Influence of key factors on ammonia and nitrous oxide emission factors for excreta deposited by livestock and land-applied manure.

Ammonia (NH3) and nitrous oxide (N2O) emissions from livestock manure management have a significant impact on air quality and climate change. There is an increasing urgency to improve our understanding of drivers influencing these emissions. We analysed the DATAMAN ("DATAbase for MANaging greenhouse gas and ammonia emissions factors") database to identify key factors influencing (i) NH3 emission factors (EFs) for cattle and swine manure applied to land and (ii) N2O EFs for cattle and swine manure applied to land, and (iii) cattle urine, dung and sheep urine deposited during grazing. Slurry dry matter (DM) content, total ammoniacal nitrogen (TAN) concentration and method of application were significant drivers of NH3 EFs from cattle and swine slurry. Mixed effect models explained 14-59 % of the variance in NH3 EFs. Apart from the method of application, the significant influence of manure DM, manure TAN concentration or pH on NH3 EFs suggests mitigation strategies should focus on these. Identifying key factors influencing N2O EFs from manures and livestock grazing was more challenging, likely because of the complexities associated with microbial processes and soil physical properties impacting N2O production and emissions. Generally, significant factors were soil-related e.g. soil water content, pH, clay content, suggesting mitigations may need to consider the conditions of the receiving environment for manure spreading and grazing deposition. Total variability explained by terms in mixed effect model was on average 66 %, with the random effect 'experiment identification number' explaining, on average, 41 % of the total variability in the models. We suspect this term captured the effect of non-measured manure, soil and climate factors and any biases in application and measurement technique effects associated with individual experiments. This analysis has helped to improve our understanding of key factors of NH3 and N2O EFs for inclusion within models. With more studies over time, insights into the underlying processes influencing emissions will be further improved.

Patient-centered outcomes after surgical treatment of peri-implantitis: a prospective clinical study.

BACKGROUND: Peri-implantitis is an inflammatory process affecting soft and hard tissues surrounding dental implants, causing progressive marginal bone loss. Peri-implant surgery is the treatment of choice. However, evidence about its impact on patients' quality of life (QoL) is limited. This study aimed to assess pain and QoL in the first seven post-operative days and measure patient satisfaction at the end of this period. MATERIAL AND METHODS: A prospective cohort study was conducted in patients with peri-implantitis. Patients reported pain on a visual analogue scale (VAS) ranging from 0 to 100mm every day during the first week after surgery. They then completed the OHIP-14sp questionnaire. A descriptive and inferential data analysis was used to assess the effect of surgical approach (resective, regenerative or combined), gender and working status on pain, satisfaction and QoL. RESULTS: Forty-one patients (93,2%) completed the daily pain VAS; scores ranged from 0 to 95 mm. Gender, occupation, or type of surgery had no significant effect upon its evolution. The mean total OHIP-14sp score was 16.7 (range = 5 to 33), indicating low to moderate deterioration in perceived oral health. Postoperative OHRQoL was significantly higher in working patients (mean difference (MD): 3.94; P = 0.042), and with the regenerative (MD: 6.34; P = 0.044) or the combined approach (MD: 5.41; P = 0.027). CONCLUSIONS: Considering the limitations of this study, postoperative pain was mild to moderate and decreased after the third day. Surgical treatment of peri-implantitis has an impact on QoL, especially when augmentation procedures are involved. This impact is higher in working patients.

Comparison between Accelerated Partial Breast Irradiation with multicatheter interstitial brachytherapy and Whole Breast Irradiation, in clinical practice.

PURPOSE: The aim of this study was to compare accelerated partial breast irradiation (APBI) with multicatheter interstitial brachytherapy (BT) and whole breast irradiation (WBI), in terms of toxicity, aesthetic result, quality of life and survival, in clinical practice. MATERIALS AND METHODS: A comparative study of two prospectively recorded cohorts of 76 breast cancer patients who complied with the recommendations of GEC-ESTRO for APBI was conducted. The main objective was toxicity, quality of life measured through validated questionnaires and the aesthetic results. Secondary objectives were overall survival and disease-free survival. RESULTS: Seventy-six stage I/II breast cancer patients, with a mean age of 66 years entered the study. APBI group showed less acute G1-2 dermatitis (51.4 vs 94.9%, p < 0.001) and late hyperpigmentation (0 vs 17.9%, p = 0.04). There were no differences in aesthetic results, both assessed by the patient herself and by the doctor. Statistically significant differences in measures of quality of life were observed in favour of the APBI, both in EORTC QLQ-BR23 and body image scale questionnaires. With a median follow-up of 72 months (6 years), the estimated overall survival at 5 and 10 years was 96.8 and 77.7%, respectively, and disease-free survival at 5 and 10 years was 91.1 and 69.4%, respectively, without statistically significant differences between groups. DISCUSSION: APBI is an attractive alternative in candidate patients with initial breast cancer, with benefits in acute toxicity and quality of life and fewer visits to the hospital, without compromising tumor control or survival.

Pronóstico al año de la hemorragia subaracnoidea cortical no traumática: Serie prospectiva de 34 pacientes / One-year prognosis of non-traumatic cortical subarachnoid haemorrhage: A prospective series of 34 patients

Introducción: Las hemorragias subaracnoideas corticales (HSAc) tienen numerosas etiologías. No hay estudios prospectivos que indiquen su evolución a largo plazo. El objetivo de este trabajo es describir las características clínicas y etiológicas de los pacientes con HSAc y conocer su pronóstico.MétodosEstudio observacional, prospectivo y multicéntrico. Se recogieron variables clínicas y radiológicas, y se siguió la evolución al año, observando la mortalidad, dependencia, tasa de resangrado y aparición de demencia.ResultadosSe incluyeron 34 pacientes (edad media 68,3 años, rango 27-89). Los síntomas más frecuentes fueron el déficit neurológico focal, con frecuencia transitorio y de repetición, y la cefalea. El TAC fue patológico en 28 pacientes (85%). Se realizó RM cerebral en 30 pacientes (88%), con isquemia aguda en 10 (29%), sangrados antiguos en 7 (21%) y siderosis superficial en otros 2 (6%). Se encontró etiología en 26 pacientes (76,5%): angiopatía amiloide (n = 8), ictus isquémico (n = 5), vasculitis (n = 4), encefalopatía posterior reversible (n = 2), trombosis venosa (n = 2), síndrome de vasoconstricción cerebral reversible (n = 2), oclusión carotidea (n = 1), síndrome de Marfan (n = 1) y carcinomatosis meníngea (n = 1). Durante el seguimiento fallecieron 3 pacientes (en 2 de ellos relacionado con la causa de la HSAc). Tres pacientes desarrollaron una demencia, 3 presentaron un hematoma lobar y otro una nueva HSAc.ConclusionesEn nuestra serie las causas más frecuentes de HSAc fueron la angiopatía amiloide, el ictus isquémico y la vasculitis. La HSAc tiene peor pronóstico que otras HSA no aneurismáticas. Puede tener numerosas causas y su pronóstico depende de la etiología subyacente. En el anciano existe una frecuente asociación con hemorragia intracraneal y deterioro cognitivo. (AU)

Introduction: Cortical subarachnoid haemorrhage (cSAH) has multiple aetiologies. No prospective study has reported the long-term progression of the condition. The objective of this study is to describe the clinical and aetiological characteristics of patients with cSAH and to gain insight into prognosis.MethodsWe performed a prospective, observational, multi-centre study. Data on clinical and radiological variables were collected; during a one-year follow-up period, we recorded data on mortality, dependence, rebleeding, and the appearance of dementia.ResultsThe study included 34 patients (mean age, 68.3 years; range, 27-89). The most frequent symptoms were headache and focal neurological deficits, which were frequently transient and recurrent. CT scans returned pathological findings in 28 patients (85%). Brain MRI scans were performed in 30 patients (88%), revealing acute ischaemia in 10 (29%), old haemorrhage in 7 (21%), and superficial siderosis in 2 (6%). Aetiology was identified in 26 patients (76.5%): causes were cerebral amyloid angiopathy in 8, ischaemic stroke in 5, vasculitis in 4, reversible posterior encephalopathy in 2, venous thrombosis in 2, reversible cerebral vasoconstriction syndrome in 2, carotid occlusion in 1, Marfan syndrome in 1, and meningeal carcinomatosis in 1. Three patients died during follow-up (2 due to causes related to the cause of cSAH). Three patients developed dementia, 3 had lobar haemorrhages, and one had a second cSAH.ConclusionsThe most frequent causes of cSAH in our series were cerebral amyloid angiopathy, ischaemic stroke, and vasculitis. This type of haemorrhage has a worse prognosis than other non-aneurysmal cSAH. There are numerous possible causes, and prognosis depends on the aetiology. In elderly patients, intracranial haemorrhage is frequently associated with cognitive impairment. (AU)

One-year prognosis of non-traumatic cortical subarachnoid haemorrhage: A prospective series of 34 patients. / Pronóstico al año de la hemorragia subaracnoidea cortical no traumática: Serie prospectiva de 34 pacientes.

INTRODUCTION: Cortical subarachnoid haemorrhage (cSAH) has multiple aetiologies. No prospective study has reported the long-term progression of the condition. The objective of this study is to describe the clinical and aetiological characteristics of patients with cSAH and to gain insight into prognosis. METHODS: We performed a prospective, observational, multi-centre study. Data on clinical and radiological variables were collected; during a one-year follow-up period, we recorded data on mortality, dependence, rebleeding, and the appearance of dementia. RESULTS: The study included 34 patients (mean age, 68.3 years; range, 27-89). The most frequent symptoms were headache and focal neurological deficits, which were frequently transient and recurrent. CT scans returned pathological findings in 28 patients (85%). Brain MRI scans were performed in 30 patients (88%), revealing acute ischaemia in 10 (29%), old haemorrhage in 7 (21%), and superficial siderosis in 2 (6%). Aetiology was identified in 26 patients (76.5%): causes were cerebral amyloid angiopathy in 8, ischaemic stroke in 5, vasculitis in 4, reversible posterior encephalopathy in 2, venous thrombosis in 2, reversible cerebral vasoconstriction syndrome in 2, carotid occlusion in 1, Marfan syndrome in 1, and meningeal carcinomatosis in 1. Three patients died during follow-up (2 due to causes related to the cause of cSAH). Three patients developed dementia, 3 had lobar haemorrhages, and one had a second cSAH. CONCLUSIONS: The most frequent causes of cSAH in our series were cerebral amyloid angiopathy, ischaemic stroke, and vasculitis. This type of haemorrhage has a worse prognosis than other non-aneurysmal cSAH. There are numerous possible causes, and prognosis depends on the aetiology. In elderly patients, intracranial haemorrhage is frequently associated with cognitive impairment.

Milk production responses, rumen fermentation, and blood metabolites of dairy cows fed increasing concentrations of forage rape (Brassica napus ssp. Biennis).

The aim of this study was to determine animal performance, rumen fermentation, and health-related blood metabolites of dairy cows in mid lactation fed with increasing levels (30 and 45%) of forage rape (FR) in the diet. Twelve pregnant multiparous lactating Holstein-Friesian dairy cows were randomly allocated to 1 of 3 dietary treatments in a replicated 3 × 3 Latin square design. The experiment was divided into three 21-d periods. For the control diet, 13.0 kg (dry matter, DM) of grass silage, 3.0 kg DM of commercial concentrate, 2.7 kg of DM cold-pressed extracted canola meal, and 0.45 kg DM of solvent-extracted soybean meal were offered daily. For the other two treatments, 30 and 45% of the DM from silage, canola meal, and commercial concentrate were replaced in equal proportions with FR. Data were analyzed individually using linear and quadratic orthogonal polynomials. Ingestive behavior was altered by the inclusion of FR. We observed a linear increase in eating time at the expense of rumination time. Nevertheless, total DM intake was not affected by dietary treatments, averaging 19.5 ± 0.24 kg of DM/d. Milk yield increased linearly with increasing concentration of FR in the diet. Thus, feed efficiency of cows (kg of milk/kg of DM intake) increased linearly with the percentage of FR in the diet. Inclusion of FR in the diet had no effect on milk composition or milk sensory characteristics. Mean rumen pH of cows decreased linearly from the control to the 45% FR diet; however, dietary treatments had no effect on the daily amount of time that rumen pH was below 5.8 (252 ± 71.4), indicating no risk of subacute ruminal acidosis. Concentrations of total volatile fatty acids in the rumen and molar proportions of acetate and butyrate were increased with FR inclusion, whereas the proportion of propionate was linearly reduced. Excretion of uric acid and total purine derivatives tended to be greater for cows fed FR, which resulted in a trend toward a linear increase in estimated microbial N flow. However, N use efficiency was not affected by FR inclusion. Although differences for some hematological measures (increased white blood cell and neutrophils counts) and a quadratic response for glutamate dehydrogenase for cows fed FR in the diet (decreased with inclusion of 30% and increased with 45% in the diet) were observed, all values were within appropriate ranges for dairy cows. These results indicated that including FR to dairy cow diets, up to 45% of diet DM, improved milk production due to changes in volatile fatty acids and predicted microbial N flow and had no negative effects on dairy cow health or sensory characteristics of milk.

Influence of information concerning a computerized anesthesia system on dental anxiety: a randomized controlled clinical trial.

BACKGROUND: A single-blinded randomized controlled trial among patients requiring an upper third molar extraction was performed to evaluate the anxiety degree after receiving information or not about the functioning of The Wand system. Secondarily, perceived pain and the need of re-anesthesia were assessed. MATERIAL AND METHODS: Patients were randomly assigned to the experimental group (detailed explanation about The Wand) or control group (no specific information). Local anesthesia with The Wand consisted in a supraperiosteal infiltrative technique injection 1.6 mL at the buccal and 0.2 mL at the palatal side. Distinct questionnaires for assessing dental anxiety and 100-mm visual analog scales to assess pain were delivered. Demographic data, radiological parameters, operative time and type of intervention were also registered. A descriptive bivariate analysis by non-parametric tests to detect differences in anxiety, pain and re-anesthesia was performed by SPSS 22.0 (SPPS Inc. Chicago, USA). RESULTS: A total of 85 patients were assessed for eligibility but 17 participants were lost due to the cancellation of the visit for the surgical intervention. Finally, sixty-eight patients were included (34 participants in each group), 47 women (69.1%) and 21 men (30.9%), with an average age of 28.8 (± 9.3) years. CONCLUSIONS: Patients that received a detailed explanation of The Wand did not have a significant reduction of the anxiety degree and perceived pain during the anesthetic act compared to patients that received no information. The need of re-anesthesia was not related to the anxiety level but was significantly related to increasing operative time.

Pulgarización en Síndrome de Nager. Caso clínico / Pollicization in Nager Syndrome. A case report

El tratamiento de las hipoplasias del pulgar, independientemente del síndrome clínico en el que estén incluidas, se basa en su severidad. La pulgarización, migración quirúrgica del índice hacia la posición del pulgar para sustituir su función, se reserva para los casos más severos. Presentamos el caso de un varón de 4 años de edad con Síndrome de Nager. Entre las características clínicas más significativas del caso destacamos: paladar hendido, microtia bilateral, fisura palpebral antimongoloide, hipoplasia malar, hipoplasia mandibular, coloboma del párpado inferior, así como hipoplasia severa bilateral de pulgares y ausencia parcial de tibia. Realizamos procedimiento de pulgarización en mano derecha sin complicaciones, con evolución satisfactoria. Tras 18 meses de seguimiento, el paciente presenta prensión esférica y cilíndrica adecuada, prensión lateral, así como oposición al quinto dedo (AU)

Treatment paradigm for a child with thumb deficiency or hypoplasia is based on severity, apart from other clinical features. Pollicization or surgical substitution of the thumb, most commonly using the index finger, is reserved for the most severe cases. We present the case of a 4-year-old male with Nager Syndrome. Among the most notable clinical characteristics we found: cleft palate, bilateral microtia, downslanting palpebral fissure, malar hypoplasia, mandibular hypoplasia, lower eyelid coloboma, partial tibial agenesis as well as bilateral hypoplastic/absent thumbs. Pollicization was performed for the right hand without complications. After 18 months follow-up, adequate cilyndrical and spherical grasp was achieved, as well as lateral prehension and opposition to fifth finger (AU)

Competencias para el desarrollo de la atención farmacéutica / Competencies required for the practice of pharmaceutical care

Objetivo: Elaborar y consensuar una propuesta de competencias genéricas y específicas para dirigir el aprendizaje en atención farmacéutica en la asignatura Estancias. Método: Partiendo del «Libro blanco del título de grado en Farmacia», se elaboró una propuesta de competencias que se sometió a análisis mediante entrevistas individuales a cinco profesionales farmacéuticos. Posteriormente, se realizó una consulta mediante cuestionarios a 47 farmacéuticos tutores de Estancias, referida a su grado de acuerdo con cada una de las competencias definidas y al grado de incidencia de actividades realizadas en el centro, dirigidas a su adquisición. Resultados: Se elaboró una propuesta de 17 competencias genéricas y 14 específicas. Respondió al cuestionario el 65,95 % de los tutores. Las competencias genéricas que alcanzaron el máximo grado de acuerdo entre los tutores fueron: «preocuparse por la calidad» (78,6%) y «manejar los conocimientos básicos de la profesión» (78,6%). De las específicas destacaron: «manejar la receta/orden médica» (76,7%), el «conocimiento y habilidades que garanticen el uso seguro del medicamento» (70%) y «comunicarse con pacientes/profesionales» (70%). Entre las competencias específicas, los valores inferiores en el porcentaje de máximo grado de acuerdo correspondieron a «utilizar y elaborar protocolos para la dispensación» (40%) y «asumir responsabilidad del seguimiento farmacoterapéutico/resultados de salud» (46,7%). Se encontró una correlación positiva entre el grado de acuerdo con las competencias propuestas y el grado de incidencia en la realización de actividades dirigidas a su adquisición en 29 de las 31 competencias. Conclusiones: Las competencias genéricas y específicas valoradas proporcionan una herramienta docente válida para dirigir el aprendizaje en atención farmacéutica durante las Estancias (AU)

Objective: To develop and reach a consensus on a proposal for generic and specific competencies for students receiving practical training in pharmaceutical care. Method: A proposal concerning competencies was developed within the framework of the White Book on Pharmacy Education. This proposal was discussed during individual interviews with five pharmacy professionals. Later, an assessment questionnaire was sent to 47 tutors in pharmacy training, asking them about their level of agreement with each of the competencies defined and the activities carried out in their practice center to help students to achieve each competency. Results: A proposal including 17 generic and 14 specific competencies was prepared. Thirty-one pharmacy tutors (65.95%) responded to the questionnaire. The highest rated generic competencies according to the maximum level of agreement were: concern for quality (78.6%) and management of the basic knowledge of the profession (78.6%). Among the specific competencies that stood out were: management of doctors’ prescriptions (76.7%), knowledge and skills that guarantee the safe use of drugs (70%) and communication with patients/ other professionals (70%). Among the specific competencies that received the lowest scores in terms of the level of agreement were: management and development of protocols for dispensing drugs (40%) and assumption of responsibility for drug therapy follow-up and health outcomes (46.7%). A positive correlation between the level of agreement with the competencies and the activities carried out to help students to achieve them was found in 29 out of the 31 competencies. Conclusion: The generic and specific competencies assessed provide a valid educational tool for guiding pharmaceutical care education in the student receiving practical pharmaceutical training (AU)

Validez y fiabilidad de la prueba de Kupperman / Validity and reliability of the Kupperman test

Objective: To study the validity and reliability of the Kupperman test (KT), which measures climacteric symptoms. Design: Validation study. Setting: an urban primary care center (Gerona-3 primary care center) in Gerona, Spain. Patients: A randomized sample of women aged between 45 and 60 years old. Sample size for the calculation of intraclass correlation coefficient (ICC): N=256. Measurements: KT was administered on two occasions. At the baseline visit, both KT and the Nottingham Health Profile (NHP) were administered. Results: Twenty-eight patients (11%) refused to participate. Reliability: the ICC for the total KT score was 0.779, and for the diverse fields was between 0.777 (for hot flushes) and 0.531 (for arthralgias). Validity: the correlation between NHP and KT was 0.605 (P<.0005). The KT score for menopausal (159) and non-menopausal women (69) showed no statistically significant differences (12.96 vs 10.51; P=.055). The ICC of the KT revealed that this test was suitable for group use but not for individual use (ICC< 0.9). KT measures quality of life in women between 45 and 60 years old indirectly (through symptoms). The lack of significant differences between menopausal and non-menopausal women could be due to the low power of KT (AU)

Objetivo: Estudiar la validez y la fiabilidad de la prueba de Kupperman (PK), que mide sintomatología climatérica. Diseño: Estudio de validación. Emplazamiento: Zona básica de salud urbana. Pacientes: Muestra aleatoria de mujeres con edades comprendidas entre los 45 y los 60 años. Tamaño muestral para el cálculo del coeficiente de correlación intraclase (CCI), n = 256. Mediciones: Se administró la PK en dos ocasiones, en la primera cita junto con el Nottingham Health Profile (NHP). Resultados: Se negaron a participar 28 (11%) mujeres. Fiabilidad: el CCI para la puntuación total de la PK fue de 0,779 y para los diversos campos CCI oscilaba entre el 0,778 de los sofocos hasta 0,531 de las artralgias. Validez: la correlación entre el NHP y prueba de PK fue de 0,605 (p < 0,0005). La puntuación para la PK entre mujeres menopáusicas (159) y no menopáusicas (69) mostraba diferencias no estadísticamente significativas (12,96 frente a 10,51; p = 0,055) Conclusiones: La PK no presenta unos CCI adecuados para su uso individual (CCI < 0,9), sino para su uso grupal. LA PK mide de modo indirecto (a través de los síntomas) la calidad de vida de las mujeres de 45 a 60 años. La falta de diferencias significativas entre menopáusicas y no menopáusicas puede deberse a poca potencia (AU)

PAAF cutánea en el diagnóstico de linfangitis carcinomatosa / No disponible

No disponible

Reordenamientos subteloméricos complejos en un síndrome de Wolf-Hirschhorn familiar / Complex subteloremic rearrangements in familial Wolf-Hirschhorn syndrome

Presentamos el caso de una recién nacida, estudiada por un fenotipo peculiar con cariotipo normal. Se realizó un análisis genético de las regiones subteloméricas mediante la técnica MLPA( multiplex ligation-dependent probe amplification) y se confirmaron los hallazgos mediante hibridación in situ fluorescente(FISH). Se detectó un reordenamiento de estas regiones en los cromosomas 4 y 20 de manera que la paciente presentaba una deleción en 4p y una amplificación en 20p, responsable la primera de ellas del síndrome clínico de Wolf-Hirschhorn. En el estudio familiar se encontró un reordenamiento subtelomérico balanceado en el padre de la niña y en la hermana del padre, cuya hija resultó también estar afectada por dicho síndrome

We report the case of a girl who presented a peculiar phenotype at birth, with a normal karyotype. Genetic analysis of the subtelomeric regions was performed using multiplex ligation-dependent probe amplification (MLPA) and the findings were confirmed by fluorescents in situ hybridisation (FISH). A rearrangement of these regions was detected in chromosomes 4 and 20, there being a 4p deletion, which is responsible for Wolf-Hirschhorn syndrome, and an amplification of 20p. In the family study, we found a balanced subtelomeric rearrangement in the girl´s father and in the father´s sister, whose daughter was also found to be affected by the syndrome

[Epidemiological notes on nasal bleeding]. / Notas epidemiológicas sobre el sangrado nasal.

The incidence of epistaxis is difficult to calculate because only a 10% of them look for medical attention. In this study the nasal bleeding means the 13.3% of the ENT emergencies (279 patients). Its incidence was 6 cases/10,000/year. The majority were over 50 years old (57.3%). There was season variations. The anterior epistaxis were more frequent but he posterior ones increased over the 40. An 18% had rebleeding more significatively with age and localization. We discuss the mechanisms that can explain the male dominance, the season incidence, and the old ages of the patients with hospital epistaxis.

Notas epidemiológicas sobre el sangrado nasal / Epidemiologic notes on nasal bleeding

La incidencia de la epistaxis es difícil de calcular porque sólo un 10 por ciento buscan atención médica. En el presente estudio prospectivo el sangrado nasal supone el 13,3 por ciento de las urgencias ORL (279 pacientes), su incidencia fue 6 casos/10.000/año. Los mayores de 50 años fueron mayoría (57,3 por ciento), y existió variación estacional. Las epistaxis anteriores fueron más frecuentes aunqeu las posteriores aumentaron tras los 40. Resangraron un 18 por ciento teniendo significación la edad y la localización. Discutimos los mecanismos que expliquen la predominancia masculina, la incidencia estacional, y la edad avanzada de los pacientes con epistaxis hospitalarias (AU)

No disponible

Cáncer de mama: papel de la radioterapia / Breast cancer: role of radiotherapy

El cáncer de mama es la primera causa de muerte por cáncer en la mujer y la principal causa de muerte en la mujer entre los 40 y 44 años. En la actualidad se están consiguiendo importantes logros en su curación, debido a destacados avances diagnósticos y terapéuticos, así como a los programas de screenning, que hace que cada vez el diagnóstico se haga en las fases más tempranas de la enfermedad. Su tratamiento requiere una actuación multidisciplinar en la que participan cirujanos, oncólogos radioterápicos y médicos. En este capítulo, los autores realizan una puesta al día del papel de la radioterapia en el tratamiento del cáncer de mama en las diferentes etapas de la enfermedad (AU)

Trabajando por la seguridad de los pacientes: puesta en marcha de un Grupo de Trabajo sobre Errores de Medicación / Working for patient safety: starting Teamwork on Medication Errors

No disponible

Primera encuesta en Internet sobre el síntoma de acidez / First Internet survey on the sympton of acidity

No disponible

[Possible factors influencing rehabilitation of the total laryngectomy patient using esophageal speech]. / Estudio de posibles factores que influyen en la rehabilitación del laringuectomizado total mediante voz esofágica.

One of the handicaps of patients that have had a total laryngectomy is the loss of oral speech. There are three possibilities to rehabilitate these patients; surgery, voice prosthesis or esophageal speech. This last one appears as an inexpensive, non-invasive rehabilitation method; it does not need a complex learning and in spite of new technics, it continues to be an effective method in the social rehabilitation of laryngectomized patients. We have made a retrospective study of patients who underwent TL between 1992-1998 and that were rehabilitated by esophageal voice learning. Three factors have been evaluated: first, those related to the patient (gender, age, study level...); second, those related to the treatment itself [TL, pharyngolaryngectomy (PTL), TL plus radiotherapy...] and third, those related to the rehabilitation (technics, delayed on starting, number of sessions...). Data were compared with rehabilitation outcome: good (usually using esophageal voice), medium (speaking sometimes) and bad (not speaking). 74.1% had an acceptable outcome and they use esophageal voice with more or less difficulty to communicate, and this outcome increases to 95.8% when we do not take into account 7 patients who gave-up rehabilitation before finishing the first five sessions.