ABSTRACT
INTRODUCTION: Occasionally, primary care pediatricians notice the presence of small clusters of pediatric cancer (PC), but are often frustrated by the findings after statistical analysis. The study of small areas in spatial epidemiology has led to advances in identifying clusters and the environmental risk factors involved. The purpose of this study was to describe the PC incidence and the spatial distribution at the minimum level of disaggregation possible in Murcia, presenting the first urban municipality map of PC in Spain. MATERIALS AND METHODS: A population-based descriptive study was conducted on the PC cases diagnosed in children younger than 15 years, between 1998 and 2013 in the municipality of Murcia. Cases were classified by sex, age group, and tumor type. Coordinates of home addresses at the time of diagnosis were assigned to each case, and spatial and spatio-temporal analyses were carried out at the level of census tracts, using FleXScan and SatScan. RESULTS: A total of 155 cases of PC were diagnosed during this period. The overall incidence of PC (138/10(6) of children under the age of 15) and the incidence for individual tumor types were within the expected ranges for Europe. A spatio-temporal cluster of Hodgkin lymphoma was identified. CONCLUSIONS: Small area analysis of PC cases may be a useful tool for the identification of PC clusters, which would allow for the generation of hypotheses regarding disease etiology, as well as developing urban models for environmental surveillance of PC.
Subject(s)
Neoplasms/epidemiology , Child , Europe , Humans , Incidence , Risk Factors , Spain/epidemiologyABSTRACT
OBJECTIVE: To assess attitudes, beliefs and knowledge of primary medical care professionals as regards the follow-up of Childhood Cancer Survivors (CCS) and the introduction of a Long-Term Follow-Up Program for Childhood Cancer Survivors in the Region of Murcia (PLASESCAP-MUR). MATERIAL AND METHODS: Descriptive cross-sectional study using a structured, self-administered questionnaire. These questionnaires were sent to all primary medical care professionals in Murcia Health District 1. RESULTS: Response rate of 58% (100/172), with 71% and 22% being family physicians and pediatricians, respectively, of whom 49% provided medical care to a CCS in the last 5 years, with 84% reporting that they never or rarely received a detailed report of overall assessment of the survivor. More than 75% found that access to detailed follow-up information was quite or very useful; 95% prefer to consult experts when providing medical care to survivors, and 80% believe that improving the quality of the environment may decrease the morbidity and mortality of the survivors. A statistically significant relationship was found between the length of practicing medicine and the perception of the importance of environmental factors. CONCLUSIONS: It seems to be important to increase the training of primary care professionals for the long-term follow-up of CCS, as well as having the detailed information through a personalized long-term follow-up of each survivor. PLASESCAP-MUR offers an integrated follow-up to CCS in a model of shared care between Long Term Monitoring Units and Primary Care Units.
Subject(s)
Attitude of Health Personnel , Health Care Surveys , Health Knowledge, Attitudes, Practice , Neoplasms/therapy , Primary Health Care , Adolescent , Child , Child, Preschool , Cross-Sectional Studies , Female , Follow-Up Studies , Humans , Infant , Male , Spain , Survivors , Time FactorsABSTRACT
The term Spondyloptosis is used to describe a grade V spondylolisthesis, being a subluxation bigger than 100%. The trauma spondyloptosis binding L5-S1 is reported the most prevalent. It is rare in the cephalad lumbar segment to the lumbosacral junction. Two cases of spondyloptosis of L4-L5 have been reported until August 2010, caused by high energy trauma, both with the L4 vertebral body presented an anterior displacement of the vertebral body of L5. We report a patient with traumatic spondyloptosis of L4-L5 caused by a high-energy mechanism. The mechanism of injury and surgical management are described and the clinical evaluation is performed with a minimum follow-up of 8 months.
Subject(s)
Lumbar Vertebrae/injuries , Spondylolisthesis/etiology , Adolescent , Humans , MaleABSTRACT
INTRODUCTION: Environment and Paediatric Cancer (PC) in the Region of Murcia (RM) is an on-going research project that has the following aims: to collect a careful paediatric environmental history (PEH) and to use geographical information systems (GIS) to map the incidence and analyze the geographic distribution of the PC incidence in the RM. The objectives are to present the methodology used for the collection and processing of data and disseminate initial results on the spatial and temporal incidence of PC in the RM (Spain). MATERIAL AND METHODS: A descriptive and georeference study of all PC cases under 15 years, diagnosed from 1 January 1998 to December 31, 2009. Three postal addresses were assigned to each case, residence during pregnancy, postnatal, and at the time of diagnosis. Other variables such as sex, date of birth, date of diagnosis, and histopathology classification were collected. RESULTS: No increase was observed in the trend of incidence of PC. The crude annual incidence rate was 14.3 cases per 100,000 children under 15 years. The standardised incidence ratio was higher in the north-west of the RM. Before diagnosis, 30% of cases had a different postal address than during the pregnancy. CONCLUSIONS: Integrating the spatial and temporal information through the PEH in a GIS should allow the identification and study of space-time clusters through an environmental monitoring system in order to know the importance of associated risk factors.
Subject(s)
Neoplasms/epidemiology , Adolescent , Child , Child, Preschool , Environment , Female , Geographic Information Systems , Humans , Infant , Male , Spain/epidemiologyABSTRACT
Two new diterpenic acids with an ent-halimane skeleton have been isolated from the aerial parts of Halimium viscosum (Villarino de los Aires chemotype) and separated as methyl esters. These diterpenes were 13-oxo-14, 15-dinor-1(10),11E-ent-halimadien-18-oic acid and 15-hydroxy-1(10),13Z-ent-halimadien-18-oic acid.
Subject(s)
Cistaceae/chemistry , Diterpenes/isolation & purification , Plants, Medicinal/chemistry , Diterpenes/chemistry , Esters/chemistry , Nuclear Magnetic Resonance, Biomolecular , Plant Stems/chemistry , Spain , Spectrophotometry, Infrared , Spectrophotometry, Ultraviolet , Spectroscopy, Fourier Transform Infrared , StereoisomerismABSTRACT
Choledocholithiasis in patients with a gallbladder "in situ" is presently one of the most frequent indications of endoscopic sphincterotomy. The crucial problem of these patients is whether or not they require eventual cholecystectomy to avoid the risks of potential complications of cholelithiasis. Of the 39 patients (mean age 80.1 +/- 8.2 years) with choledocholithiasis and gallbladder "in situ" released from this hospital from October 1979 to December 1985 after a successful endoscopic sphincterotomy (expulsion, spontaneous or not, of gallstones), 33 (84.6%) have been followed-up for an average of 41.5 +/- 20.8 months (7-92 range). During this time only one patient (3%) developed acute cholecystitis that required cholecystectomy, and two (6%) denoted mild pains in the right upper quadrant, while the other 30 (91%) remained asymptomatic. Over these years 10 patients (30.3%) died from nonbiliary causes. In conclusion, in elderly or high surgical risk patients who present choledocholithiasis and gallbladder "in situ", endoscopic sphincterotomy is effective. Later cholecystectomy to prevent the complications of cholelithiasis would not be justified as a routine measure in most of these patients.
Subject(s)
Cholecystectomy , Gallstones/surgery , Sphincterotomy, Transduodenal , Aged , Aged, 80 and over , Cholecystitis/prevention & control , Duodenoscopy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Complications/prevention & control , Time FactorsABSTRACT
There are two types of congenital bilateral subclavian steal. The first type is accompanied by severe coarctation or interruption of the aorta in which both the right and left subclavian arteries have their origin distal to the obstruction in the aorta. In most cases with complete interruption of the aorta there is a large ventricular septal defect. The second, less common type of steal is associated with isolated atresia of the proximal segment of the subclavian arteries. In the first type of steal, the anatomic predisposition for the steal is present from birth but clinical symptoms frequently do not appear until childhood or adolescence. In the newborn the presence of a widely patent duclus arteriosus and its capacity to transmit the flow and pressure from a hypertensive pulmonary artery to the descending aorta and thus to the subclavian arteries prevents cerebral symptoms and angiographic signs, but in the older infant and child, the internal diameter of the ductus has usually decreased, leading to symptoms of the subclavian steal syndrome.
