Development of the Spanish version of the Systematized Nomenclature of Medicine: methodology and main issues.

This presentation features linguistic and terminology management issues related to the development of the Spanish version of the Systematized Nomenclature of Medicine (SNOMED). It aims at describing the aspects of translating and the difficulties encountered in delivering a natural and consistent medical nomenclature. Bunge's three-layered model is referenced to analyze the sequence of symbolic concept representations. It further explains how a communicative translation based on a concept-to-concept approach was used to achieve the highest level of flawlessness and naturalness for the Spanish rendition of SNOMED. Translation procedures and techniques are described and exemplified. Both the computer-aided and human translation methods are portrayed. The scientific and translation team tasks are detailed, with focus on Newmark's four-level principle for the translation process, extended with a fifth further level relevant to the ontology to control the consistency of the typology of concepts. Finally the convenience for a common methodology to develop non-English versions of SNOMED is suggested.

Endovascular treatment of a spinal intrathecal giant arteriovenous fistula in a 3-year-old child.

A 3-year-old child with a spinal cord direct arteriovenous fistula successfully treated by endovascular occlusion is presented. Intradural direct arteriovenous fistulae are the most infrequent variety of spinal arteriovenous malformations, although they are not properly identified as such in many published series. Whereas the exact mechanism by which they produce symptoms remains an unresolved issue--steal through fistula or compression by giant venous varices--the evolution of our case, with amelioration after partial occlusion, favors the former. Surgical resection of the thrombosed venous varix was not necessary. Endovascular occlusion proved to be a safe and effective form of treatment in this case of spinal intradural direct arteriovenous fistula, no additional treatment being necessary thereafter.

Urinary estradiol-17-beta-glucuronide assay for gonadotropin therapy.

To investigate the possibility of using urinary estradiol-17 beta-glucuronide (E2-17G) measured by direct radioimmunoassay to monitor ovulation induction with human menopausal gonadotropin (hMG), serum estrogen and urinary E2-17G levels were determined daily by 21 women treated with hMG for a total of 32 treatment cycles. Urinary E2-17G was measured in 24-hour and overnight specimens. A significant correlation was found between serum estrogens (primarily estradiol) measured by radioimmunoassay without preceding chromatography and urinary E2-17G excretion measured at 24 hours and overnight. The correlation was not significantly improved by correcting the 24-hour and overnight urinary E2-17G excretion levels with creatinine measurements. Although there was significant correlation between serum estrogens and urinary E2-17G measured by direct radioimmunoassay, the urinary E2-17G concentrations observed when serum estrogens levels indicated preovulatory follicle maturation (ie, at serum estrogens levels between 500 and 1000 pg/ml) varied so much that a clinical decision to trigger or not to trigger ovulation with human chorionic gonadotropin could not be reached in each case. These data indicate that significant correlation is not the only prerequisite for a new method to replace a proved procedure. Further studies are required to determine the reliability of monitoring hMG therapy with direct E2-17G radioimmunoassays in overnight urine collections.

Hysteroscopic management of intrauterine adhesions.

Sixty-six patients who had the presumptive diagnosis of Asherman's syndrome underwent hysteroscopic evaluation and treatment. In 65 patients, hysteroscopy was performed on an outpatient basis under local anesthesia. In all but five patients, complete lysis of adhesions was accomplished during the initial hysteroscopy. Uterine perforation occurred in two of the 66 patients. The extent of the intrauterine adhesions correlated with the patients' presenting menstrual patterns, but not with prior hysterosalpingography. Of the patients who have completed surgical and hormonal therapy, 98 per cent have normal spontaneous menses. Follow-up examination of the endometrial cavity was normal in 32 of 34 patients. Seven of ten patients who wished to conceive and who had no other infertility factors have done so. The pregnancies have been uncomplicated. Hysteroscopy is the method of choice to diagnose, classify, treat, and follow-up patients with Asherman's syndrome.