[Reasons and determining factors for referrals between primary and specialised care]. / Motivos y condicionantes de la interconsulta entre atención primaria y especializada.

OBJECTIVES: To determine the reasons and characteristics of referrals from Primary to Specialised Care in the Health Area of Toledo (Spain). MATERIAL AND METHODS: A descriptive, cross-sectional study was conducted by reviewing a sample of the referrals to specialists made by 26 general practitioners from eight Teaching Health Centres during February 2011. All of them completed a questionnaire which recorded patient data, and reason and characteristics of the referral. RESULTS: A total of 332 referrals were recorded; the mean age of the patients was 51.3 years (SD; 17.9); 60.1% females; 30.7% pensioners; 54.8% had a chronic disease; 85.8% were from an urban environment. The most consulted specialists were: Traumatology (63), Gynaecology (53), and Ophthalmology (41). More than three-quarters (78.9%) were by the normal route, and 47.4% were first consultations. Around 12.7% were scheduled reviews, with a majority (51.4%) by a hospital specialist. More than two thirds (69.8%, 95% CI; 64.5-74.7%) required follow-up or treatment by the specialist. More than half (57.7%, 95% CI; 52.3-63.1%) required special diagnostic tests, and in 29.8% (95% CI; 25.0-35.1%) there was no clear diagnosis. There was a history of a repeated consultation for the same symptomatology in 28.9% of the referrals. Around 38.4% (95% CI; 33.0-43.7%) were requested specifically by the family or patient. Around 5.4% had a poor relationship with the patient. CONCLUSIONS: The majority of referrals are made by the normal route, and to surgical specialities. The need for hospital specialist follow-up and/or treatment, or the impossibility to request specific tests from Primary Care were the main reasons for requesting care from a second health care level. There were a high percentage of referrals requested by the family/patient.

[Congenital anomalies of the first branchial cleft. Retrospective study]. / Anomalías congénitas de primera hendidura branquial: estudio retrospectivo.

Anomalies of the first branchial cleft are occasional problems putting up diagnostic and therapeutic difficulties, because the imperfect settlement of reminders of this cleft, which can appear as cysts or branchial fistula, among patients of any age. Though there are several recommended classifications in order to achieve a precious diagnosis and a total surgical removal, sometimes is laborious to correlate the clinical and the histological findings. We report a sequence of congenital periauricular anomalies operated in our Department during a ten-years-term and compare our findings of those quoted after the literature series.

Ameloblastic odontosarcoma: report of a case.

Ameloblastic odontosarcoma is an extremely rare malignant odontogenic tumor. To date only 8 cases have been reported in the literature. The case of a 12-year-old Hispanic-American boy with ameloblastic odontosarcoma of the mandible is presented. The patient had a tumor diagnosed previously as benign ameloblastic fibroma that underwent transformation to ameloblastic odontosarcoma. The patient has been followed for 19 years since the surgical removal of the tumor. Radiographic and clinical examination confirm that there is no evidence of recurrence. Periodic examination for the reappearance of the tumor will be continued.

[Systemic neonatal infection by Streptococcus pneumoniae. A case report]. / Infección sistémica neonatal por Streptococcus pneumoniae. Informe de un caso.

The neonatal sepsis by Streptococcus pneumoniae is a clinical manifestation well know, but very often reported. It's role as an etiologic agent is limited to sporadic references in the medical literature, since 1972 only about fifty cases of septicaemia and/or meningitis have been reported. In the Instituto Nacional de Perinatología, from a whole of 560 confirmed cases of septicaemia in the newborn within the last 6 years, only one has been documented as systemic infections by S. pneumoniae. This was a 32.2 gestational aged male patient, with antecedent of maternal chorioamnionitis. This patient presented early-onset sepsis and died during the first 12 hours of life. Presence of S. pneumoniae was found in the blood culture. The type of clinical presentation and its correlation to the perinatal infection is discussed.

[Trichinosis in children. A report of 8 cases]. / Triquinosis en el niño. Informe de 8 casos.

A comparative study between 8 cases of trichinosis and 16 of typhoid fever is presented in this paper; all of them were attended in the INP during the period from 1970 to 1990. The diagnosis was established under epidemiologic, clinic and laboratory bases. The range of age of these patients was from 10 to 14 years, from low socioeconomic status; half of the cases had history of in take of infested pork meat. The most characteristic symptoms were: fever, myalgia and limitation of muscular movements. Leukocytosis in addition to eosinophilia were found in 7 cases. Correlation with indirect hemagglutination, CIEF positive test for Trichinella spiralis and biopsy of muscle was done. Thiabendozole therapy was utilized for treatment with satisfactory evolution, except in one case that developed progressive and fatal neurologic damage.

[Local anesthesia with vasoconstrictors. Clinical and electrocardiographic study]. / Anestesia local con vasoconstrictores. Estudio clinico y electrocardiografico.

Adding vaso constrictors to the local anaesthetics used in dentistry has meant an important advance due to the advantage it offers. Many discussions have arisen among medical science professionals as to its possible contra indications. The authors reported on the result of 158 cases of teeth extractions in which simultaneous registers revealed different variants produced in the cardio vascular system. The conclusion they came to is that the local anaesthetics with levo arterenol used in odontology in usual doses is not of risk even in patients who suffer from cardio vascular affections.

Anestesia local con vasoconstrictores. Estudio clinico y electrocardiografico / [Local anesthesia with vasoconstrictors. Clinical and electrocardiographic study]

Adding vaso constrictors to the local anaesthetics used in dentistry has meant an important advance due to the advantage it offers. Many discussions have arisen among medical science professionals as to its possible contra indications. The authors reported on the result of 158 cases of teeth extractions in which simultaneous registers revealed different variants produced in the cardio vascular system. The conclusion they came to is that the local anaesthetics with levo arterenol used in odontology in usual doses is not of risk even in patients who suffer from cardio vascular affections.

Autogenic tooth transplantation: a report of ten cases.

Modifications in the surgical procedure for transplantation of the unerupted mandibular third molar to the first molar socket are presented, and the clinical and radiographic data on ten cases with a 3-year follow-up are described. The proposed method of treatment makes it possible to stabilize the transplant without a splint by using a suture crossed over the occlusal surface of the tooth.

[Vital tooth autotransplantation]. / Autotrasplantes dentario vitales.

Ten cases of dental transplants belonging to the authors' set of cases were selected and they proved to be successful according to the factors these authors' believe to be important. The operations were carried out on young patients by transplanting the not fully formed third molar to the place of the first molar, following the technique described in the text. The success of a vital dental autotransplant depends on some factors: the tooth to be transplanted should have completed the amelogenesis so that two thirds of its root and the floor of the pulp chamber are also formed; the receiving alveolus must be prepared before the giving area, thus reducing the time in which the third molar remains dislocated out of its alveolus and the lack of communication between the two surgical beds.