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Introduction: The subarachnoid haemorrhage non traumatic assumes between the 6-8% of all acute cerebrovascular, besides is more frequent in young persons. The mortility and mortality is high and the predictive factors of the worse prognostic in unknown., Material and Methods: In the present work, we realized a study of the patients admitted to our intensive care unite (UCI) a cause of the subarachnoid haemorrhage during the last ten years. In the same time of admitted to the UCI we applied Glasgow coma scale. Apache II and Hunt-Hess scale. The clinic dates analyzed were sex, age, glycemia, rate heart, middle arterial pressure, intraventricular haemorrhage and arrhythmias. The number of patients was the 100 the 68% were female and the 32% were male. The middle age was 48,98 +/- 21,82 years-old., Results: We obtained a worse prognostic in the 58%, versus in the 42% of the patients and the prognostic factors were Glasgow coma scales. Hunt-Hess scale, rate heart, middle arterial pressure, glycemia, intraventricular haemorrhage and arrhythmias.

A case of essential thrombocytemia treated with alpha interferon is reported, with hematological remission, but as a side effect hypertriglyceridemia is relevant. It was normalized when alpha interferon was stopped. This is the first case of essential thrombocythemia in Venezuela treated with biological modifiers, with hematological remission, but with hypertriglyceridemia as side effect.

It has been suggested that bile CEA levels could represent a sensitive index for the detection of occult liver metastases in colorectal cancer (CRC) patients. We measured serum and gallbladder bile CEA concentrations in a control group, in a group of patients with benign disease of the biliary tree, and in patients with CRC at different stages. Neoplastic patients without evidence of liver metastases at the time of laparotomy, but with elevated biliary CEA levels, were selected for a follow-up study. Our results indicate that (a) bile CEA levels are falsely increased in several benign biliary diseases; (b) CRC patients with detectable liver metastases have elevated biliary CEA levels; (c) high biliary CEA levels do not represent a predictive parameter for the presence of occult liver metastases in CRC patients.

The results of 188 patients with acute lymphoblastic leukemia, studied between 1985 and 1990, showed that 8 cases were CD10 negative, Dr, and CD19 positive. These findings indicate cell dedifferentiation and poor prognosis. The patients age ranged from 2 to 30 years, with a mean of 11 years. The male/female ratio was 5/3. Lymph node enlargement and splenomegaly were found in the 8 patients. With the exception of one patient in whom leucopenia was present, the white cell counts were always higher than 30,000/dl. The karyotype was studied in four cases, and all of them were hyperdiploid. This is the first report in Venezuela of cases with acute lymphoblastic leukemia - CD 10 negative.

The paper describes the carbohydrate, lipidic and nitrogen metabolism of the postoperative period which is subdivided into an early and a late phase. Since the metabolism of caloric substrates in the early postoperative period is a stress metabolism with glucose intolerance and wide protein catabolism, the authors emphasise that an insufficient caloric intake is worse than the fasting state and suggest that alternative caloric sources, such as branched chain amino acids, fatty acids and, even, ketonic bodies, should be used.

Computerized analysis of esophageal manometry should consider the following objectives: a) objectivation of data acquisition; b) precision in calculating the various parameters; c) speed of analysis; d) an easy-to-read and promptly understandable graphic display of the manometric data; e) computation of new parameters capable of defining normal and pathologic function. It is with these objectives in mind that we launched our research project. Five normal subjects and 10 patients, of whom 5 presented esophageal achalasia and 5 gastroesophageal reflux disease, underwent computerized esophageal manometry and were evaluated on the basis of both traditional and innovative parameters, of our own inception. Among the various indexes tested, the "Esophageal transport" parameter, calculated as the ratio of momentum (dp*dT) over speed of propagation of the esophageal contractions, gave rise to particular interest. In our opinion, this parameter can be used as an index of the dynamic function of the organ.

Elster's classification differentiates epithelial gastric polyps on the basis of cells origin and relative tendency to change into a malignancy. Out of 3.920 endoscopy of upper digestive tract during the last 10 years, we found 41 gastric polyps, 50% asymptomatic. Endoscopic polypectomy were performed in 61% of cases, without any complication. The other 39% were followed-up and/or surgically resected, according to the results of biopsy. Endoscopy is mandatory for detection of lesions often asymptomatic and histological study of surrounding gastric mucosa. Small polyps must be treated by radical endoscopic polypectomy. If they are too big for endoscopic polypectomy, it's well advised and safer to perform periodic biopsy for hyperplastic type and a surgical resection for adenomatous ones. The detection of intestinal metaplastic or malignant changes beyond basal membrane suggests a resection both subtotal or total according to topography of the lesions. In conclusion the role of endoscopy is well defined in order to clarify histological attributes of gastric epithelial polyps and surrounding mucosal areas. More restricted is its role in the treatment of these lesions.

An assessment is made of the meaningfulness of endoscopy and histology in the diagnosis of oesophagitis via an examination of 240 endoscopies. An endoscopic diagnosis of oesophagitis was given in 69 cases. Biopsy was performed in only 44 cases. This confirmed the endoscopic diagnosis on all but one occasion. There were 1 histological and 10 endoscopic false negatives. It is suggested, therefore, that perendoscopic biopsy should always be performed to reduce false negatives in cases where oesophagitis or gastro-oesophageal reflux is suspected, or when hiatal hernia (even if asymptomatic) is present.

A rare case of arteriovenous angiodysplasia leading to portal hypertension due to absolute hyperafflux is reported. After a note on the singularity and rarity of the case, the importance of hepatic manometric, oxymetric and fluximetric observations in diagnosis of hyperafflux is stressed. In the case described, in particular, the pre-operative hemodynamic examinations, although they did not lead to certain diagnosis, served to demonstrate the excellent perfusion capacity a histologically healthy liver can have, even in conditions of pure portal hyperafflux lasting for a long time.

Twenty-nine cases of acute promyelocytic leukaemia of children and adults are reported. This figure represents 13.61% of all the acute leukaemias and 27.88% of the acute non-lymphoblastic leukaemias found in Zulia State between 1982 and 1987. Those findings mean a higher frequency than reported in other childhood as well as adult series. So, Zulia State appears as an important geographic area for the occurrence of this type of leukaemia.

The authors review the modern knowledge of sepsis, asepsis and antisepsis in surgery; they underline some surgeon's customary attitudes and convictions no more scientifically significant today.

One case of Chédiak-Higashi syndrome (CHS) in a black male child, born to a consanguineous couple from a rural village in the State of Falcón, is described. At birth the child had marked skin depigmentation and ash-gray hair. A few months later he developed an almost normal black skin color. The diagnosis of CHS was established by the presence of large peroxidase-positive granules in his leukocytes. Neutrophils showed decreased chemotaxis and lack of digestive capacity against Candida albicans. Unusual features included extreme rarity of CHS in blacks, progressive repigmentation of the skin, and an early benign evolution. A high consanguinity index in the village from which this patient originated raised the possibility of the presence of a new cluster of this disease in Venezuela.