[Sensitivity, specificity, and predictive values of the level of hemoglobin, hematocrit and platelet count as an activity index in ulcerative colitis]. / Sensibilidad, espedificidad y valores predictivos del nivel de hemoglobina, hematócrito y cuenta plaquetaria como índices de actividad en colitis ulcerativa.

INTRODUCTION: Ulcerative colitis (UC) is a disease characterized by relapsing and remitting non-infectious inflammation of the colorectal mucosa. Its heterogeneity makes assessment of the disease's activity a prerequisite for a rational choice of therapy. We aimed to determine sensitivity, specificity, positive and negative predictive values of hemoglobin, hematocrit, and platelets to develop a simplified activity index of UC. MATERIAL AND METHODS: Sixty patients with UC were included and submitted to measurements of hemoglobin, hematocrit, and platelets, as well as sigmoidoscopy and biopsy. Sensitivity and specificity, positive and negative predictive values were correlated with the reported degree of activity in the biopsy. Kruskal-Wallis test was used to determine differences between groups, and Pearson and Spearman rank tests were used to correlate each parameter with the degree of activity. A p value < 0.05 was considered statistically significant. RESULTS: The patients had moderate (n = 15), severe (n = 15), and normal histology as a control group (n = 15). Thirty-four (57%) were female and 26 (43%) were male. Average age was 26 +/- 12.8 years. Sensitivity and specificity for hemoglobin level was 51% and 100% for hematocrit, respectively, 51% and 100% for hematocrit, and 84% and 100% for platelet counts. Spearman's correlation for hemoglobin was r = -0.866 (p < 0.001), for hematocrit r = -0.864 (p < 0.001) and for platelets r = 0.928 (p < 0.001). CONCLUSIONS: Hemoglobin and hematocrit are useful to catalog the degree of activity of UC when it is severe. Platelet count may be a marker of severity at any time, due to its high sensitivity and specificity as a diagnostic test.

[Splenic abscess secondary to massive bee bite in immunocompetent host. A case report]. / Absceso esplénico possiblemente secundario a picadura masiva de abejas en huésped immunocompetente. Reporte de un caso.

INTRODUCTION: Spleen abscesses are considered as an infrequent infectious disease. An increase in its presentation has been seen due to certain pathologies or clinical conditions associated with immune suppression, endocarditis being one of the most frequent causes. Gram-positive aerobes are the main causal agents with non-specific clinical manifestations. CT scan and ultrasound are the elective choices for diagnosis and imaging support for punction and drainage. OBJECTIVE: To describe the case of a patients with splenic abscess and its possible association with massive bee bite. CASE REPORT: A 51-year-old man, with no important medical history, suffered a massive bee bite and developed anaphylactic shock. He was managed at the emergency room where 116 bee stings were removed from the patient. He was discharged after 3 days. Eight days later he complained of abdominal pain localized in the left upper quadrant, persisting for 3 weeks. Abdominal pain increased and was accompanied by malaise, vomiting, fever, signs of peritonitis and leucocytosis. CT scan showed left pleural effusion, a single hypodense lesion in the inferior pole of the spleen, and thickness of the parenchyma. The patient was diagnosed with spleen abscess drained to cavity and was submitted to surgery. Surgical findings included localized peritonitis, friable spleen, and 200 ml of pus. Splenectomy was performed and IV antibiotic therapy was started. Blood culture, viral profile, Widal reactions, and serological test for HIV were negative. Secretion (pus) culture was positive for Enterococcus faecium. CONCLUSIONS: Spleen abscess is a rare entity and unusual diagnosis, representing a high mortality in non-treated patients. According to our search, there is no literature-based evidence of a similar case with this association. This report represents the first case of the association between spleen abscess and massive bee bite.

[Necrotizing mediastinitis in deep neck infections]. / Mediastinitis purulenta en infecciones profundas de cuello.

INTRODUCTION: Mediastinitis is a rare complication of deep neck abscesses with a high mortality. An accelerated extension to the mediastinum can happen before the identification of the primary site of infection, delaying diagnosis and treatment. OBJECTIVE: To report the results of treatment of patients with mediastinitis as a complication of deep neck infection. MATERIAL AND METHODS: Case series. Consecutive patients with mediastinitis secondary to deep neck abscesses, from March 2001 to February 2004. RESULTS: We studied five patients: three males (60%) and two females (40%), mean age 42.2 +/- 18.4 years. In all patients there was at least a 3-day delay before appropriate diagnosis was made. Hospitalization ranged between 1 and 56 days. Symptoms were fever in five cases (100%), dysphagia in four (80%), dyspnea in four (80%), retrosternal pain in three (60%), orthopnea in two (40%), and tachycardia in one (20%). Primary infection sites were of dental origin in four cases (80%) and upper respiratory tract infection in one. Surgical management consisted of cervical and mediastinal drainage with tracheotomy in all patients (100%). Three also required pleurostomy and two required gastrostomy to improve nutritional status. Mean number of surgical procedures was 5.4 +/- 1.8. All patients developed respiratory insufficiency requiring mechanical ventilation. Mortality was 60%. CONCLUSIONS: The delayed diagnosis was common in this case series. The length of hospitalization was long because patients required management with ventilatory support and multiple surgical procedures to limit the infectious process. High mortality is an indication for the early identification and treatment of all cases.

[Academic medicine and gender: women in surgical specialities]. / Medicina académica y género. La mujer en especialidades quirúrgicas.

Scientific advances have always been used as a measure to place societies in the context of developed and developing countries. This circumstance has directly influenced the division among the sexes and among social strata. Traditionally women have been relegated to an inferior status and in some instances their role as active participants in social and economic development has been annulled. In professional spheres, women have reached positions that previously seemed unattainable due to social and cultural limitations imposed by men and sometimes by women themselves. Medical school is currently no longer an obstacle for women to gain entry to, approximately 50% of medical students are women. On the other hand, surgical residences constitute a more complex situation. In order for women to decide to apply to a surgical residence, they have to take into account a variety of factors, among them, the difficulty of joining a male dominated environment where women have to demonstrate they are able and capable of performing sometimes at the expense of having to carry an additional work load. Women admitted to surgical residences will have to face gender discrimination, pregnancy and family responsibilities as well as salary inequities and sometimes even sexual harassment. We aimed to show the circumstances and obstacles that women are confronted with during surgical training and the influence these have in their personal and professional development.

[Peritoneal and intestinal tuberculosis: an ancestral disease that poses new challenges in the technological era. Case report and review of the literature]. / Tuberculosis peritoneal e intestinal: una enfermedad ancestral que impone nuevos retos en la era tecnológica. informe de un caso y revisión de la literatura.

UNLABELLED: Tuberculosis is a public health problem. The most common presentation is pulmonary disease. The diagnosis of any extrapulmonary forms are quite difficult. Clinical manifestations of gastrointestinal tuberculosis are non-specific and compatible with pathologies such as inflammatory bowel disease, advanced ovarian cancer, deep mycosis, yersinia infection and amebomas. Abdominal form is located at 6th place of the extrapulmonary forms, after lymphatic, genitourinary, osteoarticular, miliary and meningeal infections. Eventually, 25 to 75% of patients with abdominal tuberculosis will require surgery. These procedures should be limitated with the purpose to preserve small bowel. Resection should be limitated for complicated cases. The surgical indications include: Intestinal occlusion (15-60%), perforation (1-15%), abscesses and fistulas (2-30%) and hemorrhage (2%). CONCLUSIONS: In most of the cases, the diagnosis of peritoneal or intestinal tuberculosis is made during a laparoscopy or laparotomy even during surgery performed by different purposes. Excessive manipulation of the intraabdominal organs may produced unexpected bowel lesions, increasing morbidity and mortality. Medical treatment is highly effective in the resolution of moderate complications such as bowel obstruction. Resectional procedures should be reserved for complications like perforation, bleeding or stenosis non-suitable for stricturoplasty.

[Restorative proctocolectomy with J-pouch reservoir. Experience in a national medical center]. / Proctocolectomía restaurativa con reservorio ileal en "J". 10 años de experiencia en un centro de especialidades.

OBJECTIVE: To present the experience for morbidity and mortality of surgical treatment of chronic ulcerative colitis (CUC) and familiar adenomatous polyposis (FAP) with restorative proctocolectomy with J-pouch. MATERIAL AND METHODS: We used a cases series of patients treated consecutively from January 1993 to December 2003. Selection criteria were patients with J-pouch restorative proctocolectomy with CUC and FAP who were treated and assessed prospectively. RESULTS: There were 16 cases treated with restorative proctocolectomy (nine males and seven females). Diagnosis of inflammatory bowel disease was established in 12 patients, and 4 with familiar adenomatous polyposis. Age average was 33 years. All cases had protective ileostomy. Seven patients developed at least one complication such as pelvic abscess, uretheral transection, pulmonary thromboembolism, hemoperitoneum, persistent transrectal bleeding, wound infection and sexual impotence. Only four patients required surgical reintervention. The median hospital stay was 11.9 days. Average bowel movements at 3 month-follow-up was 10.1, at 6 months 6.6. Medium average follow-up was 44.25 months. There was no mortality. CONCLUSIONS: Results of this study demonstrated adequate quality of life and appropriate functional results; rate of morbidity was acceptable with no mortality.independent of morbidity there was no mortality. Long-term follow up is necessary to identify long-term-late complications.