Epidural analgesia in pregnant with deficit of factor VII.

The congenital deficit of FVII of coagulation it's an anomaly of genetic transmission autosomal recessive type, it can occur with clinical manifestations like hematomas and spontaneous bleeding or not. The normal levels of FVII it's found between 70%-130% of the laboratory reference value. For unknown reasons there is a poor correlation between levels of FVII and bleeding risk. During pregnancy coagulation can be significantly altered, there is a no clear consensus and a very few information about how to act during labor in a patient with a FVII deficit. The case of a 35-year-old patient with 35 weeks of gestation and congenital deficit of the coagulation FVII (36%) is presented, epidural analgesia is performed during labor previously administering activated recombinant FVII (rFVIIa) without complications (Spinal hematoma, postpartum bleeding, thrombosis).

Epidural analgesia in pregnant with deficit of factor VII. / Analgesia epidural en gestante con déficit del factor VII.

The congenital deficit of FVII of coagulation it's an anomaly of genetic transmission autosomal recessive type, it can occur with clinical manifestations like hematomas and spontaneous bleeding or not. The normal levels of FVII it's found between 70%-130% of the laboratory reference value. For unknown reasons there is a poor correlation between levels of FVII and bleeding risk. During pregnancy coagulation can be significantly altered, there is a no clear consensus and a very few information about how to act during labor in a patient with a FVII deficit. The case of a 35-year-old patient with 35 weeks of gestation and congenital deficit of the coagulation FVII (36%) is presented, epidural analgesia is performed during labor previously administering activated recombinant FVII (rFVIIa) without complications (Spinal hematoma, postpartum bleeding, thrombosis).

[Microbiological diagnosis of tuberculosis. 20 years in the province of Soria. Performance and basic opportunities of improvement]. / Diagnóstico microbiológico de la tuberculosis. 20 años en la provincia de Soria. Rendimiento y oportunidades básicas de mejora.

OBJECTIVE: The aim of the study was to describe the bacteriological diagnosis of the tuberculosis in the province of Soria (Spain), as well as to analyse the techniques diagnostic performance and the use of the microbiology laboratory regarding tuberculosis. METHODS: An observational, descriptive and retrospective study was designed, including all patients with tuberculosis of any location that had their residence in the province of Soria. The period of study included patients diagnosed between 1994 and 2013 and a 24 months follow-up after the beginning of treatment was realized. RESULTS: A total of 337 patients were detected during the studied period. No sample was sent to the microbiology laboratory in more than 3% of the patients (23% in skeletal tuberculosis and 33% in lymphatic tuberculosis). Bacteriological confirmation was obtained in 80% and 32% were smear-positive. Specimens were culture on solid and in liquid media; 10% of the strains were only isolated in one type of media. There were 2.9% isoniazid-resistant strains, 0.3% multi-drug resistant strains, and 0.3% rifampicin-resistant strains. A total of 36% of smear-positive pulmonary tuberculosis patients had no specimens sent for a follow-up study. CONCLUSIONS: It is essential to combine the use of a liquid and a solid medium. Physicians should be encouraged to submit specimens for mycobacteriological diagnostic and follow-up.

[Post-myocardial infarction depression]. / La depresión tras el infarto agudo de miocardio.

Major depression is a common finding among patients recovering from a myocardial infarction. Additionally, clinically significant depressive symptoms are present in other patients whose symptom severity or duration does not meet established criteria for a diagnosis of major depression. Over the last decade, increasing evidence suggests that in addition to its effect on patient s quality of life, post-MI depression also deserves attention because of a reported relation to increased morbidity and mortality. This evidence report reviews the studies that have studied depression or depressive symptoms in patients after an MI and focuses on the prevalence, clinical significance, treatment, and methods of evaluating this condition. A large number of studies have evaluated various aspects of post-MI depression including prevalence, its association with mortality, and major adverse events, and treatment.

[Small cell neuroendocrine tumour of the bladder: with reference to a case and bibliographical revision]. / Tumor neuroendocrino vesical de célula pequeña: a propósito de un caso y revisión bibliográfica.

INTRODUCTION AND OBJECTIVES: The small cell neuroendocrine tumour is an infrecuent neoplasia, with inmunohistochemistry being the key to diagnosis. We present a new case making reference to treatment and its evolution there after. MATERIAL AND METHODS: The clinic, diagnosis and treatment of this tumour is described. Bibliographical revision follours. CONCLUSIONS: The neuroendocrine tumour of small cell is an infrecuent neoplasia, in which the inmunohistochemistry study is key in the diagnosis. The differential diagnosis includes the high degree diferentiation transitionals cells carcinoma and primary and secondary linfoma. The standard treatment is based on chemotherapy plus surgery.

[Biatrial recurrence of a left atrial myxoma]. / Recidiva biauricular de un mixoma auricular izquierdo.

A biatrial myxoma was diagnosed by 2D echocardiography in a man who was minimally symptomatic. Five years previously another similar tumour, located in the left atrium, attached to the interatrial septum, was excised. Similar histological features were present in both cases. The rarity of biatrial recurrence of this sort of myxoma is emphasized.

[Incidence of digestive system neoplasms. Trends. Soria 1981-1990]. / Incidencia neoplásica de aparato digestivo. Tendencias. Soria 1981-1990.

The aim of this study was to evaluate, to compare and to identify the various incidence rate trends in digestive tract malignant tumours in the province of Soria. Tumor sites and histological types, patient's age, sex and town and area residence were studied. All new cases of digestive tract malignant tumours were collected during the 1981-1990 period. 30.4% of all malignant tumours in men (1906 patients) and 29% in women (1,256 patients) came from digestive tract sites. Incidence rates for each site were calculated for the two 1981-1985 and 1986-1990 subperiods. The histology, rates and trends of the tumours were compared with the other national and international cancer registries. Gastric cancer showed the highest adjusted rate for men (35.1 x 10(5) and colo-rectal cancer one for women (14.7 x 10(5). The lowest rates were for men in the gallbladder (0.5) and liver (1.1) sites; and for women in the gallbladder (1.6), whose diminishing trend was significant (2.92/0.75) (p < 0.05) and liver (0.5). Colorectal cancer showed a marked increase between the two subperiods for both sexes (men: 13.1/27.6) (women: 9.8/19.2). Pancreas cancer trends ascended for both sexes (men: 1.22/2.74) (women: 0.13/1.46). Gastric cancer rates in Soria are higher than the rest of the cancer registries in Spain while gallbladder, liver, and colorectal, cancer rates are one of the lowest for both sexes. Trends are significantly increasing in colorectal sites for both sexes (p < 0.01), and for women only in the pancreas (p < 0.05). The other cancer rate sites showed lesser variations and are not statistically significant.

[Severe metabolic alkalosis during hemodialysis]. / Alcalosis metabólica severa durante la hemodiálisis.

Severe metabolic alkalosis in a patient while being hemodialysed with dialysate of bicarbonate is presented. The evolution was satisfactory after a session of hemodialysis with a bath of acetate. Disorders in the acid-base balance which appear following dialytic technics more complex each time are discussed.

[Relationship between acute phase reactant proteins (APRP) and fatigue during post-operative convalescence]. / Relación entre proteínas séricas reactantes de fase aguda (PRFA) y la fatiga durante la convalecencia postquirúrgica.

Surgery originates an inflammatory state which triggers an acute phase response (APR). In this study, variations in the acute phase reactant proteins (APRP) and their relationship with fatigue were assessed. A total of 58 candidate patients for elective abdominal surgery participated in this study. In the preoperative period (PRE) and in the post-operative period (9 days [9-P], 27 days [27-P] and 45 days [45-P]), variations in serum APRP and fatigue were analyzed. In the post-operative period (9-P), a significant decrease in PT, ALB, PAB, TRF, and an increase in CER were observed. In 27-P, significant decreases were observed in PAB and PBR, with increased PT and CER, and without significant variations in ALB ad TRF. In the 45-P day, a concomitant increase in PT and CER was observed. Dynamometric parameters also decreased significantly in the post-operative period (9-P). In conclusion, our results demonstrate the existence of changes in serum proteins and in APRP after an elective abdominal surgical intervention, which are associated with fatigue, evaluated both by subjective and objective (dynamometry) means and the use of a mathematical model that considers weight, proteins and APRP.

Descriptive epidemiology of basal cell carcinoma and cutaneous squamous cell carcinoma in Soria (north-eastern Spain) 1998-2000: a hospital-based survey.

INTRODUCTION: Better knowledge of the epidemiology of basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) will allow the development of more effective diagnostic and preventive measures. MATERIAL AND METHODS: We have reviewed the clinical records of patients from the 'Hospital General de Soria' who were diagnosed with BCC and/or SCC (lower lip included) by histopathology between 1 January 1998 and 31 December 2000. Recurrences and diagnostic duplicities (tumours first biopsied and then excised) were excluded. RESULTS: The mean age was 71.4 years for BCC subjects and significantly older, 77.3 years, for SCC subjects. Photoexposed skin areas accounted for 92.6% and 93.8% of BCC and SCC tumours, respectively. The crude incidence rate for the population of 100 000 was 148.27 for BCC and 58.24 for SCC. The age-adjusted incidence rate (adjusted for world standard population) was 57.97 and 17.87 years, respectively. Subjects with superficial BCC were significantly younger than the rest of the BCC patients and their tumours were located on non-photoexposed skin. The ears and dorsum of the hands were the almost exclusive locations of SCC. CONCLUSIONS: Our results should be compared with those to be obtained in future years to determine trends in the descriptive epidemiology of BCC and SCC.