Incidence and prognostic impact of U2AF1 mutations and other gene alterations in myelodysplastic neoplasms with isolated 20q deletion.

BACKGROUND: In myelodysplastic neoplasms (MDS), the 20q deletion [del(20q)] is a recurrent chromosomal abnormality that it has a high co-occurrence with U2AF1 mutations. Nevertheless, the prognostic impact of U2AF1 in these MDS patients is uncertain and the possible clinical and/or prognostic differences between the mutation type and the mutational burden are also unknown. METHODS: Our study analyzes different molecular variables in 100 MDS patients with isolated del(20q). RESULTS & CONCLUSIONS: We describe the high incidence and negative prognostic impact of U2AF1 mutations and other alterations such as in ASXL1 gene to identify prognostic markers that would benefit patients to receive earlier treatment.

An overview of patterns and dynamics of suspended sediment transport in an agroforest headwater system in humid climate: Results from a long-term monitoring.

Small headwater catchments deliver large quantities of suspended sediment (SS) to the ocean. However, there are relatively few studies focused on the study of patterns and dynamics of suspended sediment in headwater catchments over the long-term (10 year or more). In this study, the dynamics of suspended sediment transport were examined at different time scales in a small headwater catchment in NW Spain, based on a 12-year dataset from high-resolution monitoring. The results revealed that, similar to other humid catchments, the hydrological response was highly dependent on initial conditions, especially in autumn and summer. However, in winter and spring the hydrology was more influenced by rainfall amount. The annual suspended sediment was 117 Mg, which equates to a suspended sediment yield of 10 Mg km-2 y-1. The SS yield in the Corbeira catchment is related to runoff generation and flooding, which play a key role in sediment yield from the catchment. About 80% of the annual SS was transported over 12% of the study period. Rainfall and discharge at the beginning of the events were the most important factors in explaining the hydrological response at event scale. Suspended sediment transport in this catchment is determined by event magnitude, while the SS is mainly influenced by variables related to runoff erosivity.

Aluminum fractionation in acidic soils and river sediments in the Upper Mero basin (Galicia, NW Spain).

This study aims to determine aluminum fractions in the fine earth of acidic soils under different land uses (forest, pasture and cultivation) and in the river bed sediments of the headwater of the Mero River in order to identify and quantify Al-bearing phases to assess Al mobility and potential bioavailability (environmental availability) in the monitoring area. Sequential extraction is used to evaluate the Al partitioning into six fractions operationally defined: soluble/exchangeable/specifically adsorbed, bound to manganese oxides, associated with amorphous compounds, aluminum bound to oxidizable organic matter, associated with crystalline iron oxides, and residual fraction (aluminum within the crystal lattices of minerals). The mean concentration of total aluminum (24.01 g kg-1) was similar for the three considered uses. The mean percentage of the aluminum fractions, both in soils and sediments, showed the following order: residual fraction â‰« amorphous compounds ≈ crystalline iron oxides > water-soluble/exchangeable/specifically adsorbed > bound to oxidizable organic matter ≈ Mn oxides. However, in the soils, the amorphous compounds and water-soluble/exchangeable/specifically adsorbed fraction showed considerable differences between some types of uses, the percentage of aluminum linked to amorphous compounds being higher in forest soils (16% of total Al) compared to other uses (mean about 8% of total Al). The highest values of water-soluble/exchangeable/specifically adsorbed Al were also found in forest soils (mean 8.6% of the total Al versus about 4% of pasture and cultivation), which is consistent with the lower pH and higher organic matter content in forest soils. Nevertheless, the potentially bioavailable fraction (sum of the first three fractions) is low, suggesting very low geoavailability of this element in both soils and sediments; hence, the possibility to affect the crops and water quality is minimal.

Guía de actuaciones sanitarias frente a la mutilación genital femenina

Guía que proporciona al colectivo de profesionales los conocimientos generales necesarios sobre la mutilación genital femenina (MGF): su definición, los tipos existentes, cómo y dónde se practica, por qué se realiza y las consecuencias que tiene sobre la salud de las mujeres y las niñas, marco legal existente tanto en nuestro país como en el contexto internacional, situación en la Comunidad de Madrid (número de mujeres y niñas procedentes de países afectados y distribución dentro de nuestra comunidad) y pautas de actuación tanto para la prevención como para la correcta atención a mujeres y/o niñas supervivientes a la MGF.

Short-term nitrogen losses by overland flow in a recently burnt forest area in north-central Portugal: A study at micro-plot scale.

Over the past decades, wildfires have affected extensive areas of the Mediterranean region with negative impacts on the environment. Most of the studies on fire-affected areas have focused on sediment losses by overland flow, whereas few have addressed post-fire nutrient export. The present study aimed to address this research gap by assessing nitrogen (nitrate and total nitrogen) losses by overland flow in a recently burnt area in north-central Portugal. To this end, three burnt slopes were selected for their contrasting forest types (eucalypt vs. pine) and parent materials (granite vs. schist). The selected study sites were a eucalypt site on granite (BEG), a eucalypt site on schist (BES) and a maritime pine site on schist (BPS). Overland flow samples were collected during the first six months after the wildfire on a 1- to 2-weekly basis, after which this study had to be cancelled due to bench terracing of some of the sites. A peak in total nitrogen concentrations was observed in burnt areas immediately after the first post-fire rainfall event as a response to the erosion of the N-enriched ash layer. After this initial peak, smaller peaks were observed throughout the study period, mainly as a response to overland flow and/or erosion events. Nitrogen export differed strikingly between the two types of forests on schist, being higher at the eucalypt than at the pine site, due to the lack of a protective soil layer. Parent material did not play an important role on nitrogen export by overland flow since no significant differences were found between the eucalypt sites on granite and schist. The present study provides some insight into the differences in post-fire soil fertility losses between forest types and parent materials in the Mediterranean region, which is crucial information for defining post-fire land management measures to reduce soil degradation.

Cation export by overland flow in a recently burnt forest area in north-central Portugal.

The current fire regime in the Mediterranean Basin constitutes a serious threat to natural ecosystems because it drastically enhances surface runoff and soil erosion in the affected areas. Besides soil particles themselves, soil cations can be lost by fire-enhanced overland flow, increasing the risk of fertility loss of the typically shallow and nutrient poor Mediterranean soils. Although the importance of cations for land-use sustainability is widely recognized, cation losses by post-fire runoff have received little research attention. The present study aimed to address this research gap by assessing total exports of Na(+), K(+), Ca(2+) and Mg(2+) in a recently burnt forest area in north-central Portugal. These exports were compared for two types of planted forest (eucalypt vs. maritime pine plantations), two types of parent materials (schist vs. granite) and for two spatial scales (micro-plot vs. hill slope). The study sites were a eucalypt plantation on granite (BEG), a eucalypt plantation on schist (BES) and a maritime pine plantation on schist (BPS). Overland flow samples were collected during the first six months after the wildfire. Cation losses differed strikingly between the two forest types on schist, being higher at the eucalypt than pine site. This difference was evident at both spatial scales, and probably due to the extensive cover of a needle cast from the scorched pine crowns. The role of parent material in cation export was less straightforward as it varied with spatial scale. Cation losses were higher for the eucalypt plantation on schist than for that on granite at the micro-plot scale, whereas the reverse was observed at the hill slope scale. Finally, cation yields were higher at the micro-plot than slope scale, in agreement with the general notion of scaling-effect in runoff generation.

Initial experience with stereotactic body radiation therapy for localized prostate cancer using helical tomotherapy.

PURPOSE: Single-institution single-arm prospective study. Endpoint: To assess whether there are more than 5 % of men having grade 3 GU or any grade 3 GI acute toxicity during stereotactic body radiation therapy (SBRT) for prostate cancer using helical tomotherapy. METHODS: Since May 2012, 17 prostate cancer patients were treated with helical tomotherapy. The exclusion criteria used are the following: Gleason score ≥8, PSA >20 ng/ml, cT3b-4, IPSS ≥20 and history of acute urinary retention. CTV included the prostate gland and 1 cm of seminal vesicles in the low-risk group (LR) or the seminal vesicles completely in the intermediate (IR) and high-risk (HR) NCCN groups. CTV margins ranged from 2 to 8 mm, while PTV margins were 2 to 9 mm. Patients received eight fractions of 5.48 Gy (LR) or 5.65 Gy (IR, HR) on alternate days. Total equivalent doses at 2 Gy per fraction are 87.4 for LR and 92.3 Gy for IR-HR using an α/ß value of 1.5. Correspondent figures for a α/ß of 3 are 74.3 Gy and 78.2 Gy, respectively. Megavoltage CT (MVCT) for on-line correction was taken before every fraction. RESULTS: The patient distribution by risk group is 29, 47 and 24 % for LR, IR and HR, respectively. 82 % received neoadjuvant-concomitant hormonal therapy. Acute GU toxicity grade 1, 2 and 3 was found in 70, 6 and 0 % of men. GI toxicity was observed in 50, 0 and 0. After 136 MVCT, the standard deviation of the mean individual corrections in the anterior-posterior direction was 2.5 mm. CONCLUSION: SBRT for prostate cancer using helical tomotherapy is feasible. Initial results show an early toxicity profile no worse than SBRT delivered with robotic radiosurgery or conventionally fractionated radiotherapy.

Phosphorus loss from a mixed land use catchment in northwest Spain.

This work examined P loss from a mixed land use catchment in northwest Spain and how it was related to hydrological factors. A stream draining a mixed land use catchment of 16 km in northwest Spain was monitored for 5 yr. Water samples were taken more frequently with increased stream flows. A total of 132 runoff events of different magnitudes were analyzed in this study. Mean annual P loss from the catchment was 11.5 kg km, about 68% being transported during runoff events, which only contributed to 29% of the flow. The contribution of runoff events to particulate P and dissolved P losses was 76 and 46% of total losses during the study period, respectively. A high interannual variability in P loss was observed, the differences being related to rainfall amount and distribution. At a seasonal scale, the highest P loads and concentrations were observed during rainy seasons; the lowest P loads occurred in summer because they occurred with stream flow. Particulate P accounted for the greatest proportion (74%) of transported P. There was a high variability in P transported between runoff events, with maximum discharge and discharge increase being the most important variables explaining total P concentration in these events through their effect on suspended sediment concentration.

El aborto en las mujeres inmigrantes. Una perspectiva desde los profesionales sociosanitarios que atienden la demanda en Madrid / Abortion in immigrant women: the perspective of the social and health professionals who deal with the demand in Madrid

La elevada fecundidad del importante contingente de mujeres inmigrantes residentes en España plantea el interés de explorar su contribución a la Interrupción Voluntaria del Embarazo (IVE), las circunstancias del embarazo que se interrumpe, las razones para hacerlo y las barreras que encuentran hasta realizarlo. Para ello se ha hecho en Madrid una encuesta en profundidad a profesionales que atienden la demanda de IVE en distintos puntos del circuito sociosanitario. En mujeres de otros países la IVE está muy asociada a su situación de inmigrantes: desde el fallo en la anticoncepción que conduce al embarazo hasta la imposibilidad de asumir el cuidado de la criatura. Destacan la inadecuación horaria de las consultas de anticoncepción, la burocratización del itinerario asistencial y la falta de transparencia de los criterios de financiación en un marco normativo restrictivo de escasos recursos públicos (AU)

The high fertility rate of immigrant women resident in Spain raises the question of studying how many elective abortions they have, the circumstances behind the pregnancy which they decide to interrupt, their reasons for having the abortion and the obstacles encountered. In-depth interviews of the professionals –both of social services and health care– who deal with the demand for elective abortions at different stages in the process were carried out in Madrid. For women from other countries, elective abortion is closely associated with their situation as immigrants: from the failure of birth control to the impossibility of caring for the baby. The most relevant problems are the opening hours of birth control services, the bureaucratisation of health care provision and the lack of transparency regarding financial criteria in a framework of legal restrictions and insufficient public resources (AU)

Insuficiencia respiratoria aguda debida a mixedema / Acute respiratory failure due to myxedema

No disponible

[Lung cancer at a university hospital: epidemiological and histological characteristics of a recent and a historical series]. / Características del cáncer de pulmón en un hospital universitario. Cambios epidemiológicos e histológicos en relación con una serie histórica.

OBJECTIVE: To describe the clinical, histological, and epidemiological characteristics of patients diagnosed with lung cancer in our hospital over a period of 5 years and compare them with those of historical cases treated at the same hospital. PATIENTS AND METHODS: The cases of patients diagnosed with lung cancer from January 1998 through December 2002 were studied retrospectively and compared with data published for the period from 1978 through March 1981. RESULTS: A total of 678 patients (89% men, mean age 67 years) were studied. Fifty-six percent of the men and 38% of the women were smokers (P<.001). The most common histological types were squamous cell carcinoma (33%) and adenocarcinoma (30%): squamous carcinoma in men (36%) and adenocarcinoma in women (56%). Metastasis was present in 42% of the patients with non-small cell lung cancer and in 55% of those with small cell lung cancer. In patients with a history of neoplastic disease, laryngeal tumors were most common in patients with squamous carcinoma whereas bladder tumors were the most frequent in patients with adenocarcinoma. The ratio of men to women was lower in the recent series than in the historical one. The percentage of squamous carcinoma was lower and that of adenocarcinoma higher (P<.001). The percentage of patients diagnosed with regional involvement was greater in the recent series (P<.001). CONCLUSIONS: Squamous cell carcinoma continues to be the most frequent histological type. Male sex and smoking are associated with squamous carcinoma and female sex is associated with adenocarcinoma. Epidemiological and histological patterns have changed, possibly in relation to changes in smoking habits.

Características del cáncer de pulmón en un hospital universitario. Cambios epidemiológicos e histológicos en relación con una serie histórica / Lung cancer at a university hospital: epidemiological and histological characteristics of a recent and a historical series

Objetivo: Describir las características clínicas, histológicas y epidemiológicas de los pacientes diagnosticados de cáncer de pulmón en nuestro hospital durante un período de 5 años y compararlas con las de una serie histórica del mismo centro. Pacientes y métodos: Se incluyó retrospectivamente a todos los pacientes diagnosticados de cáncer de pulmón desde enero de 1998 hasta diciembre de 2002, y se compararon con los datos obtenidos durante el período comprendido entre enero de 1978 y marzo de 1981. Resultados: El total de pacientes fue de 678 y la edad media, de 67 años. De los varones (89%), el 56% eran fumadores, y de las mujeres, el 62% eran no fumadoras (p < 0,001). Los tipos histológicos más frecuentes fueron el carcinoma escamoso (33%) y el adenocarcinoma (30%). El carcinoma escamoso fue el más frecuente en varones (36%) y el adenocarcinoma en mujeres (56%). En el momento del diagnóstico presentaban metástasis el 42% de los pacientes con carcinoma no microcítico y el 55% de los microcíticos. Las neoplasias previas más frecuentes fueron la de laringe entre los pacientes con carcinoma escamoso y la de vejiga entre los afectados de adenocarcinoma. Al comparar con la serie histórica observamos que actualmente la relación varón:mujer es menor, la proporción de carcinoma escamoso es inferior y la de adenocarcinoma superior (p < 0,001) y el porcentaje de pacientes diagnosticados en estadio regional es mayor (p < 0,001). Conclusiones: El tipo histológico más frecuente sigue siendo el carcinoma escamoso. Ser varón y fumador se asocia a carcinoma escamoso, y ser mujer, a adenocarcinoma. En comparación con la serie histórica observamos cambios en las características epidemiológicas e histológicas, posiblemente en relación con las modificaciones en el hábito tabáquico

Objective: To describe the clinical, histological, and epidemiological characteristics of patients diagnosed with lung cancer in our hospital over a period of 5 years and compare them with those of historical cases treated at the same hospital. Patients and Methods: The cases of patients diagnosed with lung cancer from January 1998 through December 2002 were studied retrospectively and compared with data published for the period from 1978 through March 1981. Results: A total of 678 patients (89% men, mean age 67 years) were studied. Fifty-six percent of the men and 38% of the women were smokers (P<.001). The most common histological types were squamous cell carcinoma (33%) and adenocarcinoma (30%): squamous carcinoma in men (36%) and adenocarcinoma in women (56%). Metastasis was present in 42% of the patients with non-small cell lung cancer and in 55% of those with small cell lung cancer. In patients with a history of neoplastic disease, laryngeal tumors were most common in patients with squamous carcinoma whereas bladder tumors were the most frequent in patients with adenocarcinoma. The ratio of men to women was lower in the recent series than in the historical one. The percentage of squamous carcinoma was lower and that of adenocarcinoma higher (P<.001). The percentage of patients diagnosed with regional involvement was greater in the recent series (P<.001). Conclusions: Squamous cell carcinoma continues to be the most frequent histological type. Male sex and smoking are associated with squamous carcinoma and female sex is associated with adenocarcinoma. Epidemiological and histological patterns have changed, possibly in relation to changes in smoking habits

Gastro-oesophageal reflux in mechanically ventilated patients: effects of an oesophageal balloon.

Gastro-oesophageal reflux (GOR) and bronchoaspiration of gastric content are risk factors linked with ventilator-associated pneumonia. This study was aimed at evaluating the effect of a nasogastric tube (NGT) incorporating a low-pressure oesophageal balloon on GOR and bronchoaspiration in patients receiving mechanical ventilation. Fourteen patients were studied in a semi-recumbent position for 2 consecutive days. Inflation or deflation of the oesophageal balloon was randomised. Samples of blood, gastric content, and oropharyngeal and bronchial secretions were taken every 2 h over a period of 8 h. A radioactively labelled nutritional solution was continuously administered through the NGT. The magnitude of both the GOR and bronchoaspiration was measured by radioactivity counting of oropharyngeal and bronchial secretion samples, respectively. Inflation of the oesophageal balloon resulted in a significant decrease of both GOR and bronchoaspiration of gastric content. This protective effect was statistically significant from 4 h following inflation throughout the duration of the study. This study demonstrates that an inflated oesophageal balloon delays and decreases gastro-oesophageal and bronchial aspiration of gastric content in patients carrying a nasogastric tube and receiving enteral nutrition during mechanical ventilation. Although the method was found to be safe when applied for 8 h, longer times should be considered with caution.

Contrapulsación aórtica. ¿Es posible en los cuidados intensivos de hospitales sin cirugía cardíaca? / Aortic counterpulsation: can it be performed in intensive care units in hospitals without cardiac surgery?

Introducción. El uso de balón de contrapulsación aórtico está habitualmente presente en el ámbito de los servicios de hospitales con cirugía cardíaca. En los enfermos cardíacos complicados con indicación de procedimiento invasivo percutáneo o quirúrgico, se ha demostrado que el uso temprano y preoperatorio de este tipo de soporte mejora los resultados tras la resolución de la situación creada con la cirugía cardíaca pertinente en cada caso. Pacientes y métodos. Se analiza de forma retrospectiva y global a los 9 pacientes que recibieron este tipo de terapia en los primeros 6 meses del año, y se analizan las causas del proceso, las complicaciones presentadas, las técnicas complementarias que recibieron y el resultado final. Resultados. De los 9 pacientes que recibieron esta técnica, dos fallecieron en shock cardiogénico intratable y los otros siete mejoraron de forma inmediata; de estos, dos no necesitaron cirugía cardíaca y los otros cinco fueron intervenidos, con resultados satisfactorios en cuatro de ellos. El traslado de estos pacientes fue posible sin incidencias y con buen resultado. Conclusiones. Si la selección, los cuidados y el seguimiento de los pacientes son adecuados, la contrapulsación aórtica puede proporcionar la estabilidad hemodinámica y la mejoría transitoria a muchos pacientes que precisan un tratamiento quirúrgico o invasor, que puede estar distante temporal y geográficamente (AU)

Shock hemorrágico secundario a úlcera solitaria del recto / Hemorrhagic shock secondary to solitary ulcer of the rectum

No disponible

Supported discharge shortens hospital stay in patients hospitalized because of an exacerbation of COPD.

This prospective, controlled, but not formally randomized study investigates the feasibility and efficiency of an alternative to standard hospitalization for patients with exacerbated chronic obstructive pulmonary disease (COPD), based upon supported discharge with nurse supervision at home. Over a 12-month period, emergency physicians, not directly involved in the study, admitted 205 patients with exacerbated COPD to the authors' respiratory unit. Patients were included in the supported discharge group (n=105) if they voluntarily chose to participate in the programme and lived in the city of Palma de Mallorca (where adequate home support could be provided). Patients not fulfilling these criteria (mainly residents outside the city) served as controls (n=100). Inpatient treatment was standardized in all patients and included oxygen therapy, bronchodilators, antibiotics and steroids. Both groups were comparable in terms of age (mean +/- SD: 70 +/- 10 versus 65 +/- 11 yr for supported discharge and control group, respectively), severity of airflow obstruction (forced expiratory volume in one second 45 +/- 18% reference versus 46 +/- 19% ref.), comorbidity and socioeconomic status. Length of hospital stay (LOS) in the supported discharge group was shorter (5.9 +/- 2.8 versus 8.0 +/- 5.1 days, p < 0.001). After discharge, a respiratory nurse visited supported discharge patients at home during 7.3 +/- 3.8 days. Only one patient (1%) required hospital readmission during this period of time. The reduced LOS resulted in a lower utilization of hospital beds at any given point in time throughout the study period. Within the framework and potential limitations of this study, the results indicate that the supported discharge programme in Spain: 1) allows a significant reduction in the length of hospital stay of patients hospitalized because of an exacerbation of chronic obstructive pulmonary disease; 2) does not result in an inappropriately increased rate of hospital readmissions; and 3) reduces the utilization of hospital resources.

Actividad metabólica del músculo intercostal externo en pacientes con EPOC / Metabolic activity of the external intercostal muscle of patients with COPD

INTRODUCCIÓN: El músculo intercostal externo (IE) contribuye de forma relevante al esfuerzo ventilatorio en situaciones de sobrecarga. Como otros músculos respiratorios, el IE parece participar en un proceso de remodelación estructural, para adaptarse a una situación funcional desventajosa. Sin embargo, los estudios morfológicos publicados ofrecen resultados hasta cierto punto divergentes. Por un lado, aumenta la proporción de fibras de metabolismo anaerobio, mientras que por otro se incrementa el número de capilares, lo que facilitaría el uso de un metabolismo de tipo aerobio.OBJETIVO: Este estudio se diseñó para analizar la actividad de diferentes enzimas clave, correspondientes a las principales vías metabólicas, en el IE de pacientes con enfermedad pulmonar obstructiva crónica (EPOC).METODOLOGÍA: Se estudiaron 6 pacientes con EPOC (65 ñ 8 años; índice de masa corporal [IMC]: 23 ñ 3 kg/m2; FEV1: 51 ñ 9 por ciento ref., volumen residual [RV: 184 ñ 38 por ciento ref.; PaO2: 81 ñ 100 mmHg) y 6 sujetos control, apareados por edad y características antropométricas, pero con función pulmonar normal. En todos ellos se procedió a la toma de muestras del IE (quinto espacio intercostal, lado no dominante), que fueron procesadas para la determinación de las siguientes actividades enzimáticas por espectrofotometría convencional: citratosintetasa (CS, ciclo de Krebs), fosfofructocinasa (PFK, vía glucolítica común), lactodeshidrogenasa (LDH, glucólisis anaerobia) y creatinfosfocinasa (CPK, uso de reservas energéticas).RESULTADOS: Los pacientes con EPOC presentaron mayor actividad de las enzimas PFK (93 ñ 25 frente a 44 ñ 9 µmol/min/g de peso en fresco; p = 0,001) y LDH (308 ñ 42 ante 231 ñ 29 µmol/min/g; p < 0,01) que los sujetos control. Por el contrario, las actividades de CS y CPK fueron similares (82 ñ 31 frente a 90 ñ 20 µmol/min/g, y 4.017 ñ 1.734 ante 3.048 ñ 464 µmol/min/g, respectivamente), aunque la segunda presentaba una dispersión muy notable de valores en los pacientes con EPOC, que en algunos casos triplicaban a los de los controles. El RV se correlacionó directamente con la actividad de las enzimas glucolíticas (con PFK, r = 0,716, p < 0,01; con LDH, r = 0,697, p < 0,05), que también se correlacionaban entre sí (r = 0,737, p < 0,01).CONCLUSIONES: A tenor de las actividades enzimáticas estudiadas, la actividad oxidativa parece conservada en el IE de sujetos con EPOC. Por su parte, la actividad de la vía glicolítica parece hallarse aumentada, y este aumento es proporcional a la gravedad de la EPOC. Estos resultados son probablemente la expresión del efecto combinado de diversos factores estructurales de carácter adaptativo. (AU)

[The cost effectiveness of echography biopsy]. / Rentabilidad de la ecopsia.

Ecopsy is a postmortem technique which, by means of echography-guided puncture and/or aspiration obtains material for histological analysis. This study compared cost and time employed in 100 ecopsies and 100 classic necropsies and confirmed that cost of materials in ecopsy is 65% lower than that in necropsy. Physicians, necropsy technicians, laboratory technicians and secretary team personnel spent 33%, 54%, 19% and 32% less time than in necropsy. The clinical report of ecopsy was finished within nine days even with the brain study included.