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Objective: To determine bone mineral density (BMD) at axial and appendicular sites in patients with type 1 diabetes mellitus and evaluate its relationship with metabolic control and disease duration., Patients and Methods: BMD was measured by dual-energy X-ray absorptiometry (Hologic QDR-1000) in the lumbar spine (L1-L4) and at the distal third forearm in 246 healthy non-diabetic children and adolescents (111 boys, 135 girls, aged 2.8-20.8 years) and in 45 diabetic patients (18 boys, 27 girls, aged 5.2-19.4 years). The results were expressed as the mean and standard deviation. The differences were tested by analysis of variance or Students t-test, as appropriate. The relationship between BMD and the remaining variables was studied by simple Pearsons coefficient and partial correlation coefficient. Significance was defined as p < 0.05., Results: BMD Increased progressively from infancy to adulthood In both populations. Lumbar spine and forearm BMD were significantly lower in diabetic patients than in the healthy non-diabetic children, mainly during pubertal spurt. The greatest differences were found in males and in the trabecular bone. No relationship was found between metabolic control (mean glycosylated hemoglobin, insulin requirement) and duration of diabetes and the BMD in any region studied (p > 0.05)., Conclusions: Pediatric patients with type 1 diabetes mellitus appear to constitute a population at risk of osteoporosis in adult-hood. Diagnosis of osteopenia diagnosis should be established according to densitometric criteria. In this study, metabolic control parameters and duration of diabetes did not enable predetermination of diabetic patients at risk of osteoporosis in adulthood.

Methods: From November 1992 to November 1993, a prospective study was conducted on 20 controls and 61 patients with bladder carcinoma. EGFR expression was determined by radioimmunoassay and the correlation of the results of histological analysis and the clinical course was analyzed. The follow-up period was from November 1992 to July 1998. The association between qualitative variables and the x2 or Fisher exact test was compared using the hypothesis of the proportional ordinal trend for the ordinal variables, and the quantitative variables were analyzed using Student's t test and/or variance analysis (ANOVA). Survival was analyzed by the Kaplan-Meier method and comparison was performed using the Breslow exact test. The Cox proportional hazards regression model was utilized. The SPSS software for Windows 7.0 was used for the analysis., Results: The EGFR values were higher for patients with bladder carcinoma than in controls (14.48 vs 2.54 fmol/mg of protein). EGFR values were higher in patients with superficial bladder tumor than in those with infiltrating tumors (27.03 fmol/mg vs. 10.05 fmol/mg of protein; p = 0.000). Poorly differentiated tumors showed higher values of EGFR (6.73, 14.48 and 17.07 fmol/mg of protein for grades I, II and III, respectively; p < 0.05). The EGFR values were higher in patients that died from cancer during follow-up (64.8) than in those who died from other causes (47.5) and those who are alive and on follow-up (42). An increase in EGFR values did not carry a risk of death from cancer (p = 0.1269; ns). Analysis of the grade of tumor differentiation showed that for the more aggressive tumor grade, a positive EGFR was a sign of reduced survival. Survival in patients with superficial and infiltrating tumor did not appear to change significantly according to the EGFR value. EGFR determination was not useful in predicting recurrence and increased EGFR values did not correlate with a higher risk of recurrence., Conclusions: 1) The normal pattern of EGFR could not be established. 2) EGFR was not useful in identifying subgroups at risk of death. 3) Knowledge about these proteins synthesized by oncogenes offers new possibilities in the treatment of cancer.

Objective: To determine the utility of p185 oncogene in the biological characterization of transitional cell carcinoma and in the prediction of recurrence, and to analyze survival at 5 years mean follow-up., Methods: A prospective clinical cohort study was conducted on 81 patients. Tissue specimens were obtained between November 1992 and November 1993. The study comprised two groups: nontumoral bladder tissue specimens from 20 patients (group I) and tissue specimens from 61 patients with bladder carcinoma (group II). p185 expression was determined by enzyme immunoanalysis (EIA). A statistical analysis of the results was performed., Results: p185 oncoprotein levels were higher in patients with recurrence (1098.97 HNU/mg protein vs. 924.54 HNU/mg). Although higher levels of p185 were found in the patients that had died vs those who are alive, the differences were not statistically significant for overall survival or stratification by tumor grade or infiltration (p = 0.556; ns)., Conclusions: Determination of p185 oncoprotein was found to be useful in the prediction of tumor recurrence at 5 years mean follow-up.

Background: Due to possible complications and treatment limitations, the prevention of influenza in renal transplant (RT) patients is highly indicated., Methods: Forty-nine patients with a 1-year functioning RT subjected to two different immunosuppressive regimens and 37 healthy relatives (HR) were administered the anti-influenza vaccine as recommended for 1996 to 1997. Anti-influenza antibody, creatinine, and immunological markers were estimated at 1 and 3 months after vaccination., Results: Three months after vaccination, 46.2% of the RT patients and 69% of the HR (P=0.06) showed protective antibody titers to influenza A (relative risk [RR]; 0.67; 95% confidence interval: 0.44-1.02). A total of 20.5% of the RT patients and 44.8% of the HR showed antibodies to influenza B (P=0.03). Despite these differences, the incidence of illness was similar. The immunosuppressive regimen had no effect on the antibody response., Conclusions: Although the RT patients showed a reduced antibody response, no negative effects on graft outcome were observed.

Objectives: 1) To determine p53 expression in urinary wash cytology by immunohistochemistry in patients with superficial transitional cell carcinoma of the bladder and controls; 2) to correlate p53 in urinary wash cytology and anatomopathological characteristics of the bladder tumors analyzed; 3) to determine the utility of p53 expression in urinary wash cytology as a prognostic factor; and 4) to identify a subgroup of patients with superficial tumors of worse prognosis in order to improve control of the evolution of the tumor and treatment., Methods: From 1993 to 1998, 141 cases were studied; 32 controls comprised group I and 109 (38 primary and 71 recurrence) patients with transitional cell carcinoma of the urinary bladder comprised group II., Results: In group II, 29.5% were positive for p53 in urinary wash cytology, while no positive cases were found in group I. A total of 104 valid data were analyzed, which showed a higher percentage of p53-positive cases in grade III tumors (44.4%). Statistical analysis showed the percentage of p53-positive cases increased with tumor grade in a linear trend (p = 0.17). The recurrence rate in the p53-positive was 20% greater than in the p53-negative cases. Tumor progression was three times higher in the p53-positive than in the p53-negative patients., Conclusions: The application of biomolecular knowledge to cytology is a useful complement in follow-up of patients with superficial transitional cell carcinoma of the bladder and offers additional parameters to distinguish benign and malignant cells. Immunohistochemical determination of p53 in urinary wash cytology identifies patients with superficial tumors with a worse prognosis.

Objective: Mutations in the TP53 gene are frequently detected in some types of malignant tumors (bladder, prostate, kidney, lungs, breast, colon and rectum). This study analyzed the utility of semi-quantitative determination of p53 in transitional cell carcinoma of the bladder by an immunohistochemical technique and evaluated the results at 5 years., Methods/results: A prospective clinical cohort study was conducted on 81 patients. The study comprised two groups: nontumoral bladder tissue specimens from 20 patients (group I) and tissue specimens from 61 patients with bladder carcinoma (group II). In both groups the tissue specimens were obtained between November 1992 and November 1993, and during the follow-up period until July 1998. p53 expression was determined by a semi-quantitative method based on an immunohistochemical technique (NCL-p53-DO7, Novocastra)., Conclusions: p53 oncoprotein was not found to be useful in the characterization of carcinoma of the urinary bladder.

Introduction: Lacunar infarcts (LI) are small deep infarcts due to occlusion of perforating branches., Objective: Our objective was to outline the clinical and epidemiological characteristics which differentiate hemispherical lacunar infarcts (HLI) from those of the brain stem (SLI)., Patients and Methods: We present 110 cases of LI (80 HLI, 30 SLI) analysing risk factors, clinical syndromes, findings on neurological examination (dysarthria, gravity, distribution and proportional paresia), form of clinical presentation, evolution whilst in hospital, site and results of carotid duplex. Diagnosis was made in 72 patients using magnetic resonance (MR) and in 38 patients using computerized axial tomography (CT)., Results: The commonest characteristics of SLI, as compared with HLI, with statistical significance (p < 0.05) was the appearance of supranuclear facial paresia (OR = 2.68), severe motor involvement (OR = 4.23), form of presentation with previous TIA (OR = 6.33), fluctuating evolution of the symptoms (OR = 5.78) and progression of the paresia (OR = 6.41). Also, in the pontine LI there was significant correlation between site and gravity: the lower the site of the lesion, the more serious was the paresia. Patients with multiple LI presented with no previous risk factors significantly more frequently than those with a single LI., Conclusion: The different clinical profiles may help to establish the subgroups of IL, according to where they occur.

Objective: Mutations in the p53 gene are frequently detected in some types of malignant tumors (bladder, prostate, kidney, lung, breast, colon and rectum). This study analyzed the utility of p53 quantitation in transitional cell carcinoma of the bladder and evaluated the results at 5 years., Methods: A prospective clinical cohort study was conducted on 81 patients. The study comprised two groups: nontumoral bladder tissue specimens from 20 patients (group I) and tissue specimens from 61 patients with bladder carcinoma (group II). In both groups the tissue specimens were obtained between November 1992 and November 1993, including the follow-up period until July 1998. p53 expression was determined by a quantitative method based on immunoluminiscence (LIA-MAT p53)., Results: p53 expression was higher in bladder carcinoma than in healthy urothelial tissue; higher values of p53 were found for infiltrating and undifferentiated tumors. The p53 values were higher in patients with tumor recurrence than in those without (NS). The Bonferroni multiple comparisons test showed a higher mortality in patients with p53 > 0.9 than in patients who are alive or have died from other causes (p = 0.000)., Conclusion: The results show that p53 LIA-MAT is an independent prognostic factor at a cutoff of 0.9 and permits identification of a subgroup of patients at high risk.

Objective: Renal cancer accounts for 2% of tumors. The most common chromosome abnormality found in renal cancer is the loss of heterozygosity (LOH) on the short arm of chromosome 3 (3p), which suggests that near the gene responsible for von Hippel-Lindau disease, there may be one or more tumor suppressor genes between 3p14 and 3p21 with a relevant role in the development of renal cancer., Methods: 41 patients with sporadic renal cancer were tested for three microsatellites mapped to the short arm of chromosome 3 (3p14.1-3p14.3, 3p21.2-3p21.3 and 3p25) by polymerase chain reaction. The results were compared with patient habits and tumor features., Results/conclusions: 43.9% of the patients showed LOH on at least one locus. Thirty-four percent showed LOH only on one locus, 4.9% on two loci and 7.3% on the three loci tested. All the patients who showed LOH on 3p21 had a tumor size greater than 25 mm. There is a risk 1.76 times higher of no loss in tumors less than 25 mm in size than in tumors greater than 25 mm (Cl 95% 1.33-2.33).

The main goal of the present study was to explore whether regional cerebral blood flow (rCBF) differs between obsessive-compulsive disorder (OCD) patients without chronic motor tic disorder and those OCD patients with a comorbid chronic tic disorder. Twenty-seven patients suffering from OCD (DSM-IV criteria), including 7 OCD patients who met DSM-IV criteria for simple chronic motor dic disorder, and 16 healthy volunteers were examined at rest using a high resolution SPECT. Seven regions of interest (ROIs) were manually traced and quantified as a percentage of the mean cerebellar uptake. Severity of obsessive-compulsive symptoms (OCS), anxiety and depressive symptoms and presence of motor tics were assessed with the Y-BOCS, HRS-A, HRS-D, MADRS, and Yale Global Tics Severity Scale, respectively. We found a significant relative decrease in rCBF in OCD patients without motor tics compared to healthy volunteers in the right orbitofrontal cortex (OCD without tics = 0.87; healthy volunteers = 0.94; p = 0.02). No significant differences in rCBF were seen when OCD patients with and without chronic tics were directly compared. A lower severity of OCS in OCD patients with chronic tics was found. These results are consistent with previous functional neuroimaging studies at rest that have widely involved the orbitofrontal cortex in the pathophysiology of the OCD. However, our results do not support the idea that OCD patients with chronic tics may constitute a biological subgroup within the OCD.

Objective: To analyze the incidence of tumors in renal graft recipients, the course, treatment and its effect on the graft and patient., Methods: We conducted a retrospective and prospective study on 477 renal transplants performed at our hospital from 1980 to 1996. The tumor type, course and possible tumor-related factors (immunosuppression, age, sex, graft rejection, virus) were analyzed., Results: 57 tumors were found; 41 patients had at least one tumor. The most common were skin, renal and lung cancer. Age, sex and immunosuppression were found to be tumor-related factors in renal transplant recipients., Conclusions: Patients undergoing renal transplantation are at a higher risk for developing a tumor, above all in the older male patients. A relationship was found for immunosuppression, the number of drugs received and the number of rejection episodes. Furthermore, the tumor pattern in these patients is different from the usual pattern.

Background: The present study describes the use of time series analysis in the evaluation of the incidence of nosocomial infection. The main hypothesis analysed was that monthly occurrence of nosocomial infection in a hospital may be related to work-related factors such as the control and training of personnel imposed by a surveillance system, strikes supported by medical personnel and movement of personnel. Time series analysis was used to quantify, model and statistically evaluate these interventions., Methods: The data employed (March 1982-December 1990) were supplied by the nosocomial infection surveillance system of a primary-care general hospital. The monthly time series incidence of nosocomial infections (measured as percentage cumulative incidence) was analysed by curve fitting, autoregressive, integrated and moving average (ARIMA) modelling (Box-Jenkins) and intervention and dynamic regression analysis., Results: The imposed control and training of personnel by the surveillance system was associated with a 3.63% decrease in the accumulated monthly incidence of nosocomial infection from 7.82% to a baseline level of 4.19%. There was a strong indication that an increase of infection incidence of 4.34% corresponded to a medical strike. This increase was maintained over the following months raising the baseline level to 4.84%. An increase of 0.18% was associated with each new nursing contract. Evidence was obtained for the possible relationship between incidence of nosocomial infection and vacation periods., Conclusions: The results suggest the need for strict control of the activities of hospital personnel and for the adoption of certain preventative measures during vacation periods to avoid an undesirable increase in the incidence of nosocomial infections.

We propose the inclusion of deaths due to appendicitis, abdominal hernia, cholecystitis and cholelithiasis and complications occurring during pregnancy, delivery and puerperium as causes of death amenable to medical intervention occurring strictly in the hospital setting (MIPSE). We have carried out a descriptive longitudinal study with the yearly mortality series due to MIPSE and no MIPSE caused in the HUSC (1980-1990). The specific mortality rates were of 0.01 per 100 discharges for MIPSE causes and 1.61 per 100 discharges for no MIPSE causes. The difference was statistically significant (p < 0.005). Both series showed a significantly declining tendency. Once the deaths were arranged under their respective headings, we observed a general decreasing tendency that was only statistically significant for abdominal hernias, whereas there was a rising tendency for deaths due to appendicitis. The knowledge of the evolution of hospital MIPSE is a interesting sign of alarm of malfunctioning health services. We believe that a consensus is necessary to elaborate a list of strictly hospitality causes of MIPSE.

Background: Hospital mortality related to infections acquired in the hospital setting has not been well studied in Spain. We carried out a study of seven hospitals in order to assess and quantify the problem., Methods: The study period included three months of observations (between November 1, 1989 and January 31, 1990), and data pertaining to all deaths of patients hospitalized for a minimum of 24 hours were collected. The number of people admitted within the study period was 16,025, and the number of deaths registered and included in our study was 488 (3%). The data were obtained from the patient's medical history one week after death as well as from the hospital physicians on the case. In order to quantify the interobserver variability derived from the classification criteria, the simple kappa index was calculated and averaged to form an ordinal scale., Results: 216 (44.3%) of 488 deaths included in our study had no infection, 138 (28%) had an infection no-hospital-associated, and 134 (27%) had nosocomial infection (50-10%--"causally related to death", 59-12%--"contributing to death", and 25-5%--"not related to death"). The lower respiratory tract infections, bacteremias and surgical wound infections were the most related to cause of death. Staphylococcus aureus was the pathogen most frequently associated with the infections found at the time of death., Conclusions: Those patients admitted with non-fatal diseases made up the greatest percentage (39.9%) of deaths from nosocomial infections. The infection was considered the direct cause of death in 18.8% of these cases, although the differences found had no statistical significance.

A survey was carried out in the ten Health Centers in Salamanca using a questionnaire about aspects related with hypertension, the material used, diagnostic methods, risk factors, therapeutic approach, and management of hypertensive paroxysms and emergencies. Participation was 59.5% and the median age 36 years. There was a definite male predominance (85.3%). The use of three blood pressure readings in successive visits for the diagnosis was preferred by the professionals with younger working age [Cl = 8.8 to 12.8 years; (p less than 0.05)]. Regarding the type of Center (rural, urban, semiurban), significant differences regarding the investigated issues could not be established. The most relevant conclusions were deficiencies such as inadequacy of cuffs (53.3%), lack of calibration of sphygmomanometers (41.9%), introduction of thestethoscope within the cuff (34.7%), use of beta-blockers in hypertensive diabetics (13.5%).

The epidemiological surveillance provides opportunities to know the magnitude and determinants of nosocomial infection and permits, at the same time, the planning, implementation and evaluation of prevention and treatment activities in order to approach the rates of infection in the hospital, as near as possible, to the irreducible minimum. We show data collected by surveillance system Guadalajara General Hospital from 1982 to 1987. In order to analyze general trends, seasonality, accidental variations and endemic levels, we have used statistical methods as linear regression, chi 2, equality proportions and built of an endemic channel with confidence intervals of 95%. We have observed a decreasing trend, locating endemic levels around to 4% of monthly accumulated incidence. There is a possible seasonal influence concurring with holidays periods and someone accidental variation over that we expected, it was related with a deteriorated situation about medical care.