Consulta de preanestesia no presencial en niños: experiencias y recomendaciones / Telemedicine pre-anesthesia evaluation in children: Experiences and recommendations

Desde hace años se realizan consultas y seguimiento de pacientes de forma no presencial. Durante la pandemia de COVID-19 diferentes sociedades han recomendado potenciar las consultas telemáticas. La consulta preanestésica no presencial es un acto médico que debe incluir los objetivos básicos de evaluación, preparación, información y obtención del consentimiento. Se debe disponer de medios y tiempo para realizarla. Al comienzo de la consulta debe identificarse el médico y el o los progenitores. La consulta preoperatoria no presencial es especialmente útil en niños ASA I y II que van a someterse a cirugías de bajo riesgo, a una reintervención o a procedimientos diagnósticos. Aquellos pacientes que requieran una exploración física, más allá de la posible de manera telemática, deberán citarse en la consulta presencial. El personal de enfermería puede participar de forma activa en este proceso siempre y cuando el anestesiólogo supervise todo el proceso, tome todas las decisiones sobre el procedimiento y sea el responsable de la información que se da a los padres y al niño, aclarando personalmente cualquier duda. El anestesiólogo debe informar del procedimiento, sus riesgos, incluidos los personalizados, y alternativas. Se registrará en la historia clínica que se ha informado, cuándo y a quién. EL anestesiólogo firmará el Consentimiento Informado haciendo figurar la fecha que da la información y los padres deberán firmarlo antes de la intervención.(AU)

Medical consult and follow-up of patients have been carried out remotely for years. During the COVID-19 pandemic, different societies have recommended promoting online consultations. The remote pre-anesthetic consultation is a medical act that must include the basic objectives of evaluation, preparation, information and obtaining consent. You must have the resources and time to do it. At the beginning of the consultation, the doctor and the parent(s) must be identified. Non-face-to-face preoperative consultation is especially useful in ASA I and II children evaluated for low-risk surgeries, reintervention, or diagnostic procedures. Those patients who require a physical examination, beyond that possible electronically, should make an appointment in the face-to-face consultation. The nursing staff can actively participate in this process as long as the anesthesiologist supervises the entire process, makes all decisions about the procedure and is responsible for the information given to the parents and the child, personally clarifying any doubts. The anesthesiologist must inform about the procedure, its risks, including personalized ones, and alternatives. It will be recorded in the medical history the information given, when and to whom. The anesthesiologist will sign the Informed Consent stating the date that the information is given, and the parents must sign it before the intervention.(AU)

REDACS: Regional emergency-driven adaptive cluster sampling for effective COVID-19 management.

As COVID-19 is spreading, national agencies need to monitor and track several metrics. Since we do not have perfect testing programs on the hand, one needs to develop an advanced sampling strategies for prevalence study, control and management. Here we introduce REDACS: Regional emergency-driven adaptive cluster sampling for effective COVID-19 management and control and justify its usage for COVID-19. We show its advantages over classical massive individual testing sampling plans. We also point out how regional and spatial heterogeneity underlines proper sampling. Fundamental importance of adaptive control parameters from emergency health stations and medical frontline is outlined. Since the Northern hemisphere entered Autumn and Winter season (this paper was originally submitted in November 2020), practical illustration from spatial heterogeneity of Chile (Southern hemisphere, which already experienced COVID-19 winter outbreak peak) is underlying the importance of proper regional heterogeneity of sampling plan. We explain the regional heterogeneity by microbiological backgrounds and link it to behavior of Lyapunov exponents. We also discuss screening by antigen tests from the perspective of "on the fly" biomarker validation, i.e., during the screening.

Descripción de la herramienta de sobreuso de salbutamol en SEFAC e_XPERT / Description of the salbutamol overuse tool in SEFAC e_XPERT

JUSTIFICACIÓN: La evidencia actual sugiere que el sobreuso de agonistas ß2 de corta duración (SABAs) no solo podría ser uno de los responsables directos de los altos porcentajes de asma no controlado existente en nuestro país sino también de la mortalidad causada por el asma. Este fenómeno no solo se explica por sus efectos directos sino por ser usados de forma reiterada y abusiva como substitutos del uso regular de los Corticoides Inhalados (ICS) en combinación o no con ß2 agonistas de larga duración (LABAs). Los farmacéuticos comunitarios (FC) por su cercanía, accesibilidad y formación están especialmente posicionados para ayudar a otros profesionales sanitarios a identificar pacientes asmáticos mal controlados o en riesgo de estarlo ofreciéndoles educación sanitaria y derivándolos a la consulta médica en los casos que sea necesario. Este aspecto adquiere especial relevancia en la detección de abuso o sobreuso de SABAs que además suele venir acompañado de una baja adherencia al tratamiento antinflamatorio de mantenimiento.OBJETIVOS: descripción de la herramienta de sobreuso de Saba desarrollada en SEFAC e_XPERT.MATERIAL Y MÉTODOS: la herramienta de Sobreuso de SABA desarrollada en SEFAC e_XPERT se encuentra disponible en la página web https://www.sefacexpert.org/a/registry-campaign-workplace/1 y dispone de diferentes tests para llevar a cabo como la Regla del Asma, el Test de Adhesión a los Inhaladores (TAI), y el Test de Control del Asma (ACT), para evaluar el uso excesivo de SABA, el manejo de los dispositivos de inhalación y el control de la patología asmática. (AU)

Capacitación’ epoca’ 2021. Características del alumnado / Training' epoch' 2021. Characteristics of the student body

JUSTIFICACIÓN: la capacitación epoca para el servicio de cribado y abordaje del paciente con EPOC desde la farmacia comunitaria se lleva realizando desde 2015. Consta de 3 fases: teórica, práctica y clínica donde se registran casos reales de intervención en la farmacia comunitaria, para completar en un periodo de 12 meses. La edición 2021 ha tenido 3 posibles periodos de realización, 2 de ellos ya cerrados. Resulta interesante conocer qué características tienen los alumnos participantes y su nivel de participación en esta capacitación.OBJETIVOS: Describir el perfil de los alumnos matriculados y su nivel de participación en la edición 2021.MATERIAL Y MÉTODOS: estudio observacional, descriptivo, transversal, sobre base de datos obtenida de los registros del programa de capacitación época. Los datos de los alumnos se recogieron y analizaron con el programa Excel de Microsoft Office 2010.RESULTADOS: de los 178 alumnos matriculados en los 3 periodos de la edición 2021, 80.9 % son mujeres (n=144), el 55 % (n=98) son socios de SEFAC, lo que representa un 1.9 % de todos los socios de SEFAC. Respecto al ámbito laboral, el 69,6 % (n=124) son farmacéuticos adjuntos y el 29.2 % (n=52) farmacéuticos titulares de farmacia comunitaria. La distribución geográfica de los alumnos es: Canarias (33.1 %), Comunidad Valenciana (10.1 %), Castilla y León y Madrid (9.6 %), Andalucía (7.3 %), Cataluña y País Vasco (6.2 %), Castilla La Mancha (3.9 %), Aragón (3.4 %), Galicia y Región de Murcia (2.2 %), Cantabria y La Rioja (1.7 %), Extremadura y Asturias (1.1 %) e Illes Baleares (0.6 %).Referente a los 2 primeros periodos de la edición 2021, donde ya se han concluido todas sus fases y donde había 172 alumnos, el 32.5 % (n=56) ha superado la fase teórica, el 29 % (n=50) ha superado la fase práctica y el 7 % (n=12) ha superado las 3 fases. (AU)

Percepción del farmacéutico comunitario sobre la patología asmática y el control del paciente asmático. Resultados finales / Community pharmacist's perception of asthmatic pathology and asthmatic patient management. Final results

INTRODUCCIÓN: en España, alrededor del 50 % del asma está infradiagnosticado, cerca de un 13 % de los pacientes asmáticos presentan un control total de su enfermedad, y entre un 60 y un 70 % de ellos presentan un asma no controlada.OBJETIVOS: con el objetivo de mejorar el manejo del paciente asmático en España, desde la Sociedad Española de Farmacia Clínica, Familiar y Comunitaria (SEFAC) se ha apostado por mejorar la formación y ampliar y actualizar los conocimientos de los farmacéuticos comunitarios (FC) sobre la patología asmática y sobre cómo conseguir un buen control de la enfermedad. Para realizar con éxito esa actualización y lograr un cambio conductual, es imprescindible evaluar los conocimientos, las creencias y las actitudes actuales de los FC sobre esta temática, para identificar las posibles carencias formativas y actuar en consecuencia. Evaluar y analizar los conocimientos, actitudes y creencias de los FC españoles sobre la patología asmática a través de una encuesta ad hoc.MATERIAL Y MÉTODOS: estudio observacional descriptivo transversal realizado del 21 de septiembre de 2020 al 18 de enero de 2021. La población de estudio fueron los FC españoles. Las variables principales fueron los conocimientos, creencias y actitudes sobre la patología asmática y el control del asma. Las preguntas y respuestas de la encuesta se basaron en los datos y recomendaciones de la Guía GINA “Global Initiative for Asthma”y de la Guía Española para el Manejo del Asma (GEMA). El cuestionario constaba de 15 preguntas, con cuatro posibles respuestas que versaban sobre prevalencia, diagnóstico, evolución, mortalidad, etiología, control, y tratamiento.RESULTADOS: se obtuvieron un total de 566 respuestas. De ellas, los porcentajes de respuestas acertadas según la temática fueron: prevalencia 51.59 %, diagnóstico 59.01 %, evolución 80.57 %, mortalidad 20.67 %, etiología 40.46 %, control 30.45 % y tratamiento 48.35 %. (AU)

Fertilization and connectivity in the Garrucha Canyon (SE-Spain) implications for Marine Spatial Planning.

Marine Spatial Planning is usually based on benthic georeferenced information or GPS tracked human activities, whereas the pelagic ecosystem is often ignored because of scarce and limited surface information. However, the 3-D pelagic ecosystem plays a key role connecting all the other ecosystems by physical (currents) and biological (migration) processes. According to remote sensing the Garrucha Canyon is oligotrophic, but 3-D sampling reveals subsurface upwelling, and converts it into the richest area around the Cape of Gata. Vertical connectivity by means of zooplankton migration, measured at two sampling stations, is 40 and 220 times faster than microphytoplankton settling and vertical water velocities respectively. Thus coupled physical-biological connectivity models are necessary to estimate the ecosystem connection and the fate of carbon, but also other substances (e.g. radioactivity), that might accumulate throughout the food-web. This is especially important in the Garrucha Canyon and the Coastal Areas Management Programme Levante de Almería where natural heritage and extractive fishery are important for the local economy.

A novel configuration for an anaerobic submerged membrane bioreactor (AnSMBR). Long-term treatment of municipal wastewater under psychrophilic conditions.

A novel design for a pilot scale anaerobic submerged membrane bioreactor (AnSMBR) equipped with an ultrafiltration unit, treating municipal wastewater at 18 ± 2°C, and inoculated with a mesophilic inoculum without acclimation, was implemented and evaluated over 3 years of stable operation. The AnSMBR operated with a volumetric loading rate between 1.6 to 2.0 kg COD/m(3)UASBd, 12.8 to 14.2h hydraulic retention time, and reached a tCOD removal efficiency of around 90%. Biosolid production was between 0.05 and 0.083 g VS/g CODremoved. Dissolved methane oversaturation in the effluent was observed, reaching average values of 19.1 ± 0.84 mg CH4/L. The permeate flow rate ranged from 10 to 14L/m(2)h with trans-membrane pressure (TMP) values of 400-550 mbar, using cycles of 30s backwash, 7.5 min filtration, and continuous biogas sparging (9-16 m/h). During the three years of continuous operation, the membrane was not physically or chemically cleaned.

Long-term operation of a pilot scale anaerobic membrane bioreactor (AnMBR) for the treatment of municipal wastewater under psychrophilic conditions.

The performance of a pilot scale anaerobic membrane bioreactor (AnMBR), comprising an upflow anaerobic sludge blanket (UASB) reactor coupled to an external ultrafiltration membrane treating municipal wastewater at 18±2°C, was evaluated over three years of stable operation. The reactor was inoculated with a mesophilic inoculum without acclimation. The AnMBR supported a tCOD removal efficiency of 87±1% at hydraulic retention time (HRT) of 7h, operating at a volumetric loading rate (VLR) of between 2 and 2.5kgtCOD/m(3)d, reaching effluent tCOD concentrations of 100-120mg/L and BOD5 concentrations of 35-50mgO2/L. Specific methane yield varied from 0.18 to 0.23Nm(3)CH4/kgCODremoved depending on the recirculation between the membrane module and the UASB reactor. The permeate flow rate, using cycles of 15s backwash, 7.5min filtration, and continuous biogas sparging (40-60m/h), ranged from 10 to 14Lm(2)/h with trans-membrane pressure (TMP) values of 400-550mbar.

Estudio prospectivo de la eficacia del bloqueo de los nervios pudendos para analgesia postoperatoria de cirugía hemorroidal ambulatoria / No disponible

Introducción: La cirugía de hemorroides presenta un dolor postoperatorio de intensidad moderada-severa. La realización una técnica anestésico-analgésica multimodal garantiza el éxito de este procedimiento en cirugía ambulatoria. Realizamos un estudio observacional para valorar la eficacia del bloqueo de los nervios pudendos en cirugía hemorroidal en pacientes ambulatorios. Pacientes y métodos: Estudio prospectivo en cuarenta y tres pacientes divididos en dos grupos según técnica quirúrgica utilizada(Milligan-Morgan o Longo), a los cuales se les realizó bloqueo bilateral de los nervios pudendos, con 20 ml de levobupivacaína 0.5%. El dolor fue valorado con la escala verbal numérica en la sala de reanimación, al alta hospitalaria, y a las 24, 48,72 horas. Resultados: Ambos grupos fueron homogéneos con respecto alas variables demográficas, estado físico, antecedentes, duración de la cirugía y de la anestesia. El bloqueo pudendo se realizo con éxito en todos los pacientes. La evaluación del dolor postoperatorio al alta hospitalaria y a las 24 horas postalta muestra diferencias estadísticamente significativas entre ambas técnicas. Sin embargo, posteriormente no existen diferencias entre ambas técnicas. En las primeras 24 horas en el domicilio ningún paciente presento dolor severo, independientemente del grupo y solo 4 pacientes precisaron analgesia de rescate en el domicilio a las 48 y 72 horas, dos en cada grupo. Conclusiones: Nuestros resultados muestran que el bloqueo bilateralde los nervios pudendos con levobupivacaína al 0.5% asociadoa la anestesia general proporciona un buen control del dolor postoperatorio en las primeras 24 horas con baja incidencia de complicaciones en ambos grupos (AU)

Introduction: Hemorrhoids surgery presents a post-operative pain of moderate to severe in intensity. So we must make a multimodalanalgesic anesthetic technique to ensure the success of this procedure in the outpatient setting. We conducted a comparative study to assess the efficacy of pudendal nerve in hemorrhoidal surgery in ambulatory patients. Patients and methods: Prospective study forty-three patients divided into two groups according to surgical technique (Milligan-Morgan or Longo), underwent bilateral blockade of the pudendalnerve, with 20 ml of levobupivacaine 0.5%. The pain was assessed with the verbal numeric scale in the recovery room, hospital discharge, and 24, 48.72 hours. Results: two groups were similar with respect to demographic variables, physical status, history, duration of surgery and anesthesia. Pudendal block was performed successfully in all patients. The assessment of postoperative pain at discharge and 24 hours of highstatistically significant difference between both techniques. Even afterthe first 24 hours in any severe pain. Only 4 patients required rescue analgesia at home at 48 and 72 hours, two in each group. Conclusions: Our results show that the bilateral blockade of the pudendal nerve with 0.5% levobupivacaine associated with general anesthesia reduces postoperative pain, as well as the additional analgesic medication consumption (AU)

The conversion of dehydroepiandrosterone into androst-5-ene-3beta,17beta-diol (androstenediol) is increased in endometria from untreated women with polycystic ovarian syndrome.

The changes in endometrial homeostasis found in women with polycystic ovarian syndrome (PCOS) could be associated with alterations in the intracrine metabolism of steroid hormones. The uptake of dehydroepiandrosterone-sulphate (DHEA-S), precursor of the intracrine pathway, is achieved by transporters, such as organic anion transporter polypeptides (OATPs), and molecules with oestrogenic activity, such as androst-5-ene-3beta,17beta-diol (androstenediol), can be generated. We aimed to determine androstenediol generation and the expression of OATPs in human endometria throughout the menstrual cycle and in endometria from PCOS women. Endometrial samples were obtained from control women in the proliferative phase (control endometria (CEp), n=7), secretory phase (CEs, n=7), and from PCOS patients (PCOSEp, n=7). The mRNA levels of OATP-B, OATP-D and OATP-E were measured by reverse transcriptase polymerase chain reaction (RT-PCR) and protein levels of OATP-E by immunofluorescence; 3beta-hydroxysteroid dehydrogenase (HSD) by immunohistochemistry/Western blot; the metabolism of DHEA to androstenediol was evaluated by thin layer chromatography-high-performance liquid chromatography (TLC-HPLC). Lower levels of OATP-E transcript were obtained in PCOSEp (p<0.05) compared with CEp, while OATP-E protein levels (p<0.05) and DHEA conversion to androstenediol (p<0.01) were higher in PCOSEp. Lower 3beta-(hydroxysteroid dehydrogenase) HSD protein levels were found in PCOSEp (p<0.05) (Western blot, immunohistochemistry). These results reveal a higher capacity of the endometria from PCOS women to metabolise DHEA to androstenediol, which, coupled with the high oestrogen sensitivity previously found in these endometria, may account for the increase in cell proliferation in PCOSEp already reported.

Influence of velocity gradient in a hydraulic flocculator on NOM removal by aerated spiral-wound ultrafiltration membranes (ASWUF).

A hydraulic coagulation-flocculation processes combined with aerated spiral-wound ultrafiltration membranes (ASWUF) was designed with the objective of improving natural organic matter (NOM) removal by ASWUF in the treatment of water for human consumption. The pilot-scale experimental system had capacity for treating 0.9 m(3)/h. Dosage of Cl(3)Fe as coagulant and hydraulic retention time (HRT) were calculated to generate microflocculation and different velocity gradients (G=27, 47, 87 and 104 s(-1)) were applied in the hydraulic flocculator. Operating alone, the ASWUF system achieved an NOM removal performance of 39% without problems of membrane clogging, although there was a significant correlation between effluent and influent quality. Application of microflocculation achieved considerable improvement in NOM removal, but values of G< or =87 s(-1) resulted in rapid clogging of the membrane due to flocs disintegration in the aerated membrane tank. Particle analysis revealed that the reduction of the velocity gradient had the effect of inclining the particle size distribution towards larger sizes, affecting both NOM removal capacity and membrane clogging. For G=104 s(-1) an NOM removal yield of 90% was reached, while transmembrane pressure (TMP) was stabilised as a result of the control of membrane clogging.

Ultrasound pre-treatment for anaerobic digestion improvement.

Prior research indicates that ultrasounds can be used in batch reactors as pre-treatment before anaerobic digestion, but the specific energy required at laboratory-scale is too high. This work evaluates both the continuous ultrasound device performance (efficiency and solubilisation) and the operation of anaerobic digesters continuously fed with sonicated sludge, and presents energy balance considerations. The results of sludge solubilisation after the sonication treatment indicate that, applying identical specific energy, it is better to increase the power than the residence time. Working with secondary sludge, batch biodegradability tests show that by applying 30 kWh/m3 of sludge, it is possible to increase biogas production by 42%. Data from continuous pilot-scale anaerobic reactors (V=100 L) indicate that operating with a conventional HRT=20 d, a reactor fed with pre-treated sludge increases the volatile solids removal and the biogas production by 25 and 37% respectively. Operating with HRT=15 d, the removal efficiency is similar to the obtained with a reactor fed with non-hydrolysed sludge at HTR=20 d, although the specific biogas productivity per volume of reactor is higher for the pretreated sludge. Regarding the energy balance, although for laboratory-scale devices it is negative, full-scale suppliers state a net generation of 3-10 kW per kW of energy used.

Potabilization of low NOM reservoir water by ultrafiltration spiral wound membranes.

Membrane technologies such as ultrafiltration offer an interesting alternative to integral treatment of surface water destined for human consumption. With this in mind, a pilot-scale ultrafiltration module was set up, equipped with spiral-wound polyethersulphone membranes (16.6m(2)) with an effective pore size of 0.05 microm. The system operated continuously with a stable production of 0.9 m(3)/h (54 lmh) and a constant transmembrane pressure of -0.2 bar. The effluent obtained showed a total absence of faecal contamination indicators of both bacterial and viral origin, and also presented an excellent physico-chemical quality, independently of the quality of influent. Total aerobic bacteria counts revealed the problem of bacterial contamination in the membrane permeate zone, which could be controlled through daily chemical cleansing of the membrane. The chief problem presented by this type of system, applied as exclusive treatment, is low effectiveness in the retention of natural organic matter (NOM), in which respect the quality of the effluent was observed to depend on the quality of influent. This constitutes the principal limitation for applying the system to surface water due to the risk of disinfection by-products formation during the final post-chlorination. However, spiral wound ultrafiltration (SWUF) membranes could be used for low NOM reservoir water total treatment offering several advantages over conventional technologies.

Realidades en el abordaje enteral para la nutrición de nuestros pacientes / Realities in enteral nutrition approach of our patients

No disponible

Neoplasias primarias malignas múltiples en pacientes con cáncer gástrico en el área sanitaria de León / Multiple malignant primary neoplasms in patients with gastric neoplasms in the health district of León

Objetivos: analizar las características de los pacientes con tumores gástricos diagnosticados de una neoplasia primaria maligna múltiple (NPMM) en el área sanitaria de León. Pacientes y método: utilizando los datos del Registro de Tumores del Hospital de León se han seleccionado aquellos pacientes con tumores gástricos diagnosticados entre 1993 y 2002. Se realizó un seguimiento hasta el 31 de diciembre de 2004 analizando las características de los pacientes diagnosticados de una segunda neoplasia durante el periodo de seguimiento. Resultados: la prevalencia de NPMM fue del 1,96%. El 56% de los pacientes tenían antecedentes oncológicos en familiares de primer grado. Las segundas neoplasias más frecuentes fueron las digestivas (26%) y las urológicas (21%). El 87% de los pacientes fueron diagnosticados del segundo tumor en los primeros dos años. No se observaron diferencias respecto a la supervivencia entre los pacientes con NPMM sincrónicas y metacrónicas. Conclusiones: las NPMM en los pacientes con cáncer gástrico son un problema relevante. Aunque los agentes carcinógenos externos puedan actuar como promotores en el desarrollo de una segunda neoplasia, en estos pacientes parece existir una base genética que favorece el desarrollo del una NPMM. La prevención secundaria es la mejor medida para evitar el desarrollo de una NPMM

Objectives: we analyzed the characteristics of patients with gastric tumors diagnosed with multiple malignant primary neoplasm (MMPN) in the Health District of León. Material and methods: using the information in the Tumor Registry at León Hospital patients selected were those with gastric neoplasms diagnosed between 1993 and 2002. A follow-up was performed until December 31, 2004, and the characteristics of patients diagnosed with a second neoplasm were analyzed. Results: MMPN prevalence was 1,96%; 56% of patients had a history of cancer in first-degree relatives. The most frequent second neoplasms were digestive (26%) and urologic (21%); 87% of patients were diagnosed with a second neoplasm within the first two years. No significative differences in survival were observed among patients with synchronous or metachronous MMPN. Conclusions: MMPN in patients with gastric neoplasms is a relevant problem. While external carcinogenic agents could act as promoters in the development of second neoplasms, these patients seem to have a genetic background favoring the development of MMPN. Secondary prevention is the best measure to avoid MMPN development

[Analysis of the characteristics of patients with bladder cancer diagnosed of multiple neoplasms in the health district of León (Spain)]. / Análisis de las características de los pacientes con cáncer vesical diagnosticados de neoplasias múltiples en el área sanitaria de León.

OBJECTIVE: We analyzed the characteristics of the patients with bladder neoplasms who developed a multiple malignant primary neoplasm (MMPN) in the health district of León, the impact on survival and the prognostic variables. MATERIAL AND METHODS: We have used the data from the Tumor Registry of the Hospital of León and selected all those patients who were diagnosed of a bladder tumor between 1993 and 2002. They were classified into two groups: the first with 71 patients with MMPN and a second group with 159 patients with single bladder tumors diagnosed between 1996 and 1997. RESULTS: Incidence of MMPN was of 7.1 percent. More than half of the patients had familial oncologic background. The second most frequently diagnosed neoplasms were urologic, followed by gastrointestinal and respiratory. Survival of patients with MMPN was 21 percent lower than single neoplasms. Variables with prognosis significance were the stage of the second neoplasm, diagnosis of a second urologic neoplasm and surgery treatment for the second tumor. CONCLUSIONS: MMPN in patients with bladder tumors are frequent in our geographic area. The high frequency of familial oncologic antecedents in these patients suggest a genetic background. Prognosis of MMPN patients is worse than single tumors patients, but no differences were observed regarding prognosis in patients with synchronous or metachronous MMPN.

Cáncer colo-rectal multicéntrico (CCRM) en el área sanitaria de León / Multicentric colo-rectal cancer (MSCC) in the health district of León

Objetivos: Analizar las características de los pacientes diagnosticados de CCRM en el área sanitariade León, el impacto sobre la supervivencia y las posibles variables pronósticas.Material y métodos: Utilizando los datos del Registro de Tumores del Hospital de León se hananalizado las características de aquellos pacientes con tumores colo-rectales diagnosticados entre 1993y 2002, clasificándolos dos grupos: el primero constituido por 74 pacientes diagnosticados de CCRMy el segundo formado por 1342 pacientes con tumores únicos diagnosticados en el bienio 1996-1997.Resultados: La frecuencia de CCRM fue del 2,7%. La edad de los pacientes con CCRM fue 2años mayor con respecto a la de los pacientes con neoplasias únicas, con una elevada proporción(38%) de antecedentes familiares oncológicos en familiares de primer grado. No se observaron diferenciassignificativas en cuanto a la localización y el estadio del primer tumor colo-rectal con respectoal grupo de tumores únicos. La supervivencia de los pacientes con CCRM metacrónico fue netamenteinferior, posiblemente en relación con un mayor número de segundas neoplasias diagnosticadas en estadiostempranos en los pacientes con CCRM sincrónico. Las variables que influyeron en el pronósticofueron la edad, el sexo, y el padecimiento de un CCRM sincrónico o metacrónico.Conclusiones: El CCRM es una entidad frecuente en nuestro medio. La tasa de antecedentes familiaresoncológicos en estos pacientes es muy elevada. No se encontraron diferencias significativasen cuanto al pronóstico de estos pacientes respecto al de los pacientes con neoplasias únicas

Purpose: We analyze the characteristics of patients with multicentric colo-rectal cancer (MCRC)in the health district of León, the impact on survival, and the prognostic variables.Material and methods: : Using the data from the Hospital de León Tumour Registry, weanalyzed the characteristics of all the patients diagnosed of having colo-rectal tumours between 1993and 2002. The patients were classified in two groups: one of them composed by 74 patients with MCRC,and the other formed by 1342 patients diagnosed in 1996 and 1997 of having single colo-rectal tumours.Results: The observed frequency of MCRC corresponded to 2.7 percent of the whole cases. Theage of the MCRC patients was 2 years higher than that of the patients with single neoplasms, andshowed a higher familial oncologic history, that was present in 38 percent of the cases. No differenceswere observed for location and stage of the first appeared colo-rectal neoplasm. The survival of thepatients developing metachronous MCRC was lower than for those with synchronous disease,possibly due to the higher number of the second neoplasms appearing in these patients at early stages.Prognostic values were age, sex, and metachronous or synchronous type of disease.Conclusions: MCRC is a frequent entity. The frequency of familial oncologic history is veryhigh. No significant differences were seen in relation to prognosis between single and multiple colorectalcancer

[Tinnitus retraining therapy in Ménière disease]. / Terapia de reentrenamiento (TRT) en el acúfeno de la enfermedad de Ménière.

OBJECTIVE: To evaluate the response of tinnitus in Meniere's disease patients (MD) using the Tinnitus Retraining Therapy (TRT). This management includes a wide cognitive medical counselling and natural or prosthetic sound therapies (hearing aid or noise generator). DESIGN: Descriptive prospective study (EBM level 3). PATIENTS: Twenty-five patients diagnosed as definitive MD (AAO-HNS 95 criteria) were enrolled in our tinnitus protocol. MAIN OUTCOME MEASURES: Tinnitus changes were reported according to patient's self-evaluation, a visual analogue scale on tinnitus intensity (EVA) and the Tinnitus Handicap Inventory (THI). RESULTS: Seventy-three percent of the patients improved their tinnitus after 6 months of treatment (p < 0.05). THI scores were reduced from the initial 47% to 24% (p < 0.05) and EVA from 6.6 to 5.2 (p < 0.05). After 12 months, the response was slightly worse: 68% improved according to their self-evaluation (p < 0.05), THI score reached 20% (p < 0.05) but EVA did not improve significantly (6.4). Patients that refused prosthesis adaptation (hearing aid or noise generator) did not improved and the THI score (48%) and EVA score (6.6) did not change. CONCLUSIONS: TRT has proved to be an effective method for tinnitus treatment in MD that improves patient's self-evaluation, tinnitus loudness and handicap scores. Individualized medical counselling and an exhaustive prosthesis adaptation are crucial to guarantee satisfactory results.