Aprendizaje cooperativo, necesidades psicológicas básicas e intencionalidad de mantenerse físicamente activo / Cooperative learning, basic psychological needs and intention to be physically active

El objetivo de este estudio fue evaluarlos efectos de un programa de larga duración de Aprendizaje Cooperativo en las necesidades psicológicas básicas de los estudiantes y su intención de ser físicamente activos. Un total de 109 estudiantes (12-14 años) de cuatro clases diferentes de primer curso de Educación Secundaria Obligatoria aceptaron participar. Los estudiantes fueron organizados en un grupo experimental (n=56),que desarrolló un programa de intervención de Aprendizaje Cooperativo en Educación Física durante cinco meses (cinco unidades didácticas, 40 sesiones),y un grupo de control (n=53) que experimentó, durante el mismo periodo, las mismas unidades didácticas bajo un enfoque de Instrucción Directa. Se siguió un diseño cuasi-experimental de medidas repetidas, empleando una comparación de grupos pretest-postest. Los resultados evidenciaron mejoras estadísticamente significativas en la intención de ser físicamente activo y las necesidades psicológicas básicas de autonomía y relación solo en el grupo de alumnos que experimentaron el Aprendizaje Cooperativo. (AU)

The goal of this study was to assess the effects of a long-term Cooperative Learning programme in students’ basic psychological needs and their intention to be physically active. A total of 109 students (12-14 years old) enrolled in four different Year 8 classes of Secondary Education agreed to participate. Students were organised into an experimental group (n=56), who experienced a Cooperative Learning intervention programme in Physical Education for five months (five learning units, 40 sessions) and a control group (n=53) who experimented, during the same period, the same learning units under a Direct Instruction approach. A quasi-experimental repeated measure applying a pre-test, post-test comparison group design was followed. The results evidenced statistically significant improvements in the intention to be physically active and the basic psychological needs for autonomy and relatedness only in the group of students who experienced Cooperative Learning. (AU)

Impacto de la implantación de un Código Sepsis intrahospitalario en la prescripción de antibióticos y los resultados clínicos en una unidad de cuidados intensivos / Impact of the implementation of a Sepsis Code hospital protocol in antibiotic prescription and clinical outcomes in an intensive care unit

INTRODUCCIÓN: Se analiza el impacto de un Código Sepsis intrahospitalario sobre el uso y consumo de antibióticos, la estancia hospitalaria y la mortalidad. DISEÑO: Estudio retrospectivo cuasiexperimental observacional. Ámbitos: UCI polivalente de 11 camas en un hospital de tercer nivel. PACIENTES: Pacientes ingresados en UCI con diagnóstico de sepsis grave o shock séptico. INTERVENCIONES: Un grupo postintervención (POST-CS) (septiembre 2012-agosto 2013) se comparó con un grupo histórico (PRE-CS) control (enero-diciembre 2010). VARIABLES: Tipo de tratamiento antibiótico, estrategia terapéutica antibiótica y resultados clínicos. El consumo de antibióticos fue expresado en dosis diarias definidas/100 estancias. RESULTADOS: Se incluyeron 42 pacientes con sepsis grave/shock séptico en el grupo POST-CS y 50 en el grupo PRE-CS. El consumo total de antibióticos (dosis diarias definidas) fue similar en ambos grupos. En el grupo POST-CS la tasa de desescalamiento fue significativamente mayor (75 vs. 30,8%, p < 0,005), mientras que la prescripción de antibióticos de uso restringido fue significativamente menor (74 vs. 52%, p = 0,031). Finalmente, el grupo de pacientes POST-CS presentó una mortalidad intrahospitalaria y a 28 días significativamente menor (23 vs. 44% [p = 0,035] y 31 vs. 56% [p = 0,01]), así como una disminución de la estancia en UCI en el límite de la significación estadística (5 vs. 10,5 días, p = 0,05). CONCLUSIÓN: La implantación de un programa de Código Sepsis intrahospitalario se asoció a una mejor utilización del tratamiento antibiótico, incrementándose significativamente el desescalamiento terapéutico y disminuyendo el uso de antibióticos de uso restringido, así como a una significativa disminución de la mortalidad y una tendencia hacia una menor estancia en UCI

INTRODUCTION: A study was performed to analyze the impact of an in-hospital Sepsis Code (SC) program on use of antibiotic and clinical outcomes. DESIGN: Quasi-experimental observational retrospective study. SETTING: Polyvalent 11 beds ICU belonging to a tertiary Universitary hospital. PATIENTS: Patients admitted consecutively to the ICU with diagnosis of severe sepsis or septic shock. INTERVENTIONS: A post intervention group (POST-SC) (September 2012-August 2013) was compared with a historical group (PRE-SC) used as control (January-December 2010). VARIABLES: Antibiotic treatment, therapeutic antibiotic strategy, mortality and length of stay. Antibiotic consumption was expressed as defined daily doses (DDD)/ 100 stays. RESULTS: 42 patients with SS/SS in POST-SC group and 50 patients in PRE-SC group were consecutively recluted and further analyzed. Total antibiotic consumption (DDD) was similar in both groups. Rate of de-escalation therapy was significantly higher in POST-SC group (75% vs 30,8%, p < 0,005) while prescription of restricted antibiotics was significantly lower (74% vs 52%, p = 0,031). Finally POST-SC patients showed a significantly decrease in hospital and 28 days mortality rates [23% vs 44%, (p = 0,035) and 31% vs 56% (p = 0,014) respectively] as well as a reduction in ICU length of stay compared to PRE-SC cohort (5 days vs 10,5 days, p = 0,05). CONCLUSION: The implementation of a Sepsis Code-hospital protocol is associated to an improvement in the management of antibiotic therapy with a significant increase in de-escalation therapy and lesser utilization of restricted use antibiotics, as well as a significant reduction in mortality, and a tendency towards shorter ICU length stay

Impact of the implementation of a Sepsis Code hospital protocol in antibiotic prescription and clinical outcomes in an intensive care unit. / Impacto de la implantación de un Código Sepsis intrahospitalario en la prescripción de antibióticos y los resultados clínicos en una unidad de cuidados intensivos.

INTRODUCTION: A study was performed to analyze the impact of an in-hospital Sepsis Code (SC) program on use of antibiotic and clinical outcomes. DESIGN: Quasi-experimental observational retrospective study. SETTING: Polyvalent 11 beds ICU belonging to a tertiary Universitary hospital. PATIENTS: Patients admitted consecutively to the ICU with diagnosis of severe sepsis or septic shock. INTERVENTIONS: A post intervention group (POST-SC) (September 2012-August 2013) was compared with a historical group (PRE-SC) used as control (January-December 2010). VARIABLES: Antibiotic treatment, therapeutic antibiotic strategy, mortality and length of stay. Antibiotic consumption was expressed as defined daily doses (DDD)/ 100 stays. RESULTS: 42 patients with SS/SS in POST-SC group and 50 patients in PRE-SC group were consecutively recluted and further analyzed. Total antibiotic consumption (DDD) was similar in both groups. Rate of de-escalation therapy was significantly higher in POST-SC group (75% vs 30,8%, p<0,005) while prescription of restricted antibiotics was significantly lower (74% vs 52%, p=0,031). Finally POST-SC patients showed a significantly decrease in hospital and 28 days mortality rates [23% vs 44%, (p=0,035) and 31% vs 56% (p=0,014) respectively] as well as a reduction in ICU length of stay compared to PRE-SC cohort (5 days vs 10,5 days, p=0,05). CONCLUSION: The implementation of a Sepsis Code-hospital protocol is associated to an improvement in the management of antibiotic therapy with a significant increase in de-escalation therapy and lesser utilization of restricted use antibiotics, as well as a significant reduction in mortality, and a tendency towards shorter ICU length stay.

Aplicación del modelo de Educación Deportiva en segundo de Educación Primaria. Percepciones del alumnado y el profesorado / Sport Education model in second grade. Teachers and students’ perceptions / A aplicação do Modelo de Educação Desportiva no Segundo ano do primeiro ciclo de ensino. Perceções de alunos e professores

El presente trabajo pretende analizar la viabilidad del modelo de Educación Deportiva en segundo de Educación Primaria (7-8 años), a partir del análisis de las percepciones de una alumna en prácticas, su maestra colaboradora y los alumnos participantes, en el desarrollo de una unidad didáctica de balón prisionero. Se analizaron las percepciones de los docentesa través de entrevistas, y las de los alumnos mediante un cuestionario (Physical Education Season Survey; Mohr, Townsend, Rairigh y Mohr, 2003;Hastie y Sinelnikov, 2006) y la realización de dibujos. Los resultados mostraron percepciones muy positivas por parte de docentes y alumnos. Los resultados, en cuanto a dificultades y beneficios percibidos, coinciden conlo mostrado en la literatura tanto nacional como internacional en la percepción del modelo por parte de docentes y alumnos de mayor edad, lo cual parece indicar que el modelo de Educación Deportiva puede implementarse con éxito con alumnos de 7 años (AU)

This work analyzes the appropriateness of implementing Sport Education with second graders, through the experience of a pre-service teacher, the collaborator teacher, and students' perceptions during a teaching unit of Dodgeball conducted following the features of Sport Education. Pre-service teacher's and collaborator teacher's perceptions were analyzed through interviews. Students' perceptions were analyzed through the "Physical Education Season Survey" (Mohr, Townsend, Rairigh y Mohr, 2003; Hastie y Sinelnikov, 2006) and through drawings. Results are consistent with Spanish and international literature conducted with older students, thus, it can be conclude that Sport Education model can be appropriate for students as young as seven years old

Este trabalho analisa a viabilidade de implementar o Modelo de Educação Desportiva no Segundo ano do primeiro ciclo de ensino (7-8 anos), a partir da análise das perceções de um estudante-estagiário, do professor cooperante e dos alunos participantes numa unidade de ensino de dodgeball. As perceções dos professores foram captadas através de entrevistas e as dos alunos por meio de um questionário e da análise de desenhos (Physical Education Season Survey; Mohr, Townsend, Rairigh, y Mohr, 2003; Hastie y Sinelnikov, 2006). Os resultados mostraram que professores e alunos percecionaram ter vivido uma experiência extremamente positiva. A natureza dos benefícios percebidos e dos constrangimentos encontrados estão em concordância com achados anteriores, tanto da literatura espanhola como na internacional, sobre as perceções que professores e alunos mais velhos sustêm sobre o modelo. É fortemente sugerido que o Modelo de Educação Desportiva tem potencial para ser implementado com sucesso também com alunos na faixa etária dos 7 anos

La frecuencia cardiaca fetal en pacientes con diagnóstico de embarazo prolongado / Fetal heart rate in patients with prolonged pregnancy

Se determinaron los valores de la frecuencia cardiaca fetal (FCF) basal y la amplitud de las aceleraciones en pacientes con embarazo prolongado para equipararlos con un grupo testigo. El diseño del estudio fue: abierto, prospectivo, comparativo y exploratorio. La muestra la integraron 40 pacientes, se dividió en 2 grupos: Grupo 1 o problema: 20 pacientes con embarazo prolongado. Grupo 2 o testigo: 20 pacientes con embarazo normal. Con ultrasonido se determinó el diámetro biparietal. Se les practicaron registros de FCF y contractilidad uterina durante 2h.En los grupos problema y testigo, se equipararon la FCF basal y la amplitud de las aceleraciones, en el primer grupo la FCF se incrementó 3 latidos, la diferencia entre medias fue altamente significativa; en la amplitud no lo fue.En 2 trazos de FCF se registraron Dips Tipo II de mediana amplitud en medio de un patrón reactivo. Se elaboraron diagramas de dispersión y se calculó la regresión a una recta, utilizando los valores del diámetro biparietal de productos de embarazo prolongado, la ecuación de la recta fue y=2,2183x+7,6909 y el coeficiente de correlación de R2=0,8877. En el grupo con distribución normal, la ecuación de la recta fue y=2,0344x +12,944; y el coeficiente de correlación de R2=0,9981.En los grupos problema y el testigo, se (..) (AU)

Basal values of fetal heart rate (FHR) and amplitude of the accelerations were determined in patients with prolonged pregnancy and were compared with those in a control group. The study design was open, prospective, comparative and exploratory. The sample consisted of 40 patients divided into two groups. Group 1 (problem group) was composed of 20 patients with prolonged pregnancies. Group 2 (control group) consisted of 20 patients with a normal pregnancy. Ultrasound was used to determine parietal diameter. FHR and uterine contractility were measured for 2 h. Basal FHR and the amplitude of the accelerations in the two groups were compared. In group1, FHR was 3 beats higher and the difference between the means was highly significant. The difference in amplitude was not significant. In two FHR recordings, Type II Dips of moderate amplitude were registered during a reactive pattern. Dispersion diagrams were drawn and the linear regression of the biparietal diameter values of group 1 fetuses was calculated. The equation was y=2.2183x + 7.6909 and the correlation coefficient was R2=0.8877. In group 2 (normal distribution) the linear regression equation was y=2.0344x + 12.944. The correlation coefficient was R2=0.9981.The means of the biparietal diameters of the two groups were also compared but no significant differences were found. The mean values for uterine height and abdominal perimeter were 37.15cm. and 109.10cm, respectively. The physical status of the newborns was evaluated using the Apgar test at 1 and 5 minutes. Three children were born depressed with a score of 2. Three other children were not tested. Fourteen showed a score in the range of 7-8. At 5min their score was 9. Two neonates remained depressed. The weights of the neonates in the two groups were compared and those in group 1 were 418g heavier. The difference between mean weights was significant. Height was not significantly different(AU)

Treatment change in adolescents with social anxiety disorder: insights form corpus linguistics

Despite the efforts made in Clinical psychology, the remission rates of social anxiety disorder are still moderate, which might stem from a lack of sensitivity in the psychological treatment outcome measures. New interdisciplinary perspectives such as the joint efforts of Corpus Linguistics and Psychology are, therefore, being sought. The purpose of this study is to explore if the linguistic insights provided by Corpus Linguistics are of any help when assessing sensitivity on treatment in adolescents with generalized social anxiety disorder. Results revealed the relevance of analyzing adolescents ‘written texts for treatment outcome analysis by examining adolescent´s text based on the triple response system approach (cognitive, somatic and behavioural symptoms) and the DSM criteria for social anxiety disorder. The findings of this interdisciplinary paper are consistent with the DSM-V criteria in the proposed revision for social anxiety disorder (AU)

A pesar de los esfuerzos llevados a cabo por la Psicología Clínica, las tasas de mejoría en el trastorno de ansiedad social aún son moderadas, lo que puede ser consecuencia de una escasez en la sensibilidad de las escalas utilizadas para medir el cambio terapéutico. Por tanto, es necesario buscar el trabajo conjunto interdisciplinar entre campos relacionados, como son la Lingüística de Corpus y la Psicología. En este sentido, el propósito de este trabajo es explorar si la Lingüística de Corpus puede servir para el análisis de la sensibilidad del tratamiento en adolescentes con ansiedad social generalizada. Los resultados mostraron la pertinencia del examen el lenguaje expresado por los sujetos a través de un análisis a partir del triple sistema de respuesta como de los criterios DSM para este trastorno. Los resultados de este artículo interdisciplinar son consistentes con la revisión propuesta del DSM-V para el trastorno de ansiedad social (AU)

La frecuencia cardiaca en fetos con restricción en el crecimiento y desarrollo / Heart rate in fetuses with restricted growth and development

Se determinaron los valores de la FCF y las aceleraciones en fetos con restricción en el crecimiento y desarrollo y se equipararon con un grupo testigo. El estudio fue abierto, prospectivo, comparativo y exploratorio. La muestra la integraron 40 pacientes, se dividió en 2 grupos: grupo 1 o problema: 20 pacientes embarazadas con diagnóstico de RCF; grupo 2 o testigo: 20 pacientes con embarazo normal. Con ultrasonido se determinó el diámetro biparietal del feto. Se realizaron registros de FCF y contractilidad uterina. El estado físico de los RN se valoró con la prueba de Apgar, se les pesó y determinó la talla. En los grupos problema y testigo se equipararon la FCF basal y la amplitud de las aceleraciones. En el primero, la FCF se incrementó 5 latidos y la amplitud decreció 3 latidos, las diferencias fueron altamente significativas. Se elaboraron diagramas de dispersión, se calculó la regresión a una recta utilizando los valores del diámetro biparietal de fetos con restricción en el crecimiento, la ecuación fue y=0,547 x+64,38 y el coeficiente de correlación de R2=0,3561. En el grupo con distribución normal, la ecuación de la recta fue y=2,0344 x+12,944 y el coeficiente de correlación de R2=0,9981.Se equipararon las medias del diámetro biparietal entre los grupos problema y testigo. La diferencia no fue significativa. Se calcularon las medias de la altura uterina y el perímetro abdominal, los valores fueron de 33,45 y 101,15.El estado físico de los RN se valoró de acuerdo con la prueba de Apgar. En el 1.ermin, 2 neonatos nacieron deprimidos con calificación de 6;12, vigorosos con rango de 7–9 y en los 6 restantes no se aplicó la prueba; en el 5.°min la calificación fue de 7–9.Al confrontar los grupos problema y testigo, en primero el peso y la talla de los recién nacidos sufrieron un decremento de 243g y de 2c.p< indicó que las diferencias fueron significativas(AU)

Fetal heart rate (FHR) values and accelerations were determined in fetuses with restricted growth and development and were compared with those in a control group. The study design was open, prospective, comparative and exploratory. The sample consisted of 40 patients divided into two groups. Group 1 (problem group) was composed of 20 pregnant women diagnosed with restricted fetal growth and development. Group 2 (control group) consisted of 20 patients with normal pregnancies. Ultrasound was used to determine the biparietal diameter of the fetuses. FHR and uterine contractility were measured. The Apgar test was used to evaluate neonatal status. Neonates were weighed and measured. Basal FHR in group 1 was 5 beats higher with an amplitude of 3 beats less than in the control group. These differences were highly significant. Dispersion diagrams were drawn and linear regression was calculated for the parietal diameters of fetuses with restricted growth. The equation was y=0.547x+64.38 and the correlation coefficient was R2=0.3561. In the control group the equation for the linear regression was y=2.0344x+12.944 and the correlation coefficient was R2=0.9981.The means of the biparietal diameters of groups 1 and 2 were compared but no significant differences were found. The mean values for uterine height and abdominal perimeter for the two groups were 33.45cm and 101.15cm, respectively. The physical status of the newborns was evaluated using the Apgar test. At 1min, two neonates were depressed with an Apgar score of 6. Twelve neonates were vigorous with scores ranging from 7 to 9 and the six remaining neonates were not tested. At 5min, scores ranged from 7 to 9.When the two groups of neonates were compared, the weights and heights of those in group 1 were 243g and 2cm lower and these differences were significant (p<0.05)(AU)

[Effectiveness of two health interventions to get pregnant women to give up smoking]. / Efectividad de dos intervenciones sanitarias para conseguir el abandono del consumo de tabaco.

OBJECTIVE: To evaluate the effectiveness of the group intervention for getting pregnant women to give up tobacco consumption, measured by means of carbon monoxide levels in air breathed out, compared with a minimum intervention. DESIGN: Randomised clinical trial. SETTING: Four primary care teams from Area 9 of IMSALUD-Madrid. PARTICIPANTS: All the pregnant women attending for consultation with the midwives of the four PC teams involved during the study period, who are smoking at least one cigarette a day when they find out they are pregnant and who want to take part in the study once they have been informed of it. Intervention. The subjects included will be randomised into 2 intervention groups. The minimum intervention will consist of brief personal counselling (3 to 5 minutes) on why they should give up smoking, especially now they are pregnant. The group intervention will involve 3 sessions lasting approximately an hour and a half.

Efectividad de dos intervenciones sanitarias para conseguir el abandono del consumo de tabaco en embarazadas / effectiveness of two health interventions to get pregnant women to give up smoking

Objetivo. Evaluar la eficacia de la intervención grupal para el abandono del consumo de tabaco por embarazadas, medido mediante concentraciones de monóxido de carbono (CO) en aire espirado, frente a la intervención mínima. Diseño. Ensayo clínico aleatorizado. Emplazamiento. Cuatro equipos de atención primaria (EAP) del Área 9 del IMSALUD de Madrid. Participantes. Todas las embarazadas que acudan a la consulta de las matronas de los 4 EAP participantes durante el período del estudio, que fumen al menos un cigarrillo diario en el momento de saber que están embarazadas y que deseen participar en el estudio una vez hayan recibido información sobre éste. Intervención. Las participantes incluidas serán aleatorizadas en 2 grupos de intervención: - Intervención mínima: consistirá en un consejo individualizado y breve (de 3-5 minutos) sobre la conveniencia de dejar de fumar, especialmente en su situación de embarazo.- Intervención grupal: la intervención grupal consistirá en 3 sesiones, de 1,5 horas de duración aproximadamente (AU)

Fobia Social: Revision de los instrumentos de evaluacion validados para poblacion de lengua española / Social phobia: a review of assessment instriment validated for Spanish-speaking populations

El proposito de este trabajo es realizar una revisión de la literatura existente sobre las escalas disponibles actualmente para medir específicamente la fobia social. En este sentido, revisaremos tanto aquellas escalas que han sido diseñadas para población adulta como para población adolescente e infantil y han probado sus propiedades psicometricas en población de lengua española. Finalmente, se discutirán qué escalas son las más adecuadas para ser empleadas en cada período de edad

A technique using a membrane flow cell to determine average mass transfer coefficients and tortuosity factors in biofilms.

Average mass transfer coefficients of an inert compound (LiCI) within denitrifying biofilms were monitored during biofilm growth in a membrane flow cell under different flow conditions, until the biofilm reached (pseudo-) steady state. Average effective diffusivities were found to increase with the decrease tortuosity factors of the biofilm matrix. The lowest tortuosity factor corresponded the highest liquid velocity.

[Atypical regenerative changes, dysplasia, and carcinoma in situ in chronic gastritis associated with Helicobacter pylori]. / Cambios regenerativos atípicos, displasia y carcinoma in situ en gastritis crónica asociada con Helicobacter pylori.

In the present work we study the association between chronic active gastritis (CAG), atypical regeneration and dysplasia and gastric Helicobacter pylori (HP) infection. We study two groups of endoscopic biopsies. Regenerative changes and dysplasia were evaluated according to Gandur-Maymneh et al. classification which was simplified in typical and atypical regeneration, and mild and severe dysplasia. The group I included 94 patients with CAG, 9 with chronic non active gastritis (CNAG) and 2 with normal gastric mucosa. CAG was graded according to activity in; severe 28 patients; moderate 54 patients and; mild 12 patients. HP association in these cases was 100%, 77% and 25%. In cases of CNAG HP was present in 22%, there were not HP in normal gastric mucosa. There were atypical regeneration in 25% of moderate CAG and in 42% of severe CAG. Mild dysplasia was present in 7.5 and 25% in cases of moderate and severe CAG. Two biopsies showed severe dysplasia. In addition, intestinal metaplasia was found in 15% of CAG, the metaplasia was present in 25% of cases with CAG and atypical regeneration; in 54% of cases with mild dysplasia and; in 100% on cases with severe dysplasia. The group II included 9 cases of gastric cancer of intestinal type, 7 cases of diffuse type, and 4 cases of mixed type. In all these cases there was viewed CAG associated to HP infection in non-neoplastic mucosa. In 75% of cases there were showed atypical regeneration and 60% presented some type of dysplasia. There was transition between atypical regeneration and dysplasia in 6 cases of intestinal gastric cancer and in 3 cases of mixed type. We found relationship between the intensity of CAG and HP colonization, and the association with atypical regeneration and dysplasia.

[Breast-feeding]. / Lactancia materna.

In order to promote maternal lactation it is necessary to know what problems prevent it. With this in mind, a survey of 202 mothers who had children between the first of October and the end of November in 1992 was conducted. 91.5% of these mothers began normal lactation, yet 30.7% were incapable of giving milk after one month. A high frequency of lactating failure correlated with women from disadvantaged income groups. Factors that influenced the duration and difficulty of breast feeding were: lactating problems with the previous child, family opinions, rigid feeding schedules, excessive maternal preoccupation, working out of the home. Once the problems were recognized, a second objective of this study was to design a plan that would create positive attitudes toward maintaining natural lactation. After putting this plan to work, a three month study showed that 70.2% of the mothers in a experimental group continued to breast feed, whereas only 39.5% of the control group did. After four months 55% of the variable group was still nursing their children, while the control group fell to 30.2%.

[Abdominal pregnancy. An unusual case]. / Embarazo abdominal. Un caso insólito.

A general review is made about concept, incidence and clinical features of abdominal pregnancy. The early and accurate diagnosis of an abdominal pregnancy is very important in order to avoid catastrophic hemorrhage from placental separation. A case is reported of a young woman hospitalized at Morelia's General Hospital, SSA, with an abdominal pregnancy. The fetus died about 26th week and underwent mummification. Some time later the fetus spontaneously divided and the lower segment extruded through the intestines. The remain upper thoracic and cephalic segment was removed at laparotomy closing an intestine stoma; 60% of the placenta was also removed. The postoperative course was uneventful.