Actinomicosis: dos casos clínicos ginecológicos. No sólo los DIUs tienen la culpa / Actinomycosis: two gynaecological clinical cases. It's not just IUDs to blame

Introducción: La actinomicosis pélvica ha sido descrita en la literatura como asociada al uso de dispositivos intrauterinos, pero no siempre guarda relación con ellos. Hallazgos clínicos: En este artículo describimos dos casos de abscesos pélvicos en dos pacientes con cirugías previas y endometriosis, sin antecedente de uso de DIU. Diagnóstico: En ambas pacientes se aisló Actinomyces turicensis en los cultivos de los abscesos, entre otros microorganismos, siendo diagnosticadas de actinomicosis pélvica. Tratamiento: Las dos pacientes precisaron de drenaje quirúrgico de los abscesos y tratamiento antibiótico durante el ingreso y, una vez que se les dio de alta, requirieron un tratamiento de mantenimiento durante meses con amoxicilina. Resultados: Las dos pacientes mostraron resolución del cuadro clínico, analítico y radiológico durante el seguimiento posterior. Conclusión: Hacemos especial hincapié en la importancia de sospechar y tratar esta infección a tiempo, para evitar cirugías agresivas, así como realizar un adecuado diagnóstico diferencial con otros procesos que pueden presentar síntomas similares.(AU)

Introduction: Pelvic actinomycosis has been described in the literature associated with the use of intrauterine devices, but it is not always related to them. Clinical findings: In this article we describe two cases of pelvic abscesses in two patients with previous surgeries and endometriosis, without a history of IUD use. Diagnosis: Actinomyces turicensis was isolated in both patients in abscess cultures, among other microorganisms, being diagnosed with pelvic actinomycosis. Treatment: The two patients required surgical drainage of the abscesses and antibiotic treatment during admission and once they were discharged, they required maintenance treatment for months with Amoxicillin. Results: Both showed resolution of the clinical, analytical and radiological features during the subsequent follow-up. Conclusion: We place special emphasis on the importance of suspecting and treating this infection in time, to avoid aggressive surgeries and to carry out an adequate differential diagnosis with other processes that can give similar symptoms.(AU)

Positioning document on incorporating point-of-care ultrasound in Internal Medicine departments. / Documento de posicionamiento sobre la incorporación de la ecografía clínica en los servicios de Medicina Interna.

This positioning document describes the most important aspects of clinical ultrasonography in the internal medicine setting, from its fundamental indications to the recommended training period. There is no question as to the considerable usefulness of this tool in the standard clinical practice of internists in numerous clinical scenarios and settings (emergencies, hospital ward, general and specific consultations and home care). Ultrasonography has a relevant impact on the practitioner's ability to resolve issues, increasing diagnostic reliability and safety and providing important information on the prognosis and progression. In recent years, ultrasonography has been incorporated as a tool in undergraduate teaching, with excellent results. The use of ultrasonography needs to be widespread. To accomplish this, we must encourage structured training and the acquisition of equipment. This document was developed by the Clinical Ultrasonography Workgroup and endorsed by the Spanish Society of Internal Medicine.

Teaching the basics of echocardiography in the undergraduate: Students as mentors. / Enseñanza de las bases de la ecocardioscopia en el pregrado: los estudiantes como mentores.

OBJECTIVE: To analyse the ability of medical students to incorporate the practical teaching of basic echocardiography planes using a peer mentoring design. METHODOLOGY: Thirty-six medical students previously trained in obtaining echocardiography planes (mentors) taught the other 5th-year students (n=126). The teaching methodology included three stages: theory (online course), basic training (three 15h sessions of practical experience in ultrasound and at least 20 echocardiographic studies per mentor) and objective structured clinical assessment (OSCA), which scored the appropriateness of the basic ultrasound planes and the correct identification of 16 cardiac structures. RESULTS: The students' weighted mean score in the OSCA was 8.66±1.98 points (out of 10). Only 10 students (8.4%) scored less than 5, and 15 (12.6%) scored less than 7. Fifty students (42%) scored 10 points. The most easily identified structure was the left ventricle in the short-axis parasternal plane, with 89.9% of correct answers. The most poorly identified structure was the mitral valve in the subxiphoid plane, with 69.7% of correct answers. CONCLUSIONS: Peer mentoring-based teaching achieves an appropriate level of training in obtaining basic echocardiography planes. The training period is relatively short. The peer mentoring system can facilitate the implementation of teaching on basic aspects of ultrasound to a large number of undergraduate students.

Concepción de la mente y de la enfermedad mental en la antigüedad clásica / No disponible

Introducción: el milagro griego (siglo V-IV a. C.) genera la consideración de la enfermedad como un proceso provocado por causas naturales y no por castigo divino. Objetivo: estudiar la concepción de la mente y de la enfermedad mental en la Antigüedad. Metodología: las fuentes empleadas han sido artículos y libros de Historia, Historia de la Medicina y Arqueología. Resultados: en la etapa hipocrática y post-hipocrática (siglo V y IV a. C.), la medicina se escinde del saber filosófico y comienza a basarse en la ciencia natural (estequiología o teoría humoral). El enfermo deja de ser concebido como pecador si bien se encuentra excluido socialmente de acuerdo con el ideal de belleza y salud, lo que cambiará con la llegada del cristianismo. Discusión: el conocimiento científico de la mente y de la enfermedad mental se inicia en Grecia, aunque la visión mítica de la enfermedad continuó existiendo encarnada en el culto a Asclepio (AU)

Introduction: illness’ consideration as a natural process instead of divine punishment comes from greek miracle (V-IV centuries b. C). Aim: to study mind and mental illness’ conception in Classic Antiquity. Methodology: the references used have been articles and treaties about History, History of Medicine and Archaeology. Results: in old hipocratic and post-hipocratic times (V y IV centuries b. C.), medicine becomes independent from philosophy and begins to base in natural science (humoural theory). Ill people won’t be considered as sinners any mo-re, although they continue socially excluded according to beauty and health ideals, which will change with Christianity. Discussion: scientific knowledge of mental disorders begins in Classic Greece, although mythic consideration of illness continues through Asclepius’ cult (AU)

Hiperprolactinemia en pacientes esquizofrénicos en tratamiento con antipsicóticos / No disponible

Introducción: La elevación de los niveles séricos deprolactina es uno de los efectos adversos de los antipsicóticos.Parece ser más frecuente en caso de clásicosque en caso de atípicos.Objetivo: Medir este efecto adverso en nuestrospacientes según el tipo de antipsicóticos que tomanPoblación: doscientos cuarenta pacientes diagnosticadosen su mayoría de esquizofrenia según criteriosCIE-10; 55 varones y 185 mujeres, con una edad mediade 60,42 años y un tiempo medio de estancia de 18,20años.Método: Se realizaron determinaciones del nivelsérico de prolactina, considerando cifras normales paramujeres de 1,5 a 25 ng/ml en edad fértil y de 0,7 a 20ng/ml en menopausia; para hombres hasta 20 ng/ml.La población se dividió en tres grupos:–Grupo con antipsicóticos típicos: 44 pacientes–Grupo con antipsicóticos atípicos: 126 pacientes–Grupo con antipsicóticos típicos más atípicos: 57pacientes.Las evaluaciones estadísticas se realizan con el SPSSv.15.0, utilizando análisis de correlación y considerandoun nivel de significación p < 0,05.Resultados: El tanto por ciento de pacientes que presentahiperprolactinemia es de 69,5%; de los que tomanatípicos es de 64,3%, de los que toman típicos es de70,5 y de los que toman típicos y atípicos es de 80,4%.De los fármacos, risperidona da una cifra de hiperprolactinemiade 91,5%, haloperidol de 73,3 y clozapinade 7,7.Las elevaciones de prolactina son moderadas (entre25 y 99 ng/ml), pero en un 20% de los casos son cifraspor encima de 100 ng/ml. Conclusiones: De los datos de nuestro estudio se despendeque los pacientes con antipsicóticos atípicos tienencifras de prolactina mejores que los pacientes conatípsicoticos típicos. Haloperidol y risperidona son losfármacos que peores resultados ofrecen en este aspecto(AU)

Introduction: High prolactine serum level is an adverseeffect due to narcoleptic treatment. More frequently producedby typical antipsychotics than atypical ones.Aim: To find out the prevalence of hyperprolactinemiain our patients related to the type of antipsychotic drugused.Sample: Two hundred and forty patients diagnosed,mainly, of schizophrenia following ICD-10 criteria,with a mean age of 60.42 years old and a mean hospitalstay of 18.20 years.Method: Prolactine serum levels were determined(normal values: 1.5-25 ng/ml for women on fertile age,0.7-20 ng/ml for post-menopause women).The sample was divided in three groups:–Typical antipsychotics group: 44 patients.–Atypical antipsychotics group: 126 patients.–Typical and atypical antipsychotics group: 57patients.Statistical analysis was performed with SPSS v.15.0,using correlation analysis with a level of significance ofp < 0.05.Results: Prevalence of hyperprolactinemia was69.5%. Results for the different groups were the following:Atypical antipsychotics group: 64.3%; typicalantipsychotics group: 70.5; typical and atypical antipsychoticsgroup: 80.4.Statistical analysis according to concrete antipsychoticdrug showed the following hyperprolactinemiapercentages: risperidone: 91.5%; haloperidol: 73.3,clozapine: 7,7.Hyperprolactinemia usually fluctuated in moderatevalues (between 25 and 99 ng/ml), but 20% of thepatients showed higher values than 100 ng/ml. Conclusions: Our study finds lower prolactine serumlevels in patients on atypical antipsychotic treatmentthan on typical antipsychotic one. Haloperidol andrisperidone got the highest levels(AU)

Descripción y tipos de enfermedad mental en la Antigüedad Clásica / No disponible

Introducción: La Medicina hipocrática (s. V-IV a.C.) va estableciendo el modelo médico de la enfermedad,que presupone que tanto los trastornos físicoscomo los mentales constituirían un fenómeno natural.Objetivo: Estudiar los distintos tipos de enfermedadmental descritos a lo largo de la Antigüedad Clásica.Metodología: Las fuentes empleadas han sido librosde Historia e Historia de la Medicina (bibliografía cruzada)y artículos (sistema Medline).Resultados: No existe una taxonomía ni un tratadodedicado a las enfermedades psiquiátricas en la literaturaantigua. No obstante, podemos identificar ciertos síndromescomo la epilepsia, algunas enfermedades orgánicas,la ignorancia o el predominio de los instintos, lahisteria, la melancolía, la ansiedad y la locura amorosa.El suicidio no es considerado patológico.Discusión: Aunque la visión mítica de la enfermedadpersistiera, el conocimiento científico de la enfermedadmental se inicia en Grecia. Sin embargo, la tipologíadescrita no coincide con las clasificaciones actuales(AU)

Introduction: Hypocratic medicine (V-IV centuriesB.C.) introduces medical model of mental illness. Itsupports that both physical and psychiatric disordersconsist in natural phenomenons.Aim: To study the different types of mental disordersdescribed in Classic Antiquity.Methodology: The references used have been treatiesabout History and History of Medicine (crossed references)and articles (Medline search).Results: There is neither taxonomy nor mental disorderstreaty in antique literature. Nevertheless, we canfind several syndromes described by different authors,as epilepsy, brain diseases, ignorance or instinct predomination,individual and collective hysteria, depression,anxiety and erotic melancholy. Instead of a pathologicalphenomenon, suicide is considered as a rationalbehaviour.Discussion: Although mythic consideration of illnesscontinues, scientific knowledge of mental disordersbegins in Greece. However, the types described do notcoincide with modern taxonomy(AU)

Tratamiento de la depresión geriátrica en el medio residencial / Geriatric depression therapy in residentail homes

Objetivo: Revisar el tratamiento de la depresión enancianos institucionalizados.Metodología: Búsqueda en Medline (desde 1990) yartículos y capítulos de libros obtenidos mediante referenciascruzadas.Resultados: La depresión es el trastorno psiquiátricomás prevalente en el anciano (20% en residencias paraválidos y 40% en asistidas). El tratamiento se basa en:a) un manejo adecuado: incluye la aceptación del ingresopor el paciente, visitas familiares, permisos y apoyoafectivo por parte del personal; b) tratamientos biológicos:el tratamiento de primera elección serían los ISRS,siendo de segunda elección los antidepresivos de accióndual y los tricíclicos. Otras opciones terapéuticas incluyenel litio y la terapia electroconvulsiva (TEC); y c) lasdiferentes técnicas de psicoterapia son útiles, mostrandouna eficacia superior al placebo pero sin diferenciasestadísticamente significativas entre ellas.Conclusiones: El tratamiento de la depresión en elanciano institucionalizado se basa en tres pilares: unmanejo adecuado, tratamientos biológicos y psicoterapia

Objective: To review geriatric depression treatmentin institutionalized old patients.Methodology: Medline search since 1990 and severalcrossed references (articles and book chapters) obtainedfrom psychiatry treatises.Results: Depression is the most prevalent psychiatricdisorder in old people (20% in independent livinghomes and 40% in assisted nursing homes). Its treatmentis based in: a) a correct management: It includespatient’s agreement with residential home admission,family meetings and affective support provided by staff;b) biological treatments: SSRI are the first electiontreatment. Dual or tricyclic antidepressants may be thesecond election. Other therapeutic alternatives are lithiumcarbonate and electroconvulsive therapy; and c)psychotherapy is also useful. The different techniquesshow a higher effectiveness than placebo, although nostatistical differences among them have been found.Conclusions: Depression treatment in institutionalizedold patient is based in three pillars: A correct management, biological treatments and psychotherapy

Residencia y tiempo de hospitalización en relación con la calidad de vida de los pacientes esquizofrénicos / Relationship between living-residence and time of hospitalization in schizophrenia patients´ quality of life

Introducción: La edad joven y la integración en la comunidad de los pacientes se han asociado a una mejor calidad de vida (CV). El elevado tiempo de evolución de la enfermedad y la institucionalización se correlacionarían inversamente con la CV. Objetivo: Demostrar que las diferencias en la CV de los pacientes esquizofrénicos en relación con el lugar de residencia, el tiempo de hospitalización previa total, el número de ingresos realizados y la edad, son debidas al azar. Metodología: Estudio transversal en que la población (104 pacientes) se dividió en grupos según la variable independiente analizada (lugar de procedencia, tiempo de hospitalización total, número de ingresos previos y edad). Para determinar la CV (variable dependiente) se utilizó la Quality of life scale de Heinrichs y cols. (QLS). Resultados: Los pacientes obtienen puntuaciones decrecientes en su CV según procedan de consulta externa, Agudos, recursos intermedios y Unidades de Media-Larga Estancia, mostrándose las diferencias estadísticamente significativas. La CV también se asocia de forma inversa y estadísticamente significativa con el tiempo total de hospitalización previo. Conclusiones: Los niveles más altos de CV pueden deberse tanto a una mayor integración socio-familiar de los pacientes como a una menor gravedad de su enfermedad, lo cual haría posible dicha integración

Introduction: Young age and community integration of schizophrenic patients have been associated to a better quality of life. On the contrary, long-term evolution of the illness and institutionalization would have an inverse correlation with quality of life. Aim: To demonstrate that differences in quality of life of schizophrenic patients related to their place of living-residence, previous time of hospitalization, number of admissions and age, are due to random. Methodology: Transversal study in which the sample (104 patients) was divided into different groups depending on the independent variable analyzed (resource of procedence, previous time of hospitalization, previous number of admissions and age). Quality of life scale (Heinrichs, et al), was used to measure quality of life. Results: Patients obtained decreasing punctuations in quality of life depending on their resource of procedence in this order: ambulatory services, half-way houses and Long-Stay Units. Differences were statistically significant. Quality of life is also significatively associated in an inverse way to previous time of hospitalization. Conclusions: The best quality of life was obtained by patients living at home and with a shorter time of previous hospitalization. It may be due to a better social and family integration. However, we should take into account that a less severe illness can be the circumstance that makes possible the better integration referred

Estudio y análisis de las urgencias atendidas en el primer trimestre de 1999 en la Fundación Hospital Alcorcón / Study and analysis of the emergency visits attended to in the first trimesster of 1999 in the Alcorcon Hospital Foundation

No disponible

A study of dielectric anisotropy in dehydrated cortical bone.

The complex permittivity of dehydrated bovine femoral bone has been studied in vitro, in the three orthogonal directions from 1 kHz to 3 MHz, as part of an analysis of the various factors involved in the dielectric behavior of fluid-saturated cortical bone. In this study the bone's physical structure reveals its anisotropic nature by its dependence on both the real and imaginary parts of permittivity on the orientation of the applied electric field. The real permittivity and the total conductivity are generally higher in the longitudinal direction than in the other two transverse directions, with the tangential direction presenting values between those of the longitudinal and radial directions and closer to the former. The high frequency limit of the real part of the permittivity was found to be around 10 and its low frequency limit is of the order of 1000. The dispersion parameters of relaxation time show values of about 0.4 and the corresponding mean relaxation frequencies are below 100 Hz.

Correlation between low-frequency electric conductivity and permittivity in the diaphysis of bovine femoral bone.

The relationship between the low-frequency electric properties in the axial, tangential, and radial directions, along the diaphysis of a femoral bovine bone, is presented. It is shown that below 1 MHz the relative permittivity of the diaphysis exhibits a significant positive correlation with respect to the low-frequency conductivity, as measured in any direction, and therefore it could be related to the amount of fluid contained in the channels that provide low-frequency electrical connectivity in the measurement direction. It was also found an absence of significant correlation between permitivity, in either of the three measurement directions, and the total fluid volumetric fraction in the bone.

Variation of the electric properties along the diaphysis of bovine femoral bone.

A preliminary study is presented of the variability of the electric properties, in the axial, tangential and radial directions, as a function of position in the diaphysis of a femoral bovine bone. The measurements were carried out at three frequencies: 100 Hz, 10 kHz and 1 MHz. It is shown that both the conductivity and the permittivity exhibit significant variations along the diaphysis, and increase in magnitude towards the epiphyses. From this study, the variation of the electric properties cannot be clearly and directly ascribed to the longitudinal variability of the total volumetric fluid content of the bone. The results reflect the orthotropic nature of the electric properties, at any given location, and indicate a position-dependent tendency towards axis symmetry.