Osteólisis atraumática de clavícula distal en varón joven / Atraumatic distal clavicle osteolysis in a young man

Se presenta el caso de un paciente con osteólisis de clavícula distal, sin causa etiológica traumática, ni enfermedad sistémica de base. La radiología reveló una osteólisis de la clavícula distal. El paciente obtuvo mejoría con tratamiento rehabilitador, sin necesitar cirugía (AU)

We present the case of a male patient with distal clavicle osteolysis without underlying traumatic or systemic disease. Radiological assessment revealed osteolysis of the distal clavicle. The osteolysis improved with rehabilitation treatment without the need for surgery (AU)

Neumoperitoneo asintomático asociado a neumatosis quística intestinal en paciente quirúrgico / Asymptomatic pneumoperitoneum associated to pneumatosis cystoides intestinalis in surgery patient

Abstract Introduction: Pneumatosis cystoides intestinalis (PCI) is a rare entity characterized by the presence of air in the intestinal wall. In most cases, it is secondary to a number of mainly intra-abdominal processesthat mostly require urgent surgery but, in a small percentage of cases, it is idiopathic and usually has a morebenign course, caused by, among other things, a series of mechanical factors causing mucosal damage andtherefore predisposing to the formation of cysts. Case report: Here we describe a case of a patient undergoingright hemicolectomy for colon cancer and subsequently treated with chemotherapy that developed PCI twoyears after treatment ended. At all times, the patient was asymptomatic, despite the evolution of PCI and thedevelopment of associated pneumoperitoneum.

Resumen Introducción: La neumatosis quística intestinal (NQI) es una entidad poco frecuente que se caracteriza por la presencia de aire en la pared intestinal. En la mayoría de las ocasiones es secundaria a una serie de procesos fundamentalmente intrabdominales y que en su mayoría requieren cirugía urgente, pero en un pequeño porcentaje de casos es idiopática y suele tener un curso más benigno, causada entre otras cosas por una serie de factores mecánicos que ocasionan el daño de la mucosa y por lo tanto predisponen a la formación de quistes. Caso clínico: Presentamos el caso de un paciente sometido a una hemicolectomía derecha por cáncer de colon y tratado posteriormente con quimioterapia que desarrolla una NQI a los dos años de finalizado el tratamiento. En todo momento el paciente se ha encontrado asintomático a pesar de la evolución de la NQI yel desarrollo de neumoperitoneo asociado.

Identificación de las prácticas seguras simples en un área de atención primaria / Identification of simple safe practices in a primary care area

Objetivos. Valorar las prácticas seguras (PS) elaboradas por la Unidad Funcional de Gestión de Riesgos Sanitarios (UFGRS), según su complejidad de implantación y el impacto en la seguridad del paciente (SP) e identificar PS simples (PSS). Material y métodos. Desde la UFGRS del Área 4 de Atención Primaria (AP) de Madrid, se han elaborado un número importante de PS, posteriormente se valoraron según su complejidad de implantación e impacto potencial en la SP, identificándose las PSS: contra eventos adversos (EA), de baja complejidad de implantación y de alto impacto en la SP. Por último, se identificaron las barreras para su implantación efectiva y se diseñaron acciones para superar dichas barreras. Resultados. Se han elaborado 50 PS, de ellas 42 se han generalizado a todo el área. Se han identificado como PSS: 7 de nivel 1, que cumplen las condiciones ideales. Las principales barreras tienen que ver con la falta de formación, cultura, liderazgo de los equipos directivos y profesionales de los centros y escasa difusión de las PS. Conclusiones. Desde la UFGRS se ha elaborado un número importante de PS, identificándose PSS para AP. La mayoría de estas tienen que ver con el uso seguro de medicamentos y con las vacunas(AU)

Objectives. To assess the safe practices (SP) prepared by the Health Risk Management Functional Unit (UFGRS), according to their complexity of introduction and the impact on patient safety, and to identify simple SP. Material and methods. A number of important SP have been prepared by the UFGRS of Madrid Health Area 4 Primary Care (PC). They were subsequently assessed according to their complexity of introduction and their potential impact on patient safety, simple SP (SSP) for the prevention of adverse events, low complexity of introduction and impact on patient safety. Lastly, the barriers to their effective introduction were identified, and actions were designed to overcome these barriers. Results. Of the 50 PS prepared, 42 have been applied in the whole Area. Seven Level 1 SP (which fulfil the ideal conditions) were identified as simple SP. The main barriers were due to lack of training, culture, leadership of the management teams and professionals of the centre and lack of knowledge of the SPs. Conclusions. A large number of SP has been prepared by the UFGRS, with simple SP being identified for PC. The majority of these have to do with the safe use of drugs and vaccines(AU)

[Identification of simple safe practices in a primary care area]. / Identificación de las prácticas seguras simples en un área de atención primaria.

OBJECTIVES: To assess the safe practices (SP) prepared by the Health Risk Management Functional Unit (UFGRS), according to their complexity of introduction and the impact on patient safety, and to identify simple SP. MATERIAL AND METHODS: A number of important SP have been prepared by the UFGRS of Madrid Health Area 4 Primary Care (PC). They were subsequently assessed according to their complexity of introduction and their potential impact on patient safety, simple SP (SSP) for the prevention of adverse events, low complexity of introduction and impact on patient safety. Lastly, the barriers to their effective introduction were identified, and actions were designed to overcome these barriers. RESULTS: Of the 50 PS prepared, 42 have been applied in the whole Area. Seven Level 1 SP (which fulfil the ideal conditions) were identified as simple SP. The main barriers were due to lack of training, culture, leadership of the management teams and professionals of the centre and lack of knowledge of the SPs. CONCLUSIONS: A large number of SP has been prepared by the UFGRS, with simple SP being identified for PC. The majority of these have to do with the safe use of drugs and vaccines.

Cancer survival in Costa Rica, 1995-2000.

The Costa Rica national tumour registry was founded in 1976 and nationwide data collection commenced in 1980. Cancer registration is predominantly done by passive methods. The registry contributed data on survival for invasive cancers of breast and cervix and in situ cancer of the cervix registered during 1995-2000. Followup has been carried out predominantly by passive methods, with median follow-up ranging from 31-47 months. The proportion of cases with histological confirmation of cancer diagnosis was 92% for invasive cancers and almost 100% for in-situ cancer of the cervix; death certificates only (DCOs) comprised 3%, and 78-86% of total cases registered were included for survival analysis. The one-, three- and five-year relative survival were 93%, 77% and 68%, respectively for breast cancer; the corresponding figures for invasive cervix cancer were 83%, 61% and 54%, respectively. The five-year relative survival for in-situ cervix cancer was 99%. A decreasing survival with increasing age group at diagnosis was noted for in-situ cancer of the cervix, while it fluctuated for invasive breast and cervix cancers. A decreasing survival with increasing clinical extent of disease was noted for invasive breast and cervix cancers.

Comparison between lung weight and blood strontium in bodies found in seawater.

This paper examines the use of lung weight increase as an indicator of seawater drowning compared to the amount of Sr absorbed by the blood. The study population was limited to male victims older than 20 years. Significant differences between cases of drowning and "non-drowning" were detected in terms of the lung-heart weight ratio (L/H) (p<0.001) or lung-body weight ratio (L/B) (p=0.005). However, using lung weight (L), L/H or L/B to distinguish between seawater drownings and saltwater non-drownings some overlap was produced. The factor rendering least overlap was L/B, which also appeared to be non-dependent on the victim's age. Our findings suggest that a value of L/B higher than 19.5 g/kg could be a useful indicator of death by drowning, but that when a lower value is found, additional drowning diagnoses would be needed to establish the manner of death.

Síndrome de cushing por hiperplasia adrenal macronodular bilateral ACTH-independiente / Cushing's syndrome due to ACTH-independent bilateral macronodular adrenal hyperplasia

La hiperplasia suprarrenal macronodular bilateral ACTH-independiente (HAMAI) se considera hoy día una entidad diferente y separada del resto de causas de síndrome de Cushing. Su etiología es incierta aunque en los últimos años se ha demostrado la existencia de respuesta anormal de glándulas suprarrenales a distintas hormonas que estimulan la secreción de cortisol. En este artículo presentamos un caso de hipercortisolismo no suprimible con dexametasona, cifras de ACTH indetectables, hiperplasia suprarrenal bilateral de aspecto nodular y resonancia magnética nuclear hipofisaria normal. Se realizó suprarrenalectomía bilateral, objetivando cifras detectables de ACTH a los 3 meses (AU)

Characterization of vinblastine-induced supersensitivity in the rat.

A single dose of vinblastine (3 mg/kg, i.v.) in the rat produced a long lasting depletion of endogenous (-)noradrenaline (NA) in atria as well as in vasa deferentia, the depletion being greater in atria than in vasa deferentia. The maximum depletion of NA in atria occurred between 60 and 90 h after vinblastine, while in vasa deferentia the maximum depletion was 35%, 120 h after vinblastine. The 30 min in vitro uptake of (-)-(3H) NA in atria was inhibited between 78 and 83% at 30, 60 and 120 h after vinblastine. In vasa deferentia the maximum inhibition of 25% was seen 15 h after vinblastine, however the NA uptake had returned to control level between 60 and 120 h after vinblastine. The effect of vinblastine pretreatment on the sensitivity of atria to NA and (-)isoprenaline(ISOP), and of vasa deferentia to NA, (-)phenylephrine (PHE), and methoxamine (ME) was evaluated. It was found that atria became highly sensitive to the (+) chronotropic effect of NA without significant change in sensitivity to ISOP. The sensitivity of vas deferens to NA and PHE was moderately increased without significantly affecting the sensitivity to ME. The magnitude of the supersensitivity was expressed in terms of the ratio of the geometric mean ED50 of an agonist in control tissue to that obtained in the same tissue from treated animals. The sensitivity of atria to NA increased 1.5, 3.9, 7.8, and 6.7 fold, 15, 30, 60 and 120 h after vinblastine, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)