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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)

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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)

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La traqueotomía es una técnica habitual en las unidades de cuidados intensivos, sin embargo, no existen criterios uniformes sobre la periodicidad con la que deben realizarse los cambios de cánulas traqueales, por ello, el objetivo de nuestro estudio ha sido valorar si ante dos pautas diferentes de cambios de cánulas, no existía modificación en la contaminación microbiológica y se disminuían los episodios dolorosos y de sangrado relacionados con dichos cambios. Se diseñó un estudio comparativo entre dos grupos, un grupo control al que se le realizaron los cambios de cánula cada 48 horas y un grupo experimental al que se le realizaron cada cinco días. En ambos grupos, además de los datos demográficos, se valoró la técnica de traqueotomía utilizada, se realizó estudio microbiológico de la cánula, aspirado bronquial y estoma, se valoraron signos clínicos de infección del estoma y secreciones, se realizó estudio radiológico torácico. Con cada cambio de cánula se valoró el sangrado, dolor, tipo de ventilación, alteración hemodinámica, obstrucción de la vía aérea, realización de falsa vía, saturación de oxígeno previa y postcambio y el tiempo de recuperación. Se incluyeron 29 pacientes y se estudiaron 97 cánulas. Partiendo de una muestra homogénea, observamos que de forma significativa los pacientes que pertenecieron al grupo experimental, se mantuvieron con una radiología torácica normal más tiempo (p= 0,005). Los estomas del grupo experimental presentaron diferencias significativas en cuanto a menor exudado (p= 0,04) y dolor (p= 0,004). Cuando se relacionó la técnica utilizada en la realización de la traqueotomía con los estomas, se observó que de forma significativa estuvieron más enrojecidos (p< 0,004) y exudaron más (p< 0,001) aquellos cuya técnica de elección fue la quirúrgica realizada en la unidad. Como conclusión, podemos afirmar que el prolongar los cambios de cánulas a cinco días no aumenta la incidencia de contaminación y disminuye el dolor en los pacientes traqueotomizados (AU)

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Tracheostomy is a commonly used technique in intensive care units, but there are no uniform criteria governing the periodicity with which tracheal cannulas should be changed. The objective of our study was to evaluate if different cannula-change schedules modified microbiological contamination and reduced the pain and bleeding related with cannula changes. In a comparative study of two groups, a control group in which the cannula was change every 48 hours and an experimental group in which the cannula was changed every 5 days were studied. Demographic differences, tracheostomy technique, microbiological study of the cannula, bronchial aspirate and stoma, clinical signs of stomal infection and secretions, and chest radiography were compared in the two groups. With each cannula change, we evaluated bleeding, pain, type of ventilation, hemodynamic disturbances, airway obstruction, opening of a false airway, oxygen saturation before and after cannula change, and recovery time. The study included 29 patients and 97 cannulas. In a homogeneous sample, the patients in the experimental group had a normal chest radiograph for a significantly longer time (p = 0.005). The stomas of the experimental group produced significantly less seepage (p = 0.04) and pain (p = 0.004). When the tracheostomy technique was correlated with the stoma, surgical tracheostomy performed in the unit showed significantly more reddening (p < 0.004) and seeping (p < 0.001). We conclude that prolonging cannula changes to every 5 days did not increase the incidence of contamination and reduced the pain of tracheostomized patients.

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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.

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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.

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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.

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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.

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The role of tumor necrosis factor alpha (TNF) in the toxic and lethal effects of the endotoxemia associated with septic shock is well known. This study was designed to establish whether natural somatostatin (SS-14) is capable of modifying the production of TNF in a model of septic shock induced in the rat by bacterial lipopolysaccharide (LPS), and its theoretical relationship to prostaglandin E2 (PGE2). An experimental study was carried out in 80 Wistar rats subjected to intravenous LPS injection. Perfusion of SS-14 at 2 micrograms/h or continuous isotonic saline (IS) at 0.1 ml/h started 30 min prior to LPS injection and continued until 90 min after. All the animals were primed 15 days earlier with on intraperitoneal dose of BCG (2.2 x 10(7) CFU). ELISA assays were used to measure TNF levels after 90 min of perfusion and those of PGE2 at 30 and 90 min. The effects of two different doses of LPS (0.5 mg/kg of body weight and 5 mg/kg bw) were compared. SS-14 administration was associated with a decrease in TNF levels (1130.0 +/- 272.4 vs 4720.0 +/- 1278.1 pg/ml, P = 0.013), and an increase in serum PGE2 basally (255.7 +/- 94.2 vs 62.0 +/- 10.6 pg/ml, P = 0.04) and after 90 min of perfusion (1872.7 +/- 1250.6 vs 1009.7 +/- 612.0 pg/ml, P = NS), there being a statistically significant correlation between the basal PGE2 levels and these TNF after 90 min when compared using a regression model (r = -0.88, P = 0.04 for the 0.5 mg/kg dose; r = -0.47, P = 0.07 for 5 mg/kg). At 90 min, the level of TNF also depended on the PGE2 values (r = 0.84, P = 0.07 for 0.5 mg/kg; r = 0.55, P = 0.03 for 5 mg/kg). Multiple regression permitted TNF levels to be estimated on the basis of basal and 90 min PGE2 levels (P = 0.03). Pretreatment with SS-14 led to a significant reduction of TNF and an increase of PGE2, there being an apparent correlation between the two.

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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.

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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.

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