Benchmarking welfare indicators in 73 free-stall dairy farms in north-western Spain.

The aim of this study was to describe the status of body condition score (BCS), hock injuries prevalence, locomotion and body hygiene score as animal welfare measures in 73 free-stall dairy cattle farms in Lugo (Spain). A benchmarking process was established across farms: (1) the animal-based indicators were ordered from low to high values; (2) The farms were classified into three categories based on the number of indicators within less than the 25th percentile, 25th to 75th percentile and above the 75th percentile. The median prevalence of unsuitable BCS, hock injuries and clinical lameness was (median (range)) 51.7 per cent (13.3 to 89.5 per cent), 40.0 per cent (7.0per cent to 100 per cent) and 9.0 per cent (0per cent to 60.0 per cent) respectively. The dirtiness of the cow's coat had a high prevalence (73.0 per cent (37.5per cent to 100 per cent)). Most farms did not display consistently good or poor animal-based indicators and each farm had its own set of strong and weak points. Moreover, facilities design and management practices were described to understand source of the observations made of the cows. The incidence of overstocking was 31.5 per cent for stalls and 26.0 per cent for headlocks. The front lunge space was reduced (<90 cm) on most dairies (90.4 per cent). Signs of poor natural ventilation (cobwebs or humidity on the roof) and ammonia odour were observed on 32.8 per cent and 85.0 per cent of the barns totally closed or with a side openingless than 50 per cent of the wall height. The milking parlour was designed with two or more turns more than 90° (9.3 per cent), and failed to allow cows to see the parlour before entering (45.2 per cent). On 52.0 per cent of dairies, more than 15 per cent of the cows had to be forcefully moved into the milking parlour. In conclusion, there was a big variation in the animal welfare levels within and across farms and they could benefit from others by changing management practices related to facilities and herds.

Hernia diafragmática traumática / Diaphragmatic traumatic hernia

Introducción: las hernias diafragmáticas traumáticas comúnmente ocurren posteriores a trauma penetrante cerrado. Debido a las lesiones coexistentes y a la naturaleza silenciosa de las lesiones diafragmáticas, el diagnóstico fácilmente se omite. El objetivo de este estudio fue describir las características clínicas de pacientes consecutivos con hernias diafragmáticas traumáticas tratadas quirúrgicamente en nuestra institución. Material y métodos: cohorte prospectiva de pacientes tratados durante un periodo de seis años. Evaluamos edad, sexo, tipo de mecanismo del trauma, tipo de hernia, método diagnóstico, órganos herniados, lesiones asociadas, tiempo de evolución, morbilidad y mortalidad. Los resultados se describen como frecuencias y medidas de tendencia central y de dispersión. Se empleó χ2 y prueba exacta de Fisher para explorar asociación y riesgo. Resultados: se incluyeron 23 pacientes, 19 fueron hombres (82.6 %) y cuatro mujeres (17.4 %). En nueve pacientes (39.1 %) fueron diagnosticadas hernias diafragmáticas agudas y en 14, hernias crónicas (60.9 %). En 18 (78.3 %) el diagnóstico se hizo mediante radiografía de tórax y la mayoría correspondió a hernias crónicas. La historia médica de trauma toracoabdominal cerrado estuvo presente en 95.7 %, en la mayoría relacionado con accidentes vehiculares. Las principales lesiones asociadas fueron trauma encefálico, fracturas costales y contusión pulmonar. La morbilidad se observó en seis pacientes, todos con hernias crónicas. No hubo mortalidad. Conclusiones: la hernia diafragmática traumática es una entidad clínica poco frecuente y constituye un verdadero desafío debido a las dificultades para el rápido y correcto diagnóstico. En etapa crónica hay mayor riesgo para complicaciones tardías como estrangulamiento y necrosis de vísceras.

BACKGROUND: Traumatic diaphragmatic hernias commonly occur after blunt and penetrating trauma. Due to coexisting injuries and the silent nature of the diaphragmatic injuries, the diagnosis is easily missed. We undertook this study to describe the clinical characteristics of consecutive patients with traumatic diaphragmatic hernias treated surgically at our institution. METHODS: We conducted a prospective cohort of patients treated during a 6-year period. We assessed variables such as age, gender, type of mechanism of trauma, type of hernia, methods of diagnosis, herniated organs and associated lesions, time of evolution, morbidity and mortality. Results are described as frequencies, dispersion and central tendency measures. Chi(2) and Fisher's exact tests were used to explore association and risks. RESULTS: Twenty three patients were included, 19 men (82.6%) and 4 women (17.4%). Acute DTH were diagnosed in nine patients (39.1%) and 14 cases presented as chronic DTH (60.9%). In 18 cases (78.3%) the diagnosis was made by chest x-ray and most corresponded to chronic hernias. Medical history of blunt thoracoabominal trauma was present in 95.7% of the cases, most related to car accidents. The principal associated lesions were head injuries, rib fractures and lung contusion. morbidity was observed in six patients, all with chronic hernias. there was no mortality. CONCLUSIONS: DTH is a rare clinical entity and constitutes a true challenge due to difficulties for a rapid and correct diagnosis. In the chronic stage there is an increased risk for late complications such as visceral strangulation and necrosis.

[Diaphragmatic traumatic hernia]. / Hernia diafragmática traumática.

BACKGROUND: Traumatic diaphragmatic hernias commonly occur after blunt and penetrating trauma. Due to coexisting injuries and the silent nature of the diaphragmatic injuries, the diagnosis is easily missed. We undertook this study to describe the clinical characteristics of consecutive patients with traumatic diaphragmatic hernias treated surgically at our institution. METHODS: We conducted a prospective cohort of patients treated during a 6-year period. We assessed variables such as age, gender, type of mechanism of trauma, type of hernia, methods of diagnosis, herniated organs and associated lesions, time of evolution, morbidity and mortality. Results are described as frequencies, dispersion and central tendency measures. Chi(2) and Fisher's exact tests were used to explore association and risks. RESULTS: Twenty three patients were included, 19 men (82.6%) and 4 women (17.4%). Acute DTH were diagnosed in nine patients (39.1%) and 14 cases presented as chronic DTH (60.9%). In 18 cases (78.3%) the diagnosis was made by chest x-ray and most corresponded to chronic hernias. Medical history of blunt thoracoabominal trauma was present in 95.7% of the cases, most related to car accidents. The principal associated lesions were head injuries, rib fractures and lung contusion. morbidity was observed in six patients, all with chronic hernias. there was no mortality. CONCLUSIONS: DTH is a rare clinical entity and constitutes a true challenge due to difficulties for a rapid and correct diagnosis. In the chronic stage there is an increased risk for late complications such as visceral strangulation and necrosis.

[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.

[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.

[Detection of thyroid pathology during surgical exploration of the neck for primary hyperthyroidism]. / Detección de patología tiroidea durante exploración quirúrgica de cuello por hiperparatiroidismo primario.

OBJECTIVE: Our objective was to determine prevalence of incidental thyroid pathology during surgical treatment of primary hyperparathyroidism and to compare sensitivity and specificity of surgical neck exploration with histologic study of resected thyroid gland to confirm unsuspected pathologies. MATERIAL AND METHODS: This was prospective cohort study performed at the Specialty Hospital's Department of Endocrine Surgery at the Mexican Institute of Social Security's (IMSS's) Centro Médico de Occidente in Guadalajara, Jalisco State between 1995 and 2003. All were submitted to bilateral neck exploration under general anesthesia. According to the surgeon's criteria, any suspected thyroid anomaly was resected for transoperative frozen sections as well as definite histopathologic study. RESULTS: Preoperatively from a total of 44 cases of hyperparathyroidism, only four cases with thyroid anomalies were detected with neck ultrasound and/or computer tomography (CT) scan; additionally, 13 patients had thyroid anomalies found during neck exploration according to surgeon criteria. All were biopsied. Final study revealed thyroid disease in 16 cases; three had well-differentiated thyroid carcinoma and the remaining 13 patients had different benign entities. In one case, the thyroid specimen was considered normal. Sensitivity and specificity of surgeon criteria were 100 and 96%, respectively, to establish thyroid disease during neck exploration for another purpose. CONCLUSIONS: Association of hyperparathyroidism and benign and malignant thyroid disease is a common phenomenon. Independently of the ability of preoperative imaging procedures to detect unsuspected findings, we suggest exploration neck bilaterally and resection of any suspicious lesion.