The nurse''s role in future cancer services

The Calman report proposes a comprehensive national policy for cancer care. Implementation of these proposals could reduce the inequalities of opportunity of access to specialist services. The future role of nurses in cancer care has still to be clarified.     

The management of unexplained infertility

Since allyl alcohol and ethanol are both metabolized by alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), ethanol could affect allyl-alcohol induced toxicity under in vivo coexposure conditions. Male Sprague-Dawley rats were treated with ethanol (2 g/kg, i.p.) simultaneously or 2 h before with allyl alcohol (40 mg/kg, i.p.). Coexposure to allyl alcohol and ethanol resulted in neither enhancement nor protection in allyl alcohol-induced hepatotoxicity at 24 h. However, markedly increased lethality was observed under our coexposure conditions. Pretreatment with 4-methylpyrazole (4-MP) to inhibit ADH did not result in increased lethality to allyl alcohol or ethanol alone, but significantly reduced the lethality of the combined treatment. In contrast, ALDH inhibition increased the lethality of allyl alcohol alone as well as that of the combined allyl alcohol and ethanol treatment. Kinetic studies revealed that combined treatment with allyl alcohol and ethanol resulted in higher blood allyl alcohol levels compared to allyl alcohol alone, and these were accompanied by greater lethality. ADH inhibition increased allyl alcohol blood levels significantly when rats were treated with allyl alcohol alone or allyl alcohol plus ethanol, leading to protection against lethality. In contrast, ALDH inhibition did not affect blood allyl alcohol levels, but resulted in increased lethality. These data suggest a possible role for a metabolite of allyl alcohol, acrolein, in the increased lethality of allyl alcohol and ethanol coexposure in rats.     

The varicocele and male infertility

Varicocele is accepted as a common cause of male subfertility, even though many men with varicocele appear to have normal fertility. The pathophysiology of the varicocele effect on fertility remains unclear, but the association of varicocele with decreased testicular size, abnormal testicular histology, and abnormal semen parameters is clearly established. Because a small varicocele may impair fertility, it must be diligently sought, and the Doppler stethoscope may be helpful in establishing the diagnosis when a venous thrill is equivocal during the Valsalva maneuver in a standing patient. Abnormal semen parameters should be demonstrated in subfertile males with varicocele prior to advising varicocelectomy. Decreased sperm motility or a "stress pattern" in the semen should be documented; however a decreased sperm count may or may not be present. Various surgical approaches are available. When suprainguinal approaches have been used, failures have been shown to be attributable to secondarily incompetent cremasteric system veins. When high inguinal approaches are used, unsuccessful operations are probably secondary to a failure to identify one of the several venous tributaries that may be present at this level. The surgeon's approach should be based on available data, and his patients should be informed that failures are possible with any method of varicocelectomy until experience indicates otherwise. In most series, improvement in semen quality and pregnancy rates have been reported in a significant percentage of patients undergoing varicocelectomy for infertility. However, prior to subjection of the patient to varicocelectomy, the wife of the varicocele patient should be thoroughly studied (and treated when indicated).     

The pathogenesis of infertility in men

With the purpose of gaining insights into the general regularities and particular features of pathogenesis of sterility of urogenital genesis, we undertook the present studies on biopsy specimens of testes, epididymis, deferent ducts, prostate, spermogramme, blood plasma content of gonadotrophic and sex hormones in 162 patients with infertility of urogenital genesis, and in 412 rats. Infertility pathogenesis was found out to have two stages: compensatory-adaptive alterations and irreversible disorders. Infertility is believed to be a polyetiologic, monopathogenetic medical condition.     

The privatization of public services. The case of health services in Costa Rica

This article analyzes the role of the State and public enterprises in the development of nations, from a particular standing point, and inquires into the privatization issue, reviewing both its concept and the possible mechanisms for its implementation. Also, emphasis is made on the selling of public enterprises as one of the several ways to privatize. Within this context, some measures for the reorganization of the Costa Rican National Health System are proposed. These measures uphold fundamental values of social justice. This article is based on a theoretical-conceptual framework from an innovative experience in health services management in Costa Rica, in which a self-managing cooperative society (a nonprofit enterprise) manages, by contract with national health care public institutions, an urban local health care system.