[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.

[Acute infectious disease of otolaryngology focus]. / Patología infecciosa aguda de foco otorrinolaringológico.

Infections are the most common cause of antibiotic prescription and one of the most frequent reasons for consultation in Primary Care. Among them, stand out acute media otitis and diffuse external otitis, acute pharyngitis and acute rhinosinusitis. Commonly they are viral and self-limited, so their complications are rare. Currently, the indiscriminate use of antibiotics have leaded to bacterial resistances; therefore antibiotic prescription should be more careful. Nowadays, several diagnostic strategies are available. In current updated etiological and pathophysiological factors of each infection, diagnostic and therapeutic strategy to be applied in Primary Care as well as the complications of each pathology and the referral indications to be assessed by specialists in the ENT area, will be reviewed.

[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.

Determination of volatile organic compounds from biowaste and co-fermentation biogas plants by single-sorbent adsorption.

Characterisation of biogases is normally dedicated to the online monitoring of the major components methane and carbon dioxide and, to a lesser extent, to the determination of ammonia and hydrogen sulphide. For the case of Volatile Organic Compounds (VOCs), much less attention is usually paid, since such compounds are normally removed during gas conditioning and with exception of sulphur compounds and siloxanes represent a rather low risk to conventional downstream devices but could be a hindrance for fuel cells. However, there is very little information in the literature about the type of substances found in biogases generated from biowaste or co-fermentation plants and their concentration fluctuations. The main aim of this study was to provide information about the time dependencies of the VOCs in three biogas plants spread out through Germany from autumn until summer, which have different process control, in order to assess their potential as biofuels. Additionally, this study was an attempt to establish a correlation between the nature of the substrates used in the biogas plants and the composition of the VOCs present in the gas phase. Significant time-dependent variations in concentration were observed for most VOCs but only small changes in composition were observed. In general, terpenes and ketones appeared as the predominant VOCs in biogas. Although for substances such as esters, sulphur-organic compounds and siloxanes the average concentrations observed were rather low, they exhibited significant concentration peaks. The second biogas plant which operates with dry fermentation was found to contain the highest levels of VOCs. The amount of total volatile organic compounds (TVOCs) for the first, second and third biogas plants ranged from 35 to 259 mg Nm(-3), 291-1731 mg Nm(-3) and 84-528 mg Nm(-3), respectively.

[Bidimensional-ultrasound guided-craniotomy in the excision of supratentorial brain tumours]. / Craneotomía guiada por ultrasonografía bidimensional para exéresis de tumor cerebral supratentorial.

OBJECTIVES: With this 1-year retrospective study we aimed to analyze our experience on the utilization of real-time bidimensional (2-D) ultrasonography as an aid for the localization of deep-seated supratentorial brain tumours. MATERIAL AND METHODS: During the year 2006 we performed 2-D ultrasonographic localization studies in patients undergoing excision of subcortical supratentorial brain tumours whose nature was pathologically proven. The ultrasound machines utilized were 2410 A ultrasounds HP and Phillips HDI 3500 ATL. To check gross anatomical structures we used a 3 MHz probe and then a 5 MHz sound to define the brain tumour characteristics. Coronal and sagittal cuts were obtained during parietal or temporal craniotomies, and axial and sagittal slices in the case of frontal masses. After brain tumour removal and after a thorough irrigation with saline, new image acquisitions were performed to confirm the completeness of tumour excision. The amount of removed tumour was also verified by a post-contrast computerized tomography (CT) scan performed after the surgery. RESULTS: The study group was composed by 30 patients with ages comprised between 28 and 82 years. The time required for tumour localization was 17.5 (+/- 1.9) min. The lesions were approached though 8 temporal, 7 parieto-occipital, 8 parietal, 2 fronto-parietal and 5 temporo-parietal craniotomies. Mean depth of the lesions was 5.3 (+/- 1.6) cm. The histopathologic diagnosis was 17 high-grade gliomas, 3 low-grade astrocytomas, 8 metastatic lesions and 2 oligo-astrocytomas. High-grade gliomas were more echogenic than low-grade tumours and than oedema. No residual tumour was detected at the end of the surgery except in two cases in which a tumoral rest was left due to the proximity of the lesion to eloquent cerebral areas. Postoperative CT scans confirmed the completeness of tumour removal in the patients of the study as assessed by intraoperative ultrasounds. CONCLUSIONS: Real-time 2-D ultrasonography affords an adequate image quality for performing guided-craniotomy in supratentorial brain tumours, as it allows for a safe and accurate localization of the lesions. Its use is mainly indicated in the removal of tumours located in, or close to, important anatomical and functional brain areas and to depict the presence of tumour rests after surgical removal of cerebral neoplasms.

Craneotomía guiada por ultrasonografía bidimensional para exéresis de tumorcerebral supratentorial / Bidimensional-ultrasound guided-craniotomy in the excision of supratentorial brain tumours

Objetivos: El objetivo de este estudio descriptivo es presentar nuestra experiencia clínica durante un año sobre la utilización de la ultrasonografía bidimensional (2-D) en tiempo-real para la exéresis de tumor supratentorial de localización cerebral profunda. Material y métodos: Durante el año 2006 realizamos craneotomía guiada por ultrasonografía 2-D en pacientes sometidos a cirugía para exéresis de tumor supratentorial, confirmado por anatomía patológica y de localización subcortical. Para la realización de la ultrasonografía se utilizaron los modelos de ultrasonidos M 2410 A ultrasounds HP y Phillips HDI 3500 ATL. Se utilizó en primer lugar un transductor de 3Mhz para localizar estructuras anatómicas, seguido de un transductor de 5MHz para la identificación del tumor cerebral. Se consiguieron cortes en el plano sagital y coronal durante la craneotomía parietal o temporal y en el plano axial y sagital en la craneotomía frontal. Tras la exéresis del tumor, se realizó una nueva ultrasonografía tras irrigar la cavidad con suero salino para la visualización de remanentes tumorales. Se realizó una tomografía computarizada (TC) craneal postoperatoria para verificar la exéresis total del tumor. Resultados: Se incluyeron en el estudio 30 pacientes de edades comprendidas entre 28 y 82 años. El tiempo requerido para la localización de la lesión fue de 17,5 (±1,9) min. Se realizaron 8 craneotomías temporales, 7 parietooccipitales, 8 parietales, 2 frontoparietales y 5 parietotemporales. La lesión fue localizada a una profundidad media de 5,3 (±1,6) cm. El estudio histológico reveló 17 gliomas de alto grado, 3 gliomas de bajo grado, 8 lesiones metastásicas y 2 oligoastrocitomas. Los gliomas de alto grado mostraron mayor ecogenidad que los gliomas de bajo grado y el edema cerebral. No se detectaron restos del tumor al final de la cirugía, excepto en dos pacientes debido a la proximidad a áreas elocuentes del cerebro. La TC craneal postoperatoria confirmó la exéresis total del tumor en los pacientes incluidos en el estudio. Conclusiones: La ultrasonografía 2-D en tiempo-real proporciona una imagen de calidad aceptable para la realización de craneotomía guiada para exéresis de tumores supratentoriales, ya que permite su localización de manera fiable y segura, sobre todo de tumores localizados en zonas del cerebro con gran importancia anatómica y funcional, así como identificar restos de tumor una vez finalizada la cirugía (AU)

Objectives: With this 1-year retrospective study we aimed to analyze our experience on the utilization of real-time bidimensional (2-D) ultrasonography as an aid for the localization of deep-seated supratentorial brain tumours. Material and methods: During the year 2006 we performed 2-D ultrasonographic localization studies in patients undergoing excision of subcortical supratentorial brain tumours whose nature was pathologically proven. The ultrasound machines utilized were 2410 A ultrasounds HP and Phillips HDI 3500 ATL. To check gross anatomical structures we used a 3MHz probe and then a 5MHz sound to define the brain tumour characteristics. Coronal and sagittal cuts were obtained during parietal or temporal craniotomies, and axial and sagittal slices in the case of frontal masses. After brain tumour removal and after a thorough irrigation with saline, new image acquisitions were performed to confirm the completeness of tumour excision. The amount of removed tumour was also verified by a post-contrast computerized tomography (CT) scan performed after the surgery. Results: The study group was composed by 30 patients with ages comprised between 28 and 82 years. The time required for tumour localization was 17.5 (±1.9)min. The lesions were approached though 8 temporal, 7 parieto-occipital, 8 parietal, 2 fronto-parietal and 5 temporo-parietal craniotomies. Mean depth of the lesions was 5.3 (±1.6)cm. The histopathologic diagnosis was 17 high-grade gliomas, 3 low-grade astrocitomas, 8 metastatic lesions and 2 oligo-astrocytomas. Highgrade gliomas were more echogenic than low-grade tumours and than oedema. No residual tumour was detected at the end of the surgery except in two cases in which a tumoral rest was left due to the proximity of the lesion to eloquent cerebral areas. Postoperative CT scans confirmed the completeness of tumour removal in the patients of the study as assessed by intraoperative ultrasounds. Conclusions: Real-time 2-D ultrasonography affords an adequate image quality for performing guided-craniotomy in supratentorial brain tumours, as it allows for a safe and accurate localization of the lesions. Its use is mainly indicated in the removal of tumours located in, or close to, important anatomical and functional brain areas and to depict the presence of tumour rests after surgical removal of cerebral neoplasms (AU)

[Detection and typing by molecular biology of human papillomavirus in genital samples]. / Detección y tipificación mediante biología molecular del virus del papiloma humano en muestras genitales.

Recently, there has been a marked increase in human papillomavirus (HPV) infection, and the etiological relationship between some HPV genotypes and genital cancer has been confirmed. Therefore, we used current molecular biology techniques to evaluate the prevalence of these viruses and their genotype in genital samples. We processed 401 genital samples from 281 women and 120 men, all with a diagnosis compatible with HPV infection. Virus was detected using PCR, and positive samples were typed using an array technique which enabled us to detect the 35 most common types of mucous-associated HPV. Of the 401 patients studied, 185 (46.1%) were positive, and only one type of HPV was detected in 133 cases. We found that 41.6% of the women and 56.7% of the men were positive. A total of 260 HPVs were typed; 154 were high oncogenic risk. They infected 16 men (23.5%) and 88 women (75.2%). The difference was statistically significant (p<0.001). Type 6 HPV was the most frequently detected en 64 cases, followed by HVP 16 in 52 cases. We found a 46% prevalence of HPV infection. More than half of these patients were infected by high-risk HPV. The presence of high-risk HPV was significantly higher in women.

Imidazoline I(2) receptor density increases with the malignancy of human gliomas.

BACKGROUND: Current glioma grading schemes are limited by subjective histological criteria. Imidazoline I(2) receptors are principally expressed on glial cells. OBJECTIVE: To investigate the feasibility of using the measurement of imidazoline I(2) receptor expression to differentiate glial tumours from other types of brain tumours and for grading the different gliomas. METHODS: The specific binding of [(3)H]idazoxan to imidazoline I(2) receptors was measured in homogenates from human gliomas of different grades. RESULTS: The density of imidazoline I(2) receptors was significantly greater in the three types of malignant glial tumours than in postmortem control brain or non-glial tumours. The increase in density correlated with the malignancy grade of the gliomas. No significant differences in affinity values were observed. CONCLUSION: These results suggest that the density of imidazoline I(2) receptors may be a useful radioligand parameter for the differentiation of glial tumours from other types of brain tumours and for grading the different gliomas.

Lymphangioma circumscriptum of the vulva.

Lymphangioma circumscriptum is a benign disease of the lymph ducts and an unusual pathologic process that rarely affects the vulva. The etiology of this lesion is not clear, but obstruction of the lymph vessels has been suggested as a possible cause in some cases. We report the case of a 44-year-old woman with lesions similar to lymphangioma circumscriptum of the vulva and chronic idiopathic lymphedema of the lower right limb. Because there was no obvious cause, we propose that the lymphangioma was caused by the lymphedema.

Basal cell carcinoma of the scrotum.

An 80-year-old man with a 7 year history of a slowly enlarging, asymptomatic scrotal nodule is presented. He had a negative history for sexually transmitted disease, trauma to the area, radiotherapy and chemical or arsenic exposure. The lesion was excised with a margin of 0.8 cm of normal skin. Examination of the specimen revealed a basal cell carcinoma.

Vegetating iododerma with fatal outcome.

A 65-year-old woman on whom a cardiac catherization using iodine contrast had been performed developed 5 days later acute renal failure, respiratory insufficiency and cutaneous lesions consisting of two great vegetating masses located on both cheeks and pustular vesicular lesions on the extremities. A fortnight later, the patient died. We would like to stress this case because of the exceptional nature of vegetating iododerma at present, and the importance of recognizing a possibly fatal disease.

Allergy of anaesthetizing agents in Spain.

We have investigated the incidence of requests for allergy testing in 5005 patients attending an anaesthetic assessment clinic. Diagnosis of allergy to anaesthetic drugs was established using cutaneous tests. Allergy tests were requested in 151 (3.0%) patients, proving positive in 43 (0.86%). No allergic reactions were observed during subsequent anaesthesia.

[The effect of isoflurane on coronary autoregulation in hypothermia]. / Efecto del isoflurano sobre la autorregulación coronaria en hipotermia.

OBJECTIVES: To analyze the effect of isoflurane on myocardial metabolism and coronary hemodynamics during the reheating phase after heart surgery. PATIENTS AND METHODS: Sixteen patients (12 women and 4 men), with cardiac output greater than 0.5 undergoing aortic and/or mitral valve surgery, were studied prospectively. A retrograde thermodilution catheter was placed in the heart and a Swan-Ganz catheter was inserted in the pulmonary artery to determine coronary blood flow and pulmonary wedge pressure, respectively, as well as myocardial and systemic parameters. After surgery, and with hemodynamic variables stable and rectal temperature at 34 +/- 0.5 degrees C, 0.4% isoflurane was administered at the end of expiration. Variables were recorded before administering isoflurane and 20 minutes afterwards. RESULTS: Isoflurane administration decreased coronary perfusion pressure, coronary vascular resistance, regional myocardial oxygen consumption and myocardial oxygen output. Increases in coronary oxygen saturation and in large coronary vein saturation were also observed. No patient experienced significant changes in ST segment, enzymes or decreased clearance of lactic acid. CONCLUSIONS: Administering 0.4% isoflurane at the end of expiration effected coronary vasodilation without altering oxygenation or myocardial metabolism. Moreover, no electrocardiographic, enzymatic or metabolic signs of myocardial ischemia were observed.

Increased density of I2-imidazoline receptors in human glioblastomas.

A glial location has been proposed for the non-adrenoceptor [3H]idazoxan binding site termed the I2-imidazoline receptor. The specific binding of [3H]idazoxan in the presence of (-)adrenaline was measured in membranes from excised human glioblastomas (n = 6), meningiomas (n = 6) and normal brains (n = 6). The pharmacological profile of the [3H]idazoxan binding in astrocytic tumours was similar to that in normal brain, compatible with the presence of I2-imidazoline receptors. There was a higher density of I2-imidazoline receptors in astrocytic tumours (Bmax = 266 +/- 18 fmol mg-1 protein; p < 0.001) than in normal brain (Bmax = 54 +/- 4 fmol mg-1 protein), with no differences in affinity values. Almost no [3H]idazoxan-specific binding was shown in meningiomas. The results suggest that I2-imidazoline receptors may be a selective marker for glial tumours in the evaluation of intracranial neoplasms.

[Spontaneous internal carotid artery dissection as a cause of unilateral lower cranial nerve palsies]. / Disección espontánea de la arteria carótida interna como causa de parálisis de pares craneales bulbares.

We present a 60-year-old man with a complete right IX-XII nerve palsy (Collet-Sicard syndrome) due to spontaneous right internal carotid artery (ICA) dissection. Magnetic resonance imaging (MRI) and MR angiography (MRA) showed signs of subadventitial dissection of the right ICA with a mural haematoma that expanded the circumference of the vessel at the level of the retrostyloid space, adjacent to the IX-XII nerves. No narrowing of the lumen or aneurysms was found. Clinical recovery was excellent after treatment with only antiplatelet drugs. Cervical internal carotid artery dissection should be included in the differential diagnosis of lower cranial nerve palsies. MRI and MRA are noninvasive, reliable methods for diagnosis and follow-up, especially in subadventitial dissections.

[Isoflurane versus propofol for sedation after heart surgery]. / Isoflurano frente a propofol en la sedación tras cirugía cardíaca.

OBJECTIVE: To compare isoflurane and propofol as the principal sedatives in ventilated patients after cardiac surgery with extracorporeal circulation (ECC). PATIENTS AND METHODS: Forty consecutive, randomized patients undergoing cardiac surgery with ECC were studied prospectively. Patients were assigned to receive either isoflurane or propofol. Variables recorded were level of sedation, adaptation to the respirator and hemodynamic stability. RESULTS: Each group included 20 patients. The mean dose of isoflurane was 0.39% +/- 0.06% of end-tidal concentration. The mean propofol dose was 2.11 +/- 0.55 mg/kg/h. Statistically significant differences were found for stabilization of sedation time (4 min +/- 1.17 for isoflurane and 11.7 min +/- 4.78 for propofol) and time to endotracheal extubation (56.2 min +/- 20.47 for isoflurane and 72.65 min +/- 30.90 for propofol), number of times dosage had to be changed (2.20 +/- 0.89 with isoflurane and 7.05 +/- 2.58 with propofol) and time of administration had to be interrupted (8.45 min +/- 8.73 with propofol and 0.75 min +/- 1.94 with isoflurane). CONCLUSIONS: In comparison with propofol, isoflurane offers advantages of rapid stabilization of sedation, ease of use and shorter time to endotracheal extubation.

Arteriovenous fistulas in the neck: diagnosis with color Doppler sonography.

We report the use of color Doppler imaging in the diagnosis of four arteriovenous fistulas in the neck region: two had a traumatic origin and two were spontaneous. A perivascular color artifact was the most common initial finding on color images to indicate the underlying abnormality. In all four cases, a low-resistance flow with high systolic and diastolic velocities was observed in the feeding artery. Although angiography remains essential before therapeutic embolization, color Doppler sonography may be an important tool for screening and follow-up of cervical arteriovenous fistulas.

Comparison of the recovery characteristics of midazolam, alone or antagonised with flumazenil, and thiopental in ASA III-IV patients.

Sixty non-premedicated male patients, physically ASA III-IV, 50-80 years of age, undergoing translumbar aorthography, were randomly allocated into three groups. Group A received midazolam (0.13 mg.kg-1), group B received thiopental (4 mg.kg-1), and group C midazolam (0.13 mg.kg-1) combined with flumazenil (6 micrograms.kg-1) at the end of the operation. Three minutes before the anaesthesia began, fentanyl (1.5 micrograms.kg-1) was administered to all the patients. An evaluation was made of the time they took to open their eyes spontaneously, of time-space orientation, comprehension-collaboration, hypnosedation, psychomotor performance and memory. In groups "C" and "B" spontaneous opening of the eyes took place before that of group "A". The recovery of orientation, comprehension and hypnosedation was fastest with thiopental, next with midazolam combined with flumazenil, and later with midazolam. Psychomotor performance in Trieger test was impaired for a shorter period with thiopental than in the other two groups. Recovery in group "C" was incomplete within the time, with the result that resedation was detected in 20% of the subjects.