[Factors related to work overload that affect health, financial, occupational, and social activities of the primary caregiver]. / Factores relacionados con la sobrecarga que intervienen sobre la salud, las actividades económicas, laborales y sociales de los cuidadores principales de pacientes crónicos.

OBJECTIVE: To determine the areas of the life of primary caregivers (CP) that may be affected by caring for a patient, as well as the CP variables: health, occupational, economic and social problems, as well as the role that CP overload can play. MATERIAL AND METHODS: A descriptive cross-sectional study was conducted on 167 dependent chronic patients and their CPs. It included and analysis on the impact of caring about health, occupational, and economic problems, as well as maintaining social relationships in CP. A record was made of, demographic variables, age and gender, care, activities, time to care. For the dependent patients, the psychosocial typology of their disease, chronology, dependence, disability, and immobility was studied. The Zarit scale reduced by 8 items has been used for the study of the overload of CPs. RESULTS: More than two-thirds (68.8%) of CPs had health problems, 20.9% economic, 19.6% occupational, and 50.9% for positive family and social relationships. The health impact of CPs is related to psychosocial A typology, an increased level of dependence and immobility, gender, and greater number of care activities. The impact on work activities is related to age (66 years) gender, and home coexistence. The impact on social relationships is only related to kinship. Economic problems have no relationship to patient variables. The overload of CPs is related to health, work, financial, and social problems CONCLUSIONS: The health, financial, occupational, and social impact of CPs relate to variables of the sick person and CP, and especially to the overload perceived by the CPs.

[Effectiveness of intra-articular anesthesia in knee arthroscopy]. / Efectividad de la anestesia intraarticular en artroscopía de rodilla.

INDRODUCTION: Knee arthroscopy is one of the most commonly performed procedures. General anesthesia and spinal blockage are the most common forms of anesthesia. We consider that this surgery can be managed with intra-articular local anesthesia, thus avoiding prolonged stays in recovery, with effective pain management and optimization of presurgical, intrasurgical and post-surgical times. MATERIAL AND METHODS: Prospective, quasi-experimental, longitudinal study to compare two anesthetic procedures: intraarticular anesthesia (lidocaine with epinephrine, bupivacaine and fentanyl) without the use of ischemia (group A); spinal blockage and use of ischemia (group B) by assessing age, surgery time, pain during surgery and 24 hour post-op VA scale, time spent in recovery, need to administer general anesthesia or anesthetic rescue doses, 24-hour range of motion. Student t-test, significance level was used: p 0.05 for nonparametric variables and 2 parametric variables. RESULTS: 38 patients were included per group. The surgical time (45 min vs 39 min, p = 0.03), recovery time (1.9 vs 3 hours, p = 0.0004) were lower in group A, while pain during surgery was greater (17 vs 3%, p = 0.09), without requiring general anesthesia. CONCLUSION: The advantages in favor of intraarticular anesthesia were: shortened hospital stays, less pain at 24 hours, safety in its application. Its disadvantage is the possibility of pain during surgery and sedation is sufficient as adjuvant.

INTRODUCCIÓN: La artroscopía de rodilla es uno de los procedimientos que más comúnmente se realizan para tratar esta articulación. La anestesia general y el bloqueo espinal son las modalidades de anestesia más comunes para este procedimiento. Consideramos que esta cirugía se puede manejar con anestesia local intraarticular, con lo que se evitan estancias en recuperación más prolongadas; tiene un mejor manejo efectivo del dolor y optimización de tiempos prequirúrgicos, intraquirúrgicos y postquirúrgicos. MATERIAL Y MÉTODOS: Estudio prospectivo, cuasiexperimental y longitudinal, realizado para comparar dos procedimientos anestésicos: la anestesia intraarticular (lidocaína con epinefrina, bupivacaína y fentanil) sin uso de isquemia (grupo A) y el bloqueo espinal y uso de manguito de isquemia (grupo B). Ambos procedimientos se calcularon mediante la evaluación de la edad, el tiempo de cirugía, el dolor transquirúrgico y a las 24 horas mediante escala EVA, el tiempo de estancia en recuperación, la necesidad de administrar anestesia general o dosis anestésica de rescate y los grados de flexión a las 24 horas en el postquirúrgico. Se utilizó prueba t de Student con un nivel de significación p 0.05 para variables no paramétricas y 2 para variables paramétricas. RESULTADOS: Se incluyeron 38 pacientes por cada grupo. El tiempo quirúrgico fue de 45 contra 39 minutos (p = 0.03); el tiempo en recuperación: 1.9 contra 3 horas (p = 0.0004), el cual fue menor en el grupo A, mientras que el dolor transquirúrgico fue mayor (17 contra 3% [p = 0.09]), sin requerir anestesia general. CONCLUSIONES: Las ventajas a favor de la anestesia intraarticular fueron: estadías hospitalarias cortas, menor dolor a las 24 horas y seguridad en su aplicación. Su desventaja es la probabilidad de dolor transquirúrgico, siendo suficiente la sedación.

Oncological Evaluation by Positron-emission Tomography, Circulating Tumor Cells and Alpha Fetoprotein in Patients With Hepatocellular Carcinoma on the Waiting List for Liver Transplantation.

INTRODUCTION: The objectives of this study are the determination of the number of circulating tumor cells (CTCs), by means of the IsoFlux enrichment system (Fluxion Biosciences Inc, San Francisco, California, United States) in patients with hepatocellular carcinoma (HCC) in compliance with the Milan criteria and on the waiting list for hepatic transplantation, as well as the study of its relation with the of α-fetoprotein levels (AFP) and positron-emission tomography-computed tomography (PET-CT) findings. PATIENTS AND METHODS: An oncologycal evaluation with PET-CT, CTCs, and AFP was conducted in 24 consecutive patients with HCC eligible for orthotopic liver transplantation according to the Milan criteria. The diagnosis of HCC was made according to clinical, biological, and radiological findings. RESULTS: We detected CTCs in peripheral blood in 21 of 24 patients (87.5%) before liver transplantation, with a mean number CTCs of 156 ± 370 (range, 2 to 1768) with statistically significant association between number of CTCs detected in peripheral blood and the time within the waiting list (P < .05), but not betwen AFP levels and standard uptake value and time to orthotopic liver transplantation (P > .05). CONCLUSIONS: PET-TC, CTCs, and AFP levels could be an essential key for the correct management of the patients with HCC on the waiting list for liver transplantation.

Prognostic Value of 18-Fluorodeoxyglucose-Positron Emission Tomography After Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma Undergoing Orthotopic Liver Transplantation.

INTRODUCTION: The aim of this study was to analyze the correlation between 18-FDG positron emission tomography (PET)/computed tomography (CT), histological necrosis, and prognosis after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) patients undergoing orthotopic liver transplantation (OLT). PATIENTS: From January 2007 through December 2013, 81 patients with HCC and liver cirrhosis were included in our liver transplantation program. For this study we selected patients who underwent 18-FDG PET/CT pre-TACE and post-TACE. All patients underwent liver transplantation within 8 weeks after PET/CT. RESULTS: Twenty patients with a median age of 58 years (range, 46-69 years) underwent an 18-FDG PET/CT before and after TACE. The median Standardized Uptake Value (SUV) before TACE was 3.8 (range, 2.6-8.7), with a median post-TACE SUV of 0% (range, 0-4). Among patients whose post-TACE SUV decreased to <3, >70% necrosis was observed upon study of a hepatectomy sample, with a survival rate of 100% and 80% at 1 and 3 years, respectively. CONCLUSION: In conclusion, performance of an 18-FDG PET/CT before and after TACE with comparison of SUV values among patients with HCC awaiting OLT provided valuable information regarding the effectiveness of TACE.

Multidisciplinary Approach in Hepatocellular Carcinoma in a Level II Hospital: The First Decade of Hospital Universitario Fundacion Alcorcon.

BACKGROUND/AIMS: Mean survival in hepatocellular carcinoma remains low. Many efforts have been done during the last years through screening, diagnosis and treatment to improve the results. The aim of this work is to present the experience of our hospital multidisciplinary group during the first decade of this century. METHODOLOGY: The patients with hepatocellullar carcinoma presented at the multidisciplinary meeting from 1999 to 2009 were prospectively studied. According to the tumor and functional status they were treated through the current available guidelines by transplant, partial hepatectomy, local/regional procedures, systemic or symptomatic treatment. RESULTS: One hundred and forty two patients were studied. Median tumor size was 3 cm. A single tumor was diagnosed in 64.8% of the patients. Eighteen patients had liver resection (6 transplantation and 12 with partial resection), 53 tumors were not treated due to advanced stage or liver dysfunction, and in the remaining patients radiofrequency, ethanol or embolization treatments were used, single or combined. CONCLUSIONS: a multidisciplinary approach of hepatocellular carcinoma in a second level hospital with trained professionals permits a diagnosis in early tumoral and functional stages in the majority of patients, and a variety of possible treatments with adequate survival outcomes.

Influence of breeding season on fecal glucocorticoid levels in captive Greater Rhea (Rhea americana).

Sex hormones and stress-related changes can be seasonally influenced. We investigate whether fecal glucocorticoid metabolite (FGM) levels can differ between male and female captive Greater Rheas during the breeding and non-breeding seasons. Over a 3-year-period, fresh fecal samples from 10 individuals (five of each sex) were collected during the breeding months (October, November, and December) and non-breeding months (April and June). A total of 960 samples were assayed using a commercial radioimmunoassay. Results showed that FGM levels (mean ± SE) were affected by the breeding season in a sex-dependent way. Male Greater Rheas showed significantly higher FGM levels in the breeding months than in the non-breeding months (13.44 ± 0.37 vs. 7.92 ± 0.1 ng/g feces, respectively). By contrast, females did not show FGM seasonal changes throughout the same sampling periods (7.55 ± 0.14 vs. 7.26 ± 0.73 ng/g feces). Moreover, during the breeding season months, males showed higher average FGM levels than females (13.44 ± 0.37 vs. 7.55 ± 0.14 ng/g feces, respectively), and no differences were found between sexes during the non-breeding season (7.92 ± 0.1 vs. 7.26 ± 0.73 ng/g feces, respectively). Our findings suggest that male Greater Rheas have a higher adrenocortical activity during the breeding season, which is probably indirectly related to the increased testosterone levels and agonist interactions that are also observed during that phase. Studies aimed to determine the appropriate sex ratio for captive rearing should be developed to minimize male agonist encounters and therefore improve welfare of the captive group.

The influence of diet composition on egg and chick traits in captive Greater Rhea females.

1. This study was conducted to evaluate the influence of diet composition on egg number, physical and chemical characteristics of eggs and weight and survival of chicks throughout a breeding season in a captive-bred population of greater rheas (Rhea americana). 2. From August to December, individuals were offered two diets: processed feed for rheas and processed feed for chicken (which is the feed most commonly offered to farmed rheas in Argentina). Reproductive performance of 15 females was monitored and female body weight was recorded before egg-laying onset. Within each experimental group, the following variables were determined: egg morphometric variables and percentage of components, fatty acid composition, hatching success and initial weight of chicks and mortality during the first week of life. 3. Females that were fed on processed feed for rheas delayed onset of laying and reduced laying period and number of eggs produced. However, females of this group laid larger eggs, with higher percentages of yolk and yolk lipids, and exhibited higher hatching success and chick weight compared with those that received chicken diet. Survivorship of chicks in their first week of life was not affected by composition of the diet offered to parental female. 4. Some reproductive parameters of captive greater rhea females fed on processed feed for rheas were higher than those of individuals receiving processed feed for chicken.

Behavioral responses to short-term transport in male and female Greater Rheas (Rhea americana) reared in captivity.

Animal transport is an indispensable practice in species that need to be moved for management or commercial purposes. However, transport may have negative effects on individuals' welfare. The aims of the present work were to determine if the behavioral responses of adult Greater Rheas (Rhea americana) bred in captivity are sensitive to short-term transport and if males and females differ in their posttransport behavioral activity and recovery. Eight males and 8 females were placed in individual pens and allowed 6 d to habituate (d 1 to 6) before transport procedure. On the transport day (d 7), half of the birds (4 males and 4 females) were randomly assigned to a transport group that was captured and handled to be placed into the crates, exposed to a 30-min transport stressor, and immediately returned to their pens. Four transports with 1 different male and female each time were performed. The other half remained undisturbed and were used as controls. Behavior of all individuals was video-recorded during habituation days, after transport on d 7, and on the 2 following days (d 8 and 9) to evaluate pre- and posttransport behavioral activity for 2 h per day. No significant behavioral changes were observed during the last 2 d of the habituation period (d 5 and 6), suggesting that Greater Rheas were adapted to the housing conditions before transport. After transportation, several behaviors were affected: transported males and females showed null resting, transported females also showed reduced preening and increased vigilance (P < 0.05), whereas transported males showed increased drinking (P < 0.05) compared with their respective control groups. The results suggest that behavioral responses of captive-bred Greater Rheas are sensitive to short-term transport (which includes handling) and that males and females differ in their posttransport behavioral activity, recovering their overall basal levels on the third day posttransportation.

Corticosterone stress response of Greater Rhea (Rhea americana) during short-term road transport.

The effect of transport stress on blood corticosterone levels in captive Greater Rheas was investigated. Twelve adult individuals (7 males; 5 females) were loaded in pairs inside wooden crates and transported along a paved road for 30 min. Blood samples were taken before the individuals were introduced into the crate (baseline value) and immediately after they were unloaded (30 min after capture). To assess whether corticosterone levels were affected by the blood sampling procedure per se, another 6 (nontransport) control birds (3 males; 3 females) were also captured and sampled at the same times as their transported counterparts. Plasma corticosterone concentrations were measured using a commercially available corticosterone (125)I radio-immunoassay kit. Baseline corticosterone levels were similar in the control and transported birds (9.0 ± 1.6 and 10.4 ± 0.8 ng/mL, respectively). Transportation induced a highly significant (P < 0.001), more than 40-fold increase in the corticosterone levels (433.6 ± 35.4 ng/mL) that was about 5 times higher (P < 0.001) than in their nontransported counterparts (88.4 ± 14.8 ng/mL). The present findings suggest that Greater Rhea is a species highly sensitive to stressful manipulations. Both blood sampling and transportation induced highly significant adrenocortical responses. Considering that transportation is one of the unavoidable common practices in the management of Greater Rheas and, as shown in the present study, that it induces a significant 40-fold corticosterone stress response, efforts should focus on helping to generate management transport standards for optimization of the welfare of this ratite.

Efficiency of the cloacal sexing technique in greater rhea chicks (Rhea americana).

1. The feasibility and accuracy of the cloacal sexing technique in greater rhea chicks was assessed using chicks of two captive populations of greater rhea in Córdoba, Argentina. 2. A total of 46 greater rhea chicks of 2 to 3 months of age were randomly arranged into three groups and the members of each group were sexed by a different operator. 3. A feather of each chick was plucked for sexing through a molecular method and results were used as controls. 4. Sex was correctly assigned by cloacal inspection in 98% of the cases. Chick manipulation was easily performed and no infections or traumatic lesions were observed a posteriori. 5. Cloacal sexing of rhea chicks up to 3 months of age does not affect animal welfare and should be considered an efficient alternative to molecular methods.

[Postoperative management of postpneumonectomy pulmonary edema in a patient with ostium secundum atrial septal defect]. / Edema postneumonectomía en paciente con comunicación interauricular tipo ostium secundum. Manejo postoperatorio.

We report the case of a 55-year-old woman who underwent right pneumonectomy for invasive squamous cell carcinoma. At 48 hours after surgery she developed severe dyspnea and hypoxemia that required reintubation and a progressively higher inspired oxygen fraction. A radiograph demonstrated pulmonary edema; echocardiography revealed an ostium secundum atrial septal defect with increased flow to the lung and severe pulmonary hypertension. Emergency percutaneous closure of this defect was carried out. This case report describes the management and treatment of postpneumonectomy pulmonary edema and atrial septal defect, as well as the circumstances that favor their development. We recommend that cardiac defects be investigated and possible treatment be considered prior to pneumonectomy.

May captive populations of Greater Rhea (Rhea americana) act as genetic reservoirs in Argentina?

The Greater Rhea (Rhea americana) is a characteristic bird of the Argentine Pampas. Despite the increasing farming interest of this ratite, their natural populations are progressively decreasing in size and range. The object of this study was to evaluate the status of captive populations as potential genetic reservoirs. Using Inter-Simple Sequence Repeats as molecular markers, levels of genetic variability of F1 individuals from two captive populations were estimated and compared with those of wild populations in the same region. The captive populations were polymorphic for 12.22 and 13.33% of the loci, with a genetic diversity of 0.050. Differences with wild populations were not significant (z=1.79; P>0.05). Therefore, captive populations of rheas in Argentina should not be overlooked as genetic reservoir and source of individuals for reinforcement of natural populations, through reintroduction and translocation.

Effect of age and body weight of Greater Rhea (Rhea americana) females on egg number, size and composition.

1. A study was conducted to evaluate how body weight and age of each female are related to the number and physical and chemical characteristics of the eggs produced throughout a breeding season in a captive-bred population of Greater Rheas (Rhea americana). 2. Reproductive performance of 15 females of three age classes (5 individuals per class) was monitored; female body weight was recorded before laying-onset. All the eggs laid were collected and identified, and different morphometric variables, percentage of components and fatty acid composition were determined. 3. The earlier the female started egg-laying, the longer the laying period and the greater the overall number of eggs produced. The onset of egg-laying in turn seemed to be related to the attainment of a high body weight. 4. Except for length, the values of the morphometric variables of the egg and unsaturated fatty acids (palmitoleic, oleic and linoleic) increased with female age. 5. High body weight was associated with low palmitic and palmitoleic fatty acids and high linoleic, linolenic and total unsaturated fatty acids. 6. Live weight and age of females can determine several physical and chemical characteristics of eggs.

Assisted reproductive technologies in public and private clinics.

The aim of this study was to analyse the influence of the type of service provided by assisted reproduction clinics. The activities, treatment patterns and results achieved by assisted reproduction centres in Spain were examined, comparing public and private clinics. A retrospective study was carried out using the Assisted Reproductive Technology Register of the Spanish Fertility Society for 2002-2004. The results showed that 74%, 96% and 99% of IVF/intracytoplasmic sperm injection, oocyte donation and preimplantation genetic diagnosis cycles, respectively, were carried out in the private sector. Public clinics performed proportionally more transfers of three embryos than the private clinics (48.1% versus 41.7%). More elective transfers were performed in private clinics. Pregnancy rates per cycle started, per puncture and per transfer were significantly higher among private than public clinics (29.1%, 32.7% and 35.9% versus 25.2%, 28.5% and 32.6%, respectively) (P < 0.05). Implantation rate has risen year on year in both types of clinic and was significantly higher (P < 0.05), every year, among the private clinics. The multiple-pregnancy rate was significantly higher among the private clinics (30.8% versus 26.4%) (P < 0.05). In conclusion, differences exist between public and private clinics as regards to their volume of activity, the range of services offered, clinical practice and results achieved.

Diagnostic yield of brush cytology for biliary stenosis during ERCP.

AIM: To evaluate the diagnostic yield of brush cytology for biliary strictures detected on ERCP when a systematic approach is used. PATIENTS AND METHODS: Data on 62 consecutive patients with a biliary stricture on ERCP were collected. Cytological samples were processed immediately after brushing in the endoscopy room, and all were analyzed by the same pathologist. For the statistical analysis specimens were classified as positive, negative, suspicious for malignancy (presence of atypias), and unsatisfactory for evaluation. Final diagnosis was based on either histopathologic (surgery or biopsies by other techniques) or clinical/radiographic diagnosis. RESULTS: A total of 71 cytological specimens were included. Definite diagnosis was malignancy in 49 samples, and benign stricture in 22. Three samples were excluded because of insufficient material or processing artifacts. The sensitivity of biliary brushing was 62% (95% CI 0.47-0.77), specificity was 100%, positive predictive value was 100%, and negative predictive value was 58% (95% CI 0.43-0.75). When suspicious samples were included as malignant, sensitivity was 67% (95% CI 0.54-0.81) without changes in the remaining parameters. Eight patients underwent more than one ERCP. Repeated brush cytology exams in these patients yielded a definitive diagnosis in every case. CONCLUSIONS: Brush cytology has intermediate sensitivity with a high specificity. A systematic approach with a dedicated pathologist and the inclusion of significant atypias as malignant results improves sensitivity. Due to its simplicity brush cytology should be performed in all cases of biliary strictures detected on ERCP, and in case of repeated ERCPs additional cytology brushings are recommended.

Rentabilidad diagnóstica de la citología por cepillado de las estenosis biliares durante la CPRE / Diagnostic yield of brush cytology for biliary stenosis during ERCP

Objetivo: evaluar la rentabilidad de la citología por cepillado de las estenosis biliares diagnosticadas por CPRE cuando se aplica una metodología sistemática. Pacientes y métodos: se recogieron muestras de 62 pacientes consecutivos con estenosis biliares diagnosticadas mediante CPRE. Las muestras citológicas eran procesadas en la sala de endoscopias inmediatamente a su obtención y analizadas por el mismo patólogo. Para el análisis estadístico se clasificaron los casos como positivos o negativos para malignidad, sospechosos (presencia de atipias) y no válidos. Los patrones de referencia fueron el estudio de las piezas quirúrgicas, biopsias por otros métodos, o la evolución clínica y/o radiológica compatible. Resultados: fueron incluidas un total de 71 citologías. El diagnóstico fue malignidad en 49 casos, benignidad en 22 casos, y 3 muestras fueron excluidas por material insuficiente o artefactos de procesamiento. La sensibilidad de la técnica fue del 62% (IC 95% 0,47-0,77), la especificidad del 100%, el valor predictivo positivo del 100% y el valor predictivo negativo del 58% (IC 95% 0,43-0,75). Al incluir las citologías sospechosas como malignas la sensibilidad fue del 67% (IC 95% 0,54-0,81) sin modificarse el resto de parámetros. En ocho pacientes fueron necesarias nuevas CPRE durante las cuales se repitieron las tomas citológicas, llegando a un diagnóstico de certeza en todos ellos. Conclusiones: la citología biliar presenta una sensibilidad intermedia con elevada especificidad. Una metodología sistemática con un patólogo dedicado y la inclusión de las citologías con atipias celulares como malignas mejora la sensibilidad de la técnica. Dada su sencillez creemos que debe de realizarse en todos los casos de estenosis biliar observada durante una CPRE, incluyendo la repetición de las tomas citológicas siempre que sea necesario practicar más de una CPRE en el mismo paciente(AU)

Aim: to evaluate the diagnostic yield of brush cytology for biliary strictures detected on ERCP when a systematic approach is used. Patients and methods: data on 62 consecutive patients with a biliary stricture on ERCP were collected. Cytological samples were processed immediately after brushing in the endoscopy room, and all were analyzed by the same pathologist. For the statistical analysis specimens were classified as positive, negative, suspicious for malignancy (presence of atypias), and unsatisfactory for evaluation. Final diagnosis was based on either histopathologic (surgery or biopsies by other techniques) or clinical/radiographic diagnosis. Results: a total of 71 cytological specimens were included. Definite diagnosis was malignancy in 49 samples, and benign stricture in 22. Three samples were excluded because of insufficient material or processing artifacts. The sensitivity of biliary brushing was 62% (95% CI 0.47-0.77), specificity was 100%, positive predictive value was 100%, and negative predictive value was 58% (95% CI 0.43-0.75). When suspicious samples were included as malignant, sensitivity was 67% (95% CI 0.54-0.81) without changes in the remaining parameters. Eight patients underwent more than one ERCP. Repeated brush cytology exams in these patients yielded a definitive diagnosis in every case. Conclusions: brush cytology has intermediate sensitivity with a high specificity. A systematic approach with a dedicated pathologist and the inclusion of significant atypias as malignant results improves sensitivity. Due to its simplicity brush cytology should be performed in all cases of biliary strictures detected on ERCP, and in case of repeated ERCPs additional cytology brushings are recommended(AU)

Fístula humerohumeral como técnica de recurso en pacientes sin patrimonio venoso superficial / Brachiobrachial fistula as a last-resort technique in patients with no surface venous pool

Introducción. El constante incremento de la población renal crónica junto con su mayor supervivencia nosobliga a optimizar el patrimonio venoso para la realización de accesos vasculares autólogos, pues éstos presentan unamenor tasa de complicaciones y una mayor permeabilidad que los protésicos. Casos clínicos. Presentamos dos pacientescon insuficiencia renal crónica terminal en hemodiálisis, con múltiples antecedentes de fístulas arteriovenosas (FAV) antólogas,todas ellas trombosadas, que no presentaban un patrimonio venoso superficial válido para realizar nuevos accesosautológos. A ambos se les realizó una FAV humerohumeral con superficialización venosa y mostraron una buenapermeabilidad del acceso, lo que fue útil para poder proseguir con sus sesiones de diálisis periódicas, de manera que sepudo demorar la realización de un acceso vascular protésico. No hubo ninguna complicación relacionada con la técnicaquirúrgica ni para la canulación de ésta. Conclusión. A través de estos dos casos describimos esta técnica quirúrgica yla planteamos como una posible alternativa en aquellos pacientes que no presentan un patrimonio venoso superficial apto.En un futuro esta técnica puede llegar a formar parte del algoritmo de manejo de los pacientes con insuficiencia renalcrónica terminal que precisan la realización de un acceso vascular

Introduction. The steady increase in the population suffering from chronic renal failure together with longersurvival times means that it is necessary to optimise the venous pool for performing autologous vascular accesses, sincethese offer a lower rate of complications and greater patency than prosthetic accesses. Case reports. We report the casesof two patients with terminal chronic renal failure on haemodialysis who did not present a valid superficial venous poolfor performing new autologous accesses; both patients had a history of numerous antologous arteriovenous fistulas(AVF), all of which had thrombosed. Brachiobrachial AVF with venous superficialisation was performed and patency ofthe access was seen to be good in both cases. This was useful in enabling them to continue with their periodical dialysissessions and made it possible to delay having to create a prosthetic vascular access. There were no complicationsrelated to the surgical technique or to the cannulation that was carried out. Conclusions. This surgical procedure isdescribed through these two cases and we suggest it as a possible alternative in patients who do not have a suitablesuperficial venous pool. In the future this technique may become part of the management algorithm for patients withterminal chronic renal failure in whom it is necessary to carry out a vascular access

Coefficients for the estimation of fresh weight and volume of Greater Rhea eggs.

1. Specific values of constants needed to estimate fresh weight (Kw) and volume (Kv) of Greater Rhea eggs were obtained. 2. The average value for the weight coefficient (Kw) was 0.57, whereas that for volume (Kv) was 0.51. Accuracy of results obtained with these values was +/-2.1% and +/-3.5%, respectively. 3. The fresh weight and volume of Greater Rhea eggs can be easily estimated by means of these specific coefficients when those measurements cannot be taken directly.

Phospholipase A2 activity in platelets of patients with primary thrombocythemia.

Patients with primary thrombocythemia (PT) have both, bleeding and thrombotic events. Although platelet aggregation tests are usually abnormal, synthesis of thromboxane B2 (TxB2) by platelets is increased. This feature could be the consequence of an increased phospholipase activity or a facilitated metabolism of arachidonate by prostaglandin synthetase pathway. We studied the activity of phospholipase A2 as well the arachidonate metabolism in platelets of patients suffering from PT. Eleven patients and 11 controls were included. Platelets were labelled with [14C]arachidonic acid ([14C]AA). Lost of radioactivity from phospholipids and new radioactive prostanoids were evaluated in calcium ionophore A23187 activated platelets, to explore phospholipase A2 activity. This assay was also carried out in aspirin-incubated platelets. We also studied the formation of prostanoids in platelets activated by radioactive free arachidonic acid. Platelet aggregation studies of patients were abnormal. [14C]AA incorporation in platelet phospholipids was normal. Ionophore activated platelets from patients and controls lost 26.1 +/- 8.3% and 24.1 +/- 10.5% of radioactivity, respectively, mainly from phosphatidylcholine. The main arachidonate metabolite was 12-L-hydroxy-5,8,10,14-eicosatetraenoic acid (HETE), which comprised 14.1 +/- 5.1% of the radioactivity released from phospholipids in patients, and a similar amount in the controls (14.4 +/- 7.5%). Formation of TxB2 was also similar in patients (5.5 +/- 1.2%) and controls (4.9 +/- 2.9%). Formation of 12-L-hydroxy-5,8,10-heptadecatrienoic acid (HHT) was also normal. Ionophore A23187 activation of aspirinized platelets of patients released 19.5 +/- 7.4% of radioactivity from phospholipids, which was completely metabolized to HETE. Formation of prostanoids HETE, HHT and TxB2 by arachidonic acid activated platelets of patients was normal. Phospholipase A2 activity as well both cyclooxygenase and lipoxygenase activities in platelets of patients with PT were found to be normal.

Emergence of chronic myelogenous leukemia in a patient with primary thrombocythemia and absence of BCR/ABL rearrangement.

A 65-year-old woman presented with clinical features of primary thrombocythemia (PT), and absence of the BCR/ABL fusion gene. She responded to hydroxyurea treatment, although after 1 year she required progressive increases in the dose. Six years later, she maintained a high platelet count despite hydroxyurea at 2 g/day and treatment was changed to anagrelide. After 3 weeks, both platelet and leukocyte counts increased. A karyotype study detected the Philadelphia chromosome in all of the 24 metaphases studied. Fluorescent in situ hybridization (FISH) analysis revealed the BCR/ABL rearrangement. The patient was treated with imatinib mesylate and achieved a normal platelet and leukocyte count in 3 weeks. Patients presenting clinical features of PT expressing the Ph chromosome or the BCR/ABL fusion gene have been well documented but, to our knowledge, this is the first report of evolution from typical PT to chronic myeloid leukemia.