[Occupational performance skills in Parkinson's disease: relationship with health-related quality of life and caregiver burden. Letter]. / Habilidades de desempeño ocupacional en la enfermedad de Parkinson: relación con la calidad de vida relacionada con la salud y la carga del cuidador. Carta.

TITLE: Habilidades de desempeño ocupacional en la enfermedad de Parkinson: relación con la calidad de vida relacionada con la salud y la carga del cuidador. Carta.

Estrategia formativa para perfeccionar el autocuidado en pacientes con fractura de cadera / Training strategy to improve self-care in patients with hip fracture

Introducción: Los medios de enseñanzas son los ejes vertebrales de gran parte de las acciones de enseñanzas y aprendizaje desarrolladas en cualquiera de los niveles o modalidades de la educación. Objetivos: Sistematizar y resaltar los fundamentos y ventajas de la guía de autoayuda sobre la fractura de cadera en el adulto mayor, como medio de enseñanza en la superación profesional del médico de la atención primaria. Métodos: Analítico ­ sintético, hipotético ­ deductivo, análisis documental y la entrevista. Resultados: Se elaboró una guía de autoayuda sobre fractura de cadera en el adulto mayor, a partir de falencias detectadas en la atención primaria de salud, que limitan el desempeño de los médicos de este nivel en actividades de promoción de salud en este grupo social. La guía de autoayuda fue diseñada y estructurada, como medio de enseñanza de estrategias de superación profesional, determinando las particularidades del contenido que se desea enseñar y las que se necesitan aprender por estos profesionales, para mejorar su desempeño en la promoción de salud en relación con el adulto mayor con fractura de cadera. Su creación fue concebida como elemento dinamizador del contenido unido a los demás componentes del proceso en busca de lograr los objetivos propuestos. Conclusiones: Se presenta una guía de la colección de autoayuda sobre fractura de cadera en el adulto mayor, diseñado, pensado y elaborado como medio de enseñanza a utilizar en la superación profesional del médico de la atención primaria de salud donde se resaltan los fundamentos teóricos que lo sustentan.

Introduction: Teaching media are the backbone of a large part of the teaching and learning actions developed at every educational level or modality. Objectives: To systematize and highlight the rationale and advantages of the self-help guide for hip fracture in the elderly, considered as a teaching tool in the professional improvement of primary health care ( PHC). Methods: Analytical - synthetic, hypothetical - deductive, documentary analysis and interview. Results: A self-help guide for hip fracture in the elderly was developed, based on deficiencies detected on PHC, which limit the performance of doctors at this level in health promotion activities for the mentioned social group. The self-help guide was designed and structured as a means of teaching professional improvement strategies by determining the content particularities to be taught and those to be learned by these professionals, in order to improve their performance in health promotion for the elderly with hip fracture. This self- help guide was conceived as a dynamic element of the content, that relates to the other components of the process in search of achieving the proposed objectives. Conclusions: We present a self-help collection guide for hip fracture in the elderly, designed, conceived, and elaborated as a teaching tool to be used in the professional improvement of the PHC, and we highlight theoretical foundations

[Implementation of a Plan of Patient Safety in Service of Pediatric Surgery. First results]. / Implementación de un Plan de Seguridad del Paciente en un Servicio de Cirugía Pediátrica. Primeros resultados.

OBJECTIVES: In 2014 our department starts to apply the PatientSafety Strategic in Pediatric Surgery. Our aim is to describe the results obtained. METHODS: For the measurement of adverse events (AE) we used a modification of the Global Trigger Tool of the Institute for Healthcare Improvement. Population analysed: patients undergoing surgery with hospitalization. On a monthly basis, audits of the medical records of 12 patients discharged in the prior week of the assessment were performed. The evaluation team was composed by experienced pediatric surgeon, two staff nurses, and a doctor and nurse from the Quality Department. RESULTS: 95 clinical records and a total of 406 days of hospital stay were reviewed. 31 patients (32.6%) experienced one or more AE. Total AE: 43. The AE/1000 patients/day ratio: 105.9. The most common AE were: vomiting, itching and pain. 28 EA were considerd mild and 3 moderate in severity, according to the classification of the National Coordinating Council for Medication Error Reporting and Prevention. No EA were considered serious or critical. CONCLUSIONS: The analysis of prevalence through regular assessments of medical records is an easy method to obtain information about the frequency of occurrence, exact understanding of the AE types and the implementation of corrective measures. The main limitation of this method is that it can miss some of the serious EA and miss the records and analysis of sentinel events that may occur in the period between assessments.

OBJETIVOS: Durante el año 2014 se aplica el Plan de Seguridad del Paciente en un Servicio de Cirugía Pediátrica, elaborado previamente por nuestro Servicio. Se describen los resultados. MATERIAL Y METODOS: El método empleado para la medición de eventos adversos (EAs) es una modificación del Global Trigger Tool del Institute for Health care Improvement. Población analizada: pacientes intervenidos quirúrgicamente con hospitalización. Con una periodicidad mensual, se realizaron 12 auditorias de las historias clínicas correspondientes a los pacientes dados de alta en la semana anterior al día de la evaluación. El equipo evaluador estaba compuesto por: un cirujano pediátrico experto, dos enfermeras de planta más un médico y una enfermera del Servicio de Calidad. RESULTADOS: Se revisaron 95 historias y 406 días de estancia. 31 pacientes (32,6%) sufrieron uno o más eventos adversos. Total EAs: 43. Número EAs/1.000 pacientes/día: 105,9. Los 3 EA más frecuentes fueron: vómitos, prurito y dolor. 28 EAs fueron de gravedad leve y 3 moderada, según la clasificación del National Coordinating Council for Medication Error Reporting and Prevention. Ningún EA fue grave o crítico. CONCLUSIONES: La determinación de la prevalencia mediante evaluaciones regulares de historias clínicas es un método que permite obtener información de forma fácil sobre la frecuencia de aparición, el conocimiento exacto de los tipos de EAs y la aplicación de medidas correctoras. Este método tiene como limitación principal la posible falta de recogida EAs graves así como registro y análisis de eventos centinelas que pueden ocurrir en el periodo entre evaluaciones.

Ischaemic priapism as a presentation of chronic myeloid leukaemia.

OBJECTIVE: To describe ischemic priapism as an atypical presentation of chronic myeloid leukaemia. METHODS / RESULTS: We discuss two patients diagnosed with chronic myeloid leukaemia presenting an episode of priapism, adequately resolved after applying the treatment protocol established in our center. CONCLUSION: Priapism is defined as a persistent erection that persists despite not having sexual stimulus, without involvement of the spongy tissue of the penis. Its debut appearance as a hematologic dyscrasia is a rare event. It is a urological emergency, requiring early multidisciplinary (Urology and Hematology) management, since the speed in treatment will result in good functional results and the preservation of a good quality of life.

[Multidetector computed tomography assessment of the degree of differentiation of bronchial carcinoid tumors]. / Hallazgos radiológicos en tomografía computarizada de los tumores carcinoides bronquiales típicos y atípicos.

OBJECTIVE: To define the CT findings for bronchial carcinoid tumors and to determine whether these findings enable these tumors to be classified as typical or atypical. MATERIAL AND METHODS: We reviewed the chest CT studies performed between 1 January 2001 and 31 December 2009 in patients at our hospital diagnosed with bronchial carcinoid tumors. The sample consisted of 52 patients (23 women and 29 men) with a mean age of 47 years (range 11-77 years). The 52 cases were classified as typical or atypical on the basis of the following radiological findings: size, location, focality, type of growth, calcifications, signs secondary to bronchial obstruction, and the presence of significant lymph node enlargement or metastases. These findings were then compared with the histological findings. RESULTS: Typical carcinoid tumors were the most prevalent (46 cases). The variables associated with atypical tumors were: male sex, advanced age at onset, and size >3cm. The accuracy of CT in classifying atypical tumors correctly increased with the number of variables indicative of atypical carcinoid tumors. A negative result for atypical nature made it possible to rule out an atypical carcinoid tumor in 95% of the cases. CONCLUSION: CT is useful for defining and characterizing carcinoid tumors into typical or atypical, although a precise formula for differentiating between the two types remains to be defined.

Los diarios reflexivos en la tutoría clínica de enfermería: Significados atribuidos por los tutorados / Reflective diaries in tutoring clinical the nursing: Meanings attributed by tutees

El análisis de los diarios reflexivos forman parte de la investigación "La tutoría clínica como estrategia de enseñanza aprendizaje en Enfermería Fundamental" a través de la implementación de un Modelo de Tutoría Clínica Reflexiva donde los diarios reflexivos se aplican como estrategia de enseñanza aprendizaje e investigación. Objetivo: Identificar los significados que le asignan los tutorados a la práctica clínica de Fundamentos de Enfermería ll, a través de los diarios en un modelo de tutoría clínica reflexiva. Metodología: Análisis del contenido y significado de los diarios reflexivos desde la interpretación cualitativa de los textos en tres etapas: Codificación, categorización e interpretación y el establecimiento de los vínculos y relaciones en el proceso de categorización.¹ El grupo de estudio lo integran catorce tutorados, tres tutoras clínicas y 138 registros durante cuarenta días. Resultados: Del análisis del discurso se derivaron las siguientes categorías: Temor vs confianza, percepción sobre las enfermeras, identidad profesional, el ser enfermera, percepción sobre la tutoría y relación entre la teoría y la práctica, mismas que dan cuenta de las reflexiones clínicas. Discusión y conclusiones: Las categorías muestran las experiencias significativas que vive el tutorado en el entorno de práctica hospitalaria, favorecen el aprendizaje reflexivo y una relación humanizada entre el tutor-tutorado. Permiten individualizar la tutoría, la reflexión en la acción coloca en el centro del proceso al tutorado y tutor. Resultados: 96% tuvo riesgo medio para la edad (15 a 19 años); aunque 9 tuvieron mayor riesgo debido a tenían 15 años o menos; 27% eran solteras, 23% correspondían a un nivel socioeconómico bajo, dos terceras partes reportó una escolaridad de 9 años o menos. Respecto a los factores biológicos cuatro de cada 10 tuvieron riesgo medio o alto en función de su peso (35% entre 41 a 50 kgs. y 6.1% con menos de 40 kgs); la gran mayoría eran nuliparas; 12% con tabaquismo positivo; 16% tuvo amenaza de aborto; 11% con amenaza de parto pretermino; el problema de salud más importante fue la infección de vías urinarias 28% la tenía controlada y 10% activa. Discusión y Conclusión: Los resultados coinciden con otras investigaciones, pero el número de embarazadas de 15 años o menos es superior a la media nacional que es de 6 en mil; el perfil obstétrico es en mayor medida de mediano riesgo; falta conocer los riesgos y daños en el posparto y recién nacido para completar este perfil.

"Clinical Tutoring as a Teaching Learning Strategy in Fundamental Nursing" is a study in which, by implementing a Reflective Clinical Tutoring Model, reflective diaries are used. Objective: to identify the meanings given by the mentored to clinical practice in Nursing Fundamentals II, through diaries in a model of reflective clinical tutoring. Methodology: Analysis of the contents and meanings of reflective diaries following a qualitative interpretation in three stages; codification, categorization and interpretation, and establishment of links and relations within the process of categorization. 1 The study group is integrated by 14 mentored, 3 clinical tutors, and 138 registers taken during 40 days. Results: from the discourse analysis, the following categories were derived; fear vs. confidence, perceptions about nurses, professional identity, being a nurse, perceptions about the tutoring process, and relationships between theory and practice. Discussion and conclusions: the derived categories show the significant experiences which mentored live within the hospital practice. They favor reflective learning and a human relationship between mentor and mentored, showing that reflection allows the individualization of tutoring.

[Frontoethmoidal mucocele. Diagnosis and treatment in 7 cases]. / Mucocele frontoetmoidal. Diagnóstico y tratamiento en 7 casos.

Mucocele has its origin by blockage of the paranasal sinuses ostium with mucinous retention inside, sometimes purulent (mucopiocele), and progressive slimming with gradual destruction on the bone walls. We report an own review of 7 patients with diagnosis of frontoethmoidal mucocele, 4 men and 3 women, 50-years average. The oftalmologic clinical symptoms (diplopia, exoftalmos and the eyeball movement restrictiv) were the most frequentjointly to cefalea. The kind of surgery that we have performed, in 6 of 7 cases, was FES with marsupialization (4 times) and external ethmoidectomy (2). We have performes a literature review at this respect.

[Cervical hematoma after discectomy for spondylosis. An indication of urgent tracheotomy]. / Hematoma cervical tras disquectomía por espondilosis. Indicación de Traqueotomía Urgente.

We report the clinical case of a hematoma after surgery of cervical spondylosis which required an urgent tracheotomy due to failure in the orotracheal intubation. This illness in advanced degree, so called cervical spondylotic myelopathy, is the most serious consequence of cervical intervertebral disc degeneration.

[Morphology of the parathyroid glands. A study of 146 samples and review of the literature]. / Morfología de las glándulas paratiroides. Estudio de 146 muestras y revisión de la literatura.

Parathyroid hyperfunction condition has a very diverse and unspecific symptoms and signs. We have performed an anatomopathologic study of 146 parathyroid gland from patients diagnosed from hyperparathyroidism. About a 72.6% of the patients presented a parathyroid adenoma while in the rest 27.4% it was observed principal cells hyperplasia. Up to now we have not registered any cases of parathyroid carcinoma after anatomopathological exam of the removed gland. The mayority of the adenomas (85%) were found on the lower parathyroids and its size varied between 6 mm and 5 cm. In one case an double adenoma was diagnosed and in another two cases the adenoma was located in the superior mediastine.

[Diffuse large B-cells lymphoma of the parotid gland (MALT). Report of a case and review of the literature]. / Linfoma difuso de células b grandes parotídeo (MALT). A propósito de 1 caso y revisión de la literatura.

Althouh lymphomas are an illness that characteristically affects the lymph nodes they can present in other locations (extranodes). The lymphoid tissue of the salivary glands can be considered part of the called mucosa-associated lymphoid tissue (MALT). We report the case of a diffuse large B-cells parotid lymphoma. The location on the parotid gland, within its rareness, is the most common for salivary gland lymphomas whose diagnosis is always histological by examination of the removed piece since the biopsy can be nonsufficient and take to a wrong diagnosis besides the greater risk of injury on the facial nerve.

[Practical aspects regarding endoscopic treatment for epistaxis]. / Aspectos prácticos sobre el tratamiento endoscópico de la epistaxis.

INTRODUCTION: A prospective study is presented to evaluate some practical and financial aspects regarding surgical endoscopic ligation or cauterization of sphenopalatine (SP) and anterior ethmoidal (AE) arteries performed to control posterior nasal bleeding. PATIENTS AND METHODS: 35 patients admitted at the ENT ward between 2004 and 2006 were included in the study, and distributed into two groups depending on the protocol applied in each case. Until March 2005 the surgery was performed if there was failure or insecurity of the posterior packing, and since that date a substitutive surgical protocol (not including posterior packing) was applied. RESULTS: 82.9% of the patients were male, with a mean age of 55.74 years and a left bleeding in a 60% of the cases. Ligature/cauterization was performed on SP in 28 (80%) patients, on AE in 4 (11.4%), and on both arteries in 3 cases (8.6%). 38.7% of the SP approach only one sphenopalatine foramen was observed, through which an only branch of the artery passed; 42% of the cases two branches passed through an only foramen, and in 19.3% two or more branches were present, breaking into the nose through two or more independent clefts. AE was intradural in 3 cases, intranasal attached to the cranial base in other 3 and intranasal detached to the cranial base in 1 patient. Besides, highly significant differences were found between the two protocols, observing a mean reduction of hospital stay of 3.1 days, which throws up savings of 939.3 euros per patient. DISCUSSION AND CONCLUSIONS: Surgical treatment for epistaxis has proved to be effective (91.2% in our experience) and safe, determining an important reduction in hospital stay and avoiding the morbility of posterior packing. Accurate knowledge of the anatomy of the arteries implied and specific actuation upon the correct bleeding territory are essential to perform this surgery.

[Early postoperative complications of thoracoscopy versus thoracotomy in pediatric idiopathic scoliosis]. / Estudio comparativo de las complicaciones postoperatorias inmediatas de la toracoscopia frente a la toracotomía en la escoliosis idiopática infantil.

INTRODUCTION: Thoracoscopic surgery has been used for anterior release, discectomy, and fusion in severe scoliosis or kyphosis. The indications of thoracoscopy for the treatment of pediatric spinal deformity are similar to those of thoracotomy-based spinal surgery. OBJECTIVE: We designed a comparative study to observe the immediate complications in the postoperative period after thoracoscopy or thoracotomy for scoliosis in the pediatric population. MATERIAL AND METHODS: The postsurgical complications of 63 interventions for idiopathic scoliosis over a 10-year period were analyzed. Conventional thoracotomy was used in 37 interventions (59 %) and thoracoscopy was used in 26 (41 %). RESULTS: In patients treated with the thoracolumbar endoscopic procedure, oral nutrition was resumed earlier, the mean length of hospital stay was lower, and debit drainage or requirement of surgical drainage were lower. CONCLUSIONS: Fewer immediate postsurgical complications were observed in scoliosis surgery when thoracoscopy was used.

[Sudden cervical hematoma after hypertensive crisis. Report of a case]. / Hematoma cervical brusco tras crisis hipertensiva. Presentación de un caso.

We report the case ofa 61 years old woman with multiple pathologies: HTA, diabetes, relapsing polychondritis, hypercholesterolemia, iatrogenic Cushing, cardiopathy, cystic fibrosis, etc. She began, an increment of TA (220/130 mm Hg) or hypertensive crisis, with a sudden left cervical hematoma located on the carotid bifurcation according to CT imaging. We oractice an arteriography that was informed as normal and the patient was admitted and controlled of an ORL as Vascular Surgeon. The bleeding stop spontaneously we treat the patient conservativity.

[Adenoid cystic carcinoma of tongue. Report of a case and literature review]. / Carcinoma adenoide quístico de lengua. A propósito de un caso y revisión de la literatura.

We report the clinical case of an adenoid cystic carcinoma on the base of the tongue, a rare malignant tumor of slow-growing but aggressive with a propepnsity for perineural invasion. Treatment modalities more common include surgery and radiotherapy but locorregional recurrences are frequent and relatively early in the first years. A review of the literature of this pathology is performed.

[Adenoid cystic carcinoma of the larynx-hypopharynx. A case report and review of the literature]. / Carcinoma adenoide quístico de laringe-hipofaringe. A propósito de un caso y revisión de la literatura.

Laryngeal or hypopharyngeal localization of adenoid cystic carcinoma is rare due to the poor distribution of the accesory salivary glands in this area. We report one case of such neoplasm on that area, with its diagnosis confirmed histologically. The required a total laryngectomy with later reoperations because of hemorrhage and pharyngeal fistula. One year after the surgery and in spite of postoperative radiotherapy multiple pulmonary metastasis were detected causing the death of the patient. We review the literature of this tumor whose prognosis is much worse than epidermoid or scamous carcinoma.

[Diffuse sclerosing papillary carcinoma mimicking chronic lymphocytic thyroiditis. A unusual neoplasm variant]. / Carcinoma papilar esclerosante difuso simulando tiroiditis crónica linfocitaria. Una variante neoplásica inusual.

We report the clinical case of a 39 years old female diagnosed as a chronic lymphocytic tiroiditis by F.N.A.B. with multinodular goiter of long evolution. The patient was operated by total thyroidectomy and her final anatomopathologic result was papillary carcinoma diffuse sclerosing variant. During the surgical act several cervical nodes were detected and removed being informed the most of them as metastasic. A review of the literature at respect of this malignant neoplasm is performed.

[Parotid phlegmon with involvement of both lobes. Report of a case]. / Flemón parotídeo con afectación de ambos lóbulos. A propósito de un caso.

The pathologic processes involving the parotid gland include a vast group of lesions, acute and chronic inflammations, benign and malign tumors, traumas or degenerative processes. We report the case of a 55 years old male diagnosed as left parotid phlegmon with involvement of both lobes, especially the deep one, who required admission and endovenous medical treatment for 6 days up to the resolution of the symptoms.

[Laryngeal chondrosarcoma of low grade of malignancy. Report of a case located on thyroid cartilage]. / Condrosarcoma laríngeo de bajo grado de malignidad. A propósito de un caso localizado en cartílago tiroides.

Cartilaginous tumors of the larynx are rare. Only a 2-5% of all chondrosarcomas arise on head and neck area while the laryngeal forms represent less than 1% of the malignant neoplasms in that location. Laryngeal chondrosarcoma is three times more frequent in men than in women with average age of presentation about the 6th - 7th decades. Most of them are originated on cricoid (70-75%) followed by the thyroid cartilage (10-20%) as in the case that we are reporting. Its growth often is very slow with delayed clinic being hoarseness, dyspnea and dysphagia the most common symptoms. Laryngeal chondrosarcomas use to be tumors with low-grade of malignancy and their elective treatment is surgery preserving the laryngeal function. Local and late recurrences are frequent and the definitive diagnosis is the anatomopathological exam.

[Analysis of our recent results in the surgical treatment of the hyperparathyroidism (1990-2005)]. / Análisis de nuestros resultados actuales en el tratamiento quirúrgico del hiperparatiroidismo (1990-2005).

OBJECTIVE: To report our recent experience (1990-2005) in the surgical treatment of hyperparathyroidism. MATERIAL AND METHOD: Up to now we have operated 153 patients (41 male and 112 female) with ages between 14 and 79 years old studying the clinical symptoms referred by them, preoperative imaging tests, type of hyperparathyroidism, its respective surgery, result or final anatomopathological diagnosis and postoperative complications. RESULTS: Parathyroid adenomas represented a 69.73% while the hyperplasias were about 26.31%. In 6 cases the glands removed were informed as normal. It stands out that the most rare adenomas were located in lower parathyroids with a relation > 5,5:1 respect to the upper ones. Among the complications we obtained 35 postoperative hypocalcemias (31 transient and 4 persistent), one case of recurrent nerve palsy after exposure of 233 nerves, 5 haemorrhages that required reintervention and 4 persistences of hypercalcemia. Globally we were able to reduce the calcium and PTH serum levels with clinical improvement in more than 96% of the operated patients. DISCUSSION-CONCLUSION: The surgery for hyperparathyroidism provides very good results in general as we stated in other published series.

[Arachnoid cyst of cerebellar-pontine angle clinically mimicking Meniere's disease]. / Quiste aracnoideo de angulo pontocerebeloso simulando clínicamente enfermedad de Meniere.

Arachnoid cysts represent about 1% of all intracranial space-occupying lesions. Usually they are located in the middle cranial fossa while their localization in the posterior fossa is uncommon and generally remain asymptomatic or those are non-specific. The case of a 51 years old female is reported who was diagnosed by IRM of a 4,5 x 2 cm arachnoid cyst, situated on the left cerebello-pontine angle, with tinnitus, hearing loss and vertigo that mimicked a Meniere's attack. We think thees benign tumors must be included in the differential diagnosis of Meniere's disease because they can be indistinguishable from it clinically.