[Study of the prognostic implications in patients with a transient ischaemic attack before the implementation of an agreed process of treatment in the health region of Lleida]. / Estudio de las implicaciones pronósticas del paciente con ataque isquémico transitorio antes de la implantación de un proceso consensuado de tratamiento en la región sanitaria de Lleida.

AIM: The transient ischemic attack (TIA) is a medical emergency because of their high risk of early recurrence. We study the evolution and management of patients with a TIA in our hospital before establishing a process management and treatment of this condition. PATIENTS AND METHODS: We included 180 consecutive patients with suspected TIA attended in the emergency department of our hospital between January 2006 and March 2007. We collected clinical variables (risk factors, age, clinical symptoms, duration, ABCD2). Cases were reviewed by two neurologists to establish the correlation with the diagnosis. We established the risk of cerebral infarction after one year follow-up. RESULTS: 31% of patients were discharged home. There were differences between the two groups regarding age (82.9 Y 7.5 vs 70.53 Y 10.7 years); ABCD2 scale score (1.5 Y 5.32 vs 4.44 Y 1.37); and atrial fibrillation (27.5% vs 8.6%). There was much greater delay and lack of complementary explorations. During follow-up, 23% of patients not hospitalized had recurrent stroke versus 6.7% of hospitalized patients. Despite the fact that only age more than 80 years was identified as predictor of stroke recurrence (hazard ratio = 8,72; 95% CI = 2.4-31.74; p = 0.001) in regression multivariate model, the Kaplan-Meier model showed a higher risk of stroke recurrence among not admitted patients (p = 0.012). CONCLUSION: In our area, the management of TIA patients in the emergency room had high impact on the evolution of these patients. A process management should be performed in order to achieve improvement in clinical praxis.

Estudio de las implicaciones pronósticas del paciente con ataque isquémico transitorio antes de la implantación de un proceso consensuado de tratamiento en la región sanitaria de Lleida / Study of the prognostic implications in patients with a transient ischaemic attack before the implementation of an agreed process of treatment in the health region of Lleida

Objetivo. Conocer la realidad del manejo y evolución de los pacientes con un ataque isquémico transitorio (AIT) en nuestro centro antes de instaurar un proceso de tratamiento de esta patología. Pacientes y métodos. Estudiamos a 180 pacientes consecutivos que acudieron a urgencias de nuestro centro (entre enero de 2006 y marzo de 2007). Los casos fueron revisados por dos neurólogos para establecer la concordancia con el diagnóstico. Se estableció el riesgo de infarto cerebral tras un seguimiento de un año. Resultados. Hubo discordancia en el diagnóstico de AIT en 40 casos. Un 31% de los pacientes fue dado de alta a su domicilio desde urgencias. Al comparar éstos con los que ingresaron en el servicio de neurología, se observan diferencias en la edad (82,9 ± 7,5 frente a 70,53 ± 10,7 años), puntuación en la escala ABCD2 (5,32 ± 1,5 frente a 4,44 ± 1,37) y fibrilación auricular (27,5% frente a 8,6%). Asimismo, el tiempo para realizar el estudio etiológico fue mucho mayor y el número de exploraciones complementarias mucho menor. Al cabo de un año, el 23% de estos pacientes sufrió un infarto cerebral, por sólo el 6,7% de los hospitalizados en planta en neurología. Pese a que sólo la edad superior a 80 años se comportó como único predictor de recurrencia (razón de riesgo = 8,72; intervalo de confianza al 95% = 2,4-31,74; p = 0,001), el modelo de Kaplan-Meier demuestra la peor evolución del paciente no ingresado (p = 0,012). Conclusión. En nuestra zona, el alta domiciliaria desde urgencias tiene repercusión sobre el peor estudio etiológico y la evolución del enfermo. Se debe establecer un proceso de manejo del AIT consensuado para asegurar el diagnóstico y tratamiento adecuados (AU)

Aim. The transient ischemic attack (TIA) is a medical emergency because of their high risk of early recurrence. We study the evolution and management of patients with a TIA in our hospital before establishing a process management and treatment of this condition. Patients and methods. We included 180 consecutive patients with suspected TIA attended in the emergency department of our hospital between January 2006 and March 2007. We collected clinical variables (risk factors, age, clinical symptoms, duration, ABCD2). Cases were reviewed by two neurologists to establish the correlation with the diagnosis. We established the risk of cerebral infarction after one year follow-up. Results. 31% of patients were discharged home. There were differences between the two groups regarding age (82.9 ± 7.5 vs 70.53 ± 10.7 years); ABCD2 scale score (1.5 ± 5.32 vs 4.44 ± 1.37); and atrial fibrillation (27.5% vs 8.6%). There was much greater delay and lack of complementary explorations. During follow-up, 23% of patients not hospitalized had recurrent stroke versus 6.7% of hospitalized patients. Despite the fact that only age more than 80 years was identified as predictor of stroke recurrence (hazard ratio = 8,72; 95% CI = 2.4-31.74; p = 0.001) in regression multivariate model, the Kaplan-Meier model showed a higher risk of stroke recurrence among not admitted patients (p = 0.012). Conclusion. In our area, the management of TIA patients in the emergency room had high impact on the evolution of these patients. A process management should be performed in order to achieve improvement in clinical praxis (AU)

Carcinoma de origen desconocido

El carcinoma de origen desconocido constituye entre el 5 y el 10 por ciento de todos los tumores sólidos. Presenta un comportamiento muy agresivo y una evolución clínica atípica respecto a otros tumores metastásicos con un tumor primario conocido. El papel del patólogo en el proceso diagnóstico es fundamental y se requiere una estrecah colaboración entre éste y el clínico. La búsqueda a ciegas del tumor primario ha demostrado una limitada rentabilidad diagnóstica y una escasa relación coste-beneficio en cuanto a supervivencia, por lo que el objetivo del médico debe ser la identificación de subgrupos de pacientes potencialmente tratables aunque, de forma infructuosa, el 60 por ciento de los pacientes no pertenece a ninguno de ellos. Aun sin existir tratamiento específico frente a esta entidad, la utilización de nuevas combinaciones terapéuticas basadas en taxanos y gemcitabina parece asociarse a un mayor beneficio clínico y a una mayor supervivencia (AU)

[The importance of the gender perspective in health interview surveys]. / La importancia de la perspectiva de género en las encuestas de salud.

The identification and measurement of the population health needs should be the first step in health planning. In order to guarantee equity criteria, to know the situation of the whole population, and therefore also that of women, is a key issue. Health interview surveys are a good tool for pinpointing the needs of the population, but mainly they are usually focused on health risk factors that explain men's health status such as health behaviours and paid job. These factors often fail to capture aspects that are relevant for women's health, such as household work. The main objective of this paper is to emphasise the importance of a gender perspective in the design and analysis of health interview surveys, and to propose variables that should be included in health surveys in order to better know gender health inequalities. Likewise, this article deals with the gender concept and its importance as a health inequality factor. Gender is an analytical construct based on the social organisation of the sexes that can be used to better understand the conditions and factors influencing women's and men's health beginning by the social roles that each culture and society assigns to people based on their sex. Health is a complex process determined by a wide range of factors: biological, social, environmental and health services related factors. Gender, because of its close relation to all of them, plays a key role. The gender approach is characterised by the analysis of the social relation between men and women, taking into account that sex is a determinant of social inequalities. This paper presents the variables that health interview surveys should include from a gender approach point of view: reproductive work, productive work, social class, social support, self-perceived health status, quality of life, mental health and chronic conditions. In addition, issues related to the wording of questions, data collection and analysis are discussed.

[Comparative study of the medial longitudinal striae of the hippocampus (formerly called "nerves of Lancisi") in the fighting bull and domestic bull]. / Etude comparative des stries longitudinales médiales de l'hippocampe Lanciennement "nerfs de lancisi") chez le taureau de combat et le taureau domestique.

In this paper a comparative study is made of stria longitudinalis medialis in the fighting bull and domestic bull. This nervous bundles are more developed in the former, and their connections with the Gyrus dentatus and Hippocampus are demonstrated. The structural differences observed between both animals could be related with the mechanisms that control the aggressive behaviour.

The facial motor nucleus of the dog. II. Morphometric analysis.

In this study, an area of 953.2 micron 2, a diameter of 36.7 micron and a circularity factor of 0.74 have been established for the neurons of the facial motor nucleus of the dog. Significant differences (p less than 0.01) were observed by comparing the means of some of the parameters determined in the six cytoarchitectonic subdivisions of the facial motor nucleus described in a previous study. Moreover, the neurons tend to increase in size in the caudocranial direction.

The facial motor nucleus of the dog. I. Cytoarchitectonic subdivisions and cytology.

A study of the facial motor nucleus of the dog by means of cytoarchitectonic and computer-aided three-dimensional reconstruction methods has been made. We identified three regions in this structure: lateral, intermediate and medial. Taking into account the different patterns of neuron aggregation, the following subdivisions were noted in the first, the ventrolateral and dorsolateral subnuclei; in the second, the intermediate subnucleus, and in the third, the ventromedial, intermediate-medial and dorsomedial subnuclei. Their cytological characteristics are described.

[Development of 3 populations of embryonal bodies in monolayer culture and in suspension]. / Evolution sur culture en monocouche et en suspension de trois populations de corps embryonnaires.

In the present investigation the "in vitro" behaviour of three morphologically different types of embryoid bodies of the teratocarcinoma OTT 6050, which were isolated by means of a Ficoll's density gradient, was analyzed. The study of the results obtained from the culture in suspension and in monolayer show that these morphologically different types represent three different stages of one evolutional cycle which tends to reproduce them as well as creating a variety of potentially more malign embryoid body.

[An experimental model for adjusting the rhythm of irradiation to the kinetics of the tissues to be irradiated]. / Estudio de un modelo experimental para adecuar el ritmo de irradiación a la cinética de los tejidos a irradiar.

To obtain better results with radiotherapy it is necessary to take into account the tissue kinetics. Synchronized cell cultures in vitro show that the radiation-induced mitotic delay and the survival curves are cell phase-dependent. It is necessary to follow the evolution of the different cell populations in the irradiated volume. It can be done using a distribution factor (fD), that may be defined as the quotient between the number of S-phase cells and the number of cells in the remaining phases at a given moment.