Impact of Specific Training in Anaphylaxis for Triage Nursing Staff in the Pediatric Emergency Department of a Tertiary Hospital.

BACKGROUND: After a diagnosis of anaphylaxis, patients receive action management plans to prevent and treat new episodes, including attending the emergency department for follow-up or further treatment. In a previous study, we observed that more than half of the children with anaphylaxis were incorrectly prioritized in our Pediatric Emergency Unit (PEU), thus delaying their treatment. In conjunction with our PEU staff, we designed a basic educational intervention (BEI) to try to solve this problem. We analyzed the effect of the intervention on triage of children subsequently diagnosed with anaphylaxis. METHODS: Our BEI consisted of a training lecture given to the PEU triage nurses and the design of a reference card highlighting symptoms and risk factors of anaphylaxis. We included 138 children with a medical diagnosis of anaphylaxis and assessed modifications in their triage priority level and waiting times (WT) before seeing a physician after our intervention. According to the BEI implementation date, 69 children were diagnosed before the intervention (G1) and 69 after (G2). Clinical data were compared to assess the severity of the episodes. RESULTS: There were no differences between the groups. WT decreased (from 8 to 1 minute; P=.03), and the number of correctly identified patients increased after the BEI (36.2% [G1] and 72.2% [G2]; P=.0001). CONCLUSIONS: Our BEI was effective, improving the identification and prioritization of children with anaphylaxis and reducing their WT. We need to pay attention to the functioning of our patients' reference emergency department and establish interdisciplinary measures that enable optimal management of anaphylaxis.

Impact of specific training in anaphylaxis for triage nursing staff in the Pediatric Emergency Department of a Tertiary Hospital

Background: After a diagnosis of anaphylaxis, patients receive action management plans to prevent and treat new episodes, including attending the emergency department for follow-up or further treatment. In a previous study, we observed that more than half of the children with anaphylaxis were incorrectly prioritized in our Pediatric Emergency Unit (PEU), thus delaying their treatment. In conjunction with our PEU staff, we designed a basic educational intervention (BEI) to try to solve this problem. We analyzed the effect of the intervention on triage of children subsequently diagnosed with anaphylaxis. Methods: Our BEI consisted of a training lecture given to the PEU triage nurses and the design of a reference card highlighting symptoms and risk factors of anaphylaxis. We included 138 children with a medical diagnosis of anaphylaxis and assessed modifications in their triage priority level and waiting times (WT) before seeing a physician after our intervention. According to the BEI implementation date, 69 children were diagnosed before the intervention (G1) and 69 after (G2). Clinical data were compared to assess the severity of the episodes. Results: There were no differences between the groups. WT decreased (from 8 to 1 minute; P=.03), and the number of correctly identified patients increased after the BEI (36.2% [G1] and 72.2% [G2]; P=.0001). Conclusions: Our BEI was effective, improving the identification and prioritization of children with anaphylaxis and reducing their WT. We need to pay attention to the functioning of our patients' reference emergency department and establish interdisciplinary measures that enable optimal management of anaphylaxis

Introducción: Tras un diagnóstico de anafilaxia los pacientes reciben planes de tratamiento para prevenir y tratar nuevos episodios, que incluyen acudir a Urgencias para control o tratamiento subsiguientes. Previamente, nuestro grupo había observado que más de la mitad de los niños con anafilaxia eran priorizados incorrectamente en nuestra Unidad de Urgencias de Pediatría (UP). Elaboramos, en colaboración con el personal de UP, una intervención educativa básica (IEB) para resolver el problema. Analizamos el efecto de dicha intervención en el triaje de los niños atendidos posteriormente por anafilaxia. Métodos: Nuestra IEB consistió en una sesión clínica para el personal de enfermería responsable del triaje y diseñamos una Reference Card destacando síntomas y factores de riesgo de anafilaxia.Incluimos 138 niños con diagnóstico de anafilaxia, analizando los cambios en el nivel de prioridad, tiempos de espera para valoración médica (TEM) tras nuestra IEB. Según la fecha de implementación, 69 niños fueron atendidos antes (G1) y el resto después (69). Se compararon además los datos clínicos de los episodios. Resultados: No hubo diferencias en los datos clínicos entre grupos. Los TEM disminuyeron (de 8 a 1 minutos [p: 0,03]), incrementándose las cifras de pacientes priorizados correctamente (36,2% [G1] y 72,2% [G2][p=0,0001]) tras nuestra intervención. Conclusiones: Nuestra EIB ha sido eficaz, mejorando la identificación, priorización de los niños con anafilaxia y reduciendo los TEM. Debemos conocer el funcionamiento de los Servicios de Urgencias de referencia para nuestros pacientes y establecer medidas multidisciplinarias que optimicen el manejo de la anafilaxia

Enfermedad de Bruton de diagnóstico precoz: importancia de una adecuada historia clínica y los antecedentes familiares / Early diagnosis of Bruton's disease: the importance of an adequate medical and family history

La enfermedad de Bruton o agammaglobulinemia ligada al cromosoma X es una inmunodeficiencia primaria que cursa con la disminución drástica o la inexistencia de inmunoglobulinas en la sangre periférica. Esto va a originar una predisposición a desarrollar infecciones bacterianas recurrentes en el periodo de lactancia. Lo más importante y complejo a su vez es establecer el diagnóstico de sospecha, ya que se trata de una enfermedad infrecuente que cursa con manifestaciones muy comunes, como son las infecciones. Una vez sospechada la enfermedad, es importante derivar al paciente a un centro especializado para realizar los análisis pertinentes; en primer lugar, un análisis de sangre con recuento de inmunoglobulinas, y si están descendidas hay que solicitar la determinación de subpoblaciones linfocitarias mediante citometría de flujo. El diagnóstico de certeza se establece mediante análisis genéticos. El tratamiento consiste en la administración temprana de gammaglobulina intravenosa. Presentamos el caso de un paciente en el que una buena historia clínica permitió un diagnóstico precoz de enfermedad de Bruton, previo a la aparición de potenciales complicaciones (AU)

Bruton’s disease or X-linked agammaglobulinemia (XLA) is a primary immunodeficiency characterized by severe hypogammaglobulinemia. This causes increased susceptibility to bacterial recurrent infections at young age. It is very important, but difficult, to establish a diagnosis based on suspicion because of the common clinical symptoms of this rare disease. Once XLA is suspected, it is very important to refer the patient to a specialized hospital for specific analysis to confirm the disease. First, a blood analysis is done to see if antibody levels are low. In that case, a fluorocytometric analysis is needed to study the antibody classes. Genetic analysis shows mutation of BTK gene resulting in defective B cell differentiation and it must be done for diagnosis certainty. Treatment is based on intravenous immunoglobulin administration for life. We report a case in which a good clinical history was the key for an early diagnosis and treatment of a patient with Bruton´s disease before any potential complications appeared (AU)

Incidencia y evolución del trombo intraprótesis tras reparación endovascular de aneurismas aortoilíacos infrarrenales / Incidence and outcome of intraprosthetic thrombus after endovascular infrarenal aortoiliac aneurysms repair

INTRODUCCIÓN Y OBJETIVOS: La formación de trombo intraprótesis (TI) tras reparación endovascular de aneurismas aortoilíacos infrarrenales (EVAR) es un hallazgo frecuente cuya repercusión clínica no está definida. OBJETIVO: Conocer la incidencia de formación de TI, su curso clínico y la existencia de factores predisponentes. MATERIAL Y MÉTODOS: Desarrollamos un estudio observacional retrospectivo. Entre febrero de 2009 y junio de 2014, realizamos 184 EVAR con endoprótesis Endurant II(R), excluyendo aquellos con seguimiento inferior a 5 meses. Recogimos factores de riesgo cardiovascular, antiagregación/anticoagulación, anatomía del aneurisma, configuración y tamaño del dispositivo, ratio de diámetros distal y proximal del dispositivo, presencia de endofuga y de TI durante el seguimiento, evolución del TI, complicaciones isquémicas y reintervenciones. Analizamos variables cualitativas con tablas de contingencia y chi-cuadrado y variables continuas, con t de Student. Análisis actuarial y log-rank para supervivencia, aparición de complicaciones y reintervención. RESULTADOS: Obtuvimos un seguimiento medio de 20,87 meses. Desarrollaron TI en 81 pacientes (44%). Solo encontramos relación con cáncer activo (p = 0,003; OR 3,639; IC 95%; 1,501-8,825), tratamiento anticoagulante (p = 0,006; OR 0,257; IC 95%; 0,092-0,715) y endofugas tipo II (p = 0,013; OR 0,406; IC 95%; 0,197-0,836). En 6 pacientes el trombo desapareció durante el seguimiento (7%). Las tasas de complicación y reintervención en función de presencia o ausencia de TI no mostraron diferencias significativas. CONCLUSIÓN: El TI es un hallazgo frecuente que no parece tener repercusión clínica significativa. La anticoagulación y la endofuga tipo II se presentan como factores protectores y el cáncer activo, como factor predisponente

INTRODUCTION: Although the appearance of intraprosthetic thrombus after endovascular infrarenal aortoiliac aneurysms repair is common, its clinical impact is not well defined. OBJECTIVE: Endoprosthetic thrombus prevalence, clinical impact and possible related factors. MATERIAL AND METHODS: A retrospective review was conducted on 184 Endurant type II stent grafts implanted between Feb/09 and Jun/14. Patients with a follow up less than 5 months were excluded. A record was made of cardiovascular risk factors, treatment, anatomy of aneurysms, endoprosthesis features, prosthetic thrombus appearance and behaviour, endoleaks, ischaemic events, and re-interventions. RESULTS: The mean follow up was 20.87 months. Intraprosthetic thrombus was observed in 81 patients (44%). Related factors: active cancer (P=.003; OR 3.639; 95% CI; 1.501-8.825), anticoagulation therapy (P=.006; OR 0.257; 95% CI; 0,092-0,715) and type II endoleaks (P=.013; OR 0.406; 95% CI; 0.197-0.836). The thrombus disappeared in 6 patients during follow up (7%). The thrombus group did not have a higher complication or re-intervention rate when compared with the non-thrombus group. CONCLUSION: Intraprosthetic thrombus occurs frequently. Its clinical behaviour seems benign. Risk factors: Active cancer. Protective factors: Anticoagulation therapy and type II endoleaks

Postoperative atrial fibrillation in non-cardiac and cardiac surgery: an overview.

Postoperative atrial fibrillation (POAF) is the most common perioperative cardiac arrhythmia. A major risk factor for POAF is advanced age, both in non-cardiac and cardiac surgery. Following non-cardiac surgery, it is important to correct reversible conditions such as electrolytes imbalances to prevent the occurrence of POAF. Management of POAF consists of rate control and therapeutic anticoagulation if POAF persists for > 48 h and CHADS2 score > 2. After cardiac surgery, POAF affects a larger amount of patients. In addition to age, valve surgery carries the greatest risk for new AF. Rate control is the mainstay therapy in these patients. Prediction, prevention, and management of POAF should be further studied.

Aplicabilidad de las nuevas tecnologías a pacientes claudicantes. CReTe: Claudicantes y registro telemático / Using the new technologies in claudication patients: CReTe: Claudication patients and telematic register

OBJETIVO: Presentamos una aplicación informática para teléfonos móviles ideada para el control de sesiones de ejercicio domiciliario en claudicantes. Exponemos también nuestros resultados preliminares. MATERIAL Y MÉTODOS: La aplicación está diseñada para teléfonos móviles con sistema operativo Android, tecnología de geolocalización y conexión de datos. Está conectada a una base de datos codificada que preserva el secreto médico. Los datos que se recogen de las sesiones de ejercicio son la fecha, la hora de inicio y de fin, el tiempo dedicado, el número de las paradas realizadas y la velocidad máxima, la velocidad media global y la velocidad entre paradas. Durante el mes de enero de 2014 se reclutó a aquellos pacientes que aceptaran el estudio, poseyeran y entendieran un dispositivo móvil Android con geolocalización y conexión de datos. Los criterios de exclusión del estudio una vez comenzado fueron progresión hacia isquemia arterial crítica, enfermedad intercurrente grave, fallecimiento y ausencia de comunicación con el paciente. Se recogieron las principales morbilidades y los resultados de los cuestionarios de calidad de vida SF36 y EuroQol 5D. Se midió el tiempo de primera consulta y el tiempo dedicado por semana y paciente durante un seguimiento de 28 días. Se calculó el cumplimiento de las sesiones con respecto a las sesiones pactadas con cada paciente, con un mínimo de 2 semanales. RESULTADOS: Un total de 5 pacientes fueron incluidos, con edad media de 59,3 años (mediana 52; rango 40-80). De ellos 2 se excluyeron, uno por progresión a isquemia crítica y otro por ausencia de comunicación. El tiempo medio dedicado por consulta nueva fue de 29,1 min (mediana 27,5; rango 45-20). El cumplimiento de las sesiones fue del 100% en 2 pacientes y del 63% en otro. El tiempo dedicado en el seguimiento semanal por paciente fue de 1,68 min. CONCLUSIONES: CReTe es una herramienta aplicable a nuestro medio que precisa de estudios mayores para demostrar su utilidad

OBJECTIVE: The preliminary results are presented on the use of a new application for mobile phones designed to control home exercise sessions in claudication. MATERIALS AND METHODS: The application is designed for Android systems with geolocation technology and Internet connection. It is connected to a database encoded to ensure medical confidentiality. The data collected from the exercise sessions were the date, start time and end time, the time spent, the number of stops made, and the maximum speed, average speed and overall speed between stops. During the month of January 2014 patients who accepted and understood the study, and possessed an Android mobile device with geolocation and data connection, were enrolled. The exclusion criteria, 11 the study started, were progression to arterial ischemia, severe intercurrent illness, non-communication with the patient, and death. Major morbidities and results of quality of life questionnaires SF36 and EuroQol 5 D were collected. Time of first consultation and time spent per week per patient during a 28-day follow-up was recorded. Compliance as regards the agreed sessions was calculated for each patient, with a minimum of 2 weeks. RESULTS: The study included 5 patients with a mean age 59.3 years (median 52; range 40-80). Of these, 2 were excluded, one for progression to critical ischemia and another for non-communication. The average time spent in a new consultation was 29.1 minutes (median 27.5, range 45-20). The compliance with the sessions was 100% in 2 patients, and 63% in another. Time spent in the weekly monitoring per patient was 1.68 minutes. CONCLUSIONS: CReTe is an applicable tool in our environment that requires further study to demonstrate its usefulness

Accidentes neurológicos tras esclerosis de varices: a propósito de un caso / Neurological accidents after sclerosis of varicose veins: Presentation of a case

No disponible

Tratamiento con trombina de seudoaneurisma femoral poscateterismo en neonato / Treatment of a postcatheter femoral pseudoaneurysm with thrombin in a newborn

No disponible

Uso de plasma rico en plaquetas para cicatrización de úlceras crónicas de miembros inferiores / Use of Platelet-Rich Plasma in the Healing of Chronic Ulcers of the Lower Extremity

INTRODUCCIÓN Y OBJETIVOS: El plasma rico en factores plaquetarios (PRP) ha sido utilizado como terapia adyuvante en el tratamiento de úlceras crónicas de miembros inferiores (UCMI), con resultados particularmente esperanzadores en las úlceras neuropáticas. Sin embargo, su uso en úlceras venosas e hipertensivas ha sido menos estudiado. Nuestro objetivo es valorar la seguridad y factibilidad del uso del PRP en UCMI y estimar sus beneficios en la cicatrización dirigida. MATERIAL Y MÉTODOS: Se trata de un estudio prospectivo. Fueron seleccionados 11 pacientes con úlceras en miembros inferiores de más de 6 semanas de evolución, de etiología no isquémica. Se administró PRP en inyección subcutánea perilesional y aplicación tópica, en 4 sesiones separadas por una semana. Se suministraron cuestionarios de calidad de vida (SF-12), se registró el dolor (escala visual analógica) y el perímetro de la úlcera antes y después de su aplicación. RESULTADOS: Hubo predominancia de mujeres (8/11 = 73%) y de úlceras venosas (7/11 = 64%) sobre las hipertensivas (4/11 = 36%). La mediana de edad fue de 79 años y el tiempo medio de evolución de la úlcera de 17 meses (6-108 meses). Se evidenció una disminución estadísticamente significativa del dolor (p < 0,05) y mejoría mental y física de la calidad de vida (p < 0,05). Se evidenció una reducción media en el área de las úlceras del 60%, con 5 cicatrizaciones completas. No se registraron eventos adversos. CONCLUSIÓN: La aplicación local de PRP en úlceras crónicas de miembros inferiores representa una herramienta válida, de uso práctico en la cicatrización dirigida, que puede mejorar la calidad de vida de estos pacientes, siendo particularmente útil en el control del dolor local

INTRODUCTION AND OBJECTIVES: Platelet-rich plasma (PRP) is used as an adjuvant in the treatment of chronic ulcers of the lower extremity and has shown particularly promising results in the case of neuropathic ulcers. There has been less research, however, into its use in venous and hypertensive ulcers. Our aim was to assess the safety and feasibility of using PRP in the treatment of chronic ulcers of the lower extremity and to evaluate its potential benefits in directed healing. MATERIAL AND METHODS: We prospectively selected 11 patients with nonischemic ulcers of the lower extremity that had been present for at least 6 weeks. PRP was injected subcutaneously into the perilesional tissue and applied topically in 4 sessions held at 1-week intervals. We assessed quality of life (SF-12 questionnaire), pain (visual analog scale), and the circumference of the ulcer before and after treatment. RESULTS: There was a predominance of women (8/11, 73%), and venous ulcers (7/11, 64%) were more common than hypertensive ulcers (4/11, 36%). The median age of the patients was 79 years and the median time since onset of the ulcer was 17 months (range, 6-108 months). We observed a significant reduction in pain (P < 0.05) and a significant improvement in the physical and mental components of the SF-12 (P < 0.05). The mean reduction in ulcer size was 60%, and complete healing was achieved in 5 cases. No adverse effects were observed. CONCLUSION: The local application of PRP is a valuable and practical procedure that promotes the healing of chronic ulcers of the lower extremity; it can improve patient quality of life and is particularly effective in local pain relief

Use of platelet-rich plasma in the healing of chronic ulcers of the lower extremity.

INTRODUCTION AND OBJECTIVES: Platelet-rich plasma (PRP) is used as an adjuvant in the treatment of chronic ulcers of the lower extremity and has shown particularly promising results in the case of neuropathic ulcers. There has been less research, however, into its use in venous and hypertensive ulcers. Our aim was to assess the safety and feasibility of using PRP in the treatment of chronic ulcers of the lower extremity and to evaluate its potential benefits in directed healing. MATERIAL AND METHODS: We prospectively selected 11 patients with nonischemic ulcers of the lower extremity that had been present for at least 6 weeks. PRP was injected subcutaneously into the perilesional tissue and applied topically in 4 sessions held at 1-week intervals. We assessed quality of life (SF-12 questionnaire), pain (visual analog scale), and the circumference of the ulcer before and after treatment. RESULTS: There was a predominance of women (8/11, 73%), and venous ulcers (7/11, 64%) were more common than hypertensive ulcers (4/11, 36%). The median age of the patients was 79 years and the median time since onset of the ulcer was 17 months (range, 6-108 months). We observed a significant reduction in pain (P<.05) and a significant improvement in the physical and mental components of the SF-12 (P<.05). The mean reduction in ulcer size was 60%, and complete healing was achieved in 5 cases. No adverse effects were observed. CONCLUSION: The local application of PRP is a valuable and practical procedure that promotes the healing of chronic ulcers of the lower extremity; it can improve patient quality of life and is particularly effective in local pain relief.

Evolución del uso de técnicas endovasculares para revascularización infrainguinal de miembros inferiores en el periodo 2005-2011. Experiencia de nuestro centro / Development in the use of endovascular techniques for the infrainguinal revascularisation of lower limbs in the period 2005-2011: Experience for a single center

Introducción: Las intervenciones endovasculares en el sector infrainguinal han experimentado una tendencia creciente. Objetivo: Describir la evolución que ha sufrido el uso de los procedimientos endovasculares infrainguinales en nuestro centro desde su introducción en el año 2005 hasta la actualidad. Material y métodos: De 6.867 procedimientos, fueron seleccionados los 391 de revascularización infrainguinal. Estudio de corte transversal, revisando los registros de quirófano a través de los protocolos quirúrgicos e historias clínicas, clasificándolos en procedimientos endovasculares y abiertos. Se revisó el compromiso clínico y el éxito técnico morfológico de los procedimientos endovasculares para compararlos durante el periodo. Resultados: El 81,32% fueron intervenidos por isquemia crítica. Se evidenció una tendencia al aumento global de procedimientos de revascularización infrainguinal, fundamentalmente a expensas de los endovasculares, los cuales se incrementan tanto en números absolutos como en proporción con los procedimientos abiertos (23,4 a 58,5%; p < 0,05). También se observó un leve aumento de la tasa de éxito técnico al comparar el inicio y el final del periodo, aunque no estadísticamente significativo (p = 0,37). Conclusiones: El uso de técnicas endovasculares en la revascularización de miembros inferiores en nuestro centro ha ido en claro aumento en los últimos años, presentando una tendencia a seguir incrementándose. Aunque no poseemos datos que nos permitan asegurarlo, pensamos que el uso de estos procedimientos puede ser un factor importante en el aumento de pacientes candidatos a revascularización de miembros inferiores observado en nuestra serie (AU)

Introduction: There is a growing trend in the number of infrainguinal endovascular revascularisations being performed in recent years. Objective: The primary aim of this study is to describe the development of the use of endovascular procedures for infrainguinal revascularisation in a hospital centre since its introduction in 2005 to the present date. Material and methods: A study was conducted on the 391 infrainguinal revascularisations performed out of a total of 6.867 procedures. A cross-sectional study was performed by reviewing surgery records, surgical protocols, and medical histories, and sorting them into endovascular and open surgery. Clinical compromise and morphological technical success were analysed in the endovascular procedures group in order to compare them over the study period. Results: A large majority (81.32%) presented as critical limb ischaemia. An increasing trend was observed in the number infrainguinal revascularization procedures performed, mainly at the expense of the endovascular group, which increased both in absolute numbers and proportionally compared to open surgery procedures (23.4% to 58,5%; P<0.05). A slight increase in the rate of technical success was also noted when comparing the beginning and the end of the period, although this was not statistically significant (P=0.37). Conclusions: The use of endovascular techniques in lower limb revascularisation in our institution has experienced a marked growth in recent years, with a tendency to increase further. Although we do not have the necessary data to ensure this, we believe that the use of these procedures may be an important factor in the increasing number of candidates for the lower limb revascularisations observed in our series (AU)

Serie de casos. Experiencia de un único centro en el tratamiento de fístulas aortoentéricas / A case series. Experience of a single centre in the treatment of aortoenteric fistulas

Objetivo: Analizar nuestra experiencia y resultados obtenidos en una patología infrecuente, compleja y grave como la fístula aortoentérica (FAE). Material y métodos: La patología aórtica previa y su tratamiento fueron: 4 síndromes de Leriche y 2 aneurismas de aorta y un aneurisma roto tratados con bypass aortobifemoral y dos endovascular aneurysms repair (EVAR). Otros datos recogidos fueron: factores de riesgo cardiovascular, patología y cirugía abdominal previa, la localización de FAE secundaria, periodo de tiempo hasta la FAE, evolución y recidivas. Nueve pacientes (7 hombres y 2 mujeres) con fístula secundaria aortoentérica tratados durante el periodo 2000-2010 se agruparon en función de la estabilidad hemodinámica: 3 hombres estables, 4 hombres y 2 mujeres inestables. Resultados: Las FAE secundarias aparecieron tras una media de tiempo de 85,8 meses (mediana: 104; rango: 5-204). Cuatro se trataron con bypass extra-anatómico, 3 inestables. Tres pacientes con reparación in situ, 2 inestables. Dos de forma endovascular, uno inestable. Hubo una muerte intra-quirófano, inestable, y durante los primeros 30 días fallecieron otros 4 pacientes, 3 inestables y uno estable. Los 4 pacientes que sobrevivieron sufrieron una recidiva de la FAE tras tres meses de media (intervalo: 2-5); solo dos se trataron, uno con endoprótesis y otro con bypass axilobifemoral. Conclusiones: La FAE secundaria es una complicación grave, rara y compleja, con una alta morbilidad y mortalidad. No existe un tratamiento estándar, aunque es fundamental el tratamiento urgente de la hemorragia, incluyendo la terapia endovascular, con o sin una nueva intervención para el tratamiento definitivo(AU()

Objective: To analyse our experience and results of a rare, complex and serious disease, aortoenteric fistula (AEF). Material and methods: Nine patients (seven males and two females) with secondary aortoenteric fistula treated during the period 2000-2010, were grouped according to hemodynamic stability: stable three males. Four males and two females were unstable. Previous aortic pathology and its treatment were: four Leriche syndrome, two aortic aneurysms and a ruptured aortic aneurysm treated by aortobifemoral bypass and two EVAR (endovascular aneurysms repair). Other data collected: cardiovascular risk factors, previous abdominal pathology and its surgery, the location of the secondary AEF, period of time until the appearance of AEF, evolution and recurrence. Results: The secondary AEF appeared after a mean time of 85.8 months (median 104, range 5-204). Four were treated with extra-anatomical bypass, and three were unstable. Three patients with in situ repair, two unstable. Two with endograft, one unstable. There was one death during surgery, unstable, and during the first 30 days, four patients died, 3 unstable, one stable. The four surviving patients had a recurrence of the AEF after a mean of three months (range, 2-5), only two were treated, one patient with endograft and one with axilobifemoral bypass. Conclusions: Secondary AEF is a serious, rare and complex complication, with high morbidity and mortality. No standard treatment exists, although the urgent treatment of bleeding is essential, including endovascular therapy, with or without a new intervention for definitive treatment(AU)

Comprehensive comparison of various techniques for the analysis of elemental distributions in thin films.

The present work shows results on elemental distribution analyses in Cu(In,Ga)Se2 thin films for solar cells performed by use of wavelength-dispersive and energy-dispersive X-ray spectrometry (EDX) in a scanning electron microscope, EDX in a transmission electron microscope, X-ray photoelectron, angle-dependent soft X-ray emission, secondary ion-mass (SIMS), time-of-flight SIMS, sputtered neutral mass, glow-discharge optical emission and glow-discharge mass, Auger electron, and Rutherford backscattering spectrometry, by use of scanning Auger electron microscopy, Raman depth profiling, and Raman mapping, as well as by use of elastic recoil detection analysis, grazing-incidence X-ray and electron backscatter diffraction, and grazing-incidence X-ray fluorescence analysis. The Cu(In,Ga)Se2 thin films used for the present comparison were produced during the same identical deposition run and exhibit thicknesses of about 2 µm. The analysis techniques were compared with respect to their spatial and depth resolutions, measuring speeds, availabilities, and detection limits.

[Eosinophilic gastroenteritis: two cases report]. / Gastroenteritis eosinofílica: a propósito de dos casos.

Eosinophilic gastroenteritis is a rare condition characterized by eosinophilic infiltration or the different layers of the intestinal wall. Clinical symptoms depend of the site of eosinophilic infiltration and the layers involved. Usually characterized by peripheral eosinophilia. Definitive diagnosis is based on histopathological findings. We report two cases with excellent response to steroid therapy.

Polineuropatía subaguda como forma de presentación de sarcoidosis / Subacute polyneuropathy as presentation of sarcoidosis

No disponible

Gastroenteritis eosinofílica: a propósito de dos casos / Eosinophilic gastroenteritis: two cases report

La gastroenteritis eosinofílica es una enfermedad poco frecuente, caracterizada por la presencia de un infiltrado eosinófilo que puede afectar a las distintas capas de la pared intestinal. Las manifestaciones clínicas son variables y los síntomas dependen del grado de infiltración y del número de capas afectadas. Se caracteriza por presentar, en la mayoría de los casos, eosinofília periférica. Su diagnóstico definitivo es anatomopatologico. Aportamos dos casos, ambos con excelente respuesta al tratamiento esteroideo (AU)

The effect of sodium citrate intake on anaerobic performance in normoxia and after sudden ascent to a moderate altitude.

BACKGROUND: The effect of sodium citrate intake on anaerobic performance in normoxia and acute hypoxia was tested in 17 healthy male subjects. METHODS: The subjects underwent a high-intensity exercise protocol in conditions of normoxia (N) and at 2320 m above the sea level (H). Each condition was combined with the intake of a placebo (Pl) or sodium citrate (C). RESULTS: The results obtained showed a drop in the maximum HR (p<0.001), due to the effect of the altitude (185+/-8 vs 176+/-8 bpm for N and H under Pl conditions and 189+/-9 vs 178+/-8 bpm for N and H under C conditions). C caused an increase in the RER (p<0.05) and the maximum Lac (p<0.01). The action of this same factor brought about a drop in the maximum VE (p<0.01) (182.60+/-21.58 vs 177.38+/-20.29 l x min(-1) in N and 185.71+/-22.98 vs 179.06+/-22.91 l x min(-1) in H). The interaction of both C and H affected the maximum concentration of lactate obtained (p<0.01), which fell as regards that expected by the corresponding action of both factors separately (14.33+/-2.94 vs 17.8+/-2.74 mMol x l(-1) with Pl and C in N and 15.29+/-2.15 vs 15.54+/-2.59 mMol x l(-1) in H). There were no significant differences in the length of work time in each of the conditions established. CONCLUSIONS: It would, therefore, seem that in the conditions described, the intake of sodium citrate does not cause appreciable changes in anaerobic performance.

[Measurement and comparison of the rheumatoid factors class IgG, IgM and IgA in chronic juvenile rheumatoid arthritis]. / Medida y comparación del factor reumatoide de clase IgG, IgM e IgA en artritis crónica juvenil.

The rheumatoid factor (RF) was studied in 35 sera from 23 children with juvenile rheumatoid arthritis (JRA). The immunoglobulin class of RF was investigated and also its reactivity to both human and rabbit IgG. The RF of IgG class (IgG-RF) was more frequently positive than the IgM-RF and the IgA-RF. Nevertheless, against human IgG we found IgM-RF in the 51% of sera and IgA-RF in 48%, and against rabbit IgG in 65 and 37% respectively. All classes of RF were more frequent in rheumatoid patients than in normal controls (p less than 0.0005) although the IgA-RF increase was not significant in some groups. The specificity of the 5 RF types was always very high (92-100%). The sensibility ranged between 71% (IgG-RF against rabbit IgG) and the 37% (IgA-RF against rabbit IgG). Most sera simultaneously contained more than one class of RF. Against human IgG, the 37% had 2 classes. When we used rabbit IgG, the 31% had 3 classes and the 62% had 2 classes. The correlation of every RF class each other generally was very high (p less than 0.001). A correlation was also present in the seronegative and the systemic group, when we separately studied every clinic form. The ELISA allows detect positive IgG-RF and IgA-RF in seronegative cases by agglutination tests, therefore the seronegative concept must be reconsidered. The correlation among different RF classes are, frequently, very closed.

[Health care for the children population in Asturias based on levels and health care areas. Primary health care]. / La asistencia a la población infantil en Asturias por niveles y áreas sanitarias. Atención primaria.

The resources available to the public health network in Asturias are presented for each health area in the level of pediatric primary care. Demographic analysis, age distribution and density of the ageing index for health areas are reported. In addition, the coverage, the number of families and children of care per physician, the rate of children per family, the care demand and the frequentation are evaluated. Imbalances are disclosed between the health centers and the outpatients clinics and between the health areas. The most important changes to be effected are pointed out.