Telerrehabilitación en tiempos de COVID: una encuesta de satisfacción a cuidadores y pacientes con daño cerebral / Telerehabilitation in the COVID-19 pandemic: A satisfaction survey of caregivers and stroke patients

Objetivo: Determinar el grado de satisfacción de los cuidadores y de los pacientes con ictus que han recibido fisioterapia en formato de telerrehabilitación (TR) durante la primera oleada de la pandemia de SARS-CoV-2. Material y métodos: Se elaboró un estudio descriptivo mediante un cuestionario. El cuestionario incluía preguntas sobre la experiencia general, los problemas encontrados, los resultados subjetivos obtenidos y las sugerencias para futuras ediciones. Resultados: Se seleccionaron 26 sujetos: 16 pacientes (9 hombres y 7 mujeres) con diagnóstico de ictus y 10 cuidadores (3 hombres y 7 mujeres). El 87,6% de los pacientes y el 90% de los cuidadores consideraron que el sistema de conexión era fácil de usar, aunque el 30% dijeron que elegirían otro sistema de conexión en el futuro. Además, el 87,6% de los pacientes estaban de acuerdo o muy de acuerdo en repetir el tratamiento de TR. Conclusión: Los pacientes con ictus y los cuidadores que participan en el programa TR han mostrado un grado de satisfacción aceptable con su participación. (AU)

Aim: To determine the satisfaction degree of caregivers and stroke patients who received physiotherapy in telerehabilitation (TR) format during the first wave of the SARS-CoV-2 pandemic. Material and methods: A descriptive study was developed using a questionnaire. The questionnaire included questions on general experience, problems encountered, subjective results obtained and suggestions for future editions. Results: Twenty-six subjects were selected: 16 patients (9 men and 7 women) with a diagnosis of stroke and 10 caregivers (3 men and 7 women). 87.6% of the patients and 90% of the caregivers found the connection system easy to use, although 30% said they would choose another connection system in the future. In addition, 87.6% of patients agreed or strongly agreed to repeat the TR treatment. Conclusion: Stroke patients and caregivers participating in the TR program showed an acceptable satisfaction degree with their participation. (AU)

[Adaptation and feasibility of the online version of the Fugl Meyer scale for the assessment of patients following cerebrovascular accidents. Reply]. / Comentario al original 'Adaptación y viabilidad de la versión telemática de la escala Fugl Meyer para la evaluación de pacientes tras accidentes cerebrovasculares. Réplica.

TITLE: Comentario al original 'Adaptación y viabilidad de la versión telemática de la escala Fugl Meyer para la evaluación de pacientes tras accidentes cerebrovasculares. Réplica.

Validación del dispositivo de monitorización de actividad TomTom Touch Fitness Tracker® para medir la frecuencia cardíaca durante el esfuerzo / Validation of the TomTom Touch Fitness Tracker® activity monitor device for heart rate measuring during exercise (or effort)

Introducción: Las pulseras de actividad son un dispositivo asequible para controlar la salud de las personas. El modelo TomTom Touch Fitness Tracker®, por sus características, podría ser útil en este sentido. Objetivo: El objetivo de este estudio fue evaluar la validez de las pulseras de actividad física TomTom Touch Fitness Tracker® en una población de adultos sanos. Diseño: El diseño del estudio fue descriptivo, longitudinal y prospectivo, y tiene como objetivo evaluar la validez de la pulsera de actividad TomTom Touch Fitness Tracker® en adultos jóvenes sanos en comparación con el modelo POLAR RS800® validado. Métodos: Para el estudio se seleccionaron 38 jóvenes y sanos estudiantes universitarios de la Universidad de Salamanca. La frecuencia cardíaca se registró mediante la pulsera de actividad TomTom Touch Fitness Tracker®, y se comparó con los datos obtenidos por el modelo POLAR RS800®. Resultados: Se encontró una presión arterial promedio de 109 y 68mmHg. La frecuencia cardíaca basal media fue de 61 latidos por minuto (lpm). Después de realizar una prueba de esfuerzo se evidenció una fuerte correlación entre los resultados obtenidos con el dispositivo TomTom® y el modelo Polar®. Si se establece una inferencia mediante regresiones lineales, se revelan relaciones positivas con resultados estadísticamente significativos entre el dispositivo TomTom® y el modelo Polar®. Conclusiones: Los dispositivos TomTom® pueden mejorar la salud de los usuarios proporcionando datos fiables sobre la medición de la frecuencia cardíaca. Los dispositivos TomTom® permiten a los usuarios controlar el nivel de entrenamiento y esfuerzo. (AU)

Introduction: Fitness trackers are affordable devices for monitoring people's health. The TomTom Touch Fitness Tracker® model, due to its characteristics, could be useful in this regard. Objective: The objective of this study was to assess the validity of the TomTom Touch Fitness Tracker® fitness trackers in a population of healthy adults. Design: The study design was descriptive, longitudinal, and prospective and aimed to assess the validity of the TomTom Touch Fitness Tracker® activity tracker in healthy young adults compared to the validated POLAR RS800® model. Methods. In the study, 38 healthy young college students from the University of Salamanca were selected. Heart rate was produced using the TomTom Touch Fitness Tracker® activity bracelet and compared with data obtained by the POLAR RS800® model. Results: An average blood pressure of 109mmHg and 68mm Hg was found. The mean baseline heart rate was 61 beats per minute (bpm). After performing a stress test, a strong connection was evident between the results obtained with the TomTom device and the Polar model. If an inference is performed using linear regressions, positive relationships with statistically significant results are revealed between the TomTom device and the Polar model. Conclusions: TomTom devices can improve users’ health require reliable data on heart rate measurement. TomTom devices allow users to control the level of training and effort. (AU)

Comentario al original ‘Adaptación y viabilidad de la versión telemática de la escala Fugl Meyer para la evaluación de pacientes tras accidentes cerebrovasculares. Réplica / Adaptation and feasibility of the online version of the Fugl Meyer scale for the assessment of patients following cerebrovascular accidents. Reply

No disponible

Adaptación y viabilidad de la versión telemática de la escala Fugl Meyer para la evaluación de pacientes tras accidentes cerebrovasculares / Adaptation and feasibility of the online version of the Fugl Meyer scale for the assessment of patients following cerebrovascular accidents

Introducción: Los pacientes que han sufrido un accidente cerebrovascular crónico o un ictus necesitan tratamientos de fisioterapia a largo plazo. Sin embargo, la pandemia de COVID-19 ha obligado a detenerlos. Con el objetivo de poder ofrecer una evaluación funcional de forma telemática a estos pacientes, se propuso diseñar una adaptación de la escala de evaluación Fugl Meyer-versión española y comprobar su viabilidad. Pacientes y métodos: Escala telemática adaptada, basada en la escala de evaluación Fugl Meyer. Se mantuvieron los dominios de función motora, equilibrio y dolor, y se eliminaron ítems que requerían ayuda para el paciente. Dicha escala se administró a 14 pacientes con accidente cerebrovascular crónico de la Asociación de Daño Cerebral Adquirido de Salamanca, a través de diferentes plataformas web, siguiendo el mismo procedimiento que la escala original y con una duración de 30 a 45 minutos. Resultados: Todos los pacientes completaron la escala de evaluación Fugl Meyer-versión telemática. La mayor dificultad se encontró para la evaluación de las extremidades inferiores. Los pacientes y los fisioterapeutas destacaron la facilidad de realización de los ítems de la escala. Al comparar las versiones se encontraron correlaciones positivas estadísticamente significativas con la versión original (p < 0,001) y los coeficientes de correlación indicaron una fuerte asociación. La diferencia entre las secciones de la escala equivalentes en cada instrumento no fue mayor que el 5%, excepto en el equilibrio. Conclusión: La escala de evaluación Fugl Meyer-versión telemática, es una escala viable, útil y fácil de aplicar que permite la evaluación del estado funcional de los pacientes con ictus y que puede responder a las necesidades actuales durante la pandemia de COVID-19.(AU)

Introduction: Patients who have suffered a chronic cerebrovascular accident or a stroke need long-term physiotherapy treatments. However, they have had to be stopped due to the COVID-19 pandemic. To be able to offer these patients an online functional assessment, a proposal was put forward to design an adaptation of the Spanish version of the Fugl Meyer assessment scale and to test its viability. Patients and methods: The adapted online scale, based on the Fugl Meyer assessment scale. The motor function, balance and pain domains were kept, and items requiring assistance for the patient were removed. This scale was administered to 13 patients with a chronic cerebrovascular accident from the Salamanca Acquired Brain Injury Association (Asociación de Daño Cerebral Adquirido) via different web platforms. The procedure followed was the same as for the original scale and lasted from 30 to 45 minutes. Results: All the patients completed the Fugl Meyer assessment scale, online version. The greatest difficulty was encountered in the assessment of the lower limbs. Patients and physiotherapists highlighted how easy it was to complete the items in the scale. On comparing the versions, statistically significant positive correlations were found with the original version (p < 0.001) and the correlation coefficients indicated a strong association. The difference between the equivalent sections of the scale in each instrument was no greater than 5%, except for balance. Conclusion: The Fugl Meyer assessment scale, online version, is a feasible, useful and easy to apply scale that allows assessment of the functional status of stroke patients and can help meet the current needs during the COVID-19 pandemic.(AU)

[Adaptation and feasibility of the online version of the Fugl Meyer scale for the assessment of patients following cerebrovascular accidents]. / Adaptación y viabilidad de la versión telemática de la escala Fugl Meyer para la evaluación de pacientes tras accidentes cerebrovasculares.

INTRODUCTION: Patients who have suffered a chronic cerebrovascular accident or a stroke need long-term physiotherapy treatments. However, they have had to be stopped due to the COVID-19 pandemic. To be able to offer these patients an online functional assessment, a proposal was put forward to design an adaptation of the Spanish version of the Fugl Meyer assessment scale and to test its viability. PATIENTS AND METHODS: The adapted online scale, based on the Fugl Meyer assessment scale. The motor function, balance and pain domains were kept, and items requiring assistance for the patient were removed. This scale was administered to 13 patients with a chronic cerebrovascular accident from the Salamanca Acquired Brain Injury Association (Asociacion de Dano Cerebral Adquirido) via different web platforms. The procedure followed was the same as for the original scale and lasted from 30 to 45 minutes. RESULTS: All the patients completed the Fugl Meyer assessment scale, online version. The greatest difficulty was encountered in the assessment of the lower limbs. Patients and physiotherapists highlighted how easy it was to complete the items in the scale. On comparing the versions, statistically significant positive correlations were found with the original version (p < 0.001) and the correlation coefficients indicated a strong association. The difference between the equivalent sections of the scale in each instrument was no greater than 5%, except for balance. CONCLUSION: The Fugl Meyer assessment scale, online version, is a feasible, useful and easy to apply scale that allows assessment of the functional status of stroke patients and can help meet the current needs during the COVID-19 pandemic.

TITLE: Adaptación y viabilidad de la versión telemática de la escala Fugl Meyer para la evaluación de pacientes tras accidentes cerebrovasculares.Introducción. Los pacientes que han sufrido un accidente cerebrovascular crónico o un ictus necesitan tratamientos de fisioterapia a largo plazo. Sin embargo, la pandemia de COVID-19 ha obligado a detenerlos. Con el objetivo de poder ofrecer una evaluación funcional de forma telemática a estos pacientes, se propuso diseñar una adaptación de la escala de evaluación Fugl Meyer-versión española y comprobar su viabilidad. Pacientes y métodos. Escala telemática adaptada, basada en la escala de evaluación Fugl Meyer. Se mantuvieron los dominios de función motora, equilibrio y dolor, y se eliminaron ítems que requerían ayuda para el paciente. Dicha escala se administró a 14 pacientes con accidente cerebrovascular crónico de la Asociación de Daño Cerebral Adquirido de Salamanca, a través de diferentes plataformas web, siguiendo el mismo procedimiento que la escala original y con una duración de 30 a 45 minutos. Resultados. Todos los pacientes completaron la escala de evaluación Fugl Meyer-versión telemática. La mayor dificultad se encontró para la evaluación de las extremidades inferiores. Los pacientes y los fisioterapeutas destacaron la facilidad de realización de los ítems de la escala. Al comparar las versiones se encontraron correlaciones positivas estadísticamente significativas con la versión original (p menor de 0,001) y los coeficientes de correlación indicaron una fuerte asociación. La diferencia entre las secciones de la escala equivalentes en cada instrumento no fue mayor que el 5%, excepto en el equilibrio. Conclusión. La escala de evaluación Fugl Meyer-versión telemática, es una escala viable, útil y fácil de aplicar que permite la evaluación del estado funcional de los pacientes con ictus y que puede responder a las necesidades actuales durante la pandemia de COVID-19.

Fortalecimiento de la musculatura respiratoria en mujeres mayores en Atención Primaria / Training respiratory muscle in elderly women in primary care

ANTECEDENTES Y OBJETIVO: El envejecimiento implica una reducción de la masa muscular y la fuerza muscular. El objetivo del estudio fue valorar la efectividad de un protocolo de ejercicios específicos de facilitación neuromuscular propioceptiva (FNP) sobre la fuerza muscular respiratoria. MATERIAL Y MÉTODO: Estudio experimental con 69 mujeres mayores no institucionalizadas y voluntarias participantes en un programa de ejercicio físico. Fueron divididas aleatorizadamente en 2 grupos. El grupo intervención recibió un protocolo de tratamiento respiratorio específico basado en metodología de la FNP con 2 sesiones semanales de 50 min durante 8 semanas. El grupo control no recibió intervención adicional. Se evaluó la fuerza de la musculatura respiratoria mediante la presión inspiratoria máxima (PIM) y la presión espiratoria máxima (PEM). RESULTADOS: Se registró un aumento estadísticamente significativo (p < 0,001) y clínicamente relevante en el grupo de intervención en la PIM 13,84mb (IC 95%: 9,017-18,671) y la PEM 25,69 mb (IC 95%: 20,373-31,002). Se obtuvieron diferencias con significación estadística entre los grupos: PIM 20,00mb (IC 95%: 11,13-28,88; p < 0,001) y PEM 27 mb (IC 95%: 19,75-35,012; p < 0,001). CONCLUSIÓN: El trabajo muscular respiratorio específico con FNP mejoró las presiones respiratorias, lo que puede mejorar la fuerza y la función respiratorias en adultos mayores. Este tratamiento puede utilizarse como una intervención preventiva para minimizar las implicaciones del envejecimiento sobre la pérdida de masa y fuerza muscular

BACKGROUND AND OBJECTIVE: Aging results in reduced muscle mass and strength. The aim was to evaluate the effectiveness of a proprioceptive neuromuscular facilitation (PNF) exercise protocol on respiratory muscle strength. MATERIAL AND METHODS: An experimental study of 69 elderly, non-institutionalized female volunteers who participated in a physical exercise programme. They were randomly divided into 2 groups. The intervention group performed a specific respiratory treatment protocol using the PNF technique. The control group did not receive an additional intervention. The PNF treatment consisted of 2 weekly sessions lasting 50 minutes over an 8-week time period. Respiratory muscle strength was measured for both groups by maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). RESULTS: There was a statistically significant (P <. 001) and clinically relevant increase in the intervention group in MIP 13.84 mb (95% CI: 9.017-18.671) and MEP 25.69 mb (95%CI: 20.373-31.002). There was also a statistically significant difference between groups: MIP 20.00 mb (95% CI: 11.13-28.88; P < .001) and PEM 27mb (95% CI: 19.75-35.012; P < .001). CONCLUSIONS: The PNF respiratory treatment improved respiratory pressures, which may improve respiratory strength and function in older adults. This treatment can be used as prevention to minimize the loss of muscle mass and strength as a result of aging

Información, comunicación y trato en un servicio de urgencias: evaluación mediante una encuesta de opinión / Opinion survey on information, communication and treatment in an Emergency Department

Objetivo. Conocer aspectos concretos acerca de la información y la comunicación con los usuarios de los servicios de urgencias hospitalarias y el trato recibido en ellos a través de una encuesta telefónica. Métodos. Estudio prospectivo en 2 servicios de urgencias hospitalarias de Salamanca. Se incluyeron en el estudio 400 pacientes (edad media 56,4 ± 20,5 años; 58,4% mujeres). Se realizó una encuesta telefónica con 19 ítems. Doce de ellos recogían las respuestas en escala tipo Likert, con puntuaciones de 1 (muy mal) a 5 (muy bien). El resto permitían responder «sí» o «no». Resultados. El 86% de los pacientes evaluaron positivamente el trato recibido por los profesionales en general, el 92% el respeto mostrado, el 87% el trato de los médicos y el 71% el trato recibido por enfermería. El 27,5% no recuerda haber recibido información del personal del punto azul (profesionales especialmente capacitados para dar información). Se encontró significación estadística (p = 0,045) en relación a la amabilidad y respeto mostrado por enfermería. La mayoría de los pacientes que fueron ingresados en el área de observación del servicio de urgencias no fueron informados sobre los horarios de visita (p = 0,003). Conclusiones. La percepción del trato recibido por los pacientes es buena, mientras que en relación a la información y comunicación es ostensiblemente mejorable y podría ser evaluada utilizando la encuesta que proponemos, ya que permite detectar y utilizar los puntos débiles de estos aspectos de la asistencia sanitaria como lanzaderas de las iniciativas de implementación (AU)

Objective. To gather specific details about the information, communication, and treatment as regards users of hospital emergency services using a telephone survey, in order to implement improvement measures, if necessary. Methods. A prospective study was conducted in two emergency departments in Salamanca. A total of 400 patients were included in the study (mean age 56.4 ± 20.5 years, 58.4% women). A telephone survey was performed with 19 items, of which 12 required responses on a Likert-type scale, with scores of 1 (very bad) to 5 (very good). The remainder of the questions allowed to answer 'yes' or 'no'. Results. The treatment received by the professionals in general was evaluated positively by 86% of the patients; with 92% reporting they were respectful, 87% were treated by doctors and 71% received treatment from nurses. More than one-quarter (27.5%) did not recall receiving information from blue point staff (personnel specially trained to provide information. Statistical significance (P = .045) was found in relation to the kindness and respect shown by nurses. Most patients that were admitted to the observation area of the emergency department were not informed about the visiting hours (P = .003). Conclusions. Perception of care received by patients is good, while in relation to information and communication it is evidently improvable, and could be assessed using the survey that is proposed in order to detect and use the weaknesses in these aspects of health care as implementation initiatives (AU)

[Opinion survey on information, communication and treatment in an Emergency Department]. / Información, comunicación y trato en un servicio de urgencias: evaluación mediante una encuesta de opinión.

OBJECTIVE: To gather specific details about the information, communication, and treatment as regards users of hospital emergency services using a telephone survey, in order to implement improvement measures, if necessary. METHODS: A prospective study was conducted in two emergency departments in Salamanca. A total of 400 patients were included in the study (mean age 56.4±20.5years, 58.4% women). A telephone survey was performed with 19 items, of which 12 required responses on a Likert-type scale, with scores of 1 (very bad) to 5 (very good). The remainder of the questions allowed to answer "yes" or "no". RESULTS: The treatment received by the professionals in general was evaluated positively by 86% of the patients; with 92% reporting they were respectful, 87% were treated by doctors and 71% received treatment from nurses. More than one-quarter (27.5%) did not recall receiving information from blue point staff (personnel specially trained to provide information. Statistical significance (P=.045) was found in relation to the kindness and respect shown by nurses. Most patients that were admitted to the observation area of the emergency department were not informed about the visiting hours (P=.003). CONCLUSIONS: Perception of care received by patients is good, while in relation to information and communication it is evidently improvable, and could be assessed using the survey that is proposed in order to detect and use the weaknesses in these aspects of health care as implementation initiatives.

Two cases of cyclic vomiting syndrome in systemic autoimmune conditions: SLE and autoimmune hepatitis.

Vomiting directly attributable to SLE occurs in approximately 8% of patients, and its causes are sometimes obscure when common conditions are ruled out. Cyclic vomiting syndrome is a common functional disorder which usually starts from childhood. We report the first two cases of patients affected by systemic autoimmune conditions associated to cyclic vomiting syndrome. Identification and proper treatment may guide to diagnosis and alleviate neglected manifestations of autoimmune patients.

[Cervical tumoration as consultation symptom. Our experience]. / Tumoracion cervical como sintoma de consulta. Nuestra experiencia.

INTRODUCTION: A cervical tumoration is a frequent symptom presented by patients of different ages. OBJECTIVE: Analyse the clinical, diagnostical and treatment aspects of patients affected by cervical tumoration. METHOD: Retrospective study of a serie of cases during 10 years. RESULTS: A total of 182 patients, affected by cervical tumoration, were analysed. The 60% were men and the 40% women with 45 years average. The benign pathology more frequent was the branchial cyst and the malign were the metastasis of epidermoide carcinoma. The diagnostic and therapeutic procedures utilized are analysed. CONCLUSIONS: An anamnesis and a minoutious exploration diminish in great measure the diagnostic possibilities. The TAC and the PAAF are diagnostic methods of great value in the study of a cervical tumoration and facilitate an adequate scheme of treatment, that is essential for a good prognosis.

Tumoración cervical como síntoma de consulta. Nuestra experiencia / Cervical tumoration as consultation symptom. Our experience

Introducción. Una tumoración cervical es un síntoma frecuente que se presenta en pacientes de cualquier edad. Objetivo. Analizar los aspectos clínicos, diagnósticos y de tratamiento de pacientes con una tumoración cervical. Método. Estudio retrospectivo de una serie de casos en un período de 10 años. Resultados. Se analizaron un total de 182 pacientes que consultaron por tumoración cervical. El 60% eran varones y el 40% mujeres, con una media de edad de 45 años. La patología benigna más frecuente fue el quiste branquial y la maligna fueron las metástasis de carcinoma epidermoide. Los procedimientos diagnósticos y terapéuticos utilizados son analizados. Conclusiones. Una anamnesis y una exploración minuciosa disminuyen en gran medida las posibilidades diagnósticas. La TAC y la PAAF son métodos diagnósticos de gran valor en el estudio de una tumoración cervical y facilitan un adecuado plan de tratamiento, lo cual es esencial para un buen pronóstico

lntroduction. A cervical tumoration is a frequent symptom presented by patients of different ages. Objective: Analyse the clinical, diagnostical and treatment aspects of patients affected by cervical tumoration. Method: Retrospective study of a serie of cases during 10 years. Results: A total of 182 patients, affected by cervical tumoration, were analysed. The 60% were men and the 40% women with 45 years average. The benign pathology more frequent was the branchial cyst and the malign were the metastasis of epidermoide carcinoma. The diagnostic and therapeutic procedures utilized are analysed. Conclusions: An anamnesis and a minoutious exploration diminish in great méasure the diagnostic possibilities. The TAC and the PAAF are diagnostic methods of great value in the study of a cervical tumoration and facilitate an adequate scheme of treatment, that is essential for a good prognosis

[Nesidioblastosis as extracolonic manifestation associated with adenomatous familial polyposis]. / Nesidioblastosis como una manifestación extracolónica asociada a poliposis familiar adenomatosa.

OBJECTIVE: To describe the case of a patient with familial adenomatous polyposis (FAP) who developed organic hyperinsulinemia and hypoglycemia due to pancreatic nesidioblastosis. BACKGROUND: FAP can be considered as one of the familial cancer syndromes. The development of endocrine tumors in these patients is an infrequent event, and most of these tumors have been well-differentiated thyroid neoplasms. To our knowledge, the occurrence of organic hyperinsulinemia in the context of FAP has not been reported. METHODS: Organic hyperinsulinemia was demonstrated during a 72-h fast, measuring insulin and C-peptide by RIA at the time of hypoglycemia. Immunohistochemistry for insulin and other pancreatic hormones was performed on the surgical pancreatic specimen. RESULTS: The patient underwent a distal pancreatectomy with resolution of hypoglycemia. Histopathologically, the excised pancreas showed beta cell hyperplasia arising from the ductal epithelium. Such beta cells strongly immunostained for insulin, pancreatic polypeptide, and neuron-specific enolase. CONCLUSIONS: The development of endocrine tumors in an inherited cancer syndromes such as FAP is rare. Such an association may suggest shared mechanisms of tumorigenesis. The case herein reported should prompt us to consider organic hyperinsulinism as an extracolonic manifestation of FAP.

[Ultrasonic evaluation of the gallbladder during pregnancy]. / Valoración ultrasonográfica de vesícula biliar en la embarazada.

The purpose was to explore by ultrasound the gallbladder in the pregnant woman. A prospective longitudinal study of 292 pregnant woman, was done. Gallstones were detected in 41 patients (14.04%), in other 2 patients (0.68%) sludge in gallbladder. Cholesterolosis was found in 2 patients more (0.68%), and polyposis in another 2 patients (0.68%). In comparing first pregnancy and subsequent as to frequency of gallstones, there were no statistical difference in both groups. P > 0.5. Test X2. A high proportion of pathology in gallblader was where gallstone its predominant which justifies its routinely exploration in al women that are examined for during pregnancy in any moment of gestation.

Early versus late necrosectomy in severe necrotizing pancreatitis.

BACKGROUND: Debate as to whether surgery in severe necrotizing pancreatitis (SNP) should be done early or late has been present ever since the disease was described. There are no prospective, randomized studies addressing this specific issue. METHODS: Patients with SNP, documented clinically, with Ranson's criteria, and dynamic pancreatography (DP) findings were randomly allocated in two groups for treatment. Group A included early necrosectomy (within 48 to 72 hours of onset) and group B, late necrosectomy (at least 12 days after onset). Both groups continued with open packing and staged necrosectomies. Cultures were obtained at each laparotomy and necrosis was verified histologically in all instances. RESULTS: During a 36-month study period, 150 patients with unequivocal acute pancreatitis were admitted for treatment. Forty-one with SNP initially entered the study; there were 5 drop outs. Patients in group A (25) and group B (11) had no difference in distribution by gender or mean age, etiology, mean Ranson's signs (4 versus 3.8), DP findings, rate of infected necrosis, or necrosectomies required per patient. Although the mortality rate (58% versus 27%) did not reach statistical significance, the odds ratio for mortality was 3.4 times higher in group A, which made us finish the study. CONCLUSION: This prospective, randomized study from a single institution clearly demonstrates that early intensive conservative treatment with late necrosectomy for selected cases is the current rationale approach for SNP.

[Breast feeding ; follow up during the puerperium]. / Lactancia materna: seguimiento durante el puerperio.

In a prospective longitudinal study carried out in the Ginecoobstetric Department of the HGZ 6 Cd. Valles S.L.P., from March 1st to July 15th 1995. One hundred patient were evaluated 24 h after puerperium (in hospital), and 20 and 40 days later at home. With the objective to determine the continuity of lactancy, because all mothers were informed and trained about the benefits of human milk. 31% of the pregnancies were cesarean section and 69% vaginal. A lost of continuity was found in 43% at 20 days and 44% at 40 days. The incidence of respiratory and diarrheic diseases were evaluated with mother milk and artificial formulate (No significant p > 0.5%). The reason for ending the lactancy are cultural and behavior distortion about the benefits of human milk, this is necessary to change to enforce the values of this natural resource.

[Surveillance of the clinical course of 6,030 surgical wounds]. / Vigilancia de la evolución de 6.030 heridas quirúrgicas.

This report describes a 4 year prospective study of postoperative wound infections, utilizing a program of wound surveillance. Surgical wounds after 6030 operations of a general surgery service were surveyed by the authors and a specialist nurse, daily and in the follow up clinic for 30 days. Results were reported to all the surgeons monthly. The rates of infections demonstrated a decline over the years of surveillance. In the first year there was a 6.37 percent incidence of infection and the fourth year 4.7 percent. This represents an improvement in hospitalization days and expenses.

[Surveillance of the course of 6030 surgical wounds]. / Vigilancia de la evolución de 6030 heridas quirúrgicas.

This report describes a 4-year prospective study of post-operative wound infections, utilizing a program of wound surveillance. Surgical wounds after 6030 operations of a general surgery service were surveyed by the authors and a specialist nurse, daily, and in the follow-up clinic for 30 days. The rates of infections showed a decline over the years of surveillance. On the first year there was a 6.37 per cent incidence of infections, and the fourth year, of 4.7 per cent. This represented an improvement in hospitalization days and expenses.

[Acute pancreatitis. The classification of its severity by dynamic pancreatography and the results of surgical treatment]. / Pancreatitis aguda. Clasificación de la severidad con pancreatografía dinámica y resultados del tratamiento quirúrgico.

In acute pancreatitis determination of glandular necrosis has been difficult because of the lack of an objective method; with dynamic enhanced tomography (bolus injection of contrast media) we have reasonably classify 28 patients with acute pancreatitis. With this technique 5 grades of sequelae of acute pancreatitis are identified: I. Non complicated acute pancreatitis; II. pancreatic abscess: III. peripancreatic necrosis; IV. less than 50% pancreatic necrosis and V. more than 50% pancreatic necrosis. A 100% correlation was found between tomography and surgical findings. This is the first report in Mexico of this method to identify pancreatic or peripancreatic necrosis; we also present the surgical results with a programmed pancreatic debridation; mortality has decreased form 80 to 31.9% in our hospital in recent years.