Diagnostic findings in sinonasal aspergillosis in dogs in the United Kingdom: 475 cases (2011-2021).

OBJECTIVES: To describe the diagnostic tests used and their comparative performance in dogs diagnosed with sinonasal aspergillosis in the United Kingdom. A secondary objective was to describe the signalment, clinical findings and common clinicopathologic abnormalities in sinonasal aspergillosis. MATERIALS AND METHODS: A multi-centre retrospective survey was performed involving 23 referral centres in the United Kingdom to identify dogs diagnosed with sinonasal aspergillosis from January 2011 to December 2021. Dogs were included if fungal plaques were seen during rhinoscopy or if ancillary testing (via histopathology, culture, cytology, serology or PCR) was positive and other differential diagnoses were excluded. RESULTS: A total of 662 cases were entered into the database across the 23 referral centres. Four hundred and seventy-five cases met the study inclusion criteria. Of these, 419 dogs had fungal plaques and compatible clinical signs. Fungal plaques were not seen in 56 dogs with turbinate destruction that had compatible clinical signs and a positive ancillary test result. Ancillary diagnostics were performed in 312 of 419 (74%) dogs with observed fungal plaques permitting calculation of sensitivity of cytology as 67%, fungal culture 59%, histopathology 47% and PCR 71%. CLINICAL SIGNIFICANCE: The sensitivities of ancillary diagnostics in this study were lower than previously reported challenging the clinical utility of such tests in sinonasal aspergillosis. Treatment and management decisions should be based on a combination of diagnostics including imaging findings, visual inspection, and ancillary testing, rather than ancillary tests alone.

Vía clínica de terapia metabólica con 131I en cáncer diferenciado de tiroides / Clinical pathway of metabolic therapy with 131I in differentiated thyroid cancer

Las vías clínicas son planes asistenciales que se aplican a procesos clínicos de curso predecible con la intención de protocolizarlos y disminuir la variabilidad en su manejo. Nuestro objetivo ha sido desarrollar una vía clínica para la terapia metabólica con 131I, proceso asistencial aplicado a los pacientes con carcinoma diferenciado de tiroides. Se organizó un equipo de trabajo formado por médicos (endocrinología y medicina nuclear), personal de enfermería (unidad de hospitalización y medicina nuclear), de radiofísica y del servicio de apoyo a la gestión clínica y continuidad asistencial. Para el diseño de la vía clínica se realizaron varias reuniones del equipo, en las que se pusieron en común las revisiones bibliográficas y se abordó el diseño y el desarrollo de la vía, respetando las guías clínicas vigentes. Este equipo ha logrado mediante consenso la elaboración del plan asistencial, estableciendo sus puntos clave y redactando los distintos documentos que componen la vía clínica: matriz temporal, documento de registro de variaciones de la vía clínica, documentos de información al paciente, encuesta de satisfacción del paciente, folleto de pictogramas, indicadores de evaluación de calidad. Por último, la vía clínica se ha presentado a todos los servicios clínicos involucrados y a la dirección médica del hospital, procediendo a su implementación en la práctica clínica (AU)

Clinical pathways are care plans that are applied to clinical processes with a predictable course, with the intention of protocolizing them, and reducing the variability in their management. Our objective was to develop a clinical pathway for 131I metabolic therapy, in its application to differentiated thyroid cancer. A work team was organised consisting of doctors (Endocrinology and Nuclear Medicine), nursing staff (Hospitalisation Unit and Nuclear Medicine), Radiophysics and the Clinical Management and Continuity of Care Support Service. For the design of the clinical pathway, several team meetings were held, in which the literature reviews were pooled and the design and development of the clinical pathway was undertook, in accordance with current clinical guidelines. This team has achieved consensus on the development of the care plan, establishing its key points and drafting the different documents that make up the clinical pathway: timeframe-based schedule, clinical pathway variation record document, patient information documents, patient satisfaction survey, pictogram brochure, quality assessment indicators. Finally, the clinical pathway was presented to all clinical departments involved and to the medical director of the hospital, and it is now being implemented in clinical practice (AU)

Clinical pathway of metabolic therapy with 131I in differentiated thyroid cancer.

Clinical Pathways are care plans that are applied to clinical processes with a predictable course, with the intention of protocolizing these processes and reducing the variability in their management. Our objective was to develop a clinical pathway for 131I metabolic therapy in its application to differentiated thyroid cancer. A work team was organized consisting of doctors (Endocrinology and Nuclear Medicine), nursing staff (Hospitalization Unit and Nuclear Medicine), Radiophysics and the Clinical Management and Continuity of Care Support Service. For the design of the clinical pathway, several team meetings were held, in which the literature reviews were pooled and the design and development of the clinical pathway was undertaken in accordance with current clinical guidelines. This team achieved consensus on the development of the care plan, establishing its key points and drafting the different documents that make up the Clinical Pathway: Timeframe-based schedule, Clinical Pathway Variation Record Document, Patient Information Documents, Patient Satisfaction Survey, Pictogram Brochure, Quality Assessment Indicators. Finally, the clinical pathway was presented to all the clinical departments involved and to the Medical Director of the Hospital and is now being implemented in clinical practice.

Radioguided surgery in primary hyperparathyroidism: a review of the different available techniques. / Cirugía radioguiada en el hiperparatiroidismo primario: revisión de las diferentes técnicas disponibles.

Parathyroidectomy has evolved over the years from bilateral neck exploration to a single gland approach using minimally invasive surgery. The precise presurgical localization of the problem gland, using functional techniques, such as double-phase scintigraphy with [99mTc] Tc-MIBI including SPECT-CT and PET-CT with [18F]-Choline and morphological ones, such as ultrasound have played a crucial role in this paradigm's shift. Radioguided surgery techniques have also adapted and grown with new contributions known for their indication in other fields. Thus, we currently have a wide range of techniques that have been added to the minimally invasive radioguided parathyroidectomy with [99mTc] Tc-MIBI, which was the first on the stage and for which more experience exists. Among them, in this update, we will discuss parathyroidectomy using ultrasound-guided ROLL technique as well as with the use of 125I seeds and finally, hybrid techniques that use radiotracer and fluorescence.

El test cuantitativo sensorial y su importancia en la valoración de la radiculopatía lumbosacra / Quantitative sensory testing and its importance in the assessment of lumbosacral radiculopathy

La lumbalgia crónica constituye hasta dos tercios de los motivos de consulta en las Unidades de Dolor. La radiculopatía secundaria a hernia discal lumbar constituye una de las causas más importantes de lumbalgia crónica. Conocer los mecanismos nociceptivos y valorar de forma objetiva el dolor neuropático secundario a esta entidad, es de gran importancia para el enfoque terapéutico óptimo de estos pacientes. En este contexto, el Test Cuantitativo Sensorial (QST) se establece como una prueba psicofísica no invasiva que permite determinar la alteración de las fibras del Sistema Somatoensorial, o detectar precozmente neuropatí- as periféricas cuyo resultado es normal con otros exámenes de rutina, entre otras muchas utilidades prácticas. Ello hace que esta técnica sea de especial interés en el estudio de la génesis del dolor

Low back chronic pain extends up to two-thirds of the consultations in Pain Units. Radiculopathy secondary to lumbar disc herniation is one of the most important causes of low back pain. Knowing the nociceptive mechanisms and objectively assessing secondary neuropathic pain implies a great importance for the optimal therapeutic approach of these patients. In this context, the Quantitative Sensory Testing (QST) is an non invassive examination that allows to determine the alteration of the fibers of the Somato-Sensory System, or to detect early peripheral neuropathies whose result is normal with other routine exams, among many other practical uses. This technique brings a special interest in the study of pain genesis

Mejora de la calidad asistencial II. Gestión del cambio / Improvement of assistance qualty II. Change management

Las políticas de salud en gran parte del mundo desarrollado se ocupan de evaluar y mejorar la calidad de la atención de la salud. Las estrategias para mejorar la prestación de atención a nivel nacional e internacional incluyen la práctica basada en la evidencia, la eficacia clínica, las directrices clínicas basadas en evidencia y la auditoría, y se está haciendo una inversión considerable en una nueva infraestructura para apoyar estas iniciativas. La comunicación eficaz y el trabajo en equipo, son esenciales para la entrega segura de alta calidad y atención al paciente. El objetivo de este trabajo es intentar afianzar el pensamiento sobre la naturaleza de las culturas organizacionales en la atención de la salud como un medio de apoyar los debates sobre ella misma y cómo tales culturas deben o, de hecho, pueden, ser transformadas. En nuestra opinión, las estrategias destinadas a revolucionar la calidad de los servicios de salud a través de la transformación cultural deben ser más articuladas sobre los destinos culturales buscados, y los mecanismos que llevarán a las organizaciones hacia estos destinos

Health policy in much of the developed world is concerned with assessing and improving the quality of health care. Strategies for improving the delivery of healthcare at a national and international level include evidence based practice, clinical effectiveness, evidence based clinical guidelines, and audit, and considerable investment is being made in a new infrastructure to support these initiatives. Effective communication and teamwork is essential for the delivery of high quality, safe patient care. The aim of this paper is attempted to sharpen thinking on the nature of organisational cultures in health care as a means of underpinning debates on whether and how such cultures should or, indeed, can be transformed. It is our view that strategies aimed at revolutionising the quality of health services through cultural transformation need to be more articulate on the cultural destinations sought, and the mechanisms that will carry organisations towards these destinations

Mejora de la calidad asistencial III. Diseño. Implantación y evaluación de un plan de calidad / Improvent of assistance quality III

Las políticas de salud en gran parte del mundo desarrollado se ocupan de evaluar y mejorar la calidad de la atención de la salud. Las estrategias para mejorar la prestación de atención a nivel nacional e internacional incluyen la práctica basada en la evidencia, la eficacia clínica, las directrices clínicas basadas en evidencia y la auditoría, y se está haciendo una inversión considerable en una nueva infraestructura para apoyar estas iniciativas. La comunicación eficaz y el trabajo en equipo, son esenciales para la entrega segura de alta calidad y atención al paciente. El objetivo de este trabajo es intentar afianzar el pensamiento sobre la naturaleza de las culturas organizacionales en la atención de la salud como un medio de apoyar los debates sobre ella misma y cómo tales culturas deben o, de hecho, pueden, ser transformadas. En nuestra opinión, las estrategias destinadas a revolucionar la calidad de los servicios de salud a través de la transformación cultural deben ser más articuladas sobre los destinos culturales buscados, y los mecanismos que llevarán a las organizaciones hacia estos destinos

Health policy in much of the developed world is concerned with assessing and improving the quality of health care. Strategies for improving the delivery of healthcare at a national and international level include evidence based practice, clinical effectiveness, evidence based clinical guidelines, and audit, and considerable investment is being made in a new infrastructure to support these initiatives. Effective communication and teamwork is essential for the delivery of high quality, safe patient care. The aim of this paper is attempted to sharpen thinking on the nature of organisational cultures in health care as a means of underpinning debates on whether and how such cultures should or, indeed, can be transformed. It is our view that strategies aimed at revolutionizing the quality of health services through cultural transformation need to be more articulate on the cultural destinations sought, and the mechanisms that will carry organisations towards these destinations

Canine versus human epilepsy: are we up to date?

In this paper we analyse and compare features of canine and human epilepsy and we suggest new tools for better future understanding of canine epilepsy. The prevalence of epileptic seizures in dogs ranges between 0.5% and 5.7% and between 1% and 3% in the human population. Studies on human epilepsy provide a ready-made format for classification, diagnosis and treatment in veterinary epilepsy. Human studies highlight the value of a thorough seizure classification. Nevertheless, a matter of concern in canine epilepsy is the limited information regarding seizure description and classification because of the lack of EEG-video recording. Establishment of a consensus protocol for ambulatory home video-recording in dogs who suffer from epilepsy, mainly considering indications, duration of monitoring, the sufficient essential training for an optimal interpretation of ictal semiology and the methodology of recordings is needed. The ultimate goal is that the information gathered by these videos will be analysed to describe the epileptic seizures thoroughly, recognize patterns and move towards a better understanding and therefore classification of canine epileptic seizures.

Mejora de la calidad asistencial. I. Definiciones y ciclo de evaluación y mejora / Improvement of assistance quality. I. Definitions and evaluation cycle and improvement

Este artículo define diversos aspectos de la calidad de la asistencia sanitaria y la técnica del ciclo de mejora. Estos elementos son discutidos en términos de la estructura del sistema sanitario, los diversos procesos de salud y los resultados de los mismos. Existe una demanda creciente por el cuidado de la salud, que acarrea unos elevados costes, una escasez de recursos y la existencia de evidentes variaciones en la práctica clínica, lo que ha motivado un creciente interés en la medida y la mejora de la calidad de la asistencia sanitaria en muchos países del mundo. Ha existido un movimiento de valoración de los costes y una actividad de valoración de la calidad, con énfasis en el uso eficiente de los recursos y la efectividad en el cuidado de la salud. El ciclo de evaluación y mejora es un método iterativo de seis pasos empleado en técnicas empresariales para el control y la mejora continuada de procesos y productos, que ha demostrado su aplicabilidad en la mejora de la calidad sanitaria

This paper defines several aspects of quality of health care and the evaluation and the technique of improvement cycle. The elements are discussed in terms of the structure of the health care system, the processes of care, and outcomes resulting from care. Growing demand for health care, rising costs, constrained resources, and evidence of variations in clinical practice have increased interest in measuring and improving the quality of health care in many countries of the world. There has been a move away from assessing costs and activity to assessing quality with an emphasis on both efficient use of resources and on the effectiveness of health care. The evaluation and improvement cycle is an iterative six-step management method used in business technology for the control and continual improvement of processes and products which have demonstrated its applicability in quality health improvement

Revisión de la seguridad en anesthesia ante un incendio en quirófano / Review: safety in anesthesia in case of fire in the operating room

Los incendios en quirófano son poco frecuentes pero potencialmente catastróficos. Suponen un peligro potencial en la práctica de la anestesia quirúrgica. El anestesiólogo debe prevenir este tipo de eventos, mediante el chequeo del funcionamiento de equipos y materiales, y la prevención de circunstancias que podrían llevar a la producción de fuego. Presentamos una revisión sobre las consideraciones principales en la seguridad intraoperatoria, a propósito de un caso acontecido en nuestro quirófano que precisó el empleo de sierra radial

Fires at operating are rare but catastrophic, supposing a potential hazard during the practice of surgical anesthesia. It is essential for the anesthesiologist the prevention of these events by identifiying the elements that could cause such situations, performing a correct checking of the equipment and materials, and taking extreme care with circumstances which could lead to the production of fire. We present main considerations about safety at operating room, by explaining our experience while using a radial jaw during an intestinal surgery

Cardiac and Pulmonary Ultrasound for Diagnosing TRALI.

Unexpected acute respiratory failure after anesthesia is a diagnostic challenge: residual neuromuscular blockade, bronchial hyperresponsiveness, laryngospasm, atelectasis, aspiration pneumonitis, and other more uncommon causes should be taken into account at diagnosis. Lung ultrasound and echocardiography are diagnostic tools that would provide the differential diagnosis. We report a suspected case of a transfusion related acute lung injury (TRALI) following administration of platelets. The usefulness of lung and cardiac ultrasound is discussed to facilitate the challenging diagnosis of the acute early postoperative respiratory failure.

Valoración de la lesión vascular tras la aplicación de métodos extraluminales de oclusión temporal / Vascular injury assessment after the application of extraluminal methods for temporal occlusion

INTRODUCCIÓN: Los sistemas de oclusión temporal provocan la lesión de la pared arterial. Nuestro objetivo es comparar el daño arterial de los métodos de oclusión vascular extraluminal (tangenciales y circunferenciales). MATERIAL Y MÉTODOS: Un total de 80 ratas fueron sometidas a la oclusión de la carótida común durante 60 min. Se aleatorizaron en 8 grupos: pinza vascular (CV) y bulldog vascular (BD), como técnicas tangenciales; y lazo de Potts (LZ) y torniquete de Rumel (RM), como técnicas circunferenciales. RESULTADOS: El grupo tratado con CV y RM presentó un mayor grosor máximo en la media que el grupo tratado con BD a los 7 días (p < 0,05), mientras que a los 15 días el grupo tratado con LZ presentó un grosor máximo de la media superior al medido en el grupo CV (p < 0,05). Tras 7 y 15 días, las arterias ocluidas por técnicas de oclusión circunferencial presentaron un mayor engrosamiento total de la pared (p < 0,01). Los grupos tratados con BD, RM y LZ presentaron un mayor grosor total de la pared vascular que el tratado con CV (p < 0,05). El grupo tratado con RM, además, presentó mayor grosor total que el tratado con BD y el LZ (p < 0,05). A los 7 días en las arterias tratadas mediante técnicas tangenciales se apreció una mayor área de la luz vascular que en las arterias tratadas mediante técnicas circunferenciales (p < 0,05). CONCLUSIONES: Los métodos tangenciales dañan menos la estructura de la pared arterial que los métodos circunferenciales, produciendo una menor alteración en el grosor de la pared vascular y una menor estenosis de la luz

INTRODUCTION: Temporary occlusion systems cause arterial wall injury. The aim of this study is to compare the arterial damage extraluminal methods of vascular occlusion (tangential and circumferential). MATERIAL AND METHODS: A sample of 80 rats were subjected to occlusion of the common carotid artery for 60 minutes. They were randomized into 8 groups: vascular clamp (CV) and vascular bulldog (BD) as tangential techniques, and Potts loop (LZ) and Rumel tourniquet (RM) as circumferential techniques. RESULTS: The CV and RM treated groups had a higher average maximum medial thickness in the treated BD at 7 days (P<.05), whereas 15-day LZ-treated group had a higher average medial thickness than the measures in the CV group (P<.05). After 7 and 15 days, the arteries occluded by occlusion circumferential techniques showed a greater total wall thickening (P<.01). The groups treated with BD, RM and LZ showed greater vessel total wall thickness than the group treated with CV (P<.05). The RM-treated group also showed a greater total thickness than the BD and LZ groups (P<.05). At 7 days, arteries treated by tangential techniques showed a greater area of the luz than arteries treated by circumferential techniques (P<.05). CONCLUSIONS: Tangential methods are less destructive methods of the artery wall structure than the circumferential methods, producing a minor disturbance in the thickness of the vessel wall and less luz stenosis

Biopsia de ganglio centinela en pacientes con cáncer de mama multifocal y multicéntrico: 5 años de seguimiento / Sentinel node biopsy in patients with multifocal and multicentric breast cancer: A 5-year follow-up

Objetivo: La biopsia selectiva del ganglio centinela (BSGC) como procedimiento de estadificación en el cáncer de mama múltiple es cuestión de controversia. Nuestro objetivo es evaluar la eficiencia de detección del ganglio centinela (GC) en las pacientes con cáncer multifocal o multicéntrico, y la seguridad de su aplicación clínica, tras un seguimiento prolongado. Material y métodos: Se realiza un estudio prospectivo descriptivo. Se estudian 89 pacientes con cáncer múltiple de mama sometidas a BSGC (73 procesos multifocales, 16 multicéntricos), comparándolas con las que presentaron neoplasia unifocal. En la mayor parte de las BSGC se realizó administración periareolar del radiocoloide. Se realiza la evaluación a los 67,2 meses de seguimiento medio (32-126 meses). Resultados: Las tasas de localización gammagráfica y quirúrgica del GC en las pacientes con cáncer de mama múltiple fueron respectivamente 95,5% y 92,1%, observándose mayor porcentaje de GC extraaxilares que en los procesos unifocales (11,7% frente a 5,4%) y un número de GC por paciente significativamente mayor (1,70 frente a 1,38). La tasa de localización del GC en el cáncer multicéntrico fue ligeramente inferior al multifocal (87,5% frente a 93,1%) y el hallazgo de drenajes extra-axilares más elevado (20% frente a 10%). El número promedio de GC por paciente fue significativamente superior en el cáncer multicéntrico (2,33 frente a 1,57). No se han registrado recurrencias axilares en el seguimiento de las pacientes con cáncer múltiple. Conclusiones: La BSGC mediante inyección periareolar es un procedimiento preciso y fiable de estadificación del cáncer de mama múltiple, incluso multicéntrico (AU)

Objective: Sentinel lymph node biopsy (SLNB) as a staging procedure in multiple breast cancer is a controversial issue. We have aimed to evaluate the efficacy of sentinel node (SN) detection in patients with multifocal or multicentric breast cancer as well as the safety of its clinical application after a long follow-up. Material and methods: A prospective descriptive study was performed. Eighty-nine patients diagnosed of multiple breast cancer (73 multifocal; 16 multicentric) underwent SLNB. These patients were compared to those with unifocal neoplasia. Periareolar radiocolloid administration was performed in most of the patients. Evaluation was made at an average of 67.2 months of follow-up (32-126 months). Results: Scintigraphic and surgical SN localization in patients with multiple breast cancer were 95.5% and 92.1%, respectively. A higher percentage of extra-axillary nodes was observed than in the unifocal group (11.7% vs 5.4%) as well as a significantly higher number of SN per patient (1.70 vs 1.38). The rate of SNlocalization in multicentric cancer was slightly lower than in multifocal cancer (87.5% vs 93.1%), and the finding of extra-axillary drainages was higher (20% vs 10%). Number of SN per patient was significantly higher in multicentric breast cancer (2.33 vs 1.57). No axillary relapses have been demonstrated in the follow-up in multiple breast cancer patients group. Conclusions: SLNB performed by periareolar injection is a reliable and accurate staging procedure of patients with multiple breast cancer, including those with multicentric processes (AU)

Empleo de la espirometría incentiva en el análisis de la función pulmonar y la predicción de complicaciones postoperatorias en cirugía torácica / Incentive spirometry in lung function analysisi and prediction of postoperative complications in thoraci surgery

INTRODUCCIÓN: La disminución de la función pulmonar tras la cirugía torácica se involucra en la etiología de las complicaciones respiratorias. Concretamente, el FEV1 y la morbimortalidad postoperatorios se relacionan inversamente. La medición del FEV1 durante el postoperatorio requiere una dotación tecnológica no disponible en la mayoría de las unidades de Cirugía Torácica. La espirometría incentiva es un método sencillo y ampliamente utilizado en este periodo perioperatorio. OBJETIVOS: Cuantificar la correlación entre los resultados del la espirometría incentiva y del FEV1 durante el día preoperatorio y los siguientes días a la intervención, en los pacientes sometidos a intervenciones torácicas. MATERIAL Y MÉTODOS: Estudio prospectivo durante 6 meses de pacientes sometidos a intervenciones programadas mediante técnicas de toracotomía, toracotomía vídeo asistida, videotoracoscopia (VATS) y esternotomía. Recogida de los valores de volumen inspiratorio máximo mediante espirometría incentiva y de FEV1 empleando espirometría forzada durante el día prey postoperatorios hasta el alta. RESULTADOS: De los 74 pacientes estudiados se obtuvieron las mediciones en 56 hombres y 7 mujeres, edad media 58+16 años. El 57% se intervino mediante toracotomías, el 25% con toracotomías vídeo asistidas, 13% VATS y 5% esternotomías. 43 sujetos fueron sometidos a cirugía de resección pulmonar (8 neumonectomías, 19 lobectomías y 16 segmentectomías). La estancia media alcanzó los 5 + 3 días, ingresando todos el día previo a la cirugía. Se obtuvo un coeficiente de correlación de 0,719 (p = 0,0005). CONCLUSIONES: Existe una correlación lineal significativa entre los valores de volumen inspiratorio máximo y de FEV1 en los pacientes sometidos a intervenciones de Cirugía Torácica

INTRODUCTION: Decreased lung function following thoracic surgery is involved in the etiology of respiratory complications. Specifically, FEV1 and postoperative morbidity and mortality are related inversely. Measuring postoperative FEV1 requires technological equipment not available in most units of Thoracic Surgery. The incentive spirometry is a simple and widely method used in the perioperative period. OBJECTIVES: To quantify the correlation between the results of the incentive spirometry and FEV1 during the preoperative day and the days following surgery, in patients undergoing thoracic surgery. MATERIAL AND METHODS. A prospective study of patients undergoing thoracic surgery techniques (video assisted thoracotomy, video-assisted thoracoscopy (VATS) and sternotomy) were included. Collecting values encourages maximum inspiratory volume by using spirometry and spirometry FEV1 during the pre and postoperative day until discharge. Follow-up 6 months. RESULTS: 74 patients were included (56 men and 7 women), mean age 58 +16 years were obtained. 57% were operated by thoracotomy, 25% with video assisted thoracotomy, VATS 13%, and 5 % sternotomy. 43 subjects underwent lung resection surgery (8 pneumonectomies, 19 lobectomies and 16 segmentectomies). The average stay reached 5 +3 days, starting the hospital stay the day before surgery. A correlation coefficient of 0.719 (p = 0.0005) was obtained. CONCLUSIONS: there is a significant linear correlation between the values of maximum inspiratory volume and FEV1 in patients undergoing thoracic surgery interventions

Anestesia para cirugía no cardiaca en paciente post-trasplantado cardiaco. Revisión y puesta al día, a propósito de un caso / Anaesthesia for non-cardiac surgery in the heart-transplanted patient: a case report, review and update

Los pacientes receptores de trasplante de corazón se someten con mayor frecuencia a procedimientos quirúrgicos no cardíacos. El incremento de la supervivencia de esta población en los últimos años se debe a la disminución del rechazo con la introducción de la terapia inmunosupresora. Resulta esencial para el anestesiólogo la comprensión de las implicaciones fisiológicas y farmacológicas en un corazón atípico y un organismo inmunodeprimido. El corazón trasplantado está denervado, y la modulación del gasto cardíaco depende principalmente del aumento del volumen sistólico según la ley de Frank-Starling. Durante el acto anestésico, deben garantizarse una adecuada precarga, unas condiciones de asepsia estricta y el empleo de fármacos con acción directa sobre el miocardio. Se revisan los aspectos anestésicos perioperatorios del paciente trasplantado, a propósito de un caso que llegó a nuestro hospital y fue sometido a una técnica de revascularización de extremidad inferior bajo anestesia subaracnoidea

Recipients of heart transplant undergo more often noncardiac surgical procedures nowadays. The increased survival of this population in recent years is due to the decrease in rejection with the introduction of immunosuppressive therapy. It is essential for the anesthesiologist to understand the physiological and pharmacological implications in the atypical heart and the immunosuppressed body. The transplanted heart is denervated, and modulation of cardiac output mainly depends on the ncrease in stroke volume according to the Frank- Starling law. During anesthesia, an adequate preload, strict aseptic conditions and the use of drugs with direct action on the myocardium must be ensured. Perioperative anesthetic aspects of the transplanted patient are reviewed, and a case that came to our hospital and underwent revascularization of lower limb under spinal anesthesia is reported

[Sentinel node biopsy in patients with multifocal and multicentric breast cancer: A 5-year follow-up]. / Biopsia de ganglio centinela en pacientes con cáncer de mama multifocal y multicéntrico: 5 años de seguimiento.

OBJECTIVE: Sentinel lymph node biopsy (SLNB) as a staging procedure in multiple breast cancer is a controversial issue. We have aimed to evaluate the efficacy of sentinel node (SN) detection in patients with multifocal or multicentric breast cancer as well as the safety of its clinical application after a long follow-up. MATERIAL AND METHODS: A prospective descriptive study was performed. Eighty-nine patients diagnosed of multiple breast cancer (73 multifocal; 16 multicentric) underwent SLNB. These patients were compared to those with unifocal neoplasia. Periareolar radiocolloid administration was performed in most of the patients. Evaluation was made at an average of 67.2 months of follow-up (32-126 months). RESULTS: Scintigraphic and surgical SN localization in patients with multiple breast cancer were 95.5% and 92.1%, respectively. A higher percentage of extra-axillary nodes was observed than in the unifocal group (11.7% vs 5.4%) as well as a significantly higher number of SN per patient (1.70 vs 1.38). The rate of SN localization in multicentric cancer was slightly lower than in multifocal cancer (87.5% vs 93.1%), and the finding of extra-axillary drainages was higher (20% vs 10%). Number of SN per patient was significantly higher in multicentric breast cancer (2.33 vs 1.57). No axillary relapses have been demonstrated in the follow-up in multiple breast cancer patients group. CONCLUSIONS: SLNB performed by periareolar injection is a reliable and accurate staging procedure of patients with multiple breast cancer, including those with multicentric processes.

Análisis de residuos de herbicidas en aguas procedentes de Navarra mediante lc-ms/ms / Lc-ms/ms analysis of herbicide residues in waters from Navarre

Fundamento. El objetivo del trabajo fue obtener informaciónacerca de los residuos de herbicidas (imazametabenz,simazina, isoproturon, clortoluron, metribuzina,atrazina, cianazina, terbutrina, propanil,terbutilazina, alacloro y pendimetalina) presentes enaguas procedentes de Navarra.Material y métodos. Se tomó un total de 465 muestrasde agua; de ellas, 378 se obtuvieron en 141 abastecimientos;las 87 restantes procedieron de 37 fuentes,manantiales y sondeos situados en zonas agrícolas delsur de Navarra. La técnica empleada fue LC-MS/MS.Resultados. Se detectaron residuos de herbicidas en el33% de los abastecimientos, y su concentración superóel límite normativo en el 8% de ellos. Se encontraron residuosde herbicidas en el 86% de las muestras de pozos yfuentes de zonas agrícolas del sur de Navarra. El númerode abastecimientos con residuos de herbicidas aumentóde norte a sur de Navarra. No obstante, el porcentaje deabastecimientos en los que la concentración de herbicidassuperó los límites fue mayor en la zona centro de Navarraque en la zona sur y norte. Imazametabenz fue el herbicidamás detectado en las muestras de las zonas norte, centro ysur. Atrazina, terbutilazina e imazametabenz se detectaronpreferentemente en las muestras de la zona sur.Conclusiones. Las diferencias entre las tres zonas deNavarra pueden explicarse atendiendo a las diferentesprácticas agrícolas de cada región. No se detectaronconcentraciones de herbicidas superiores a los límitesnormativos en ninguna de las muestras de agua procedentesde las poblaciones mayoritarias de Navarra(AU)

Background. The aim of the study was to obtain informationon the residues of herbicides (imazametabenz,simazine, isoproturon, clortoluron, metribuzine, atrazine,cianazine, terbutrin, propanil, terbutilazine, alachlorand pendimetalin) present in water proceedingfrom Navarre.Material and methods. A total of 465 samples of waterwere taken: 378 were taken from 141 water supplies; theremaining 87 proceeded from fountains, springs and boringsin agricultural areas in the south of Navarre. Thetechnique employed was LC-MS/MS.Results. Herbicide residues were detected in 33% of thewater supplies, and their concentration exceeded thenormative limit in 8% of them. Herbicide residues werefound in 86% of the samples from wells and fountains ofthe agricultural areas of the south of Navarre. The numberof water supplies with herbicide residues increased fromnorth to south. However, the percentage of water suppliesin which the concentration of herbicides exceeded the limitswas greater in the centre of Navarre than in the northand south. Imazametabenz was the herbicide most detectedin the samples from the northern, central and southernareas. Atrazine, terbutilazine and imazametabenz weremost detected in the samples of the southern area.Conclusions. The differences amongst the three areasof Navarre can be explained as being due to the differentagricultural practices of each area. Concentrationsof herbicides exceeding the normative limits were notdetected in any of the water samples proceeding fromthe larger towns of Navarre(AU)

[LC-MS/MS analysis of herbicide residues in waters from Navarre]. / Análisis de residuos de herbicidas en aguas procedentes de Navarra mediante LC-MS/MS.

BACKGROUND: The aim of the study was to obtain information on the residues of herbicides (imazametabenz, simazine, isoproturon, clortoluron, metribuzine, atrazine, cianazine, terbutrin, propanil, terbutilazine, alachlor and pendimetalin) present in water proceeding from Navarre. MATERIAL AND METHODS: A total of 465 samples of water were taken: 378 were taken from 141 water supplies; the remaining 87 proceeded from fountains, springs and borings in agricultural areas in the south of Navarre. The technique employed was LC-MS/MS. RESULTS: Herbicide residues were detected in 33% of the water supplies, and their concentration exceeded the normative limit in 8% of them. Herbicide residues were found in 86% of the samples from wells and fountains of the agricultural areas of the south of Navarre. The number of water supplies with herbicide residues increased from north to south. However, the percentage of water supplies in which the concentration of herbicides exceeded the limits was greater in the centre of Navarre than in the north and south. Imazametabenz was the herbicide most detected in the samples from the northern, central and southern areas. Atrazine, terbutilazine and imazametabenz were most detected in the samples of the southern area. CONCLUSIONS: The differences amongst the three areas of Navarre can be explained as being due to the different agricultural practices of each area. Concentrations of herbicides exceeding the normative limits were not detected in any of the water samples proceeding from the larger towns of Navarre.

Defecto escrotal en una gammagrafía ósea / Scrotal defect on bone scintigraphy

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