Childhood cerebral palsy and the use of positioning systems to control body posture: Current practices. / Parálisis cerebral infantil y el uso de sistemas de posicionamiento para el control postural: estado actual del arte.

INTRODUCTION: One of the consequences of poor postural control in children with cerebral palsy is hip dislocation. This is due to the lack of weight-bearing in the sitting and standing positions. Orthotic aids can be used to prevent onset and/or progression. OBJECTIVE: The aim of this study is to analyse the effectiveness of positioning systems in achieving postural control in patients with cerebral palsy, and discuss these findings with an emphasis on what may be of interest in the field of neurology. DISCUSSION: We selected a total of 18 articles on interventions in cerebral palsy addressing posture and maintenance of ideal postures to prevent deformities and related problems. The main therapeutic approaches employed combinations of botulinum toxin and orthoses, which reduced the incidence of hip dislocation although these results were not significant. On the other hand, using positioning systems in 3 different positions decreases use of botulinum toxin and surgery in children under 5 years old. The drawback is that these systems are very uncomfortable. CONCLUSION: Postural control systems helps control hip deformities in children with cerebral palsy. However, these systems must be used for prolonged periods of time before their effects can be observed.

Effects of an Ai Chi fall prevention programme for patients with Parkinson's disease.

INTRODUCTION: One of the main symptoms of Parkinson's disease is the high incidence of falls occurring due to the decline of both static and dynamic balance. The aim of this study is to determine the effect of an Ai Chi programme designed to prevent falls in patients with Parkinson's disease by improving both functional independence and perception of physical pain. METHODS: Fifteen patients diagnosed with Parkinson's disease (Hoehn and Yahr stages 1-3) participated in a 10-week Ai Chi programme consisting of 30 to 45-minute aquatic exercise sessions twice a week. The assessment measures used in this study were the pain visual analogue scale (VAS), the Tinetti gait and balance assessment tool, and the Timed Get up and Go test. RESULTS: The results were calculated by applying the Friedman test to 3 related measurements: patients at baseline, at post-treatment (at the end of the 10 week programme) and after one month of follow-up. The data obtained showed a significant improvement (p <.001) in scores for pain perception, balance, and gait function after the treatment programme. Furthermore, patients continued to show significant improvements and the benefits remained at the one-month follow-up visit. CONCLUSION: Ai Chi is a promising and feasible aquatic treatment for improving pain perception, balance, and functional capacity in patients diagnosed with mild or moderate Parkinson's disease.

Erratum:Quality of life in long-term premenopausal early-stage breast cancer survivors from Spain. Effects of surgery and time since surgery.

In this article published in Volume 21, issue 5, the authors' names were incorrectly stated in the Pubmed abstract as: "Ignacio Arraras J(1), Juan Illarramendi J, de la Cruz S, Asin G, Manterola A, Ibanez B, Salgado E, Cambra K, Zarandona U, Angel Dominguez M, Vera R.". The correct authors' names are: "Arraras JI(1), Illarramendi JJ, de la Cruz S, Asin G, Manterola A, Ibanez B, Salgado E, Cambra K, Zarandona U, Dominguez MA, Vera R.". This error appeared only in the PubMed database and not in the print form of the Journal.

The Impact of Hydroxyethyl Starch Use in Deceased Organ Donors on the Development of Delayed Graft Function in Kidney Transplant Recipients: A Propensity-Adjusted Analysis.

Our objective was to evaluate the impact of hydroxyethyl starch (HES) use in organ donors after neurologic determination of death (DNDD) on recipient renal graft outcomes. The following data elements were prospectively collected for every DNDD managed by a single organ procurement organization from June 2011 to July 2013: demographics; critical care endpoints; treatments, including the use of HES; graft cold ischemia time (CIT); and the occurrence of recipient delayed graft function (DGF, dialysis in the first week after transplantation). Logistic regression was performed to identify independent predictors of DGF with a p-value <0.05. The results were then adjusted for each donor's calculated propensity to receive HES. Nine hundred eighty-six kidneys were transplanted from 529 donors. Forty-two percent received HES (1217 ± 528 mL) and 35% developed DGF. Kidneys from DNDDs who received HES had a higher crude rate of DGF (41% vs. 31%, p < 0.001). After accounting for the propensity to receive HES, independent predictors of DGF were age (OR 1.02 [1.01-1.04] per year), CIT (OR 1.04[1.02-1.06] per hour), creatinine (OR 1.5 [1.32-1.72] per mg/dL) and HES use (OR 1.41 [1.02-1.95]). HES use during donor management was independently associated with a 41% increase in the risk of DGF in kidney transplant recipients.

Consensus of the Spanish society of laboratory medicine and the Spanish society of medical oncology on the methodology and criteria for evaluation of circulating tumour markers in breast cancer.

The measurement of circulating tumour markers (TMs) for the diagnosis or monitoring of breast cancer has sometimes been considered of limited utility. In addition to the overinterpretation of irrelevant changes in marker levels, the characteristics of the patient, the disease or other pathologies that can modify them are often not considered in their evaluation. On the other hand, there are recent data on the relationship of TMs with molecular subtypes and on their prognostic value, the knowledge of which may improve their clinical utility. This consensus article arises from a collaboration between the Spanish Society of Laboratory Medicine (SEQCML) and the Spanish Society of Medical Oncology (SEOM). It aims to improve the use and interpretation of circulating TMs in breast cancer. The text summarizes the current knowledge and available evidence on the subject and proposes a series of recommendations mainly focussed on the indication, the frequency of testing and the factors that should be considered for correctly interpreting changes in the levels of TMs.

[Treatment of the pelvic floor in males with incomplete spinal cord injury: a systematic review].

Pelvic floor disorders are one of the most common complications in male patients with spinal cord injury. The aim of this review was to analyse the available evidence on the efficacy of different treatments used for pelvic floor dysfunctions in men with incomplete spinal cord injuries. The Scopus, Medline, PEDro, Web of Science, Dialnet, Pubmed and Cochrane databases were consulted for papers in Spanish and English published in the last twenty years. Fifteen articles were included, comprising a total of 706 male patients with incomplete spinal cord injury. In male patients with neurogenic bladder and erectile dysfunction, the best results were obtained with neuromodulation and combined treatments (electrotherapy or acupuncture / electroacupuncture with catheterization or bladder training).

SEOM clinical guidelines on cardiovascular toxicity (2018).

One of the most common side effects of cancer treatment is cardiovascular disease, which substantially impacts long-term survivor's prognosis. Cardiotoxicity can be related with either a direct side effect of antitumor therapies or an accelerated development of cardiovascular diseases in the presence of preexisting risk factors. Even though it is widely recognized as an alarming clinical problem, scientific evidence is scarce in the management of these complications in cancer patients. Consequently, current recommendations are based on expert consensus. This Guideline represents SEOM's ongoing commitment to progressing and improving supportive care for cancer patients.

Quality of life in elderly breast cancer patients with localized disease receiving endocrine treatment: a prospective study.

PURPOSE: In this paper we study the quality of life (QoL) of elderly breast cancer patients receiving endocrine treatment (ET). More QoL data on elderly patients treated with ET are needed. Our aims are to study QoL in early-stage breast cancer patients throughout the treatment period and compare the QoL of ET groups. METHODS: 148 patients > 65 years who began ET with either tamoxifen or aromatase inhibitor (AI) completed the EORTC QLQ-C30 and QLQ-BR23 and the Interview for Deterioration in Daily Living Activities in Dementia (IDDD) questionnaires three times over 3 years of ET. Linear mixed-effect models were used to evaluate longitudinal QoL changes. ET group comparisons were conducted after 3 years of treatment via ANCOVA adjusted by basal QoL. RESULTS: QoL scores were high (> 80/100 points) in most QoL areas, with moderate limitations (> 30) in sexual functioning and enjoyment and in future perspective. After 3 years of ET, four QoL areas improved (< 6 points) compared to baseline and 3-month assessments. Hot flushes worsened (8 points) at the 3-month assessment but by 3 years had recovered. AI patients showed more hot flushes, pain and diarrhea and less sexual enjoyment than tamoxifen patients after 3 years of ET (differences 3-12 points). CONCLUSIONS: Results indicate that elderly early-stage breast cancer patients adapted well to their disease and ET treatment over the 3 years. Few QoL differences were observed between ET groups.

[Hormonal therapy in breast cancer]. / Tratamiento hormonal del cáncer de mama.

Hormonal therapy has been the first systemic treatment against breast cancer. Up to now Tamoxifen and ovarian supression/ablation were the best optionts we had to treat early breast cancer as advancer disease. The advent of aromatase inhibitors, new SERMS and antistrogen Fulvestrant have supoused a great advance in the treatment of this disease and at the same time have complicated the election of the optimal drug for each patient. This article tries to review the aviable treatment options insiting on its indications.

Primary central nervous system lymphoma treated with rituximab plus temozolomide in a second line schedule.

We report a case of primary CNS lymphoma treated with high-dose methotrexate in the first line. After disease progression the patient received cranial radiotherapy with concomitant temozolomide, followed by rituximab plus temozolomide, with complete remission of the disease maintained for at least two years and without major toxicity.

[Efficacy of the application of kinesio tape in patients with stroke]. / Eficacia de la aplicacion del vendaje neuromuscular en accidentes cerebrovasculares.

AIMS: To review the effects achieved by the kinesio tape in patients with stroke in scientific studies published on date and to discuss these findings may be of interest to neurology. DEVELOPMENT: An exhaustive search in the main scientific databases using keywords such as kinesio tape, kinesiotaping, musculoskeletal tape, taping medical concept was carried out. Citations of selected articles and scientific papers published on the website of the Spanish Association of Neuromuscular Bandage were analyzed. Experimental, quasi-experimental, clinical trials and case studies published were used, without limit date, with therapeutical treatment purpose provide important results. Eight articles have met the inclusion criteria. There are eight studies that examine the effect on kinesio tape on lower limb, gait and balance in this kind of therapy, even upper limb and swallowing problems that these patients could present. CONCLUSION: The kinesio tape in neurological patients can be a complementary technique that empirically provides benefits. However, better methodological quality studies demonstrating the effects attributed to him are still needed.

TITLE: Eficacia de la aplicacion del vendaje neuromuscular en accidentes cerebrovasculares.Objetivos. Revisar la efectividad del vendaje neuromuscular (kinesio tape) en pacientes con accidente cerebrovascular en los estudios cientificos publicados hasta la fecha y discutir estos hallazgos a la luz de lo que pueda ser de interes para la neurologia. Desarrollo. Busqueda exhaustiva en las principales bases de datos cientificas utilizando palabras clave como kinesio tape, kinesiotaping y vendaje neuromuscular, asi como analisis de las citas bibliograficas de los articulos seleccionados y los estudios publicados en la pagina oficial de la Asociacion Española de Vendaje Neuromuscular. Se han admitido estudios cuantitativos experimentales, cuasiexperimentales y estudios de casos, sin limite de fecha, con finalidad terapeutica del vendaje neuromuscular, y que han aportado resultados importantes. Ocho articulos han cumplido los criterios de inclusion. Existen estudios que muestran el tratamiento de los miembros inferiores, la marcha y el equilibrio con este tipo de terapia, asi como de los miembros superiores, y los problemas de deglucion que estos pacientes pueden presentar. Conclusion. El vendaje neuromuscular en patologia neurologica en adultos puede ser una tecnica complementaria que, empiricamente, aporta beneficios, pero aun se precisan estudios de mejor calidad metodologica que evidencien los efectos que se le atribuyen.

SEOM Clinical Guideline of fertility preservation and reproduction in cancer patients (2016).

Chemotherapy and radiotherapy often result in reduced fertility in cancer patients. With increasing survival rates, fertility is an important quality-of-life concern for many young cancer patients. Around 70-75% of young cancer survivors are interested in parenthood but the numbers of patients who access fertility preservation techniques prior to treatment are significantly lower. Moreover, despite existing guidelines, healthcare professionals do not address fertility preservation issues adequately. There is a critical need for improvements in clinical care to ensure patients are well informed about infertility risks and fertility preservation options and to support them in their reproductive decision-making prior to cancer treatment.

Conditioning and recovery of functions lost by brain damage.

The muscle spindle is a receptor apparatus in striated muscle that is necessary for voluntary muscle movement. Paralysis victims lose the feedback of this receptor and cannot initiate motor responses. Four hemiplegic patients were trained to use auditory feedback from electromyographic recordings to initiate activity in paretic limbs. With the addition of visual feedback and the use of the auditory signal as a reinforcing stimulus, the patients' muscle activity was then shaped to approximate normal movement.

[Introspection into the condition of the group of puertorican patients with mental disorders]. / Introspección hacia su condición de un grupo de pacientes Puertorriqueños con trastornos mentales.

The purpose of this study was to explore the degree of insight towards their condition of a group of Puerto Rican mental patients. A non-probabilistic (n = 51) sample was used for convenience and availability from the total patient population with mental conditions who received treatment, during June 1997, in a Diagnostic and Treatment Center (DTC) of the Puerto Rico Department of Health. Descriptive statistics were used, as well as the Cramer chi-square and the Mann Whitney t-test. Fifty two percent of the participants had a high level of insight and the participant's gender (t = 1.92, p = 0.05). Males obtained a higher average grading in the insight scale than females. It was expected that the studied population would be stable in their conditions since they were being treated at the outpatient level. Even so, almost half of the patients had a low level of insight towards their conditions. Implications of these results are very important for health education efforts, since almost half of the patients do not understand that they suffer a serious mental disturbance.

[Invasive studies at the office in the diagnosis of stress urinary incontinence]. / Estudios invasivos de consultorio en el diagnóstico de incontinencia urinaria de esfuerzo.

A revision of the available diagnostic method is being made for the stress urinary incontinence, paying special attention to those which can be enhanced in the doctor's office. Three of the requiring catheters, endoscopic instruments or another kind of advices for his realization and they can be considered such as "Invasive test". There is mentioned that with these techniques there can be found an appropriate diagnosis of the genuine incontinence even up to a 75% of the cases. The remaining percentage requires studies either urodynamic or of any other kind in order to complete the diagnosis. The criterions are enlisted in order to send the patient to a specialized center.

[New approaches to the treatment of urinary tract infection]. / Nuevos enfoques en el tratamiento de infección de vías urinarias.

A revision of the therapeutic alternatives actually available is carried out for the treatment of urinary tract infections in the non pregnant woman. It stands out the importance of differentiats between the complicated infections from the ones which are not. It is related that indications and results are obtained with the administration of one single dose. The causes and diagnoses as well as the therapeutic methods are empasized in the cases of persistent or recurrent infections.

[Criteria for the selection of surgical technic in patients with anatomical urinary stress incontinence]. / Criterios de selección de técnicas quirúrgicas en la paciente con incontinecia urinaria de esfuerzo anatómica.

In this paper it is described the minimum necessary investigation in the evaluation of the incontinent patient, the surgical methods accepted up to date for the treatment of genuine incontinence as well as the facts to be considered and the interrogatives to be solved for the candidate patient ready for surgery as a guide for the election of the most adecuate surgical procedure for the patient. This stands out that the position that the preoperatory measurement of pressure of the urethral closing can lead to the evolution in the operated patients.

[Stress urinary incontinence. A comparison of of 4 methods of cystourethropexy. A 2-year follow-up]. / Incontinencia urinaria de esfuerzo. Comparación de cuatro métodos de cistouretropexia. Seguimiento a dos años.

All successful operations for relief of genuine stress urinary incontinence (SUI) have three objectives: elevation and retropubic maintenance during stress of the urethrovesical junction. The present study was realized at the Urogynecologic Service of the "Luis Castelazo Ayala" hospital IMSS to evaluate the results in a two years follow up of 597 patients that suffered from SUI treated by retropubic urethropexy, from February 1984 to May 1991. Patients were studied according to the service norms, previously published. We realized four types of procedures: Pereyra (379 cases), Burch (90 cases), Marchall-Marchetti-Kratz (60 cases) and Powell surgery (68 cases). Vaginal approach was realized in cases of pelvigenital statics disturbances like cysto- or rectocele; and abdominal approach was indicated in patients with enlarged uterus or pelvic masses. The complications rate was 15.3%. Success rate was 87.06% for all procedures and not statistic significance was found (p > or = 0.1 and X2 = 6.15), the best rate to the Burch and Pereyra procedures. We conclude the most important tip to successful rate in SUI surgery is correct choice of the procedure according to the patient.

[Myomatosis of rare localization]. / Miomatosis de localización poco frecuente.

We described three cases of female patients with myomata of rare location. A 37 year old female with abnormal genital bleeding, secondary to cervical neoplasm; underwent total abdominal hysterectomy in 1993. A year later an excision of anterior vaginal dependent neoplasm was performed. A 16 year old female with Bartholinitis. Excision of vulvar tumor was performed. A 35 year old female with urinary stress incontinence, hematuria, referring foreign body sensation in the vagina, with a neoplasm in the urethra. The patient underwent for excision of the tumor. In all three cases the neoplasm excised underwent histopathologic analysis resulting as vulvar, vaginal and urethral myomata.

[Uterine leiomyomatosis in the female in late menopause]. / Miomatosis uterina en la mujer en la posmenopausia tardía.

Leiomyomatosis is less frequent in old woman, and its clinical and histological characteristic in late postmenopause are unknown. Uterine leiomyomas were confirmed histologically in 14 out of 69 patients (20.2%) who were 65 or older and in whom a vaginal hysterectomy was performed. Another group without myomas was paired by age to the study group. In both groups, the uterine volume and the minor diameter of the uterus were compared, as well as age at menarche, menopause and duration of the menstrual life. Statistical analysis was done with ANOVA. It was observed, as expected, that uterine volumes of women with leiomyomatosis were significantly greater (p < 0.01) than those of women that did not have myomas; however, the smaller uterine diameters were not significantly different between the two groups, which is an important finding for surgical treatment of these patients. In addition, the menstrual life of patients with myomas was significantly greater (p < 0.04) than that of women without leiomyomatosis. In conclusion, one fifth women 65 years old or older can present myomas and consequently an increase in uterine volume, but without increase in minor diameters. Furthermore, the greater menstrual life span must be recognized as possible risk factor for the presence of leiomyomatosis.