Compression Behavior of Hybrid Tubes for Lightweight Steel Structures.

This research shows the results of an experimental investigation carried out on the compression behavior of hybrid steel tubes formed by two concentric steel tubes and four different fillers of non-metallic material interposed between both tubes: polyurethane foam, polyurethane, epoxy and a cement-based mortar. The tests show that the incorporation of a resistant filler in the double tube allows it to improve its mechanical behavior by allowing a second load cycle. Furthermore, the strain energy absorbed during the two cycles led to the conclusion that the epoxy-filled tube absorbed more energy per unit of weight than the other resistant fillers.

Where and when should natural killer cells be tested in women with repeated implantation failure?

The aim of this study was to identify the candidates for natural killer (NK) testing and to define the best methodology. For this purpose a prospective study was performed on 73 women with repeated implantation failure (RIF). RIF was considered to exist in patients not achieving clinical pregnancy after three transfers with at least one good-quality embryo. Idiopathic RIF was considered to exist in patients in whom thrombophilia, hysteroscopy and endometrial culture were normal, and no chromosomal factor was suspected. Thirty-two of the 73 patients were considered to have idiopathic RIF, and 17 fertile women with children were taken as controls. Immunohistochemical staining for endometrial CD56+ and blood CD56+ or CD16+ NK cells measured using flow cytometry were compared during the mid-luteal phase in both patients and controls. Seventeen out of the 32 patients with idiopathic RIF and only one of the controls had >250 CD56 cells per high power field 400× in endometrial biopsy (p<0.001). The percentage of blood NK cells out of the total lymphocyte population was higher in women with idiopathic RIF (13.4±1.2%; range, 2.63-29.01) than in controls (8.4±0.7%; range, 5.72-13.28; p=0.026). There was a positive correlation between blood and endometrial CD56 cells (ρ=0.707; p<0.001). No significant differences were found between patients with other types of RIF and controls. This study suggested that testing for NK cells might be useful in women with idiopathic RIF during the mid-luteal phase.

Calidad de los resultados de la enseñanza de la medicina: percepción de la profesión / Quality of the results of the medical education: perception of the profession

No disponible

Renal angiomyolipoma during pregnancy: review of the literature.

The incidence of renal angiomyolipoma (RA) is 0.3% in the general population, and even more infrequent during pregnancy. Pregnancy can increase the risk of rupture, although the causal mechanism is still not clearly defined. We completed a Medline literature search for articles on RA and pregnancy and its complications. We identified 16 articles (all case reports), but selected only 13 because of unavailable data in the 3 other articles. We report the case of a 30-year-old primiparous woman who presented at the emergency ward with a non-reassuring pattern at fetal monitoring; an urgent cesarean section was decided and carried out. After surgery, a wide retroperitoneal hematoma was observed caused by the rupture of an RA. Conservative management by means of arterial embolism was done and the patient was discharged on postoperative day 10. RAs seem to have a higher risk of rupture during pregnancy, but they should be managed conservatively when hemodynamically possible. Individualization of each case is necessary in order to achieve the best outcome for both the mother and fetus.

[Sonographic ovarian vascularization and volume in women with polycystic ovary syndrome treated with clomiphene citrate and metformin]. / Vascularización y volumen ovárico ecográfico en mujeres con síndrome de ovario poliquístico tratadas con citrato de clomifeno y metformina.

OBJECTIVE: To measure the vascularization and ovarian volume with three-dimensional sonography in patients diagnosed of polycystic ovary syndrome with stimulated ovulation treatment, and to analyse the differences between the patients treated with clomiphen citrate versus clomiphen citrate and metformin. MATERIAL AND METHOD: Therty patients were studied. Twenty ovulation cycles were obtained with clomiphen citrate and 17 with clomiphen citrate plus merformin (added in case of obesity or hyperglucemy/hyperinsulinemia). Ovarian volumes and vascular indexes were studied with 3D-sonography and results were analysed by treatment. RESULTS: There were no statistical differences of ovarian volume by treatment along the cycles, although bigger volume were found in ovulatory cycles compared to non-ovulatory ones (20,36 versus 13,89 ml, p = 0,026). No statistical differences were also found concerning vascular indexes, neither by treatment nor by the obtention of ovulation in the cycle. CONCLUSIONS: Ovarian volume and vascular indexes measured with three-dimensional sonography in patients diagnosed of polycystic ovary syndrome do not show differents values in patients treated with clomiphen citrate alone versus clomiphen citrate plus metformin.

[Reproducibility of the fetal nasal bone measurement by means of bidimensional and three-dimensional ecography during the second trimester of the pregnancy]. / Reproducibilidad de la medición del hueso nasal fetal mediante ecografía bidimensional y tridimensional durante el segundo trimestre del embarazo.

AIMS: The utility of the valuation-measurement of the nasal bone in the prognosis of chromosomopaties during the second trimester of the pregnancy is demonstrated. OBJECTIVE: To evaluate the repeatability of nasal bone measurement during second trimester with bidimensional and three-dimensional sonography. MATERIAL AND METHOD: Nasal bone was measured in 50 single pregnancies. First observer carried out two measures of nasal bone with bidimensional sonography, and 1 measure with three-dimensional sonography. Second observer carried out just one measure with bidimensional sonography (2D) and just another one with three-dimensional sonography (3D). We studied the intraobserver variability with 2D sonography, and the interobserver variability with 2D and 3D sonography. RESULTS: 2D-sonography: nasal bone measurement showed excellent intraobserver correlation with a correlation coefficient of 0,87 (CI 95%: 0,78-0,93) and a little means difference of 0,18 (SD: 0,74). Indeed, there was a good interobserver correlation with a correlation coefficient of 0,92 (CI 95%: 0,85-0,95), and a means difference of 0,14 (SD: 0,56). 3D-sonography: there was a acceptable interobserver correlation with correlation coefficient of 0,70 (CI 95%: 0,52-0,82). CONCLUSION: Nasal bone measurement is highly reproducible by means of bidimensional sonography while using three-dimensional sonography, the results are just acceptable.

Cribado combinado del síndrome de Down: validación del riesgo estimado por Fetaltest / Combined screening of Down syndrome: validation of the risk estimated by Fetaltest

Objetivo: Validar empíricamente el riesgo de síndrome de Down estimado por Fetaltest usando marcadores bioquímicos del primer trimestre (la proteína A asociada al embarazo [PAPP-A] y subunidad beta libre de la gonadotropina coriónica humana [HCG]) y translucencia nucal (TN). Material y métodos: Estudio retrospectivo de los 15.009 cribados combinados del primer trimestre, incluidos en la base de datos mantenida prospectivamente por el estudio multicéntrico Fetaltest, y finalizados antes de 31 de diciembre de 2007. El estudio incluye 39 casos de síndrome de Down detectados pre o posnatalmente y usó un método de análisis previamente establecido. Resultados: La correlación entre el riesgo predicho y la prevalencia observada de síndrome de Down fue muy alta (r = 0,999967). Conclusiones: El riesgo estimado por el sistema de cálculo de Fetaltest concuerda muy fielmente con la prevalencia de síndrome de Down observada, por lo que este sistema de cálculo es válido y puede usarse con tranquilidad en la atención de gestantes de nuestro entorno (AU)

Objective: To validate empirically the risk for Down syndrome estimated by Fetaltest using biochemical markers in the first trimester (PAPP-A and free beta subunit of hCG) and nuchal translucency. Material and methods: We performed a retrospective study of the data from 15,009 pregnant women screened for Down Syndrome in the first trimester, included in the database prospectively maintained by the Fetaltest multicenter study, and completed before December 31, 2007. The study included 39 cases of Down syndrome detected either prenatally or postnatally, and used a previously established analysis method. Results: The correlation between predicted risk and the observed prevalence of Down syndrome was very high (r = 0.999967). Conclusions: The risk estimated by Fetaltest agrees closely with the observed prevalence of Down syndrome. Therefore, this calculation system is valid and can be used with confidence when counseling pregnant women in our environment (AU)

Pneumomediastinum during the fourth stage of labor.

Postpartum spontaneous pneumomediastinum (Hamman's syndrome) is a very rare event with an estimated incidence of 1 in 100,000 deliveries. It occurs mainly in the second stage of labor and is potentially lethal. We report the case of a 29-year-old primiparous woman during the immediate puerperium (Leff's fourth stage of labor) presenting with acute chest pain, dyspnea and petechiae. She was admitted to the intensive care unit with a suspected diagnosis of amniotic fluid embolism. A chest radiograph revealed a pneumomediastinum that finally resolved with oxygen therapy and supportive management in 3 days.

[Urogenital prolapse repair using polypropylene mesh]. / Reparación del prolapso urogenital con malla de polipropileno.

BACKGROUND: Urogenital prolapse is a condition that affects 1 to 43% of post-hysterectomized patients. Since several years some synthetic meshes have been used to repair pelvic floor, and apparently they have advantages over them predecessors. OBJECTIVE: To evaluate the efficacy and security of polypropylene meshes in the repair of urogenital prolapse. MATERIAL AND METHOD: Retrospective and non-randomized study in 106 patients that had different kinds of urogenital prolapse repaired using polypropylene meshes. The follow-up was carried out by two visits to the hospital, 2 and 6 months after surgery. The variables analyzed were age, parity, menopause presence, kind of surgical technique, surgical time, time at hospital and complications. Afterwards, the information was analyzed descriptively. RESULTS: Average age was 64.4 years. The rate of multiparity and menopause women was 91.51% and 92.45% respectively. The most used surgical technique was the anterior mesh with tension-free band (34,90%) to repair the associated urinary incontinence. The rate of intraoperatory complications was 2.8%, immediate complications was 37.7% and late complications was 21.6%. The success rate after 6 months was 80 to 100%, depending on the technique. CONCLUSIONS: There is a low rate of intraoperatory and medium-term complications in the reconstructive surgery of pelvic floor for the urogenital prolapses using polypropylene meshes, which makes this technique a secure and effective option for the treatment of this problem.

Three-dimensional ultrasonography and power Doppler in ovarian cancer screening of asymptomatic peri- and postmenopausal women.

AIM: To determine whether introducing three-dimensional (3D) ultrasonography with power Doppler facilities as a secondary screening test, preceded by annual transvaginal grayscale ultrasonography (TVUS) (followed by transvaginal color Doppler (TVCD) in selected cases) as a primary screening test for ovarian cancer improves the accuracy of ovarian cancer screening studies. METHODS: Annual TVUS was performed on 3,201 peri- and postmenopausal asymptomatic women aged > or =50 years from March 1, 2001 to June 30, 2003. Cystic ovarian lesions in perimenopausal women were routinely reevaluated by TVUS and TVCD at 4-6 week intervals to avoid unnecessary surgical intervention for physiological cysts. Any multiloculated, complex or solid ovarian mass, as well as persistently cystic mass >5 cm in diameter, in which the echo architecture and/or blood flow pattern was not highly suggestive of a benign histology, was categorized malignant. In these cases, TVUS and TVCD findings were obtained in no more than 2 weeks and supplemented by secondary screening, including 3D ultrasonography, and 3D power Doppler, in combination with serum CA 125 determination. After detailed ultrasonographic examination, surgical removal of the tumor and pathohistological classification were completed. RESULTS: Twenty-five patients (0.8%) with persisting ultrasonographic abnormalities after primary and secondary screening underwent surgery to remove the ovarian tumor. Five epithelial ovarian cancers were detected: 3 stage IA, 1 stage IB, and 1 stage IC. Three stage I patients had a palpable abnormality on clinical examination. Furthermore, in three patients with stage I disease, CA 125 serum value was elevated (> or =35 U/mL). Three-dimensional ultrasonography and power Doppler, as well as TVUS findings were indicative of malignancy in all 5 patients with stage I ovarian cancer, whereas TVCD finding was false-negative in 2 patients with stage I disease. Screening test (primary+secondary screening) had the sensitivity of 100%, specificity of 99.4%, positive predictive value of 20%, and negative predictive value of 100%. CONCLUSION: Application of 3D ultrasonography and power Doppler imaging in patients with "positive" standard ultrasound tests (annual TVUS, followed by TVCD in selected cases) represents a novel approach for the early and accurate detection of ovarian cancer through screening.

Epidemiología del cáncer renal en el Hospital Regional Lic. Adolfo López Mateos / Epidemiology of renal cancer in the Hospital Regional Lic. Adolfo López Mateos

Estudio retrospectivo de tipo epidemiológico en el que se incluyen 12 pacientes a quienes entre noviembre de 1985 y noviembre de 1990 se les efectuó nefractomía, diagnostiandose histopatológicamente cáncer renal; nueve pacientes se encontraron entre el sexto y séptimo decenios de la vida (75 porciento). La relación hombre-mujer fue de 2:1 respectivamente. El síntoma más frecuentemente encontrado fue hematuria macroscópica en nueve pacientes (75 porciento), en cuatro cólico renoureteral del lado de la tumoración (33 porciento), en tres tumoración abdominal palpable (25 porciento), en dos por cada signo y síntoma tuvieron dolor, pérdida de peso mayor de 8 kg y fiebre (16 porciento cada uno), uno refería sudoración nocturna y otro cuadros intestinales obstructivos. El tiempo desde el inicio de los síntomas hasta el tratamiento quirúrgico fue de uno a 15 meses. Once de ellos tuvieron el diagnóstico prequirúrgico de tumoración renal y uno de ellos de tumoración abdominal basados en los estudios de gabinete, aunque en general hubo hipoestadificación. No hubo correlación entre la supervivencia y el tipo histológico, así como la nefrectomía radical completa que se efectuó en cinco sujetos. cuatro de los cinco individuos muertos, fallecieron por metástasis, siendo los órganos más afectados el pulmón y el hígado en 60 y 40 porciento respectivamente. Los siete pacientes vivos tienen seguimiento entre nueve y 52 meses, dos de ellos tienen metástasis al pulmón. La reacción a la medroxiprogesterona fue equiparable a los informes de la literatura mundial.