Estenosis del tronco celíaco. estudio Retrospectivo de su tratamiento endovascular / Stenosis of the celiac trunk. Retrospective study of its endovascular treatment

La oclusión parcial de la arteria celiaca o tronco celiaco es una patología generalmente de origen ateroscleroso que puede ocasionar isquemia a nivel de las vísceras digestivas de la cavidad abdominal y especialmente del intestino. Tradicionalmente se ha considerado que para tener repercusión clínica debería de afectarse por lo menos dos de las tres arterias digestivas en mayor o menor grado y esta situación es la que se mostraba como base de la actuación quirúrgica terapéutica. Con la llegada de la era endovascular, con la posibilidad de realización de procedimientos quirúrgicos menos agresivos se han incrementado las indicaciones terapéuticas realizándose los procedimientos de forma preventiva para evitar el cierre u oclusión total del vaso arterial. Se realiza un estudio prospectivo de la experiencia del servicio con la utilización de procedimeintos endovasculares. (AU)

The partial occlusion of the celiac artery or celiac trunk is a disease generally of atherosclerosis origin that can cause ischemia at the level of the digestive viscera of the abdominal cavity and especially the intestine. Traditionally, it has been considered that in order to have clinical repercussion, at least two of the three digestive arteries should be affected to a greater or lesser degree and this situation is the one that was shown as the basis of therapeutic surgical action. With the arrival of the endovascular era, with the possibility of performing less aggressive surgical procedures, the therapeutic indications have increased, with the procedures being carried out preventively to avoid the closure or total occlusion of the arterial vessel. A prospective study of the service’s experience with the use of endovascular procedures is carried out. (AU)

Cirugía de la patología de la arteria vertebral. Revisión / Surgery of the pathology of the vertebral artery. Revision

Se realiza una revisión sobre la patología de la arteria vertebral, valorando las repercusiones que su oclusión parcial o total desarrolla. Se analiza la clínica que ocasiona este tipo de patología a la vez que se valoran los medios diagnósticos para la detección dela lesión oclusiva. Se discuten las diferentes estrategias y procedimientos terapéuticos en los pacientes portadores de esta patología y se valoran los diferentes datos aportados en la bibliografía y que corresponden a los estudios más importantes que se han realizado. Este tipo de afección se muestra como una patología con dificultades para su detección y con unas indicaciones terapéuticas quirúrgicas muy discutibles cuando se aplican con una no muy clara evidencia científica de la pertinencia de su realización. (AU)

A review is carried out on the pathology of the vertebral artery, assessing the repercussions that its partial or total occlusion develops. The symptoms that cause this type of pathology are analyzed at the same time as the diagnostic means for detecting theocclusive lesion are evaluated. The different strategies and therapeutic procedures in patients with this pathology are discussed andthe different data provided in the bibliography and corresponding to the most important studies that have been carried out are valued. This type of condition is shown as a pathology with difficulties in its detection and with highly debatable surgical therapeuticindications when applied with not very clear scientific evidence of the relevance of its performance. (AU)

Vertebro-Basilar occlusive disease

Vertebro-basilar occlusive disease is a condition that can cause symptomatology related to encephalic posterior circulation ischemia. Vertebro-basilar (VB) ischemia represents a 25% of all TIA’s and Strokes in North America (1). In a patient with a VB-TIA, if vertebro-basilar (VB) pathology is demonstrated, he or she will have a 30-35% risk of having a VB circulation stroke in the next 5 years (2); demonstrating that vertebro-basilar occlusive disease is a relevant condition regarding mortality, morbidity and health-related costs. Since Crawford and colleagues described the trans-subclavian vertebral artery endarterectomy by the end of the 50’s, vertebro- basilar occlusive disease has been studied rather little. We pretend to do a revision of this disease, and to discuss briefly the most up-to-date therapies described in current literature for this condition (AU)

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Síndrome compartimental abodominal en cirugía vascular: manejo y revisión bibliográfica / Abdominal compartment syndrome in vascular surgery: management and bibliographic review

INTRODUCCIÓN. El síndrome compartimental abdominal (SCA) continúa siendo actualmente una complicación que asocia una importante morbi-mortalidad en el paciente vascular. El objetivo de nuestro trabajo es revisar la bibliografía científica para actualizar pautas de manejo del SCA y las consecuencias asociadas. MATERIAL Y MÉTODOS. Se realizó una revisión de la literatura científica de los últimos años que versa sobre el manejo diagnóstico y terapéutico del SCA además del abdomen abierto tras laparotomía descompresiva. Para ello se utilizó la base de datos de la Nacional Library of Medicine (PubMed). El estudio se limitó a trabajos publicados en los últimos 10 años en inglés y español que dispusieran de abstract on-line. Las palabras clave introducidas para la búsqueda fueron abdominal compartment symdrome, vascular surgery, ruptured aneurysm. RESULTADOS. Con dichos parámetros de búsqueda aparecen 84 trabajos de los cuales, 46 de ellos hacen referencia directa o indirecta mientras que los 38 trabajos restantes fueron desechados por no ajustarse a la finalidad de la búsqueda. De los trabajos recogidos se analizaron detenidamente 16 de ellos, a los cuales se hace referencia en el artículo de acuerdo al orden de aparición. CONCLUSIONES. El paciente sometido a cirugía vascular abdominal presenta alto riesgo para desarrollar el SCA por ello se debería monitorizar la presión intraabdominal en el ingreso en la unidad de cuidados intensivos tras la cirugía. La descompresión quirúrgica debería reservarse para aquellos pacientes con SCA refractario al tratamiento médico intensificado, utilizando un sistema de cierre asistido por vacío (VAC) como primera elección siempre que fuera posible (AU)

INTRODUCTION. The abdominal compartmental syndrome (SCA) is a complication that associates an important morbi-mortality in the vascular patient. The objective of our paper is to review the scientific bibliography in order to modernize rules of management of the SCA and the associated consequences. MATERIAL AND METHODS. We reviewed the scientific literature of the last years that deal with diagnosis and therapeutic of the SCA. We used the data base of the National Library of Medicine (PubMed). The study was limited to articles published in 10 last years, in English and Spanish language that they have an abstract on-line. The key words introduced for the search was abdominal compartment symdrome, vascular surgery, ruptured aneurysm. RESULTS. With these parameters we found 84 works, 46 of them makes direct reference to our aim while the 38 remaining works were discarded by not adjusting to the purpose of the search. 16 of them were analyzed. CONCLUSIONS. The vascular patient presents high risk in order to develop the SCA for it would be monitorized the intraabdominal pressure in the unit of intensive cares after the surgery. The surgical decompression should reserve for those patient with refractory SCA to the medical treatment, using a system of vacuum assisted closure (VAC) whenever it is possible (AU)

Case report on the clinical results of a combined cellular therapy for chronic spinal cord injured patients.

OBJECTIVES: With the intention to ameliorate the clinical condition of patients with chronic spinal cord injury (SCI), a program that combines three cell therapies and an appropriate neurorehabilitation program were used to recreate and enhance the natural conditions of SCI repair. METHODS: Vascularization recovery is approached by selective artery infusion of BMMNCs (bone marrow mononuclear cells) to the disrupted area. Eighteen days later, with the aim to restore the specific inflammatory activity, an i.v. infusion of spinal cord specific ETCs (effector T cells) is carried out. With the intention of supplying cellular components for the process of repair, an infusion of autologous neural stem cells (NSCs) through selective feeding artery infusion is carried out, followed by an appropriate neurorehabilitation program. RESULTS: A total of eight ASIA (American Spinal Injury Association) A patients (five with jeopardized brachial plexus and three without) received the treatment. No severe adverse events was observed in any of the receptor patients: five patients evolved from ASIA A to ASIA D and regained the ability to stand up and, with varying effectiveness, to walk; two patients remained in the same condition, but exhibited motor and sensitive improvements; and one patient could not be evaluated. CONCLUSIONS: These reports suggest that the biological characteristics of acute SCI may be recreated in a comprehensive, safe and effective manner.

Effect of postoperative restrictive fluid therapy in the recovery of patients with abdominal vascular surgery.

OBJECTIVE: To compare the outcome of the postoperative administration of a restricted or standard intravenous fluid regimen in patients who underwent elective abdominal vascular surgery. The primary end point was postoperative hospital stay. DESIGN: Prospective observer-blinded, randomised controlled trial. MATERIAL AND METHODS: Patients were considered eligible if they underwent transperitoneal aorto-iliac approach with infrarenal graft repair. During the operation and intensive care unit stay, fluids were prescribed by the anaesthetists who were unaware of the details of the study. In the vascular surgical ward, patients in the standard group (SG) received 2500ml of fluids per day, whereas patients in the restricted group (RG) received 1500ml of fluids per day. All the patients were evaluated on an intention-to-treat basis. RESULTS: Forty patients were randomised to the RG (n=20) or SG (n=20). No significant differences were observed in the recovery of gastrointestinal function. However, the postoperative hospital stay was shorter in the RG (8 days) than in the SG (12 days) (p=0.003). CONCLUSIONS: The use of a restrictive postoperative fluid protocol significantly reduces the duration of hospital stay in patients who have undergone major elective abdominal vascular surgery.

Tromboendarterectomía carotídea tras ictus o accidente isquémico transitorio: revisión bibliográfica / Carotid endarterectomy after cva or transient ischaemic accident: Bibliographic review

Introducción: Actualmente existe una gran controversia sobre la indicación en el tiempo de la realización de la cirugía sobre una carótida sintomática (ICTUS, TIA, INI). El objetivo de esta revisión es determinar ese momento óptimo de acuerdo la literatura científica más reciente. Material y métodos: En el presente trabajo se realizó una revisión de la literatura científica de los últimos años. Para ello se utilizó la base de datos de la Nacional Library of Medicine (PubMed). El estudio se limitó a trabajos publicados en los últimos 10 años en inglés y español que dispusieran de abstract on-line. Las palabras clave introducidas para la búsqueda fueron carotid stenosis, endovascular, stenting, thromboendarterectomy. Resultados: Con dichos parámetros de búsqueda aparecen 140 trabajos de los cuales, 77 de ellos hacen referencia directa o indirecta. De los trabajos recogidos se analizaron detenidamente 22 de ellos, a los cuales se hace referencia en el artículo de acuerdo al orden de aparición. Conclusiones: El beneficio potencial para el paciente aumenta cuanto mayor es el riesgo de ICTUS o de recurrencia. Por ello recomendamos la cirugía precoz en las dos primeras semanas (AU)

Background: Actually there is a great controversy on the indication in the time in order to carry out the surgery on a symptomatic carotid (CVA, TIA, INI). The aim of this revision is to determine that good moment of agreement the most recent scientific literature. Material and methods: This paper was carried out a revision of the scientific literature of the last years. We used the data base of the National Library Medicine (PubMed). The study was limited to papers published in English and Spanish with abstract on-line in the last 10 years. The key words introduced for the search was carotid stenosis, endovascular, stenting, thromboendarterectomy. Results: With these parameters of search appear 140 articles. 77 of them makes reference to the aim of the article. We reviewed 22 of them. Conclusions. The potential benefit for the patient increases in the high risk period. We recommend the early surgery in the first two weeks (AU)

Utilidad y pautas de seguimiento de la revacularización de miembros inferiores: Revisión bibliográfica / Utility and surveillance protocol of lower limbs revascularization: A bibliographic review

INTRODUCCIÓN. Actualmente no existe unanimidad sobre las pautas de seguimiento de la revascularización de miembros inferiores; ni siquiera si ésta resulta útil a medio y largo plazo. La finalidad del trabajo es revisar la bibliografía científica para establecer un protocolo de seguimiento actualizado según las últimas publicaciones. MATERIAL Y MÉTODOS. Se utilizó la base bibliográfica de la Nacional Library of Medicine (PubMed). El estudio se limitó a trabajos publicados en los últimos 10 años en inglés, español que dispusieran de abstract on-line. RESULTADOS. Con dichos parámetros de búsqueda aparecen 124 trabajos de los cuales, 22 de ellos hacen referencia directa o indirecta mientras que los 102 trabajos restantes fueron desechados por no ajustarse a la finalidad de la búsqueda. CONCLUSIONES. Aunque la tasa de amputaciones, permeabilidad y salvamentos a los 18 meses en los pacientes seguidos mediante eco-doppler no difiere significativamente de los pacientes que se incluyen dentro de programas de seguimiento clínico, un estudio ecográfico a las 6 semanas puede predecir la historia natural de un by-pass con vena y así establecer los pacientes que se beneficiarían del seguimiento ecográfico. De ésta forma se reducurían los costes asociados y la tasa de reintervenciones (AU)

INTRODUCTION. At the moment there is no unanimity on the rules of surveillance of the revascularization of lower limbs; not even if this is useful to half and long term. The purpose of the article is to revise the bibliography in order to establish a protocol of follow up modernized according to the last publications. METHODS. The bibliographical base of the National Library Medicine (PubMed) was used. The study was limited to papers published into 10 last years. RESULTS. With this parameters of search 124 entries appear of which, 22 of them makes direct or indirect reference to the purpose while the 102 remaining papers were discarded by not adjusting to the purpose of the search. CONCLUSIONS. Although the rate of amputations, patency and salvages at the 18 months in the followed patients by echo-doppler don't differ significantly of the patients that are included into programs of clinical follow up, a duplex scan sonography at the 6 weeks predicts the natural history of a vein graft and so establish the patients that would benefit from the surveillance by echo-doppler in order to decrease the associate costs and the rate of reinterventions (AU)

Reinfusión de sangre procedente del drenaje mediastínico en cirugía cardiaca / Autotransfunsion of shed mediastinal blood in cardiac surgery

El considerable incremento de intervenciones quirúrgicas, el desarrollo de técnicas complejas, edad media cada vez más elevada,y la mayor comorbilidad que acompaña a los pacientes intervenidos, ha motivado un mayor consumo de sangre homóloga.La cirugía cardiaca, por varios factores, fundamentalmente el empleo de la derivación cardiopulmonar o circulaciónextracorpórea, determina una utilización importante de sangre y hemoderivados. Esta situación de creciente demanda juntocon una oferta hospitalaria insuficiente a partir de las donaciones hace difícil mantener un balance adecuado entre demanday disponibilidad. En consecuencia se plantean y desarrollan diversas estrategias de ahorro de sangre en cirugía. La autotransfusiónprocedente del drenaje mediastínico, de uso habitual en algunas unidades de cirugía cardiaca, es un procedimientoaún sometido a debate con opiniones diversas y variadas en cuanto a su capacidad de ahorrar recursos sanguíneosy garantía en cuanto a problemas derivados de su uso. En el presente trabajo nos planteamos el análisis de la reinfusión postoperatoriade sangre como alternativa a la transfusión homóloga en cirugía cardiaca con los siguientes objetivos: Verificarque se trata de un método factible y de fácil aplicación, y en segundo lugar analizar y evaluar las alteraciones de la coagulación,en el paciente y en la sangre recogida, implícitas a la aplicación de esta técnica (AU)

The growing number of surgical interventions, the development of high complexity techniques, the higher comorbility and theincrease in the average age of patients, has lead to a greater spent of homologous blood. By means of many factors, especiallybecause of the cardiopulmonary bypass, undergoing cardiac surgery determines the use of an important amount ofblood and other by-products. This background of an increasing demand and an insufficient offer of blood from donations,makes it very difficult to maintain an adequate balance between demand and availability. In answer to this situation, newstrategies in blood saving are being developed. The autotransfusion of mediastinal shed blood is an usual technique in manycardiac surgery units, nevertheless there is still an ongoing debate regarding to it’s safety and capability to save blood-bankresources. In this study, we carried out the analysis of mediastinal shed blood transfusion in cardiac surgery as an alternativeto homologous blood transfusion with this aims: to verify that it is a feasible and easy to carry out method, and in secondplace, to analyze and evaluate the alterations of the coagulation in patients and in the recovered blood (AU)

Autoreactive T cells induce in vitro BM mesenchymal stem cell transdifferentiation to neural stem cells.

BACKGROUND: The degree of post-injury inflammation of the damaged area of a spinal cord is the main difference between the natural successful repair in inferior vertebrates and failure in superior vertebrates. The treatment of rats with anti-myelin lymphocytes after experimental spinal cord injury induces their functional recovery. On the other hand, mesenchymal stem cells (MSC) from adult BM implanted in injured areas recover the morphology and function of spinal cord in mammals. The purpose of this study was to determine whether there is a direct relationship between anti-nervous tissue T cells and MSC reparatory properties. METHODS: Circulating autoreactive lymphocytes of patients with spinal cord injuries and amyotrophic lateral sclerosis were isolated and activated in vitro. These cells were cocultured with autologous MSC for 2-15 days. Cocultures of non-selected lymphocytes were used as controls. RESULTS: After 48 h of coculture, MSC adopted a spindle shape with polarization of the cytoplasm that resembled bipolar neurons. Their nuclei diminished the nucleolus number and the chromatin lost its granular appearance. After 15 days of culture the cells developed the typical structure of a neural network. No morphologic changes were observed in control cultures. The differentiated cells reacted positively to tubuline III, GFAP and nestin. No differences were observed between the different patient cell sources. DISCUSSION: We observed that autoreactive cells may induce the transdifferentiation of MSC to neural stem cells. This T-cell-MSC interaction may be a common phenomenon during physiologic nerve tissue repair.

Combined protocol of cell therapy for chronic spinal cord injury. Report on the electrical and functional recovery of two patients.

BACKGROUND: This is a preliminary report on successful results obtained during treatment of two patients with chronic spinal cord injury. The therapeutic approach was based on the generation of controlled inflammatory activity at the injury site that induced a microenvironment for the subsequent administration of autologous, BM-driven transdifferentiated neural stem cells (NSC). METHODS: BM mesenchymal stem cells (MSC) were cocultured with the patient's autoimmune T (AT) cells to be transdifferentiated into NSC. Forty-eight hours prior to NSC implant, patients received an i.v. infusion of 5 x 10(8) to 1 x 10(9) AT cells. NSC were infused via a feeding artery of the lesion site. Safety evaluations were performed everyday, from the day of the first infusion until 96 h after the second infusion. After treatment, patients started a Vojta and Bobath neurorehabilitation program. RESULTS: At present two patients have been treated. Patient 1 was a 19-year-old man who presented paraplegia at the eight thoracic vertebra (T8) with his sensitive level corresponding to his sixth thoracic metamere (T6). He received two AT-NSC treatments and neurorehabilitation for 6 months. At present his motor level corresponds to his first sacral metamere (S1) and his sensitive level to the fourth sacral metamere (S4). Patient 2 was a 21-year-old woman who had a lesion that extended from her third to her fifth cervical vertebrae (C3-C5). Prior to her first therapeutic cycle she had severe quadriplegia and her sensitive level corresponded to her second cervical metamere (C2). After 3 months of treatment her motor and sensitive levels reached her first and second thoracic metameres (T1-T2). No adverse events were detected in either patient. DISCUSSION: The preliminary results lead us to think that this minimally invasive approach, which has minor adverse events, is effective for the repair of chronic spinal cord lesions.

Empalamiento transabdominal / Transabdominal impalament

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Mixoma intramuscular inguinal y compresión de elementos vasculonerviosos femorales / Inguinal intramuscular myxoma and compression of femoral vascular-nervous elements

Introducción. La tumoraciones no pulsátiles inguinales son tratadas por cirujanos vasculares por su relación con los vasos femorales. El mixoma intramuscular es un caso raro de tumor benigno con tendencia a la compresión de las estructuras vecinas y con potencial de recidiva local. La resección completa con márgenes amplios es el tratamiento indicado para ellos. Caso clínico. Varón de 57 años. Clínica de parestesias en cara anteriomedial del muslo izquierdo, ausencia de patología vascular en la extremidad afectada. En la exploración, se palpa una masa inguinal bien delimitada, blanda, compresible, no fluctuante, adherida a planos profundos, no dolorosa a la palpación, de 10 cm de diámetro. En el estudio radiológico mediante tomografía axial computarizada y resonancia magnética, se demuestra una colección líquida de contorno liso y bien definido, en íntimo contacto con el músculo psoasilíaco que se prolonga por encima del anillo inguinal con imagen en ‘reloj de arena’ con desplazamiento de vasos femorales y sospecha diagnóstica de bursitis. Tras la resección quirúrgica, el estudio anatomopatológico es compatible con el diagnóstico de mixoma intramuscular. Conclusión. Se trata de la primera descripción en la literatura de este tumor en esta localización anatómica y con la forma en ‘reloj de arena’ a través del anillo inguinal. Constituye una posibilidad a tener en cuenta en tumores de partes blandas en la región inguinal

Introduction. Due to their relationship with the femoral vessels non-pulsatile inguinal tumours are treated by vascular surgeons. Intramuscular myxomas are a rare case of benign tumours with a tendency to compress neighbouring structures and are potentially capable of recurring locally. They are best treated by means of complete resection with wide margins around the excision. Case report. We report the case of a 57-year-old male whose clinical symptoms included paresthesias in the anteromedial side of the left thigh in the absence of any vascular pathology in the affected extremity. Examination of the patient revealed a well-defined, soft, compressible, non-fluctuating inguinal mass adhered to deep structures, with a diameter of 10 cm and which was not painful when palpated. A radiological study using computerised axial tomography and magnetic resonance scanning showed the presence of a smooth-contoured, welldefined collection of liquid that was in contact with the psoas-iliac muscle and which extended above the inguinal ring with a sandglass-shaped image and displacement of the femoral vessels and a suspected diagnosis of bursitis. After surgical resection, the pathology study was compatible with the diagnosis of intramuscular myxoma. Conclusions. This is the first time this tumour has been reported in the literature as appearing in this anatomical location and with a ‘sandglass’ shape crossing the inguinal ring. It is therefore a possibility that must be taken into account in cases of tumours in the soft parts of the inguinal region

Depuración plasmática de alfa-1-antitripsina, método simple para el estudio de la pérdida proteica intestinal / Plasma clearance of alpha 1-antitrypsin, a simple method for the study of intestinal protein losing

Tratamos de corroborar el valor del clearence de alfa-antitripsina como una técnica eficaz para objetivar la pérdida de proteínas a través del tubo digestivo y su aplicación como método de diagnóstico en tal patología. Se estudiaron 22 individuos; 11 con patología intestinal capaz de producir pérdida proteica y 11 controles sin daño de la mucosa intestinal. Se determinó la concentración de alfa-1-antitripsina tanto en suero como en materia fecal en días consecutivos y pesando la materia fecal de 24 horas se pudo obtener el clearence intestinal de dicha proteína. En los pacientes con enfermedad perdedora de proteínas el valor del clearence fue siempre patológico mientras que en los controles se obtuvieron valores normales. Este método es útil para diagnosticar la pérdida proteica intestinal y tiene la ventaja de no utilizar material radioactivo para su determinación

Depuración plasmática de alfa-1-antitripsina, método simple para el estudio de la pérdida proteica intestinal / Plasma clearance of alpha 1-antitrypsin, a simple method for the study of intestinal protein losing

Tratamos de corroborar el valor del clearence de alfa-antitripsina como una técnica eficaz para objetivar la pérdida de proteínas a través del tubo digestivo y su aplicación como método de diagnóstico en tal patología. Se estudiaron 22 individuos; 11 con patología intestinal capaz de producir pérdida proteica y 11 controles sin daño de la mucosa intestinal. Se determinó la concentración de alfa-1-antitripsina tanto en suero como en materia fecal en días consecutivos y pesando la materia fecal de 24 horas se pudo obtener el clearence intestinal de dicha proteína. En los pacientes con enfermedad perdedora de proteínas el valor del clearence fue siempre patológico mientras que en los controles se obtuvieron valores normales. Este método es útil para diagnosticar la pérdida proteica intestinal y tiene la ventaja de no utilizar material radioactivo para su determinación (AU)

[Plasma clearance of alpha 1-antitrypsin. A simple method for the study of intestinal protein loss]. / Depuración plasmática de alfa-1-antitripsina. Método simple para el estudio de la perdida proteica intestinal.

We tried to evaluate the value of the alpha-1-antitrypsin clearance in order to search for the protein loss through the digestive tract. Twenty-two patients were studied, 11 with protein losing enteropathy and 11 normal controls. Alpha-1-antitrypsin concentration was determined in serum and feces to obtain the clearance of such protein. The values were always abnormal in patients with protein losing enteropathy, and normal in control patients. We consider this method simple and safe for the evaluation of intestinal protein loss, besides having the advantage of not using radioactive material.

Depuración plasmática de alfa-1-antitripsina. Método simple para el estudio de la perdida proteica intestinal. / [Plasma clearance of alpha 1-antitrypsin. A simple method for the study of intestinal protein loss]

We tried to evaluate the value of the alpha-1-antitrypsin clearance in order to search for the protein loss through the digestive tract. Twenty-two patients were studied, 11 with protein losing enteropathy and 11 normal controls. Alpha-1-antitrypsin concentration was determined in serum and feces to obtain the clearance of such protein. The values were always abnormal in patients with protein losing enteropathy, and normal in control patients. We consider this method simple and safe for the evaluation of intestinal protein loss, besides having the advantage of not using radioactive material.