"Evita Una Muerte, Esta en Tus Manos" Program: Bystander First Aid Training for Terrorist Attacks.

BACKGROUND: The latest terrorist attacks in Europe and in the rest of the world, and the military experience in the most recent conflicts leave us with several lessons learned. The most important is that the fate of the wounded rests in the hands of the one who applies the first dressing, because the victims usually die within the first 10 minutes, before professional care providers or police personnel arrive at the scene. A second lesson is that the primary cause of preventable death in these types of incidents involving explosives and firearms is massive hemorraghe. OBJECTIVE: There is a need to develop a training oriented to citizens so they can identify and use available resources to avoid preventable deaths that occur in this kind of incidents, especially massive hemorrhage. METHODS: A 7-hour training intervention program was developed and conducted between January and May 2017. Data were collected from participants' answers on a multiple-choice test before and after undertaking the training. Improved mean score for at least 75% of a group's members on the posttraining test was considered reflective of adequate knowledge. RESULTS: A total of 173 participants (n = 74 men [42.8%]; n = 99 women [57.2%]) attended the training. They were classified into three groups: a group of citizens/ first responders with no prior health training, a group of health professionals, and a group of nursing students. Significant differences (ρ < .05) between mean pre- and post-training test scores occurred in each of the three groups. CONCLUSION: There was a clear improvement in the knowledge of the students after the training when pre- and post-training test scores were compared within the three groups. The greatest improvement was seen in the citizens/first responders group.

Enfermedad de Mondor / Mondor´s disease

La enfermedad de Mondor, es una entidad caracterizada por el desarrollo de tromboflebitis de venas subcutáneas. La localización más frecuente, es la cara ántero lateral de la pared torazo-abdominal. El cuadro clínico se caracteriza por la aparición de un cordón palpable, doloroso, que involuciona en un período de tiempo variable, generalmente corto. La patogenia no ha sido aclarada, pero se han identificado una serie de factores predisponentes como: cirugía mamaria, estados de hipercoagulabilidad, electrocución, infecciones, uso de drogas vasoconstrictoras, compresión de vasos sanguíneos y esfuerzos físicos intensos. La asociación descrita con patologías sistémicas, tales como el cáncer de mama y estados de hipercoagulabilidad, obliga a realizar una completa evaluación de los pacientes afectados, para descartar las mencionadas afecciones. Presentamos tres pacientes con enfermedad de Mondor, desencadenada luego de realizar esfuerzos físicos intensos.(AU)

Mondors disease is an entity, characterized by the development of thrombophlebitis of subcutaneous veins. The most common location is theanterolateral aspect of the thoraco-abdominal wall. The clinical condition is characterized by the appearance of a painful palpable cord, which retrogresses in a generally brief, variable period of time. The pathogenesis has not been established, but it has been identified a number of predisposing causes such as breast surgery, hipercoagulables states, electrocution, infections, use of vasoconstrictors, compression of blood vessels and intense physical effort. Since it is associated with systemic diseases such as breast cancer and hipercoagulables states, it is required to conduct a complete evaluation of affected patients to rule out the above mentioned conditions. We present three patients with Mondors disease, which was triggered as a result of intense physical effort.(AU)

Enfermedad de Mondor / Mondor´s disease

La enfermedad de Mondor, es una entidad caracterizada por el desarrollo de tromboflebitis de venas subcutáneas. La localización más frecuente, es la cara ántero lateral de la pared torazo-abdominal. El cuadro clínico se caracteriza por la aparición de un cordón palpable, doloroso, que involuciona en un período de tiempo variable, generalmente corto. La patogenia no ha sido aclarada, pero se han identificado una serie de factores predisponentes como: cirugía mamaria, estados de hipercoagulabilidad, electrocución, infecciones, uso de drogas vasoconstrictoras, compresión de vasos sanguíneos y esfuerzos físicos intensos. La asociación descrita con patologías sistémicas, tales como el cáncer de mama y estados de hipercoagulabilidad, obliga a realizar una completa evaluación de los pacientes afectados, para descartar las mencionadas afecciones. Presentamos tres pacientes con enfermedad de Mondor, desencadenada luego de realizar esfuerzos físicos intensos.

Mondor's disease is an entity, characterized by the development of thrombophlebitis of subcutaneous veins. The most common location is theanterolateral aspect of the thoraco-abdominal wall. The clinical condition is characterized by the appearance of a painful palpable cord, which retrogresses in a generally brief, variable period of time. The pathogenesis has not been established, but it has been identified a number of predisposing causes such as breast surgery, hipercoagulables states, electrocution, infections, use of vasoconstrictors, compression of blood vessels and intense physical effort. Since it is associated with systemic diseases such as breast cancer and hipercoagulables states, it is required to conduct a complete evaluation of affected patients to rule out the above mentioned conditions. We present three patients with Mondor's disease, which was triggered as a result of intense physical effort.

Análisis de recurrencias axilares tras biopsia selectiva del ganglio centinela en cáncer de mama inicial / Axillary recurrences after sentinel lymph node biopsy in initial breast cancer

Objetivo. Analizar los resultados de la aplicación de la biopsia selectiva del ganglio centinela en cáncer de mama en nuestro medio, mediante el análisis de recurrencias axilares en pacientes con Ganglio Centinela (GC) negativo sin vaciamiento axilar convencional, tras seguimiento clínico posterior. Material y métodos. Se han incluido un total de 218 pacientes a quienes se aplicó la BSGC tras diagnóstico de cáncer de mama en estadio inicial (T1-2N0) con vaciamiento axilar convencional únicamente si GC positivo. Se aplicó en todos los casos protocolo de 2 días para detección del GC tras inyección de 99mTc- Nanocoloide. Resultados. La media de seguimiento clínico posterior fue de 27 meses. Se extirparon un total de 413 GC con una media de 1,89/paciente (1–5). En un 33,9% se detectó infiltración [59,45% macrometástasis, 22,97% micrometástasis y 17,5% células tumorales aisladas (CTA)], siendo negativo el resto de ganglios extirpados en el vaciamiento axilar convencional en el 60% de los casos. En nuestra serie de pacientes se detectó un único caso de falso negativo de GC por bloqueo linfático masivo, identificándose intraoperatoriamente una adenopatía no captante adyacente al GC, sin detectarse ningún caso de recidiva axilar durante un seguimiento clínico medio de 27 meses. Conclusión. La ausencia de recidivas axilares en nuestra serie de pacientes con GC negativo sin vaciamiento axilar convencional indica el adecuado control local que la biopsia selectiva del ganglio centinela ofrece en el cáncer de mama en estadios iniciales(AU)

Objective. The aim of our study was to analyze the application of the Selective Sentinel Lymph Node Biopsy (SLNB) in early Breast Cancer of our population, through the analysis of axillary recurrences in patients with false negative sentinel node procedures without complete axillary lymphadenectomy, after a subsequent clinical follow-up. Material and methods. A total of 218 early Breast Cancer patients who underwent SLNB after being diagnosed of early breast cancer (T1-2N0) with complete axillary dissection only when the SLNB was positive in the histopathological analysis. In every case, a 2-day protocol was used to localize the sentinel node after injection of 99mTc-Nanocolloid. Results. The mean subsequent clinical follow-up was 27 months. A total of 413 sentinel nodes were removed with a median of 1.89/p (range 1–5). Infiltration was detected in 33.9% of patients (59.45% macrometastasis, 22.97% micrometastasis and 17.5% Isolated Tumor Cells (ITC)) and negative for the other nodes excised after conventional lymphadenectomy in 60% of cases. In our population, there was only one case of false negative (FN) SLN due to massive lymphatic blockage, and an abnormal lymph node without uptake adjacent to the SLN was identified intraoperatively. No case of axillary recurrence was detected during an average follow-up of 27 months. Conclusion. The absence of axillary recurrences in our population with negative SLNB without complete axillary dissection demonstrates the appropriate local control offered by this procedure in early Breast Cancer(AU)

[Axillary recurrences after sentinel lymph node biopsy in initial breast cancer]. / Análisis de recurrencias axilares tras biopsia selectiva del ganglio centinela en cáncer de mama inicial.

OBJECTIVE: The aim of our study was to analyze the application of the Selective Sentinel Lymph Node Biopsy (SLNB) in early Breast Cancer of our population, through the analysis of axillary recurrences in patients with false negative sentinel node procedures without complete axillary lymphadenectomy, after a subsequent clinical follow-up. MATERIAL AND METHODS: A total of 218 early Breast Cancer patients who underwent SLNB after being diagnosed of early breast cancer (T1-2N0) with complete axillary dissection only when the SLNB was positive in the histopathological analysis. In every case, a 2-day protocol was used to localize the sentinel node after injection of (99m)Tc-Nanocolloid. RESULTS: The mean subsequent clinical follow-up was 27 months. A total of 413 sentinel nodes were removed with a median of 1.89/p (range 1-5). Infiltration was detected in 33.9% of patients (59.45% macrometastasis, 22.97% micrometastasis and 17.5% Isolated Tumor Cells (ITC)) and negative for the other nodes excised after conventional lymphadenectomy in 60% of cases. In our population, there was only one case of false negative (FN) SLN due to massive lymphatic blockage, and an abnormal lymph node without uptake adjacent to the SLN was identified intraoperatively. No case of axillary recurrence was detected during an average follow-up of 27 months. CONCLUSION: The absence of axillary recurrences in our population with negative SLNB without complete axillary dissection demonstrates the appropriate local control offered by this procedure in early Breast Cancer.

Composting olive mill pomace and other residues from rural southeastern Spain.

The costly disposal of the semisolid residual pomace generated in the two phase extraction used in modern olive mills is causing serious problems to the small oil producers of rural southeastern Spain. Composting may be a viable alternative since complementary residues are usually available in these areas to prepare an adequate starting mixture. In this work, four different combinations of residues (pomace+rabbit manure, pomace+sheep manure, pomace+rabbit manure+rice straw, pomace+rabbit manure+almond shells) were composted in 3 ton piles aerated by turnings, using technology available to any small community of oil producers. During the four long processes (9-10 months), a steady decrease of organic matter and increases in the concentrations of nutrient and humic substances were observed, together with large increases in pH and salinity which may reduce the agronomic value of the final products.

Miofibroblastoma intranodular axilar / Axillary intranodular myfibroblastoma

El miofibroblastoma intranodular es una tumoración primaria de ganglio linfático, infrecuente y de comportamiento benigno. En un principio se pensó que sólo se asentaba en los ganglios linfáticos inguinales, pero posteriormente fue descrito en localizaciones extrainguinales. El diagnóstico diferencial debe realizarse con otras neoplasias mesenquimales y con posibles metástasis de melanomas, sarcomas o carcinomas fusocelulares. Presentamos el caso de una mujer de 41 años portadora de una tumoración en la región axilar derecha que fue diagnosticada por punción-aspiración con aguja fina como neoplasia mesenquimal benigna y posteriormente, con la biopsia, como miofibroblastoma (AU)

Organic matter components, aggregate stability and biological activity in a horticultural soil fertilized with different rates of two sewage sludges during ten years.

The effects of the application as fertilizer during ten years of two sewage sludges (aerobically and anaerobically digested, at rates of 400, 800, and 1200 kg of N/ha yr), on the aggregate stability and contents of related organic matter components, microbial biomass and levels of five enzymatic activities (alkaline phosphomonoesterase, phosphodiesterase, urease, arylsulphatase and dehydrogenase) were investigated. The application of both sludges at mid and high rates gave rise to significant increases of organic matter, humified substances and humic acids, but no effects on carbohydrates, microbial gums and aggregate stability were observed. As for biological activity in soils, the high variability of data led to a general absence of statistical significance despite the large differences between treatments observed. Significant increases of phosphodiesterase activity were nevertheless produced by the high rate of aerobic sludge and the mid and high rates of the anaerobic sludge.

Biodegradation of polycyclic aromatic hydrocarbons (PAHs) by native microflora and combinations of white-rot fungi in a coal-tar contaminated soil.

Four white-rot fungi (Phanerochaete chrysosporium IMI 232175, Pleurotus ostreatus from the University of Alberta Microfungus Collection IMI 341687, Coriolus versicolor IMI 210866 and Wye isolate #7) and all possible combinations of two or more of these fungi, were incubated in microcosms containing wheat straw and non-sterile coal-tar contaminated soil to determine their potential to degrade polycyclic aromatic hydrocarbons (PAHs). Biotic and abiotic controls were prepared similarly and PAH concentrations remaining in each microcosm were determined after 8, 16 and 32 weeks by GC-MS following extraction with dichloromethane. The greatest PAH losses were in the biotic control, compared to small or negligible differences in microcosms inoculated with one or more fungi. These results suggest that in the biotic control native microorganisms colonised the straw added as organic substrate and degraded PAH as an indirect consequence of their metabolism. By contrast, in other microcosms, colonisation of straw by the natural microflora was inhibited because the straw was previously inoculated with fungi. Soil cultures prepared at the end of the experiment showed that though introduced fungi were still alive, they were unable to thrive and degrade PAH in such a highly contaminated soil and remained in a metabolically inactive form.

Organic matter components and aggregate stability after the application of different amendments to a horticultural soil.

The effects of usual or recommended rates of application of five organic amendments (24 t/ha yr of MSW compost, sewage sludge, and ovine manure, 2.4 t/ha yr of commercial vermicompost, and 100 l/ha yr of a commercial humic acids solution) on the soil contents of organic matter, total humified substances, humic acids, carbohydrates and microbial gums, and the structural stability of aggregates were investigated. Four and five years after the beginning of the experiment, significant increments in most of the parameters studied were found after the application of organic residues, whereas the two commercial amendments did not produce any significant change, suggesting that rates recommended by the producers and imposed by their high prices are too low to be useful. MSW compost yielded the highest increases, even if the amount of organic matter applied as ovine manure was very similar. Organic matter and carbohydrates appeared to be the parameters most closely related to soil aggregate stability.

Enfermedad de castleman retroperitoneal / Retroperitoneal Castleman's disease

La enfermedad de Castleman es una entidad poco frecuente que a menudo se comporta clínica y radiológicamente como una neoplasia. Presentamos un caso de enfermedad de Castleman del tipo plasmocelular, de localización retroperitoneal yuxtarrenal, interpretada inicialmente como un sarcoma retroperitoneal. Aportamos una revisión de los diferentes subtipos de esta enfermedad con sus diversas formas de presentación, abordaje diagnóstico y terapéutico (AU)

Ki-ras mutation modifies the protective effect of dietary monounsaturated fat and calcium on sporadic colorectal cancer.

The geographic differences in the incidence of colorectal cancer have been mostly attributed to variations in diet. The diversity of the Mediterranean diet and the heterogeneity of acquired genetic alterations in colorectal cancer sets the stage for investigating the possible association between dietary factors and mutations in tumor genes known to play a role in the pathogenesis of these neoplasms. With this purpose, we have studied the Ki-ras gene in 108 colorectal cancers using archival tissue and epidemiological data from our previous case-control study. Mutations in exon 1 of the Ki-ras gene were detected by a PCR-single strand conformation polymorphism approach. A polychotomous logistic regression model was used to assess the significance of observed differences between wild-type and mutated tumors with respect to population controls in the different categories of nutrient consumption. Multivariate density models were used to adjust the correlation between nutrients and total energy. Our studies show that high consumption of monounsaturated fats, mostly derived from olive oil, is associated with a statistically significant decrease in the risk of cancer with wild-type Ki-ras genotype but not of Ki-ras mutated cancers. Conversely, we find that high calcium intake is associated with a decreased risk of Ki-ras mutated tumors but not of wild-type tumors. Tumor genotyping can reveal epidemiological associations that are weak or unapparent when cases-control studies are not stratified by tumor genotype.

[Antiphospholipid antibodies and epilepsy in patients with systemic lupus erythematosus]. / Anticuerpos antifosfolípido y epilepsia en los pacientes con lupus eritematoso sistémico.

OBJECTIVE: To verify the possible relationship between the presence of antiphospholipid antibodies (APLA) and the presence of epileptic seizures in patients with systemic lupus erythematosus (SLE). METHODS: A total of 168 patients with SLE were studied. Fifteen patients had antecedents of epilepsy which were non attributable to a cause other than SLE. Epilepsy was diagnosed on clinical and electroencephalographic grounds. Antibodies to cardiolipin (CLa) and lupus anticoagulant (LA) were measured. RESULTS: Epileptic seizures were generalized in 13 and partial in two patients. The lupus anticoagulant was positive in 40% of patients with epilepsy compared to 32% in the control group; CLa IgG in 53.5% compared to 65.6%, and CLa IgM in 40% compared to 35.2%. Differences were never statistically significant. Neither when patients with moderate/high CLa levels were studied. Seven patients (40%) had some of the classical manifestations of antiphospholipid syndrome. CONCLUSIONS: No association was found between positive APLA and epilepsy in patients with SLE.

[Herpes-zoster virus infection in patients with systemic lupus erythematosus]. / Infección por virus del herpes zoster en pacientes con lupus eritematoso sistémico.

The prevalence of infection with VZV in 145 patients with SLE was investigated, with a mean follow-up of 7.6 years; its relationship with different variables, particularly with therapy of the underlying disease, was analyzed. Twenty episodes of VZV infection in 19 patients were diagnosed (13.1%). In no case was the therapeutic regime changed nor was worsening of SLE observed. There was neither dissemination of herpes nor superinfection. An increase in the number of VZV infections was observed in patients with SLE under corticosteroid therapy (p = 0.04) and particularly when drug administration was on a daily basis (p = 0.00006). Cytotoxic agents also favored the infection (p = 0.0014). VZV infection is of a benign nature in SLE and its emergence is favored by immunosuppressive agents. The risk is lower if corticosteroid administration is on alternate days. There is no need to decrease therapy for SLE.

Histological evolution of chronic hepatitis C. Factors related to progression.

We have evaluated the histological progression of liver disease in 29 untreated patients with chronic hepatitis C. All patients were positive to antibodies to hepatitis C virus by ELISA2 and RIBA2. Two liver biopsies were carried out for each patient, with an interval ranging between 12 and 126 months (mean 50.2 +/- 30.7). In all cases the usual histological classification was applied and the histological activity index scoring system according to Knodell et al. was determined. Fifteen cases worsened (51.7%), 12 cases showed no histological changes (41.4%) and two patients improved (6.9%). Cirrhosis was found in five patients (18.5%) in the second liver biopsy. Epidemiological, clinical, biochemical and histological progression and the group with impairment in liver histology. Factors related to histological worsening were: more advanced age (p = 0.002), high levels of aspartate aminotransferase (p = 0.04), high global histological activity index (p = 0.03) and piecemeal necrosis and bridging necrosis scores (p = 0.02) at first biopsy. The histological activity index can be applied to assess the natural history of chronic viral hepatitis, and is a good tool to evaluate the prognosis. Thus chronic hepatitis C virus infection is a histologically progressive disease in at least half the cases.

Endoscopic diagnosis of the excluded gastric antrum.

A 69-year-old woman was admitted to our hospital with GI haemorrhage. Twenty-two years previously, she had had a Billroth II operation to treat a duodenal ulcer. A gastroscopy performed on admission showed two ulcers on the anastomotic crest. We were able to visualize all of the blind duodenal pouch and how in the proximal end the mucosa was prominent and different in colour. Excluded gastric antrum was confirmed by endoscopic biopsy. We discuss the different approaches to the diagnosis of excluded gastric antrum, and we conclude that endoscopy must play important role in the diagnosis of this pathology.