Taponamiento cardíaco tras movilización de catéter central de inserción periférica / Cardiac tamponade after withdrawal of a peripheral access central catheter

El cateterismo de venas centrales es una técnica de uso muy frecuente, aunque las complicaciones de los catéteres centrales pueden ser múltiples y, en ocasiones, fatal. Presentamos un caso de taponamiento cardiaco por nutrición parenteral pocas horas después de la movilización de un catéter central de acceso periférico colocado días antes. El diagnóstico fue realizado por ecocardiografía, y se realizó una pericardiocentesis urgente, logrando la recuperación total de la paciente. Los catéteres centrales de acceso periférico son más susceptibles de movilización por los movimientos del brazo del paciente, por lo que es importante utilizar catéteres blandos, asegurarse de que la punta se encuentra por encima de la carina para evitar perforaciones de la reflexión pericárdica y realizar una buena fijación a la piel. El diagnóstico debe hacerse lo antes posible, dada la elevada mortalidad de esta complicación, y la herramienta diagnóstica esencial es la ecocardiografía. El tratamiento consiste en la retirada del catéter y la pericardiocentesis urgente (AU)

Central venous catheterization is a very common technique, although its complications can be multiple and sometimes fatal. A case is presented of cardiac tamponade by parenteral nutrition a few hours after moving a central venous catheter peripherally inserted a few days before. The diagnosis was made by echocardiography, and an emergency pericardiocentesis was performed, achieving complete recovery of the patient. Peripherally inserted central venous catheters are more likely to change their position secondary to the movements of the patient’s arm, thus it is important to use soft catheters, make sure the tip lies above the carina to avoid perforation of the pericardial reflexion, and fix it well to the skin. Diagnosis must be made as soon as possible, given the high mortality rate of this complication, and the essential diagnostic tool is echocardiography. Elective treatment consists of early catheter withdrawal and emergency pericardiocentesis (AU)

[Cardiac tamponade after withdrawal of a peripheral access central catheter]. / Taponamiento cardíaco tras movilización de catéter central de inserción periférica.

Central venous catheterization is a very common technique, although its complications can be multiple and sometimes fatal. A case is presented of cardiac tamponade by parenteral nutrition a few hours after moving a central venous catheter peripherally inserted a few days before. The diagnosis was made by echocardiography, and an emergency pericardiocentesis was performed, achieving complete recovery of the patient. Peripherally inserted central venous catheters are more likely to change their position secondary to the movements of the patient's arm, thus it is important to use soft catheters, make sure the tip lies above the carina to avoid perforation of the pericardial reflexion, and fix it well to the skin. Diagnosis must be made as soon as possible, given the high mortality rate of this complication, and the essential diagnostic tool is echocardiography. Elective treatment consists of early catheter withdrawal and emergency pericardiocentesis.

Analysis of human mammary fibroadenoma by Ki-67 index in the follicular and luteal phases of menstrual cycle.

OBJECTIVES: Fibroadenoma is the most common benign mammary condition among women aged 35 or younger. Expression of Ki-67 antigen has been used to compare proliferative activity of mammary fibroadenoma epithelium in the follicular and luteal phases of the menstrual cycle. MATERIALS AND METHODS: Ninety eumenorrheic women were selected for tumour excision; they were assigned to either of the two groups, according to their phase of menstrual cycle. At the end of the study, 75 patients with 87 masses were evaluated by epithelial cell Ki-67 expression, blind (no information given concerning group to which any lesion belonged). RESULTS: Both groups were found to be homogeneous relative to age, menarche, body mass index, previous gestation, parity, breastfeeding, number of fibroadenomas, family history of breast cancer and tabagism. Median tumour size was 2.0 cm and no relationship between proliferative activity and nodule diameter was observed. No typical pattern was observed in the expression of Ki-67 in distinct nodules of the same patient. Average values for expression of Ki-67 (per 1000 epithelial cells) in follicular and luteal phases were 27.88 and 37.88, respectively (P = 0.116). CONCLUSION: Our findings revealed that proliferative activities in the mammary fibroadenoma epithelium did not present a statistically significant difference in the follicular and luteal phases. The present study contributes to clarifying that fibroadenoma is a neoplasm and does not undergo any change in the proliferative activity during the menstrual cycle.

[Latex allergy]. / Alergia al látex.

OBJECTIVE: To review the etiology, diagnosis, prevention and treatment of latex allergy in the hospital setting, and to establish a list of potentially hazardous drugs. METHOD: A literature search was performed. A guide about latex-containing drugs (any component) was developed by contacting manufacturers. RESULTS: The most relevant factor for latex sensitization is exposure extent. Regarding diagnosis the medical history and skin testing are crucial; regarding secondary prevention, identifying the various at-risk groups. Immunotherapy is currently considered a valid option for the management of this condition. CONCLUSIONS: The development of a guide listing latex-containing drugs is essential for the primary prevention of allergic reactions to this substance in hospital.

Morphometric analysis of fibroblasts of the mammary lobular stroma during the follicular and luteal phases of the menstrual cycle.

We determined the nuclear volume of fibroblasts of the normal mammary lobular stroma during the follicular and luteal phases of the menstrual cycle. Twenty patients aged 15 to 35 years and eumenorrheic for at least 6 months were randomly assigned to 2 groups, i.e., 10 women in the follicular phase and 10 in the luteal phase. The nuclear volume was 34.4 micron 3 and 98.8 micron 3 for the follicular and luteal phases, respectively, with the difference being statistically significant (p < 0.05). These data suggest a higher metabolic activity in the mammary intralobular stroma during the luteal phase of the menstrual cycle, probably due to a synergistic action of estradiol and progesterone.

Fasciola hepatica: characterization of somatic and excretory-secretory antigens of adult flukes recognized by infected sheep.

The immune response of sheep to somatic components and excretory/secretory products of adult Fasciola hepatica, was studied during an experimental infection. Antibodies against adult fluke somatic and excretory/secretory antigens were detected by thin layer immunoassay from the second week post infection. Similarly, the results of Western blot analysis showed specific recognition of several components as early as two weeks after infection. However, an increase in the number and intensity of bands with time of infection was observed in the patterns of antigenic recognition. Most notorious was the strong reactivity of all infected sheep sera towards components of 20-23 kDa in the somatic preparation and components of 23-27 kDa in the excretory/secretory products of adult F. hepatica, specially noticeable after the sixth week post-infection. Since these polypeptides were recognized by all infected animals, they could play an important role in the diagnosis of sheep fascioliasis.

[Importance of maternity routines in the success of maternal breast feeding]. / Importancia de las rutinas de la maternidad en el éxito de la lactancia materna.

Many of the problems that are associated with breast-feeding appear to be caused by various postnatal care procedures that take place in the majority of our hospitals. In order to identify these obstacles, a survey was carried out on a sample of 400 mothers whose children were born in Móstoles in 1989. The results were as follows: 1) The average duration of breast-feeding was 2.43 months (SD = 2.19 months). 2) The lower the baby's birth weight and the longer that he was kept in the hospital, the shorter the time that he was breast-fed. Two basic procedures in the hospital "norms" appear to contribute to the failure of breast-feeding. First, the provision of glucose water or formula bottles and second, a ridged feeding schedule. If the newborn was fed on demand in the hospital it tended to be continued once at home. In both the hospital and in the home, on demand feeding was strongly associate with successful breast-feeding. Some simple modifications to the Maternity departments are recommended.

The histopathology of the skin basal cell carcinoma with areas of intermediate differentiation. A metatypical carcinoma?

The histopathology of the skin basal cell carcinomas (BCCs) with areas of intermediate differentiation (ID) has been investigated. In a series of 127 BCCs, areas of ID were found in 28 tumors (22%), and also in an additional 10 cases of other series. These areas consisted of compact masses of cells without peripheral palisading, and with intermediate differentiation between basal and squamous cells. In comparison with the common undifferentiated BCCs, the BCCs with the ID areas may behave in a more aggressive fashion, since they displayed more precocious ulceration in small tumors (p less than 0.001), greater infiltrative features (p less than 0.001), more atypical cells (p less than 0.001) with increased nuclear-cytoplasmic ratio and more mitoses (p less than 0.001). The relation of such basal cell carcinomas to the metatypical carcinoma of the skin was discussed. Metatypical carcinoma, however, has been poorly defined and thus has no general acceptance in the literature. The new definition of the basosquamous cell carcinoma and the presence of intermediate areas of differentiation in this tumor were emphasized, and it was suggested that metastatic basal cell carcinoma and metatypical carcinoma may be the same tumor.