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Introduction: Laparoscopic splenectomy was reserved for selected cases, however and because of the improvement in surgical technique and laparoscopic instruments, nowadays, there are few contraindications., Method: Retrospective and observational study of patients surgically treated of laparoscopic splenectomy secondary to hematologic diseases in a period span of 6 years. We analyzed demographic, preoperative, transoperative and postoperative variables., Results: We studied eight patients, 62.5% were men with a mean age of 47.5 years. The most frequent hematologic diagnosis was idiopathic thrombocytopenic purpura (50%). The approach was laparoscopic in 100%. Median surgical time was 129.87 min and median transoperative bleeding was 396.25 cc. Median length of resected spleen was 15 cm. Median time for oral feeding was 20.62 h and total hospital stay was 4 days. There was only one reported complication., Conclusion: Laparoscopic splenectomy represents a safe and feasible option with rapid recovery and few complications., (Copyright: © 2019 Permanyer.)

Objective: To determine the percentage of new Specialist Healthcare prescriptions received and modified by Primary Healthcare physicians., Design: Descriptive, cross-sectional and multi-centre study with the participation of Primary Healthcare physicians from one Madrid Health Area during 2 months. A method was established for registering the origin of the new prescriptions in the Computerised Medical Record System. In order to register new prescriptions without any change from Specialist Healthcare, the «second level» option was marked when the prescription was issued. A protocol was prepared and was available on the Computerized Medical Record System, so for those cases where there was a new Specialist Healthcare prescription, the Primary Healthcare physician would not issue any prescription or issue a prescription with changes as regards the original one., Results: A total of 69 Primary Healthcare physicians from 15 Primary Healthcare centres registered 46,512 new prescriptions, 3,893 (8.4%) from Specialist Healthcare. From this number, 3,544 prescriptions (91.0% 95% CI: 90.1-91.9) were issued without changes, and 298 prescriptions were modified (7.7% 95% CI: 7.0-8.7). In 46 cases (1.2% 95% CI: 0.8-1.5) no prescription was issued. Some prescriptions were changed by 51% of Primary Healthcare physicians, and the median of prescriptions changed or not issued was 3. The main reason for the modification was replacement with generics., Conclusions: A high percentage of new Specialist Healthcare prescriptions are issued without any changes being made by Primary Healthcare physicians. Modifications are concentrated in half of the participating physicians. Therefore, these data suggest that this practice is not generally adopted by the professionals., (Copyright © 2011 SECA. Published by Elsevier Espana. All rights reserved.)

Pheochromocytomas, which derive from chromaffin cells, can secrete catecholamines in large amounts. The incidence of these tumors is low at 2 to 8 cases per million population and only 10% of cases occur in children. A thorough understanding of the pathophysiology of these tumors and the consequent effect of drugs will be necessary for treating these patients during the perioperative period. A great deal has been published on drugs that can be used in this setting, but only a small portion of the information is relevant to children. Esmolol, a short-action beta-blocker, figures among the drugs that have been developed in recent years. We report a case in which esmolol was used during surgery in a 10-year-old girl undergoing scheduled removal of a bilateral pheochromocytoma.

Background and Objective: Early alterations in retinal microcirculation are observed in most hypertensive patients seen in daily practice and the European guidelines consider it is necessary an objective method to quantify these alterations. We have previously described a semi-automatic computerized system to evaluate the calibre of retinal blood vessels that has shown high sensitivity and specificity to calculate the arteriovenous ratio (AVR), though with limitations. We describe a method based on the snakes model to calculate the arteriovenous ratio., Patients and Method: We had compared it with the previously reported lineal method, and we have analyzed 173 digital photographs from 96 hypertensive patients, most of them receiving treatment. Photos were made in two hospitals (A Coruña: 66 and Santiago de Compostela: 107), and were analysed by the same people in each Centre, by the lineal and snake method., Results: We have observed that the arithmetic mean and the differences in AVR between both methods were minimal and showed a normal distribution. Cronbach statistics was 0.974 and intraclass correlation coefficient 0.949 (p<0.001), for the images from Santiago and 0.923 with an intraclass correlation coefficient of 0.857 (p<0.001) for the images from A Coruña., Conclusion: This semiautomatic method to calculate the AVR ratio has a high sensitivity and a greater specificity than previous method, and the correlation between the results obtained with both is excellent., (Copyright © 2009 Elsevier España, S.L. All rights reserved.)

Cornelia de Lange syndrome involves multiple malformations with particular phenotypic features (craniofacial abnormalities such as microcephaly or hypertrichosis with synophrys; cutaneous abnormalities such as hirsutism, and limb anomalies) and it is associated with a high percentage of mental retardation and complications such as digestive tract abnormalities, cardiac defects, and endocrine disorders. We report the case of a 2-month-old infant girl who underwent a laparoscopic antireflux procedure, with closure of a diaphragmatic hernia and a gastric stoma. The medical history included repeated episodes of aspiration pneumonia and hypertension. Early in the procedure, 2 episodes of sudden desaturation, hypotension, and bradycardia with a probable diagnosis of air embolism. The complications resolved with specific treatment. Anesthetic management for laparoscopic surgery in these patients is truly complex and must be informed by a thorough understanding of the disease and complications that may develop.

Objective: To find out the opinion of Primary Health Care (PHC) professionals on the impact of the Preventive Activities and Health Promotion Program (PAPPS)., Design: Descriptive qualitative-quantitative study. In a first phase the SWOT technique was used. In a second phase a 47 item questionnaire was designed using an ordinal scale., Participants: Professionals of PAPPS health centre, PAPPS managers and PHC management, using the Autonomous Community, and the time of ascribing or knowledge of PAPPS as segmentation criteria. In the qualitative study 62 participants were selected by theoretical sampling. In the quantitative study, 198 professionals took part in the survey., Principal Measurements: The assessment of the results has taken into account the responses to the questions formulated and by performing a crossed analysis between strengths/threats and weaknesses/opportunities. A descriptive statistical analysis of the questions in the questionnaire., Results: There is agreement in that PAPPS has greatly influenced the development of PHC, contributing to improving the quality of care, but it is also fundamental to try revitalise the programme, as the limited involvement by the professionals in the postulated preventive recommendations is its main weakness, due to lack of motivation and professional burn-out.., Conclusions: According to the participants PAPPS has contributed significantly to the development of PHC in our country and has had an influence on professional practice by instilling a prevention culture that hardly existed before.

Background: To evaluate the possible relation between left ventricular hypertrophy and vascular changes in retine, in patients with mild hypertension., Patients and Methods: We established a group with 51 hypertensives (27 males and 24 females), with essential mild hypertension, which had never been treated. An ambulatory monitoring blood pressure, 24 hours electrocardiographic monitoring, echocardiography and funduscopy were realized to all of them., Results: Fifty-five per cent of the hypertensives had retinopathy grades I-II. We established two subgroups with and without retinopathy. The age, systolic, diastolic and mean blood pressures, so as body mass index higher in the group with retinovascular damage. No significant differences were observed in the ecographic parameters between two subgroups except the interventricular septal thickness (10.5 +/- 2.1 min in the subgroup without vs 11.1 +/- 2.3 mm in the subgroup with retinovascular damage) (p < 0.05). As 24-hour maximum and mean systolic and diastolic blood pressure, daytime mean systolic blood pressure (SBP) and diastolic blood pressure (DBP), daytime and night-time DBP load, as daytime SBP load were higher in the hypertensive patients with retinovascular changes. There was echocardiographic left ventricular hypertrophy in 51% of the hypertensive patients, without differences between both subgroups of hypertensive patients. Body mass index (g/m) correlated significantly (p < 0.01) with the retinovascular damage. In the multivariant analysis, male as well as female, the funduscopy correlated with left ventricular mass index (g/m2). We established a discriminant function to separate hypertensives with and without left ventricular hypertrophy and another to separate hypertensives with and without retinopathy. Both functions included body mass index and maximum SBP, so as daytime SBP load and nighttime mean DBP to the left ventricular hypertrophy function., Conclusions: Left ventricular hypertrophy and retinovascular damage appear early in the course of blood pressure elevation and both changes develop in parallel. Our results indicate that there exists a relation between both cardiac and vascular changes in the hypertension. Body mass index and maximum SBP, appear to be important determinants of structural adaptation in mild hypertension.

Background: To establish if the differences between male and female hypertensives, with similar characteristics, are associated with different cardiovascular damage., Patients and Methods: We compare a group of 27 mild hypertensive males with another one of 24 females with similar characteristics. A 24-hour ambulatory blood pressure monitoring, a 24-hour ECG holter, an echocardiography and eye funduscopy, were done to all the patients., Results: The mean of 24 hour-systolic blood pressure (p < 0.01), the daytime and night-time systolic blood pressure load (p < 0.05), and the mean of systolic blood pressure daytime, were significantly are not higher in male than in female hypertensives. Neither echocardiographic differences nor frequency of arrhythmias were observed between both groups. 66.7% of the women had left ventricular hypertrophy vs 37% of the men, without significant difference. 40.7% of the male had rethynopathy I-II vs 50% of the female. Left ventricular mass index correlated with different parameters of the ambulatory monitoring in the multivariate analysis. Body mass index and daytime systolic blood pressure load classified correctly 89% of the male-group in with or without hypertensive rethynopathy. The body mass index, age and 24-hour maximal systolic blood pressure, classified correctly 87.5% of female hypertensives in with and without hypertensive rethynopathy., Conclusions: The differences in the ambulatory blood pressure monitoring between male and female mild hypertensive patients, were not associated with different cardiovascular damage. We emphasize the importance of the body mass index in the development of hypertensive rethynopathy in both sexes.

Background: The development of arrhythmias in patients with high blood pressure has been related to the presence of left ventricular hypertrophy. The aim of this study was to determine the presence and relationship between left ventricular hypertrophy and arrhythmias in patients with slight arterial hypertension., Methods: One hundred and two individuals (54 males and 48 females), 51 of whom were hypertensive and 51 normotensive, were included in the study. None of the subjects had received antihypertensive treatment. Twenty-four hour electrocardiographic registry, echocardiogram and ambulatory blood pressure monitorization were performed., Results: Fifty one percent of the hypertensive individuals had left ventricular hypertrophy (LVH) versus 18% of the normotensive subjects. Supraventricular and ventricular arrhythmias were equally frequent in the hypertensive and the normotensive subjects as were the episodes of ST depression (7.8% versus 9.8%, respectively). Both types of arrhythmias were correlated with the age of the hypertensive subject. Twenty-seven of the hypertensive subjects had white coat hypertension. The left ventricular mass in these subjects was similar to that of the hypertensive subjects with maintained hypertension and both were greater than the normotensive subjects. In regard to the frequency of LVH in the hypertensive subjects with maintained hypertension, 15 (62.5%) did not differ from either the LVH in white coat hypertensive subjects 11 (40.7%) or in regard to the frequency of supra and ventricular arrhythmias. On multivariate analysis both types of arrhythmias correlated with the index of ventricular mass in the hypertensive patients in both males and females., Conclusions: Left ventricular hypertrophy may develop early in hypertension although it is not related to a greater frequency of arrhythmias in patients with slight arterial hypertension.

A study of 100 patients with chronic urticaria by Giardia lamblia parasitic infection were reviewed. The urticaria had been resistant to antihistamine, corticosteroid and antiparasitic therapy. An urticaria evaluation included CBC, immunoglobulins M, G, A and E determinations, and stool examination, bile drainage and duodenal smear for ova and parasites. A prick test with Giardia's allergen 1, 10 and 100 UNP dilutions were realized. We found a 93% improvement in clinical symptoms using allergy immunotherapy with Giardia's antigen preparation associated to treatment.

A prospective study that included 50 patients with acute anterior uveitis was done. The aim was to describe their immunological behavior. According to the results, patients with an allergic basis are predisposed and have more severe disease. However, immunoallergic tests are positives in patients with acute anterior uveitis where associated pathologies modify the tests, even if allergic etiology may or may not be possible. We recommend further studies in patients with allergic antecedents, in order to pay more attention to them.