Infraclavicular anterior thoracic approach for access to the upper thoracic vertebrae: case report and description of a new surgical technique.

Patient with spondylodiscitis who presented kyphosis deformity with neurological compromise at the upper thoracic level, who was treated with a new right infraclavicular anterior thoracic approach, as a new alternative surgical technique. 72-year-old male with kyphosis deformity secondary to T2-T3 ASIA "C" spondylodiscitis, treated with C5 to T6 posterior cervicothoracic instrumentation and right infraclavicular transthoracic anterior approach utilizing an expandable cylinder. Within the literature review carried out in the search engines, no similar techniques to the one described in this article were found. Given the complexity of the surgical approach, this new technique is described as a new way for accessing the upper thoracic spine, demonstrating that the right infraclavicular anterior thoracic approach is a new alternative to access the upper thoracic spine from T1 to T4.

Paciente con espondilodiscitis que presentó deformidad cifótica con compromiso neurológico a nivel torácico superior, quien fue tratado con un nuevo abordaje torácico anterior infraclavicular derecho, como nueva técnica quirúrgica alternativa. Varón de 72 años con deformidad en cifosis secundaria a espondilodiscitis T2-T3 ASIA "C", tratado con instrumentación cervicotorácica posterior C5 a T6 y abordaje anterior transtorácico infraclavicular derecho con colocación de cilindro expandible. Dentro de la revisión bibliográfica realizada en los buscadores no se encontraron técnicas similares a la descrita en este artículo. Dada la complejidad del abordaje quirúrgico, esta nueva técnica se describe como una nueva forma de acceder a la columna torácica superior, demostrando que el abordaje torácico anterior infraclavicular derecho es una nueva alternativa para acceder a la columna torácica superior desde T1 a T4.

Dragon 1 Protocol Manuscript: Training, Accreditation, Implementation and Safety Evaluation of Portal and Hepatic Vein Embolization (PVE/HVE) to Accelerate Future Liver Remnant (FLR) Hypertrophy.

STUDY PURPOSE: The DRAGON 1 trial aims to assess training, implementation, safety and feasibility of combined portal- and hepatic-vein embolization (PVE/HVE) to accelerate future liver remnant (FLR) hypertrophy in patients with borderline resectable colorectal cancer liver metastases. METHODS: The DRAGON 1 trial is a worldwide multicenter prospective single arm trial. The primary endpoint is a composite of the safety of PVE/HVE, 90-day mortality, and one year accrual monitoring of each participating center. Secondary endpoints include: feasibility of resection, the used PVE and HVE techniques, FLR-hypertrophy, liver function (subset of centers), overall survival, and disease-free survival. All complications after the PVE/HVE procedure are documented. Liver volumes will be measured at week 1 and if applicable at week 3 and 6 after PVE/HVE and follow-up visits will be held at 1, 3, 6, and 12 months after the resection. RESULTS: Not applicable. CONCLUSION: DRAGON 1 is a prospective trial to assess the safety and feasibility of PVE/HVE. Participating study centers will be trained, and procedures standardized using Work Instructions (WI) to prepare for the DRAGON 2 randomized controlled trial. Outcomes should reveal the accrual potential of centers, safety profile of combined PVE/HVE and the effect of FLR-hypertrophy induction by PVE/HVE in patients with CRLM and a small FLR. TRIAL REGISTRATION: Clinicaltrials.gov: NCT04272931 (February 17, 2020). Toestingonline.nl: NL71535.068.19 (September 20, 2019).

Imaging following thermal ablation of early lung cancers: expected post-treatment findings and tumour recurrence.

Thermal ablation is a minimally invasive technique that is growing in acceptance and popularity in the management of early lung cancers. Although curative resection remains the optimal treatment strategy for stage I pulmonary malignancies, percutaneous ablative treatments may also be considered for selected patients. These techniques can additionally be used in the treatment of oligometastatic disease. Thermal ablation of early lung tumours can be achieved using several different techniques. For example, microwave ablation (MWA) and radiofrequency ablation (RFA) utilise extreme heat, whereas cryoablation uses extremely cold temperatures to cause necrosis and ultimately cell death. Typically, post-ablation imaging studies are performed within the first 1-3 months with subsequent imaging performed at regular intervals to ensure treatment response and to evaluate for signs of recurrent disease. Surveillance imaging is usually undertaken with computed tomography (CT) and integrated positron-emission tomography (PET)/CT. Typical imaging findings are usually seen on CT and PET/CT following thermal ablation of lung tumours, and it is vital that radiologists are familiar with these appearances. In addition, radiologists should be aware of the imaging findings that indicate local recurrence following ablation. The objective of this review is to provide an overview of the expected post-treatment findings on CT and PET/CT following thermal ablation of early primary lung malignancies, as well as describing the imaging appearances of local recurrence.

Encefalitis límbica de origen no paraneoplásico / Non-paraneoplastic limbic encephalitis

La encefalitis límbica se caracteriza por el inicio subagudo de alteraciones cognitivas, crisis epilépticas temporales y sintomatología psiquiátrica (1,3) . Las causas más frecuentes de este desorden poco usual son desórdenes y enfermedades de tipo autoinmune, dentro de las cuales se incluyen los síndromes paraneoplásicos (2,4) . La gran mayoría de las veces, la sintomatología neurológica se manifiesta previo a la detección de una neoplasia, sin embargo, ésta no se detecta en la totalidad de los casos (3,4) . Se presentan las imágenes con 18 F-FDG PET/CT de un paciente con sintomatología neurológica típica de encefalitis límbica que se traduce desde el punto de vista de la imagenología molecular, en alteraciones metabólicas a nivel del hipocampo.

Limbic encephalitis is characterized by sub acute onset of cognitive functions, temporal lobe epilepsy and psychiatric symptoms. Most common causes of this rare disorder include autoimmune diseases, and rarely, as a manifestation of a paraneoplastic syndromes. Most of the times, neurological symptoms precede the detection of a primary tumor, however, a neoplasm is not often identified. In this article we describe F-18 FDG PET/CT images of a male patient with typical neurological symptoms that suggested limbic encephalitis, which, from a molecular point of view, translates into metabolic changes at the level of the hippocampal region.

Use of 2-octyl cyanoacrylate for skin closure of sternal incisions in cardiac surgery: observations of microbial barrier effects.

INTRODUCTION: The systematic use of 2-octyl cyanoacrylate (2-OCA) became routine in our cardiac unit in 2000. This topical skin adhesive has been used in conjunction with conventional suturing for skin closure and prevention of postoperative wound infections by means of its performance as a microbial barrier to exogenous bacteria. It is, therefore, important to validate its effectiveness in the reduction of infection rates and, consequently, in the length of postoperative hospital stays. OBJECTIVE: To evaluate the impact of the use of 2-OCA as an add-on measure in the closure of sternotomy incision wounds by comparing postoperative infection rates and length of hospital stays before and after this procedural change. METHODS: We reviewed the records of 680 patients whose cardiovascular surgery performed between 2000 and 2004 included the use of 2-OCA and an equal number of patients who did not receive the topical skin adhesive (surgeries performed between 1995 and 1999), used as a control group. RESULTS: From 1995 to 1999 (without the topical skin adhesive) the infection rate was 4.9%. This rate was reduced to 2.1% after the systematic use of the topical skin adhesive (p < 0.001). Superficial and deep infection rates decreased from 4.3% and 0.6% to 2.1% and 0%, respectively. Postoperative hospital stays were also significantly reduced, decreasing from a median of 13 days to 9 days (p < 0.001). CONCLUSION: From the patient records reviewed in this study, it was found that the routine use of 2-octyl cyanoacrylate as an add-on measure to conventional sutures was associated with a significant reduction in infection rates for cardiovascular surgery patients.

Genéricos, cuestión de bioequivalencia / No disponible

No disponible

En la práctica real no se observa que los inhibidores de la COX-2 se asocien a menos acontecimientos adversos gastrointestinales / No disponible

No disponible

[Efficacy of educational sessions to modify the prescription of new drugs]. / Eficacia de las sesiones educativas para modificar la prescripción de fármacos nuevos.

OBJECTIVE: To evaluate the efficacy of an educational intervention to minimise the prescription of those new medicines whose therapeutic effects are of little benefit. DESIGN: Controlled and randomised experimental study. SETTING: 27 health centres in the province of Sevilla, Spain. PARTICIPANTS: 376 general practitioners. The 264 who worked in the same posts were randomised for the 6 pre-intervention months. 10 of them did not complete the post-intervention period. INTERVENTIONS: Four 45-minute training sessions in a 2-month period, given by health team doctors, with a critical reading of the studies available on recently marketed drugs, plus personal feed-back on prescription and bulletins on therapeutic novelties. The control group received only the feed-back and bulletins. MAIN MEASUREMENTS: Prescription of new medication of little benefit, measured as the number of packages out of the total. Second, the amount of coxib and eprosartan measured as defined daily doses. RESULTS: In the 6 months after the educational sessions, the doctors in the intervention group prescribed proportionately fewer therapeutic novelties of little benefit than those allocated to the control group (1.34% vs 1.62%; P<.001). The coxib and eprosartan prescribed showed only a non-significant trend towards less prescription by the intervention group. CONCLUSIONS: The group educational sessions, run by doctors trained in aspects of evidence-based medicine and prepared jointly with the pharmacy unit, reduced discreetly the prescription of new medicines that were not very innovative.

Modificación de la calidad de vida de pacientes polimedicados mediante atención farmacéutica / No disponible

Fundamento. Determinar si las actividades de seguimiento farmacoterapéutico a pacientes crónicos polimedicados,como parte de la atención farmacéutica realizada por farmacéuticos comunitarios, modifica las distintas dimensiones de la calidad de vida percibida. Métodos. 110 pacientes polimedicados fueron aleatorizados ofertándosele a la mitad el seguimiento farmacotera-péutico en la farmacia comunitaria, y a la otra mitad atención habitual. La oferta de seguimiento farmacoterapéutico se hizo en 8 farmacias de la provincia de Sevilla durante 6 meses, cuyos titulares son farmacéuticos específicamente entrenados en actividades de atención farmacéutica. La variable resultado principal es la calidad de vida percibida, medida según el cuestionario SF-36 (versión española). La evaluación se hizo por investigadores independientes.Resultados. A los 6 meses, no se observan diferencias estadísticamente significativas en ninguno de los ochocomponentes de la calidad de vida (función física, rol físico, dolor corporal, salud general, vitalidad, funciónsocial, rol emocional y salud mental). Comparativamente con los valores nacionales de referencia, los pacientescrónicos polimedicados tienden a manifestar peor calidad de vida que la media nacional de referencia,especialmente las mujeres en las dimensiones de rol físico, dolor corporal, vitalidad, función social y saludmental (p<0,05).Conclusiones. La calidad de vida de los pacientes polimedicados es peor que la media nacional. El seguimiento farmacoterapéutico desde las oficinas de farmacia no demuestra mejoría

Objective. To determine whether pharmacotherapeutic follow-up activities in chronic patients on multidrugtherapy, as part of the pharmaceutical care provided by community pharmacists, modifies the dimensionsof perceived quality of life.Methods. The study involved 110 patients on multidrug therapy. Half of them were randomized to undergopharmacotherapeutic follow-up in the community pharmacy and the other half to regular care. The offer ofpharmatherapeutic follow-up involved eight pharmacies in the province of Seville over a six-month period.The proprietors were pharmacists specifically trained in pharmaceutical care activities. The main outcomevariable was the perceived quality of life, measured according to the Spanish version of the SF-36 questionnaire. The evaluation was carried out by independent investigators.Results. After six months of study, no statistically significant differences were observed in any of the eightquality of life components (physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role and mental health). When compared with the national reference values, chronicpatients on multidrug therapy tended to present a lower quality of life than the national average. The mostmarked differences were found in women with respect to physical role, bodily pain, vitality, social functioningand mental health (p<0.05).Conclusions. The quality of life in patients on multidrug therapy is lower than the national average. Pharmacotherapeutic follow-up carried out in pharmacies is not associated with an improvement

[Community effectiveness of vaccines against infectious parotiditis (mumps). Report of cases]. / Efectividad comunitaria de las vacunas frente a la parotiditis infecciosa. Estudio de casos.

BACKGROUND: In our country, there are two types of infectious mumps vaccines available. In recent times, doubts have been raised regarding the overall effectiveness of these vaccines and the comparative effectiveness of the two strains (Rubini strain and Jeryl Lynn strain). In the "East Seville" Primary Care district, 245 cases were reported in 1997 (90.1 cases per 100,000 inhabitants). This study is aimed at taking advantage of the outbreak of cases of mumps to evaluate affected populations and comparative incidence according to type of vaccines given during childhood. METHODS: Descriptive analysis of the cases (age, territorial spread, inoculation history') and trend analysis (annual incident rates) within this health care district and the surrounding area. The overall effectiveness of the mumps vaccines. The case incidence rates among those inoculated with Rubini strain and those inoculated with Jeryl Lynn strain are also estimated. RESULTS: The highest rates of incidence are found among children in the 1-4 age range. Overall effectiveness rates for these vaccines have been estimated. A significantly higher rate of infection has been found among the children inoculated with Rubini strain than those inoculated with the Jeryl Lynn strain (relative risk of 6.5 with a Confidence Interval of 95% 3.6-11.8). CONCLUSIONS: The effectiveness which follows from this study does not seem as good as the theoretical effectiveness anticipated for the mumps vaccines. It thus seems advisable for other case studies to be conducted by types of vaccines used. The data to be furnished by means of sero-epidemiological studies are also of major interest.

Cholera on Guam, 1974: epidemiologic findings and isolation of non-toxinogenic strains.

In August 1974, six cases of cholera occurred on Guam. The index case had severe diarrhea and metabolic acidosis and died from pneumonia on the ninth day of illness; the other five cases had only mild to moderate diarrhea. Fish caught in Agana Bay and home-preserved was found to be the vehicle most likely responsible for the cases. Vibrio cholerae, El Tor Ogawa, was isolated from two patients, the Guam sewerage system, and a river emptying into Agana Bay. V. cholerae, El Tor Inaba, was isolated from the sewerage system, three storm drains imptying into Agana Bay, and Agana Bay. The Ogawa and Inaba isolates differed in their sucrose fermentation and hemolysis reactions, phage type and ability to produce toxin. Although this was the first reported cholera outbreak on Guam, the isolation of differentV. cholerae strains suggested that multiple introductions of V. cholerae had occurred on the island.