Doppler ultrasound study and venous mapping in chronic venous insufficiency.

Chronic venous insufficiency of the lower limbs is very prevalent. In recent decades, Doppler ultrasound has become the method of choice to study this condition, and it is considered essential when surgery is indicated. This article aims to establish a method for the examination, including venous mapping and preoperative marking. To this end, we review the venous anatomy of the lower limbs and the pathophysiology of chronic venous insufficiency and explain the basic hemodynamic concepts and the terminology required to elaborate a radiological report that will enable appropriate treatment planning and communication with other specialists. We briefly explain the CHIVA (the acronym for the French term "cure conservatrice et hémodynamique de l'insuffisance veineuse en ambulatoire"=conservative hemodynamic treatment for chronic venous insufficiency) strategy, a minimally invasive surgical strategy that aims to restore correct venous hemodynamics without resecting the saphenous vein.

[Effect of growth hormone and parenteral nutrition on the catabolic phase following major digestive surgery]. / Efecto de la hormona del crecimiento y la nutrición parenteral sobre la fase catabólica tras cirugía digestiva mayor.

The purpose of the present study was to determine if the administration of a biosynthetic human growth hormone (bGH) was able to enhance the efficacy of total parenteral nutrition (PN). Patients (n = 38) who had undergone major gastrointestinal surgery were randomly divided in two groups. Group I (n = 20) treated only with PN and Group II (n = 18) treated as in Group I plus bGH (4 UI/daily). Our study shows that the administration of bGH produces a significant increase in serum levels of growth hormone and Somatomedin-C. It also caused a positive nitrogen balance from the first 24 hours on (p less than 0.01). In Group II on day 12 after operation a statistically significant increase in transferrin (p less than 0.05), albumin (p less than 0.01) and total proteins (p less than 0.02) was observed. Our study suggest that the administration of bGH produces, perhaps through Somatomedin-C as mediator, an increase in protein synthesis.

[A fibrous pseudotumor of the tunica vaginalis testis. A report of a new case and a review of the literature]. / Pseudotumor fibroso de la túnica vaginal del testículo. Presentación de un nuevo caso y revisión de la literatura.

Presentation of one case of benign fibrous pseudotumor of the tunica vaginalis testis in a 22-year-old male patient who underwent radical orchiectomy due to suspected testicular neoformation. Contribution of radiological findings with ultrasound and CAT, emphasizing the significance of considering this rare entity as part of the differential diagnosis of extratesticular intrascrotal masses.

[Renal carcinoma and acquired cystic disease of the kidney in a patient after transplantation and under hemodialysis]. / Carcinoma renal y enfermedad quística adquirida del riñón en paciente trasplantado y en hemodiálisis.

Renal Acquired Cystic Disease (RACD) is a frequent entity in patients with a long standing renal failure under hemodialysis treatment. Incidence of a tumor pathology is higher in those patients than in the general population. A new case is presented and some possible etiopathologenical factors of RACD and neoplasias on such pathology are established.

[Pregnancy and childbirth in adolescents]. / Embarazo y parto en adolescentes.

OBJECTIVE: To establish what the most common complications are in the pregnancies of adolescent women in our environment. DESIGN: Retrospective study. SETTING: Pregnant women who had their children in the Ciudad de Jaén Maternity Centre. PATIENTS: Pregnant women who gave birth in our centre in 1991 and 1992. The study group was composed of 104 adolescents (under 19 years old) and the control group by 7,824 non-adolescent pregnant women during this same period. MEASUREMENTS AND MAIN RESULTS: The most common general complication is the threat of premature delivery, which was more common in pregnant women under 19 than in the control group (p < 0.001). There was no higher incidence among the adolescents of any other medical or obstetric pathology, including the frequency of Caesarean deliveries and neonatal morbidity/mortality. CONCLUSIONS: In our environment, the most common complication in adolescent pregnancies is the threat of premature birth. For other pathologies there are no differences from other women.

Can the use of growth hormone reduce the postoperative fatigue syndrome?

Convalescence after surgery is characterized by a period of fatigue (POF). If we assume that the POF syndrome has a multifactorial etiology, it is clear that the aim of therapeutic measures should be to reduce the response to surgical stress. The purpose of the present study was to determine if administering exogenous human growth hormone (hGH) can prevent the development or reduce the duration of the POF. We carried out a placebo-controlled randomized double-blind trial with 48 patients after elective cholecystectomy (placebo, or control group, n = 26; hGH-treated group, n = 22). Eligibility criteria were strict so as to introduce as few variables as possible. The results obtained in the study show that for moderate surgical injury (cholecystectomy in metabolically healthy subjects) the administering of low doses of hGH (8 IU/day) minimized the POF syndrome (Christensen score). Furthermore, a positive nitrogen balance was achieved in the hGH-treated group during the postoperative period from the first 24 hours onward. This finding correlates with the significant increase in serum levels of hGH (p < 0.05) and insulin-like growth factor 1 (IGF-1) (p < 0.001). On the other hand, anthropometric measurements in the hGH-treated group revealed a slight but continuous decrease in body weight and thickness of the triceps skinfold; however, arm muscle circumference did not significantly change during the postoperative period. These findings are related to the effects of the application of exogenous growth hormone, which preserves or increases lean body mass and reduces adipose tissue mass. The serum transferrin level proved to be a reliable biochemical indicator of POF.

[Bladder metastasis of signet-ring cell adenocarcinoma from the stomach]. / Metástasis vesical de adenocarcinoma de células en anillo de sello de origen gástrico.

OBJECTIVE: To describe an additional case of metastatic bladder tumor from gastric signet-ring cell adenocarcinoma. METHODS/RESULTS: Local recurrence was demonstrated by gastrointestinal endoscopy and biopsy in a 52-year-old female who underwent total gastrectomy for signet-ring cell gastric adenocarcinoma two years earlier. A CT scan showed bilateral hydronephrosis and diffuse thickening of the bladder wall. Bladder biopsy demonstrated signet-ring cell adenocarcinoma. Palliative treatment with ureteral catheterization was instituted. CONCLUSIONS: Signet-ring cell adenocarcinoma of the bladder is usually a primary tumor. Metastatic signet-ring cell adenocarcinoma to the urinary bladder is uncommon.