[Desmoid tumor: a simple problem with severe sequelae]. / Tumor desmoide: un problema banal de graves secuelas.

Desmoid tumours are rare benign lesions with an important local invasive potential and high risk of recurrence. The reported incidence is low, and the diagnosis is made in young women with an abdominal mass. Estrogen levels, a history of trauma and Gardner's syndrome have been incriminated. The defect of the entire thickness of the abdominal wall was reconstructed with a graft of marlex in three cases. The aggressive behavior of these three cases, and diagnosis of eight extraperitoneal cases in a short period of two years prompted us to review the features of the disease.

[Mucoprotein secretion in calculous gallbladder]. / Secrección de mucoproteínas en la vesícula biliar con cálculos.

Secretion of mucoproteins or mucine (MP) have been studied as possible markers in several pathological conditions of the digestive tract, such us colonic polyposis or gastric dysplasia. In the gallbladder (VB) it has been established that form the core of crystalization for the calculi. A study in 100 gallbladders have been made based on the utility of the analysis of the qualitative and quantitative modifications of MP in lithogenesis. It was been determined by histochemical techniques the three main types of MP (neutral, low and high sulphated acid) to evaluate the alterations in the process of lithiasis. Results show a high production of the MP in VB with lithiasis, presenting in 97% a mixed composition of MP (48.9% of 2 types, and 3 types in 46%), without a predominating type in this pathology.

[Epithelioid hemangioendothelioma localized in the small intestine]. / Hemangioendotelioma epitelioide localizado en intestino delgado.

Epithelioid hemangioendothelioma is a unique tumor of adult life which is characterized by epithelioid or histiocytoid endothelial cells. These tumors are rare, and developed preferentially in the dermis and subcutaneous tissues of the distal extremities. They grow in a slowly progressive fashion, have a borderline biological behavior, and a good response to surgical treatment. The authors present a 63-years-old woman with an epithelioid hemangioendothelioma localized in small intestine. The patient had a history of abdominal pain and recurrent rectal bleeding being surgically treated.

[Pseudomyxoma peritonei]. / Seudomixoma peritoneal.

Pseudomyxoma peritonei is an infrequent clinical entity, characterized by peritoneal implantations organized in cyst of mucine or free peritoneal mucine. Most arise from cystadenoma or cystadenocarcinoma of the ovary and appendix, and fewer from other tumours and locations. It is more common in females, and it is usually diagnosed over the fifth decade. Three cases of pseudomyxoma peritonei are presented, two associated to appendicular carcinoma and one to carcinoma of the ovary, and the data published about this disease are reviewed.

[Diagnostic validity of signs and symptoms defining the diagnosis of acute appendicitis]. / Validez diagnóstica de los signos y síntomas que definen el diagnóstico de apendicitis aguda.

A prospective study of 810 consecutive cases submitted to emergency appendicectomy was performed to determine the predictive value of abdominal pain, nausea, vomiting, fever, abdominal tenderness and total and differential leucocyte count in the diagnosis of appendicitis. Age, sex, time of evolution and degree of inflammation were considered as conditioning factors. Most of the cases were diagnosed within the first 12 h. Pain demonstrated acceptable sensitivity (85.2%) and a high positive predictive value (95.7%) but with an important proportion of false negatives (14.8%). The predictive value of abdominal exploration was 97.6% with a sensitivity of 96.1%. Leucocytosis increased with the degree of inflammation and values above the cut off point established (12,500 leucocytes/dl and 85% segmented) significantly increased the strength of the association. Pain on palpation and leucocytosis with shift to the left increased the sensitivity to 98.1% with false positives of 1.3%. The percentage of acute perforated appendicitis increased from 5 to 15.3% when diagnosis was delayed more than 12 h. Once the clinical manifestations and analytical alterations were established (6 h after initiation of the clinical picture) these did not modify with the time of evolution. The greater the involvement of the appendix the earlier the presentation although, logically, the later the diagnosis the greater the percentage of perforated appendix. The classical criteria of pain, tenderness and leucocytosis with left deviation does not allow the diagnosis of 1.9% of the cases of appendicitis with 1.3% of false positives. Once the clinical manifestations are established, these do not modify with the time of evolution, but the percentage of perforations does increase with time. To reduce this percentage, diagnosis must be made within the first 24 h.

[Various hemodynamic characteristics of the venous circulation of the lower limbs in the patient with recurrent varices]. / Estudio de algunas características hemodinámicas de la circulación venosa de los miembros inferiores en el paciente con varices recidivantes.

The present study included a control group of 30 lower limbs without venous disease, a group of 30 lower limbs with primary varicosities and a group of 30 lower limbs with recidivant varicosities. Technics used for diagnosis were: Doppler ultrasonography and "strain-gauge" plethysmography. We found a relentisement of the venous flow on patients with recidivant varicosities. No differences on basal and maximal flow between primary and recidivant varicosities have been reported. It seems that no disturbances on the arterial flow are present. It seems also that patients with recidivant varicosities have no special incidence of valvular failure.

[Arteriovenous fistula in patients with a complicated postphlebitic syndrome]. / Fístula arteriovenosa en pacientes con síndrome postflebítico complicado.

An investigation, which goal is to evidencing AV fistulas in patients with a complicated postthrombotic syndrome, as well as to determinate the efficacy of noninvasive methods used for the study of AV fistulas in such patients, is presented. So, patients with a complicated postphlebitic syndrome interned into the Instituto de Angiología were studied. Twenty-five patients were included in the study, 9 of these patients (36%) had arteriovenous fistulas, arteriographically evidenced. Haemodynamic study do not support the evidence of such communications.

[Hemodynamic evaluation of the patient with microvarices]. / Valoración hemodinámica del paciente con microvarices.

The present study included 21 lower limbs with micro varicosities, 56 lower limbs with retrograde flow-varicosities (positive Rivlin) and 35 health lower limbs. Technics used for diagnosis were: Doppler ultrasonography and strain gauge plethysmography. We found a higher incidence of valvular failure on the varicose patients with retrograde flow (showing changes on their viscoelastic features of their venous walls). On the contrary, patient with microvaricosities showed an hemodynamics similar to the healty patient: we did not found any difference on the variables analyzed between the two groups. We conclude that the presence of microvaricosities has no influence on the analyzed hemodynamic parametres.

[A mathematical analysis of strain-gauge curves in the diagnosis of deep venous thrombosis]. / Análisis matemático de las curvas de "strain gauge" en el diagnóstico de las TVP.

The plethysmographic strain gauge venous outflow curves were studied by means of an exponential function. The parameters analyzed made possible the establishment of differences between patients with and without DVT.

[Physical capacity and some determining factors in the patient with the postphlebitic syndrome]. / La capacidad física y algunos factores que la determinan en el paciente con síndrome postflebítico.

40 limbs from normal persons and 32 limbs from patients with postphlebitic syndrome were studied. The latter group was classified according to the phlebography in partial and total recanalized postphlebitic groups. The research was carried out with a strain gauge plethysmograph and an ergometric bicycle. The patients showed the greater values of the venous volume, the maximal venous outflow and the rate of venous refilling, specially, the patients with total recanalized postphlebitic syndrome; this suggest a greater degree of venous valve insufficiency and a loss of the viscoelastic properties of venous vascular wall. The peripheral resistance was greater in the postphlebitic groups and it suggests a higher sympathetic nervous tone. The physical working capacity was lower in the postphlebitic patients and no relation was observed between it and the plethysmographic parameters.

Correlación para la medición d ela presión sistólica en el muslo / Correlation ofr the measurement of the systolic pressure in the thigh

INTRODUCCIÓN. El índice de presiones pierna brazo es una de las pruebas más ampliamente utilizadas en el laboratorio vascular para el estudio de la insuficiencia arterial y la determinación de los niveles oclusivos. Para obtener dichas presiones se emplea un esfigmomanómetro que se coloca en la pierna (para estudiar la arteria pedia y tibial posterior) y en el muslo (para la poplítea). Internacionalmente se ha recomendado que el ancho de la bolsa inflable de esfigmomanómetro debe de ser de12.5 cm para el brazo de un adulto normal y de 18 cm para el muslo. Sin embargo en nuestro país no contamos con manguitos que poseen las dimensiones adecuadas para la determinación de la presión en el muslo. PROPÓSITO DEL ESTUDIO. Corregir la determinación habitual que se realiza, adaptando un brazalete del tamaño requerido procedente de otro equipo. MATERIALES Y MÉTODOS. Se midió la presión arterial sistólica del muslo en 80 miembros inferiores mediante un esfigmomanómetro convencional (bolsa de 12.5 cm de ancho) y otro de dimensiones apropiadas (bolsa de 18 cm de ancho). RESULTADOS Y CONCLUSIONES: se obtuvo una excelente correlación lineal (r = 0.9978) entre ambos valores para cada individuo, pero la presión fue sobreestimada cuando se utilizó el instrumento estrecho. Se obtuvo una ecuación para corregir las determinaciones, así puede mejorarse su precisión en los laboratorios que carezcan del instrumentos con las dimensiones recomendadas (AU)

INTRODUCTION. The index of pressures leg arm is one of the tests more widely used in the vascular laboratory for the study of the arterial insufficiency and the determination of the occlusive levels. In order to obtain these pressures sphygmomanometry is used that is placed in the leg (to study later the foot and tibial artery) and in the thigh (for the poplíteal artery). Internationally it has been recommended that wide of stock-market the inflatable one of sphygmomanometry must of being de 12.5 cm for the arm of a normal adult and of 18 cm for the thigh. Nevertheless in our country we did not count on sleeves that have the dimensions adapted for the determination of the pressure in the thigh. Intention of the study: To correct the habitual determination that it is made, adapting a bracelet of the size required coming from another equipment. Materials and methods: One was moderate the systolic arterial pressure of the thigh in 80 inferior members by means of conventional sphygmomanometry (stock market of 12,5 cm wide) and another one of appropriate dimensions (stock market of 18 cm wide). Results and Conclusions: an excellent linear correlation (r = 0,9978) between both values for each individual was obtained, but the pressure was overestimated when the close instrument was used. An equation was obtained to correct the determinations, thus can improve its precision in the laboratories that lack the instruments with the recommended dimensions (AU)

Timoma maligno microinfiltrante de localización ectópica cervical / Ectopic microinvasive malignant thymoma in neck

Se presenta el caso de una mujer de 54 años con un timoma maligno microinfiltrante de localización ectópica cervical. El tumor estaba situado por debajo del lóbulo izquierdo del tiroides en la cara anterior del cuello, encapsulado y presentaba un aspecto lobulado al corte. Histológicamente, el tumor estaba formado por una población mixta de linfocitos y células epiteliales con escasa mitosis que infiltraba la cápsula. Se discuten las pautas diagnósticas y terapéuticas en este tipo tumoral (AU)