Dynamic Fracture Resistance under Plane Strain Conditions of High-Density Polyethylene Nanoclay Composites.

Polymer nanoclay composites have received significant attention due to their substantially enhanced mechanical, thermal and barrier properties. However, the effect of these nanoclays on the dynamic fracture resistance of a polymer matrix during fast fracture events has not been documented. In this study, the effect of nanoclay addition on the rapid crack propagation (RCP) resistance of high-density polyethylene (HDPE) was investigated through the high-speed double torsion test. Results showed that the addition of 1, 3, and 5% of nanoclays improved the dynamic fracture resistance under the plane strain conditions (Gd1) of HDPE up to 65%. An increase in the storage and loss modulus, and a decrease in crystallinity and melt flow index with nanoclay content was also found. Although the presence of agglomerates can hinder the enhancement of Gd1 as it promotes agglomerate fracture and debonding, the increase in energy consumption through fibrillation and crazing promoted by the nanoclay prevails, suggesting that the nanoclay's toughening effect that has been extensively reported under quasi-static and impact tests, is also present under RCP conditions, and that the HDPE nanocomposites could be used in applications in which RCP must be prevented.

Análisis de variables sociodemográficas relacionadas con la automedicación / Analysis of socio-demographic variables related to self-medication

JUSTIFICACIÓN: el concepto de automedicación hace referencia a la utilización/reutilización por parte del paciente de medicamentos sujetos o no a prescripción médica sin el consejo farmacéutico o consulta médica previa. Según la Encuesta Nacional de Salud de 2017, en España, se recogió un porcentaje de automedicación del 15,33 %, siendo los analgésicos, los antibióticos y los ansiolíticos los fármacos mayormente utilizados de esta forma en nuestro país. El farmacéutico comunitario es clave en la lucha de este grave problema.OBJETIVO: conocer el patrón de autoconsumo, en la población española, de 3 grupos farmacológicos (analgésicos/antiinflamatorios, ansiolíticos y antibióticos) a través de la realización de una encuesta junto con el desarrollo de una revisión bibliográfica. Metodología: Se realizó una encuesta de 11 preguntas mediante un cuestionario a través de Googleforms desde el 19 hasta el 31 de diciembre de 2021 (https://docs.google.com/forms/d/e/1FAIpQLSfXCH_zqDpeWhvj967qEUaO4fOr3EyJRNSoqOyMRh1edR71sg/viewfor m?usp=sf_link). También se realizó una revisión bibliográfica mediante la consulta de las bases de datos Google académico y Pubmed empleando los MeSH; Self Medication, Anti-bacterial Agents, Anti-Inflammatory Agents, Non- Steroidal y Anti-Anxiety Agents y sus equivalentes en castellano. Se realizó un análisis comparativo de los resultados obtenidos.RESULTADOS: participaron 136 personas con una media de 50 años de edad, mayoritariamente mujeres (52,94 %) y con título universitario (45 %). El 86 % de los encuestados afirmaron automedicarse. Los mayores porcentajes de automedicación se observaban en mujeres (91,6 % vs 79,7 % de los hombres), menores de 30 años (96 % vs 83 % de entre 30 y 60 años y el 76 % de los mayores de 60) y en los titulados universitarios (86,8 % vs 75 % de aquellos que solo poseen estudios primarios). (AU)

[Lethality by neonatal sepsis, risk factors and microbiological characteristics]. / Letalidad por sepsis neonatal, factores de riesgo y características microbiológicas.

INTRODUCTION: Neonatal sepsis is one of the leading causes of death in this population and is related to gestational and perinatal factors as well as factors inherent in the newborn. OBJECTIVE: To associate perinatal, neonatal, and microbiological factors to sepsis mortality. PATIENTS AND METHOD: Retrospective ca se-control study of hospitalized newborns with confirmed neonatal sepsis through blood cultures, from 2013 to 2019. Cases were defined as those patients with confirmed sepsis that presented a fa tal outcome and controls as those newborns with confirmed sepsis without a fatal outcome. Cases and controls were compared regarding maternal, perinatal, neonatal, and microbiological factors for quantitative variables in order to identify the trend and concentration of the variables studied. RESULTS: Eleven cases were identified and three controls were randomly assigned to each case, stra tified by gestational age groups. The median birth weight and gestational age were 1,004 grams and 28 weeks, respectively. Escherichia coli was identified in 21% of the patients, Candida parapsilosis in 16%, and Staphylococcus aureus in 14%. There was a statistically significant association between sepsis lethality and vaginal delivery (P = 0.023), infection before 7 days of life (P = 0.025), and Can dida parapsilosis infection (P = 0.049). The multivariate analysis determined a statistically significant association between neonatal sepsis lethality and vaginal delivery and microbiological identification of Candida parapsilosis. CONCLUSION: Neonatal sepsis lethality was more frequent in the group of extremely preterm infants, newborns withhistory of vaginal delivery, early microbiological isolation, and t infection with Candida parapsilosis.

N metabolism performance in Chenopodium quinoa subjected to drought or salt stress conditions.

Currently it is estimated that the 20% of total cultivated land is affected by salt. Besides, drought events will increase worldwide. These factors are affecting plant growth and crop production compromising food security. Within this context, quinoa (Chenopodium quinoa) is becoming an alternative pseudocereal for food supply due to its capacity to grow under harsh environmental conditions. Besides, it is being proposed as key model species to study the physiological processes that permit this tolerance, although how N metabolism responds has been barely studied. This paper addresses, on one hand, the response of quinoa's N metabolism (N uptake, translocation, reduction and assimilation) under the forthcoming climatic conditions and, on the other hand, the comparison of the effects of both stresses when plants have similar relative water content and photosynthetic rates. Under mild salt stress (120 and 240 mM NaCl) N assimilation is not affected, while the N uptake is favored. Under severe salt stress (500 mM NaCl), N uptake is reduced, decreasing leaf nitrate and protein concentration; nevertheless, leaf free amino acids are maintained -to perform osmotic adjustment-. N uptake rate is more affected under drought than under severe salt; furthermore, under severe salt stress, quinoa allocates more nitrogen to roots to finely regulate NO3- and Cl- uptake, while under drought it allocates more to leaves to ensure photosynthesis. These results indicate that quinoa's N metabolism is tolerant to drought and salt stress, although the strategies of this species for coping with the aforementioned stresses are different.

Post-traumatic stress disorder in parturients delivering by caesarean section and the implication of anaesthesia: a prospective cohort study.

BACKGROUND: Post-traumatic stress disorder (PTSD) occurs in 1-7% of women following childbirth. While having a caesarean section (C-section) is known to be a significant risk factor for postpartum PTSD, it is currently unknown whether coexisting anaesthesia-related factors are also associated to the disorder. The aim of this study was to assess anaesthesia-linked factors in the development of acute postpartum PTSD. METHODS: We performed a prospective cohort study on women having a C-section in a tertiary hospital in Switzerland. Patients were followed up six weeks postpartum. Patient and procedure characteristics, past morbidity or traumatic events, psychosocial status and stressful perinatal events were measured. Outcome was divided into two categories: full PTSD disease and PTSD profile. This was based on the number of DSM-IV criteria of the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) present. The PTSD Checklist Scale and the Clinician Administered PTSD Scale were used for measurement. RESULTS: Of the 280 patients included, 217 (77.5%) answered the questionnaires and 175 (62.5%) answered to an additional phone interview. Twenty (9.2%) had a PTSD profile and six (2.7%) a PTSD. When a full predictive model of risk factors for PTSD profile was built using logistic regression, maternal prepartum and intrapartum complications, anaesthetic complications and dissociative experiences during C-section were found to be the significant predictors for PTSD profile. CONCLUSION: This is the first study to show in parturients having a C-section that an anaesthesia complication is an independent risk factor for postpartum PTSD and PTSD profile development, in addition to known perinatal and maternal risk factors.

The type of competition modulates the ecophysiological response of grassland species to elevated CO2 and drought.

The effects of elevated CO2 and drought on ecophysiological parameters in grassland species have been examined, but few studies have investigated the effect of competition on those parameters under climate change conditions. The objective of this study was to determine the effect of elevated CO2 and drought on the response of plant water relations, gas exchange, chlorophyll a fluorescence and aboveground biomass in four grassland species, as well as to assess whether the type of competition modulates that response. Elevated CO2 in well-watered conditions increased aboveground biomass by augmenting CO2 assimilation. Drought reduced biomass by reducing CO2 assimilation rate via stomatal limitation and, when drought was more severe, also non-stomatal limitation. When plants were grown under the combined conditions of elevated CO2 and drought, drought limitation observed under ambient CO2 was reduced, permitting higher CO2 assimilation and consequently reducing the observed decrease in aboveground biomass. The response to climate change was species-specific and dependent on the type of competition. Thus, the response to elevated CO2 in well-watered grasses was higher in monoculture than in mixture, while it was higher in mixture compared to monoculture for forbs. On the other hand, forbs were more affected than grasses by drought in monoculture, while in mixture the negative effect of drought was higher in grasses than in forbs, due to a lower capacity to acquire water and mineral nutrients. These differences in species-level growth responses to CO2 and drought may lead to changes in the composition and biodiversity of the grassland plant community in future climate conditions.

Awareness in children: a secondary analysis of five cohort studies.

Five recent cohort studies have shown a frequency of awareness in paediatric anaesthesia of between 0.2% and 1.2%, but they were not individually large enough to identify risk factors. This study pooled raw data from these five studies to identify factors associated with awareness in children. The outcome of awareness was taken as the cases judged to be most likely awareness cases in each study. Logistic regression was used to identify awareness-associated factors. A combined sample of 4486 anaesthetics revealed 33 cases of awareness. Unadjusted analysis demonstrated weak evidence that nitrous oxide used as an anaesthetic maintenance adjunct was associated with awareness (OR 2.04 (95% CI 0.97-4.33), p=0.06), and some evidence that use of a tracheal tube was associated with awareness (OR 2.78 (95% CI 1.11-6.94), p=0.03). Multivariable regression analysis revealed that nitrous oxide maintenance and use of a tracheal tube were independently associated with awareness (nitrous oxide, OR 2.4 (95% CI 1.08-5.32), p=0.03; tracheal tube, OR 3.0 (95% CI 1.20-7.56), p=0.02).

Immunization of Bos taurus steers with Babesia bovis recombinant antigens MSA-1, MSA-2c and 12D3.

The purpose of this research was to evaluate the recombinant proteins MSA-1, MSA-2c and 12D3 as a combined immunogen for cattle. Fifteen steers were randomly assigned into three groups of five animals each (I, II and III). On day 0, cattle in group I were injected with 50 microg each of rMSA-1, rMSA-2c and r12D3 with the adjuvant Montanide 75; cattle in Group II received adjuvant-PBS, and Group III were untreated controls. On day 14, cattle in Group I received a second injection of the three recombinant proteins in adjuvant and cattle in Group II again received adjuvant alone. On day 28, all groups of cattle were challenged with a field strain of Babesia bovis. After challenge, the experimental cattle were clinically and serologically monitored. Three of the five steers immunized with the combined recombinant B. bovis proteins seroconverted on day 14 post-immunization (P.I.) and the maximum titre was 1 : 1600. All five immunized steers presented strong seropositivity to B. bovis antigens at day 21 P.I. The prepatent periods of vaccinated cattle were delayed until day 10 post-challenge exposure versus 8 and 7 days in Groups II and III, respectively. Cattle in all groups had fever above 41 degrees C; the reduction in packed cell volume was not significantly different (P > 0.05) in vaccinated group I compared with Groups II and III (29% versus 26% and 31%, respectively). Treatment was required for one steer in the control group. During the period of the study, the weight of cattle in Groups I and II increased an average of 9 and 7 kg, whereas the weight of the control cattle was reduced on average 4 kg. Immunization with rMSA-1-rMSA-2c-r12D3 proteins was not sufficient to prevent clinical symptoms against challenge, but the immunologic response was sufficient to protect steers against a mild virulent strain of B. bovis.

Does implicit memory during anaesthesia persist in children?

BACKGROUND: Recent studies suggest that implicit memory (especially perceptual implicit memory) persists during adequate general anaesthesia in adults. Studies in children, however, have failed to demonstrate implicit memory during general anaesthesia, possibly because of differences in methodological design. We therefore designed a prospective study with the aim of evaluating implicit memory in children undergoing general anaesthesia, using a perceptual memory test based on the mere exposure effect, previously tested in a control group. METHODS: Twelve infrequent neutral words were played 12 times in a random sequence via headphones to 36 children aged 8-12 yr during elective or emergency surgery. The children were not premedicated, and general anaesthesia was maintained with isoflurane. The word presentation started immediately after the surgical incision. Within 36 h after the stimulus presentation, the memory was assessed by using a forced-choice preference judgement task. Time constraint and word deterioration with a low-pass filter were used to prevent the subjects from utilizing intentional retrieval. The implicit memory score was obtained by calculating the proportion of target words preferred, which was compared with the chance level (0.5). RESULTS: The percentage of correct responses given by the children was comparable with the chance level. The memory score was mean (sd) 0.48 (0.16) (95% CI 0.43-0.53). CONCLUSIONS: The use of a perceptual implicit memory test based on the mere exposure procedure in children failed to reveal any evidence of implicit memory under general anaesthesia.

Intra-operative awareness in children and post-traumatic stress disorder.

Adults who experience intra-operative awareness can develop disturbing long-lasting after-effects, such as daytime anxiety, sleep disturbances, nightmares, flashbacks and, in the worst case, a post-traumatic stress disorder (PTSD). It is unknown whether intra-operative awareness has a similar psychological impact in children. We designed the present study in order to evaluate the incidence of psychological symptoms in children who had either confirmed or possible intra-operative awareness. Attempts were made to locate 11 children who had been identified in a previous study, approximately 1 year following their experience. A PTSD questionnaire was administered to the children and their parents in order to detect any long-term or short-term psychological symptoms (the 1-month postoperative data were evaluated retrospectively). Factors believed to be associated with PTSD, such as intra-operative perceptions, the children's temperament and cognitive strategies, and the parents' coping strategies, were also analysed. Seven children were successfully located and interviewed and no short or long-term psychological symptoms were identified. None of them offered negative appraisals of the traumatic event and none had displayed dysfunctional behaviour or cognitive strategies. Thus, none of them had developed a PTSD syndrome. In contrast with what has been reported in adults, these children claimed not to have experienced major pain, terror or helplessness during their surgery. Despite the small sample size, the results of the present study suggest that children suffer less psychological sequelae than adults following intra-operative awareness. This may be due to the fact that the children reported less frightening intra-operative sensations as compared with the adults, and had less understanding of the anaesthesia procedure, and this may have influenced their appraisal of their awareness and protected them from the full impact of this potentially traumatic experience.

Sedación: analgésia en endoscopía digestiva / Sedation: analgesia in gastrointestinal endoscopy

La sedación es la manipulación del estado cerebral por medios farmacológicos. Su utilización en procedimientos endoscópicos mejora la tolerancia del paciente y facilita la práctica del procedimiento al endoscopista. Todo esto implica que el uso de la sedoanalgesia sea cada vez más habitual durante las exploraciones endoscópicas. Por lo cual médicos encargados de realizar estos procedimientos debemos estar familiarizados con los fármacos utilizados en la sedación, sus antagonistas, las indicaciones y sus compl icaciones.

Utilidad de los predictores clásicos de severidad en pancreatitis aguda / Usefulness of the classic predictors of severity in acute pancreatitis

Objetivo. Evaluar la utilidad de las escalas tradicionales de Ranson, Glasgow, Apache II y Balthazar en la predicción de la severidad de la pancreatitis aguda. Métodos. De forma prospectiva en el servicio de Gastroenterología del HCAM analizamos una serie de casos, entre julio del 2005 y julio del 2006. Se incluyeron 135 de 138 pacientes con pancreatitis aguda, que cumplieron con los criterios de inclusión. Se obtuvo datos clínicos, estudios de laboratorio e imagen para establecer los valores de las escalas de Ranson, Glasgow, Apache 11 y Balthazar. Calculamos sensibilidad, especificidad, valor predictivo positivo (YPP), valor predictivo negativo (VPN) y Likelihood ratio (LR) de cada escala. Resultados. De los 135 pacientes, 101 (74.8%) presentaron PA leve y 34 (25.2%) PA grave. El valor promedio (OS) de las escalas evaluadas en los pacientes con PA leve versus grave fue: Ranson 2,64 (1,41) vs 4,6 (1 ,6); Glasgow 1,81 (1,17) vs 3,32 (1,42); Apache TI 6,84 (3,63) vs 11,82 (5,05); ISTC 1,63 (1,14) vs 7,47 (1,97). La sensibilidad, especificidad, YPP y VPN para cada escala fue: Ranson 76,5%, 72,2%, 48,1%, y 90,1%; Glasgow 70,6%, 72,3%, 46,2% y 87, 9%; Apache 11 82,3%, 57,4%, 39,4% y 90.6%; ISTC 79,4%, 100%, 100% y 93.5% respectivamente, Conclusión. Oe acuerdo a nuestros resultados en esta serie, el ISTC es la mejor escala para predecir la severidad de la PA. Tiene el inconveniente de la temporalidad, ya que se requiere esperar más de 48 horas, para la valoración real.

Intra-operative awareness in children: the value of an interview adapted to their cognitive abilities.

Intra-operative awareness in paediatric patients has been little studied for many years because of the difficulties in relying on children's testimony. Earlier questionnaires used to detect this complication were not adapted to children's language and memory capacities. By using a qualitative method, a semi-structured in-depth interview adapted to their cognitive abilities, we have now conducted a prospective evaluation of the incidence and risk factors for intra-operative awareness in children undergoing general anaesthesia. Data were obtained from interviews with 410 children (aged 6-16 years) which were conducted within 36 h of general anaesthesia for elective or emergency surgery. One month after surgery, 293 of these patients were interviewed again. Three independent adjudicators classified each potential case of awareness. We considered awareness to include both the 'confirmed awareness' and the 'possible awareness' cases. The accuracy of the children's recall was calculated. The relationship between their awareness and the anaesthesia management was examined. There were five cases of confirmed awareness, and six cases of possible awareness. The incidence of confirmed awareness was 1.2%, but when the possible cases were also considered, the overall incidence of this complication was as high as 2.7% (95% confidence interval, 1.4-5.0%). The only predictive factor identified was the multiple manoeuvres with which the airways were secured (odds ratio, 8.4; 95% confidence interval, 2.4-29.07%). The present study confirms the existence of intra-operative awareness in the paediatric population. The application of a semi-structured in-depth interview adapted to the cognitive capacities of the children appears to enhance the detection of awareness in this population.

Alteración de los Estudios de Conducción Nerviosa y su Relación con la Intensidad del Dolor en Pacientes con Neuropatía Diabética / Alteration of nervous conduction and its relation with pain intensity in polyneurophatic diabetic patients

Objetivo: Evaluar la intensidad del dolor en pacientes con neuropatía diabética y su relación, con la severidad del daño nervioso reportado en estudios de conducción nerviosa. Material y métodos: Se efectuó un estudio descriptivo y retrospectivo, de los pacientes que acudieron, en el periodo de enero del 2005 a Julio del 2006, a la consulta externa de la clínica del dolor, diagnosticados con polineuropatía diabética dolorosa en miembros pélvicos. Se consideraron a los expedientes de pacientes, que tuvieran al menos tres consultas y una evaluación clínica completa, con medición de la intensidad del dolor, mediante la escala visual análoga de once puntos (cero al diez) y sus cualidades. A los resultados obtenidos se le aplicaron medidas de tendencia central y de dispersión y pruebas de hipótesis (U de Mann - Whitney) para comparar los valores numéricos de la EVA respecto al grado de afección reportados por estudios de conducción nerviosa. Resultados: Se identificaron 108 casos, 78 de ellos contaban con estudios de conducción nerviosa, se consideraron para su análisis únicamente 39 expedientes por reunir los criterios establecidos. Se excluyeron el resto por tener además de polineuropatía diabética dolorosa otros diagnósticos (radiculopatía lumbosacra, neuropatías por atrapamiento, neuralgia postherpética agregada), o por no llenar los criterios establecidos. No se encontraron diferencias en las características demográficas. En cuanto al reporte neurofisiológico, los pacientes quedaron agrupados en los portadores de una afección leve a moderada y con afección severa, no encontrándose diferencias significativas entre estos; en ninguna de las tres evaluaciones. Los pacientes con afección severa reportaron una intensidad de dolor respecto a la EVA de 6.3 en comparación con los de afección leve y moderada que fue de 5.9 en la primera consulta. Conclusiones: En la muestra estudiada, se puede observar que no existe una relación directa entre la severidad del daño nervioso, reportado por los estudios de conducción nerviosa y la intensidad del dolor, en pacientes con polineuropatía diabética dolorosa de miembros podálicos. Sin embargo consideramos que esta herramienta es útil para corroborar el diagnostico, y se requieren de estudios controlados para concluir categóricamente sobre la falta de relación entre estas dos variables estudiadas (AU)

Objetive: To evalúate the intensity of pain in patients with diabetic neuropathy and its relation with the severity of nerve damage as reported in nerve conduction studies. Material and method: A descriptive and retrospective study in patients attending the pain clinic, from January 2005 to July 2006, with the diagnosis of painful diabetic neuropathy in the feet was carried out. Clinical records of patients attending at least three consecutive appointments and with a complete clinical evaluation were considered. Pain character was recorded and pain intensity was measured with a eleven points (0-10) visual analogue scale (VAS). The results obtained were evaluated with descriptive statistics and the hypothesis with Mann- Whitney U, to compare the numeric valúes of VAS with the severity of nerve damage reported in nerve conduction studies. Results: 108 cases were identified, 78 had nene conduction studies, 39 fulfilled all the criteria and were considered for evaluation. The rest were excluded due to the presence of further painful conditions (lumbosacral radiculopathy, entrapment neuropathies, postherpetic neuralgia) or because they did not fulfil the criteria. There were no differences in demographic characteristics. Depending on the neurophysiologic report, patients were divided in two groups depending on whether the affection was mild-moderate or severe. No significant differences between the groups were found in any of the three evaluations. Levéis of pain were very similar in patients with a severe affection (VAS 6.3) and those with a mild-moderate affection (VAS 5.9) in the first appointment. Conclusions In this sample of patients with painful diabetic polineuropathy of the feet, a relationship between the severity of nerve damage as shown in nerve conduction studies and the intensity of pain measured with a VAS was not found. However, they still are important as a diagnostic tool and further controlled studies are required to reach a consistent conclusión (AU)

Personality in patients with migraine evaluated with the "Temperament and Character Inventory".

The objective of this study was to assess the personality profile of a sample of Mexican patients with migraine using the Temperament and Character Inventory (TCI). A cross-sectional study was performed including adult migraine patients identified from the outpatient neurology clinics of two large teaching hospitals in Mexico City. Patients were asked to voluntarily participate in the study. A physician conducted a standardised diagnostic interview adhering to the criteria of the International Headache Society (IHS). Patients were interviewed and administered the TCI. We used two healthy controls groups and a third group of non-migraine pain controls. One hundred and fortytwo subjects with migraine, 108 healthy blood donors, 269 young healthy controls and 30 patients with non-migraine pain (NMP) were included in the study. Patients with migraine had higher scores in the dimension harm avoidance (HA) and all its sub-dimensions (p<0.05) than healthy patients. Patients with non-migraine pain had high scores in HA and low scores in novelty seeking, self-directedness and cooperativeness. Blood donors had high scores in the following subdimensions: HA1, HA4 and C3 (Cooperativeness). Personality features consistent with migraine are avoidance, rigidity, reserve and obsessivity. Our study shows that patients with chronic pain share some of the personality features of patients with migraine but their TCI profile could be indicative of cluster C avoidant personality. Blood donors were shown to have more energy, with a tendency to help other people and be more optimistic. The results support serotoninergic involvement as explaining the physiopathology of migraine.

Comparacion entre la tecnica de capilaridad y la biopsia aspiracion con aguja fina (BACAF) en nodulos de tiroides / Comparison between capillary technique and fine-needle aspiration biopsy (BACAF) in thyroid nodules

La biopsia aspiración con aguja fina de tiroides es el examen de elección en los nódulos tiroideos. Se realizó un estudio en el cual se comparó la técnica de capilaridad con la biopsia por aspiración con aguja fina (BACAF) en lesiones de tiroides.Se efectuaron en total 50 biopsias de tiroides. Sc encontró que los resultados de los extendidos citológicos preparados para cada método fueron comparables en calidad, cantidad y rendimiento diagnóstico. Las dos técnicas tuvieron una adecuada eficacia diagnóstica. Se concluyó que la capilaridad es un excelente método diagnóstico y combinado con el bacaf mejora la sensibilidad diagnóstica.

The thyroid Fine-Needle Aspiration Biopsy is the test of choice for thyroid nodules. We carried out a study to compare the Capillarity technique versus Fine-Needle Aspiration Biopsy (FNAB) in thyroid lesions. We performed 50 thyroid biopsies. We found that the results of the cytology smears prepared for cach technique were comparable in qualit, amount and diagnostic reward. Both techniques had an adequate diagnostic efficacy. We concluded that capillarity, is an excellent diagnostic method and combined with FNAB improves the diagnostic sensitivity.

[Ultrasonography in diagnosis and monitoring the progress of dissection of cervicocerebral arteries]. / La ecografía en el diagnóstico y control evolutivo de las disecciones de arterias cervicocerebrales.

INTRODUCTION: Ultrasonography has become part of the arsenal of diagnostic methods available for examining the dissection of cerebral blood vessels (DCV). AIMS: To analyse the value of ultrasonography in the diagnosis and monitoring of DCV. PATIENTS AND METHODS: We conducted a consecutive study of 67 patients with a history and clinical picture compatible with DCV; all of them had been given confirmation of their diagnosis by another reference method (digital angiography or MR angiography) during the 48 hours prior to or following the ultrasound study. The ultrasonography was carried out on the neck and skull as per the usual system using continuous Doppler, neck duplex and transcranial Doppler ultrasonography. Diagnosis of the dissection was based on direct and indirect signs, in the absence of an atheroma plaque. The following were considered to be direct signs: haematoma in the wall of the vessel, flap, local increase in the flow velocity and echograms with split systole. Indirect signs were: haemodynamic alterations proximal to the dissection, a pattern of slow flow and high resistance. The transcranial Doppler showed the findings lying distal to the dissection to be a lowered mean velocity and pulsatility. RESULTS: The ultrasonography of the series revealed direct signs in 46 patients (69%) and indirect signs in 21 (31%). Ultrasonography was used as the primary diagnostic method in 29 (43%) patients; in the other 38 (57%) it was employed to verify the diagnosis or for the follow up. All the ultrasound diagnoses were confirmed using digital angiography (21 cases) or magnetic resonance angiography (46 cases). CONCLUSIONS: Due to its harmlessness, ultrasonography should be the first examination used to establish a probable diagnosis of DCV.

La ecografía en el diagnóstico y el control evolutivo de las disecciones de las arterias cervicocerebrales / Ultrasonography in diagnosis and monitoring of dissection of cervicocerebral arteries

Introducción. La ecografía se ha incorporado al arsenal de métodos diagnósticos disponibles para el examen de la disección de vasos cerebrales (DVC). Objetivo. Analizar la utilidad de la ecografía en el diagnóstico y el seguimiento de la DVC. Pacientes y métodos. Estudio consecutivo de 67 pacientes con antecedentes y clínica compatibles con DVC, que dentro de las 48 horas previas o posteriores al estudio ecográfico tuvieron confirmación diagnóstica con otro método de referencia -angiografía digital o angiorresonancia magnética-. La ecografía se realizó en el cuello y cráneo según la sistemática habitual, mediante estudio Doppler continuo, dúplex de cuello y estudio Doppler transcraneal. El diagnóstico de disección se basó en signos directos e indirectos, en ausencia de placas de ateroma. Se consideraron signos directos: hematoma de la pared del vaso, flap, aumento localizado de la velocidad del flujo y ecogramas con sístole bífida; como signos indirectos: alteraciones hemodinámicas proximales a la disección y patrón de flujo de baja velocidad y alta resistencia. En el estudio Doppler transcraneal se apreciaron los hallazgos distales a la disección: disminución de la velocidad media y pulsatilidad. Resultados. La ecografía de la serie reveló signos directos en 46 pacientes (69 por ciento) e indirectos en 21 (31 por ciento). La ecografía se empleó como método primario de diagnóstico en 29 (43 por ciento) pacientes; en los 38 (57 por ciento) restantes, para verificar el diagnóstico o para el seguimiento. Todos los diagnósticos ecográficos se confirmaron mediante angiografía digital (21 casos) o angiorresonancia magnética (46 casos). Conclusiones. Por su inocuidad y fiabilidad, la ecografía debería constituir el primer examen para establecer un diagnóstico presuntivo de DVC (AU)

Introduction. Ultrasonography has become part of the arsenal of diagnostic methods available for examining the dissection of cerebral blood vessels (DCV). Aims. To analyse the value of ultrasonography in the diagnosis and monitoring of DCV. Patients and methods. We conducted a consecutive study of 67 patients with a history and clinical manifestations compatible with DCV; all of them were given confirmation of their diagnosis by another reference method (digital angiography or MR angiography) during the 48 hours prior to or following the ultrasound study. The ultrasonography was carried out on the neck and skull as per the usual system using continuous Doppler, neck duplex and transcranial Doppler ultrasonography. Ultrasound diagnosis of the dissection was based on direct and indirect signs, in the absence of an atheroma plaque. The following were considered to be direct signs: haematoma in the wall of the vessel, flap, local increase in flow velocity and echograms with split systole. Indirect signs were: haemodynamic alterations proximal to the dissection, a pattern of slow flow and high resistance. Transcranial Doppler showed the findings lying distal to the dissection to be a lowered mean velocity and pulsatility. Results. The ultrasonography of the series revealed direct signs in 46 patients (69%) and indirect signs in 21 (31%). Ultrasonography was used as the primary diagnostic method in 29 (43%) patients; in the other 38 (57%) it was employed to verify the diagnosis or for the follow-up. All the ultrasound diagnoses were confirmed using digital angiography (21 cases) or magnetic resonance angiography (46 cases). Conclusions. Due to its harmlessness, ultrasonography may be the first examination used to establish a probable diagnosis of DVC (AU)

Manejo anestésico para el trasplante de páncreas: experiencia de cinco casos / Anesthetic management for pancreatic transplantation: the initial experience

El trasplante de páncreas, es la única forma terapéutica que consigue la normalización de la glucos y que libera al enfermo diabético tipo I del tratamiento insulínico. En un periodo de cuatro años se hace una revisión retrospectiva de la expereincia de trasplantes de páncreas en sus diferentes modalidades. En el presente artículo se describen cinco casos y se discuten los aspectos fundamentales del manejo perioperatorio y transanestésico que representa en la actualidad un verdadero desafío para el anestesiólogo