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Se han descrito hasta ochos estructuras anatómicas causas de compresión del nervio mediano en su recorrido, siendo muy raras las originadas por un proceso supracondíleo y ligamento de Struthers, que desde un punto de vista anatómico hay que diferenciarlo de la Arcada de Struthers, aunque no descrita por este autor, y sitio de compresión del nervio cubital en el codo. En el síndrome de Struthers, a diferencia de la compresión del nervio mediano en otras localizaciones, el tratamiento quirúrgico inicial consigue la desaparición de la sintomatología neurológica en menos de un mes.

The production of vegetables on substrates has become a great alternative. Therefore, different substrates were evaluated in a greenhouse lettuce culture. A completely randomized block design (BCA) with three treatments was used as follows: T1: peat 30% coconut peat 70%, T2: peat 70% coconut peat 30% and T3: peat 50 % Coconut peat 50%, for a total of 9 experimental units each consisting of 10 plants. Every 8 days, during 32 days, the height of the plant, fresh and dry mass of leaves and root, leaf area and every 2 days, the SPAD units and the stomatal conductivity (SC) were determined. There were significant differences in the SPAD units in time for day 11 ddt with a value of 20.7. The SC presented the highest values in T3 and T2 with values of 354.2 and 366.2 mol m-2 s–1, respectively. T1 presented the highest value of stomatal resistance (RE) with 7.5 m2 s mol–1. The leaf area and height did not show significant differences. T2 at 15 days after transplant showed the highest values of fresh root mass (MFR), dry root mass (MSR) and fresh leaf mass (MFH) with 3.1 g, 0.106 g and 13.19 g respectively. In harvest, T3 showed 10% and 15% more production of MFH in lettuce than treatments T2 and T1, respectively.

Continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) represent two strategies of intensive insulin therapy, obtaining a strict metabolic control. The importance of such rigorous metabolic control in reducing the frequency and severity of diabetes long-term complications was highlighted by the Diabetes Control and Complication Trial (DCCT).To review the experience in the use of ISCI at Hospital São João, comparing it with the therapeutic modality of MID, regarding metabolic control, weight and body mass index (BMI), microalbuminuria, frequency of adverse events, lipid profile and quality of life.This retrospective, observational study included 25 type 1 diabetic patients followed-up on Endocrinology outpatient at Hospital São João, receiving CSII for more than 3 months after they were treated with MDI also for a period exceeding 3 months. For both periods of treatment, clinical data were obtained on the quality of glycaemic control (assessed by the levels of glycated hemoglobin--A1c), lipid profile, weight and body mass index (BMI) and microalbuminuria. To evaluate the impact on quality of life we used the ADDQoL questionnaire. A questionnaire was also used to determine the frequency of adverse events (severe hypoglycemia and ketoacidosis).The sample of 25 subjects with mean age of 33.35 ± 9.59 years, with a duration of disease, on average, of 17.1 ± 8.15 years and receiving ISCI for an average of 2.48 ± 1 08 years, obtained a decrease of 1.1% (p = 0.001) on the median value of A1c between 3 and 6 months of treatment when compared to MDI, reduction sustained throughout the analyzed period. The variation of the daily insulin requirements after pump placement was 12.75 units of insulin (p = 0.015), equivalent to a decrease of 0.20 units/kg (p = 0.023). The median of the distribution of BMI decreased 0.48 kg/m2 (p = 0.507) during CSII. The parameters of lipid profile and microalbuminuria showed no trend upward or downward after institution of CSII. The score obtained in the ADDQoL questionnaire was greater with CSII, the difference between the medians of the score distribution, before and after pump placement, was 0.056 (p = 0.92). There was a subjective perception of reduced frequency of adverse events with ISCI.The introduction of CSII allowed optimization of metabolic control, reduction of the daily insulin requirements and achievement of a higher level of satisfaction with no change in lipid profile, no weight gain and without increasing the frequency of adverse events.

El presente trabajo aborda las fallas a monitorear, la selección de las variables y parámetros de estado dediagnóstico, el método de identificación de las fallas y el flujo de la información.Los resultados mostradosdemuestran que los controles mediante Descargas Parciales (DP) son los más efectivos para el diagnósticodel aislamiento; que, para el caso de los grandes hidrogeneradores de la empresa estatal Electrificación delCaroní (EDELCA), filial de CORPOELEC en Venezuela, el predominio de las DP son de tipo corona y barrabarra(en los extremos o cabezales del devanado) a la vez que, atendiendo a las características ydisponibilidades de dichas instalaciones, existen posibilidades de implementar el sistema propuesto para eldesarrollo de controles en tiempo real. This paper showed the failure to monitoring, the selection of state variables and parameters of diagnostic,method of identification of failures and the flow of information. The results showed that the controlsPartial Discharge (PD) are most effective for diagnostics of insulation, whereas, in the case of the largehydrogenerators of EDELCA filial of CORPOELEC in Venezuela, the predominant PD are corona and barbar(at the endwinding) while, depending on the features and availability of these facilities, there areopportunities to implement the system proposed for the development of real time controls.

The burn injury probably represents the largest stimulus for muscle protein catabolism. This state is characterized by an accelerated catabolism of the lean or skeletal mass that results in a clinical negative balance of nitrogen and muscle wasting. The determination of an appropriate value for protein intake is essential, since it is positively related to the nitrogen balance (NB) and accordingly several authors argue that a positive NB is the key parameter associated with nutritional improvement of a burn patient.Evaluation of the degree of protein catabolism by assessment of the Nitrogen Balance; Defining of nutritional support (protein needs) to implement in patients with burned surface area (BSA) = 10%.We prospectively evaluated the clinical files and scrutinized the clinical variables of interest. The NB was estimated according to three formulae. Each gram of nitrogen calculated by the NB was then converted into grams of protein, subtracted or added to protein intake (or administered enteric or parenterically) and divided by kg of reference Weight (kg Rweight), in an attempt to estimate the daily protein needs.The cohort consisted of 10 patients, 6 females, with average age of 58(23) years old, a mean of BSA of 21.4(8.4)%, ranging from a minimum of 10.0% and máximum of 35.0%. On average, patients were 58 (23) years old. The average number of days of hospitalization in the burn unit was 64.8(36.5) days. We observed significant differences between the 3 methods used for calculating the NB (p = 0.004), on average the NB was positive. When the formula A was used the average value of NB was higher. Regarding the attempt to estimate the needs of g prot/kg Rweight/day most of the values did not exceed, on average, 2.6 g Prot/kg Rweight/day and no significant differences between patients with a BSA% of 10-20% and with BSA% > 20% were found.Despite being able to estimate the protein catabolism through these formulas and verifying that most values were above zero, wide individual fluctuations were visible over time. Based on the sample reference that recommends a value of 1.5-2 g Prot/kg Rweight/day, we can conclude it to be underestimated, when comparing with the mean value of 2.6 g Prot/kg Rweight/day we established.

Cushing's syndrome is a diagnostic challenging endocrinous entity. Many laboratorial examinations are available for the study of these patients. Available examinations are not absolutely trustworthy for its diagnosis, so that, very often, it is necessary to conjúgate informations from different laboratory tests. In this revision one exposes the current evidence and the suggestions of different authors in the laboratorial diagnosis of Cushing's syndrome and the differential diagnosis in patients with biochemical confirmed diagnosis.

In the post-partum period the immune alterations are associated with the multiple autoimmune diseases relapse. After birth, immune-tolerance variation slowly disappear, and is observed a return to a normal state - after an exacerbation period - of autoimmune reactivity, during which a great increase in T cells and autoantibodies is observed. In this period - 3 to 9 months after birth - the thyroid autoimmune disease relapses or reappears. The reactivation of the immune system in the post-partum period unchains an acute phase of celular destruction which characterizes the post-partum thyroiditis.

There are several barriers related to the non-accomplishment of the dietary treatment of overweight. Social desirability (SD), defined as the tendency to transmit a culturally accepted image, may bias parameters evaluated in scientific studies.(1) To evaluate SD in overweight women; (2) To evaluate the association between SD and other characteristics; (3) To compare the level of SD between patients evaluated in their first appointment or in subsequent appointments; (4) To evaluate the differences in the level of SD between patients who mention or not each barrier to the accomplishment of the dietary treatment; (5) To evaluate the effect of SD in the frequency of each statement pointed out as a barrier to the accomplishment of the dietary treatment.Sixty-seven women with BMI over 25,0 kg/m2 (mean BMI = 40,0 kg/m2; sd= 5,7) and mean age of 40 years (sd = 11) were evaluated on age, education, height, present and desired weights, perception of heath condition, weight and body image (Likert scale from 1 feels very well to 5 very bad). BMI, weight they desired to loose and corresponding BMI were calculated. The number of previous appointments and the date of the first appointment were registered and the time since the first appointment was calculated. Psychopathologic characteristics were studied with the Psychological General Well-Being Index. Barriers to the accomplishment of the dietary treatment were evaluated by pointing, from a list of 34 sentences mentioning obstacles to its accomplishment, those which patients identified themselves with. SD was evaluated with the Marlowe-Crowne Social Desirability Scale (MC-SDS).Mean score on the MC-SDS was 20,9 (sd = 4,0). Positive and weak correlations were found between SD and the number of previous appointments and time since the first appointment. Patients with previous appointments show significantly higher levels of SD than those who were evaluated in their first appointment (means of 21,7 and 18,8; p = 0,005). There weren't found significant differences on the level of SD of patients who pointed or not each sentence and it wasn't found a significant effect of SD in the frequency of any sentence.The mean score on the MC-SDS was higher than values found in the majority of studies, which may result from the higher age, lower education and the presence of pathology. Previous contact with the patients seems to influence SD and may bias and make difficult the interpretation of parameters measured by self-report. The identification of barriers to the accomplishment of the dietary treatment seems to be independent from SD.

Craniopharyngiomas are rare brain tumors of the hypothalamo-pituitary region, developing from embryonic remnants of Rathke's pouch and sac. Their overall incidence is 0.13 per 100,000 person years. Most frequently, they are suprasellar, start growing in childhood and originate neurological and hormonal symptoms. We retrospectively studied patients treated in our institution for craniopharyngioma in the last 10 years, in order to evaluate their clinical, imaging and pathological characteristics. Of the 32 patients analysed, 18 were females and 14 males with ages ranging between 6 and 81 years (early onset group--EOG aged 5-14 years: 7 patients; middle age onset group--MAOG aged 15-49 years: 15 patients; late age onset group--LOG aged > or = 50 years: 10 patients). Visual impairment was the most frequent presenting clinical feature in EOG (71.4%) and MAOG (86.6%), while in the LOG personality and cognitive changes including memory loss predominated (60%). Headaches were very frequent in all groups (EOG 42.8%, MAOG 60%, LOG 40%). Meningitis and seizures were presenting features, each in one patient. Regarding endocrine symptoms and signs, growth failure was present in 57.2% of the EOG. Amenorrhea was present in 5 of 10 female patients of the MAOG. Preoperatively, TSH was deficient in 25%, ACTH in 15.6% and gonadotropin in 25% of the patients. There were no cases of diabetes insipidus. Preoperative CT and MR revealed a calcified mass in 12 (37.5%), a partially cystic mass in 20 (62.5%) and a lesion involving or extending into the third ventricle in 7 (21.9%) patients. Twenty seven (84.4%) patients were treated primarily by surgery. In 4 (12.5%) cases the tumour was considered inoperable and 1 (3.1%) patient refused surgery; all were in the LOG. Surgical approach was transsphenoidal in 2/27 (7.4%) (all of them in the LAOG) and by craniotomy in the others. The tumour removable was considered complete in 10 (37%--EOG 2/7, MAOG 6/15, LOG 2/5) and subtotal in 17 (62.9%) patients. Eight (29.6%) patients were reoperated for recurrent tumour. Postoperative radiotherapy was administered in 12 cases with residual tumor, and 3 inoperable tumors were treated primarily by conventional external radiotherapy. Pathological study revealed the adamantinomatous type in 25 (92.6%) and the papillary type in 2 (7.4%--all men in the MAOG) tumors. The average follow-up was longer in the EOG (82.6 +/- 40.7 months) than in MAOG (57.2 +/- 48.5 months) and in LOG (48 +/- 92 months). Four (12.5%) patients died, 1 during the follow-up period due to a radiation-induced astrocytoma and 3 in the postoperative period because of cerebral hemorrhage and hydrocephalus (1 in the EOG and 2 in the LOG). In summary, we found the clinical presentation to be different in the 3 age groups, with a large number of patients in the MAOG. In this group were the only examples of the papillary form. Better prognosis was associated with a total resection at initial surgery.

Quality assurance is a relatively recent concern but already plays a major role in health care management and provision. Quality involves the definition of a comprehensive programme tailored by realistic and effective objectives and norms that include the structured review of procedures (namely clinical audits) and the use of up-to-date protocols. The involvement and motivation of health professionals, together with an adequate internal and external communication strategy, play a key role in the planning and application of these programmes. The use of programmed assessment, based on a solid knowledge of current practice, should have practical implications, optimising procedures in order to improve the quality of care. This commitment towards quality in health care should go far beyond governmental policy and should have clear support from health professionals.

The authors review some etiological, clinical and diagnostic aspects of nephrolithiasis, describing briefly the approach that should be taken to study this disease. Some of the practical aspects of its treatment are also discussed.

In a comparative analysis, the political philosophy and the economic thought of Valentín de Foronda are presented. In his works, the modern social ideas merge with the theories of criminal law in a detailed study of the impediments of development. His pedagogical approach has been the driving force for a series of reflections – both pragmatic and metapolitical – about the structure of the state and the nature of justice.