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O estudo faz uma reflexão acerca do sistema de informação de AIDS, dando visibilidade às potencialidades e limitações deste sistema no contexto atual da epidemia e numa perspectiva mais ampliada de vigilância epidemiológica. Buscou-se fazer uma descrição do sistema, considerando seus diversos componentes. Além disso, tratou-se do resultado referente ao levantamento nas fichas de notificação/investigação de AIDS no período de 1985 a 1995, e, em uma atualização da base de dados como contribuição para a qualidade do sistema. Os resultados mostraram melhora na consistência do banco de dados de AIDS, em particular das variáveis: ocupação, bairro, escolaridade e categoria de exposição, embora tenham sido identificadas limitações concretas na concepção e na estrutura do sistema para dar conta da complexidade e heterogeneidade da vigilância da AIDS. Daí ter sido apontada a necessidade de estruturação de um eficiente sistema de vigilância do HIV/AIDS, tomando-se como referência os indicadores epidemiológicos direcionados ao monitoramento e à avaliação mediante acompanhamento das mudanças no padrão epidemiológico, como da análise do impacto na morbi-mortalidade decorrente do acesso a formas mais eficientes de prevenção, aos novos tratamentos e terapêuticas.

Pancreatic carcinoma is becoming more common in our environment; the mortality rate for this tumor has barely changed over the last 20 years. Early diagnosis and accurate staging are crucial to ensure an appropriate therapeutic approach, which should aim to improve survival in patients in whom complete resection is possible and to minimize surgical morbidity and mortality in those with a high risk of residual disease after the intervention. Various imaging techniques are used for tumor staging: multidetector computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET)-CT, endoscopic ultrasound, and diagnostic laparoscopy. Currently, multidetector CT is the technique of choice for the study of pancreatic tumors; thus, this article aims to review the state of the art in staging adenocarcinoma of the pancreas, focusing mainly on the applications and limitations of this technique., (Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: To evaluate the utility of virtual cystoscopy (VC) performed with CT urography in patients being studied under gross hematuria or patients being followed-up after a previous bladder cancer and compare the results with those obtained with gold standard technique (optical cystoscopy)., Methods: Retrospective study of 117 patients who were referred for VC by the Urology Department between May 2014 and May 2015. Those patients presented with gross hematuria or they were previously treated patients from bladder cancer being followed up. These patients were evaluated with MDCT and virtual cystoscopy after distending the bladder with air. The results were compared with those obtained with optical cystoscopy which was performed no more than a week after., Results: The global sensitivity and specificity of VC were 81,8 and 92,1%. Aditional findings detected in CT urography were an aortic dissection, urinary lithiasis and colonic metastasis., Conclusion: VC seems an useful technique in the diagnosis and follow-up for bladder cancer with a good correlation with OC. The main limitations are the impossibility of biopsy during the procedure and the detection of erythematous lesions. Collateral findings can be detected performed with CT urography although the high radiation exposure does not recommend their combined use., (Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Determine the impact, characteristics, and changes in out-of-pocket health spending of households in Chile in 1997 and 2007., Methods: A descriptive econometric study was conducted based on household surveys with cross-sectional information on spending in two years-1997 and 2007-for Greater Santiago. The evolution of indicators of per capita household spending by quintile was reviewed. The method proposed by the World Health Organization was used for econometric analysis of the determinants of out-of-pocket spending and catastrophic spending. The Gini indices were also calculated to analyze equity., Results: Out-of-pocket health spending in the households of Greater Santiago increased significantly (39.5% per capita). The ratio of health spending in quintile 5 compared to quintile 1 decreased, but the increase in spending was less in quintile 5. In 2007, out-of-pocket spending was still determined by the presence of risk groups: under 5 years and, although to a lesser extent, over 65 years of age. Catastrophic spending decreased slightly and the presence of older adults continues to increase this risk. The presence of women of childbearing age tends to minimize out-of-pocket spending., Conclusions: Out-of-pocket health spending in the households is high and has increased. It continues to have a significant influence on inequality. The effects of out-of-pocket spending containment programs such as AUGE are evident, but new financial protection policies that address the problem are needed.

Objectives: To show standard CT findings and their diagnostic usefulness in female patients suffering from Fournier's gangrene., Method/result: A woman who had undergone a previous lateral internal sphincterotomy presented to the emergency department with severe pain in the hypogastrium and perianal region; physical examination revealed an induration in the left buttock. CT images showed an abscessed collection in the rectovaginal space and gas in the levator ani muscle, left ischiorectal fossa and the root of the left thigh., Conclusions: CT scan is considered an excellent diagnostic tool in the management of patients with Fournier's gangrene, as it shows both the origin of the infection and its extent.

Purpose: To describe the findings obtained with magnetic resonance imaging (MRI) in patients with ano-rectal atresia, after treatment by posterior sagittal anorectoplasty (PSARP), who have fecal incontinence and to describe its usefulness in the evaluation of causes of incontinence., Subject and Methods: Twelve patients, 9 men and 3 women, with anorectal atresia were examined with 0.5T MRI after performing PSARP for imperforate anus. The study included T1-weighted, T2-weighted and proton-density, axial, sagittal and coronal planes. The location of descended neorectus and the degree of development of pelvic musculature were evaluated., Results: Normal development of anus levator muscles and sphincterian complex were observed in six patients, with correct situation of neorectus between anus levator muscles and sphincterian complex in five of them and eccentric in the other one. Diverse grades of striate muscular complex underdevelopment were showed in the other six cases, moderate grade in four of them and severe hypoplasia in the other two. Spinal and urogenital congenital anomalies were found in these patients. Sagittal and coronal T1-weighted MR images were the most useful planes in evaluating the relationship between anus levator muscles and sphincterian complex and axial T1-weighted MR images in the evaluation of the level of development of striated muscle complex in the evaluation of patients., Conclusions: MRI is useful in the evaluation of patients with fecal incontinence after performing PSARP for anorectal atresia. Unsuitable neorectus position or striated muscle complex hypoplasia are causes of postoperative incontinence in these patients.

Objective: Our objective was to evaluate the sensitivity of indirect computed tomography (CT) venography in the evaluation of deep vein thrombosis and to establish possible general indications for this technique in cases with clinical suspicion of thromboembolic disease., Material and Methods: We studied 76 patients with clinical suspicion of pulmonary thromboembolism who underwent CT angiography of the pulmonary arteries and indirect CT venography. We correlated the results with those of ultrasound examination of the limbs in 63 cases to determine the sensitivity of the test. We analyzed the cases in which the findings at indirect CT venography changed the management of the patient., Results: The concordance between indirect CT venography and ultrasound was 92%. Thromboembolic disease was diagnosed in 40% of the cases. In these cases, CT angiography of the pulmonary arteries was positive in 80% and in the remaining 20% only CT venography was positive. In two cases, abdominal pathology that changed the clinical management of the patients was found., Conclusions: Indirect CT venography is sensitive in the detection of deep vein thrombosis in patients with clinical suspicion of pulmonary thromboembolism. This technique can shorten the time to diagnosis, increase diagnostic precision, and provide additional clinical data that may be important in the patient's management. However, its generalized use is limited because it involves the use of ionizing radiation.

Wandering spleen is an uncommon clinical entity accounting for less than 0.5% of all splenectomies performed. It can be an incidental finding in asymptomatic patients or it can be found in patients with acute or chronic clinical presentation due to compression (urinary retention, constipation), alterations in splenic function (thrombocytopenia or hypersplenism), or torsion of a vascular pedicle. Wandering spleen is diagnosed by imaging techniques, usually ultrasound, CT, or MRI. scintigraphy or arteriography can also be useful in cases with inconclusive findings. Although cases of wandering spleen associated to diverse masses (epidermoid cysts, simple cysts, cystic lymphangiomas, and lymphomas) have been reported in the literature, to our knowledge there are no reports of this entity associated to inflammatory pseudotumor. We present the case of a patient with wandering spleen associated to inflammatory pseudotumor.

Introduction and Clinical Cases: The Pitt Rogers Danks syndrome is characterized by prenatal and postnatal retardation of growth, mental retardation, microcephaly, convulsions and a peculiar facies. It is believed to represent a clinical variant of the Wolf Hirschhorn syndrome, since there is a deletion in the 4p16.3 region in both syndromes. We report two cases in the same family caused by maternal mal segregation of a 4:8 balanced translocation. We describe the clinical characteristics, investigations done and a review of the literature.

Objective: To find and compare the social and demographic features and health status of two different ethnic and cultural groups, gypsies and payos (non-gypsies)., Design: Observational, descriptive, crossover study., Setting: Primary care., Participants: The 121 gypsy patients > 14 registered at the centre and 121 controls who were matched for age., Interventions: Social and demographic variables, risk factors, chronic illnesses and involvement in preventive and health promotion programmes were gathered., Measurements and Main Results: On the basis of a questionnaire that was filled out with data from the primary care health histories, we saw that there were significant differences in educational background, jobs and work situation (p < 0.0005). Among the gypsies there were more alcohol consumers, intravenous drug users and patients at social-health risk. Hb, Hc and HIV affected gypsies significantly more (the two groups were included in preventive programmes and activities). Mean age of death among gypsies was early (40.6 years vs. 73). Paradoxically, gypsies used private medicine more., Conclusions: There were significant social-health differences between the two groups studied. The gypsies on our health centre lists need greater care from the primary care team, so that they can achieve better health status.

Background: High density lipoproteins are an heterogeneous population of particles. Two main subpopulations have been identified, one contains Apo A-I and Apo A-II and is denominated LpA-I:A-II and another one contains only Apo A-I and is denominated LpA-I., Aim: To measure the concentrations of these particles in patients with stable coronary artery disease., Patients and Methods: Serum lipids, A-I and B apolipoproteins, LpA-I, LpA-I:A-II and LpB particles were measured in 73 men aged 33 to 82 years with angiographically documented coronary artery disease (CAD) and 33 control subjects aged 39 to 76 years. LpA-I, LpA-I:A-II and LpB were measured by a noncompetitive enzyme linked immunoassay using previously characterized monoclonal antibodies against ApoA-I, ApoA-II and apoB., Results: Patients with CAD had significantly higher mean levels of LDL cholesterol than the control group (p = 0.038). The mean concentration of LpA-I particles in patients with CAD was significantly lower (p = 0.031) than in control subjects, while the concentration of LpA-I:A-II particles was significantly higher (p = 0.016). The percentage of coronary stenosis correlated negatively with LpA-I and positively with LpA-I:A-II. The best relative risk (RR) indicator in these patients was LDL-cholesterol. The relative risk increases 2.5 fold when LpA-I falls below the cut-off level. Likewise, the relative risk increases 3-fold when LpA-I:A-II raises over the cut-off level., Conclusions: Our findings indicate that the quantification of LpA-I and LpA-I:A-II particles might allow a more accurate evaluation of the CAD risk than HDL cholesterol. LpA-I might represent the antiatherogenic fraction of HDL.

Introduction: Moebius's syndrome is an entity present at birth, characterized by oculofacial paralysis and external ophthalmoplegia. Other cranial nerves can also be affected and associated to skeletal abnormalities and neurologic symptoms. It appears sporadically, sometimes of familiar nature, presenting special facies with total absence of facial expression and severe strabismus. The pathogenesis of the syndrome still remains unknown, being the transitory situation of fetal hypoxia/ischemic the most accepted theory. In some cases chromosomal abnormalities have been detected., Clinical Case: We reported three children with different symptoms, two of them are siblings whose father is affected, but he was not diagnosed until adult age., Conclusions: We conclude pointing out the different presentation of the disease, the appearance in several members of a family and its chronically evolution.

We describe a five year old boy with inversion duplication of chromosome 15 (inv dup (15)) who, at the age of six months had started to develop West's syndrome. He later developed cryptogenic myoclonic epilepsy which was resistant to medication. On examination there was dysmorphia, overall hypotonia and diffuse pyramidalism. On starting ACTH the crises of flexion spasms were reduced but these were soon followed by myoclonic crises, both tonic and atonic, which did not respond to the various anticonvulsive treatments given. We comment on the changes in chromosome 15 linked to convulsions, and particularly the phenotypes of the inv dup (15) which depend on the size and genetic composition of the anomaly. This is the third case described in the literature of a patient with West's syndrome associated with supernumerary inversion duplication of chromosome 15. It is suggested that the karyotype be included when studying convulsive encephalopathies and cryptogenic refractory epilepsy, especially in infantile spasms.

We report an atypical case of spermatocele in which sonographic findings demonstrated an intraescrotal mass fixed to the testicle, apparently solid and with important vascularity, being these findings suspicious of malignant tumor. We recommend to include complicated spermatocele in the differential diagnosis of ecographically solid masses.

Report of a 32-year old male patient with an injury of the posterior urethra caused by firearm. Initial examination only revealed fracture of the femoral vein. Absence of spontaneous micturition during the immediate post-operative made necessary to undertake retrograde urethrography, in which a fracture of the posterior urethra with extraperitoneal pelvian extravasation was found. The lack of references on urethral injuries by firearm and the good evolution obtained in this case with a conservative approach, suprapubic cystotomy, had encouraged us to report this case.

Two cases of prostate cancer (PC) which presented clinically with affectation of the cranial pairs due to skull base metastasis. In both cases, existence of intraparenchimatous brain metastasis was excluded. Initial improvement with hormonal therapy was followed by clinical, analytical and radiological relapse due to spread of process until death, at 11 and 36 months from diagnosis. Although PC's bone metastasis are frequent, their location at the skull base is uncommon. Even more rare are the cases which present with changes in the cranial pairs in the absence of signs and symptoms of prostatism.

A variety of non-invasive diagnostic procedures for assessing deep vein thrombosis (DVT) have appeared over the last 10 years. One is conventional ultrasound imaging, called B-mode at first and now called the Doppler-duplex mode. Several authors speak of the high level of reliability of this method for diagnosing DVT in the iliofemoral and popliteal regions. We found an initial sensitivity of 84% in a total of 162 ultrasound studies of lower extremities. Specificity was 100% in the 41 cases in which phlebograms were also used.

A recent study of cancer of the larynx made at the Manuel Ascunce Domenech Provincial Hospital in Camagüey, Cuba, from 1985 to 1992 is presented. In this period 168 patients were diagnosed as having this illness. Male patients of 51-70 years age were predominant and smoking was an important factor in 76% of all patients and alcohol consumption in 20.2% of patients. The most common site was the glotis (39.2%) and the epidermoid variety was the most frequent type (95.5%). The tumors classified as T1a No Mo were the most representative of the group (32.1%). We encountered metastasis in only 11.3% of our patients. The terapeutic regimen used was radiotherapy.

We studied cancer of the larynx in women seen at our hospital from 1985 to 1992. The incidence was 15.4%, a figure exceeding that usually reported in the bibliography. It was predominant between 51 and 70 years. The tumors had diverse clinical stages, stage I being predominant with the exception of glottic-supraglottic tumors. The most frequent treatment was radiotherapy, followed by total laryngectomy.

The neck-tongue syndrome is an extremely rare entity consisting of the compression of the second cervical root in the atloaxoid space in relation to certain brusque movements of the neck. Given the infrequency of this syndrome, the authors present a diagnosed and controlled case of the same in the Reina Sofia Hospital in Tudela. A 25 year old patient was consulted who, for some time, had presented paresthesia in the right half of the tongue and contraction of the cervical musculature related to certain neck postures made during sports activities. Clinical examination was completely normal. Radiography only demonstrated a defect in the segmentation between the posterior C2, C3 arches. Herewith, the authors have revised the literature concerning the topic, discuss the physiopathological theories made in other studies and analyze the therapeutic possibilities of the disease inclinning towards conservative treatment.

Treatment of severe hand ischemia a associated to progressive systemic sclerosis and other disorders is controversial. We studied prospectively 45 patients, 41 female and 4 males, over an 11 year period. Age ranged from 16 to 73 years, mean 46. Underlying disease was systemic sclerosis in 30, CREST in 8, overlapping syndrome in 4, systemic lupus in 1 and non rheumatic vasculitis in 2 patients. Treatment consisted of intravenous injection of reserpine, 1 mg, at a superficial arm vein after controlled local circulatory block for 15 min. Regional anesthesia was required in 38 patients. Adequate follow up was obtained in 32 females and 2 males, receiving a mean of 3.1 therapy sessions (range 1 to 13). Morphologic improvement from 3.09 +/- 0.16 to 1.57 +/- 0.13 and functional improvement from 3.6 +/- 0.12 to 1.75 +/- 0.14 (5 grade scoring system), was observed (p < 0.001). These results correlate with adequate rehabilitation confirmed clinically.

Diabetic angiopathy prevents adequate access of antibiotic agents to septic areas of the diabetic foot. We treated 22 such patients with antibiotics infused through a superficial vein associated to tourniquet occlusion of the limb (Group A). A control group of 47 patients, similar in age, sex and severity of diabetes received conventional systemic therapy (Group B). 45% of the patients exhibited occlusive arterial disease. Surgery was performed by the same team in both groups. Group A received regional anesthesia at the same time of the first antibiotic infusion. Group B received general or spinal anesthesia. Amputation was required in 5% of patients in Group A compared to 30% of patients in Group B (p < 0.02). Hospital stay was also significantly shorter in patients from Group A. No complications of this form of therapy were observed. Thus, regional antibiotic therapy may improve prognosis and facilitate management in patients with septic diabetic foot.

We characterized the acute manifestations of gastroesophageal reflux in 46 patients attending an emergency ward. 43 were females and the mean age was 41 +/- 14. The diagnosis of G-E reflux was confirmed in all by the acid reflux test; esophagitis was present in 55% of patients submitted to endoscopy; the Bernstein test was positive in 43%. The population represents 3% of all emergency consults and 8% of gastroenterological consults. Severe epigastric pain, usually burning or constrictive and radiating to the dorsum, left hypochondrium and sternal region was the presenting form in 55% of patients. Pain was refractory to antispasmodic agents but was relieved by antacids. Dyspnea or bronchial obstruction was the main symptom in 16% of cases, heartburn in 13%, hematemesis in 6%. Among these patients a prolonged history of chronic G-E reflux was common. Surgical correction was undertaken in 6%, with some symptoms persisting in 17%.

Neuroblastoma is one of the most frequent tumors in childhood. Suprarenal area is its main abdominal location, appearing in lesser proportion in paravertebral ganglionar chains. Its prediction depends principally on the age of the patient and the pathological stage. US are the best method for its diagnosis. Its most frequent appearance is as an hyperechogenic heterogeneous mass with calcifications inside. In evaluation tumoral extension, other complementary methods such as CT and MRI should be used.

Postraumatic arteriovenous fistulas (AVF) usually occur after traumatisms or surgical procedures. A clinic hemodynamic repercussion, or even a cardiac failure, can be caused by them. AVF diagnosis is mainly made angiographic study. In the present works we study different "Diagnosis by Images" methods (i.e.: CT, echography, MNR, angiography, gammagraphy, etc.) used in AVF diagnosis. Also, a Bibliographic Review of such disease was made. We present four cases reports with postraumatic arteriovenous fistulas; two were located in extremities (right upper limb and left lower limb, respectively) and the other two were abdominal (left reno-renal and right renocava).