[Duplex sonography in the diagnosis of deep venous thrombosis in the lower limbs]. / Sonografía Duplex en el diagnóstico de trombosis venosa profunda en miembros inferiores.

Duplex ultrasonography (DUS) has shown high sensitivity and specificity in the diagnosis of proximal deep vein thrombosis (DVT). It is now considered the initial procedure of choice for the evaluation of this entity because of its advantages (low cost, non invasiveness, no need for contrast media, no ionizing radiation) and because of the possibility of making other diagnoses, v.g. Baker's cyst. With the development of color Doppler, this study has become easier and now includes the calf and iliac vessels. Nevertheless, it has not improved the sensitivity and specificity of DUS. Phlebography, until now the "golden standard", has become a "second choice" procedure for proximal DVT but it continues to be of value in the evaluation of calf veins, which are more difficult to evaluate with DUS, and other venous pathology.

Sonografía Duplex en el diagnóstico de trombosis venosa profunda en miembros inferiores / Duplex sonography in the diagnosis of deep venous thrombosis in the lower limbs

Duplex ultrasonography (DUS) has shown high sensitivity and specificity in the diagnosis of proximal deep vein thrombosis (DVT). It is now considered the initial procedure of choice for the evaluation of this entity because of its advantages (low cost, non invasiveness, no need for contrast media, no ionizing radiation) and because of the possibility of making other diagnoses, v.g. Baker's cyst. With the development of color Doppler, this study has become easier and now includes the calf and iliac vessels. Nevertheless, it has not improved the sensitivity and specificity of DUS. Phlebography, until now the [quot ]golden standard[quot ], has become a [quot ]second choice[quot ] procedure for proximal DVT but it continues to be of value in the evaluation of calf veins, which are more difficult to evaluate with DUS, and other venous pathology

[Regional pancreatectomy in tumors invading the portal vein]. / Pancreatectomía regional en tumores con invasión a la vena porta.

The authors present the clinical history of a patient who underwent the first regional pancreatectomy performed in Panama. The patient had been operated on one year before and the tumor in the head of the pancreas had been considered unresectable at that time because it had invaded the portal vein. Since the patient was in excellent health and her diabetes and hypertension (diagnosed ten years before) were well controlled, the size of the tumor, as demonstrated in CAT scans, had not changed in one year and the biopsy of the tumor had characterized it as of neuroectodermic origin without regional lymph node involvement, it was decided to perform a regional pancreatectomy. The authors describe the different stages of the resection of the tumor and the anatomical reconstruction. They point out the recommendations of different schools of thought about the operation and report on the excellent results obtained in this patient.

The impact of organization of family planning clinics on waiting time.

Mathematical simulations and structured observations were used to assess factors in family planning clinic procedures responsible for long waiting times for clients. Principal causes of unnecessarily long waiting times in selected clinics of a Mexican program included: inflexibilty of client's routes within the clinic and of staff functions, late arrival of staff, patterns of client arrival times, and the proportion of clients seen by the doctor.

PIP: Waiting times for patients were studied in 6 Mexican clinics. Waiting times were recorded for each step through which the client had to pass, as were the amounts of time spent acutally receiving services at each step. Simulation techniques were employed to estimate the effects altering certain clinic conditions would have on the average total time spent in the clinic. The clinics whose actual waiting times exceed the simulated times are characterized by 1 or more of the following: late arrivals of personnel, wasted time, inflexibility of routes and staff activities, and an inefficient filing system. 3 basic functions are necessary at all clinics--education, medical services, and record keeping. Rigidity in the order of these 3 elements appears to result in increased waiting time.