Syndrome of professional wear and tear or «burnout¼ in Andalusian ophthalmology. / Síndrome de desgaste profesional o «burnout¼ en la oftalmología andaluza.

INTRODUCTION: Burnout syndrome refers to the physical and psychological fatigue suffered by workers as a result of their professional activity. It has three main characteristics: emotional exhaustion, depersonalization and lack of personal fulfillment. PURPOSE: To determine the prevalence of burnout syndrome among Andalusian ophthalmologists, both consultants and residents, analyzing its relationship with several sociodemographic variables. MATERIAL AND METHODS: Descriptive cross-sectional study. All the sociodemographic variables were included in a Google® form together with the standardized questionnaire Maslach Burnout Inventory-Human Services Survey (MBI-HSS). This form was sent to the Andalusian ophthalmological community by different electronic means (Andalusian Society of Ophthalmology, instant messaging mobile apps, etc.). RESULTS: One hundred fourty two ophthalmologists answered the form, with a similar distribution by sex and a mean age of 43.77 years, with 67.1% of them meeting criteria of burnout syndrome. Its prevalence was higher among young ophthalmologists, with fewer years of clinical practice, divorced/separated, those with fewer children, belonging to centers in the province of Huelva, workers in rural/regional areas, those with exclusive public activity, consultants with temporary contracts and four-year residents. Regarding subspecialties, its prevalence was higher among those who focused on cornea-ocular surface-refractive surgery. CONCLUSIONS: This study quantify for the first time in Andalusia the prevalence of burnout syndrome among ophthalmologists. The fact that two thirds of the analyzed sample meet criteria proves the need to implement improvements in the clinical and professional conditions of our group.

Giant cell tumour of frontal bone in a patient with bilateral retinoblastoma. / Tumor óseo de células gigantes en techo orbitario de paciente con retinoblastoma bilateral.

A case is presented of a 5 year-old patient with bilateral hereditary retinoblastoma treated with radiotherapy in the right eye and enucleation of the left eye. After three years without evidence of progression, the patient presented with a right orbital mass that compromised the frontal bone. After surgical excision, the histology analysis was consistent with a diagnosis of giant cell tumour. Primary orbital bone neoplasms, such as giant cell tumours, are extremely rare. Both radiological and histopathology studies are essential to establish the differential diagnosis of orbital mass lesions.

[Changes in immunoglobulin levels following adenoidectomy and tonsillectomy]. / Alteraciones de la inmunidad tras adenoidectomía y amigdalectomía.

INTRODUCTION: Lymphoid tissue from Waldeyer's ring produces all types of immunoglobulins, mainly G and A, and between 4 to 10 years, of age. In other words, the age in which the adenoid and tonsillar surgery is carried out. Our study tries to analyze the impact of the tonsillar surgery on the serum levels of immunoglobulins. MATERIAL AND METHODS: We present a prospective study with 89 healthy children aged between 4 to 10 years. Immunoglobulin G, A and M levels were measured preoperatively, at a month and at four months after adenoidectomy and/or tonsillectomy. RESULTS: Serum IgG levels dropped after surgery, but partially recovered four months later. IgA dropped less significantly and IgM did not change its levels. No one of the studied inmunoglobulins dropped below the normal serum levels. DISCUSSION/CONCLUSIONS: Adenoid and tonsilar surgery cause a fall of postoperative immunoglobulin G and A serum levels, partially recovering after four months. Serum levels never dropped below normal levels, and of the studied children suffered a postoperative disease due to immunodeficiency.

Balloon catheter sphincteroplasty and biliary stone expulsion into the duodenum in patients with an indwelling T tube.

BACKGROUND: To present an alternate approach for treating residual biliary stones in patients with indwelling T tube that uses the immature tract created by the T tube to carry out both sphincteroplasty and expulsion of the calculi with the same angioplasty balloon catheter. METHODS: This technique was performed in five patients. Access to the bile duct was through an 8-Fr T tube. First a guidewire was inserted and advanced beyond the obstructing stone to the duodenal lumen. The T tube was removed over the guidewire, and a balloon catheter was introduced. Sphincteroplasty was carried out. Then the balloon was deflated and retracted to a position proximal to the stone. It was then reinflated and used to push the stone, expelling it into the duodenum. RESULTS: In all cases, all biliary stones were expelled without pain, in a single session, and with no immediate complications. All patients showed rapid clinical and analytic improvement. During clinical and echographic follow-up of 2-22 months (mean = 12.4 months), there were no complications or relapses. CONCLUSIONS: Our limited experience indicates that sphincteroplasty and expulsion of biliary stones with angioplasty balloon catheters through the T tube immature tract is a simple, safe, low-cost technique that gives good results.

Cellulose granulomatosis of the lungs.

Chest radiographs and high-resolution chest CT scans were performed in a 30-year-old man with a history of intravenous drug abuse and diffuse micronodular infiltrates. Transbronchial biopsy gave a diagnosis of cellulose granulomatosis of the lung. Cellulose granulomatosis should be considered in the differential diagnosis of pulmonary interstitial disease, especially in the setting of intravenous drug abuse.

Hepatocellular carcinoma presenting as portal thrombosis with intrabiliary growth: US and MR findings.

We present an unusual case of hepatocellular carcinoma presenting as massive portal vein thrombosis with progression to the intrahepatic bile ducts without demonstrable primary hepatic tumor. Ultrasound, magnetic resonance, and percutaneous transhepatic cholangiography findings are described. The histologic diagnosis was achieved by means of percutaneous forceps biopsy of the endobiliary mass.

The impact of stereotactic large-core needle biopsy in the treatment of patients with nonpalpable breast lesions: a study of diagnostic accuracy in 510 consecutive cases.

The objective of this study was to assess the usefulness of stereotactic large-core needle biopsy (LCNB) in the management of nonpalpable breast lesions (NBL) and compare it with stereotactic fine-needle aspiration biopsy (SFNA) performed simultaneously in a significant number of cases. From November 1993 through June 1997, 510 consecutive patients with NBL underwent 14-gauge LCNB with 354 women undergoing simultaneous 21-gauge SFNA in the same lesson. Mammographic findings lesion size, number of core biopsy specimens, complications and diagnoses of both techniques were analysed. Surgical biopsy, tumorectomy or mastectomy was indicated for malignancy or poor correlation between SFNA or LCNB results and clinical or radiological findings. Values of diagnostic accuracy of both LCNB and SFNA were determined. The ratio benign surgical biopsies/malignant surgical biopsies (BB/CB) of the series was calculated. A total of 171 patients underwent surgical treatment: in 31 (18.1%) a benign process or atypical ductal hyperplasia was the final diagnosis. The ratio BB/CB was 0.22. Sensitivity and specificity were 93.2 and 100%, respectively, for LCNB, and 77.2 and 92.3%, respectively, for SFNA with cytological analysis. Large-core needle biopsy provides more accurate diagnosis than SFNA in the management of nonpalpable breast lesions and obviates a surgical diagnostic procedure in a significant number of cases.

Idiopathic pylephlebitis and idiopathic sclerosing peritonitis in a man with protein S deficiency.

Idiopathic pylephlebitis and primary sclerosing peritonitis are two highly unusual entities. To our knowledge, the association of the two diseases has not been described previously. We report a 42-year-old patient with a protein S deficiency who presented with fever and chills, in whom idiopathic pylephlebitis was diagnosed. A year later, the patient was readmitted because of recurrent vomiting and weight loss. An exploratory laparotomy yielded diagnosis of sclerosing peritonitis, which resolved after surgery. The short time interval between the processes suggests that they were related to each other, and also to the protein S deficiency.

Ductal carcinoma in situ and atypical ductal hyperplasia of the breast diagnosed at stereotactic core biopsy.

Stereotactic core needle biopsy (SCNB) allows specific histopathologic diagnoses to be made without surgery and has been demonstrated to be an accurate, cost-effective method of diagnosing breast disease, particularly nonpalpable lesions. However, recent studies have concluded that the diagnosis of atypical ductal hyperplasia (ADH) by means of SCNB has resulted in nearly equal odds that a coexisting malignant lesion will be missed. Furthermore, others have concluded that SCNB diagnosed as DCIS cannot reliably indicate the absence of tumor invasion in surgical excision. Between 1993 and 1998, 1,221 consecutive SCNB of mammographically identified lesions were performed using a 14-gauge automated device with an average of 5.3 cores obtained per lesion. ADH was identified in 19 (1.6%) lesions and DCIS in 89 (7.3%). Surgical biopsy was performed in 89 of these patients and histopathologic results from SCNB and surgical biopsies were reviewed and correlated. In 12 cases of ADH diagnosed by SCNB, surgical biopsy showed ADH in 8 (67%) cases and DCIS in the other 4 (33%) cases. In 77 cases of DCIS diagnosed by SCNB, a surgical biopsy showed DCIS in 55 (71%) cases, 6 more cases (8%) had DCIS with focal microinvasion, and 15 (19%) had invasive ductal carcinoma. In one case no residual tumor was found at surgery. In the author's patient population, the diagnosis of ADH at SCNB indicates high probability of DCIS or residual ADH in the surgical biopsy. The diagnosis of DCIS at SCNB is confirmed in the majority of surgical biopsies; however, a significant number of cases may show microinvasion or invasive carcinoma.

Hallazgos por TC en la sarcoidosis torácica / CT findings in sarcoidosis with thoracic involvement

Objetivo: La sarcoidosis es una enfermedad sistémica idiopática, caracterizada por la presencia de granulomas epitelioides no caseificantes en múltiples órganos. La afectación intratorácica ocurre en el curso de la enfermedad en casi todos los pacientes. Describimos los hallazgos en nuestros pacientes por TC convencional y TCAR de esta enfermedad.Material y método: Se ha realizado un análisis retrospectivo de los estudios mediante TC realizados en nuestro servicio a 43 pacientes diagnosticados de sarcoidosis mediante biopsia y/o lavado broncoalveolar.Resultados: Hemos dividido los hallazgos según su localización en intra y extraparenquimatosos, resaltando hallazgos poco frecuentes como el engrosamiento pleural y pericárdico, adenopatías calcificadas o en localizaciones inusuales y esplenomegalia, patrón alveolar, patrón en panal y atrapamiento de aire.Conclusión: La TC convencional y la TCAR en la sarcoidosis, son técnicas más útiles que la radiología convencional en la detección y estudio de la extensión de las lesiones intra y extraparenquimatosas, así como en la valoración de la evolución. Permite, además, guiar la biopsia torácica en caso de ser necesaria (AU)

Alteraciones de la inmunidad tras adenoidectomía y amigdalectomía / Changes in immunoglobulin levels following adenoidectomy and tonsillectomy

Introducción: Los órganos linfoides del anillo de Waldeyer producen todos los tipos de inmunoglobulinas (principalmente la G y la A), desarrollando su actividad principal entre los 4 y los 10 años de edad, es decir, aquella en la que la patología adenoamigdalar causa el mayor número de indicaciones quirúrgicas de las mismas. Nuestro estudio pretende analizar el impacto que la exéresis adenoamigdalar causa sobre los niveles de inmunoglobulinas en el niño.Material y métodos: Presentamos un estudio prospectivo de 89 pacientes sanos entre 4 y 10 años intervenidos en nuestro servicio de adenoidectomía y adenoamigdalectomía, a los cuales se les determinaron los niveles de inmunoglobulinas G, A y M preoperatoriamente y al mes y cuatro meses. Resultados: Las cifras de IgG sérica sufrieron un descenso postoperatorio, recuperándose parcialmente a los cuatro meses. La IgA descendió en menor medida y la IgM apenas sufrió variaciones. Ninguna de las inmunoglobulinas estudiadas descendió por debajo de niveles considerados normales. Discusión/Conclusiones: La intervención amigdalar y adenoidea causan descensos postoperatorios en las cifras séricas de inmunoglobulinas G y A, con recuperación parcial a medio plazo. En ningún caso las cifras séricas descienden por debajo de los niveles considerados normales, y en ninguno de los niños estudiados la intervención causó patología postoperatoria derivada de una alteración de la inmunidad (AU)

INTRODUCTION: Lymphoid tissue from Waldeyer's ring produces all types of immunoglobulins, mainly G and A, and between 4 to 10 years, of age. In other words, the age in which the adenoid and tonsillar surgery is carried out. Our study tries to analyze the impact of the tonsillar surgery on the serum levels of immunoglobulins. MATERIAL AND METHODS: We present a prospective study with 89 healthy children aged between 4 to 10 years. Immunoglobulin G, A and M levels were measured preoperatively, at a month and at four months after adenoidectomy and/or tonsillectomy. RESULTS: Serum IgG levels dropped after surgery, but partially recovered four months later. IgA dropped less significantly and IgM did not change its levels. No one of the studied inmunoglobulins dropped below the normal serum levels. DISCUSSION/CONCLUSIONS: Adenoid and tonsilar surgery cause a fall of postoperative immunoglobulin G and A serum levels, partially recovering after four months. Serum levels never dropped below normal levels, and of the studied children suffered a postoperative disease due to immunodeficiency (AU)