Ultrasonic blood flow measurements in arteriovenous fistulas: an experimental study.

Femoral arteriovenous fistulas (AVF) were constructed in dogs. Fistulas blood flow was measured simultaneously with standard Doppler equipment, with electromagnetic flow probes and by direct timed blood collection. A good correlation was observed between Doppler and direct timed blood collection (r = 0.822, p less than 0.001) and also between Doppler and electromagnetic determinations (r = 0.747, p less than 0.001). These results lead us to suggest that transcutaneous measurement of AVF flow is possible with standard Doppler equipment and we recommend this technique for the management of AVF constructed in uremic patients.

Hand exercise effect in maturation and blood flow of dialysis arteriovenous fistulas ultrasound study.

With the help of the Doppler Ultrasound we have measured the radial artery blood flow of 20 healthy volunteers and the fistula flow of 40 uraemic patients. The measurements were made at rest and repeated one, three and five minutes after initiation of hand exercise, and one minute after the exercise had finished. Radial artery mean flow increased significantly with the exercise (p less than 0.001); radial arteries with greater baseline flow had less flow increase (p less than 0.002). However, we were not able to demonstrate any fistula flow increase with the hand exercise. Therefore, we conclude that there is no benefit in advising uraemic patients to squeeze a rubber ball which, otherwise, supposes an unnecessary preoccupation for these patients.

Effects of pharmacological doses of synthetic salmon calcitonin on wound healing in rats.

The effect of pharmacological doses of synthetic salmon calcitonin (CT) on the healing of experimental wounds in rats is studied. Subcutaneous administration of 20 IU/Kg body weight/day induces a significant increase in collagen content in the scars of treated animals at five, eight, ten and 15 days, as compared with the scars of non-treated animals. The scars of the treated animals also showed a greater tensile strength (TS) than those of the control group, except on day 8.

Peri-incisional and preoperative administration of cefmetazole for the prophylaxis of wound infection after appendicectomy.

The tissue and blood levels of Cefmetazole are compared after preoperative administration of a single dose of 30 mg/K body weight of the antibiotic administered intravenously (15 patients) and peri-incisionally (30 patients) to patients scheduled for emergency appendicectomy. Local and general tolerance to the antibiotic was good by both routes. No local or general complications arose in any of the patients. As expected, the tissue concentrations achieved with peri-incisional infiltration were significantly higher than those obtained by the intravenous route. With the blood levels, exactly the opposite happens at the start of the operation whereas at the end, there were no significant differences between the two routes employed. The prophylactic administration by peri-incisional infiltration is an easy and safe method which provides high tissue concentrations simultaneously with adequate blood levels and should be considered as useful in the preoperative administration of antibiotics for prophylaxis.

[Carcinoid tumor of the Vater's ampulla]. / Tumor carcinoide de la ampolla de Vater.

We report a patient with biliary obstruction of two years evolution. Blood chemistry evaluation was compatible with obstructive jaundice. Endoscopy and CT were suggestive of ampullary tumor. At laparotomy, the biopsy specimen was diagnosed as carcinoid tumor, and was treated by a Whipple's procedure.

[Postoperative cortical blindness after resection of a retroperitoneal teratoma]. / Ceguera cortical postoperatoria tras resección de teratocarcinoma retroperitoneal.

We present a rare case of cerebrovascular accident involving non-cardiac, non-neurological, non-carotid surgery in a 44-year-old man with no cardiovascular risk factors who underwent retroperitoneal resection of a teratocarcinoma, immediately after which he showed signs of confusion accompanied by cortical blindness. Neurological signs and symptoms remitted completely 5 days after surgery. Complementary tests and the patient's evolution confirmed a diagnosis of reversible ischemic neurological deficit.

[Acceptance of recombinant hepatitis B vaccine by health personnel]. / Aceptación de la vacuna recombinante antihepatitis B en el personal sanitario.

OBJECTIVE: To find the level of acceptance of the recombinant anti-Hepatitis B vaccination by our area's health staff as well as the reasons why some staff had not been vaccinated. DESIGN: A descriptive study of a crossover type (cross-sectional), with data-gathering by means of a self-administered questionnaire. SETTING: Primary Care teams (PCT) in Asturias Area III (Avilés county) and their referral hospital. PARTICIPANTS: 379 health workers (115 from PCT and 264 from the referral hospital) from Asturias Area III, with a simple random sample selection based on the Area's staff lists. MEASUREMENTS AND MAIN RESULTS: 34 of the subjects under study stated that they were immune prior to vaccination. Out of those without immunity, and therefore available for vaccination, 77.1% (80.9% doctors, 88.5% nurses and 57.7% auxiliary staff) accepted vaccination. There were no significant differences between PCT and hospital, except for auxiliary staff, for whom there were more vaccinations in the hospital. Doctors and nurses, independently of the work centre, were vaccinated to a significantly greater extent than the auxiliary staff. Among those who were not vaccinated, the main reason for refusing the vaccination was laziness or lack of interest (36.1% in PCT and 44.1% in hospital). CONCLUSIONS: Hepatitis B vaccination in our areas is greater among health staff most exposed to risk of contagion. Despite the high vaccination rate, an important number of staff remain non-vaccinated, mainly because of their own lack of interest. This must be borne in mind when vaccination programmes are being designed.

Flow of dialysis fistulas. Noninvasive study performed with standard Doppler equipment.

Ultrasound was used for the measurement of the flow of 50 dialysis fistulas. Mean flow was 806.2 ml/min. There was no difference between the flow of the different types of fistula. It has been observed that although the vein diameter determines the fistula flow, and the former continues to increase even after the fistula has matured, blood flow through the fistula does not increase as its velocity decreases with greater diameters. Flow measurements with ultrasound have important advantages and indications, which are commented.

Evidencia científica del tratamiento hormonal sustitutivo en la actualidad / Scientific evidence of the hormonal substitute treatment at present

Hasta épocas recientes, en España la sintomatología que acontecía durante el periodo de la menopausia (sofocos, sudores, cambios en el carácter, etc) se consideraban como achaques propios de la edad y por tanto sin necesidad de tratamiento, sin tener en cuenta que la menopausia por el contrario es una larga etapa de la mujer que en muchas ocasiones precisa de tratamiento. Se ha insistido reiteradamente que la Terapia Hormonal Sustitutiva (THS) es enormemente eficaz en la osteoporosis y en la cardiopatía isquémica. España es uno de los países de la Unión Europea con menor porcentaje de uso de THS, aproximadamente un 5% de la población susceptible de tratamiento, a diferencia de la media Europea establecida en un 20%. Se analiza en este estudio la evidencia científica publicada sobre el uso de THS

Until recent times, in Spain the symptoms that happened during the periodo f the menopause (hot flashes, sweating, change in the character, etc) they were considered like ailments characteristics of the age and therefore without treatment necessity, without keeping in mind that the menopause on the contrary is the woman’s long stage that she specifies treatment in many occasions. Repeatedly has been insisted that the Hormone Replacement Therapy. It is vastly effective in the Osteoporosis and in the coronary heart disease. Spain is one of the countries of the European Union with smaller percentage of user of THS, approximately the susceptible population’s of treatment 5%, contrary to the European stocking settled down in 20%. There is analyzed in this study the scientific evidence published on THS’s use

Pubertad precoz / Precocious puberty

A lo largo de los últimos años la Ginecología ha ido tomando un interés creciente por los problemas de los primeros años de la vida de la mujer. Si bien es cierto que la mayor parte de la patología femenina de esos años pertenece al campo de las malformaciones congénitas –muchas de las cuales sólo se diagnostican con motivo de la llegada de la pubertad o cuando consultan por esterilidad– es evidente que las niñas pueden consultar básicamente por los mismos problemas que las mujeres adultas (infecciones, tumores o sangrado genital anormal). El dolor es un síntoma subjetivo de difícil evaluación. Constituye uno de los motivos más frecuentes de consulta ginecológica junto con la hemorragia y la leucorrea. Es difícil marcar la diferencia entre dolor agudo y crónico, ya que según diversos criterios un dolor agudo puede ser aquel que dura desde unas horas a semanas. Nos parece más fácil diferenciar como dolor agudo aquel que motiva una consulta de urgencia, frente al crónico que puede ser visto de forma diferida en la consulta común (12, 33). El objeto del presente trabajo es el estudio de su etiología, diagnóstico y tratamiento

In last few years the study of adolescence gynaecology is increasing, and although the most frequent pathology is congenital, we can find the same pathology in adolescent as in the adult women, infections, tumours, menstrual problems. Pelvic acute and chronic pain in adolescence, is the most frequent consult next with bleeding and vaginal discharge. We can define pelvic acute pain as the pain that cause urgent consult, and the pelvic chronic pain, as the one that cause not urgent consult. The aim of this article is the study of aetiology, diagnosis and treatment of pelvic acute and chronic pain in adolescence

Tratamiento del hirsutismo en mujeres con síndrome de ovario poliquístico / Treatment of hirsutism in women with polycystic ovary syndrome

El hirsutismo es un grave problema estético de origen endocrino que precisa un enfoque cuidadoso y comprensivo hacia las mujeres que lo padecen. El objeto de este trabajo es presentar las perspectivas de tratamiento del hirsutismo

The hirsutism is a serious cosmetic problem, with endocrine aetiology, to need a careful and compressive approach to the women with him. The aims of this work is to present the new therapeutic perspectives of treatment of hirsutism

Corazón univentricular fetal / Univentricular foetal heart

Las cardiopatías congénitas constituyen una de las principales causas de mortalidad infantil (el 30% en período neonatal), con una incidencia del 7-8 ¿ de recién nacidos vivos. El diagnóstico prenatal es posible gracias a la ecografía fetal que presenta una sensibilidad del 30-36%. Dentro de las cardiopatías congénitas existen cuadros complejos como el corazón univentricular, de escasa incidencia pero de mal pronóstico, que puede mejorarse si se realiza un diagnóstico prenatal óptimo que permita, entre otros, una atención y tratamiento adecuados (AU)

Demandas judiciales. Un problema a resolver / Medical lawsuit. Unsolved problem

Las denuncias médicas colapsan la sanidad, y aunque la mayoría obtienen sentencias absolutorias, producen daños irreparables en el honor y en la fama profesional, siendo condenados públicamente previamente en los periódicos y en otros medios a pesar de ser inocentes. Se presentan tres casos de denuncias; existen en nuestro Servicio más, que se comentan y se solicita que las instituciones médicas, nuestras relevantes personalidades médicas y todos nosotros consigamos que no se nos trate como delincuentes por ejercer la profesión, así como que las investigaciones previas a cualquier procedimiento sean realizadas por tribunales médicos y no por jueces que carecen de la formación necesaria, siendo estos en el caso de error o negligencia los que impongan las sanciones correspondientes según la vigente legislación (AU)

Infarto hemorrágico cerebral durante la gestación / Cerebrovascular diseases associated with pregnancy

La incidencia aproximada de accidentes cerebrovasculares relacionados con la gestación es de 1:6000 partos (1), responsables del 5-15 por ciento de las muertes maternas. Alrededor del 50 por ciento de los accidentes cerebrovasculares relacionados con la gestación se producen durante el puerperio. Los infartos se clasifican en isquémicos (arteriales o venosos) y hemorrágicos. La mayoría de los infartos asociados con el embarazo son oclusiones arteriales y, la mayoría, se producen durante el tercer trimestre y el puerperio (2).Presentamos el caso de una gestante en la semana 25 que padeció un infarto cerebral con un hematoma posterior (AU)