antibody uptake after short-term ethanol ingestion. Despite the small sample size, the power to detect clinically relevant differences in most variables that did not reach statistical significance was amply sufficient. CONCLUSIONS: In alcohol-induced dilated cardiomyopathy, alcohol withdrawal is associated with the reduction or disappearance of myocardial damage and improvement of function. The difference in prevalence of antimyosin antibody uptake in patients with and without cardiac disease who consume similar amounts of alcohol suggests the presence of those with different myocardial susceptibilities to alcohol. Short-term ethanol ingestion in healthy subjects does not induce detectable uptake of antimyosin antibodies.

[4 proposals for ventricular remodelling in the surgical treatment of dilated myocardiopathy]. / Cuatro propuestas para la remodelación ventricular en el tratamiento quirúrgico de la miocardiopatía dilatada.

Four surgical procedures are proposed to achieve an efficient remodelling of the ventricles with a low injury to heart muscle, for the treatment of the dilated cardiomyopathy. Those procedures are based the partial ventriculectomy technique of Batista an on the new conception of the macroscopical myocardium structure of the ventricles evidenced in the second half of the present century.

[Atypical coarctation. Repair with Dacron graft and aortic sarcoma]. / Coartación atípica. Corrección con injerto de Dacron y sarcoma de aorta.

A patient with a localized severe stenosis of his lower thoracic aorta is described. He presented a coarctation like syndrome with hypertension, pulseless legs and left ventricular failure. At surgery a biopsy of the lesion and bypass graft were performed. Pathology diagnosed intimal hyperplasia. Twenty eight months later he developed a sarcoma.

[Pulmonary artery thrombosis in a patient with mitral-tricuspid valve disease. Added value of peroperative transesophageal echocardiogram]. / Trombosis arterial pulmonar en una paciente con valvulopatía mitro-tricuspídea. Valor añadido del ecocardiograma transesofágico peroperatorio.

The performance of peroperative transesophageal echocardiography on a 60 year old woman with mitral and tricuspid valve disease discovered a previously undiagnosed thrombus in the right pulmonary artery that completely occluded the inferior lobar branches. Following valvular surgery, a successful thromboendarterectomy was performed.

[Right ventricular myxoma. A rare case of pulmonary stenosis]. / Mixoma ventricular derecho. Un caso raro de estenosis pulmonar.

We discuss a case of a fourteen year old girl in whom, clinical signs of right ventricular outflow obstruction were discovered following a syncopal attack. A right ventricular tumor was observed by echocardiography. Histology confirmed the diagnosis of myxoma.

[Bilateral pulmonary thromboendarterectomy in chronic pulmonary thromboembolism. A case report and review of the literature]. / Tromboendarterectomía pulmonar bilateral en el tromboembolismo pulmonar crónico. Presentación de un caso y revisión de la literatura.

A 39-years-old male patient with chronic venous insufficiency, deep venous thrombosis and recurrent pulmonary embolism in the past medical history. After syncopal event was diagnosed of bilateral chronic pulmonary embolism, pulmonary hypertension and right ventricular failure. Fibrinolytic treatment was no effective therapeutic modality. Under cardiopulmonary bypass, bilateral pulmonary thromboendarterectomy with extension into lobe arteries, plus insertion of caval filter was performed. We present our experience with this case and a review of the literature.

The use of bacteriophages of Bacteroides fragilis as indicators of the efficiency of virucidal products.

The potential use of bacteriophage B40-8 of Bacteroides fragilis for the evaluation of the virucidal activity of antiseptics or disinfectants was investigated. The antiviral activity of two antiseptics and two disinfectants was evaluated according to a standard guideline. The effect of the virucidal agents was assessed on (i) viruses usually spread by direct contact with surfaces with contaminated secretions, i.e. herpes virus 1 and 2, and vaccinia virus, and (ii) viruses transmitted by the fecal-oral route, i.e. hepatitis A virus, poliovirus, adenovirus and rotavirus. The survival of B40-8 always equalled or exceeded that of the animal viruses tested. Our data suggest the use of bacteriophage B40-8 to complement the information furnished by some standardized methods in ascertaining the antiviral activity of virucidal preparations.

Indium-111-monoclonal antimyosin antibody studies after the first year of heart transplantation. Identification of risk groups for developing rejection during long-term follow-up and clinical implications.

The long-term clinical course and results of biopsies in 21 patients studied with monoclonal antimyosin antibodies more than 12 months after heart transplantation according to the presence and degree of antimyosin-antibody uptake is described. Eighteen men and three women aged 20-52 years (39 +/- 9 years) were studied with antimyosin antibodies 12-40 months (mean, 22 +/- 9 months) after heart transplantation, and followed for a mean of 18 months (10-28 months). The number of biopsies performed during follow-up was 102. Results showed normal antimyosin-antibody studies in nine patients and abnormal studies in 12 patients. Myocyte damage was identified in 18 of the 102 biopsies (17.6%), one in the normal antimyosin-antibody group of patients and 17 in those patients with myocardial antimyosin-antibody uptake. Patients who developed rejection comprised 11% and 67% of each respective group; the mean number of rejection episodes per patient was 0.11 +/- 0.33 and 1.41 +/- 1.41, respectively (p less than 0.01). A trend was noted by which higher heart-to-lung ratios were associated with greater probability of rejection. Conclusively, 1) antimyosin-antibody studies performed after more than 1 year after heart transplantation indicate the presence and level of rejection activity, 2) groups of patients at risk for developing rejection at biopsy during long-term follow-up may be detected by antimyosin-antibody study, and 3) surveillance for rejection and the degree of immunosuppression should be tailored to meet individual patient needs.

Dopamine treatment of locally procured donor hearts: relevance on postoperative cardiac histology and function.

UNLABELLED: Administration of catecholamines can lead to myocyte damage. Dopamine treatment is often used in potential cardiac donors to attain hemodynamic stability. Donor hearts exposed to dopamine are rejected or selected for transplantation without clearly defined criteria. A prospective study was undertaken to analyze the clinical relevance of dopamine-induced myocardial lesions in 25 hearts (21 male, 4 female; 15-40 years, mean: 26 +/- 7) that were later used for transplantation. Donors were divided into those who had received dopamine and those who had not. Dopamine doses ranged from 2-12.5 micrograms/kg/min (mean: 6.3 +/- 3). Time of administration was 3-26 hours (mean: 16 +/- 8). Use of dopamine was unrelated to donor electrocardiographic findings, intra- or postoperative death, or difficulty coming off by-pass. Postoperatively, filling pressures were similar in both groups of patients at 2 and 10 days postoperatively. Left ventricular ejection fraction was similar in the two groups. Dopamine requirements were significantly higher in the dopamine-treated hearts (P = 0.05). Histologic findings at first biopsy revealed infiltration and cell damage in a similar proportion of patients in both groups. IN CONCLUSION: donor hearts exposed to dopamine can be accepted for transplantation if doses ranging from 2-12.5 micrograms/kg/min have been administered up to 24 hours.

Patterns of evolution of myocyte damage after human heart transplantation detected by indium-111 monoclonal antimyosin.

The indium-111 labeled Fab fragment of antimyosin monoclonal antibody was used to study cardiac rejection and the time course of myocyte damage after transplantation. Fifty-three studies were performed in 21 patients, 17 men and 4 women, aged 19 to 54 years (mean 37 +/- 8), from 7 to 40 months after transplantation. Repeat studies were available in 8, and 10 were studied after the first year of transplantation. A heart-to-lung ratio was used for quantitation of uptake (normal 1.46 +/- 0.04). Differences between absent (1.69 +/- 0.29) and moderate (1.90 +/- 0.36) rejection were significant (p less than 0.03). Antimyosin ratio at 1 to 3 months (1.89 +/- 0.35) differed from that at greater than 12 months (1.65 +/- 0.2) (p less than 0.01). Repeat studies revealed a decrease in antimyosin ratio in 5 patients with uneventful clinical course; 2 had persistent activity after transplantation and suffered heart failure from rejection. After 1 year of transplantation uptake was within normal limits in 7 of 10 patients, and high uptake was associated with vascular rejection in 1. Because they can define evolving patterns of myocardial lesion activity, antimyosin studies could be useful both in patient management and in concentrating resources for those patients who most require them. The heart-to-lung ratio is suggested to monitor sequentially the degree of myocyte damage after transplantation.

Theoretical interstellar and prebiotic organic chemistry: a tentative methodology.

A theoretical methodology for the systematic study of the interstellar molecules is proposed. Some examples, dealing with formaldehyde excited states, formyl radical and ion, reactivity of the excited states of formic acid, methyl cyanide and methyl acetylene, as well as the reaction patho of formaldehyde photodecomposition are presented. Quantum chemical methods appear to be a powerful tool to study the structure and behaviour of molecules related with interstellar space and the Origin of Life.