Structure and diversity of Erica ciliaris and Erica tetralix heathlands at different successional stages after cutting.

In NW Europe, it is known that cutting is a useful tool for managers with regard to decisions about the conservation and management of wet heathlands. Nevertheless it is rarely described quantitatively in the international literature. In Spain, knowledge about this is scarce or lacking. In this study, twenty communities were selected in Galicia (NW Spain) that would represent from one to four stages of vegetation development after cutting. Two 5 × 5 m plots were established for each stage to characterise the vegetation on the basis of its species composition, frequency values, vertical structure and linear cover features. The Diversity Shannon index was calculated and multivariate analyses were performed. As succession advanced, notable changes were produced in the cover of dominant species, Erica ciliaris and Ulex gallii in the first stages and Erica tetralix and Genista berberidea in mature ones. Also, the species richness decreased because of the reduced number of herbs species in the mature stages and, finally, the cover values are indicators of the degree of vegetation development, together with the other parameters of height, overlayering or diversity. Cutting is a useful tool for management of heathlands because the existence of vegetation units belonging to different succession stages increases the internal diversity of communities. On the other hand, the vertical and horizontal structure reflects the formidable resilience of the vegetation community to this practice. This study offers a global vision of the dynamics of wet heathlands after cutting, with very useful ecological information that can be used by the people responsible for their management.

El reumatólogo clínico / The clinical rheumatologist

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Vestibular migraine: objective diagnostic criteria.

Classification of migraine or vertigo based only on clinical symptoms is rather difficult, especially in the postacute stage. The use of diagnostic instrumentation greatly aids clinicians in offereing objective measures of patient physiology. In migraine and vertigo, the "gold standard" objective measure has not been fully defined thereby hindering a criteria for vestibular migraine. This study proposes the use of two seperate modalities; infrared videonystagraphy for vertigo and electric pain thresholds for migraine to quantify patient complaints. While these instruments offer to document patient pathophsyiology, simple clinical procedures are presented to provoke the dizzyness of vertigo and the allodynia of migraine in patients being evaluted allowing clinicians larger diagnostic and therapeutic options

El síndrome de Schnitzler / Schnitzler's syndrome

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Association of systemic lupus erythematosus and hypermobility.

OBJECTIVE: To investigate joint laxity in patients with systemic lupus erythematosus (SLE). SETTING: University Hospital. METHODS: 81 patients with SLE (1999 American College of Rheumatology criteria; 72 (89%) women and nine (11%) men, mean age 42.9 (SD 16.1) years), who regularly attended a specialist SLE clinic were examined. The control group comprised 280 patients attending a general practitioner (193 (69%) women and 87 (31%) men, mean age 44.7 (SD 11.2) years). Joint laxity was measured according to the criteria of Beighton et al (total score 4 or more). A regression analysis was performed. RESULTS: Thirty nine (48%) patients with SLE and 42 (15%) of the control group were hypermobile. A logistic regression model was developed. The odds ratio of the association between laxity and SLE after adjustment for age and sex was 2.31 in the group younger than 49 years, and 17.99 in the group aged 49 years or older. Neither the clinical and analytical profile nor the use of corticosteroids was related to joint laxity. CONCLUSION: Patients with SLE showed more hypermobility than controls. Hypermobility was more profound in older patients with SLE (> or =49 years). Joint laxity was not associated with any clinical or analytical pattern. Treatment with corticosteroids was not related to joint laxity.

Artritis tras ingesta de éxtasis / Arthritis after ecstasy consumption

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Carcinoma renal (1990-1996) (113 Pacientes) / Renal carcinoma (1990-1996) (113 patients)

Las historias clínicas de 113 pacientes de carcinoma renal (C.R.) estudiados en un período de 7 años son evaluadas retrospectivamente, analizando los síntomas de presentación, métodos para su diagnóstico de certeza y modalidades terapeúticas. Se informa sobre la morbimortalidad global y operatoria de la serie. Se discuten los resultados en comparación con los comunicados en la bibliografía nacional y extranjera, de lo cual se deducen algunas conclusiones referidas a la detección, diagnóstico de certeza y terapeútica quirúrgica del carcinoma renal

Carcinoma renal (1990-1996) (113 Pacientes) / Renal carcinoma (1990-1996) (113 patients)

Las historias clínicas de 113 pacientes de carcinoma renal (C.R.) estudiados en un período de 7 años son evaluadas retrospectivamente, analizando los síntomas de presentación, métodos para su diagnóstico de certeza y modalidades terapeúticas. Se informa sobre la morbimortalidad global y operatoria de la serie. Se discuten los resultados en comparación con los comunicados en la bibliografía nacional y extranjera, de lo cual se deducen algunas conclusiones referidas a la detección, diagnóstico de certeza y terapeútica quirúrgica del carcinoma renal(AU)

[Ventilation in prone decubitus in a patient with respiratory distress during heart surgery]. / Ventilación en decúbito prono en un paciente con distrés respiratorio tras cirugía cardíaca.

Acute respiratory failure and adult respiratory distress syndrome are serious complications after heart surgery and are associated with a high mortality rate. We report the case of a 50-year-old man who developed severe respiratory distress after heart surgery with extracorporeal circulation and for whom oxygenation was possible with ventilation in prone decubitus position only after other therapeutic measured had failed. The physiological bases of ventilation in prone decubitus position, as well as the indications and contraindications of the technique are discussed. Early treatment, which is fundamental for managing these patients, facilitates a favorable outcome as is illustrated by the case we report.

Association between joint hypermobility syndrome and panic disorder.

OBJECTIVE: The purpose of this study was to assess whether joint hypermobility syndrome is more frequent in patients with panic disorder, agoraphobia, or both than in control subjects and, if so, to determine whether mitral valve prolapse modifies or accounts in part for the association. METHOD: A case-control study was conducted in a general teaching hospital outpatient clinic. Subjects were 99 patients, newly diagnosed and untreated, with panic disorder, agoraphobia, or both and two groups of age- and sex-matched control subjects: 99 psychiatric patients and 64 medical patients who had never suffered from any anxiety disorder. Measures consisted of the Structured Clinical Interview for DSM-III-R, Beighton's criteria for joint hypermobility syndrome, and two-dimensional and M-mode echocardiogram. The presence of mitral valve prolapse and joint hypermobility syndrome was explored by raters who were blind to subjects' psychiatric status. RESULTS: Joint hypermobility syndrome was found in 67.7% of patients with anxiety disorder but in only 10.1% of psychiatric and 12.5% of medical control subjects. On the basis of statistical analysis, patients with anxiety disorder were over 16 times more likely than control subjects to have joint laxity. These findings were not altered after the presence of mitral valve prolapse was taken into account. Of the patients with anxiety disorder, those who had joint hypermobility syndrome were younger and more often women and had an earlier onset of the disorder than those without joint hypermobility syndrome. CONCLUSIONS: Joint laxity is highly prevalent in patients with panic disorder, agoraphobia, or both and may reflect a constitutional disposition to suffer from anxiety. Mitral valve prolapse plays a secondary role in the association between joint hypermobility and anxiety.