Evaluación de la Vigilancia Específica de la salud de los trabajadores en los Servicios de Prevención del Principado de Asturias / Evaluation of Specific Monitoring worker`s health in Prevention Services of Principado de Asturias

Objetivo: Valorar la utilización y eficacia de los protocolos de Vigilancia Sanitaria Específica. Material y Métodos: Se han utilizado los datos obtenidos del Sistema de Información en Salud Laboral SISPA-SPL, así como los resultados de la Encuesta de Opinión. Resultados: El 84.6% de usuarios del SISPA-SPL cumplimentan la evaluación de riesgos. Los protocolos más utilizados son: pantallas de visualización de datos y manejo manual de cargas. Conclusiones: Los protocolos más utilizados son los relacionados con factores de riesgo físico. Además, la mayoría de los profesionales sanitarios de los Servicios de Prevención realizan una valoración buena sobre dichos protocolos

Objective: To value the use and effectiveness of protocols of Specific Sanitary Monitoring. Material and Methods: The collected data of Occupational Health Information System SISPA-SPL, as well as the results of the Survey of Opinion have been used. Results: The 84,6% of users of the SISPA-SPL compliment the risk`s evaluation. The most used protocols are: screen of visualization of data and manual handling of loads. Conclusions: The most used protocols are related with factors of physical risk. In addition, most of sanitary professionals of Prevention Services make a good valuation on these protocols

[Health surveillance of workers exposed to asbestos: an example of cooperation between the occupational prevention system and the national health system]. / La Vigilancia de la Salud de los trabajadores expuestos al amianto: ejemplo de colaboracion entre el sistema de prevencion de riesgos laborales y el sistema nacional de salud.

The Ministry of Health and Consumer Affairs and the Autonomous Governments of Spain have designed and agreed by consensus with the sanitary professionals and major employer's organizations and Unions a Integral Health Surveillance Programme of asbestos-exposed workers, in order to assure appropriate, uniform and harmonized action throughout the national territory with relation to these workers. PROGRAM DESCRIPTION: This initiative started from the Occupational Health Working group of the Interterritorial Council, with inputs from the Asbestos Working Group of the National Occupational Safety and Health Commission. It was agreed with occupational medicine and infirmary professionals and was approved by the Health and Labour authorities. The program is organised in seven main activities. CURRENT PROGRAM STATUS: two years after the Programme approval a total of 5778 workers are included in the Registry of asbestos-exposed workers. 208 workers have COPD, 198 benign pleural disease, 8 lung cancer, 10 mesothelioma and 7 workers have other cancers possibly related to asbestos (gastric, larynx and colon cancer). REMARKS: the agreement and participation reached in this Programme allow achieving much higher coverage of occupational prevention policies than those obtained with a mere law approval, as we could see during the second year of implementation of the Programme in which the number of attended workers has doubled.

La vigilancia de la salud de los trabajadores expuestos al amianto: ejemplo de colaboración entre el sistema de prevención de riesgos laborales y el sistema nacional de salud / Health surveillance of workers exposed to asbestos: an example of co-operation between the occupational prevention system and the national health system

El Ministerio de Sanidad y Consumo y las Comunidades Autónomashan diseñado y consensuado con los profesionales sanitariosy las organizaciones empresariales y sindicales representativas unPlan Integral de Vigilancia de la Salud de los Trabajadores que hanestado expuestos a Amianto, con el objetivo de garantizar una intervenciónadecuada, uniforme y armonizada de estos trabajadores entodo el territorio nacional. La elaboración del Programa partió delGrupo de Trabajo de Salud Laboral del Consejo Interterritorial, seenriqueció con las aportaciones del Grupo de Trabajo Amianto de laComisión Nacional de Seguridad y Salud en el Trabajo, fue consensuadocon los profesionales de la medicina y enfermería del trabajo,y fue aprobado por las autoridades sanitarias y laborales. El Programaconsta de siete grandes bloques de actividades. Dos años despuésde aprobado el Programa, el estado de implantación en las ComunidadesAutónomas es desigual. Las principales dificultades para supuesta en marcha se encuentran en la elaboración del Registro deexpuestos. Un total de 5.778 trabajadores están incluidos en el Registro.208 trabajadores tienen EPOC, 198 alteraciones pleurales benignas,8 cáncer de pulmón, 10 mesotelioma y 7 presentan otros cáncerescon posible relación con el amianto (gástrico, de laringe y colon). El consenso y la participación alcanzados alrededor de este Programaestán permitiendo lograr coberturas de las políticas de prevenciónde riesgos laborales muy superiores a las que se consiguen conla mera actuación institucional y elaboración de normativa, ya que ensólo los dos primeros años de implantación del Programa se ha duplicadoel número de trabajadores atendidos

The Ministry of Health and Consumer Affairs and the AutonomousGovernments of Spain have designed and agreed by consensuswith the sanitary professionals and major employer's organizationsand Unions a Integral Health Surveillance Programme ofasbestos-exposed workers, in order to assure appropriate, uniformand harmonized action throughout the national territory with relationto these workers. Program description: this initiative startedfrom the Occupational Health Working group of the InterterritorialCouncil, with inputs from the Asbestos Working Group of theNational Occupational Safety and Health Commission. It was agreedwith occupational medicine and infirmary professionals and wasapproved by the Health and Labour authorities. The program isorganised in seven main activities. Current Program status: twoyears after the Programme approval a total of 5,778 workers areincluded in the Registry of asbestos-exposed workers. 208 workershave COPD, 198 benign pleural disease, 8 lung cancer, 10 mesotheliomaand 7 workers have other cancers possibly related toasbestos (gastric, larynx and colon cancer). Remarks: the agreementand participation reached in this Programme allow achievingmuch higher coverage of occupational prevention policies than those obtained with a mere law approval, as we could see duringthe second year of implementation of the Programme in which thenumber of attended workers has doubled

[Ureteral complications of retroperitoneal prosthetic vascular surgery]. / Complicaciones ureterales de la cirugía vascular protésica retroperitoneal.

OBJECTIVE: Ureteral obstruction following retroperitoneal vascular by-pass has rarely been reported in the international world literature (only 169 cases). That's why we present three new cases to contribute at best knowledge of this iatrogenic disease. MATERIAL AND METHOD: Our cases were diagnosed by symptoms (number 2 and 3) and incidentally (number 1). The case 3 is exceptional because only 6 cases were previously described. RESULTS: Three different treatments were applied in our cases. The urinary fistula resulted into nephrectomy and the others were treated by endourological and reconstructive methods. We noted that the added comorbidity factors in all these cases make the pronogstic hazardous.

Complicaciones ureterales de la cirugía vascular protésica retroperitoneal / Ureteral complications and retroperitoneal prothesic vascular surgery

OBJETIVO: Sólo 169 casos han sido, hasta hoy, publicados referidos a obstrucción ureteral tras by-pass de los vasos retroperitoneales. Por este motivo presentamos 3 nuevos casos con el ánimo de contribuir al mejor conocimiento de esta afección yatrógena. MATERIAL Y MÉTODO: Los casos que presentamos fueron diagnosticados por síntomas (casos número 2 y 3) y de forma incidental (caso 1). El caso 3 es realmente excepcional ya que sólo 6 casos de fístula urinaria han sido comunicados previamente. RESULTADOS: Hemos aplicado tres diferentes formas de tratamiento en nuestros casos. La fístula urinaria obligó a la nefrectomía. Los otros dos fueron tratados mediante métodos endourológicos y por cirugía reconstructora. Hemos constatado en los tres que la importante comorbilidad de estos pacientes hipoteca fuertemente el pronóstico (AU)

[Extraperitoneal anterior approach to renal vessels in radical surgery of renal cancer]. / Acceso anterior extraperitoneal a los vasos renales en la cirugía radical del cancer renal.

The authors present a modification of Droller approach to the renal vessels prior to any Kidney manipulation, even in fat patients. The anatomical situation of the hilium elements is on the basis of their rationale. The ascending ureter dissection allows the blunt advance of the middle finger by the posterior way until the arterial beat. Then pushing up the artery, its identification, by the anterior way, is facilitated. With an initial series of 7 cases the results show no ileus complication and shorter hospital stay. This extraperitoneal approach enables to keep oncologic surgical rules in selected cases of renal cell carcinoma.

[Reutilization of a transplanted kidney by a 2nd receptor]. / Reutilización de un riñón trasplantado por un 2o receptor.

Contribution of what we believe to be the first case of successful reutilization of the same renal graft by a second receptor after functioning for some time in other patient. Transplantectomy was performed 8 days after initial RT, subsequent to the recipient suffering a fatal AVC. The purpose of this paper is to underline the sequence and technical methodology of this procedure which may become a resource to be taken into account in similar cases.

[An analysis of the anomalies, pathologies and iatrogenic diseases in the kidney graft: an evaluation of bench surgery]. / Análisis de las anomalías, patologías y yatrogenias del injerto renal: valoración de la cirugía de banco.

OBJECTIVES: This study analyzes the anomalies, pathologies and iatrogenic lesions of renal grafts, their impact on graft viability and the possibilities of repair. METHODS: From 1980 to 1983, 315 kidneys were available for transplantation; 50 were from living donors and 265 from cadavers. Of the 265 cadaver grafts, our staff harvested 173 and 92 came from other centers. Of these, 113 (42.6%) presented anomalies, pathologies or iatrogenic lesions requiring surgical repair. RESULTS: 13 kidneys were not suitable for transplantation due to pathologies. Sixty-one grafts presenting anomalies and pathologies, and 38 with iatrogenic lesions were repaired by bench surgery. CONCLUSIONS: Although there was a high incidence of anomalies, pathologies or iatrogenic lesions (42.6%), repair by bench surgery permitted transplantation of these grafts and only 6 (3.01%) allografts required subsequent removal, which is a low incidence considering that a higher percentage of kidneys are lost due to family refusal (19%) or as a result of legal problems.

[Is the inverted position of the kidney graft a cause of disease after transplantation?]. / Es la posición invertida del injerto renal causa de patología tras el trasplante?

The authors explain their experience in a series of 317 consecutive RTs that resulted in renal inversion during transplantation surgery. The likely vascular complications as well as those of the excretory tract are correlated with the above situation of heterotopic graft. No differences have been noted due to placement with regard to necrosis of the ureter; stenosis of the passage, whether distally or at the pyelo-ureteral junction, have occurred in inverted kidneys but at a really low rate (1.7%) in both cases. There has been, however, a higher incidence of arterial thrombosis when the kidney is not inverted. A conclusion can be drawn that it is preeminent to place the kidney with a good vascular arrangement and that, once this is achieved, the tendency is to leave the posterior pelvis which allows to shorten the ureter.

[Urinary tract involvement as the first clinical manifestation of adenocarcinoma of the colon]. / Afectación de la vía urinaria como primera manifestación clínica de un adenocarcinoma de colon.

A patient with a previous history of left renal colic and no evidence of passing calculi was admitted to hospital for exacerbation of the urinary condition. The IVP and US evaluation revealed a ureteral stop which appeared to be extrinsic on retrograde uretero-pyelography. Surgery disclosed a large urinoma in the lumbar fossa. The compromised ureteral segment was removed and the pathological analysis of the surgical specimen revealed infiltration from adenocarcinoma. A primary tumor was sought early postoperatively due to irregular constipation referred by the patient. Finally, adenocarcinoma of the sigmoid colon was found. Only 8 similar cases of urinoma from extravasation due to ureteral obstruction secondary to a tumor have been reported in the literature up to 1982.

[Nephrectomy following treatment with ESWL of staghorn lithiasis complicated with urinoma]. / Nefrectomía tras tratamiento con ESWL de una litiasis coraliforme complicada con urinoma.

We report on a female patient that had undergone extracorporeal shock wave lithotripsy for a staghorn stone. We describe the endourological maneuvers that were performed, but had failed to avoid nephrectomy due to renal fistula with urinoma.

[Pulmonary fibrosis secondary to nitrofurantoin]. / Fibrosis pulmonar secundaria a nitrofurantoína.

Herein we report a case of pulmonary fibrosis secondary to chronic administration of nitrofurantoin following radical surgery for a bladder tumor and urinary intestinal diversion. The patient developed pulmonary superinfection and acute respiratory failure. She initially responded to treatment, but relapsed after two weeks. She died from the underlying disease.

[Leiomyoma of the renal capsule. Presentation of a case and review of the literature]. / Leiomioma de cápsula renal. Presentación de un caso y revisión de la literatura.

Leiomyoma of the renal capsule is rare and very difficult to diagnose preoperatively. We report on a patient in whom a solid renal mass had been incidentally detected during ultrasound evaluation for a gastroenterological condition. A CT scan confirmed the presence of a solid mass. The intraoperative biopsy showed it was a benign tumor and conservative surgery was performed. According to the literature, this tumor type has, as yet, not been diagnosed preoperatively. However, some angiographic features may indicate the presence of this condition. This is the fourth case of leiomyoma of the renal capsule reported in the literature and the second case treated by conservative surgery.

[Pulmonary fibrosis secondary to nitrofurantoin]. / Fibrosis pulmonar secundaria a nitrofurantoina.

We report a case of pulmonary fibrosis from long-term furantoin therapy after radical surgery for a bladder tumor and urinary intestinal diversion. The patient developed pulmonary superinfection and acute respiratory failure. She initially responded to treatment, but relapsed two weeks later. The underlying pathological condition led to the patient's death.

[Paratesticular rhabdomyosarcoma. Report of 2 cases]. / Rabdomiosarcoma paratesticular. Aportación de dos casos.

Reporting 2 cases of paratesticular embryonal rhabdomyosarcoma with different locations, one epididymal and one in the testicle tunic vaginalis. In both cases a retroperitoneal disease was present at the time of diagnosis. Although the treatment was similar the clinical evolution has been very different. One patient died 3 years after diagnosis with pulmonary metastasis, the other one is still disease-free 7 years after diagnosis. Discussion of the clinical presentation, differential diagnosis and most important the multidisciplinary therapy used in this type of tumours.

[Solitary contralateral, asynchronous adrenal metastasis of renal adenocarcinoma. Review of the literature]. / Metástasis suprarrenal solitaria, contralateral y asincrónica de adenocarcinoma renal. Revisión de la literatura.

A case of solitary, contralateral, asynchronous adrenal metastasis that appeared 5 years following nephrectomy is described herein. To our knowledge, ours is the fifth case reported in the world literature.