A community-based intervention study involving family gardens with aromatic herbs on changes in dietary and urinary sodium.

OBJECTIVE: To measure dietary and urinary changes in sodium (Na) intake and excretion through the implementation of family gardens with aromatic herbs and workshops for cooking, using the herbs as a substitute for salt and seasoning powder. METHODS: Thirty-five participants from a neighborhood of Mexico City were included. A general questionnaire was administered to collect information on sociodemographic factors. At baseline and 3 months later, a dietary evaluation was conducted, and 24-hour urine samples were collected. Food items reported were classified according to the NOVA classification. Visits to participants´ houses were conducted to measure the amount of salt and seasoning powder added to food during the preparation of meals as well as a home food inventory. All participants were given a family garden with 6 aromatic herbs and a recipe book. The intervention included 7 cooking and 3 garden care workshops. Qualitative information on the experience was also collected. Linear regression models were run in order to estimate the contribution of each NOVA group, salt, and seasoning powder to total dietary Na intake. RESULTS: Participants were 44 years old on average and were mainly women (91.4%). The participation compliance in the workshops was 69.5%. After 3 months, there was a Na intake mean reduction of 976 mg. There was also a reduction in the excreted urinary Na of 325 mg per day. CONCLUSION: A positive level of involvement in this program had a direct influence on dietary habits to lower Na consumption.

Severe head injury combined with orthopedic and vascular trauma of the limbs.

From 1982 to 1992, 2766 brain injury patients were admitted to the University Hospital San Cecilio of Granada, Spain. In 873 cases head injury was concomitant with other injuries but the association of severe head injury and combined orthopedic and vascular trauma of the limbs was observed only in 23 cases (incidence 2%). Thirteen patients were scheduled for revascularization, and of these secondary amputation was mandatory in two cases to keep rising intracranial pressure under control. Except for epidural hematomas which constitute an absolute neurosurgical emergency, combined orthopedic and vascular trauma of the limbs can be treated before head injury. However, we prefer to work with two operating teams simultaneously. Physical examination and judicious arteriography provide means for prompt diagnosis and treatment of the injured limb. The compartment syndrome should be anticipated and fasciotomy should be used routinely. Vascular repairs normally using reverse autogenous vein are the first priority, but we must always bear in mind the deleterious effects of the revascularization syndrome which expose the brain to a second aggression, and amputation, when necessary, should be undertaken to reduce mortality.

[A superior vena cava syndrome secondary to a pleural fibrous mesothelioma]. / Síndrome de cava superior secundario a mesotelioma fibroso pleural.

Benign fibrous or pleural mesothelioma are rare tumors that seem to originate in the mesenchyma (subpleural fibromas). They are usually discovered by chance and the prognosis for the patient is favorable after surgery. If the tumors are large, extrapulmonary signs may be present (hypertrophic osteoarthropathy, hypoglycemia). We describe a case of unusually large fibrous mesothelioma of the pleura that presented as superior vena cava syndrome, a complication not described in the literature.

Comparison of the effects of volume resuscitation with Dextran 60 vs. Ringer's lactate on central hemodynamics, regional blood flow, pulmonary function, and blood composition during hyperdynamic endotoxemia.

In hyperdynamic porcine endotoxemia the pulmonary as well as macro-and microcirculatory effects of volume substitution using 6% Dextran 60 (DX) vs. Ringer's lactate (RL) were analyzed. Endotoxemia was induced by continuous i.v. infusion of S. abortus equi endotoxin over 3.5 hr. Pulmonary capillary wedge pressure (PCWP) was maintained by titrated infusion of either DX (n = 6) or RL (n = 6). Regional blood flow was analyzed in 290 samples from 12 organs by means of the radioactive microspheres technique (diameter 15 microns). Lung function was impaired in both groups, as reflected by an increase of airway resistance and a decrease of O2 index. More than three times the volume of RL had to be substituted as compared to DX for maintenance of left ventricular filling pressure: cardiac output, however, remained higher with DX treatment (P < 0.05). In both groups, blood flow to the spleen decreased, while liver blood flow (hepatic artery) increased (P < 0.05); cerebral blood flow remained unchanged. In contrast, blood flow to kidneys, gastric mucosa, and intestine was preserved at significantly higher values upon treatment with DX as compared to RL (P < 0.05). It is concluded that volume replacement with 6% Dextran 60 sufficient to maintain stable left ventricular filling pressure is superior to Ringer's lactate infusion in acute endotoxemia; it effectively restores intravascular volume at constant plasma colloid osmotic pressure and--together with its positive rheological properties--favors high cardiac output and high nutritional blood flow.

[Double primary pulmonary neoplasms: epidermoid and oat cell pulmonary carcinoma with metachronous presentation]. / Doble neoplasia pulmonary primitiva: carcinoma epidermoide y oat-cell pulmonar de presentación metacrónica.

The finding of a double primitive pulmonary neoplasm in the same patient is a fact rarely published, between 0.5 and 3.5% depending on the series, most of them surgical or necropsies series. We present the case of a patient who after being diagnosed of bronchial epidermoid carcinoma and treated with radiotherapy, developed, one year later, a relapsing homolateral pleural effusion due to an oat-cell type carcinoma. We review the incidence of this association in the scientific literature, outlining the difficulty to establish the diagnosis in patients non treated with radical surgery.

Efficacy of oral streptokinase-streptodornase in the treatment of ankle sprains.

To evaluate the analgesic and antiinflammatory properties of oral streptokinase-streptodornase (SS) in cases of minor trauma, 190 patients with ankle sprains were studied. Subjects were randomly given an active drug or a placebo in doses of two tablets three times a day for eight days. A scoring system was used to rate the following symptoms: spontaneous pain, mobilization pain, wearing pain, articular disability, flaccidity, muscular spasm, edema, and hematoma. Each symptom was categorized as none (0), mild (1), moderate (3), or severe (4). Patients were evaluated at the beginning of the study and on the fourth and eighth days of treatment. At the end of the trial, the decrease in each symptom score was significantly greater in patients receiving SS than in patients receiving a placebo. Analgesic intake during the study was also noticeably lower in the SS group. The incidence of drug-induced side effects (mainly abdominal discomfort) was minimal. Oral SS ameliorates the inflammatory symptoms associated with ankle sprains and therefore may be used as an alternative to nonsteroidal antiinflammatory drugs.

Redistribution of intraorgan blood flow in acute, hyperdynamic porcine endotoxemia.

In a standardized porcine model of acute, hyperdynamic endotoxemia the distribution of intraorgan blood flow within heart, kidney and brain was analyzed. Twelve pigs received either short-term (23 min) or long-term (205 min) continuous intravenous infusion of endotoxin (Salmonella abortus equi). A high cardiac output/low peripheral resistance state was maintained throughout the 3.5 h observation period. Total organ blood flow in heart, kidney and brain remained high; however, already small amounts of endotoxin provoked a significant redistribution of intraorgan blood flow within the left ventricle and the kidney. These characteristic alterations were absent in a control group of 5 animals subjected to the same protocol, but receiving 0.9% saline instead of endotoxin. Deterioration of respiratory function developed exclusively after continuous intravenous endotoxin infusion over 205 min, indicating incipient organ failure. Using electron microscopy, endothelial cells swelling and entrapment of blood cells in capillaries of the midmyocardium as well as severe ultrastructural damage in the kidney could be demonstrated already after 90 min of endotoxemia in two additional animals. It is concluded that already in the initial phase of acute endotoxemia, in the presence of high cardiac output and high global organ blood flow microcirculatory deterioration and organ failure develops. As small amounts of endotoxin are capable of inducing these alterations, earliest possible diagnosis of endotoxemia should be achieved in critically ill patients.

[Thovara inguinal hernia operation. Results of follow-up in adults]. / Leistenbruchoperationen nach Thovara. Nachuntersuchungsergebnisse bei Erwachsenen.

A new procedure for inguinal hernia operations is described: the Thovara method, which is really a modified version of the plastic technique by Bassini-Kirschner-Lichtenstein. From 1985-1986 167 patients were operated on for inguinal hernia in our University Hospital, using this hernia plastic technique with a tension-free mesh. Though the rate of early complications is good, we should mention that there were 19 cases of testicle swelling. The number of early and late recurrences were very low: 2 cases (1.2%). Hospitalization averaged from 2 to 4 days. The procedure is easy to perform and almost painless.

[Echinococcosis of the spleen. Its conservative surgical treatment]. / Milzechinokokkose. Ihre konservative chirurgische Behandlung.

Echinococcosis cysts in the spleen are very rare, even in endemic areas. We report here on 4 patients (0.5% of the total number of cases of echinococcosis disease) who have been treated in the University Hospital Granada from 1970 to 1990. Formerly, splenectomy was for most surgeons the recommended surgical procedure. From 1980, however, most authors have rejected such a radical procedure and most now recommend conservative surgery of the spleen. We have always followed this conservative procedure, as of course in cases of liver echinococcus, that is: cyst enucleation and marcupialisation (Posadas-Dew method), if there are no cyst complications. And in cases of infected or suppurating cysts we used drainage-marsupialisation. We have obtained very good results: no mortality was recorded.

[Treatment of distal venous thrombosis of the lower extremity with "moderated" doses of heparin]. / Tratamiento de las trombosis venosas distales de la extremidad inferior con dosis "moderadas" de heparina.

The effectiveness of a therapeutic protocol, using 15,000 to 22,500 IU/day of heparin by subcutaneous injection, to treat the distal postoperative vein thrombosis on the lower limb, was evaluated. The study was made on 427 patients, which were analyzed by the Fibrinogen I125 marked accumulation test, to give an early diagnostic and follow-up of their thrombosis (thrombus lysis, stabilization or expansion). Treatment made, showed its efficacy preventing from proximal expansion, as well as avoiding pulmonary embolism and postphlebitic syndrome. Its cost is lower than other therapeutic option's costs, and it doesn't extend the hospital stay.

[Intraoperative autotransfusion in massive hemorrhage following thoracic-abdominal trauma]. / Intraoperative Autotransfusion bei Massivblutungen nach Thorax-Bauch-Traumen.

In the University Hospital of Granada (Spain), 359 surgical trauma patients underwent intraoperative autotransfusion. The patients were divided into 2 groups, according to their blood loss: group I (blood loss less than or equal to 2000 ml) and group II (blood loss greater than 2000 ml). Patients from group I did not require homologous blood transfusion. So the high risk involved in this type of transfusion was avoided. Macroscopic haemoglobinuria was only found in those patients where the Solcotrans, Viavae type of autotransfusion system was used; with the Bentley ATS system, no macroscopic haemoglobinuria was registered. With patients from group II, however, that is, those with a blood loss of more than 2000 ml, we had to fall back on homologous transfusion in addition to retransfusing autologous blood. When the transfusion exceeds 4000 ml there is increasing bleeding, which requires treatment with fresh frozen plasma, platelets and/or fibrinogen. The mortality rate of patients in group II was very high but the patients died from the severity of their injuries or from postoperative complications which were not due to autotransfusion in itself with the exception of 3 patients who underwent massive autotransfusion (12,000 to 25,000 ml) and died from acute renal failure. The main indication for intraoperative autotransfusion is without doubt abdominal and thoracic trauma which lead to high blood loss.

[Intraoperative autotransfusion in massive hemorrhage after thoracic-abdominal trauma]. / Intraoperative Autotransfusion bei Massivblutungen nach Thorax-Bauch-Traumen.

In the University Hospital of Granada (Spain), 359 trauma surgical patients underwent intraoperative autotransfusion. Patients from group I (blood loss less than 2000 ml) did not requiere homologous blood transfusion. So the high risk involved in the type of transfusion was avoided. With patients from group II, however, that is, those with a blood loss of more than 2000 ml, we had to fall back on homologous transfusion in addition to retransfusing autologous blood. The main indication for intraoperative autotransfusion is without doubt abdominal and thoracic trauma which lead to high blood loss.

[Is appendiceal surgery performed by residents safe?]. / Es segura la cirugía apendicular realizada por residentes?

An evaluation was made of the participation of residents in appendicular surgery as compared to staff surgeons, the evolution of results over the residency period and the influence of the presence of experienced surgeons together with residents during the emergency operation. Seven groups were made according to the surgeons involved. Parietal, intraabdominal and general complications of each group were quantitated, as well as postoperative hospitalization and mortality. Statistical study revealed similar results for the different groups.

Evaluation of toupet antireflux operation, by means of gastroesophageal scintiscan.

The Toupet operation (270 degrees posterior fundoplication) has been performed in 99 patients suffering from symptoms of gastro-oesophageal reflux secondary to a hiatal hernia. To assess the effects of the Toupet antireflux procedure, we performed in 20 cases oesophageal manometry, intraoperatively and gastro-oesophageal scintiscan in the early postoperative period (3 months: 98 cases) and also later (5 years). For us gastro-oesophageal scintiscan is the ideal method of detecting reflux because it is a noninvasive technique as sensitive as the intra-oesophageal pH, is easy to perform and well-tolerated by the patient. Our long-term follow-up, with only 6% of poor results show that the Toupet operation like the Nissen fundoplication is the most effective surgical technique that can be used to correct gastro-oesophageal reflux and has an added advantage: the side effects, particularly the postfundoplication or gas-bloat syndrome are minimal. Additional follow-up after 10 years will be needed to establish the final outcome of the operation.

[Conservative management versus osteosynthesis in the treatment of tibial shaft fractures]. / Konservative Versorgung versus Osteosynthese in der Behandlung der Unterschenkelschaftbrüche.

Treatment was rendered to 1,693 patients with 1,728 tibial shaft fractures at the University Hospital of Granada, Spain, between 1971 and 1987. After 139 patients had died, 1,554 patients with 1,571 tibial fractures were actually left for treatment. Forms of fractures were subdivided according to Johner and Wruhs. Conservative treatment, according to Böhler-Sarmiento, was applied to 589 cases, while surgery was performed on 982. Different ways of osteosynthesis were used, including tibial plates (n = 284), intramedullary nailing according to Küntscher (n = 308), and lock nailing according to Klemm (n = 336). Other methods of osteosynthesis, such as elastic nailing according to Ender (n = 36) and external fixation (n = 18) were rarely used and, therefore, were not statistically evaluated. --The author's result have provided evidence to the effect that conservative treatment according to Böhler (and modified by Sarmiento) worked well, with only 11.4 per cent complications in cases of closed and open fractures. However, only moderate results were obtained from follow-up checks, since compensation was usually not possible for the majority of primary lateral fragment displacements, so that for consolidation limbs had to be kept immobilised for much longer periods of time, and this entailed poor functional results. --Very poor results were obtained from plate osteosynthesis, in the context of surgical treatment, with the rate of complications being as high as 34.9 per cent. Better results were achieved by intramedullary nailing, with complications in 14.9 per cent of all cases. Yet, it is the author's view that lock nailing has become the established optional method.