Neck dissection for head and neck malignancies with concurrent carotid endarterectomy.

Head and neck malignancies share similar risk factors as carotid artery stenosis and these can often present together. Patients who require external beam radiotherapy are at a higher risk of developing significant worsening stenosis. The workup of the oncologic patient often includes computed tomography, which can reveal underlying carotid artery stenosis, offering an opportunity to address both conditions in one operation and prevent the need for a complicated carotid endarterectomy (CEA) in irradiated and previously operated tissue. It was postulated that these two operations can be combined safely. The surgical protocol, surgical technique, and outcomes of a case series of four patients with head and neck cancer who underwent neck dissection and CEA for carotid artery stenosis during the same operation is presented. CEA was performed safely, simultaneously with neck dissection. CEA did not affect the surgical outcomes or postoperative course of the patients, and no minor or major complications were observed related to this procedure. Carotid endarterectomy performed by a vascular surgeon can be safely combined with oncologic neck dissection in the same procedure to avoid future complications in head and neck cancer patients.

Anaesthetic-surgical guide in the treatment of ascending aorta and surgery of the ascending aorta and aortic arch. Consensus document of the Spanish Society of Cardiovascular and Endovascular Surgery and the Sociedad of Anaesthesiology, Resuscitation and Pain Therapy.

Aortic pathology is always a challenge for the clinician, and must be diagnosed and treated by a multidisciplinary team due to the technical and technological complexity of the resources used. Ongoing efforts to implement a systematic, protocolized approach involving "Aortic teams" made up of cardiologists, cardiac surgeons, vascular surgeons, anaesthesiologists and radiologists, among others are now leading to improved outcomes. The aim of this consensus document drawn up by the Aortic working groups of the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy (SEDAR) and the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) is to disseminate a set of working protocols. The latest consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) define the concept of "AORTIC TEAM"(1). The aortic team should be closely involved from diagnosis to treatment and finally follow-up, and should be formed of cardiac and vascular surgeons working together with anaesthesiologists, cardiologists, radiologists and geneticists. Treatment of aortic pathologies should be centralised in large centres, because this is the only way to effectively understand the natural course of the disease, provide the entire range of treatment options under one umbrella and treat potential complications. A streamlined emergent care pathway (24/7 availability), adequate transportation and transfer capabilities, as well as rapid activation of the multidisciplinary team must be available. In light of the complexity and constant evolution of therapeutic options, we present this first version of the Anaesthesiology and surgical guidelines for surgery of the ascending aorta and aortic arch. Some questions will no doubt remain unanswered, and future versions will include new techniques that, though implemented in some centres, are still not widely recommended.

Guía anestésico-quirúrgica en el tratamiento de la cirugía de aorta ascendente y del arco aórtico. Documento de consenso de la Sociedad Española de Cirugía Cardiovascular y Endovascular y la Sociedad Española de Anestesiología, Reanimación y Terapeútica del Dolor / Anaesthetic-surgical guide in the treatment of ascending aorta and surgery of the ascending aorta and aortic arch. Consensus document of the Spanish Society of Cardiovascular and Endovascular Surgery and the Sociedad of Anaesthesiology, Resuscitation and Pain Therapy

La patología de la aorta siempre supone un reto para la medicina. Tanto para sudiagnóstico como para su tratamiento, dicha patología requiere ser abordada de forma multidisciplinar debido a la complejidad técnica y tecnológica de los medios empleados. Gracias a los esfuerzos durante años se están obteniendo frutos en forma de mejora de resultados, mediante un abordaje sistemático y protocolizado llevado acabo en el seno de un grupo de expertos (Comités de aorta o “Aortic team”) en el quese implican cardiólogos, cirujanos cardíacos, cirujanos vasculares, anestesiólogos y radiólogos, entre otros. Con este documento, realizado entre los grupos de trabajo de Aorta de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del dolor (SEDAR) y la Sociedad Española de Cirugía Torácica y Cardiovascular (SECTCV) se busca difundir protocolos de trabajo consensuados por ambas sociedades. La EACTS y la ESVS en el último documento de consenso de expertos definen el concepto de “AORTIC TEAM”(1). El equipo debe estar estrechamente involucrado en todo el proceso de diagnóstico, tratamiento y seguimiento y debe estar compuesto por miembros de cirugía cardiovascular en colaboración con anestesiología, cardiología, radiología y genética. Se recomienda la centralización de la atención de las patologías del arco aórtico en grandes centros porque es la única forma de comprender de manera efectiva el curso natural de la enfermedad, proporcionar toda la gama de opciones de tratamiento bajo un mismo prisma y tratar las posibles complicaciones. Debe estar disponible una vía simplificada de atención de emergencias (con disponibilidad 24h al día y 7 días a la semana), una adecuada capacidad de transporte y transferencia de pacientes, así como la posibilidad de una activación rápida del equipo multidisciplinar.(AU)

Aortic pathology is always a challenge for the clinician, and must be diagnosed and treated by a multidisciplinary team due to the technical and technological complexity of the resources used. Ongoing efforts to implement a systematic, protocolized approach involving “Aortic teams” made up of cardiologists, cardiac surgeons, vascular surgeons, anaesthesiologists and radiologists, among others are now leading to improved outcomes. The aim of this consensus document drawn up by the Aortic working groups of the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy (SEDAR) and the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) is to disseminate a set of working protocols. The latest consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) define the concept of “AORTIC TEAM”(1). The aortic team should be closely involved from diagnosis to treatment and finally follow-up, and should be formed of cardiac and vascular surgeons working together with anaesthesiologists, cardiologists, radiologists and geneticists. Treatment of aortic pathologies should be centralised in large centres, because this is the only way to effectively understand the natural course of the disease, provide the entire range of treatment options under one umbrella and treat potential complications. A streamlined emergent care pathway (24/7 availability), adequate transportation and transfer capabilities, as well as rapid activation of the multidisciplinary team must be available. In light of the complexity and constant evolution of therapeutic options, we present this first version of the Anaesthesiology and surgical guidelines for surgery of the ascending aorta and aortic arch. Some questions will no doubt remain unanswered, and future versions will include new techniques that, though implemented in some centres, are still not widely recommended.(AU)

Modified Lip Revision Surgery for the Severe Whistle Lip Deformity in Bilateral Cleft Lip.

PURPOSE: Whistle deformity is a sequela of primary surgical repair of the bilateral cleft lip that leads to a vertical tissue deficiency and a nonfunctional orbicularis oris muscle in the medial portion of the upper lip. This sequel is significantly limiting functionally and esthetically. We propose a complete labial revision with a secondary cheiloplasty of Mulliken and a submucosal inferiorly based flap in the central tubercle to increase the volume at this usually deficient area. METHODS: We present our series of 9 patients with whistle deformity who underwent our modified technique. Width and length lip measurements were analyzed pre- and postoperatively. RESULTS: There was a significant decrease in the width of the philtrum (mean 18.7% and 37% measured at the columella base and Cupid's apexes, respectively), an increase in the labial length (mean 11.2%), and improvement of the shape and volume of the vermilion in its middle third. All patients reported a very good to excellent improvement in the function and shape of their lips. CONCLUSIONS: The addition to a complete revision cheiloplasty of our inferiorly based submucosal flap technique solved in a single operation the function of the orbicularis oris and the normal labial anatomy with good functional outcomes in all cases and improved esthetic results.

Anaesthetic-surgical guide in the treatment of ascending aorta and surgery of the ascending aorta and aortic arch. Consensus document of the Spanish Society of Cardiovascular and Endovascular Surgery and the Sociedad of Anaesthesiology, Resuscitation and Pain Therapy. / Guía anestésico-quirúrgica en el tratamiento de la cirugía de aorta ascendente y del arco aórtico. Documento de consenso de la Sociedad Española de Cirugía Cardiovascular y Endovascular y la Sociedad Española de Anestesiología, Reanimación y Terapeútica del Dolor.

Aortic pathology is always a challenge for the clinician, and must be diagnosed and treated by a multidisciplinary team due to the technical and technological complexity of the resources used. Ongoing efforts to implement a systematic, protocolized approach involving "Aortic teams" made up of cardiologists, cardiac surgeons, vascular surgeons, anaesthesiologists and radiologists, among others are now leading to improved outcomes. The aim of this consensus document drawn up by the Aortic working groups of the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy (SEDAR) and the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) is to disseminate a set of working protocols. The latest consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) define the concept of "AORTIC TEAM"(1). The aortic team should be closely involved from diagnosis to treatment and finally follow-up, and should be formed of cardiac and vascular surgeons working together with anaesthesiologists, cardiologists, radiologists and geneticists. Treatment of aortic pathologies should be centralised in large centres, because this is the only way to effectively understand the natural course of the disease, provide the entire range of treatment options under one umbrella and treat potential complications. A streamlined emergent care pathway (24/7 availability), adequate transportation and transfer capabilities, as well as rapid activation of the multidisciplinary team must be available. In light of the complexity and constant evolution of therapeutic options, we present this first version of the Anaesthesiology and surgical guidelines for surgery of the ascending aorta and aortic arch. Some questions will no doubt remain unanswered, and future versions will include new techniques that, though implemented in some centres, are still not widely recommended.

RETRACTED: Anesthesic and surgical guideline for the treatment of the thoraco-abdominal aorta. Consensus Document of the Spanish Societies of Anesthesia and Cardiovascular Surgery. / Guía anestésico-quirúrgica en el tratamiento de la patología de aorta toracoabdominal. Documento de Consenso de la Sociedad Española de Cirugía Cardiovascular Endovascular y la Sociedad Española de Anestesiología, Reanimación y Terapeútica del Dolor.

Este artículo ha sido retirado por indicación del Editor Jefe de la revista, después de constatar que parte de su contenido había sido plagiado, sin mencionar la fuente original: European Heart Journal (2014) 35, 2873 926.: https://academic.oup.com/eurheartj/article/35/41/2873/407693#89325738 El autor de correspondencia ha sido informado de la decisión y está de acuerdo con la retirada del artículo. El Comité Editorial lamenta las molestias que esta decisión pueda ocasionar. Puede consultar la política de Elsevier sobre la retirada de artículos en https://www.elsevier.com/about/our-business/policies/article-withdrawal

Potentially inappropriate medications in older adults living with HIV.

OBJECTIVES: We assessed the prevalence of potentially inappropriate medication (PIM) among older (≥ 65 years) people living with HIV (O-PLWH) in the region of Madrid. METHODS: We analysed the dispensation registry of community and hospital pharmacies from the Madrid Regional Health Service (SERMAS) for the period between 1 January and 30 June 2017, looking specifically at PIMs according to the 2019 Beers criteria. Co-medications were classified according to the Anatomical Therapeutic Chemical (ATC) classification system. RESULTS: A total of 6 636 451 individuals received medications. Of these individuals, 22 945 received antiretrovirals (ARVs), and of these 1292 were O-PLWH. Overall, 1135 (87.8%) O-PLWH were taking at least one co-medication, and polypharmacy (at least five co-medications) was observed in 852 individuals (65.9%). A PIM was identified in 482 (37.3%) O-PLWH. Factors independently associated with PIM were polypharmacy [adjusted odds ratio (aOR) 7.08; 95% confidence interval (CI) 5.16-9.72] and female sex (aOR 1.75; 95% CI 1.30-2.35). The distribution of PIMs according to ATC drug class were nervous system drugs (n = 369; 28.6%), musculoskeletal system drugs (n = 140; 10.8%), gastrointestinal and metabolism drugs (n = 72; 5.6%), cardiovascular drugs (n = 61; 4.7%), respiratory system drugs (n = 13; 1.0%), antineoplastic and immunomodulating drugs (n = 10; 0.8%), and systemic anti-infectives (n = 2; 0.2%). Five drugs accounted for 84.8% of the 482O PLWH with PIMs: lorazepam (38.2%), ibuprofen (18.0%), diazepam (10.2%), metoclopramide (9.9%), and zolpidem (8.5%). CONCLUSIONS: Prescription of PIMs is highly prevalent in O-PLWH. Consistent with data in uninfected elderly people, the most frequently observed PIMs were benzodiazepines and nonsteroidal anti-inflammatory drugs . Targeted interventions are warranted to reduce inappropriate prescribing and polypharmacy in this vulnerable population.

Evaluación de los desenlaces posoperatorios de los pacientes sometidos a septoplastia y turbinoplastia entre los años 2016 a 2018 de la Fundación Santa Fe de Bogotá / Evaluation of postoperative outcomes of septoplasty and septoturbinoplasty patients of Fundación Santa Fe de Bogota between the years 2016 to 2018

Introducción: La tasa de infección después de la cirugía nasal electiva es muy baja, lo que hace que la profilaxis antibiótica de rutina sea redundante. En Colombia no disponemos de información acerca de la tasa de infección de septoplastia; por esta razón, en este artículo se busca describir la tasa de infección posquirúrgica en los pacientes llevados a septoplastia o septoplastia y turbinoplastia de la Fundación Santa Fe de Bogotá, entre los años 2016-2018. Metodología: se realizó un estudio observacional, descriptivo y retrospectivo mediante la revisión de la base de datos del servicio. Se calculó la proporción de infección para todos los individuos participantes del estudio de manera general y estratificada por el uso de antibiótico profiláctico y posoperatorio, y se describió la frecuencia de las complicaciones. Resultados: encontramos 255 pacientes en la base de datos de la sección de otorrinolaringología, de los cuales 206 cumplieron con los criterios de inclusión. El 23,3 % de los pacientes recibió un antibiótico profiláctico y el 24,76 % recibió un antibiótico postoperatorio. La tasa de infección posoperatoria fue de 2,91 % (intervalo de confianza [IC] del 95 %: 1,07-6,23). El 96,6 % de los pacientes no presentaron complicaciones. Conclusiones: nuestros hallazgos se correlacionan con la literatura global

Introduction: infection rate after elective nasal surgery is very low which makes routine antibiotic prophylaxis redundant. In Colombia we do not have information about postoperative infection in septoplasty. A study was designed to determine the postoperative infection rate in patients undergoing septoplasty or septoplasty and turbinoplasty at Fundación Santa Fe de Bogotá between 2016 to 2018. Methods: an observational, descriptive and retrospective study was conducted. The database of the Otolaryngology Section was reviewed. The proportion of infection for all individuals participating in the study was calculated in a general and stratified manner by use of prophylactic and postoperative antibiotic and the frequency of complications was described. Results: we found 255 patients in the patient database of which 206 patients met the inclusion criteria. 23.3 % of patients received prophylactic antibiotic and 24.76 % received postoperative antibiotic. The percentage of postoperative infection was 2.91 % (95 % CI: 1.07-6.23). 96.6 % of the patients did not present any complications. Conclusion: septoplasty has a low risk of infection which was in accordance to the findings found in the present study.

Flattening of the orbital lower eyelid fat as a long-term outcome after surgical treatment of orbital floor fractures.

Our aim was to report the incidence of asymmetry of the lower eyelid (that manifests itself as flattening of the eyelid fat) as a long-term complication of the surgical approach of unilateral fractures of the orbital floor. We retrospectively reviewed the aesthetic appearance of the lower eyelid in 43 patients after repair of such fractures. Long-term asymmetry seen as asymmetrical flattening of the eyelid fat was evaluated and graded qualitatively as mild, moderate, and severe. We studied its relations to the surgical approach, patient's age and sex, and postoperative time; 20 of the 43 had flattening of the lower eyelid fat. There were significantly more patients with flattening of the fat after a transconjunctival approach than after transcutaneous ones (p=0.03). We found a statistical likelihood of the development of flattening of the fat when patients were between 40 and 60 years old at the time of operation (p=0.006). Increasing age at the time of the study was related to increased severity (p=0.0019), with the greatest significance over 55 years old (p=0.006). We found no relation to patients' sex, or duration of operation. To our knowledge this is the first time that flattening of the eyelid fat has been described as a long-term complication after a particular approach to orbital floor fractures. The transconjunctival incision was more likely to be associated with this long-term outcome. Patients over 40 years old are also at risk of developing flattening, and this is more severe when the patient is over 55. A short follow-up period is not sufficient for the evaluation of the aesthetic outcome of traditional approaches to fractures of the orbital floor in the lower eyelid.

Brainstem and Autonomic Nervous System Dysfunction: A Neurosurgical Point of View.

Central autonomic control nuclei and pathways are mainly integrated within the brainstem, especially in the medulla oblongata. Lesions within these structures can lead to central dysautonomia.Central autonomic control structures can be damaged by tumors, during surgery, or by other neurosurgical pathologies. These may elicit clinical or subclinical autonomic complications that can constitute a serious clinical problem.The authors present a broad review of the central autonomic nervous system, its possible dysfunctions, and the relation between neurosurgery and this "not-well-known system". Preliminary results of an autonomic study of brainstem lesions that is currently being carried out by the authors are also shown.

Pre-Transplant Assessment of Vascular Calcification as a Risk Factor of Mortality, Graft Loss, and Cardiovascular Events in Renal Transplant Recipients.

BACKGROUND: Vascular calcification (VC) is known as an independent predictor of mortality in patients undergoing hemodialysis; nevertheless, there is a lack of studies about the impact of vascular calcification in renal transplant recipients, and none of them use the Kauppila Index (KI) as a predictor of patient and graft prognosis. METHODS: We conducted an observational, retrospective study of 119 renal transplants, evaluating abdominal aortic calcifications (L4-S1) with the KI. We established 2 categories: absence (KI = 0-2) and presence (KI = 3-24) of VCs before transplantation. We analyzed the impact of calcification in graft and patient survival, new-onset diabetes mellitus, hypertension, cardiovascular events, renal function, and mineral metabolism. RESULTS: VCs were observed in 50 patients (42%) before renal transplantation. Patients with VCs were older, but no statistical differences were found in the pre-transplant study between sex, diabetes, body mass index, and cardiovascular events. We found a major patient survival (limited to first 2 years after transplantation), graft survival, and death-censored graft survival in those without VCs (P = .037, P = .015, and P = .023, respectively). In line with results, a higher incidence of major cardiovascular events (MACE) and cardiovascular death was observed in the group with preexisting calcification (P = .016/P = .019). In the multivariable analysis, VCs were not an independent predictor for graft loss, death-censored graft loss, or major cardiovascular events. CONCLUSIONS: Simple evaluation of VCs with the use of the KI at the time of transplantation relates with graft and patient survival and with MACE after renal transplantation.

Neural differences between monolinguals and early bilinguals in their native language during comprehension.

Research has shown that semantic processing of sentences engages more activity in the bilingual compared to the monolingual brain and, more specifically, in the inferior frontal gyrus. The present study aims to extend those results and examines whether semantic and also grammatical sentence processing involve different cerebral structures when testing in the native language. In this regard, highly proficient Spanish/Catalan bilinguals and Spanish monolinguals made grammatical and semantic judgments in Spanish while being scanned. Results showed that both types of judgments recruited more cerebral activity for bilinguals in language-related areas including the superior and middle temporal gyri. Such neural differences co-occurred with similar performance at the behavioral level. Taken together, these data suggest that early bilingualism shapes the brain and cognitive processes in sentence comprehension even in their native language; on the other hand, they indicate that brain over activation in bilinguals is not constrained to a specific area.

Banda libre de tensión transobturadora en el tratamiento de la incontinencia urinaria femenina. Cinco años de experiencia en un hospital comarcal / Tension-free baginal transobturador tape for the treatment of femenine urinary incontinence. Five years of experience in a district hospital

Objetivo: Evaluar los resultados de aplicar una banda suburetral transobturadora (TOT) en el tratamiento de la incontinencia urinaria femenina, aislada o asociada a cirugía del prolapso de órganos pélvicos, así como analizar las complicaciones intra y postoperatorias de la cirugía. Sujetos y métodos Estudio prospectivo durante un periodo de 5 años incluyendo 107 pacientes. La valoración preoperatoria incluyó un estudio urodinámico en todos los casos, y la valoración de los resultados fue subjetiva con el cuestionario ICIQ-SF en encuesta telefónica efectuada a 105 de los pacientes. Se define curación como una puntuación de 0 en el citado cuestionario, mejoría como una puntuación de 1 a 5 y fracaso como una puntuación superior a 5.ResultadosLa tasa de curación global de la incontinencia urinaria es del 80%. Se han registrado un 0,9% de lesión vesical, un 5,6% de retención urinaria y un 12% de inestabilidad del detrusor de novo. En el grupo de cirugía de la incontinencia aislada, la curación de la misma es de un 69% y en el grupo de cirugía de la incontinencia asociada a cirugía del prolapso es del 87% (p < 0,05).Conclusiones La banda TOT es un tratamiento seguro y efectivo en el tratamiento de la incontinencia urinaria femenina, tanto aislada como asociada a cirugía del prolapso genital, en el seguimiento a largo plazo (AU)

Objective: To evaluate the efficacy of the tension-free obturador tape procedure in the treatment of female urinary incontinence, alone or associated with pelvic organ prolapse surgery, and to analyze the intra and postoperative complications Subjects and methods: Prospective study over a period of five years including 107 patients. Preoperative evaluation included urodynamic study and assessment of the results was subjective with an ICIQ-SF questionnaire in a telephone survey of 105 patients. Cure is defined as a score in that questionnary, improvement as a score of 1 to 5 and failure as a score more 5.Results: The overall cure rate is 80%.There have been an 0.9% the bladder injury, 5.6% of urinary retention and 12% de novo urgency developed. In the group of incontinence surgery alone overall cure rate is the 69% and in the surgery group of incontinence associated with prolapse surgeryis the 87% (P<.05).Conclusions: The transobturador tape is a safe and effective procedure in the treatment of female urinary incontinence, alone or associated with pelvic organ prolapse surgery, in longterm follow-up (AU)

Analysis of "task-positive" and "task-negative" functional networks during the performance of the Symbol Digit Modalities Test in patients at presentation with clinically isolated syndrome suggestive of multiple sclerosis.

An abnormal pattern of brain activations has been shown in patients with multiple sclerosis during the performance of several cognitive tasks. The aim of this study is to investigate abnormalities of the patterns of activation/deactivation in the functional networks related to "task-positive" and "task-negative" events during the execution of the Symbol Digit Modalities Test (SDMT) in patients with clinically isolated syndromes (CIS) and preserved cognitive abilities. Eighteen CIS patients within 3 months from their first clinical attack and 15 healthy controls (HC) underwent neuropsychological assessment and performed an adapted functional magnetic resonance imaging (fMRI) version of the SDMT. "Task-positive" responses to task execution and "task-negative" activity of the default mode network were compared between groups. A regression analysis was performed to investigate the correlation between fMRI results and T2 lesion load (T2 LL) and brain atrophy. Neuropsychological performance did not differ between groups. Compared to HC, CIS patients exhibited an enhanced deactivation of the "task-negative" network at the level of the posterior cingulate cortex, whereas no differences between groups were found when the patterns of "task-positive" events were compared. A regression analysis detected a correlation (p < 0.001,r ranging from 0.62 to 0.73) between T2 LL and "task-positive" activations of areas that are part of the attention network, comprising the anterior cingulate gyrus, left prefrontal gyrus and inferior parietal lobe. No correlation was found between patterns of functional modifications and brain atrophy. CIS patients experience an enhanced pattern of brain deactivations during cognitive performances, which might contribute to their normal neuropsychological status.

Functional magnetic resonance imaging correlates of cognitive performance in patients with a clinically isolated syndrome suggestive of multiple sclerosis at presentation: an activation and connectivity study.

BACKGROUND/OBJECTIVE: To assess whether abnormalities on functional magnetic resonance imaging (fMRI) are related to cognitive function in patients at presentation with clinically isolated syndrome (CIS) suggestive of multiple sclerosis. METHODS: Eighteen patients with CIS and 15 healthy controls (HCs) performed an adapted fMRI version of the Paced Auditory Serial Addition Test (PASAT). According to their PASAT performance, CIS patients were divided into two groups: 10 with a low PASAT performance (<1 SD from the mean value of HCs) were considered 'cognitive impairment' (CI); eight patients were defined as 'cognitively preserved' (CP). Between-group differences in the patterns of brain activations and effective connectivity were assessed. RESULTS: During PASAT, compared to HCs, CIS patients showed increased activations of the bilateral inferior parietal lobe (IPL), bilateral precuneus, bilateral middle frontal gyrus (MFG), left anterior cingulate cortex (ACC), left claustrum, right thalamus and right caudate nucleus. When CIS patients were analyzed, the CI group had a more significant activation of the bilateral IPL than HCs and CP patients. Compared to CP patients, they also had more significant recruitment of the right superior parietal lobe, right cerebellum, left MFG and left ACC. The analysis of effective connectivity showed stronger connections between several regions of the right hemisphere involved in working memory function in CI patients versus CP and HC. CONCLUSIONS: During performance of the PASAT, CIS patients show abnormalities in the patterns of cortical recruitment and connectivity related to the level of their cognitive impairment.

Neural bases of language switching in high and early proficient bilinguals.

The left inferior frontal cortex, the caudate and the anterior cingulate have been proposed as the neural origin of language switching, but most of the studies were conducted in low proficient bilinguals. In the present study, we investigated brain areas involved in language switching in a sample of 19 early, high-proficient Spanish-Catalan bilinguals using a picture naming task that allowed contrasting switch and non-switch trials. Compared to the non-switching condition, language switching elicited greater activation in the head of the left caudate and the pre-SMA/ACC. When the direction of the switching was considered, the left caudate was more associated with forward switching and the pre-SMA/ACC with backward switching. The discussion is focused on the relevance of these brain structures in language control in early, high-proficient bilinguals, and the comparison with previous results in late bilinguals.

Utilidad de la monitorización Video-EEG en los pacientes con epilepsia farmacorresistente / Usefulness of Video-EEG monitoring in patients with drug-resistant epilepsy

Objetivo: Evaluar el patrón de pacientes a los que se realiza monitorización prolongada Video-EEG en un centro especializado en epilepsia y valorar la utilidad de dicha técnica en la epilepsia farmacorresistente. Métodos: Se realizó el estudio y análisis prospectivo de la monitorización de 100 pacientes consecutivos con epilepsia farmacorresistente correspondientes a un solo centro. Se analizaron los datos demográficos de la serie, el tiempo trascurrido hasta la primera crisis, las maniobras de provocación de crisis y el rendimiento de la prueba (utilidad del test, cambio de actitud, mejoría en el ajuste farmacológico y mejoría quirúrgica). Se realizó un subanálisis en diferentes grupos diagnósticos.Resultados: El estudio se realizó fundamentalmente en población joven (34,4 años) y la media de horas trascurridas hasta la primera crisis fue de 30, requiriendo en la mayoría de pacientes (90%) retirar la medicación antiepiléptica. Pese a ello, no se produjo ningún caso de status epiléptico. La utilidad del test fue elevada en todos los grupos permitiendo cambiar el manejo de los pacientes en un 65%, lo cual se tradujo en mejorías tanto a nivel farmacológico como quirúrgico.Conclusión: La monitorización prolongada Video-EEG es una técnica adecuada para el estudio de pacientes con una epilepsia farmacorresistente, siendo el mayor problema en nuestro medio su difícil accesibilidad (AU)

Objective: To evaluate the characteristics of patients on whom long-term Video-EEG monitoring is performed in a specialist centre and to assess its suitability to study refractory epilepsy patients. Methods: A prospective analysis and study of Video-EEG monitoring was performed in a series of 100 refractory epilepsy patients from a single centre. The analysis included demographic data, the time until the first seizure, the methods used to provoke seizures, and the outcome (usefulness, change in the management, pharmacological and surgical improvement). A subgroup analysis based on diagnosis was performed.Results: The study was performed mainly on young people (mean 34.4 years) and the first seizure appeared in a mean of 30hours, requiring most of the patients to withdraw the medication. Nevertheless, there were no cases of status epilepticus. The usefulness of the test was high in all the groups. The management was changed in 65% of the patients with pharmacological and surgical improvement. Conclusion: Long-term Video-EEG monitoring is a suitable test to study refractory epilepsy patients. The main problem in our country is accesibility (AU)

Usefulness of Video-EEG monitoring in patients with drug-resistant epilepsy.

OBJECTIVE: To evaluate the characteristics of patients on whom long-term Video-EEG monitoring is performed in a specialist centre and to assess its suitability to study refractory epilepsy patients. METHODS: A prospective analysis and study of Video-EEG monitoring was performed in a series of 100 refractory epilepsy patients from a single centre. The analysis included demographic data, the time until the first seizure, the methods used to provoke seizures, and the outcome (usefulness, change in the management, pharmacological and surgical improvement). A subgroup analysis based on diagnosis was performed. RESULTS: The study was performed mainly on young people (mean 34.4 years) and the first seizure appeared in a mean of 30hours, requiring most of the patients to withdraw the medication. Nevertheless, there were no cases of status epilepticus. The usefulness of the test was high in all the groups. The management was changed in 65% of the patients with pharmacological and surgical improvement. CONCLUSION: Long-term Video-EEG monitoring is a suitable test to study refractory epilepsy patients. The main problem in our country is accesibility.

Consumer satisfaction with dry-cured ham in five European countries.

The objective is to investigate consumer satisfaction with dry-cured ham in five European countries. A logistic regression model has been fitted using data collected through a cross-sectional web-based survey carried out in Belgium, Germany, Denmark, Poland and Greece during January 2008 (n=2437 of which 2156 were dry-cured ham consumers). Satisfaction was evaluated as overall satisfaction, as well as specific satisfaction with healthfulness, price, convenience and taste. The findings show that the main determinant of overall satisfaction is taste satisfaction, hence, producers are recommended to focus on matching sensory acceptability of dry-cured ham. No significant between-country differences were found, reflecting the wide availability of this product in all countries. Consumer characteristics influenced their level of satisfaction. Men, older (age > 52 years) and frequent consumers of dry-cured ham consumption were more likely to be satisfied with dry-cured ham. Consumers trust the butcher's advice and they preferred purchasing dry-cured ham at a butcher shop rather than in a supermarket.