[Gender differences in the hospitalization and reperfusion delays in the acute coronary syndrome]. / Diferencias de género en los retrasos de ingreso y reperfusión en el síndrome coronario agudo.

OBJECTIVE: To study delay times in women with acute coronary syndrome (ACS) and ST segment elevation (STSEACS) until administration of possible reperfusion therapy as well as its possible differences in relationship to the men. MATERIAL AND METHODS: A study was conducted in 1,849 patients consecutively hospitalized in a Coronary Unit from January 2000 to December 2005 who had been diagnosed of ACS. Different delay times were studied from the beginning of the symptoms, comparing them between genders and correcting this by variable age. RESULTS: The percentage of women was 24.4% with a mean age of 71.5 years. Medium delay time from the beginning of the symptoms to contact with the first health care agent was significantly (p < 0.001), longer for women than for men, 164 min. vs 120 min. Reperfusion treatments were used in 57.6% of the subjects, with a significant difference (p < 0.01) of 7.6% between men (59.5%) and women (51.9%). CONCLUSIONS: Delay times are greater in women than men, above all regarding the beginning of the symptoms until arrival to the first health care agent. Currently, reperfusion treatments are performed more in men than in women, the differences are minimum when adjusted by age.

[Sentinel ganglion in breast cancer: selective biopsy compared with axillary lymphadectomy]. / Ganglio centinela en cáncer de mama: biopsia selectiva comparada con linfadenectomía axilar. Seguimiento a largo plazo.

BACKGROUND: Selective biopsy of the sentinel ganglion (SBSG) has replaced axillary lymphadectomy (AL) as the procedure of choice in staging breast cancer in its initial stages and in clinically negative axilla. The aim of this study is to compare global event-free survival of those patients subjected to SBSG followed by AL, during the period of validation of the technique, with respect to those subjected to SBSG and AL if the sentinel ganglion (SG) showed metastasis. METHODS: One hundred and forty-eight patients were included, 81 belonging to the period of validation and 67 to the clinical application group. Radiocoloid was administered intraperitumorally, obtaining images up until the visualisation of the SG; its identification and extirpation were carried out subsequently in the surgical intervention. RESULTS: The efficacy of the technique in the validation group was 92.5%, sensitivity was 95.6% and the rate of false negatives was 4%. Of the 81 patients, 75 are free of disease (92.6%). Of the 67 patients belonging to the clinical application group, 63 (94%) are free of disease. No patient has presented axillary ganglion recurrence. CONCLUSION: In the validation of the technique we obtained values that fall within the demands of generally accepted quality. With an average follow up of 6 years we did not observe axillary ganglion recurrence in any of the two groups. There is no statistically significant difference in global and event free survival between the two groups.

[Evaluation of the information on sexual activity provided to patients with acute coronary syndrome]. / Evaluación de la información sobre actividad sexual proporcionada a pacientes con síndrome coronario agudo.

INTRODUCTION: It is common for the nursing staff to report on aspects such as feeding, medication, physical activity, control of other diseases, toxic habits and driving in the acute phase of acute coronary syndrome (ACS). However, we overlook such a vital aspect of the human being such as sexuality. Thus, we propose the following objectives: 1. describe the information provided to the patients diagnosed of ACS on possible sexual alteration; 2. evaluate the demand for information by the patients on how their disease will affect their sexual activity; and 3. evaluate the patient's interest in receiving this information. METHODOLOGY: A descriptive study has been performed on 55 patients admitted to the Coronary Unit between November 2004 and April 2005, who were diagnosed of ACS after 72 hours by means of a self-administered questionnaire. RESULTS: A total of 89.1% were male with mean age of 55 years and 63.3% had not received information and thought that the stroke would not affect their sexual life, 55.6% being concerned. A total of 7.4% thought that they could reinitiate their sexual activity at 6 months while 9.3% thought that it could never happen. CONCLUSIONS: 1. Most of the patients had not received information on possible alterations in their sexual activity. 2. Most wanted to have information before the discharge and a minority did not consider that it was important to have information on the subject for different reasons. 3. The young subjects were the most interested in acquiring knowledge due to the importance they gave to their sexual activity.

[Hepatitis C virus infection in different risk groups and among blood donors]. / Estudio de la infección por virus de la hepatitis C en diferentes grupos de riesgo y en donantes de sangre.

We have studied serological markers of viral hepatitis type A, B, delta and C in 7,713 blood-donors, 265 patients with a clinical diagnosis of hepatitis, 41 inmates of a mental and physical retardation institution and 41 health care workers at the same institution and 35 chronic hemodialysis patients. The results showed a 0.8% anti-HCV prevalence in blood-donors, but a higher percentage (47.5%) among HBV positive patients and in two different groups of the inmates at the mental institution (12.5% and 36%). We can not establish a relationship with the presence of anti-HCV and serological markers for HBV or H-delta V, neither with any serological markers pattern of B hepatitis nor with the anti-HCV levels and pathological findings in the biopsy of the cases in which this procedure was performed. The detection of anti-HCV has two direct applications: to exclude positive blood-donors in order to reduce the risk of post-transfusion hepatitis and to better establish a precise diagnosis in patients otherwise classified of having nonA-nonB hepatitis.

Ganglio centinela en cáncer de mama: biopsia selectiva comparada con linfadenectomía axilar. Seguimiento a largo plazo / Sentinel ganglion in breast cancer: selective biopsy compared with axillary lymphadectomy

Fundamento. La biopsia selectiva del ganglio centinela(BSGC) ha reemplazado a la linfadenectomía axilar (LA),como procedimiento de elección, en el estadiaje del cáncerde mama en estadios iniciales y axila clínicamente negativa.El objetivo de este trabajo es comparar la supervivenciaglobal y libre de eventos de aquellas pacientes a lasque se realizó, en el periodo de validación de la técnica,BSGC seguida de LA respecto a las que se practicó BSGCy LA si el ganglio centinela (GC) presentaba metástasis.Material y métodos. Se han incluido 148 pacientes, 81pertenecientes al periodo de validación y 67 al grupo deaplicación clínica. El radiocoloide se administró intraperitumoralmente,obteniéndose imágenes hasta la visualizacióndel GC, posteriormente en la intervenciónquirúrgica se procedió a su identificación y extirpación.Resultados. En el grupo de validación, la eficacia de latécnica ha sido del 92,5%, la sensibilidad del 95,6% y latasa de falsos negativos del 4%. De las 81 pacientes, 75se encuentran libres de enfermedad (92,6%). De las 67pacientes pertenecientes al grupo de aplicación clínica,63 (94%) viven libres de enfermedad. Ninguna pacienteha presentado recurrencia ganglionar axilar.Conclusiones. En la validación de la técnica hemos obtenidounos valores que se hallan dentro de las exigenciasde calidad generalmente aceptadas. Con una mediade seguimiento de 6 años no hemos observado recurrenciaaxilar en ninguno de los dos grupos. No existediferencia estadísticamente significativa en la supervivenciaglobal y libre de eventos entre ambos grupos(AU)

Background. Selective biopsy of the sentinel ganglion(SBSG) has replaced axillary lymphadectomy (AL) asthe procedure of choice in staging breast cancer in itsinitial stages and in clinically negative axilla. The aimof this study is to compare global event-free survival ofthose patients subjected to SBSG followed by AL, duringthe period of validation of the technique, with respectto those subjected to SBSG and AL if the sentinelganglion (SG) showed metastasis.Methods. One hundred and forty-eight patients wereincluded, 81 belonging to the period of validation and67 to the clinical application group. Radiocoloid wasadministered intraperitumorally, obtaining images upuntil the visualisation of the SG; its identification andextirpation were carried out subsequently in the surgicalintervention.Results. The efficacy of the technique in the validationgroup was 92.5%, sensitivity was 95.6% and the rate offalse negatives was 4%. Of the 81 patients, 75 are freeof disease (92.6%). Of the 67 patients belonging to theclinical application group, 63 (94%) are free of disease.No patient has presented axillary ganglion recurrence.Conclusion. In the validation of the technique we obtainedvalues that fall within the demands of generallyaccepted quality. With an average follow up of 6 yearswe did not observe axillary ganglion recurrence in anyof the two groups. There is no statistically significantdifference in global and event free survival between thetwo groups(AU)

Diferencias de género en los retrasos de ingreso y reperfusión en el síndrome coronario agudo / Gender differences in the hospitalization and reperfusion delays in the acute coronary syndrome

Objetivo. Estudiar los tiempos de retraso hasta una eventual terapéutica de reperfusiónen las mujeres con síndrome coronario agudo (SCA) y elevación del segmento ST, así comolas posibles diferencias en relación con los varones.Material y métodos. Se ha llevado a cabo un estudio con 1.849 pacientes con diagnósticode SCA ingresados consecutivamente en una Unidad Coronaria, desde enero de 2000 a diciembrede 2005. Se estudian diversos tiempos de retraso desde el inicio de los síntomas,se comparan entre sexos y se corrigen por la variable edad.Resultados. Fueron mujeres el 24,4%, con una media de edad de 71,5 años. La medianaen el tiempo de retraso desde el inicio de los síntomas hasta el contacto con el primerescalón sanitario fue significativamente (p < 0,001) más prolongada en las mujeres queen los hombres, 164 minutos frente a 120 minutos. Los tratamientos de reperfusión seemplearon en el 57,6% de los sujetos, con una diferencia significativa (p < 0,01) del 7,6%entre hombres (59,5%) y mujeres (51,9%).Conclusiones. Los tiempos de retraso son mayores en las mujeres que en los hombres,sobre todo desde el inicio de los síntomas hasta la llegada al primer escalón sanitario.Los tratamientos de reperfusión se realizan más en hombres que en mujeres, aunque,ajustando por edad, las diferencias son mínimas(AU)

Objective. To study delay times in women with acute coronary syndrome (ACS) and STsegment elevation (STSEACS) until administration of possible reperfusion therapy as wellas its possible differences in relationship to the men.Material and methods. A study was conducted in 1,849 patients consecutively hospitalizedin a Coronary Unit from January 2000 to December 2005 who had been diagnosed of ACS.Different delay times were studied from the beginning of the symptoms, comparing thembetween genders and correcting this by variable age.Results. The percentage of women was 24.4% with a mean age of 71.5 years. Mediumdelay time from the beginning of the symptoms to contact with the first health careagent was significantly (p < 0.001), longer for women than for men, 164 min. vs 120 min.Reperfusion treatments were used in 57.6% of the subjects, with a significant difference(p < 0.01) of 7.6% between men (59.5%) and women (51.9%).Conclusions. Delay times are greater in women than men, above all regarding thebeginning of the symptoms until arrival to the first health care agent.Currently, reperfusion treatments are performed more in men than in women, thedifferences are minimum when adjusted by age(AU)

Evaluación de la información sobre actividad sexual proporcionada a pacientes con síndrome coronario agudo / Evaluation of the information on sexual activity provided to patients with acute coronarym syndrome

Introducción. Es habitual en la fase aguda delsíndrome coronario agudo (SCA) que enfermeríainforme sobre aspectos como la alimentación, lamedicación, la actividad física, el control de otrasenfermedades, los hábitos tóxicos y la conducción devehículos. Sin embargo, ignoramos un aspecto tanvital del ser humano como la sexualidad, por lo quenos propusimos los siguientes objetivos: 1. describirla información proporcionada a los pacientesdiagnosticados de SCA sobre posibles alteracionessexuales; 2. evaluar la demanda de información porparte de los pacientes sobre cómo afectará suenfermedad a su actividad sexual; y 3. evaluar elinterés en recibir esta información por parte de lospacientes.Metodología. Se ha llevado a cabo un estudiodescriptivo sobre 55 pacientes ingresados en unaUnidad Coronaria entre el mes de noviembre de 2004y el mes de abril de 2005, diagnosticados de SCA, apartir de las 72 horas mediante un cuestionarioautoadministrado.Resultados. El porcentaje correspondiente a varonesfue del 89,1%, con una edad media de 55 años. El63,6% no había recibido información y pensaba queel infarto no afectaría a su vida sexual, aunquepreocupaba a un 55,6%. El 7,4% pensaba que podríareanudar la actividad sexual a los 6 meses, mientrasque el 9,3% pensaba que no podría reanudarla nuncamás.Conclusiones. 1. Una mayoría de pacientes no habíarecibido información sobre posibles alteraciones enla actividad sexual. 2. Una mayoría quiere tenerinformación antes del alta y una minoría no consideraimportante tener información sobre el tema pordiferentes razones. 3. Fueron los jóvenes los másinteresados en adquirir conocimientos por laimportancia que daban a su actividad sexual

Introduction. It is common for the nursing staff toreport on aspects such as feeding, medication,physical activity, control of other diseases, toxichabits and driving in the acute phase of acutecoronary syndrome (ACS). However, we overlooksuch a vital aspect of the human being such assexuality. Thus, we propose the following objectives:1. describe the information provided to the patientsdiagnosed of ACS on possible sexual alteration; 2.evaluate the demand for information by thepatients on how their disease will affect their sexualactivity; and 3. evaluate the patient’s interest inreceiving this information.Methodology. A descriptive study has beenperformed on 55 patients admitted to the CoronaryUnit between November 2004 and April 2005, whowere diagnosed of ACS after 72 hours by means ofa self-administered questionnaire.Results. A total of 89.1% were male with mean ageof 55 years and 63.3% had not receivedinformation and thought that the stroke would notaffect their sexual life, 55.6% being concerned. Atotal of 7.4% thought that they could reinitiate theirsexual activity at 6 months while 9.3% thought thatit could never happen.Conclusions. 1. Most of the patients had notreceived information on possible alterations intheir sexual activity. 2. Most wanted to haveinformation before the discharge and a minoritydid not consider that it was important to haveinformation on the subject for different reasons. 3.The young subjects were the most interested inacquiring knowledge due to the importance theygave to their sexual activity

Paciente intervenido de aneurisma de aorta abdominal por técnica quirúrgica endovascular. Caso clínico / Abdominal aortic aneurysm treated by endovascular surgery. A case report

Un aneurisma es una dilatación anormal o abombamiento irreversible de una porción de una arteria. La aorta abdominal es el lugar donde con mayor frecuencia se desarrollan los aneurismas y su aparición suele ser debida a la degeneración de la pared arterial, relacionada con la arteriosclerosis y favorecida por factores de riesgo como el tabaquismo y la hipertensión arterial, entre otros. La evolución natural de un aneurisma de aorta abdominal no tratado es hacia la rotura. El tratamiento esquirúrgico, consistente en la introducción en la aorta de una prótesis cuyos componentes básicos son un stent y un introductor. El caso clínico que se presenta es el de un paciente diagnosticado de aneurisma de aorta abdominal en un examen de salud rutinario, que ingresa ambulatoriamente para la realización de este procedimiento quirúrgico. Para ello se elaboró un plan de cuidados, siguiendo el modelo conceptual de Virginia Henderson. El plan se dividió en 2 partes: una fase de ejecución o preoperatoria y otra de vigilancia o período postimplante. En él hemos usado la taxonomía NANDA, NOC y NIC, problemas interdependientes y complicaciones potenciales. El paciente fue dado de alta a su domicilio tras contactar con la enfermera de referencia en el centro de salud, ya que durante la fase hospitalaria quedaron pendientes de resolución algunos indicadores NOC propuestos (AU)

An aneurysm is an abnormal dilation or irreversible convex of a portion of an artery. The most common site of aneurysms is the abdominal aorta and their appearance is often due to degeneration of the arterial wall, associated with atherosclerosis and favored by risk factors such as smoking and hypertension, among others. Left untreated, aneurysm of the abdominal aorta usually leads to rupture. Treatment is surgical, consisting of the introduction of a prosthesis, composed basically of astent and an introducer, into the aorta. We report the case of a person diagnosed with abdominal aortic aneurysm in a routine examination who was admitted for ambulatory surgical treatment. We designed a nursing care plan, following Virginia Henderson’s conceptual model. The careplan was divided into 2 parts, a first preoperative phase and a second post implantation or monitoring phase. The care plan contained the principal nursing diagnoses, based on the taxonomies of the North American Nursing Diagnosis Association (NANDA), nursing interventions classification (NIC) and nursing outcomes classifications (NOC), and collaboration problems/potential complications. The patient was discharged to home after contact was made with his reference nurse inthe primary health center, since during the hospital phase, some NOC indicators remained unresolved (AU)