Validez y fiabilidad del cuestionario DASH en mujeres con linfedema secundario a tratamiento de cáncer de mama / Validity and reliability of DASH questionnaire in women who suffer from lymphedema as a side effect of a breast cancer treatment

Introducción: El cuestionario DASH está diseñado para la valoración funcional del miembro superior en enfermedad musculoesquelética. El objetivo de este trabajo es verificar las principales propiedades instrumentales (validez y fiabilidad) del cuestionario para su aplicación en mujeres españolas con linfedema secundario a tratamiento de cáncer de mama. Métodos: Cohorte prospectiva de 65 mujeres con linfedema secundario a tratamiento de cáncer de mama, en las que se estudió la fiabilidad de la puntuación del DASH mediante la consistencia interna (coeficiente alfa de Cronbach) y test-retest en un intervalo de 15 días (coeficiente de correlación intraclase), y la validez mediante la correlación con las puntuaciones del SF-36v2 y de la FACT-B+4 (r o τ b de Kendall). Resultados: La consistencia interna y fiabilidad test-retest fueron alfa de Cronbach 0,969 y coeficiente de correlación intraclase 0,861, respectivamente. Existía correlación entre las puntuaciones del DASH y las del SF-36v2, sobre todo con los dominios de función física, dolor corporal y rol físico (r de 0,800, 0,738 y 0,682, respectivamente; p<0,001), y menos con el rol emocional y social. Se correlacionaba con la puntuación FACT-B+4 (r=0,836; p<0,001) y la subescala miembro superior (r=0,816; p<0,001) y no existe correlación con la subescala social/familiar (r=0,193; p=0,216). Conclusión: El cuestionario DASH es una herramienta fiable y válida para ser utilizada en la valoración funcional de miembro superior de mujeres españolas con linfedema secundario a tratamiento de cáncer de mama.(AU)

Introduction: DASH questionnaire was designed to assess upper limb function in musculoskeletal pathologies. The aim of this manuscript is to study the reliability and validity of this questionnaire, to determine if is adequate to use in women with lymphedema due to breast cancer treatment. Methods: Prospective study in 65 women with lymphedema due to breast cancer treatment was done, in which the reliability of DASH score with internal consistency (Cronbach's alpha) and test–retest reproducibility 15 days’ interval (interclass correlation coefficient) and validity by correlation with SF-36v2 and FACT-B+4 (r or Kendall's τ b) scores was investigated. Results: The internal consistency and the test–retest were Cronbach's alpha 0.969 and interclass correlation coefficient 0.861, respectively. There was correlation between the DASH score with the SF-36v2 score, mainly in the areas of physical function, body pain and physical role (r 0.800, 0.738, and 0.682, respectively; p<0.001), and lowest with the emotional and social wellbeing. The DASH score had correlation with FACT-B+4 (0.836; p<0.001) and the subscales the upper limb score (r=0.816; p<0.001), and there was no correlation with the social/familiar subscale (r=0.193; p=0.216). Conclusion: The DASH questionnaire is a reliable and valid tool to assess upper limb functionality in Spanish women with breast cancer related lymphedema.(AU)

Movimientos involuntarios del muñón tras una amputación transtibial: síndrome del muñón saltarín / Involuntary movements of the stump after transtibial amputation: Jumping stump syndrome

Mujer de 45 años, con antecedente de cirugía de hallux valgus de evolución tórpida, derivando en amputación transtibial. A los 6 meses poscirugía comenzó con movimientos involuntarios del muñón tipo mioclonías desencadenados con el roce o extensión de la cadera, agravándose el dolor previo de muñón y de miembro fantasma. Durante el siguiente año, coincidiendo con el cambio de prótesis, empeoró la clínica progresivamente limitando la marcha. El abordaje terapéutico del dolor y de las mioclonías fue inicialmente farmacológico, sin respuesta. Ante la sospecha clínica y ecográfica de neuroma en el nervio ciático poplíteo externo, se infiltró el mismo con corticoide y anestésico y los gastrocnemios con toxina botulínica tipo A, sin éxito. Finalmente, las mioclonías desaparecieron y el dolor disminuyó tras el remodelado quirúrgico del muñón y la resección del neuroma. Este cuadro clínico es conocido como síndrome del muñón saltarín, y es una complicación rara que debe tenerse en cuenta tras una amputación.(AU)

45-year-old woman with history of hallux valgus surgery and torpid evolution, which led to transtibial amputation. Six months after surgery, she began to experience involuntary movements of the stump such as myoclonus, that were triggered by touch or hip extension, associating worsening of the previous stump and phantom limb pain. During the following year, concurring with change of prosthesis, symptoms progressively worsened, which limited walking. The therapeutic approach to pain and myoclonus was initially pharmacological, without response. Given the clinical and ultrasound suspicion of neuroma in the external popliteal sciatic nerve, it was infiltrated with corticosteroid and anesthetic, and the gastrocnemius with botulinum toxin type A, without success. Finally, the myoclonus disappeared, and the pain decreased after surgical remodeling of the stump and resection of the neuroma. This clinical picture is known as jumping stump syndrome and is a rare complication that must be considered after amputation.(AU)

[Validity and reliability of DASH questionnaire in women who suffer from lymphedema as a side effect of a breast cancer treatment]. / Validez y fiabilidad del cuestionario DASH en mujeres con linfedema secundario a tratamiento de cáncer de mama.

INTRODUCTION: DASH questionnaire was designed to assess upper limb function in musculoskeletal pathologies. The aim of this manuscript is to study the reliability and validity of this questionnaire, to determine if is adequate to use in women with lymphedema due to breast cancer treatment. METHODS: Prospective study in 65 women with lymphedema due to breast cancer treatment was done, in which the reliability of DASH score with internal consistency (Cronbach's alpha) and test-retest reproducibility 15 days' interval (interclass correlation coefficient) and validity by correlation with SF-36v2 and FACT-B+4 (r or Kendall's τ b) scores was investigated. RESULTS: The internal consistency and the test-retest were Cronbach's alpha 0.969 and interclass correlation coefficient 0.861, respectively. There was correlation between the DASH score with the SF-36v2 score, mainly in the areas of physical function, body pain and physical role (r 0.800, 0.738, and 0.682, respectively; p<0.001), and lowest with the emotional and social wellbeing. The DASH score had correlation with FACT-B+4 (0.836; p<0.001) and the subscales the upper limb score (r=0.816; p<0.001), and there was no correlation with the social/familiar subscale (r=0.193; p=0.216). CONCLUSION: The DASH questionnaire is a reliable and valid tool to assess upper limb functionality in Spanish women with breast cancer related lymphedema.

[Involuntary movements of the stump after transtibial amputation: Jumping stump syndrome]. / Movimientos involuntarios del muñón tras una amputación transtibial: síndrome del muñón saltarín.

45-year-old woman with history of hallux valgus surgery and torpid evolution, which led to transtibial amputation. Six months after surgery, she began to experience involuntary movements of the stump such as myoclonus, that were triggered by touch or hip extension, associating worsening of the previous stump and phantom limb pain. During the following year, concurring with change of prosthesis, symptoms progressively worsened, which limited walking. The therapeutic approach to pain and myoclonus was initially pharmacological, without response. Given the clinical and ultrasound suspicion of neuroma in the external popliteal sciatic nerve, it was infiltrated with corticosteroid and anesthetic, and the gastrocnemius with botulinum toxin type A, without success. Finally, the myoclonus disappeared, and the pain decreased after surgical remodeling of the stump and resection of the neuroma. This clinical picture is known as jumping stump syndrome and is a rare complication that must be considered after amputation.

La formación en entrenamiento de fuerza dirigida a médicos aumenta su prescripción / Strength training education for physicians increases its prescription

Introducción: Tradicionalmente la prescripción médica se centra en el ejercicio aeróbico, pero son cada vez más los autores que señalan al entrenamiento de fuerza como la modalidad de ejercicio más saludable. El objetivo del presente trabajo es evaluar los cambios en los conocimientos y la seguridad para la prescripción de ejercicio de fuerza tras haber realizado un curso teórico-práctico de ejercicio físico dirigido a médicos, con respecto a no haberlo realizado. Material y métodos: Se realizó un estudio de intervención en 160 médicos con 2 cohortes, 80 realizaron un curso sobre ejercicio (grupo de intervención) y 80 no lo realizaron (grupo comparativo). Se recogieron datos personales, profesionales, sobre el ejercicio físico en general y de fuerza que practicaban o prescribían, y seguridad y conocimientos para su prescripción. Se analizaron las diferencias entre los grupos y la repercusión de haber realizado o no el curso. Resultados: Los 2 grupos eran homogéneos en sexo, edad, especialidad y realización de ejercicio físico, destacando la baja tasa de práctica y prescripción del entrenamiento de fuerza en ambos grupos. Se objetivó que el grupo que había realizado el curso adquirió conocimientos y seguridad para la prescripción de ejercicio de fuerza y consideraba que era la odalidad que debía ser potenciada (p<0,001). Conclusiones: La formación en entrenamiento de fuerza dirigida a médicos mediante un curso teórico-práctico aumenta los conocimientos y la seguridad para su prescripción.(AU)

Introduction: Medical prescriptions have traditionally been focused on aerobic exercise. However, an increasing number of authors are pointing towards strength training as the healthiest exercise modality. The purpose of this study is to assess whether physicians increase their knowledge as well as their confidence to prescribe strength training after attending a physical training course. Materials and methods: A prospective cohort study of 160 physicians was conducted, 80 physicians out of the 160 attended a physical training course, whereas the remaining 80 physicians did not. Personal and professional data was collected, as well as data regarding the type of exercise they were practising or prescribing and the confidence and knowledge for their prescription. Finally, differences between the two groups and the impact of attending the course where analysed. Results: Both groups were homogeneous in gender, age, medical speciality and practice of physical exercise, with very low rates of strength training and prescription for both groups. It was established that the group attending the course acquired knowledge and confidence for prescribing strength training. Moreover, this group considered that strength training was the exercise modality which should be encouraged (P<.001). Conclusions: Education in strength training for physicians by means of a theoretical-practical course increases knowledge and confidence for its prescription.(AU)

[Strength training education for physicians increases its prescription]. / La formación en entrenamiento de fuerza dirigida a médicos aumenta su prescripción.

INTRODUCTION: Medical prescriptions have traditionally been focused on aerobic exercise. However, an increasing number of authors are pointing towards strength training as the healthiest exercise modality. The purpose of this study is to assess whether physicians increase their knowledge as well as their confidence to prescribe strength training after attending a physical training course. MATERIALS AND METHODS: A prospective cohort study of 160 physicians was conducted, 80 physicians out of the 160 attended a physical training course, whereas the remaining 80 physicians did not. Personal and professional data was collected, as well as data regarding the type of exercise they were practising or prescribing and the confidence and knowledge for their prescription. Finally, differences between the two groups and the impact of attending the course where analysed. RESULTS: Both groups were homogeneous in gender, age, medical speciality and practice of physical exercise, with very low rates of strength training and prescription for both groups. It was established that the group attending the course acquired knowledge and confidence for prescribing strength training. Moreover, this group considered that strength training was the exercise modality which should be encouraged (P<.001). CONCLUSIONS: Education in strength training for physicians by means of a theoretical-practical course increases knowledge and confidence for its prescription.

Síndrome axillary web tras cirugía de cáncer de mama. Variante rara con nódulos subcutáneos / Axillary web syndrome following breast cancer surgery. Rare variant with subcutaneous nodules

Se presenta el caso de una mujer de 49 años, tratada e intervenida por cáncer de mama, quien, a las 3semanas de presentar síndrome de axillary web (SAW), desarrolló nódulos subcutáneos, blandos e indoloros a lo largo de su recorrido y cerca de la flexura del codo. Las pruebas complementarias (ecografía Doppler y de partes blandas) descartaron etiología dérmica/subcutánea o neoplásica, y se evidenció trombosis venosa cefálica y cubital. Se pautó tratamiento con anticoagulante y a las 3-4 semanas el SAW mejoró y los nódulos desaparecieron. Con la clínica, evolución y las pruebas complementarias realizadas, junto con la evidencia científica publicada, se diagnosticó de SAW con nódulos subcutáneos. El SAW es una complicación posquirúrgica precoz del cáncer de mama conocida entre los profesionales y cuyo diagnóstico es clínico. La asociación del SAW con nódulos subcutáneos es una de las variantes poco frecuente, en las que es preciso ampliar el estudio. Se cree que los nódulos, al igual que el SAW, son debidos a procesos trombóticos linfovenosos (AU)

We describe the case of a 49-year-old woman who, after surgical treatment of breast cancer, developed axillary web syndrome (AWS) followed, 3 weeks later, by the appearance of soft and painless subcutaneous nodules along the cords and close to the flexure of the elbow. After tests (soft tissue and Doppler ultrasound), a dermal/subcutaneous or neoplastic cause was ruled out, although a cephalic and ulnar venous thrombosis was revealed. Anticoagulant medication was prescribed, with disappearance of the nodules 3-4 weeks later and improvement of AWS. The symptoms, clinical course, diagnostic tests, as well as the published evidence, helped to establish a diagnosis of AWS with subcutaneous nodules. AWS is an early complication after axillary surgery, which is well known among breast cancer professionals and whose diagnosis is based on clinical presentation. Its association with subcutaneous nodules is one of its rare variants and requires compulsory complementary studies to exclude other causes. Like AWS, nodules are believed to be due to lymphatic vessel thrombosis (AU)

[Axillary web syndrome following breast cancer surgery. Rare variant with subcutaneous nodules]. / Síndrome axillary web tras cirugía de cáncer de mama. Variante rara con nódulos subcutáneos.

We describe the case of a 49-year-old woman who, after surgical treatment of breast cancer, developed axillary web syndrome (AWS) followed, 3 weeks later, by the appearance of soft and painless subcutaneous nodules along the cords and close to the flexure of the elbow. After tests (soft tissue and Doppler ultrasound), a dermal/subcutaneous or neoplastic cause was ruled out, although a cephalic and ulnar venous thrombosis was revealed. Anticoagulant medication was prescribed, with disappearance of the nodules 3-4 weeks later and improvement of AWS. The symptoms, clinical course, diagnostic tests, as well as the published evidence, helped to establish a diagnosis of AWS with subcutaneous nodules. AWS is an early complication after axillary surgery, which is well known among breast cancer professionals and whose diagnosis is based on clinical presentation. Its association with subcutaneous nodules is one of its rare variants and requires compulsory complementary studies to exclude other causes. Like AWS, nodules are believed to be due to lymphatic vessel thrombosis.

[Fighting against COVID-19: clinical activities of spanish rehabilitation physicians: A cross-sectional study]. / Luchando contra la COVID-19: labor asistencial de los médicos rehabilitadores españoles. Estudio transversal.

OBJECTIVE: The aim of this study was to analyse both the impact of the pandemic and clinical and teaching organisation in Spanish Physical Medicine and Rehabilitation Departments during the COVID-19 pandemic. METHODS: A survey was conducted of the tutors of rehabilitation departments. The questionnaire contained 31 questions divided into 6 parts about the following: general information on the department, adaptation of rehabilitation departments to the COVID pandemic, clinical work of rehabilitation physicians, the approach to rehabilitation in COVID patients, and the effects of the pandemic on the health and teaching activity of rehabilitation physicians during this period. RESULTS: A total of 54 responses were obtained. Almost half of the departments cancelled face-to-face medical consultations (40%) and 48% of the treatment rooms were turned into COVID beds. In 30 hospitals (55.6%), the physicians worked in COVID units. Most of the rehabilitation departments developed both graphic and audiovisual material with exercises, referral protocols and guidelines for the rehabilitation management and treatment of COVID 19 patients. Half of the departments reported some anxiety symptoms in medical staff. Tutorial work has been cancelled (40.7%) or reduced (35.2%). CONCLUSIONS: The organisation of Spanish rehabilitation departments in response to the COVID pandemic has been very similar throughout the country. The response of these departments to the healthcare crisis has revealed the versatility of rehabilitation physicians.

[Idiopathic axillary web syndrome]. / Síndrome axillary web idiopático.

We report the case of a 67-year-old woman who developed a cord of subcutaneous tissue extending from the axilla into the medial arm, accompanied by axillary neuropathic pain, with no history of surgery or infection. The patient was instructed in home exercises, and the condition progressively improved. Four months later, a small cord was visible on abduction with mild axillary dysesthesia, which was less severe than at onset. Diagnosis of exclusion was idiopathic axillary web syndrome (AWS). This syndrome is widely recognized after surgical axillary lymph node removal to treat breast cancer, but the etiopathogenesis is still unknown. Published reports of AWS with no history of surgery are rare, but a few reports have described this entity after infection or intense exercise. There are currently no previous reports of idiopathic AWS. The anatomical and clinical presentation, and clinical course of AWS without prior surgery, are similar to those of postoperative AWS.

[Subcutaneous botulinum toxin in the treatment of peripheral neuropathic pain]. / Toxina botulínica subcutánea en el tratamiento del dolor neuropático periférico.

Neuropathic pain impairs quality of life in affected individuals and poses a challenge to clinicians due to the complexity of its treatment and frequent therapeutic failures. We present 4clinical cases of chronic neuropathic pain (LANSS ≥ 19), refractory to conservative treatment (meralgia paraesthetica, post-surgical pain and 2surgical scars). Subcutaneous botulinum toxin type A was infiltrated periodically over the painful area. All patients experienced subjective improvement in pain and improvement measured by the visual analogic scale. Pain relief started at 5-21 days and continued up to 1.5-3 months, and up to 9 months in one patient. Pain that reappeared was of lower intensity in 3patients and was reduced in area in 2patients.

[Children's and adolescents' perception of their quality of life in cases of attention deficit hyperactivity disorder with and without pharmacological treatment and in controls]. / Percepcion de niños y adolescentes sobre la calidad de vida en casos de trastorno por deficit de atencion/hiperactividad con y sin tratamiento farmacologico y en controles.

INTRODUCTION: Health-related quality of life perceived by children and teenagers is important to assess the effects of therapeutic intervention. AIM: To analyze quality of life, comparing cases of attention deficit hyperactivity disorder (ADHD) treated with methylphenidate, untreated cases and controls. SUBJECTS AND METHODS: Sampling of 228 participants between 8 and 14 years-old. Consecutive sampling in ADHD according to DSM-IV criteria (ADHD Rating Scales IV) and random sampling of matched controls by sex and age. Evaluation of quality of life using KIDSCREEN-52 (children version). ANOVA with Bonferroni correction was used. RESULTS: There is a moderate significant correlation between greater intensity of ADHD symptoms and worse quality of life, except in the dimension of physical well-being. Cases of untreated ADHD have significantly worse quality of life than controls on psychic well-being, mood, autonomy school environment and social acceptance. Cases of treated ADHD present similar results, except in the school environment and psychological well-being. The cases of ADHD treated only differ significantly from ADHD not treated in having a better school environment. CONCLUSIONS: The cases of ADHD present dimensions of KIDSCREEN-52 with worse quality of life than controls and the cases of ADHD treated with methylphenidate only differ significantly from those not treated in presenting better results in the school environment.

TITLE: Percepcion de niños y adolescentes sobre la calidad de vida en casos de trastorno por deficit de atencion/hiperactividad con y sin tratamiento farmacologico y en controles.Introduccion. La calidad de vida relacionada con la salud percibida por niños y adolescentes es un factor importante para valorar los efectos de una intervencion terapeutica. Objetivo. Analizar la calidad de vida comparando casos con trastorno por deficit de atencion/hiperactividad (TDAH) tratados farmacologicamente con metilfenidato, casos no tratados y controles. Sujetos y metodos. Muestra de 228 participantes de 8-14 años. Muestreo consecutivo de casos de TDAH segun los criterios del Manual diagnostico y estadistico de los trastornos mentales, cuarta edicion, y muestreo aleatorio de controles emparejados por sexo, edad y zona sociodemografica. Evaluacion de la calidad de vida mediante el KIDSCREEN-52 (version niños y adolescentes). Para responder al objetivo se utilizo ANOVA con correccion de Bonferroni. Resultados. Observamos una correlacion significativa moderada entre mayor intensidad de sintomas de TDAH y peor calidad de vida, excepto en el bienestar fisico. Los casos de TDAH no tratados tienen significativamente peor calidad de vida que los controles en bienestar psiquico, autonomia, estado de animo, entorno escolar y aceptacion social. Los casos de TDAH tratados observan similares resultados excepto en el entorno escolar y el bienestar psiquico, que no presentan diferencias significativas con los controles. Los casos de TDAH tratados por comparacion con los de TDAH no tratados solo presentan significativamente mejor calidad de vida en el entorno escolar. Conclusion. Los casos de TDAH presentan dimensiones del KIDSCREEN-52 con peor calidad de vida que los controles y los casos de TDAH tratados con metilfenidato solo se diferencian significativamente de los no tratados porque presentan mejores resultados en el entorno escolar.

Características del asma infantil en Atención Primaria. Mejora del seguimiento / The asthma in children is the second cause of infantile chronic morbidity, consuming great part of the sanitary resources

El asma infantil es la segunda causa de morbilidad crónica infantil consumiendo gran parte de los recursos sanitarios. Material y métodos: estudiamos de forma transversal 1.509 historias de pacientes de 6 a14 años, seguidos en un centro de salud de la meseta castellana (España). Resultados: la edad media de los niños con asma fue 8,9 años con un ligero predominio en varones, la prevalencia acumulada de 11,9% y en los últimos 3 años del 9%. La edad de inicio fue de 3,5 años. Presentaban antecedentes familiares de enfermedad atópica el 39,4% y personales en el 54,7%. Otra patología respiratoria se halló en el 51,4%. El 89,8% de los niños erancontrolados en Atención Primaria, las pruebas de estudio de sensibilización alérgica se realizaron en el 44,1% y la función pulmonar en el 48,8%. Conclusiones: el seguimiento mayoritario de estos pacientes se ha realizado en Atención Primaria y ha permitido una mejora en el control de los pacientes (AU)

The asthma in children is the second cause of infantile chronic morbidity, consuming greatpart of the sanitary resources. Methodology: we made of cross-sectional study of 1,509 histories of patients of 6 to 14 years, followed in Primary Care in the Castilian plateau (Spain). Results: the average age was 8.9 years with a slight predominance of males, accumulated prevalence of 11.9% and in the last 3 years of 9%. The age of onset was 3.5 years. Familiar atopic disease was present in 39.4% and personal antecedents in 54.7%. Another respiratory condition was present in 51.4%. Eighty-nine point eight percent of the children were controlled in primary care. Forty-four point one percent of children had sensitization tests performedand 48.8% had undergone tests of pulmonary function. Conclusions: most of the follow up of these patients takes place in Primary Care and thisfact has allowed an improvement in the control of the patients (AU)

Abscesos hepáticos: análisis retrospectivo de 68 casos / Liver abscess: retrospective review of 68 cases

Objetivos: Conocer las características clínicas y de las pruebas complementarias de pacientes con abscesos hepáticos (AH) y establecer factores pronósticos. Pacientes y métodos: Análisis retrospectivo de pacientes diagnosticados de AH en el Hospital Severo Ochoa, entre 1989 y 2005. Resultados: Se recogieron 68 pacientes: 39 hombres y 29 mujeres; incidencia: 26 casos/100.000 ingresos hospitalarios; edad (Me): 63 años. El origen fue: biliar (37%), portal (16%), por diseminación hematógena (7%), por inoculación directa (4%), desconocido (35%). La ecografía fue diagnóstica en 43% de casos y la tomografía computarizada en 57%. Los AH fueron mayores a 3 cm de diámetro en 62% de casos y en 28% fueron AH múltiples. Fueron positivos 71% de cultivos de pus y 52% de hemocultivos. Se aisló el germen causal en 73,5% de AH. Se realizó antibioterapia en 100% de pacientes, drenaje percutáneo en 56% y cirugía en 25%. Evolución: 13% de complicaciones, 9% de recidivas y 19% de mortalidad. Conclusiones: Cuadro clínico mal definido del AH. Factores asociados a complicaciones: enfermedad neurológica o tumoral abdominal, previas y AH múltiples. Factores asociados a mortalidad: índice de comorbilidad de Charlson corregido por la edad > 5, índice de Quick < 60% y aparición de complicaciones. Es necesario individualizar la indicación de drenaje en cada paciente

Objetive: To assess clinical and laboratory features of patients with liver abscesses (LA), and determine prognostic features. Methods: We performed a retrospective analysis of medical records of patients receiving a diagnosis of LA in the Hospital Severo Ochoa, between 1989-2005. Results: We were able to find 68 patients: 39 males and 29 females; the incidence amounts 26 cases/100,000 hospital admissions; mean age 63 years. A biliary source accounted for 37%, 16% were of portal origin, 7% were ascribed to hematogenous dissemination, 4% direct inoculation during a procedure and no cause could be found in 35%. Liver ultrasonography allowed diagnosis in 43% of cases, and CT scan un 57%. Sixty-two percent of LA were larger than 3 cm in diameter; 28% of cases had multiple abscesses. Cultures of abscess fluid were positive in 71%,and blood cultures in 52%. Globally, we were able to isolate the causal microorganism in 73.5% of cases. Hundred percent of patients received antimicrobials, 56% had percutaneous drainage performed and 25% were surgically managed. There were complications in 13%, 9% suffered recurrences and we found a 19% mortality rate. Conclusions: LA has an ill-defined clinical picture. A history of neurological disease or abdominal tumor, and multiple LA are associated with an increased complication rate. Following factors correlated with increased mortality: Age-adjusted Charlson’s morbidity index >=5; Quick index < 60% and development of complications. Drainage indication has to be individualized

[Liver abscess: retrospective review of 68 cases]. / Abscesos hepáticos: análisis retrospectivo de 68 casos.

OBJECTIVE: To assess clinical and laboratory features of patients with liver abscesses (LA), and determine prognostic features. METHODS: We performed a retrospective analysis of medical records of patients receiving a diagnosis of LA in the Hospital Severo Ochoa, between 1989-2005. RESULTS: We were able to find 68 patients: 39 males and 29 females; the incidence amounts 26 cases/100,000 hospital admissions; mean age 63 years. A biliary source accounted for 37%, 16% were of portal origin, 7% were ascribed to hematogenous dissemination, 4% direct inoculation during a procedure and no cause could be found in 35%. Liver ultrasonography allowed diagnosis in 43% of cases, and CT scan un 57%. Sixty-two percent of LA were larger than 3 cm in diameter; 28% of cases had multiple abscesses. Cultures of abscess fluid were positive in 71%, and blood cultures in 52%. Globally, we were able to isolate the causal microorganism in 73.5% of cases. Hundred percent of patients received antimicrobials, 56% had percutaneous drainage performed and 25% were surgically managed. There were complications in 13%, 9% suffered recurrences and we found a 19% mortality rate. CONCLUSIONS: LA has an ill-defined clinical picture. A history of neurological disease or abdominal tumor, and multiple LA are associated with an increased complication rate. Following factors correlated with increased mortality: Age-adjusted Charlson's morbidity index > or =5; Quick index < 60% and development of complications. Drainage indication has to be individualized.

Perforación duodenal neonatal espontánea / Spontaneous duodenal perforation in the neonate

No disponible

Lignans and Other Constituents of Centaurea sphaerocephala ssp. polyacantha.

Extraction of the aerial parts of CENTAUREA SPHAEROCEPHALA L. ssp. POLYACANTHA (Willd.) Dostal furnished the lignans (-)-matairesinol, (-)-arctigenin, and (-)-arctiin, two sesquilignans lappaol A and a stereo- or structural isomer of lappaol A, and a new dithienylacetylene.

Ambrosanolides and other constituents of two rudbeckia species.

Aerial parts of RUDBECKIA SUBTOMENTOSA Pursh furnished four C-15 functionalized ambrosanolides, one of them new, as well as coumarin. Aerial parts of RUDBECKIA TRILOBA L. var. TRILOBA furnished coumarin and two closely related thiopheneacetylenes.