Choosing the best HMO.
Contrary to recent studies, the form of a health plan--whether it's a group-model or IPA-model HMO--is less important than quality, performance, and administrative efficiency.
Cost-Benefit Analysis↗
Biomedical subjects
L Lopez
Publications and source records attributed to L Lopez.
Integrated delivery systems ... managed care organizations, hospitals, doctors, and insurers are developing new entities to compete for business.
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Computer Communication Networks↗
The interwined roles of primary care physicians and specialists.
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Communication↗
[Development of products for the elderly population: vitamin enriched pudding].
An instant dessert powder, pudding type was developed to be consumed at lunch or dinner time. The dessert was designed to be prepared in skim milk and meets the nutritional needs of elderly people. The dessert contains modified starch, carragenine, vegetal fat, sacharose. Each serving has been enriched with 30% of the daily vitamin requirement advised for adults over 51 years old. The optimized process was carried out according to the Karlsruhe test. Each serving consists of 22g powder prepared in proportion of 18% in skim milk. The optimized dessert powder was controlled by means of physical, chemical and microbiological analyses. The sensory quality was determined in the ready to eat product and the acceptability level was measured in a group of people selected according to the characteristics of the target population. The dessert powder contains 1.1% protein, 5.2% fats, 89.76% carbohidrates, and provides 409 Kcal/100g. Both the sensory and microbiological quality were good and the level of acceptance reached 98%.
Aged↗
[Manufacture of a freeze dried stew for mountaineers].
The mountaineers use to eat at the evening dinner which ought to fulfil the following requirements: it should be nutritive and have an adequate composition, a small volume and should be light, keeping a good quality during a long period of time. Its preparation must be fast and easy, being well accepted by the group of mountaineers. A stew of common use in Chile based on meat and vegetables was elaborated, known as < >, a typical chilean stew. It was dehydrated by freeze-drying, a process based in the freezing and subsequent ice sublimation of the product, achieving a very high retention of both sensory and nutritional qualities. The final product corresponded to individual portions of 60g of Charquican which was vacuum-packed in a coextrude polyamide-polyethylene pack, which protects from the moisture and oxygen. It was used an outer packaging of plastic-coated aluminum foil, in order to protect him from the light. Controls of the optimized product indicate a 6,7% of humidity with an aw value of 0,26. The chemical composition is nutritionally adequate, with a 45.6% of carbohydrates, 5,0% of lipids and 29,5% of proteins. It presents a sensory quality with typical characteristics which ranged from good to very good. The microbiological quality meets the Standards of the Chilean Sanitary Regulation for Foods. The total plate count and the molds and yeasts count were below the proposed limits. The study of the Charquican s shelf life performed at environmental storage conditions (20-25 degrees C and 50-55 RH) showed that the microbiological quality is mantained without significant differences. The sensory quality presents a slight and gradual decrease until the average score fo 6,7 after 200 days storage. The evaluation with excursionists at the mountains, showed the excellent acceptability and the good reliability of the product.
Chile↗
Structural dimorphism in the mammillary bodies of the rat.
Diverse structures of the CNS show sexual differences in the anatomical and functional organization. In particular, many dimorphic nuclei have been found in the hypothalamus: the preoptic area, suprachiasmatic nucleus and ventromedial hypothalamus. Our investigation has shown a statistically significant difference in relation to volume of the medial mammillary and left lateral nuclei, and the number of glial cells of the medial mammillary nucleus. The volume and glial cell population is greater in the male than in the female. Thus, the existence of dimorphic functions in which this structure could be involved are discussed herein.
Animals↗
Extended cervical mediastinoscopy: prospective study of fifty cases.
To assess the usefulness of extended cervical mediastinoscopy (ECM) in the staging of bronchogenic carcinoma, an ECM was performed prospectively in 50 patients with bronchogenic carcinoma of the left lung. The ECM was used after evaluation of disease operability and computed tomographic findings, and was performed simultaneously with standard cervical mediastinoscopy. In ECM, using the same cervical incision as in a standard cervical mediastinoscopy, dissection is performed behind the anterior face of the sternum. The aortic arch is reached at the level of the origin of the innominate artery. The mediastinoscope is then passed by sliding it along the left anterolateral face of the aortic arch until it reaches the aortopulmonary window. Extended cervical mediastinoscopy was considered positive when a nodal biopsy result consistent with a neoformative process or direct invasion of the mediastinal structures was found. Four patients with positive standard cervical mediastinoscopy and negative ECM were excluded. A false negative ECM was defined as the presence of infiltrated adenopathies at the paraaortic level detected on postoperative histologic study. The ECM was positive in 5 patients in whom operation was contraindicated. Resectability in the remaining 41 patients was 97.6%. Postoperative pathologic study showed infiltrated adenopathy in 3 patients (2 subcarinal, 1 subaortic) accounting for 40 true negatives (the subcarinal group is inaccessible by ECM). This study suggests that ECM has outstanding specificity (100%), sensitivity of 83.3%, and a diagnostic accuracy of 97.8%. A positive predictive value of 100% and a negative predictive value of 97.5% were also identified by this study.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Human T-cell lymphotropic virus type I disease in Argentine intravenous drug users with human immunodeficiency virus type 1 infection.
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Adolescent↗
Progression of multiple primary plasmacytomas under interferon-alpha therapy.
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Aged↗
Torsional nystagmus. A neuro-otological and MRI study of thirty-five cases.
Thirty-five patients with torsional nystagmus (TN) underwent vestibular and ocular motor assessment and magnetic resonance image (MRI) scanning of the head. Patients were divided into two groups according to whether TN was predominant and present in primary gaze (Group I, 23 patients) or elicited by head positioning or gaze deviation and less prominent than other concurrent nystagmus (Group II, 12 patients). The main aetiologies in both groups were demyelination, vascular disease and posterior fossa tumours. In Group I, a frequent pattern of findings, occurring in 30-50% of cases, was a caloric canal paresis contralateral to the direction of the fast phases ('beat') of the TN, whereas the duration of horizontal caloric/rotational nystagmus and the slow-phase eye velocity of pursuit and of optokinetic nystagmus were all reduced in the direction of beating. The TN was more frequently and consistently modulated by vertical canal stimuli (head oscillation in roll) than by otolith stimuli (static tilt). Statistical analysis of the MRI showed significant overlap of abnormal MRI signals in the area of the vestibular nuclei, on the side opposite to the beat direction of TN. These results suggest that TN originates in a central imbalance of vertical semicircular canal function, resulting from lesions involving the vestibular nuclei on the opposite side of the TN. Group II was heterogeneous with no consistent pattern of neuro-otological findings, although lesions ipsilateral to the TN were frequent occurrence; in these cases cerebellar system lesions may have produced ipsilateral vestibular nuclei disinhibition.
Adolescent↗
Rapid detection of chromosome aneuploidies in uncultured amniocytes by using fluorescence in situ hybridization (FISH).
Herein we report the results of the first major prospective study directly comparing aneuploidy detection by fluorescence in situ hybridization of interphase nuclei with the results obtained by cytogenetic analysis. We constructed probes derived from specific subregions of human chromosomes 21, 18, 13, X, and Y that give a single copy-like signal when used in conjunction with suppression hybridization. A total of 526 independent amniotic fluid samples were analyzed in a blind fashion. All five probes were analyzed on 117 samples, while subsets of these five probes were used on the remaining samples (because of insufficient sample size), for a total of over 900 autosomal hybridization reactions and over 400 sex chromosome hybridization reactions. In this blind series, 21 of 21 abnormal samples were correctly identified. The remaining samples were correctly classified as disomic for these five chromosomes. The combination of chromosome-specific probe sets composed primarily of cosmid contigs and optimized hybridization/detection allowed accurate chromosome enumeration in uncultured human amniotic fluid cells, consistent with the results obtained by traditional cytogenetic analysis.
Amniocentesis↗
Tracheal agenesis: an unresolved problem.
A case of tracheal agenesis diagnosed at birth is discussed in which surgical correction was attempted. Both main bronchi were divided and anastomosis of the main right bronchus to the larynx was attempted, after intrapericardial release of the right lung and severing of the lower pulmonary ligament: bronchoplastic reconstruction of the trachea was impossible. We think that tracheal agenesis, a rare cause of respiratory distress in the newborn, has no suitable therapy today. It is justified to attempt surgical correction if any promising device is at hand or if any doubt exists that an uncorrectable situation is present.
Humans↗
Multimodal characterization of population responses evoked by applied electric field in vitro: extracellular potential, magnetic evoked field, transmembrane potential, and current-source density analysis.
An external electric field applied parallel to longitudinal axis of neurons selectively depolarizes either end and thereby activates voltage-sensitive conductance changes in a large population of neurons. Here, we characterized such population responses in the in vitro turtle cerebellum. The responses were recorded and analyzed using a multimodal approach: the magnetic evoked field was measured using a Superconducting Quantum Interference Device (SQUID) magnetometer, and concurrently the electric field potentials were recorded. Laminar profile and current-source density analysis were used to uncover the pattern of activation due to the applied electric field. Intracellular recording provided further information for identifying the elements producing the observed responses. Finally, pharmacological manipulations confirmed the nature of the conductance changes. Our results show that it is possible to activate a defined cell population of the cerebellum by an applied field and obtain a magnetic response of the order of 0.5-2 pT. A field applied from the dorsal to the ventral side of cerebellum produced tetrodotoxin-sensitive population spikes. This component was followed by a kynurenic acid (KYNA)-sensitive postsynaptic response, most likely comprised of Ca(2+)-mediated action potentials occurring at the proximal pole of the Purkinje cell dendrites and evoked by climbing fiber inputs. The applied electric field directed from the ventral to the dorsal side of cerebellum gave rise to a complex of responses that was made up of a KYNA-sensitive component (presumably synaptically activated) and an Mn(2+)-sensitive but KYNA-insensitive component (probably due to a directly activated calcium conductance change). This study provides insights into the effects of electric and magnetic fields applied to the nervous tissue of experimental animal and human studies.
Animals↗
Use of Gianturco self-expandable stents in the tracheobronchial tree.
Gianturco self-expandable stents were used successfully in the management of 5 patients with tracheobronchial pathology. Placement was performed under endoscopic and fluoroscopic guidance. None of the patients has experienced complications secondary to the stent placement, and in all of them the clinical problems resolved satisfactorily. Longer follow-up is required to determine the place of tracheobronchial stenting in patients with respiratory compromise.
Aged↗
Compression in the treatment of leg telangiectasia: a preliminary report.
The use of postsclerotherapy compression was evaluated in 37 women with bilaterally symmetrical telangiectatic leg veins. Compressed vessels tended to achieve a greater clinical resolution when located on the distal leg and/or when greater than 0.5 mm in diameter. Postsclerotherapy hyperpigmentation fell from 40.5% to 28.5% with the use of compression. In addition, ankle and calf edema were lessened if a graduated compression stocking was worn immediately after sclerotherapy.
Adult↗
Vertical ocular motor apraxia.
We report a case of vertical ocular motor apraxia in a 4-year old boy whom we have followed for 2 years. The patient had no upward and downward voluntary movements of the eyes since birth, but horizontal movements were normal. He achieved gaze changes in the vertical plane by combined blinks and head movements. Magnetic resonance imaging demonstrated bilateral lesions at the mesencephalic-diencephalic junction.
Apraxias↗
Long-term lipid profiles with isradipine and hydrochlorothiazide treatment in elderly hypertensive patients.
Lipid profiles were determined in 56 elderly patients with benign essential hypertension during an open-label 1-year study of the safety and efficacy of isradipine, a new calcium antagonist, in controlling blood pressure. Patients with diastolic blood pressures between 96 and 115 mm Hg were titrated with isradipine (mean dose of 11 mg/day) to reduce blood pressure to less than 90 mm Hg. Ten of these patients received concomitant hydrochlorothiazide (HCTZ) 50 mg/day for additional control. Sera were analyzed using standard methods at the end of a 2- to 4-week washout period, and at the end of Months 6 and 12, for total cholesterol (CHOL) and HDL- and LDL-cholesterol. Changes in lipid values (mg/dl) from baseline to 12 months with isradipine alone (n = 38) were as follows: CHOL, -7.5; HDL, +3.9 (p less than 0.05); LDL, -6.2; CHOL/HDL, -0.6 (p less than 0.05). For patients receiving concomitant HCTZ (n = 9), the changes were as follows: CHOL, -4.9; HDL, +3.4; LDL, -16.8; CHOL/HDL, -0.4. In conclusion, isradipine alone was associated with significant improvements in HDL cholesterol and total CHOL/HDL ratio. Lipid profiles of patients receiving isradipine and HCTZ were minimally affected. Favorable lipid changes with isradipine suggest that it may have advantages in the treatment of hypertensive patients.
Aged↗
Pilot study of nicardipine for acute ischemic stroke.
The author performed a pilot study of nicardipine (NC), a Ca(+)+ channel blocker, to study its dosing, toxicity, and possible efficacy for hemispheric cerebral infarction within 12 hours (mean 6.9 hr) of onset to determine the advisability of proceeding with a multi-centered controlled trial. NC was administered IV (3 to 7 mg/hr) X 72 hours by titrating dose to mean arterial blood pressure (MABP not less than 10% of baseline), then orally X 30 days. Forty-three patients have been entered; mean age 63 (range 34-89), 25 male and 18 female. Only 3 had CT evidence of infarct on entry. Results have shown improvement in a 100-point (pt) graded exam (40 pts at entry, 68 pts at 3 months). Of 20 patients completing 3 months' evaluation, 17 improved and none worsened. Sixteen out of 20 were at home and 8 had minimal or no impairment. Mean Barthel's index was 72. Mean maximal serum NC level was 75 ng/mL. MABP decreased from 103 (entry) to 83 (72 hours). A larger controlled study is warranted to determine the efficacy of NC for acute cerebral infarct.
Acute Disease↗