Psychological impact after treatment in patients with head and neck cancer.

BACKGROUND: Cancer is the second cause of death all over the world and it causes considerable morbidity, disability, and treatment sequela, which often lead to post-treatment pain and disfigurement. This study aims to evaluate such physical sequelae, and their psychological, (cognitive and emotional), impact, in a cohort of patients treated for Head and Neck (HNC) cancer, in search for methods to help such patients deal effectively with the psychological effects of their cancer treatments adverse consequences. MATERIAL AND METHODS: The sample consists of 56 subjects, 47 men and 9 women, ranging from 47 years to 86 years of age, who were treated for head and neck cancers at Spanish Public General Hospital in the Otolaryngology Unit, Surgery Section. Two types of questionnaires were used in the study: the Questionnaire of Sequelae after Treatment of head and neck carcinoma and the State-Trait Anxiety Inventory (STAI-E and R). RESULTS: With respect to anxiety, the study found high levels of state anxiety which was significantly associated with the degree of perception of social stigma but was not associated with the post-treatment sequelae themselves nor with the level of discomfort that such symptomatic sequelae produced. The presence of a post-surgical stoma with cannula, increased patient's stigma (both components: external rejection and self-rejection) and state anxiety ratings, while there was no difference in state anxiety between cannulated and non-cannulated patients. There are few differences between men and women in terms of the presence of anxiety and their responses are similar in terms of the after-effects of surgery. CONCLUSIONS: Our study confirmed that current treatments for Head and Neck carcinoma generate adverse symptomatic sequela that impose significant psychological and physical burden for these patients. We will discuss the various pathways for preventive intervention that these findings open up.

Conservation Status of Killer Whales, Orcinus orca, in the Strait of Gibraltar.

Killer whales (Orcinus orca) in the Mediterranean Sea are currently restricted to the Strait of Gibraltar and surrounding waters. Thirty-nine individuals were present in 2011, with a well-differentiated social structure, organized into five pods. Killer whale occurrence in the Strait is apparently related to the migration of their main prey, Atlantic bluefin tuna (Thunnus thynnus). In spring, whale distribution was restricted to shallow waters off the western coast of the Strait where all pods were observed actively hunting tuna. In summer, the whales were observed in the shallow central waters of the Strait. A relatively new feeding strategy has been observed among two of the five pods. These two pods interact with an artisanal drop-line fishery. Pods depredating the fishery had access to larger tuna in comparison with pods that were actively hunting. The Strait of Gibraltar killer whales are socially and ecologically different from individuals in the Canary Islands. Molecular genetic research has indicated that there is little or no female-mediated gene migration between these areas. Conservation threats include small population size, prey depletion, vessel traffic, and contaminants. We propose the declaration of the Strait of Gibraltar killer whales as an endangered subpopulation. A conservation plan to protect the Strait of Gibraltar killer whales is urgently needed, and we recommend implementation of a seasonal management area where activities producing underwater noise are restricted, and the promotion of bluefin tuna conservation.

Prevalence, diversity, and interaction patterns of avian haemosporidians in a four-year study of blackcaps in a migratory divide.

Migratory birds contribute to the movement of avian parasites between distant locations, thereby influencing parasite distribution and ecology. Here we analyse the prevalence, diversity and interaction patterns of Haemosporida parasites infecting Blackcap (Sylvia atricapilla) populations in a recently established migratory divide of southwestern Germany across 4 years. We hypothesize that the temporal and spatial isolation provided by 2 sympatric Blackcap breeding populations (migratory divide) might modify ecological interactions and thus create differences in the structure of the parasite community according to migratory route. We used a fragment of the mitochondrial DNA cytochrome b gene to determine haemosporidian haplotypes. We detected an overall infection prevalence of 70.3% (348 out of 495 blackcaps sampled from 2006 to 2009), and prevalence rates were significantly different among years and seasons. We observed a total of 27 parasite haplotypes infecting blackcaps, from them 6 new rare Haemoproteus haplotypes were found in 2 mixed infections. H. parabelopolskyi haplotypes SYAT01 (35.7%) and SYAT02 (20.8%) comprised most of the infections. An association analysis suggests that SYAT01 and SYAT02 are interacting negatively, implying that they are either competing directly for host resources, or indirectly by eliciting a cross-immune response. Molecular data show no clear difference between the parasite communities infecting blackcaps with different migratory routes, despite some temporal and spatial isolation between the two sympatric blackcap populations.

[Patient satisfaction with spinal cord stimulation for failed back surgery syndrome]. / Satisfacción del paciente con síndrome de dolor de raquis postquirúrgico portador de un sistema de neuroestimulación medular.

INTRODUCTION: The incidence of failed back surgery syndrome is about 40%. We studied the efficacy of and patient satisfaction with use of a spinal cord stimulator to treat this syndrome. MATERIAL AND METHODS: A period of 72 months of experience with implanted spinal cord stimulators was analyzed in this observational, descriptive study of patients who were included retrospectively. Patients met criteria for failed back surgery syndrome according to the taxonomy of the International Association for the Study of Pain. A chi2 test was used to compare qualitative variables. Results for quantitative variables were compared by analysis of variance. Statistical significance was set at P < 0.05. RESULTS: Thirty-four patients were studied. Both lumbar back and radicular pain assessed on a visual analog scale (VAS) decreased significantly from the mean overall score of 6. As time passed, fewer patients felt the system met their expectations. More patients said the system met their expectations in the first months after implantation (73.5%) than at a later interview (55.9%). Seventeen complications were reported, the most common being mechanical difficulties with the implanted stimulator. None of the complications were serious. Use of additional medication to control pain decreased in 38.2% of the cases. A total of 73.5% of the patients considered the implanted stimulator to be beneficial and 67.6% would have a spinal cord stimulator implanted again. CONCLUSIONS: Spinal cord stimulation improves lumbar back pain in patients with failed back surgery syndrome and reduces the amount of additional medication taken to control pain. It is important for patients to adjust their expectations about the implanted stimulator.

Premature ovarian failure and hypothyroidism associated with sicca syndrome.

Two cases of premature ovarian failure, hypothyroidism, and sicca syndrome are described. To our knowledge, this association of sicca syndrome and multiglandular deficiency has not been previously reported. The finding of specific organ antibodies, as well as antibodies to nonorgan antigens in the 2 cases studied, supports the hypothesis that these rare clinical conditions may share a common autoimmune pathogenesis.

[Bibliometric analysis of the Spanish Journal of Chemotherapy (1996-2000)]. / Análisis bibliométrico de la Revista Española de Quimioterapia (1996-2000).

A bibliometric study of the output of Spanish scientific research into antimicrobial and antiparasitic chemotherapy was carried out, based on articles published in the Spanish Journal of Chemotherapy from 1996 to 2000. The 20 issues of the journal corresponding to the 5-year period studied were analyzed using the main indicators for bibliometry: article typology; output; Bradford's Law and Lotka's estimation; collaboration index; institutional origin; geographic location; subject; and advertising. The majority of the articles were original, and a small group of high-output authors and an appropriate level of contribution were identified. The greatest percentage of scientific output was from the autonomous regions of Madrid and Valencia. The majority of studies included in the analysis were hospital-based and the most researched topic was antimicrobial drugs. A reduction in the amount of advertising was noted.

[Serum levels of lithium in patients with endemic goiter]. / Niveles séricos de litio en pacientes con bocio endémico.

In this study, the lithium concentration in the blood sera of 85 patients with endemic goiter was evaluated. The results were compared with those obtained in 114 normal subjects. The lithium concentration in the blood sera of the patients with endemic goiter was 74.00 +/- 2.88 micrograms/dl compared with 39.00 +/- 0.19 micrograms/dl detected in normal subjects. Based on these findings, a possible explanation to the values obtained is given.

[Epidural anesthesia and analgesia in the perioperative treatment of a patient with Kartagener syndrome]. / Anestesia y analgesia epidurales en el tratamiento perioperatorio de una paciente con síndrome de Kartagener.

Kartagener's syndrome is an inherited disease characterized by a triad of symptoms--bronchiectasis, situs inversus and sinusitis--and is classified as an immotile cilia syndrome. Patients may experience specific airway problems when undergoing anesthesia for surgical procedures. We report the case of a woman with Kartagener's syndrome who underwent surgery under epidural anesthesia with postoperative epidural analgesia, both techniques proving successful.

[Ketamine for subarachnoid anesthesia during hypovolemia: preliminary study in pigs]. / Utilización de ketamina para anestesia subaracnoidea durante hipovolemia. Estudio experimental preliminar en cerdos.

OBJECTIVES: To assess whether subarachnoid ketamine has fewer hemodynamic effects than lidocaine in normal and hypovolemic pigs and to determine whether or not the effects of ketamine are dose-dependent. METHODS: Thirty pigs were randomly allocated to receive subarachnoid administration of lidocaine 2 mg x kg(-1), ketamine 1 mg x kg(-1) or ketamine 2 mg x kg(-1), in a situation of either normal or reduced blood volume. The pigs were assigned to six groups: group L2 (2% lidocaine 2 mg x kg(-1), normovolemia), group L2H (2% lidocaine 2 mg x kg(-1), hypovolemia), group K1 (ketamine 1 mg x kg(-1), normovolemia), group K1H (ketamine 1 mg x kg(-1), hypovolemia), group K2 (ketamine 2 mg.kg(-', normovolemia), and group K2H (ketamine 2 mg x kg(-1), hypovolemia). To induce hypovolemia 30% of the calculated blood volume was withdrawn from each pig. The subarachnoid space was catheterized, and invasive measurements of hemodynamic variables (derived from arterial, central venous and pulmonary artery catheter monitoring) were obtained. Variables were recorded at baseline and 5 and 15 min after drug injection in the normovolemic groups, and at baseline after inducing hypovolemia and 5 and 15 min after drug injection in the hypovolemic groups. RESULTS: In the normovolemic pigs no significant differences were detected between groups. In hypovolemic pigs differences were observed in heart rate and arterial pressure between the ketamine 1 mg x kg(-1) and lidocaine 2 mg x kg(-1) groups (P < 0.05). The decreases in heart rate and arterial pressure were less marked in the ketamine group. Mixed venous oxygen saturation and cardiac index deteriorated to a lesser degree in both ketamine groups than in the lidocaine groups (P < 0.05). CONCLUSIONS: Racemic ketamine administered by subarachnoid injection in hypovolemic pigs produces less deterioration in hemodynamic variables than does lidocaine. Hemodynamic changes caused by ketamine were not dose-dependent. These findings may be of interest, given the increased use of ketamine in neuroaxial anesthesia and analgesia and perhaps the possible use of neuroaxial ketamine in hypovolemic patients.

Relationship of limited joint mobility and foot deformities with neurological examination in patients with diabetes.

AIMS: The aim is to define the association of forefoot deformity and limited joint mobility in the ankle and hallux joints in patients with diabetes mellitus subject to different diagnostic tests for diabetic neuropathy. Prospective study with 118 type 2 diabetic patients (68 men, mean age of 65.6±9.9 years) enrolled consecutively from the Diabetic Foot Unit of the Complutense University of Madrid subject to evaluation of plantar surface sensitivity by 10-g Semmes-Weinstein Monofilament, vibratory threshold by biothesiometer, and sudomotor dysfunction by Neuropad®. The patients presented with limited joint mobility of the ankle and the first metatarsophalangeal joints, and forefoot deformities were registered. Statistical analysis was done through a univariate model to test the association between neurological and biomechanical alteration. There was an association of abnormal Monofilament (p=0.01; OR=3.9) and biothesiometer tests (p=0.01; OR=2.6) with the presence of forefoot deformity. Furthermore, a relation was found between abnormal Monofilament (p=0.02; OR=4.8) and biothesiometer (p<0.00; OR=12.8) tests with limited mobility of the first metatarsophalangeal joint both in loading and off-loading. Abnormal sudomotor function test was related with limited joint mobility of the ankle joint with the knee flexed (p=0.04; OR=2.8). CONCLUSIONS: The results of this study show discordance between biomechanical abnormalities and neuropathy depending on the diagnostic test used. Tests that assess large myelinated nerve fibers are associated with the presence of deformities. Abnormal sudomotor function test is associated with limited joint mobility and this test has a greater capacity for selecting patients at risk.

Cambios morfológicos en la ontogenia temprana de Chirostoma riojai / Morphological changes in the early ontogeny of Chirostoma riojai

El charal de Toluca Chirostoma riojai es un pez de alto valor cultural e ictiológico. Los trabajos sobre esta especie se enfocan en el tipo de alimentación o forman parte de revisiones taxonómicas y son pocos los estudios sobre los cambios morfológicos durante su ontogenia. Se evaluó la figura de C. riojai mediante morfometría geométrica desde su eclosión hasta los 90 días de vida. Los ejemplares se cultivaron en condiciones controladas y fueron fijados 171 organismos pertenecientes a 11 intervalos de edad incluidos en cinco fases: embrión libre, apterolarva, pterolarva, juvenil y adulto. Se usaron seis puntos anatómicamente homólogos en una primera configuración de marcas y en una segunda se delinearon dos contornos (dorsal y ventralmente) de la región anterior. Un análisis de componentes principales mostró una fuerte diferenciación en su figura durante la transición larva-juvenil, en tanto un análisis de variables canónicas señaló diferencias significativas (ps<0.001) entre los 11 grupos de edad. La regresión lineal entre el logaritmo del tamaño centroide y las distancias procustes muestran que los organismos mantienen un cambio de figura constante hasta el término del periodo larvario, punto en el que el periodo juvenil comienza y las modificaciones en su figura disminuyen. La descripción del desarrollo temprano de C. riojai sin considerar el desarrollo de las aletas, muestra que la característica con el mayor cambio es el desplazamiento del poro anal, seguido por el alargamiento de la región cefálica. El tamaño y la figura de C. riojai durante su vida temprana pueden servir para diferenciar faces de desarrollo y ser utilizada en otras especies hermanas para evaluar si su figura es específica en cada fase. Los cambios morfológicos de C. riojai durante su vida temprana se pueden describir de forma gradual hasta el periodo larval y saltatoria en el cambio a juvenil.

Toluca silverside Chirostoma riojai is a fish with high cultural and ictiological values. Studies on this species have focused on the type of diet or as part of taxonomic reviews, while few reports are known on the morphological changes during its ontogeny. In this study the shape of C. riojai was evaluated by means of geometric morphometrics from hatchings up to 90 days-old individuals. Specimens of C. riojai were cultivated in controlled conditions, and 171 organisms there fixed, belonging to 11 age intervals included within five phases: free embryo, apterolarva, pterolarva, juvenile, and adult. There were used six landmarks in an initial configuration, and in a second configuration there were outlined two contours (dorsal and ventral) on the anterior region. A principal component analysis showed a strong differentiation in the shape during the transition larva-juvenile, for both an analysis of canonical variables found significant differences (ps<0.001) between the 11 age groups. The linear regression between the logarithm of the size centroid and procustes distances, showed that the individuals maintain a constant change in shape up to the end of the larval phase, at which time the youth stage begins and the changes in its shape decreases. The description of the early development of C. riojai without considering the development of the fins, shows that feature with greatest change is the movement of the anal pore, followed by the lengthening of the cephalic region. The size and shape of C. riojai during its early life could serve to differentiate developmental phases and could be used with other sister species to assess whether their shape is specific in each phase. The morphological changes of C. riojai during his early life could be described in a gradual form up to the the larval period, while saltatory in the change to juvenile.