Workplace aggressions on hospital workers: A current and prevalent problem with a high demand for training.

BACKGROUND: Workplace aggressions on hospital workers is a very frequent and under-reported problem. OBJECTIVE: The novel objective of our study was to analyze the number of workplace aggressions per hospital worker. Other objectives of the study were to analyze the management knowledge and interest in receiving training on aggressions by hospital workers. METHODS: An anonymous survey was handed out among all professionals in a university hospital. RESULTS: A total of 1118 anonymous surveys were collected. The responders declared that throughout their working life they had suffered some sort of verbal aggression in the hospital in 766 cases (68.5%) and physical aggression in 393 cases (35.2%). Multiple logistic regression analyses found higher risk of receiving physical and verbal aggression in the nursing category and in the Emergency, Critical Care or Psychiatry Units, and a higher risk of receiving physical aggression in women. The score on the level of personal knowledge regarding the legal, physical, and psychological management of aggressions (score 0-10 for each of the 3 aspects) was 2.91±2.68 in legal management, 2.97±2.77 in psychological management and 2.91±2.76 in physical management. The opinion about the interest of receiving training (score from 0 to 10) on the legal management of hospital aggressions was 8.90±1.72, on psychological management was 8.85±1.78 and on physical management was 8.88±1.78. CONCLUSIONS: Workplace aggression on hospital workers mainly affects women, the nursing category and the Emergency, Critical Care or Psychiatry Units. Hospital workers showed little knowledge on the topic but a great interest in receiving training.

Desarrollo de tratamientos experimentales para pacientes con retinosis pigmentaria / Development of experimental treatments for patients with retinitis pigmentosa

La retinosis pigmentaria es un grupo de enfermedades de origen hereditario que produce la degeneración de la retina y una disminución de la visión. La Organización Mundial de la Salud reporta alrededor de 1.300 millones de personas afectadas por algún tipo de deficiencia visual a nivel mundial. La prevalencia es de 1 por cada 4.000 habitantes y es la primera causa de ceguera de origen genético, frecuente en los varones con un porcentaje del 60% y el 40% en mujeres. Existe falta de información sobre esta patología en el mundo, principalmente sobre los tratamientos existentes para esta enfermedad, por lo que esta revisión bibliográfica tiene como objetivo actualizar los tratamientos existentes o en estudio e informar de las limitaciones que tiene cada una de estas terapias. Se realizó esta revisión de literatura científica mediante la consulta en bases de datos como PubMed y Web of Sciense; la búsqueda se limitó a artículos de los años 2018 al 2022. Existen varios tipos de terapia en estudios: terapia génica, estimulación eléctrica transcorneal, uso de neuroprotectores, terapia optogénica, trasplantes de células madre y terapia con oligonucleótidos, de los que se hablará en este artículo, tanto de sus beneficios como de las barreras existentes en cada tratamiento experimental. En conclusión, cada una de estas terapias promete un tratamiento viable en el futuro para grupos selectivos de personas con retinosis pigmentaria; sin embargo, algunas terapias han demostrado beneficio al inicio de la enfermedad, perdiendo su eficacia a largo plazo (AU)

Retinitis pigmentosa is a group of inherited diseases that lead to degeneration of the retina and decreased vision. The World Health Organization reports around 1300 million people affected by some type of visual impairment worldwide. The prevalence is 1 in every 4000 inhabitants and it is the first cause of blindness of genetic origin, frequent in men with a percentage of 60% and 40% in women. There is a lack of information on this pathology in the world, mainly on the existing treatments for this disease, so this bibliographic review aims to update the existing or under-study treatments and inform the limitations of each of these therapies. This review of scientific literature was carried out by consulting databases such as PubMed and Web of science, the search will be limited to articles from the years 2018 to 2022. There are several types of therapy in studies: gene therapy, transcorneal electrical stimulation, use of neuroprotectors, optogenic therapy, stem cell transplants and oligonucleotide therapy, which will be discussed in this article, both their benefits and the existing barriers in each experimental treatment. In conclusion, each of these therapies promises a viable treatment in the future for selective groups of people with retinitis pigmentosa, however, some therapies have shown benefit at the beginning of the disease, losing their efficacy in the long term (AU)

Development of experimental treatments for patients with retinitis pigmentosa.

Retinitis pigmentosa (RP) is a group of inherited diseases that lead to degeneration of the retina and decreased vision. The World Health Organization reports around 1,300 million people affected by some type of visual impairment worldwide. The prevalence is 1 in every 4000 inhabitants and it is the first cause of blindness of genetic origin, frequent in men with a percentage of 60% and 40% in women. There is a lack of information on this pathology in the world, mainly on the existing treatments for this disease, so this bibliographic review aims to update the existing or under-study treatments and inform the limitations of each of these therapies. This review of scientific literature was carried out by consulting databases such as PubMed and Web of science, the search will be limited to articles from the years 2018-2022. There are several types of therapy in studies: gene therapy, transcorneal electrical stimulation, use of neuroprotectors, optogenic therapy, stem cell transplants and oligonucleotide therapy, which will be discussed in this article, both their benefits and the existing barriers in each treatment experimental. In conclusion, each of these therapies promises a viable treatment in the future for selective groups of people with retinitis pigmentosa, however, some therapies have shown benefit at the beginning of the disease, losing their efficacy in the long term.

Acid-base and electrolyte evaluation in dogs with upper GI obstruction: 115 dogs (2015-2021).

OBJECTIVES: Metabolic alkalosis, although uncommon in small animals, has been previously associated with gastrointestinal obstructions. Depending on the population and disease process evaluated, previous prevalence of metabolic alkalosis is reported as ranging from 2% to 45% in canine patients. The objective of this study was to determine the prevalence of metabolic alkalosis and other acid-base and electrolyte disorders in a cohort of dogs with a confirmed upper gastrointestinal obstruction. MATERIALS AND METHODS: Electronic medical records were reviewed to identify dogs who presented for vomiting with evidence of an upper gastrointestinal obstruction from January 2015 to October 2021. Patients were enrolled only if a preoperative venous blood gas was obtained and analysed in house. Traditional acid-base analysis was utilised to determine an acid-base status before relieving the obstruction. When available, post-operative venous acid-base status was determined within 24 hours after surgery, and compared to preoperative results. RESULTS: A total of 115 dogs were included in the study. Twenty-five out of 115 (22%) dogs displayed either a simple metabolic alkalosis or a mixed acid-base disturbance before surgery. Twenty-seven out of 115 dogs (37%) had a normal acid-base status at entry. Seventy-one dogs had pre- and post-operative venous blood gas results available. Metabolic alkalosis was resolved in nearly all patients post-operatively, with no patients displaying a simple metabolic alkalosis. A mixed metabolic acidosis and respiratory alkalosis was the most common condition post-operatively, found in 25 of 71 (35%) dogs. Severe derangements of electrolytes were infrequent preoperatively (3/115; 2.6%). A majority of patients in this study exhibited hypokalaemia (64.4%), hypochloraemia (72.8%) and hyponatraemia (77.4%) on preoperative venous blood gases. Venous pH, Pv CO2 , bicarbonate and base excess were significantly higher preoperatively when compared to the post-operative results. CLINICAL SIGNIFICANCE: This study found the prevalence of pre-operative metabolic alkalosis in dogs with a documented upper gastrointestinal obstruction to be lower than previously reported. Surgical or endoscopic alleviation of the upper gastrointestinal obstruction resulted in resolution of metabolic alkalosis in nearly all patients.

Plasmocitoma extramedular de canal auditivo externo: caso clínico / Extramedullary plasmacytoma of external auditory canal: a case report

Resumen El plasmocitoma extramedular es una neoplasia de células plasmáticas poco frecuente, que se ubica en 80% a 90% de los casos en la cabeza o cuello. Esta neoplasia representa menos del 1% de toda la patología maligna de cabeza y cuello. Dada la poca frecuencia de la patología y la escasez de casos publicados, esta entidad presenta una gran dificultad clínica y terapéutica. El diagnóstico se basa en el análisis histológico con inmunohistoquímica de la muestra obtenida, y el tratamiento varía según la ubicación, donde se puede realizar radioterapia o cirugía. En este artículo presentamos el caso de una paciente de 56 años, con antecedentes de otorrea de larga data en oído derecho, al examen físico presentaba un tumor que obstruía todo el conducto auditivo externo. Se realizó exéresis tumoral y la biopsia evidenció un plasmocitoma.

Abstract Extramedullary plasmacytoma is a rare plasma cell neoplasm, affecting 80% to 90% of the head or neck. This neoplasm represents less than 1% of all malignant head and neck pathology. Given the infrequency of the pathology and the scarcity of published cases, this entity presents great clinical and therapeutic difficulty. Diagnosis is based on histology and immunohistochemistry and treatment varies depending on the location, where radiation therapy or surgery can be performed. In this article, we present the case of a 56-year-old patient with a history of long-standing otorrhea in the right ear. Physical examination presented a tumor that obstructed the entire external auditory canal. Tumor excision was performed, and the biopsy revealed a plasmacytoma.

Estudio comparativo de laringes humanas y de cerdos: hacia un modelo de entrenamiento quirúrgico / Comparative study of human and pig larynxes: towards a surgical training model

Introducción: La laringe de cerdo doméstico tiene similitudes con la laringe humana. La capacidad elástica de las cuerdas vocales del cerdo demuestran tener la mayor similitud con la humana comparado con otros animales por lo que se ha propuesto usar las laringes de cerdo como modelo de entrenamiento quirúrgico. Objetivo: Determinar las diferencias y similitudes anatómicas e histológicas entre la laringe del cerdo y la humana. Material y método: Se realizaron mediciones por 4 observadores en 5 laringes porcinas cuyos resultados se compararon con los descritos en la literatura para las laringes humanas. Además se realizaron cortes histológicos para visualizar fibras elásticas, mucinas neutras y mucinas ácidas. Resultados: El cartílago tiroides porcino mide entre las astas superiores 37,55 ±7,30 mm, entre astas inferiores 31,33 ±3,27 mm, desde la prominencia laríngea al borde posterior 34,32 ±7,30 mm. En el cartílago cricoides, desde el borde superior-inferior en el arco anterior 7,28 ±2,21 mm, altura borde superior-inferior pared posterior 27,47 ±3,40 mm, ancho máximo pared posterior 30,99 ±4,51 mm, diámetro interior anteroposterior (borde cefálico) 30,90 ±2,12 mm, diámetro interior anteroposterior (borde caudal) 21,78 ±2,55 mm, diámetro interior derecha-izquierda (borde cefálico) 18,11 ±2,13 mm, diámetro interior derecha-izquierda (borde caudal) 21,10 ±2,40 mm. Histológicamente, la laringe de cerdo y humana presentan leves diferencias en cuanto al epitelio de cada porción de la laringe, a pesar de que el tipo de cartílago es el mismo en ambas especies. Conclusión: Si bien existen diferencias anatómicas e histológicas entre la laringe de cerdo y el humano, el modelo porcino es una alternativa útil, accesible y de bajo costo para el entrenamiento en cirugía laringotraqueal y microcirugía laríngea.

Introduction: The domestic pig larynx has similarities with the human larynx. The elastic capacity of the vocal folds of the pig has the greater similarity with the human one compared with other animals. It has been proposed to use the porcine larynx as a model for surgical training. Aim: To determine the anatomical and histological differences and similarities between the pig larynx and the human larynx. Material and method: Measurements were made by 4 observers in 5 porcine larynxes whose results were compared with those described in the literature. In addition, histological sections were performed to visualize elastic fibers, neutral mucins and acid mucins. Results: The porcine thyroid cartilage measured 37.55 ±7.30 mm between the upper horns, 31.33 ±3.27 mm between lower horns and 34.32 ±7.30 mm from the laryngeal prominence to the posterior margin. In the cricoid cartilage, from the upper-lower edge in the anterior arch 7.28 ±2.21mm, height upper-lower edge posterior wall 27.47 ±3.40 mm, maximum posterior wall width 30.99 ±4.51 mm, anteroposterior inner diameter (head margin) 30.90 ±2.12 mm, inner diameter anteroposterior (caudal edge) 21.78 ±2.55 mm, inner diameter right-left (head edge) 18.11 ±2.13 mm, inner diameter right-left (caudal edge) 21.10 ±2.40 mm. Histologically, the pig and human larynxes present slight differences in the epithelium of each portion of the larynx, despite the fact that type of cartilage is the same in both species. Conclusions: Although there are anatomical and histological differences between the pig larynx and the human larynx, the porcine model is a useful, accessible and low cost alternative for training in laryngotracheal surgery and laryngeal microsurgery.

La información sexual en pacientes urostomizados, ¿una asignatura pendiente? / No disponible

Tras años de experiencia con pacientes urostomizados detectamos una falta de información en relación a la vida sexual, cuándo podrán retomarla y los cambios que sufrirá tras la intervención. Nuestro objetivo es conocer si a los pacientes a los que se les ha realizado una cistectomía se les ha dado información relativa a la sexualidad, cuándo la recibieron, si fue de utilidad y qué necesidad de información tenían los usuarios. Para ello realizamos un estudio con pacientes sometidos a una cistectomía en el Hospital Son Llàtzer entre enero de 2007 y enero de 2016. Evaluados los resultados constatamos que, informando a los pacientes previamente a la intervención, estos podrían obtener un aumento de su calidad de vida sexual, por lo que observamos la necesidad de la creación de una guía multidisciplinar para poder proporcionar la educación correcta y necesaria en cada caso

After years of experience with urostomized patients, we detected a lack of information regarding the sexual life, when it is resumed and the changes that occur after the intervention. Our objective is to know patients who have had a cystectomy and have given information about sexuality, when it was received, if it was useful and what information users need. To do this, he carried out a study with some patients with a cystectomy at the Hospital Son Llàtzer between January 2007 and January 2016. Evaluating the results, those who inform the patients prior to the intervention, the latter receive an increase in their quality of sexual life. That we observe the need for the creation of a multidisciplinary guide to be able to provide the correct and necessary education in each case

Tumor miofibroblástico de laringe: reporte de caso clínico y revisión de literatura / Miofibroflástico larynx tumor: case report and literature review

El tumor miofibroblástico inflamatorio de laringe es una patología rara dentro de los tumores de cabeza, cuello y de vía aérea, con una baja prevalencia, existiendo escasa literatura al respecto. Corresponde a un tumor benigno que generalmente se presenta como hallazgo incidental en relación a cuerdas vocales con mayor frecuencia, que puede ser de carácter asintomático o presentarse con clínica de obstrucción de vía aérea como estridor y disnea progresiva, además de disfonía. Puede afectar a pacientes de cualquier edad, siendo más frecuentes en adultos en edad media. El diagnóstico se hace a través de radiología y visualización directa mediante laringoscopía con la consiguiente obtención de muestra y estudio histopatológico. El tratamiento consta en la resección quirúrgica completa de la lesión, asociado o no a terapia esteroidal, sin embargo la curación completa no se logra en todos los casos producto de la naturaleza recidivante de la lesión.

The inflammatory myofibroblastic umor of the larynx is a rare condition in tumors of head, neck and airway, with a low prevalence, and scarce existing literature. It corresponds to a benign tumor that usually occurs as an incidental finding in relation to vocal cords more frequently, which can be asymptomatic or present with clinical character of airway obstruction, as progressive stridor and dyspnea, plus dysphonia. It can affect patients of any age are more common in adults in middle age. The diagnosis is made by radiology and direct laryngoscopy with visualization by obtaining sample and histology. Treatment consists of surgical removal of the entire lesion with or without steroid therapy, however complete healing is not achieved in all the cases product of the recurrent nature of the patology.

Sarcoidosis. Comienzo como pseudotumor orbitario / Sarcoidosis. Debut as orbital pseudotumour

CASO CLÍNICO: Paciente mujer de 78 años remitida para estudio de pseudotumor orbitario izquierdo de 17 días de evolución. Observamos proptosis, dolor sin limitación de los movimientos oculares, edema periorbitario y ptosis palpebral, clínica compatible con pseudotumor orbitario. La resonancia magnética orbitaria evidencia una masa adyacente al globo ocular ocupando la vertiente superoexterna y aumento de partes blandas a nivel de la glándula lagrimal. El estudio anatomopatológico de una lesión palpebral demuestra la presencia de granulomas no caseificantes. DISCUSIÓN: Se realiza el diagnóstico de sarcoidosis orbitaria definitiva. El tratamiento oral con corticoides y metotrexato logra el control de la enfermedad

CASE REPORT: 78 year-old female patient being investigated for a left orbital pseudotumour of 17 days onset. She had proptosis, pain, with no limitation of eye movements, periorbital oedema, and upper eyelid ptosis, compatible with an orbital pseudotumour. The MRI showed an upper outer left orbital mass adjacent to the side of eyeball and an increase in soft tissue at the level of lacrimal gland. The histopathology study of an eyelid lesion demonstrated the presence of non-caseating granulomas. DISCUSSION: A definitive diagnosis of orbital sarcoidosis was made. Oral treatment with corticosteroids and methotrexate achieved gradual control of the disease

Evaluación de la contaminación microbiológica de la lechuga (lactuca sativa) en la cadena alimentaria, provincia de Quillacollo, Cochabamba, Bolivia 2015 / Evaluation of microbiological contamination of lettuce (Lactuca sativa) in the food chain, province of Quillacollo, Cochabamba, Bolivia 2015

Las enfermedades transmitidas por alimentos constituyen un problema de salud, diversos estudios demuestran la alta contaminación microbiológica de la lechuga en la cadena alimentaria. El objetivo de la presente investigación fue evaluar la contaminación microbio-lógica de la lechuga (Lactuca sativa) en la cadena alimentaria, en la provincia Quillacollo-Cochabamba-Bolivia. Muestras de lechugas fueron tomadas en los meses de abril y mayo, con el mismo de número de muestras, en tres puntos de la cadena alimentaria: parcelas de producción (localidad Combuyo), puestos de venta de lechuga y de comida de los Mercados 9 de diciembre y Central de Quillacollo. El procesamiento de las muestras fue realizado en los laboratorios de Microbiología de LABIMED, y Post Grado de Medicina Tropical de la Facultad de Medicina, UMSS. Los resultados demuestran la contaminación de las lechugas con bacterias Aerobias Mesófilas, colifor-mes totales y fecales en concentraciones superiores a los estándares permitidos en los tres puntos de la cadenas alimentaria evaluadas; identificándose Salmonella sp en una de las muestras de lechugas procesada de los puestos de venta de comida de los mercados. La contaminación parasitaria fue evidenciada en los puestos de venta solo en el mes de mayo en 83% (n=10) de las 12 muestras analizadas, detectándose quistes de Entamoeba coli y larvas de Strongyloides sp, contaminación relacionada con la utilización de abono de aves en el cultivo y la manipulación inadecuada de la lechuga en la cadena alimentaria. En conclusión podemos indicar que las lechugas presentan una importante contaminación microbiana en los tres puntos evaluados de la cadena alimentaria, por lo que constituye un riego para la salud pública.

Infectious diseases transmitted by food, are considered a public health issue, several studies shown the high microbiological contamination of the letucce in particular (Lactuca sativa). The aim of this study was to evaluate the contamination of letucce at Quillacollo Province of Cochabamba- Bolivia. The samples were taken between april and may, with the same number of samples at production plots (Combuyo location), and at selling places of vegetables and food (markets) such as "9 de diciembre” market and "Central Quillacollo” market. The samples were processed at LABIMED laboratories (microbiology, and Tropical Medicine Post grade of medicine Faculty of San Simón University). Results shows contamination of lettuce with Aerobic Mesophilic Bacterias, and total coliforms and fecal coliforms, in higher concentration than standard allowed, at any point of chain food that has been evaluate; Sallmonella sp was identify at selling points with 83% of the samples and only at the month of may (n=10 of 12 samples examined) also Entamoeba coli cysts and Strongyloides sp worms; the contamination was associate with bird fertilizer at crops and at inapropiate food management of the lettuce. Therefore we can conclude that lettuce's contamination is present at the three evaluated points of its chain, production selling points until consume, wich must be considered as a public health risk.

Sarcoidosis. Debut as orbital pseudotumour.

CASE REPORT: 78 year-old female patient being investigated for a left orbital pseudotumour of 17 days onset. She had proptosis, pain, with no limitation of eye movements, periorbital oedema, and upper eyelid ptosis, compatible with an orbital pseudotumour. The MRI showed an upper outer left orbital mass adjacent to the side of eyeball and an increase in soft tissue at the level of lacrimal gland. The histopathology study of an eyelid lesion demonstrated the presence of non-caseating granulomas. DISCUSSION: A definitive diagnosis of orbital sarcoidosis was made. Oral treatment with corticosteroids and methotrexate achieved gradual control of the disease.

Quantification of physical activity using the QAPACE questionnaire: A two stage cluster sample design survey of children and adolescents attending urban school.

BACKGROUND: Quantification of physical activity as energy expenditure is important since youth for the prevention of chronic non communicable diseases in adulthood. It is necessary to quantify physical activity expressed in daily energy expenditure (DEE) in school children and adolescents between 8-16 years, by age, gender and socioeconomic level (SEL) in Bogotá. METHODS: This is a Two Stage Cluster Survey Sample. From a universe of 4700 schools and 760000 students from three existing socioeconomic levels in Bogotá (low, medium and high). The random sample was 20 schools and 1840 students (904 boys and 936 girls). Foreshadowing desertion of participants and inconsistency in the questionnaire responses, the sample size was increased. Thus, six individuals of each gender for each of the nine age groups were selected, resulting in a total sample of 2160 individuals. Selected students filled the QAPACE questionnaire under supervision. The data was analyzed comparing means with multivariate general linear model. Fixed factors used were: gender (boys and girls), age (8 to 16 years old) and tri-strata SEL (low, medium and high); as independent variables were assessed: height, weight, leisure time, expressed in hours/day and dependent variable: daily energy expenditure DEE (kJ.kg-1.day-1): during leisure time (DEE-LT), during school time (DEE-ST), during vacation time (DEE-VT), and total mean DEE per year (DEEm-TY) RESULTS: Differences in DEE by gender, in boys, LT and all DEE, with the SEL all variables were significant; but age-SEL was only significant in DEE-VT. In girls, with the SEL all variables were significant. The Post-hoc multiple comparisons tests were significant with age using Fisher's Least Significant Difference (LSD) test in all variables. For both genders and for all SELs the values in girls had the higher value except SEL high (5-6) The boys have higher values in DEE-LT, DEE-ST, DEE-VT; except in DEEm-TY in SEL (5-6) In SEL (5-6) all DEEs for both genders are highest. For SEL (3-4) all DEEs are lowest. CONCLUSIONS: Children and adolescents in Bogotá have less DEE than at other latitudes. Girls have more free time but lower energy expenditure in their different activities. The socioeconomic level has influence in DEE.

Carcinoma mioepitelial ex adenoma pleomorfo de parótida: reporte de un caso y revisión de la literatura / Myoepithelial carcinoma ex pleomorphic adenoma of parotid: a case report and review of literature

El carcinoma mioepitelial (CME), es una neoplasia infrecuente, representando el1% de los tumores malignos de las glándulas salivales (GS). El diagnóstico se basa en sus características tanto morfológicas como inmunohistoquímicas, siendo la combinación de vimentina, proteína S-100 y calponina lo más frecuente. El tratamiento consiste en exéresis con márgenes libres y en algunos casos disección cervical sumado a radioterapia posoperatoria. Se ha documentado que un adenoma pleomorfo recurrente se malignice a CME, pero no al realizar el diagnóstico patológico inicial. Se presenta un caso y revisión de la literatura.

Myoepithelial carcinoma is a rare neoplasm, representing about 1% of malignant tumours from salivary glands. Diagnosis is based on morphological and inmunohistochemical features. Vimentin, S-100 protein and calponin are the most frecuent immunohistochemical findings. Treatment is based on surgical removal with free margins, and sometimes, neck dissection and postoperative radiotherapy. It has been reported that recurrent pleomorphic adenoma could transform into a myoepithelial carcinoma, but in our report, we present a case with this particular malignant transformation within the first tumor presentation and review of literature.

Mid-to long-term results of revision total hip replacement in patients aged 50 years or younger.

Revision total hip replacement (THR) for young patients is challenging because of technical complexity and the potential need for subsequent further revisions. We have assessed the survivorship, functional outcome and complications of this procedure in patients aged < 50 years through a large longitudinal series with consistent treatment algorithms. Of 132 consecutive patients (181 hips) who underwent revision THR, 102 patients (151 hips) with a mean age of 43 years (22 to 50) were reviewed at a mean follow-up of 11 years (2 to 26) post-operatively. We attempted to restore bone stock with allograft where indicated. Using further revision for any reason as an end point, the survival of the acetabular component was 71% (sd 4) and 54% (sd 7) at ten- and 20 years. The survival of the femoral component was 80% (sd 4) and 62% (sd 6) at ten- and 20 years. Complications included 11 dislocations (6.1%), ten periprosthetic fractures (5.5%), two deep infections (1.1%), four sciatic nerve palsies (2.2%; three resolved without intervention, one improved after exploration and freeing from adhesions) and one vascular injury (0.6%). The mean modified Harris Hip Score was 41 (10 to 82) pre-operatively, 77 (39 to 93) one year post-operatively and 77 (38 to 93) at the latest review. This overall perspective on the mid- to long-term results is valuable when advising young patients on the prospects of revision surgery at the time of primary replacement.

[Development and validation of a scale on sense of suffering: the "Humanizar" Scale]. / Desarrollo y validación de una escala sobre el sentido del sufrimiento: Escala Humanizar.

BACKGROUND: There are studies on the causes and sense of suffering, but not a measuring instrument for clinical and research use that eliminates the subjectivity of the evaluator. The aim of this article is to analyse the meaning that people give to suffering and its underlying factors by developing a measuring scale. METHODS: Descriptive and correlational study for scale validation. Following a review of the literature, a list of items was developed that were subjected to a validity analysis: content through judges, criterion through external variable contrast, and construct using exploratory factor analysis. Reliability using Cronbach alpha coefficient. RESULTS: The questionnaire was answered by 253 people, 83% (207) women and 17% (42) men, average age 41.37 years. The 24 item scale offered a Cronbach alpha of 0.871. Seven dimensions were obtained that explained 62.42% of total variance. Five factors were named Transcendence (26.367% of the variance), Punishment (9.929%), Catalyst of change (6.498%), Masochism (5.691%) and Inherent to life (5.254%). Except the last one, all the subscales obtained an alpha superior to 0.67. No gender differences were found, although they were found depending on the existence or absence of religious beliefs. CONCLUSIONS: The "Humanizar" Scale is a valid and reliable scale with a coherent structure of five factors. It collects the meaning that a person gives to suffering, leaving open the possibility of exploration depending on populations and on whether or not there are religious beliefs.

Desarrollo y validación de una escala sobre el sentido del sufrimiento: Escala Humanizar / Development and validation of a scale on sense of suffering: The “Humanizar” Scale

Fundamento. Existen estudios sobre causas y sentido del sufrimiento, pero no un instrumento de medida que elimine la subjetividad del evaluador para su uso en clínica y en investigación. El objetivo del presente trabajo es analizar el sentido que las personas damos al sufrimiento y los factores que subyacen desarrollando una escala de medida. Material y método. Estudio descriptivo y correlacional de validación de escala. Tras revisión bibliográfica, se elaboró un listado de ítems que se sometieron a análisis de validez; de contenido mediante jueces, de criterio mediante contraste con variable externa y de constructo mediante análisis factorial exploratorio. La fiabilidad mediante coeficiente alfa de Cronbach. Resultados. Contestaron al cuestionario 253 personas, 83% (207) mujeres y 17% (42) hombres, con una media de edad de 41,37 años. La escala con 24 ítems ofreció un alfa de Cronbach 0,871. Se obtuvieron 7 dimensiones que explicaban un 62,42% de la varianza total. Se nombraron los factores Trascendencia (26,367% de la varianza), Castigo (9,929%), Catalizador de cambio (6,498%), Masoquismo (5,691%) e Inherente a la vida (5,254%). Salvo la última, todas las subescalas obtuvieron un alfa superior a 0,67. No existieron diferencias de género, pero sí en función de la existencia o no de creencias religiosas. Conclusiones. La Escala Humanizar se plantea fiable y en principio válida con una estructura coherente de cinco factores, que recoge el sentido que la persona da al sufrimiento, dejando abierta la posibilidad de la exploración según poblaciones y en función de que existan o no creencias religiosas (AU)

Background. There are studies on the causes and sense of suffering, but not a measuring instrument for clinical and research use that eliminates the subjectivity of the evaluator. The aim of this article is to analyse the meaning that people give to suffering and its underlying factors by developing a measuring scale. Methods. Descriptive and correlational study for scale validation. Following a review of the literature, a list of items was developed that were subjected to a validity analysis: content through judges, criterion through external variable contrast, and construct using exploratory factor analysis. Reliability using Cronbach alpha coefficient. Results. The questionnaire was answered by 253 people, 83% (207) women and 17% (42) men, average age 41.37 years. The 24 item scale offered a Cronbach alpha of 0.871. Seven dimensions were obtained that explained 62.42% of total variance. Five factors were named Transcendence (26.367% of the variance), Punishment (9.929%), Catalyst of change (6.498%), Masochism (5.691%) and Inherent to life (5.254%). Except the last one, all the subscales obtained an alpha superior to 0.67. No gender differences were found, although they were found depending on the existence or absence of religious beliefs. Conclusions. The “Humanizar” Scale is a valid and reliable scale with a coherent structure of five factors. It collects the meaning that a person gives to suffering, leaving open the possibility of exploration depending on populations and on whether or not there are religious beliefs (AU)

Carcinoma mucinoso ecrino primario de la piel: reporte de un caso clínico patológico y revisión de la literatura / Primary mucinous eccrine carcinoma of skin: a case report and literature review

El carcinoma mucinoso ecrino primario de la piel es infrecuente, existen cerca de 100 casos publicados en la literatura. Fue descrito por primera vez por Lennox y colaboradores el año 1952. Presentamos un caso de carcinoma mucinoso ecrino primario de la piel, en un hombre de 82 años de edad, quien consultó por una masa cutánea retroauricular de 10 años de evolución, sin evidencias de enfermedad sistémica ni recurrencia local al año del control postoperatorio

The primary mucinous eccrine carcinoma of skin is infrequent, nearby 100 cases are published in the literature. It was described by the first time by Lennox and cols. at 1952. We present a case of primarily mucinous eccrine carcinoma of the skin, in an 82 year old man, who consulted for a retroauricular cutaneous mass of 10 years of evolution, without evidences of systemic disease or local recurrence at the year of the after surgery.

Neuromodulation of the posterolateral hypothalamus for the treatment of chronic refractory cluster headache: Experience in five patients with a modified anatomical target.

INTRODUCTION: Deep brain stimulation (DBS) of the posterior hypothalamus has been found to be effective in the treatment of refractory chronic cluster headache (CCH). METHODS: We report the long-term outcomes of five patients with refractory CCH on whom stimulation of a modified target of approximately 3 mm in radius, which included the posterolateral hypothalamus, the fasciculus mammillotegmentalis, the fasciculus mammillothalamicus and the fasciculus medialis telencephali, was performed. The stereotaxic coordinates were 4 mm from the third ventricle wall, 2 mm from behind the mid-intercommissural point and 5 mm from under the intercommissural line. RESULTS: All patients became pain-free for 1-2 weeks after the procedure, but then needed an average of 54 days to optimize stimulation parameters. After a mean follow-up of 33 months, two remain pain-free, two have an excellent response (>90% decrease in attack frequency) and in one the attacks have been reduced by half. There were no serious adverse events. Permanent myosis and euphoria/well-being feeling were seen in three patients. Other adverse events, such as diplopia, dizziness, global headache of cervical dystonia, were seen transiently related to an increase in stimulation parameters. Attacks reappeared transiently in two patients as a result of cable rupture and when the stimulator was disconnected. CONCLUSIONS: Our results supports the efficacy of DBS in very refractory CCH with a slightly modified hypothalamic target conceived to avoid the lateral ventricle wall so as to extend the stimulated brain area and to decrease the morbidity of potential haemorrhagic complications.

Cáncer renal multicéntrico: presentación de serie clínica anatomopatológica y revisión de la literatura / Multicentric renal cancer: clinical series presentation and literature review

Introducción: El carcinoma renal muticéntrico es decir aquellos carcinomas que cuentan con un tumor principal y uno o más secundarios, ocurre en el 10 por ciento de los casos. Su ocurrencia se asocian entre otro, a factores tales como el tamaño tumoral y el tipo histológico. El riesgo de multicentricidad permite evaluar la mejor opción de tratamiento quirúrgico oncológico. Objetivos: Evaluar la frecuencia de multicentricidad en el carcinoma renal y factores morfológicos asociados. Material y método: Análisis de 165 nefrectomías radicales por tumor renal desde 1990 hasta el año 2005 por un protocolo preestablecido. Resultados: La multicentricidad se presentó en 18 casos (10,9 por ciento). El número promedio de tumores secundarios fue de 4,9 por caso, la concordancia con el grado nuclear de Furhman y el tipo histológico con el tumor principal fue de 100 por ciento y 66 por ciento respectivamente. 8 de los 18 casos (44 por ciento) correspondían a un estadio T1a de la OMS, de estos 5 eran carcinomas papilares. Del total de la muestra 6 de 6 (100 por ciento ) carcinomas papilares fueron multicéntricos y 12 de 148 (8,1por ciento) carcinomas de células claras fueron multicéntricos. Trece de 18 tumores principales median menos de 7 cm y el 93 por ciento de los tumores secundarios median menos de 2,5 cm. Conclusiones: La frecuencia de multicentricidad en el carcinoma renal fue cercana al 10 por ciento, casi la mitad de los casos se presentaron en el estadio T1a, de los cuales la mayoría correspondieron a Carcinomas papilares. El conocimiento del tipo histológico es importante a la hora de seleccionar el tipo de cirugía a practicar, en este caso por sobre el tamaño tumoral.

Introduction: Multicentric renal carcinoma (ie those that have a primary tumor and one or more secondary), occurs in 10 percent of cases. Its occurrence is associated to tumor size and histologic type. The multicentricity risk allows to assess the best surgical treatment. Objectives: To evaluate the frequency of multicentricity in renal cell carcinoma and his morphological factors.Material and methods: An analysis of 165 radical nephrectomies for renal tumors from 1990 until 2005 was conducted. Results: Multicentricity was found in 17 cases (10.9 percent). The average number of secondary tumors was 4.9; the correlation with histologic type and Furhman nuclear grade with the main tumor was 100 percent and 66 percent respectively. Eight cases (44 percent ) were stage T1a (5 were papillary carcinomas). 6 / 15 (40 percent) of papillary carcinomas were multicentric and 12/179 (6.7 percent) of clear cell carcinoma were multicentric tumors.13/18 of the primary tumor measured less than 7 cm and 93 percentof secondary tumors measured less than 2.5 cm. Conclusions: The frequency of multicentricity in renal cell carcinoma was 10 percent, most of the cases were in stage T1a, most of which were papillary carcinomas. Knowledge of the histologic type is more important than the tumor size for the selection of the best surgical approach.