[Lumbar herniated disks treated with a dynamic interspacer]. / Hernias discales lumbares tratadas con interespaciador dinámico.

UNLABELLED: Lumbar herniated disks result in lumbar pain with neurologic involvement. Medical treatment and rehabilitation provide improvement for this type of lumbar pain at the early stages. When conservative treatment fails, the surgical option offers the possibility of improving patients' health status. Moojen considers that the application of interspinous spacers provides good results. The purpose of this research is to assess the clinical and imaging results in patients with contained lumbar herniated disk treated with the DYNAMIC INTERSPACER interspinous spacer, a Mexican product. MATERIAL AND METHODS: The efficacy of the interspinous device was assessed by means of a near-investigational and longitudinal study conducted at "General Ignacio Zaragoza" ISSSTE Regional Hospital in patients with a diagnosis of lumbar pain. RESULTS: The mean age of the sample is 46.1 years, with an age range of 26-55 years. The treated levels were 6 L5-S1 and 5 L4-L5; two levels were treated in two patients. The mean preoperative VAS score was 8.1. The mean VAS score at postoperative year three was 1.6. CONCLUSION: Multiple types and brands of foreign interspinous devices are applied in Mexico which results in patients' clinical improvement. We proved that the use of the Mexican interspinous device can clinically improve patients with lumbar pain due to herniated disk. A decrease in the compression of the sac or the nerve roots by the hernia was observed in the comparative preoperative and postoperative MRI images.

[Infected pseudoarthrosis of the tibia, a pediatric case. Case report and literature review]. / Seudoartrosis infectada en tibia, un caso infantil. Caso clínico y revisión de la literatura.

Chronic posttraumatic osteomyelitis and infected pseudoarthrosis of the tibia are complex problems associated with considerable morbidity which may compromise the viability of the involved limb. The most frequent age of presentation is 2 to 6 years, with predominance in males at a 2:1 ratio. We present the case of a male 4 year-old patient with diagnosis of infected pseudoarthrosis. During the physical exam a fistula was detected in the anterior aspect of the right leg, with discharge of purulent material, and inability for weight bearing and gait. X-rays, culture of the exudate and biopsy were performed. Treatment consisted of antimicrobial therapy, surgical debridement's, and application of an autologous bone graft. The infection was controlled, the tibia healed, and function was restored.

Hacia una nueva salud pública en Latinoamérica / Towards a new public health in Latin America

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Necesidades básicas insatisfechas / Basic needs unsatisfied

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La culpa fue de Hipócrates / It was all Hippocrates' fault

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The uptake and distribution of buried radionuclides by pocket gophers (Thomomys bottae).

Material Disposal Area G (Area G) at the Los Alamos National Laboratory is a low-level radioactive waste disposal facility. The noticeably high activity of pocket gophers on closed waste burial sites of various types at Area G resulted in the need to understand possible interactions between gophers and radioactive waste. Fossorial animals can influence the fate of contaminants by directly burrowing into waste trenches, pushing contaminated soil to the surface, or through indirect mechanisms such as consumption of contaminant-laden vegetation or the ingestion of soil. In our study, pocket gophers, mound soil, surface soil, and vegetation were collected at Area G and at offsite reference locations. The samples were analyzed for 241Am, 238Pu, 239Pu, 3H, and total U. It did not appear that gophers were responsible for any upward transport of radionuclides. Concentrations of 241Am, 238Pu, 239Pu, and 3H in some gophers, soil, and vegetation were higher than at reference sites; however, only 3H in gopher carcasses at only one of five sites within Area G was higher than a conservative ecological screening level.

[Dynamic high-contrast computed tomography in the diagnosis of pancreatic necrosis]. / Tomografía computada dinámica de alto contraste en el diagnóstico de necrosis pancreática.

UNLABELLED: This work intended to find out whether dynamic high-contrast computed axial tomography (CAT scan) in effective and more useful than conventional computed tomography for the diagnosis of pancreatic necrosis in patients with severe acute pancreatitis. BACKGROUND: Although many methods have been used to predict the severity and extent of pancreatic necrosis, few studies have assessed computed tomography. METHODS: Longitudinal, prospective and comparative study was performed on consecutive patients with severe acute pancreatitis in which dynamic high-contrast computed tomography and conventional computed tomography were carried out. RESULTS: In pancreatic necrosis, pancreatic densities were lower. Necrosis by itself was also associated with higher severity scores, but not with a higher mortality rate. However, mortality rates were influenced by the extent of pancreatic necrosis. Sensitivity of 100%, specificity of 68%, positive predictive and negative predictive values of 100 and 42% were achieved. STATISTICS: Densities of TCNL and TCAC were analyzed using student's t test of independent samples. The correlation of the aorta/pancreas index and the presence of necrosis was analyzed using a linear correlation test. CONCLUSIONS: The authors conclude that dynamic high-contrast computed tomography is more effective than conventional computed tomography in diagnosing pancreatic necrosis. Moreover, the diagnosis of pancreatic necrosis and its extent makes it possible to formulate a prognosis as to severity of the disease.

[Pancreatic abscess. Extraperitoneal drainage]. / Absceso pancreático, drenaje por vía extraperitoneal.

The pancreatic abscess occurs in two to six per cent of patients with acute pancreatitis and in 40 to 50 per cent of whom develop the severe form of the disease. The postoperative morbidity rate is 85 to 90 per cent and the mortality rate is 30 to 50 per cent due to persistence or recurrence of infection. The anatomical location and dissemination of the pancreatic abscess allows an extraperitoneal approach. Twelve patients with pancreatic abscess are reported. Seven males and five females, with an average age of 36 years. Fever, abdominal pain, cutaneous hypersensitivity and palpable abdominal mass were the most frequent clinical signs. Most of them developed multiple organic failure, leukocytosis, hyperglycemia, increasing L.D.H. and alkaline phosphatase levels. The CAT scan was most useful to localize the abscess. About 83 per cent of patients had been operated on previously. The extraperitoneal surgical approach was anterior in 10 patients and posterior in two patients. Ten patients developed complications that resolved with conservative measures. Two patients (17%) died. Extraperitoneal drainage is a valid alternative to prevent peritoneal contamination and some other serious postoperative complications in the management of pancreatic abscess.

Optimal lead subsets for reconstruction of QRS and ST-T in 35-lead precordial maps.

Precordial maps have been used for some 15 years to estimate the extent of myocardial injury in patients with acute anterior or lateral wall infarction. Estimates have been based on various QRS- and ST-T-derived parameters, including amplitude sum of ST elevations. Application of the electrodes, commonly 35, is cumbersome and time-consuming with the critically ill. A subset of 5 or 7 selected leads can be applied instead, and the remaining leads calculated from that subset with minimal loss of QRS and ST-T information. Maps were recorded from 100 patients within 72 hours of onset of anterior or lateral infarct. Optimal lead subsets for QRS and ST-T feature extraction were found by the sequential selection method of Lux. Subsets numbering between 2 and 15 leads were derived, with their lead-transform coefficients. Measures to estimate goodness of fit for reconstructed leads included correlations, error-to-signal ratios and root-mean-square errors. These measures were calculated separately over the QRS and ST-T complexes. Reconstructions from a 7-lead subset had a mean 0.92 correlation with ST-T in the original leads and root-mean-square error of only 0.04 mV. Sum of ST elevation differed by only 2% between original leads and reconstructions based on 5 or more leads. To confirm repeatability, lead-transform coefficients were also calculated from a training population of 50 patients and applied to the maps of the other 50.

Constitutional background to the Social Security Act of 1935.

In June 1937, the Senate Judiciary Committee reported unfavorably on Roosevelt's Court-packing plan and the bill was effectively killed. In the same month, Justice Van Devanter retired and gave Roosevelt his first opportunity to make an appointment to the Supreme Court. Over the following 6 years, Roosevelt made seven more appointments to the Court, and in the years that followed the Court continued in the direction boldly advanced in the spring of 1937. A residual effect of the taxing-spending construction of the old-age insurance provisions of the Social Security Act of 1935 has been the Court's continued adherence to the view that social security programs consist of separate taxing and spending provisions and are not, constitutionally speaking, social insurance programs. The issue has arisen in both a due process context and an equal protection context. But it is unlikely that the decisions reached in these contexts would have been different had the old-age insurance program been drafted as an earned-benefits program pursuant to the commerce power. Of course, the Court's decisions in the social security cases represented a significant constitutional development in establishing the breadth of Congress' powers to tax and spend for the general welfare. The decisions not only cleared the way for other general welfare programs, but more fundamentally provided the Federal Government with the substantive power and institutional flexibility to respond to the changing needs of the Nation.

Colangitis aguda supurada. / Acute suppurative cholangitis

Se analizo retrospectivamente la experiencia del Hospital de Especialidades del Centro Medico La Raza con veinticuatro pacientes con colangitis obstructiva supurada aguda tratados de Abril de 1979 a Agosto de 1981. El 84% de los casos tenia etiologia benigna; embargo, la morbilidad fue de 38% y, aunque la mortalidad de toda la serie fue de 8%, en los casos con septicemia fue de 29%. Se encontro que el caracter supurativo de la colangitis no necesariamente se anuncia con un cuadro clinico tipico, que la presencia de pus en la via biliar y la diseminacion de la infeccion dependen del tiempo de evolucion y que si bien el tratamiento medico preoperatorio mejora el pronostico, cuando las condiciones clinicas del enfermo permiten instituirlo, el tratamiento definitivo es el drenaje del coledoco y no debe soslayarse mas alla del lapso indispensable para hacer el diagnostico de la enfermeda

The impact of an ECG computer analysis program on the cardiologist's interpretation. A cooperative study.

Nine experienced electrocardiographers and the ECG computer program developed in the Veterans Administration (AVA 4.0) were evaluated against ECG-independent evidence of 180 patients' true diagnoses. A cross section of cardiac abnormalities was included. Each reader was given the 12-lead and orthogonal 3-lead ECG. The impact of ECG computer reports on the interpretations by the nine readers was evaluated by comparing their interpretations before and after the addition of a computer report. Using only high probability statements, the average accuracy of ECG diagnosis by the nine readers was 54%. It increased to 62% when the computer report was added. Computer interpretation was correct in 76%. It was shown that the Bayesian classification method together with multivariate analysis, used in the VA program, are mainly responsible for the improvement in diagnostic accuracy.

The electrocardiogram in epidemiologic investigations. A new classification system.

A new coding system for ECG abnormalities was developed, based on Frank's orthogonal ECG leads. In contrast to other systems, such as the Minnesota Code (MC), the new system was based on data collected prospectively in a cooperative study of 5031 records. The records were classified solely on the basis of non-ECG information. A record sample from normal women was also available. The large data base allowed stratification of ECG criteria according to sex and race. ECG criteria were determined at two levels of sensitivity and specificity. Specificity was 80-100% at the first level and 90-90% at the second. The new system has fewer criteria than other codes, which leads to reduction of coding errors and coding time. For common problems in differential diagnosis, optional criteria were included. A computer program for automated coding was also developed.