Frey syndrome: factors influencing the time to event.

Frey syndrome is a common complication after parotidectomy. The time from surgery to disease onset may be quite long; therefore, a time-to-event analysis was performed for the occurrence of this syndrome post-parotidectomy. Three hundred and thirty-four patients who underwent a parotidectomy between January 2002 and November 2012 were identified (retrospective study). Of these patients, 102 developed Frey syndrome post-surgery and 232 did not. The time-to-onset analysis enabled us to estimate the risk ratio associated with different types of parotid gland tumours, various parotidectomy procedures, and repeat parotidectomy, which is useful for predicting preoperative and surgical risk. The risk of developing Frey syndrome was lower in patients with malignant tumours than in those with benign tumours (risk ratio 0.351, 95% confidence interval (CI) 0.155-0.594). Risk ratios for lumpectomy PA (pre-auricular area), superficial parotidectomy, and total parotidectomy with respect to lumpectomy T (tail) were 4.378 (95% CI 1.168-16.410), 8.040 (95% CI 3.286-19.670), and 8.174 (95% CI 3.076-21.723), respectively. Repeat parotidectomy also increased the risk of developing Frey syndrome (risk ratio 3.214, 95% CI 1.547-6.678). No effect of the use of a superficial muscular aponeurotic system (SMAS) flap on the risk of developing Frey syndrome was detected (P=0.888).

Expression of so-called adhesion proteins and DNA cytometric analysis in malignant parotid tumours as predictors of clinical outcome.

Tumours of the salivary glands are rare, and account for only 0.5-1% of all tumours. We have analysed the cytoarchitectural structure of such tumours by studying 3 binding proteins that act on different parts of the glandular epithelial architecture: e-cadherin, laminin, and CD44. We analysed the DNA using image cytometry to evaluate ploidy, S-phase, and 5c exceeding rate, and to compare the biological aggressiveness of the proteins. Our goal was to correlate the degree of structural integrity and the histological grade of the injury, and to try to find new biological factors that would help to predict the evolution of disease in the salivary glands. The immunoexpression pattern of the so-called adhesion proteins of the salivary glands, when combined, yields important data about the aggressiveness of malignant neoplasms, and provides useful tools with which to predict the biological evolution of malignant lesions.

[Usefulness of IPC continuous monitoring in shunt dysfunction]. / Utilidad de la monitorizacion de la PIC en pacientes con sospecha de disfuncion valvular.

Shunt dysfunction is a common situation in neurosurgery. Often symptoms, physical examination and radiology are not enough to set a diagnosis. ICP continuous monitoring is a safe and reliable tool that provides valuable information about CSF dynamics in these patients. Not only quantitative analysis is needed but also a qualitative one that enables pathological waves identification, because high amplitude B waves are strongly related to shunt dysfunction. In this paper experience about ICP continuous monitoring in patients with shunt dysfunction suspect is presented. Quantitative and qualitative data analysis led to a correct diagnosis, improving all the patients treated according to this criterion. An intraparenchymatous Camino® sensor and neuroPICture software (developed by first author) for data collection and graphic representation were used. Complications related to monitoring were absent and graphics obtained useful for qualitative analysis.

Utilidad de la monitorizacion de la PIC en pacientes con sospecha de disfunción valvular / No disponible

La sospecha de disfunción valvular constituye una situación frecuente en neurocirugía. En numerosas ocasiones ni la clínica, ni la exploración, ni la radiología pueden confirmar o descartar el diagnóstico. La monitorización continua de la PIC es un método seguro y fiable que aporta valiosa información acerca de la situación de la dinámica del LCR en estos pacientes. El sistema de registro debe permitir no sólo el análisis cuantitativo de la PIC sino también morfológico deltrazado, para identificar ondas patológicas (como las B de alta amplitud) relacionadas con situaciones de disfunción valvular. En el presente trabajo se recogela experiencia de monitorización continua de la PIC en pacientes con sospecha de disfunción valvular sincriterios clínicos y radiológicos concluyentes, en los que el análisis morfológico del registro permitió un diagnósticofiable que se tradujo en la mejoría de todos los pacientes tratados conforme a este criterio. El método utilizado fue un sensor intraparenquimatoso Camino®con software de recogida y representación neuroPICture© (desarrollado por el primer autor). Las complicaciones relacionadas con la monitorización fueron nulas y el registro obtenido útil para las objetivos propuestos (AU)

Shunt dysfunction is a common situation in neurosurgery. Often symptoms, physical examination and radiology are not enough to set a diagnosis. ICP continuous monitoring is a safe and reliable tool that provides valuable information about CSF dynamics in these patients. Not only quantitative analysis is needed but also a qualitative one that enables pathological waves identification, because high amplitude B waves are strongly related to shunt dysfunction. In this paper experience about ICP continuous monitoring in patients with shunt dysfunction suspect is presented. Quantitative and qualitative data analysis led to a correctdiagnosis, improving all the patients treated according to this criterion. An intraparenchymatous Camino®sensor and neuroPICture software (developed by firstauthor) for data collection and graphic representation were used. Complications related to monitoring wereabsent and graphics obtained useful for qualitative analysis (AU)

Quiste pericárdico / Pericardial cyst

Los quistes pericárdicos son raros, habitualmente asintomáticos y su descubrimiento suele ser casual. Presentamos el caso de un paciente con un quiste pericárdico que fue encontrado casualmente en una radiografía de tórax como una lesión radiopaca en el ángulo cardiofrénico derecho (AU)

Pericardial cysts are rare, are usually asymptomatic and their discovery is generally incidental. We report the case of a male patient with a pericardial cyst that was found incidentally on a chest X-ray as a radio-opaque lesion in right cardiophrenic angle (AU)

["Idiopathic" syringomyelia: report of a case]. / Siringomielia "idiopática"; a propósito de un caso.

Syringomyelia is the condition in which cavities fulfilled with CSF are found within spinal cord. Syringes are caused by obstructions of CSF pathways of different causes. If we can not find a cause responsible for the blockage, we call it "idiopathic" syringomyelia. Drainage procedures have been widely used but results, especially long-term results, are not favourable and complication rate is high. Some authors prefer to restore CSF circulation instead to drain the syrinx. Results of this treatment modality are better in literature than drainage procedures. Adequate radiological studies help to identify problem location and to plan the approach. A case of "idiopathic" syringomyelia is presented. Treatment consisted on arachnoid webs dissection and dural plastia. Clinical and radiological response was good. Literature concerned about this kind of syringomyelia and treatment modalities are reviewed.

Siringomielia “idiopática”: a propósito de un caso / No disponible

intramedularllena de líquido cefalorraquídeo (LCR). En laetiología de toda cavidad siringomiélica subyace unaalteración en la circulación del LCR de diversa índole.Hablamos de formas "idiopáticas" cuando no se identificanmecanismos causales de la misma. El uso de procedimientosderivativos ha sido ampliamente practicadopero el resultado de los mismos, especialmente a largoplazo, no es favorable y asocian un índice de complicacionesimportante. Otras modalidades de tratamientopretenden restaurar la circulación del LCR, eliminandoasí el mecanismo causal de la cavidad. Los resultadoscon este tipo de tratamiento son mejores a la luz de laliteratura publicada. Un adecuado estudio radiológicopermite identificar el espacio problema y planear eficazmenteel abordaje.Se presenta un caso de siringomielia idiopática tratadomediante disección de bridas aracnoideas y plastiadural con buena respuesta clínica y radiológica asícomo se revisa la literatura publicada en torno a estamodalidad de siringomielia y los distintos abordajesterapéuticos (AU)

Syringomyelia is the condition in which cavities fulfilledwith CSF are found within spinal cord. Syringesare caused by obstructions of CSF pathways of differentcauses. If we can not find a cause responsible forthe blockage, we called it "idiopathic" syringomyelia.Drainage procedures have been widely used but results,especially long-term results, are not favourable and complication rate is high. Some authors prefer to restoreCSF circulation instead to drain the syrinx. Resultsof this treatment modality are better in literature thandrainage procedures. Adequate radiological studieshelp to identify problem location and to plan the approach.A case of "idiopathic" syringomyelia is presented.Treatment consisted on arachnoids webs dissection anddural plastia. Clinical and radiological response wasgood. Literature concerned about this kind of syringomyeliaand treatment modalities are reviewed (AU)

[Comparative study of burnout in Intensive Care and Emergency Care nursing staff]. / Estudio comparativo del burnout en personal de enfermería de Cuidados Intensivos y Urgencias.

OBJECTIVE: To assess and compare the burnout level between Intensive Care Unit and Emergency Unit, and study its association with the sociodemographic and work characteristics of the professionals surveyed. DESCRIPTION: Cross-sectional, descriptive study. Emplacement. Intensive Care Unit of the university hospital Morales Meseguer, Murcia-Spain. STUDIED SAMPLE: 97 nursing professionals: 55 professionals belong to the Emergency Department, and 42 professionals belong to the Intensive Care Department. METHOD: Two evaluation tools were used: a sociodemographic and work survey, and the Maslach Burnout Inventory, 1986. Quantitative variables expressed as mean +/- SD compared with the Student's T test and qualitative variables compared with the chi2 test. STATISTICAL ANALYSIS: SPSS 12.0(c). RESULTS: The comparative analysis of the burnout dimensions shows that emotional exhaustion level is significantly higher in the intensive care service than in the emergency one (25.45 +/- 11.15 vs 22.09 +/- 10.99) p < 0.05. The rest of burnout dimensions do not show significant differences between both departments. The masculine gender obtains a higher score in the depersonalization dimension of burnout (10.12 +/- 5.38) than female one (6.7 +/- 5.21) p < 0.01. There is greater vulnerability to emotional exhaustion among the professional group with more than 15 years of work experience (F = 3.592; p = 0.031). CONCLUSIONS: The burnout levels are moderate to high among the nursing professionals studied. A total of 5.15% of the sample studied achieves a high score in the three dimensions of the burnout syndrome. The intensive care professionals are the most vulnerable to suffering high levels of emotional exhaustion, and the masculine gender is more susceptible to depersonalization attitudes.

Estudio comparativo del burnout en personal de enfermería de Cuidados Intensivos y Urgencias / Comparative study of burnout in Intensive Care and Emergency Care nursing staff

Objetivo. Estimar y comparar el nivel de burnout existente en los Servicios de Cuidados Intensivos y Urgencias, y estudiar su asociación con las características sociodemográficas y laborales de los profesionales encuestados. Diseño. Estudio descriptivo transversal. Emplazamiento. Servicios de Urgencias y Cuidados Intensivos del Hospital Morales Meseguer (Murcia). Muestra. Noventa y siete profesionales de enfermería, 55 pertenecientes al Servicio de Urgencias y 42 al Servicio de Cuidados Intensivos. Método. Se emplearon dos instrumentos de evaluación: una encuesta de variables sociodemográficas y laborales, y el cuestionario Maslach Burnout Inventory, de 1986. Las variables cuantitativas se expresan como media ± desviación estándar comparadas con t de Student y las cualitativas se comparan con Chi2. El análisis de datos se realizó mediante el programa informático SPSS 12.0(C). Resultados. El análisis comparativo de las dimensiones que componen el burnout demuestra que los niveles de agotamiento emocional son significativamente mayores en el Servicio de Cuidados Intensivos que en el de Urgencias (25,45 ± 11,15 frente a 22,09 ± 10,99) p < 0,05. El resto de dimensiones que componen el síndrome no ha demostrado diferencias significativas entre ambos servicios. El género masculino obtiene una mayor puntuación en la dimensión de despersonalización (10,12 ± 5,38) que el género femenino (6,7 ± 5,21) p < 0,01. Existe una mayor vulnerabilidad al agotamiento emocional en el grupo de profesionales que llevan más de 15 años trabajando (F = 3,592; p = 0,031). Conclusiones. Los niveles encontrados de burnout resultaron ser moderados-altos. El 5,15% de la muestra total estudiada puntúa alto en las tres dimensiones del síndrome, los profesionales de Cuidados Intensivos son los más vulnerables a padecer elevados niveles de agotamiento emocional y el género masculino es el más propenso a las actitudes de despersonalización

Objective. To assess and compare the burnout level between Intensive Care Unit and Emergency Unit, and study its association with the sociodemographic and work characteristics of the professionals surveyed. Description. Cross-sectional, descriptive study. Emplacement. Intensive Care Unit of the university hospital Morales Meseguer, Murcia-Spain. Studied sample. 97 nursing professionals: 55 professionals belong to the Emergency Department, and 42 professionals belong to the Intensive Care Department. Method. Two evaluation tools were used: a sociodemographic and work survey, and the Maslach Burnout Inventory, 1986. Quantitative variables expressed as mean ± SD compared with the Student's T test and qualitative variables compared with the chi2 test. Statistical analysis: SPSS 12.0(C). Results. The comparative analysis of the burnout dimensions shows that emotional exhaustion level is significantly higher in the intensive care service than in the emergency one (25.45 ± 11.15 vs 22.09 ± 10.99) p < 0.05. The rest of burnout dimensions do not show significant differences between both departments. The masculine gender obtains a higher score in the depersonalization dimension of burnout (10.12 ± 5.38) than female one (6.7 ± 5.21) p < 0.01. There is greater vulnerability to emotional exhaustion among the professional group with more than 15 years of work experience (F = 3.592; p = 0.031). Conclusions. The burnout levels are moderate to high among the nursing professionals studied. A total of 5.15% of the sample studied achieves a high score in the three dimensions of the burnout syndrome. The intensive care professionals are the most vulnerable to suffering high levels of emotional exhaustion, and the masculine gender is more susceptible to depersonalization attitudes

Clinical evolution of heart transplantation in patients with previous valvular cardiomyopathy.

OBJECTIVE: Heart transplantation (HT) due to valvular cardiomyopathy is rare, namely, about 3% of cases in the Registry of the International Society for Heart and Lung Transplantation (ISHLT). Usually, these patients present some risk factors such as previous valvular operations and pulmonary hypertension. Since there are few studies in the literature, we retrospectively analyzed our early and long-term results. MATERIALS AND METHODS: We studied our experience in 22 HT cases for valvular cardiomyopathy (9.3% of our total experience), namely, 12 men and 10 women, of overall mean age of 52.6 +/- 10 years. Five patients had mitral; 8, aortic; and 1, tricuspid valve disease; 7 had double valve disease and 1, triple valve disease. Nineteen patients (87%) had been operated previously between 1 and 4 times. The mean ejection fraction was 23% +/- 7.3% and the mean New York Heart Association (NYHA) functional class was 3.7. Fifty-three percent of the patients had pulmonary hypertension. Two patients were operated as an emergency "O." We used the standard HT technique. RESULTS: Four patients (18%) were reoperated due to hemorrhage. The hospital mortality was 2 cases (9%). Another patients (9%) died on follow-up due to cardiac allograft vasculopathy. All surviving patients have been followed to the end of 2006. The mean follow-up has been 72 +/- 53 months. They are functional class I or II. CONCLUSIONS: HT for this indication was more frequent in our experience than in the Registry of the ISHLT. The immediate and long-term results were good, with an 82% mean survival at 6 years. HT can be a good treatment for patients with valvular cardiomyopathy and bad ventricular function and/or multiple valvular reoperations.

[Quality of life in intracranial aneurysm: surgery versus endovascular treatment]. / Calidad de vida en pacientes con aneurismas intracraneales: cirugía versus tratamiento endovascular.

BACKGROUND: Based on earlier studies, we aimed to determine the quality of life of patients with intracranial aneurysm after their treatment by surgery or embolization and to compare the quality of life of these two groups. METHODS: The SF-36 health questionnaire was retrospectively applied to 93 patients with intracranial aneurysm treated with surgery (n=56) or embolization (n=37). RESULTS: The quality of life of some patients was impaired but 50% of patients treated with surgery and 40.5% of patients treated with embolization showed no impairment in any SF-36 domain. The quality of life in the Physical Functioning domain was higher in embolization-treated than in surgery-treated patients. CONCLUSIONS: Some patients with intracranial aneurysms treated with surgery or endovascular embolization have an impaired quality of life. Endovascular treatment may cause less limitation in physical function. The quality of life of these patients is affected by numerous factors, in addition to the type of treatment.

Calidad de vida en pacientes con aneurismas intracraneales: cirugía versus tratamiento endovascular / Quality of life in intracranial aneurysm: surgery versus endovascular treatment

Objetivo. Basados en estudios anteriores, nuestro propósito es determinar la calidad de vida de los pacientes con aneurismas intracraneales después de haber sido intervenido mediante cirugía o embolización y comparar la calidad de vida de estos dos grupos. Material y métodos. El cuestionario SF-36 fue aplicado retrospectivamente a 93 pacientes con aneurismas tratados mediante cirugía (n=56) o embolización (n=37). Resultados. La calidad de vida de los pacientes tratados con cirugía estaba deteriorada en el 50% y en los pacientes tratados por embolización el 40,5% no mostraron ningún deterioro en ninguno de los dominios delSF-36. Los análisis muestran que el dominio de la función física está menos deteriorada en los pacientes que han sido embolizados que los que han sido intervenidos quirúrgicamente. Conclusiones. Los pacientes con aneurismas intracraneales tratados mediante cirugía o embolización tienen afectada la calidad de vida. El tratamiento endovascular puede causar menos limitaciones en la función física. En la calidad de vida de estos pacientes influyen varios factores, además del tipo de tratamiento

Background. Based on earlier studies, we aimed to determine the quality of life of patients with intracranial aneurysm after their treatment by surgery or embolization and to compare the quality of life of these two groups. Methods. The SF-36 health questionnaire was retrospectively applied to 93 patients with intracranial aneurysm treated with surgery (n=56) or embolization(n=37).Results. The quality of life of some patients was impaired but 50% of patients treated with surgery and40,5% of patients treated with embolization showed no impairment in any SF-36 domain. The quality of life in the Physical Functioning domain was higher in embolization-treated than in surgery-treated patients. Conclusions. Some patients with intracranial aneurysms treated with surgery or endovascular embolization have an impaired quality of life. Endovascular treatment may cause less limitation in physical function. The quality of life of these patients is affected by numerous factors, in addition to the type of treatment

[Neuropsychological impairment in patients with intracranial aneurysms: surgical versus endovascular treatment]. / Alteraciones neuropsicológicas en pacientes con aneurismas cerebrales: tratamiento quirúrgico versus tratamiento endovascular.

OBJECTIVES: To describe the neuropsychological status of patients with intracranial aneurysms and to compare the cognitive status of patients with intracranial aneurysm treated by surgical or endovascular methods. MATERIAL AND METHODS: Ninety-three cases with intracranial aneurysms treated with surgery (n = 56) or embolization (n = 37) were included. A neuropsychological assessment was applied to both groups retrospectively, at least one year after treatment. RESULTS: Neuropsychological impairment was found in both groups. 35.7% of the patients treated with surgery and 43.2%, of those treated with embolization did not show any cognitive impairment. Visual Memory and Cued Recall of verbal information are better in patients treated by embolization. CONCLUSIONS: Our results show that a large proportion of patients with intracranial aneurysms have cognitive impairment after treatment. Endovascular management may cause less impairment in visual and verbal memory. However, bleeding may be the most important factor to explain these cognitive impairments.

Alteraciones neuropsicológicas en pacientes con aneurismas cerebrales: tratamiento quirúrgico versus tratamiento endovascular / Neuropsychological impairment in patients with intracraneal aneurysms: surgical versus endovascular treatment

Objetivos. Describir el rendimiento neuropsicológico de pacientes con aneurismas cerebrales que han sido tratados mediante cirugía o embolización, y determinarla existencia de diferencias en función de la modalidad de tratamiento. Material y métodos. Serie clínica compuesta por 93pacientes voluntarios, con aneurismas cerebrales, tratados mediante cirugía (n = 56) o embolización (n = 37). A ambos grupos se les realizó una evaluación neuropsicológica retrospectiva, al menos un año después de realizar el tratamiento. Resultados. En ambos grupos se encontraron pacientes con déficit neuropsicológicos. En el grupo de pacientes tratados quirúrgicamente el porcentaje de pacientes sin ninguna afectación neuropsicológica es del 35.7%, mientras que en el grupo de pacientes embolizados este porcentaje asciende al 43.2%. Los análisis muestran una ejecución mejor en el grupo de tratamiento endovascular, respecto al quirúrgico, sólo en memoria visual y en el recuerdo con claves de la memoria verbal. Conclusiones. Años después del tratamiento, un importante porcentaje de pacientes presenta alteraciones neuropsicológicas. El tratamiento endovascular se asocia con un mejor rendimiento en memoria visual yen el recuerdo con claves de la memoria verbal, aunque explica un porcentaje muy escaso de la varianza. Por lo tanto, en la explicación del deterioro neuropsicológico parece más importante el propio efecto de la hemorragia que la modalidad de intervención

Objectives. To describe the neuropsychological status of patients with intracranial aneurysms and to compare the cognitive status of patients with intracranial aneurysm treated by surgical or endovascular methods. Material and methods. Ninety-three cases with intracranial aneurysms treated with surgery (n = 56) or embolization (n = 37) were included. A neuropsychological assessment was applied to both groups retrospectively, at least one year after treatment. Results. Neuropsychological impairment was found in both groups. 35.7% of the patients treated with surgery and 43.2%, of those treated with embolization did not show any cognitive impairment. Visual Memory and Cued Recall of verbal information are better inpatients treated by embolization. Conclusions. Our results show that a large proportion of patients with intracranial aneurysms have cognitive impairment after treatment. Endovascular management may cause less impairment in visual and verbal memory. However, bleeding may be the most important factor to explain these cognitive impairments

Acute myocardial infarction with cardiogenic shock: treatment with mechanical circulatory assistance and heart transplantation.

UNLABELLED: The mortality of cardiogenic shock (CS) after an acute myocardial infarction (AMI) still remains high. Thrombolysis, PTCA or CABG, when possible, can improve the results, but when all the treatments fail death is almost certain. OBJECTIVE: We investigate the use of the mechanical circulatory assistance (MCA) and heart transplantation (HT) to improve the adverse results in this irreversible situation. METHODS: Among 11 patients with irreversible CS after an AMI we used a MCA (Abiomed BVS-5000). After improvement and hemodynamic stabilization, we performed heart transplantation in 7 patients of mean age 52 years (35-60) including two women. The MCA was univentricular in 7 patients and biventricular in 4. Mean duration of the MCA was 5 days (1-12). RESULTS: Three patients died during the MCA: two due to cerebrovascular accidents and one multiorgan failure. Weaning was possible in one patient. Among Seven transplanted patients one died due to sepsis. Seven (64%) patients are long-term survivors. CONCLUSION: When all the treatments have failed for CS after an AMI, MCA may be used as a bridge to heart transplantation in a select group of patients where the procedure is not contraindicated. The long-term results of 64% survivors in our experience is satisfactory.

Sirolimus in heart transplantation: a single center initial experience.

Sirolimus (SRL) is a potent non-nephrotoxic immunosuppressant. In our unit, SRL was administered to 17 heart transplant (HT) recipients at 1770+/-1234 days' posttransplant surgery, for the following reasons: (1) calcineurin inhibitor (CI) withdrawal due to renal insufficiency (RI; n=6); (2) neurotoxicity (n=1) and pancytopenia (n=1); (3) vascular graft disease (VGD) treatment (n=5); (4) immunosuppression optimization due to lung cancer (n=2); (5) CI use was delayed due to postsurgery RI (n=2). The mean follow-up was 190+/-165 days. Mean SRL doses (mg)/concentrations (ng/mL) at 7 (n=17), 30 (n=14), and 180 (n=8) days were: 1.2+/-0.6/5.9+/-6; 1.6+/-0.8/4.8+/-3.1; and 1.7+/-1.0/5.2+/-3.7. Among group 1, CI patients were discontinued without favorable functional impact. Neurotoxicity and pancytopenia improved, but there were no major clinical events in the VGD group. One "bridge" to CI was successfully performed (postsurgery RI). Total leukocyte count fell while hemoglobin, platelet, and cholesterol profiles were not affected. Ten of 15 patients (67%) were discontinued from CI without rejection and with a dose reduction of mycophenolate mofetil. There were 8 episodes (47%) of SRL-related toxicity, leading to 4 discontinuations (23%); 8 patients (47%) have died during follow-up. This retrospective analysis of outcomes in the context of severe complicated patients suggests that more premature introduction SRL is preferable, particularly in a large patient cohort.