Hepatitis C: Part I. Routine serologic testing and diagnosis

Hepatitis C, which is caused by the hepatitis C virus (HCV), is a major public health problem in the United States. HCV is most efficiently transmitted through large or repeated percutaneous exposures to blood. Most patients with acute HCV infection develop persistent infection, and 70 percent of patients develop chronic hepatitis. HCV-associated chronic liver disease results in 8,000 to 10,000 deaths per year, and the annual costs of acute and chronic hepatitis C exceed $600 million. An estimated 3.9 million Americans are currently infected with HCV, but most of these persons are asymptomatic and do not know they are infected. To identify them, primary health care professionals should obtain a history of high-risk practices associated with the transmission of HCV and other bloodborne pathogens from all patients. Routine testing is currently recommended only in patients who are most likely to be infected with HCV.     

Psoralen photochemotherapy

Psoralens and sunlight have been used by the Egyptians and Indians for hundreds of years for treating vitiligo. The combination of oral psoralens and artificial ultraviolet A (PUVA) therapy was approved for managing severe psoriasis by the Food and Drug Administration in 1982. Since then, PUVA therapy has been an effective modality for treating many cutaneous conditions (psoriasis, atopic dermatitis, vitiligo, and mycosis fungoides). However, proper knowledge and administration of PUVA therapy are vital to treatment success and reducing side effects.     

A unified approach to the surgical exposure of pancreatic and duodenal injuries

OBJECTIVE: It is necessary to have thorough knowledge of the survival of extreme low birth weight infants (ELBWI) in order to make it easier for obstetricians, neonatologists and the family to make a decision. PATIENTS AND METHODS: A revision of the 100 ELBWI in our service between 1988 and 1995, considering live births, those deceased in the same birthing room and those followed until their discharge from the hospital, was performed. The differences between the periods before and after the introduction of pulmonary surfactant in 1992 were analyzed. RESULTS: The total survival was 37% for those with a birth weight superior to 750 g or 26 weeks gestation. There were 44.2% males and 28.9% females. The total survival improved from 26.1% during 1988-1991 to 46.3% during the period of 1992-1995. During this period (1992-1995), the newborns weighing more than 750 g had a survival rate of 72.4% and for those of 26 weeks gestation it was 73.3%. Those born at 28 weeks gestation and those with 25 weeks of gestation and weighing more than 750 g, the total survival was 63% and the survival rate in the last four years was 75.9%. CONCLUSIONS: The mortality of the ELBWI descends in similar proportion to the remainder fo the ELBWI. In order to predict the prognosis, it would be necessary to carry out a correct ultrasound estimation of the gestational age and weight. It is necessary to offer a mother in the process of childbirth with a fetus of 28 weeks gestation or with 25 weeks gestation and a fetus with an ultrasound weight greater than 750 g, intrapartum fetal monitoring and to finish by Cesarean section in case of acute fetal distress, as well as intense and immediate neonatal attention as indicated by the index of survival reached in the group mentioned during the later years.