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Introduction: Patient satisfaction is the degree of conformity with the healthcare they receive. It is real evidence and one of the most important factors in determining the effectiveness and quality of healthcare systems., Objective: To identify the quality of care in the Urology outpatient department of a third-level hospital., Materials and Methods: The NHS (National Health Service) 2018 quality of care questionnaire with 11 sections, 133 items, and duration of approximately 25min was randomly administered to 250 patients attending Urology outpatients at a third-level public hospital in Mexico., Results: According to responses, 92% (n=230) knew the reason for the consultation. 64.8% (n=162) had a consultation with the same physician by whom they were initially seen. The longest reported hospital wait time before being seen was more than 2h in 29.6% (n=74). As for consultation time, 212 patients responded and the duration was 11-20min in 52.8% (n=112). Finally, 33.2% (n=83) considered the quality of service to be good., Conclusions: The use of the NHS 2018 survey in the Urology service at a third-level public hospital in Mexico is feasible, since we managed to obtain a significant and continuous improvement in all its indicators which is satisfactory for all., (Copyright © 2023 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

This document is the update of the Consensus published by SAP in 2014, so that no child nor adolescent is excluded from their right to health and physical activity. The periodic medical control and the school physical education are fundamental tools. As a result, of the SARS-CoV-2 pandemic, sports practice decreased dramatically. Recommendations are formulated that serve as a reference to pediatricians, members of health care teams, educational institutions, and sports at the local, regional, and national level in the preparation of the health certificate for a child or adolescent who will participate in physical or sports activities. The pediatrician will evaluate the child or adolescent knowing that to carry out a healthy life, must perform physical activities with moderate or vigorous intensity. The health certificate implies a shared responsibility between the child or adolescent and/or the responsible adult, the doctor, the physical education teachers and/or the coaches in charge., Competing Interests: None, (Sociedad Argentina de Pediatría.)

Introducción: Los rabdomiomas son los tumores cardiacos benignos más prevalentes en la etapa fetal y durante la infancia. Objetivo: Nuestro objetivo es dar a conocer nuestra experiencia durante 39 años en pacientes pediátricos con rabdomioma en nuestra institución, así como enfatizar la importancia de su detección, estudio y control por la asociación que tiene con esclerosis tuberosa (ET). Material y métodos: Realizamos un estudio retrospectivo y descriptivo, de enero de 1980 a marzo del 2018. Veinticuatro cumplieron con nuestros criterios, recogimos información respecto a la clínica y estudios de gabinete, así como su evolución y el tratamiento dado. Se les llamó vía telefónica para conocer su evolución y estado actual. Resultados: Encontramos 51 pacientes con diagnóstico de tumor cardiaco, de los cuales 24 eran rabdomiomas. El diagnóstico se hizo prenatal en 8 pacientes, 5 al nacimiento y en 11 durante el primer año de vida. Las manifestaciones clínicas más frecuentes fueron la presencia de soplo, arritmias, cianosis, disnea y diaforesis. En 17 de ellos se hizo diagnóstico de ET. La mitad tuvo seguimiento por neurología, 10 por dermatología, 8 por oftalmología y 4 con genética. La mitad se dejó en vigilancia, a 7 se les dio tratamiento médico y 5 requirieron cirugía. En cuanto a la evolución, 17 pacientes se mantuvieron estables, 5 presentaron regresión espontánea y 2 fallecieron. Conclusiones: El rabdomioma es un tumor benigno poco frecuente, su evolución puede ser maligna y asociado a ET ensombrece el pronóstico.

The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.redar.2019.06.002. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal., (Copyright © 2019 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. All rights reserved.)

Introduction: Obesity (OB) is a global pandemic, which is associated with arterial hypertension (AH). The differences in this relationship according to gender and age remain unclear. The objectives of this study were to establish the prevalence of OB and AH in an adult population, and to determine the risk of AH associated with OB in relationship to gender and age., Material and Methods: A cross-sectional study was performed using the database of successive cross-sectional studies carried out in 5 city squares in Resistencia (Argentina) during the years 2008-2014. The sample was randomised according to gender and age, according to the distribution of the last National Argentine Census., Results: A total of 7,898 passers-by (46.8% males) with a mean age 42.74 ± 16.70 years were included. OB in men increased from 21.3% to 26.9%, and in women from 15.2% to 23%, the former having the highest prevalence between 40-49 years, and the latter between 50-59 years, and thereafter it was always higher in women. AH increased in men from 39.9% to 42.7%, and in women from 25.8% to 29.2%, the former having the highest prevalence between 60-69 years, the latter between 70-79 years., Conclusion: In the 7 years of the study, OB and AH prevalence increased. It was higher in men, although the risk of developing AH associated with OB was greater in older women. The highest prevalence of OB and AH appears a decade earlier in men., (Copyright © 2018 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: In Mexico, the first meniscus transplant was performed in 2002. The objective was to describe the clinical evolution of patients with pain associated with postmenisectomy syndrome, who underwent meniscal allograft transplantation (MAT), with bony blocks via arthroscopy, with follow-up to one year., Material and Methods: A retrospective cohort study with a one-year follow-up was conducted. We included patients with joint interlining pain secondary to partial or total menisectomy, between 15 and 55 years of age, of both sexes, who underwent MAT. The clinical evolution was evaluated with visual analogue scale (VAS), SF-36 and Lysholm scale; the results are described in frequencies, percentages and p value was significant at 0.05., Results: We included nine patients; eight men and one woman with an age of 31.3 years (16-52), the follow-up was 16.6 months (12-23). The preoperative VAS was 8.5 (6-10) and, at one year of follow-up, the average of this scale was 1.25 (0-5) (p 0.001). In the follow-up one year after the MAT, the Lysholm scale was on average 91 (68-100) and the SF-36 was on average 79.17 (65-92.92); three patients returned to their sports practice prior to the injury., Conclusion: This is the first report in Mexico that describes the one year follow-up of the MAT; significant clinical improvement was demonstrated (p 0.001) with remission of pain in the knee with previous menisectomy and in some cases the return to sports practice.

Cat scratch disease (CSD) is an infectious disorder caused by Bartonella henselae and characterized by fever and granulomatous lymphadenopathy. Immunosuppression is a risk factor for the development of atypical forms of the disease. We report the case of a 52-year-old woman who presented with fever and bilateral inguinal lymph node enlargement. She did not have apparent contact with animals. The patient was receiving etanercept therapy for rheumatoid arthritis. Lymph node biopsy demonstrated granulomatous lymphadenitis. She was successfully managed by discontinuing etanercept and by treatment with minocycline. She developed clinical remission and typical seroconversion. Infection with Bartonella should be considered in the differential diagnosis in rheumatoid arthritis patients with lymphadenopathy of unknown origin., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Objetivo: Comparar la efectividad de un plan de alimentación hipocalórico hiperproteico con otro normoproteico sobre la composición corporal, los parámetros bioquímicos y las citocinas inflamatorias en pacientes obesos precirugía bariátrica sometidos a un tratamiento integral., Método: Se estudiaron 76 pacientes con un índice de masa corporal (IMC) ≥ 40 kg/m² previamente a la cirugía bariátrica. Un grupo fue tratado con una dieta hipocalórica hiperproteica y se comparó con una dieta hipocalórica normoproteica. Se evaluaron parámetros bioquímicos, parámetros antropométricos, composición corporal y valores de citocinas inflamatorias en suero al inicio y después de 4 meses de tratamiento., Resultados: En ambos grupos se observó una disminución de peso, de IMC y de masa grasa, así como un incremento de la masa muscular respecto al momento basal (p < 0.05), sin diferencias entre los grupos estudiados. No se encontraron cambios en los parámetros bioquímicos ni en las concentraciones séricas de factor de necrosis tumoral (TNF) e interleucina (IL)-6 antes y después de 4 meses de tratamiento, ni entre los grupos evaluados (p > 0.05). Las concentraciones séricas de IL-1β disminuyeron únicamente con la dieta hipocalórica normoproteica (p = 0.02)., Conclusiones: La dieta hipocalórica hiperproteica no muestra ventajas en la reducción de peso y grasa corporal, ni en la ganancia de masa muscular, en comparación con la dieta hipocalórica normoproteica en pacientes con obesidad mórbida precirugia bariátrica sometidos a un tratamiento integral., Objective: Compare the effectiveness of a hyperproteic hypocaloric feeding plan with a normoproteic on body composition, biochemical parameters and inflammatory cytokines in obese pre-bariatric surgery patients in the integral treatment., Method: Seventy-six pre-bariatric surgery patients with body mass index (BMI) ≥ 40 kg/m² were studied. One group was treated with a hyperproteic hypocaloric diet and compared with a normoproteic hypocaloric diet. Biochemical parameters, anthropometric parameters, body composition and levels of tumor necrosis factor (TNF), interleukin (IL)-6 and IL-1β in serum were evaluated at the initiation of treatment and after 4 months., Results: In both groups studied, a decrease in weight, BMI and fat mass was observed, as well as an increase in muscle mass compared to baseline (p < 0.05), no differences showed between the groups studied. No change was found in the biochemical parameters and serum levels of TNF and IL-6 before and after 4 months of treatment, nor among the groups evaluated (p > 0.05). Serum IL-1β levels decreased after treatment with only a normoprotein hypocaloric diet (p = 0.02). ­., Conclusions: Hyperproteic hypocaloric diet does not show advantages in weight reduction and body fat or in muscle mass gain compared to the normoproteic hypocaloric diet in patients with morbid obesity bariatric pre-surgery in the integral treatment., (Copyright: © 2018 Permanyer.)

Antecedentes: Una de las principales complicaciones de la diabetes mellitus es la amputación de alguna extremidad. En todo el mundo, la prevalencia de amputaciones asociadas a la diabetes es muy variada y tiene un impacto considerable en la calidad de vida del paciente., Objetivo: Analizar la frecuencia de las amputaciones en el Hospital Universitario Dr. José E. González y evaluar si se presenta un patrón estacional., Método: Se realizó un estudio retrospectivo de 2009 a 2012, en el que se revisaron los expedientes de pacientes diabéticos que se sometieron a amputación. La estacionalidad se analizó con la bondad de ajuste de ji al cuadrado., Resultados: Se analizaron 456 amputaciones. Los resultados muestran que febrero es el mes que presenta la mayor frecuencia de amputaciones. La estación anual con mayor número de amputaciones fue el invierno., Conclusiones: Las amputaciones en pacientes diabéticos del área metropolitana de Monterrey presentan un patrón estacional, siendo los meses de invierno los de mayor frecuencia., Background: The amputation of an extremity is a main complication of Diabetes mellitus. Worldwide the prevalence of amputations associated with diabetes mellitus is variable and had a considerable impact in the quality of life., Objective: Analyze the frequency of amputations in the University Hospital, Dr José E González and evaluate if a seasonal pattern is present., Method: A retrospective analysis from 2009 to 2012 was carried out. Clinical files of diabetic patients undergoing to amputation were studied. The seasonality was evaluated with a chi square goodness of fit., Results: A total of 456 amputations were studied. Results shown that February was the month with highest frequency of amputations while winter was the annual season with highest frequency of amputations., Conclusions: Amputations of diabetic patients from Metropolitan Monterrey Mexico show a seasonal pattern being the winter months those that present highest frequency., (Copyright: © 2018 Permanyer.)

Background: Pediatric open fractures account for more tan 10% of hospital admissions in a Pediatric Trauma Clinical Department. It is important to identify the predominant surgical management prescription pattern in pediatric patients presenting with Type I open forearm fractures at a referral center in an emerging economy., Material and Methods: Observational, cross-sectional, analytical, secondary-source (logs) sampling study of consecutive cases. The cases included subjects under 17 years of age presenting with Type I open forearm fractures at a Pediatric Trauma Clinical Department from January 1st, 2009 to December 31st, 2013., Results: Ninety-two patients with a diagnosis of Type I open forearm fracture were included. All patients received parenteral antibiotics and underwent surgical debridement. However, in 69 (75%) of them a cast was used; in 9 (10%) a splint was used; 9 (10%) underwent fixation with Kirschner nails, and 5 (5.4%) underwent open reduction and internal fixation (ORIF). Eight patients (9%) required reoperation., Conclusions: Surgical management is the predominant prescription pattern in pediatric patients with Type I open forearm fracture. The latter is the predominant eepidemiology. The type of management was associated with a second surgery (p 0.000); however, this did not have a statistically significant impact on the hospital stay (p = 0.09).

School violence has been recognized worldwide as a public health problem that negatively impacts the educational process. However, in Puerto Rico official statistics and the media generally focus on isolated incidents of extreme violence in which weapons are used or property is destroyed. Little data is available about the most common forms of violence that often occur in schools on a daily basis. The Instrumento de Observación de Violencia Escolar (INOVE) , developed with the input of school communities participating in Project VIAS (Violence and Asthma Health Disparity Network) of Universidad del Este (UNE), was used in this study to gather information about the characteristics of violence in two Puerto Rican schools. Among the study findings we highlight gender differences in observed violence and aggressive games and interactions between students. The data collected have served as a basis for decision-making regarding violence prevention in participating schools and have implications for the development of prevention strategies and programs.

Objective: To evaluate the eating habits of the students of the University of Alicante of the degrees of Human Nutrition and Dietetics and Nursing., Material and Methods: The study was carried out to 184 students of both sexes (96 of Human Nutrition and Dietetics and Nursing 88) of the University of Alicante. Were weighed and carved to calculate BMI; food consumption was estimated by the reminder of 24 hours; intake of macro and micronutrients were calculated using the program Easydiet. Comparing the results obtained in both qualifications and according to nutritional status by performing the corresponding statistical analysis., Results: The majority of the students analyzed are normal weight (80%). There were significant differences in the quality of the diet both degrees, being the same characteristics: low in carbohydrates and high in protein. It also shows an imbalance in the type of fat consumed, with a higher consumption of saturated and less from polyunsaturated than recommended. Likewise, analyzed that nutrition students do more exercise than the nurses, although they sleep fewer hours and spend more time in front of the computer and TV., Conclusion: While the levels of overweight and obesity among students is less than that of the general population, there are imbalances in your diet, noting that consumption of macronutrients is located away from the recommendations, and that there are deficiencies in the intake of micronutrients. Showing that have knowledge of nutrition, does not affect healthy decision-making to a diet and lifestyle.

Introduction: laparoendoscopic single-site surgery (LESS) using transumbilical access and conventional laparoscopic instruments is a very attractive alternative to perform ureterolithotomy for ureteral stone with failed endourological management., Material and Method: a 29-year-old woman presented with chronic right lumbar pain and a 1.2 cm impacted calculus localized at transition of abdominal to pelvic ureter. Semi-rigid ureteroscopy had failed to fragment the stone and shockwave lithotripsy was not available. Double-J ureteral catheter had been inserted preoperatively. We performed a transumbilical single-incision laparoscopic ureterolithotomy. Three conventional trocars were inserted in a single semi-circular umbilical incision. Right colon was detached and the ureter was identified. Calculus was extracted and the ureteral incision was closed with intracorporal sutures., Results: ureterolithotomy was successfully completed, with all the operative steps performed transumbically. Operative time was 180 minutes. No single-port device or articulating and bent instruments were utilized. Estimated blood loss was less than 50 mL. No intraoperative, access-related and postoperative complications took place. The duration of hospitalization was 24 hours and scarless appearance was observed on postoperative day 15., Conclusion: transumbilical single-incision laparoscopic ureterolithotomy is feasible and safe. This approach offers an inherent cosmetic advantage and few postoperative discomfort. Additional experience and continued investigation are warranted., (Copyright © 2010 AEU. Published by Elsevier Espana. All rights reserved.)

Linear lichen planopilaris of the face is a rare variant of lichen plano- pilaris. Asymptomatic follicular papules in a linear configuration are the characteristic clinical features. The incidence is still unknown, but there are a few cases reported exclusively in male adults. We present the case of a fourteen-year-old girl with linear lichen planopilaris of the face. Improvement was obtained with the use of tacrolimus 0.03 percent ointment.

Calcium is essential for bone and tooth formation, achievement of optimal peak bone mass and also for regulation of physiological processes. The calcium demand depends on age, gender and different physiological processes. These requirements are higher during childhood, pregnancy and lactation. Dietary Ca2+ deficiency modifies Ca2+ homeostasis and the metabolism of calciotropic hormones and increases the efficiency of intestinal Ca2+ absorption and renal reabsorption, altering bone metabolism. The low Ca2+ diet is associated with hypertension and risk of cancer.

Cystic fibrosis is the most frequent lethal genetic disease that affects the caucasian population. The main cause of morbidity is the chronic lung infection, being the infection caused by Pseudomonas aeruginosa the most difficult to eradicate. This bacteria can be acquired in direct form, by person-to-person transfer, or indirectly, by hospital acquired infection. The Centro Provincial de Referencia de Fibrosis Quistica functioning in the Hospital de Niños "Sor María Ludovica", in La Plata, cares almost 220 patients aged two months to 45 years. The life expectancy depends of factors like the early diagnosis of the disease and the later acquisition of the chronic lung infection. The purpose of this work was the molecular typing of P. aeruginosa isolates obtained from cystic fibrosis patients to evaluate the genomic relationship among them. The study was carried out using RAPD-PCR. The analysis showed a great genetic heterogeneity among the isolates. The separation of the patients in groups in accordance with its bacteriology, that implies the attendance in different days and the implementation of isolation (or segregation) measures had demonstrated to be, in addition to other strategies, effective in the reduction of cross infections.

The present study has as objective to describe behavior of the different components of functionality and muscular mass, in institutionalized older people. Because levels of muscular mass have been associated with reduced levels of force, activity, functionality, depression of the immune function and increase of the morbidity and mortality risk. Were evaluated 152 elderly people older than 60 years old, men and women, of 14 geriatric centers of the Gran Caracas. Anthropometrical variable was measured to value the muscular mass and the body mass index. It was evaluated: hand isometric force, walking time 4.88 m and getting up of a seat. Descriptive statistic was carried out for all the variables, t of Student, Anova and Scheffé. It was observed that 80 years older elderly as well as, women present higher levels of disability, performed motor activities (to walk and to get up of a seat and a impair in physical conditions (lean mass and muscular strength) that interfere with functional status.

Contamination of soil and water with petroleum hydrocarbons has significantly increased as a result of accidental spills, thus, several biological systems have been applied to cleanup and rehabilitate the negatively impacted regions. The present review discusses the fundamental principles required to understand the effectiveness of some bioremediation systems applied to soil and water contaminated with petroleum hydrocarbons and other organic pollutants. The practical aspects of several experimental approaches such as composting and soil amendment application, plant utilization and rhizosphere microbial activity as a keystone during phytoremediation, slurry bioreactors utilization, and potential utilization of microalgae to decontaminate wastewater, are also described.

With the availability of new diagnostic techniques, numerous alterations are found, whose real importance for health is uncertain. The term <>, is used for non apparent tumors found in diagnostic procedures. In Endocrinology, the incidental finding of thyroid nodules is common. The occurrence of those incidental nodules requires a review of the <> statements for the management of palpable nodules. The most important issue is to rule out the presence of cancer. The Chilean Society of Endocrinology, Metabolism and Nutrition appointed a group of experts to generate a consensus on tbe management of non palpable nodules. These experts reviewed international literature, and the local experience, analyzed the value of thyroid ultrasound examination and the efficiency of fine needle aspiration biopsy. This consensus is a clinical guide for the management of non palpable thyroid nodules, considering that a unique and optimal approach is still lacking.

The resurgence and spread of antimalarial drug resistance is one of the causes of the worldwide increase of malaria. In Colombia, uncomplicated Plasmodium falciparum malaria has been treated with a combination of amodiaquine (AQ) and sulfadoxine/pyrimethamine (SP) since 2000. The efficacy of these two antimalarials was evaluated after the implementation of the new malaria treatment scheme. In the municipalities of El Charco and Tumaco (Nariño) on the Pacific Coast region, the standard PAHO protocol was used to evaluate antimalarial efficacy in areas of low to moderate malaria transmission. Patients were randomly allocated to treatment regime in two cities of Nariño, El Charco (n = 48) and Tumaco (n = 50). After 14 days none of El Charco patients presented therapeutic failure to either antimalarial. However, in Tumaco after 28 days, 12 of 24 (95% CI: 30.6-69.4) patients presented AQ treatment failure while 4 of 26 (95% CI: 5.1-33.1) patients had SP treatment failure. The high level of AQ treatment failure in Tumaco was unexpected because it had been introduced only recently as an antimalarial treatment in Colombia. The results suggest that the use of the current dose of AQ in combination with SP will be therapeutically useful for less time than expected. Use of combined therapies is a key strategy to delay antimalarial resistance. Unfortunately, its success depends on the efficacy of antimalarial drugs individually.

Arcanobacterium haemolyticum is a bacterial pharyngeal pathogen that predominantly infects adolescents and young adults. It rarely causes severe infection. A case of sinusitis in an 18-year-old female patient with a skin rash is presented. The strain was susceptible to erythromicin, ampicilin, vancomicin, cephalotin, clindamicin, rifampicin and penicillin. Erythromicin has been proposed as first-line therapy.

The most favorable conditions of pH, temperature ratio for the yielding of a protein concentrate (PC) of seed flour from Amaranthus cruentus was determined. The optimal values were: extraction pH 11, stirring time 1 h 30 min, precipitation pH 4.5 and a flour/ solvent ratio of 1:15. Obtained the PC, its functional properties were assayed. The PC chemical composition expressed in g/100 g was: protein 50.9: humidity 3.3; ethereal extract 5.8; raw fiber 6.4; ashes 3.8; total carbohydrates 29.9. The following PC functional properties were found: a maximal solubility value of 94.3 at pH 1); emulsification activity (EA) 47.90 +/- 4.9, water absorption capacity (WAC) 2.0 +/- 0.3; and oil absorption capacity (OAC) of 0.7 +/- 0.8. The use of this product as supplement for cereals and for others foods with poor lysine content is considered possible. Despite of the functional properties which show the hydrophilic character of the protein from the Amaranthus cruentus PC, great expectancies are inferred for its future utilization in bread products.

Background: Lower gastrointestinal bleeding is a highly frequent clinical problem that may reflect serious pathology in the colon. Colonoscopy is generally accepted as the diagnostic procedure of choice. Decisions as to whether to carry out colonoscopy or not, are not well defined., Methods: 536 colonoscopies, made to discover the cause of lower gastrointestinal bleeding were analyzed and a final 457 included in the study. All of these patients came to the hospital because they had presented at least in one occasion, one episode of rectal bleeding, and were send by the specialist of the zone, in order to achieve a correct diagnosis of its process. In all cases the following associated symptoms were analyzed: the presence of diarrhea, constipation, abdominal pain and rectal mass on examination. The characteristics of lower gastrointestinal bleeding were analyzed in a subset of 150 consecutive patients., Results: Mean age was 59 +/- 16.9 years. 54.5% were male and 45.5% female. The exploration was normal until the cecum in 146 patients (32%). In the remaining 311, the findings were: polyps (25.1%), diverticular disease (24%), neoplasia (12.6%), inflammatory bowel disease (9.4%), unspecific proctitis (2.4%), ischemic colitis (2.4%), angiodysplasia (1.9%), infectious colitis (1.1%), and miscellaneous (0.7%). An age of less than 40 years and the existence of anal pathology were significantly more frequent among patients with a normal examination (p < 0.001), but with a sensitivity of only 66%. No differences were found among patients with disordered bowel frequency or abdominal pain in relation to the colonoscopic findings. Previous presence of a rectal mass when the examination proved abnormal (p=0.06). Intermittent bleeding and the presence of blood in the stools were more frequent in patients with normal examination (p= 0.07 and p< 0.05, respectively). No significant differences in relation to colour, duration of bleeding, or to whether toilet paper was stained with blood were found., Conclusions: 1) The more frequent endoscopic findings were polyps and diverticular disease. 2) Clinical data are of little value in predicting a normal examination. 3) Total colonoscopy appears to be the first procedure of choice in all patients with lower gastrointestinal bleeding, irrespective of the clinical data and the presence of anal pathology.

Background: The aim of the present study was to know the current prevalence of HBsAg positivity in Asturias blood donors and to carry out a clinical study of the carriers of the hepatitis B virus (HBV) accidentally detected in a blood donation program., Methods: A prospective study of incidence and prevalence of HBsAg positivity in blood donations performed in Asturias over two years from October 1989 and 1991 was carried out and the epidemiologic, clinical, and analytical characteristics, as well as histologic liver lesions in the HBsAg positive cases were determined., Results: Among the 42,789 blood donors during this above mentioned period in Asturias 119 cases of HBsAg positivity were found, representing a prevalence of 0.16% of the donations and 0.28% of the donors, generally new donors (95.8%) with a prevalence of 1.2% in this subgroup. No risk factors or known source of contagion were found in 43.6% of the cases and in most occasions the donors were asymptomatic HBsAg carriers (96.5%) with normal transaminases (87.3%) with 4.6% of the cases being HBeAg positive and 3.5% being mutant "e minus" carriers., Conclusions: The prevalence of HBsAg was almost limited to new donors with a higher prevalence being observed with respect to other regions. Most of the cases may be considered as "apparently healthy" and in the group with positive replicative markers a similar number of positive HBeAg carriers and "e minus mutants" were present.

The study presents four cases of monoclonal gammopathy accidentally detected in anti-HCV-positive blood donors without previously known hepatopathy. A hematological and hepatic studies were performed, including liver biopsy in all the cases, discussing the implications of the association between the two phenomena and the possible false positives of anti-HCV in hypergammaglobulinemias.

We describe the case of a patient with non A-non B post-transfusional cirrhosis and type-II mixed cryoglobulinemia, who showed in relation with said processes several acute symptoms of vasculitis, polyarthritis, pericarditis and autoimmune hemolytic anemia, finally dying due to an advanced hepatocellular insufficiency. In this patient the determination of antibodies against hepatitis C virus (anti-HCV) was positive, that is why we assume a possible relationship between both processes and the first literature references, after the clonation of the hepatitis C virus (HCV) genome, are reviewed.

We report the case of a 22-year-old man with a craniopharyngioma, who developed ascites following a ventriculoperitoneal shunt procedure for hydrocephalus. The ascites was resolved with diversion of the distal catheter into the right atrium. A ventriculoperitoneal shunt can cause ascites, even without neurological symptoms suggestive of shunt malfunction.

The historical background to the currently used methods for continent bladder substitution is shortly outlined. The significance for the patient's quality of life of various methods for bladder reconstruction or urinary diversion is briefly discussed. The importance of reservoir configuration for achieving a high compliant urinary receptacle is pointed out. Factors affecting reabsorption of urinary constituents are stressed and the significance of an antireflux mechanism is discussed. Currently the majority of patients undergoing cystectomy for cancer or for other reasons can be offered bladder substitutes providing continence and easy emptying; that is, complete control over voiding. This can be achieved by orthotopic bladder reconstruction or by diverting the urine to the augmented and valved rectum or to the skin via a continent intestinal reservoir.

Among the 1,993 patients undergoing open-heart operations, our incidence rate of mediastinitis was 0.6%. Six patients have been treated with the pedicled omentum. Two of the 6 patients had a valvular disease and a coronary bypass the others. All patients had a good result with this procedure. After this experience, we think it is the best technique for management of this major complication.

Since uricosuria is an essential compensative factor in hyperuricemia, multiple factors exist which can influence on the uric acid excretion in the tubules. Normally, 90% of the uric acid filtered by the glomerulus is reabsorbed, and its active tubular secretion forms the greater part of the uric acid present in the urine. One of the factors observed as leading to urinary excretion of uric acid, is saline overload, although this effect cannot always be achieved. This study is an attempt to assess the importance of hyperuricemia as a determinant of the action of sodium upon the urinary excretion of uric acid. The series were grouped according to the plasma and urinary values of uric acid. In cases studied, the percentage of sodium was similar independent of the excretion percentages obtained for uric acid. Nevertheless, in the groups with increased plasma levels of uric acid, a direct and significant correlation was found between the excretion percentage of sodium and that of uric acid. These data cannot be obtained in groups with normal plasma levels of uric acid. Since saline overload does not always lead to hyperuricosuria, other factors must condition the secondary effect. The obtained results suggest that hyperuricemia can be one of those factors, offering a great amount of uric acid to the renal tubule, a condition in which the sodium may act as a dragging factor which may not be possible with a lesser degree of uric acid.

We present 4 cases of dissection of the coronary arteries during coronary radiography, which required emergency surgery. The right coronary was dissected in 2 cases and the left coronary in the remaining cases. Coronary artery bypass was carried out using saphenous vein. Although one patient suffered myocardial infarction, all patients had successful recovery and evolution.