[Initial management of the patients with psychiatric involvement in hospital emergency departments: a systematic review].

This article is a systematic review of studies that have investigated the initial management of patients with psychiatric conditions in hospital emergencies services in order to establish practical recommendations. A systematic review of the literature was carried out, consisting of studies published from 2010 to 2020, available in any language, consulting Cochrane Library Plus, PubMed, IBECS, LILACS and MEDLINE. The quality of the studies included in this review was assessed by the AMSTAR2 tool and the FCL 3.0 platform, together with the PRISMA statement. Results from the eleven papers selected showed that improvements in staff training, available resources, appropriate use of restraint and appropriate choice of medication can help to improve the care of patients with mental pathology in hospital emergency services. The same management for any other patient is recommended. However, if the patient is agitated or uncooperative, verbal, pharmacological and/or mechanical restraint (in this order) may be necessary. Keywords. Psychiatry. Psychomotor agitation. Crisis intervention. Hospital emergency service.

[Excessive daytime sleepiness and sleep hygiene of working adults in Spain]. / Somnolencia diurna excesiva e higiene del sueño en adultos trabajadores de España.

BACKGROUND: To calculate the prevalence of excessive daytime sleepiness (EDS) (through the Epworth Sleepiness Scale, ESE) and to identify the personal and working variables predicting the risk of EDS. METHODS: Cross-sectional study performed on 476 civil servants from Murcia (October 2013 - February 2016). Prevalence of EDS and bad sleep hygiene (LSH) were determined from scores on the Epworth Sleepiness Scale and Sleep Hygiene Scale (SHS), respectively, and their association with different variables was obtained from a self-administered questionnaire. Independent predictors of EDS were identified by multivariate logistic regression. RESULTS: EDS was less prevalent (16.7%) than LSH (23.4%). Women scored higher in ESE (7.5 vs 6.3; p=0,001) and suffered twice the EDS of men (23.0 vs 10.7%, p<0.001). Workers with EDS scored higher on SHS (34.3 vs 32.7; p=0.044) and had LSH more frequently (38.7 vs 24.9%, p=0.014). Smokers were predominantly women (57.0%; p=0.087) with LSH (50.0 vs 25.8 and 18.9% amongst ex-smokers and non-smokers, p<0.001). Being a woman OR=2.5, 95%IC: 1.4-4.3; p<0.001) and having bad sleep hygiene (OR=1.8 95%IC: 1.0-3.2, p=0.032) were predictive factors irrespective of suffering from EDS. CONCLUSIONS: EDS was present in civil servants in the region of Murcia, and was higher in women than men. Excessive daytime sleepiness is strongly associated with bad sleep hygiene and became a woman.

Topical EMLA for pain control during extracorporeal shock wave lithotripsy: prospective, comparative, randomized, double-blind study.

Patient collaboration in external shock wave lithotripsy (ESWL) is critical for its correct application, making proper analgesic selection indispensable. The aim of this study was to evaluate the efficacy of combined application of EMLA and intravenous (i.v.) pethidine compared with pethidine plus placebo cream in patients undergoing ESWL for ureteral and/or renal lithiasis. Prospective, controlled, randomized, double-blind study was conducted in patients receiving ESWL for renal and/or ureterolithiasis. The patients were randomly assigned to receive i.v. pethidine plus either EMLA cream (group A) or placebo hydrating cream (group B). Evaluated were type, location, and size of lithiasis, patient's sex, age, body mass index, comorbidity, Visual Analogue Scale (VAS) score of pain, and degree of lithiasis fragmentation. EMLA cream provided significantly better pain relief and lithiasis fragmentation and more completed ESWL treatment. Topical application of EMLA cream combined with i.v. pethidine improved VAS scores and lithiasis fragmentation and decreased the rate of withdrawal from ESWL procedure versus i.v. pethidine plus placebo therapy.

[Radiofrequency ablation as an alternative treatment for organ confined renal tumor]. / Ablación con radiofrecuencia como alternativa de tratamiento para el tumor renal localizado.

INTRODUCTION: We report our early clinical experience associated with radiofrequency (RF) ablation in patients with renal cell carcinoma (RCC) and evaluate the efficacy, tolerability and complications. MATERIAL AND METHODS: Retrospective review of patients treated in our hospital with kidney ecoguide RF. All of them diagnosed with renal tumor and not candidates for surgery because of bilateral tumor, significant comorbidity or refusal to surgical treatment. We use an Amitech® 220 Watts generator with an electrode tip 3 cm. Straight knitting needles and hooks. Controls were performed with axial tomography at 24h, 7 days, 1, 3 and 6 months and every 6 months thereafter. RESULTS: 11 tumors, 9 patients. The mean age was 76 years (63-85 years). The average tumor size was 3.5 cm (2.2-5.8 cm). In 2 tumors was needed prior chemoembolization. In other two new RF session was needed. 9 tumors with treatment considered effective. Mean follow-up was 17.5 months (3-52 months). One patient had local recurrence at 14 months and needed a laparoscopic radical nephrectomy and two patients developed lung metastases 41.5 months after RF. There were no clinically relevant complications. CONCLUSIONS: In our experience, we believe that RF is considered an alternative treatment for renal tumors with clinical stage T1 or T2 very symptomatic in patients in whom surgery is not possible, with acceptable results in the medium term, a good tolerance, reduced consumption of hospital resources and low complication rate.

Ablación con radiofrecuencia como alternativa de tratamiento para el tumor renal localizado / Radiofrequency ablation as an alternative treatment for organ confined renal tumor

Introducción: Presentamos nuestra serie inicial de tumores renales tratados mediante radiofrecuencia (RF) continua percutánea y evaluamos la eficacia, la tolerabilidad y las complicaciones de la técnica. Material y métodos: Revisión retrospectiva de los pacientes tratados en nuestro hospital con RF renal ecoguiada. Todos diagnosticados de tumor renal y no candidatos a cirugía por tumor bilateral, comorbilidad importante o rechazo al tratamiento quirúrgico. Utilizamos un generador Amitech® de 220W con una punta de electrodo de 3 cm, agujas de punta recta y en gancho. Los controles fueron realizados mediante una tomografía computarizada toracoabdominopélvica a las 24h, a los 7 días, al mes, a los 3 meses y a los 6 meses, y cada 6 meses después. Resultados: Se hallaron 11 tumores en 9 pacientes. La media de edad fue de 76 años (63–85). La media de tamaño tumoral fue de 3,5cm (2,2–5,8). En 2 tumores se necesitó de quimioembolización previa y en otros dos se necesitó una nueva sesión de RF. Hubo 9 tumores con tratamiento considerado como eficaz. La media de seguimiento fue de 17,5 meses (3–52). Un paciente tuvo persistencia de enfermedad a los 3 meses con necesidad de nefrectomía radical laparoscópica y otros dos tuvieron metástasis pulmonares a los 26,5 meses de media. No hubo complicaciones relevantes clínicamente. Conclusiones: En nuestra experiencia, estimamos que la RF es un tratamiento considerado como una alternativa para los tumores renales de estadio clínico T1 o T2 muy sintomáticos, en pacientes en los que no es posible la cirugía, con unos resultados aceptables a medio plazo, una buena tolerancia, un escaso consumo de recursos hospitalarios y un bajo índice de complicaciones (AU)

Introduction: We report our early clinical experience associated with radiofrequency (RF) ablation in patients with renal cell carcinoma (RCC) and evaluate the efficacy, tolerability and complicactions. Material and methods: Retrospective review of patients treated in our hospital with kidney ecoguide RF. All of them diagnosed with renal tumor and not candidates for surgery because of bilateral tumor, significant comorbidity or refusal to surgical treatment. We use an Amitech® 220 Watts generator with an electrode tip 3cm. Straight knitting needles and hooks. Controls were performed with axial tomography at 24h, 7 days, 1, 3 and 6 months and every 6 months thereafter.Results11 tumors, 9 patients. The mean age was 76 years (63–85 years). The average tumor size was 3.5cm (2,2–5,8cm). In 2 tumors was needed prior chemoembolization. In other two new RF session was needed. 9 tumors with treatment considered effective. Mean follow-up was 17.5 months (3–52 months). One patient had local recurrence at 14 months and needed a laparoscopic radical nephrectomy and two patients developed lung metastases 41.5 months after RF. There were no clinically relevant complications. Conclusions: In our experience, we believe that RF is considered an alternative treatment for renal tumors with clinical stage T1 or T2 very symptomatic in patients in whom surgery is not possible, with acceptable results in the medium term, a good tolerance, reduced consumption of hospital resources and low complication rate (AU)

[Malignant fibrous histiocytoma of the bladder. A literature review]. / Histiocitoma fibroso maligno de vejiga. Revisión bibliográfica.

OBJECTIVES: Malignant fibrous histiocytoma (MFH) is an uncommon urinary tract tumor. This paper is intended to provide an update on its diagnostic criteria, pathological and immunohistochemical characteristics, histological classification, prognostic factors, and alternative treatments. MATERIALS AND METHODS: All published articles on MFH of the urinary bladder have been reviewed and a descriptive study has been done. RESULTS: Twenty-nine cases of MFH of the bladder have been reported. The most common morphological variants are storiform-fascicular (41%) and inflammatory (36%) MFH. Non-myxoid variants have a poorer prognosis. Stage T3 MFH was found in 72% of cases at the time of diagnosis. MFH local recurrence and distant metastasis rates were 50% and 25% respectively after surgical treatment only. CONCLUSIONS: MFH of the bladder is a tumor with high local and distant recurrence rates and a low survival rate, and therefore requires early and aggressive treatment. Radical cystectomy with lymphadenectomy and adjuvant radiotherapy is considered to be the treatment of choice, eventually associated to chemotherapy.

Histiocitoma fibroso maligno de vejiga. Revisión bibliográfica / Malignant fibrous histiocytoma of the bladder. A literature review

Objetivos: El histiocitoma fibroso maligno (HFM) es un tumor poco frecuente del tracto urinario. Pretendemos actualizar los criterios diagnósticos, las características anatomopatológicas e inmunohistoquímicas, la clasificación histológica, los factores pronóstico y las alternativas terapéuticas. Material y métodos: Revisión bibliográfica y estudio descriptivo de los casos de HFM de vejiga publicados en la literatura médica internacional. Resultados: Existen 29 casos publicados de HFM de vejiga y las variantes morfológicas más frecuentes son la estoriforme-fascicular (41%) y la inflamatoria (36%). Las variantes no mixoides comportan peor pronóstico. El 72% fue T3 en el momento del diagnóstico. La tasa de recurrencia local y a distancia del HFM de vejiga fue del 50 y del 25%, respectivamente, tras tratamiento exclusivamente quirúrgico. Conclusiones: El HFM de vejiga es un tumor con alta tasa de recurrencia local y a distancia, así como baja supervivencia, requiriendo un tratamiento precoz y agresivo. La cistectomía radical con linfadenectomía y radioterapia adyuvante, con eventual quimioterapia, se considera el tratamiento de elección (AU)

Objectives: Malignant fibrous histiocytoma (MFH) is an uncommon urinary tract tumor. This paper is intended to provide an update on its diagnostic criteria, pathological and immunohistochemical characteristics, histological classification, prognostic factors, and alternative treatments. Materials and methods: All published articles on MFH of the urinary bladder have been reviewed and a descriptive study has been done. Results: Twenty-nine cases of MFH of the bladder have been reported. The most common morphological variants are storiform-fascicular (41%) and inflammatory (36%) MFH. Non-myxoid variants have a poorer prognosis. Stage T3 MFH was found in 72% of cases at the time of diagnosis. MFH local recurrence and distant metastasis rates were 50% and 25% respectively after surgical treatment only. Conclusions: MFH of the bladder is a tumor with high local and distant recurrence rates and a low survival rate, and therefore requires early and aggressive treatment. Radical cystectomy with lymphadenectomy and adjuvant radiotherapy is considered to be the treatment of choice, eventually associated to chemotherapy (AU)

Orquiepididimitis por Brucella SPP / Brucella Spp orchiepididymitis

OBJETIVO: Presentar un caso de orquiepididimitis unilateral por Brucella y realizar una pequeña revisión de diagnóstico y tratamiento de la patología. MÉTODO: Presentamos a un varón de 62 años que refiere síndrome constitucional, fiebre y dolor testicular, el diagnóstico se basó en la anamnesis, hemocultivos y estudios de imagen ecográfica. RESULTADOS: El tratamiento se inició con Doxiciclina y Teicoplanina, manteniéndose el primero durante seis semanas y sustituyéndose el segundo por ciprofloxacino (dos semanas en total) al alta, con resolución completa del cuadro. CONCLUSIÓN: Se debe ser exhaustivo en la anamnesis del paciente con orquitis infecciosa, ya que ésta puede revelar datos sugerentes de la etiología del cuadro, siendo de especial relevancia en la afectación por Brucella, ya que se presenta en pacientes de riesgo. Sin embargo se antoja necesaria la realización de hemocultivos que revelen Brucella en sangre para confirmar el diagnóstico. Los tratamientos antibióticos orales actuales son más que suficientes para resolver el cuadro. Siendo el tratamiento quirúrgico excepcional hoy en día (AU)

OBJECTIVE: To report a brucellar orchie-pididymitis case and to review the diagnosis and treatment of this pathology. METHOD: We present the case of a 62 year old man presenting with fever, testicular pain and constitutional syndrome. The diagnosis was made after ultrasound, blood cultures and anamnesis. RESULTS: The treatment was Doxiciclin six weeks and teico-planin, the second one was replaced with ciprofloxacin. CONCLUSION: It is important to make a correct anamnesis to the patient with orchiepididymitis to identify any risk factor for brucellosis. The diagnosis is confirmed with blood cultures. The oral antibiotics are enough to cure patients (AU)

[Effect of prophylactic treatment with intravesical epirubicin in recurrence of superficial bladder tumor]. / Efectos del tratamiento profiláctico con epirrubicina intravesical en la recidiva del tumor vesical superficial.

OBJECTIVES: To determine the efficacy in the prevention of tumor recurrence, disease free interval and side effects of intravesical epirrubicin post-TUR of superficial bladder tumor. METHODS: From February 1993 to November 1997, 57 patients with stage Ta, T1, grade I, II and III tumor of the bladder were studied. These patients were treated with 50 mg epirrubicin in 50 ml saline solution administered intravesically on 15 occasions for one year after surgery. The mean follow-up was 18 months. The follow-up protocol included clinical, analytical, cytological, US and cystoscopic control evaluations every 3 months for the first year, every 6 months for the second and third year, and yearly thereafter. RESULTS: At a mean follow-up of 30.2 months, 31.5% (18/55) of the patients showed tumor recurrence; the disease free interval was 17 months for the remaining 18 patients and 43 months for the overall group. Cystitis was observed as an adverse effect in 5 of 57 patients (8.8%). CONCLUSIONS: The study shows that prophylactic treatment with intravesical epirrubicin for the prevention of recurrence in superficial bladder tumor has few side effects and its efficacy is similar to that reported in other studies.

[Efficacy of antimicrobial prevention with single-dose ceftriaxone in urologic surgery]. / Eficacia de la profilaxis antimicrobiana con dosis única de ceftriaxona en cirugía urológica.

One gm ceftriaxone was administered i.m. to 266 patients 1 h before urologic surgery. The antimicrobial spectrum and long half life of this beta-lactam make it potentially useful for prophylaxis. Its efficacy was determined by the incidence of infections and antibiotics required postoperatively. Postoperative bacteriuria was determined by two urine cultures: one at discharge from hospital or after catheter removal and another 4 weeks postoperatively. The overall postoperative infection rate was 9.7% and bacteriuria was 11.2%; most of these were asymptomatic. Antibiotics were administered postoperatively in 13.9% of the patients. The foregoing results corroborate the efficacy of this agent given in a single dose for prophylaxis against infection in urologic surgery.

[Retroperitoneal ganglioneuroma]. / Ganglioneuroma retroperitoneal.

We report a case of retroperitoneal ganglioneuroma that had been incidentally discovered during ultrasound evaluation in a young female patient. The plain X-ray, IVP and ultrasonography only revealed the presence of a retroperitoneal mass and its approximate size. CT and arteriography provided further information relative to the location, nature of the extrarenal mass, its borders, and size although these did not permit us to determine its origin.

[Diagnosis and treatment of renal angiomyolipoma]. / Diagnóstico y tratamiento del angiomiolipoma renal.

Fourteen cases of angiomyolipoma have been diagnosed and treated at our center since it opened 19 years ago. The diagnostic methods and therapeutic approach have changed since then. Noninvasive imaging techniques like CT and ultrasound have significantly enhanced the accuracy of diagnosis. The mode of presentation, number, size and the differential diagnosis may decide between conservative or surgical management of these tumors. A small tumor mass only requires observation. For larger ones, the treatment of choice is preferably by conservative surgery or highly selective embolization if permitted by the severity of the disease. Surgery is warranted when doubt exists on CT and ultrasonography.