Aims Despite the large number of hospital admissions due to syncope, information on the in-hospital cost of management of these patients remains incomplete. Methods and results In order to assess such cost, we analysed the clinical histories of the patients suffering from syncope who were admitted to our Unit of Cardiology in 2003. We determined the length of stay (in days) for each inpatient, the number of diagnostic tests performed, and the various therapeutic procedures undertaken. Two hundred and three patients (mean age 68 +/- 14, 49% female) were admitted because of syncope. Final diagnoses on discharge were drug-induced syncope in 10 patients, vasovagal syncope in 11, syncope secondary to cardiac ischaemia in 18, valvular disease in 4, rapid supraventricular arrhythmia in 20, ventricular arrhythmia in 19, atrioventricular block in 90, and unexplained syncope in 31 patients. Of these 203 patients, 70 (34.5%) had a previous history of cardiac disease. The global cost for all 203 patients was 2 264 979EURO. The overall cost per patient was 11 158EURO (range: 1651-31 762) including stay, diagnosis, and treatment. The overall cost of hospital stay per patient was 3718EURO (range: 1436-5679). The overall cost per diagnosis of the 203 patients was 1141EURO (range: 155-3577), and the cost of the therapeutic procedures required was 6299EURO (range: 0-23 115). The most expensive were those cases of syncope secondary to ventricular arrhythmia, the cost of which is 20 times that of drug-induced syncope. Conclusion The cost per diagnosis and treatment of a patient admitted because of syncope varies widely with important differences depending on the specific cause.

Los sistemas de cuencas de ante-país son zonas de tránsito donde los sedimentos provenientes de la erosión de lascadenas montañosas son primero acumulados, luego transferidos progresivamente hacia los océanos. La Cuenca oriente que se sitúa sobre el borde oriental de los andes ecuatorianos, constituye un buen ejemplo de cuenca de ante-país, donde los procesos de transferencia de sedimentos son relativamente rápidos. La evolución geodinámica de la Cuenca oriente es bien conocida, sin embargo no existen análisis cuantitativos de los procesos de la erosión del eoceno medio y del fin del neógeno y Cuaternario. Este artículo presenta las primeras cuantificaciones de dichos procesos. Los cálculos son realizados a partir de indicadores térmicos y marcadores de enterramiento sedimentario tales como la reflectancia de vitrinita y trazas de fisión de apatitas. ellos han permitido la calibración de modelizaciones simulando la subsidencia y erosión de la cuenca desde el eoceno, a lo largo de un corte regional que pasa sobre su parte sur. en el eoceno medio, la erosión (entre 0,6 mm/a - 1 mm/a) decrece hacia el este, y está ligada a un período con poca deformación y rebote isóstatico (descarga orogénica). Al final del neógeno y en el Cuaternario, en el oeste de la Cuenca oriente la erosión es intensa (0,8 mm/a), producto del emplazamiento y deformación de la Zona subandina, mientras que en la parte central de la cuenca, la erosión es nula y por el contrario muestra subsidencia (zona de foredeep). Al este de la Cuenca, la erosión reciente es estimada en 0,16 mm/a y se explicaría por el levantamiento del forebulge del sistema de ante-país.

BACKGROUND AND OBJECTIVE:The prevalence and morbidity of the vaso-vagal syncope are well-known. With the intention of measuring the Quality of Life (QoL) of patients with vaso-vagal syncope, as well as age and gender influence, we have used the Spanish version of Short form 36 (SF-36) questionnaire in those patients and have compared it with the general population and with patients with heart failure.PATIENTS AND METHOD:All consecutive patients with vaso-vagal syncope submitted for head-up tilt test performance from January 2001 to December 2002 were included. SF-36 was self-administered prior to the head-up tilt test.RESULTS:Two hundred and seventy one patients were included (50.5% females). In these patients, QoL scores were lower than those of the Spanish general population and similar to those in patients with heart failure. Women's scores were lower in eight dimensions, and only four were lower in men's. Women QoL was worst than men's (p < 0.05). Age had a negative influence on the eight dimensions of SF-36, especially in women. The number of syncopes was the most influential clinic parameter on the QoL of such patients.CONCLUSIONS:In our series, patients suffering from vaso-vagal syncope had a poor QoL when compared with heart failure or control populations. Women had lower QoL than men, and there was an age-related worsening in both men and women. Our data show that the number of syncopes is the clinic parameter having the best correlation with QoL.

Son conocidas la prevalencia del síncope vasovagal y su morbilidad. Con objeto de cuantificar la calidad de vida relacionada con la salud (CVRS) de los pacientes que lo sufren y evaluar la influencia de la edad y el sexo, se compararon los resultados obtenidos tras la administración de la versión española del Cuestionario de Salud SF-36 en esta población con los valores de la población general y de pacientes con insuficiencia cardíaca. Además se ha analizado la influencia de diversos parámetros clínicos. Se incluyó consecutivamente a todos los pacientes con síncope vasovagal sometidos a test de tabla basculante desde enero de 2001 hasta diciembre de 2002. El cuestionario se contestó previamente a la realización del test. Se calcularon los valores utilizando estadísticos apropiados a la distribución de la muestra, se analizaron según la edad y el sexo, y se correlacionaron con diversos parámetros clínicos. Se incluyó a 271 pacientes (50,5% mujeres). La CVRS en estos pacientes fue inferior a los valores poblacionales y similar a la de los pacientes que sufren insuficiencia cardíaca. En el varón sólo 4 dimensiones del SF-36 fueron inferiores a la población general, y en la mujer lo fueron las 8. La mujer tuvo peor percepción de su CVRS que el varón (p < 0,05). La edad influyó negativamente en todas las dimensiones del SF-36, sobre todo en la mujer. El número de síncopes fue el parámetro clínico que más se relacionó con la CVRS. En nuestra serie, los pacientes con síncope vasovagal tienen peor CVRS respecto a la población general de referencia y similar a la que sufre insuficiencia cardíaca. La CVRS es peor en la mujer y empeora con la edad en ambos sexos. Nuestra serie indica que el número de síncopes es el parámetro clínico que mejor se correlaciona con la CVRS. The prevalence and morbidity of the vaso-vagal syncope are wellknown. With the intention of measuring the Quality of Life (QoL) of patients with vaso-vagal syncope, as well as age and gender influence, we have used the Spanish version of Short form 36 (SF-36) questionnaire in those patients and have compared it with the general population and with patients with heart failure. All consecutive patients with vaso-vagal syncope submitted for head-up tilt test performance from January 2001 to December 2002 were included. SF-36 was self-administered prior to the head-up tilt test. Two hundred and seventy one patients were included (50.5% females). In these patients, QoL scores were lower than those of the Spanish general population and similar to those in patients with heart failure. Women's scores were lower in eight dimensions, and only four were lower in men's. Women QoL was worst than men's (p < 0.05). Age had a negative influence on the eight dimensions of SF-36, especially in women. The number of syncopes was the most influential clinic parameter on the QoL of such patients. In our series, patients suffering from vaso-vagal syncope had a poor QoL when compared with heart failure or control populations. Women had lower QoL than men, and there was an age-related worsening in both men and women. Our data show that the number of syncopes is the clinic parameter having the best correlation with QoL.

Background Peak oxygen uptake (peak VO2 ) is a reference parameter in the assessment of functional capacity of patients with chronic heart failure, but the procedure for cardiopulmonary exercise testing with expired gas analysis is complex and expensive, so more simple and available methods are desirable. Methods We compared the usefulness of a time-limited walk test, the 6-minute walk test (6-MT), with that of a symptom-limited walk test, the shuttle walk test (SWT), in the evaluation of patients with moderate to severe chronic heart failure. We prospectively studied 46 clinically stable patients in New York Heart Association class II to IV heart failure with left ventricular ejection fraction <40% (aged 53 ± 10 years, ejection fraction 23% ± 8%, New York Heart Association functional class 2.8 ± 0.7). Each patient performed two 6-MT, two SWT and a cardiopulmonary exercise testing within 2 weeks. Results We found a close correlation between distance walked in SWT and peak VO2 (r = 0.83, P < .001) and a moderate correlation between distance in 6-MT and peak VO2 (r = 0.69, P < .001). Both walk tests showed to be reproducible after just one practice walk. All patients who walked > 450 m in SWT had a peak VO2 >14 mL/kg/min. The overall discriminatory accuracy for SWT distance was greater than that for 6-MT distance for predicting a peak VO2 <14 mL/kg/min (area under receiver operator characteristic curves 0.97 and 0.83 respectively, P = .02). Stepwise multivariate regression analysis, including clinical, exercise testing, echocardiographic, radionuclide-angiographic, and rest hemodynamic data, showed that distance walked in SWT was the only independent predictor of peak VO2 (P < .001) and the strongest predictor of percent achieved of age- and sex-predicted peak VO2 (%PVO2 ) (P < .001), with only age offering additional information (P = .02). Conclusions The SWT shows to be a feasible and safe method to evaluate patients with chronic heart failure that strongly and independently predicts peak VO2 and %PVO2. This symptom-limited walk test seems to be more useful than 6-MT in the assessment of functional capacity in these patients. (Am Heart J 1999;138:291-8.)

By means of external electron emission produced by double-exciton annihilation inside anthracene crystal, evidence is produced for the existence of a charge-transfer (CT) exciton in anthracene at 3.45 eV, with a lifetime conjectured to be 2 × 10−7 sec. The efficiency of generating the CT exciton increases markedly at an incident light energy greater than 4 eV. This value is associated with that of an upper conductivity band. The lowest conductivity level in anthracene must be larger than 3.45 eV, and is estimated to lie at 3.7 eV. Delayed fluorescence produced by α-particle bombardment of anthracene is discussed in terms of CT excitons.