Development of burnout and moral distress in intensive care nurses: An integrative literature review.

AIMS: To describe, through an integrative literature review, the factors contributing to the development of burnout and moral distress in nursing professionals working in intensive care units and to identify the assessment tools used most frequently to assess burnout and moral distress. METHODS: An integrative literature review was carried out. PubMed, CINAHL, PsycINFO, SciELO, Dialnet, Web of Science, Scopus, and Cochrane databases were reviewed from January 2012 to February 2023. Additionally, snowball sampling was used. The results were analysed by using integrative synthesis, as proposed by Whittemore et al., the Critical Appraisal Skills Programme for literature reviews, the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for quantitative observational studies, and the Joanna Briggs Institute checklist for qualitative research were used to evaluate evidence quality. RESULTS: Forty-one articles were selected for review: 36 were cross-sectional descriptive articles, and five were literature reviews. The articles were grouped into five-factor categories: 1) personal factors, 2) organisational factors, 3) labour relations factors, 4) end-of-life care factors, and 5) factors related to coronavirus disease 2019 (COVID-19). The Maslach Burnout Inventory-Human Services Survey and the Moral Distress Survey-Revised instruments were the most commonly used to measure burnout and moral distress. CONCLUSIONS: This review highlights the multiple personal, organisational, relational, situational, and end-of-life factors promoting burnout and moral distress among critical care nurses. Interventions in these areas are necessary to achieve nurses' job satisfaction and retention while improving nurses' quality of care.

The needs of families who care for individuals with kidney failure on comprehensive conservative care: A qualitative systematic review.

BACKGROUND: Integrating the family of patients with kidney failure on comprehensive conservative care could benefit patients, families, and the health care system. However, there is a knowledge gap in this phenomenon since no systematic review has focused on the families' needs who care for individuals with kidney failure on comprehensive conservative care. OBJECTIVES: To understand the primary needs of families who care for people with kidney failure on comprehensive conservative care. METHOD: A systematic literature review of qualitative studies, followed by a content analysis was carried out. PubMed, CINAHL, and PsycINFO databases were used to search for articles published in English and Spanish between 2010 and 2021. The ENTREQ guideline was used for reporting. RESULTS: Five relevant studies were included in this study. The analysis has allowed identifying key aspects of knowledge, psychological, social and spiritual needs of family members of patients with kidney failure on comprehensive conservative care. CONCLUSIONS: This systematic review has revealed that families experience a lack of information and continuity of care by health care professionals. Added to this is the psychological burden they bear due to the feeling of indefinite care in time and uncertainty about the death of their loved one. All this, without the necessary support from their immediate family environment and social institutions. In light of these data, a paradigm shift in society and the health care received by these families is essential.

Factors associated to recurrent wheezing in infants under one year of age in the province of Salamanca, Spain: Is intervention possible? A predictive model

OBJECTIVES: Wheezing is a very common problem in infants in the first months of life. The objective of this study is to identify risk factors that may be acted upon in order to modify the evolution of recurrent wheezing in the first months of life, and to develop a model based on certain factors associated to recurrent wheezing in nursing infants capable of predicting the probability of developing recurrent wheezing in the first year of life. METHODS: The sample was drawn from a cross-sectional, multicentre, descriptive epidemiological study based on the general population. A total of 1164 children were studied, corresponding to a questionnaire response rate of 71%. The questionnaire of the Estudio Internacional de Sibilancias en Lactantes (EISL) was used. Multiple logistic regression analysis was used to estimate the probability of developing recurrent wheezing and to quantify the contribution of each individual variable in the presence of the rest. RESULTS: Infants presenting eczema and attending nursery school, with a mother who has asthma, smoked during the third trimester of pregnancy, and did not consume a Mediterranean diet during pregnancy were found to have a probability of 79.7% of developing recurrent wheezing in the first year of life. In contrast, infants with none of these factors were seen to have a probability of only 4.1% of developing recurrent wheezing in the first year of life. These results in turn varied according to modifications in the risk or protective factors. CONCLUSIONS: The mathematical model estimated the probability of developing recurrent wheezing in infants under one year of age in the province of Salamanca (Spain), according to the risk or protective factors associated to recurrent wheezing to which the infants are or have been exposed

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Factors associated to recurrent wheezing in infants under one year of age in the province of Salamanca, Spain: Is intervention possible? A predictive model.

OBJECTIVES: Wheezing is a very common problem in infants in the first months of life. The objective of this study is to identify risk factors that may be acted upon in order to modify the evolution of recurrent wheezing in the first months of life, and to develop a model based on certain factors associated to recurrent wheezing in nursing infants capable of predicting the probability of developing recurrent wheezing in the first year of life. METHODS: The sample was drawn from a cross-sectional, multicentre, descriptive epidemiological study based on the general population. A total of 1164 children were studied, corresponding to a questionnaire response rate of 71%. The questionnaire of the Estudio Internacional de Sibilancias en Lactantes (EISL) was used. Multiple logistic regression analysis was used to estimate the probability of developing recurrent wheezing and to quantify the contribution of each individual variable in the presence of the rest. RESULTS: Infants presenting eczema and attending nursery school, with a mother who has asthma, smoked during the third trimester of pregnancy, and did not consume a Mediterranean diet during pregnancy were found to have a probability of 79.7% of developing recurrent wheezing in the first year of life. In contrast, infants with none of these factors were seen to have a probability of only 4.1% of developing recurrent wheezing in the first year of life. These results in turn varied according to modifications in the risk or protective factors. CONCLUSIONS: The mathematical model estimated the probability of developing recurrent wheezing in infants under one year of age in the province of Salamanca (Spain), according to the risk or protective factors associated to recurrent wheezing to which the infants are or have been exposed.

Crosectomía alta sin sección vascular frente a safenectomía clásica. Ensayo clínico aleatorizado: análisis de la recidiva varicosa / High crossectomy without vascular sectioning vs classic saphenectomy. Randomized clinical trial: analysis of recurrent varicose

Fundamento. El presente estudio fue diseñado con el propósito de definir un nuevo procedimiento quirúrgico para la cirugía de las varices y compararlo con estudios de crosectomía clásica en términos de reducir la tasa derecidiva varicosa. Material y métodos. El estudio presentado es un ensayo clínico aleatorizado, doble ciego. Para facilitar el acceso se seleccionaron 150 pacientes que acudieron a consulta Unidad de Flebología, que facilitaron su consentimiento cumpliendo los criterios de inclusión. Se hicieron dos grupos: Grupo 1: safenectomía clásica (CS); 75 pacientes. Grupo 2 : crosectomía alta sin sección vascular (HCWVS) . En ambos grupos el seguimiento se realizó a los 12 y 24 meses por estudio eco- Doppler. Resultados. La incidencia de recidiva varicosa a los 12meses de seguimiento fue de 69,3 % en el grupo de pacientes sometidos a safenectomía clásica, mientras que en el grupo que recibió HCWVS fue 29,3 % (p < 0,0001).Estas diferencias, aunque menores, siguen siendo estadísticamente significativa a los 24 meses de evolución (76 % vs 48 %, p = 0,0004). El tipo más común de recurrencia es del tipo I, con diferencias estadísticamente significativas a los 12 y 24 meses. Conclusiones. La crosectomía alta sin sección vascular tiene una probabilidad global de recurrencia significativamente menor que la safenectomía clásica a los 12 meses (29,3 % frente a 69,3 % ) , que sigue siendo , aunque más pequeña , estadísticamente significativa a los dos años de evolución ( 48 % vs 76 % ) . La tasa de recurrencia del tipo reticular es significativamente menor en el grupo de pacientes sometidos a alta crosectomía sin sección vascular que en los sometidos a safenectomía clásica (AU)

Background. This study was designed with the purpose of defining a new surgical procedure for varicose veins surgery and to be compared with classic crossectomy interms of reducing varicose recurrence rate. Material and methods. Double-blind randomized clinical trial. For easy access, we selected 150 patients who came to Phlebology Unit Consultation, meeting the criteria for inclusion in the study with their informed consent, to be included in a study group using random table numbers table numbers. Group 1: (CS) Saphenectomy classic 75 patients. Group 2: (HCWVS) High crossectomy without vascular sectioning. In both groups the monitoring was conducted at 12 and 24 months by Eco-Doppler study. Results. The incidence of varicose recurrence at 12months follow up was 69.3% in the group of patients undergoing CS, while in the group receiving HCWVS was29.3% (p <0.0001). These differences, though minor, remain statistically significant at 24 months of evolution (76% vs. 48%, p = 0.0004). The most common type of recurrence is the type I with statistically significant differences at 12 and 24 months. Conclusions. High crossectomy without vascular section has a global recurrence probability significantly lower than with classic saphenectomy at 12 months (29.3% vs. 69.3%), which remains, though smaller, statistically significant at two years of evolution (48% vs.76%). The recurrence reticular type rate is significantly lower in the group of patients undergoing high crossectomy without vascular section compared to those undergoing saphenectomy with classic crossectomy (AU)

High crossectomy without vascular sectioning vs classic saphenectomy. Randomized clinical trial: analysis of recurrent varicose veins.

BACKGROUND: This study was designed with the aim of defining a new surgical procedure for varicose veins and for comparison with classic crossectomy in terms of reducing the recurrence rate of varicose veins. MATERIAL AND METHODS: Double-blind randomized clinical trial. For easy access, we selected 150 patients who came to the Phlebology Consultation Unit meeting inclusion criteria. With their informed consent, they were included in a study group using random table numbers. Group 1: (CS) Classic saphenectomy, 75 patients. Group 2: (HCWVS) High crossectomy without vascular sectioning. Both groups were monitorised at 12 and 24 months by Eco-Doppler study. RESULTS: The incidence of varicose vein recurrence at 12 month follow-up was 69.3% in the group of patients undergoing CS, while in the group receiving HCWVS it was 29.3% (p <0.0001). These differences, though minor, remained statistically significant at 24 months of evolution (76% vs. 48%, p = 0.0004). The most common recurrence type was type I, with statistically significant differences at 12 and 24 months. CONCLUSIONS: We believe that saphenectomy with crossectomy without vascular sectioning is the appropriate procedure to treat varicose veins, reducing type 1 or reticular relapse rate and maintaining the principles of classic surgery to reduce type 2 or truncular recurrence rate. This technique should be implemented with procedures based on saphenous sclerosis with foam art the saphenous femoral junction, in order to assess the recurrence rate of type 2 or truncular varicose veins.

Estudio de farmacovigilancia para evaluar la seguridad y la efectividad del tratamiento con losartán: efectos a largo plazo de losartán solo o en combinación sobre la uricemia / Pharmacovigilance study of the safety and effectiveness of losartan therapy: long-term effects of losartan alone or in combination on uricemia

Introducción: se evalúa la acción del tratamiento con losartán sobre la uricemia, en pacientes hipertensos en el medio comunitario. Material y método: estudio de farmacovigilancia, observacional, prospectivo, multicéntrico, no aleatorizado, abierto, de 1 año de seguimiento. Centros de atención primaria de Ávila, Burgos, León, Palencia, Salamanca, Valladolid y Zamora. Se incluyó a 275 pacientes de 67,5 años, con hipertensión arterial, no diabéticos y diabéticos (n = 19), a los que se trató con losartán, 50 mg/día. A las 8 semanas se aumentaba a 100 mg/día si era preciso. Si a las 24 semanas la presión arterial (PA) persistía elevada, se añadía hidroclorotiazida, 25 mg. Se procedió a la toma de sangre para uricemia, creatinina, electrolitos, glucemia, colesterol y triglicéridos al comienzo y a las 48 semanas de tratamiento. Resultados: la uricemia disminuyó significativamente en el grupo de pacientes tratados con losartán y losartán + tiazidas. El 30% de los pacientes recibió 50 mg de losartán, el 14%, 100 mg y el 56%, losartán + tiazida. La PA media ± desviación estándar varió desde 166 ± 29 mmHg de sistólica y 96 ± 19 mmHg, al comienzo del estudio, a 145 ± 23 mmHg de sistólica y 83 ± 18 mmHg de diastólica al finalizarlo. La creatinina, el sodio, el potasio, la glucemia, el colesterol y los triglicéridos no sufrieron deterioro durante el año de seguimiento. Conclusiones: el losartán es un fármaco seguro, con pocos efectos secundarios y que, tras 1 año de seguimiento, disminuye la uricemia sin deterioro del perfil lipídico, hidrocarbonato ni renal. Se postula como fármaco de primera elección en hipertensos mayores con hiperuricemia

Objectives: to evaluate the effect of losartan therapy on uricemia in patients with hypertension in the community setting. Design: observational, prospective, multicenter, nonrandomized, open-label pharmacovigilance study with a 1-year follow-up. Setting: primary care centers in Avila, Burgos, Leon, Palencia, Salamanca, Valladolid, and Zamora (Spain). Patients and method: two hundred seventy-five men and women (mean age 67.5 years), without diabetes (n = 256) and with diabetes (n = 19), treated with 50 mg/day of losartan were included. If high blood pressure (BP) (> 140/90 mmHg) was uncontrolled at 8 weeks, the dose was increased to 100 mg/day. If BP continued to be high at 24 weeks, hydrochlorothiazide (25 mg) was added. BP was measured after the patient had been sitting for 7 minutes with a mercury manometer and phase V Korotkoff's sound as the reference point. Blood samples were drawn for analysis of uricemia, creatinine, electrolytes, glycemia, cholesterol, and triglycerides at the beginning of the study and after 48 weeks' treatment. Results: uricemia significantly decreased in the group of patients treated with losartan and losartan + thiazides. Thirty percent of the patients received 50 mg of losartan, 14% received 100 mg and 56% received losartan + thiazide. Systolic BP was reduced from 166 (SD 29) mmHg at the beginning of the study to 145 (SD 23) at the end of the study. Diastolic BP was reduced from 96 (SD 19) mmHg to 83 (SD 18) mmHg. No negative effects on creatinine, sodium, potassium, glycemia, cholesterol or triglyceride values were found during the 1-year follow-up. Conclusions: losartan is a safe drug with few adverse effects. After a 1-year follow-up, it reduces uricemia without producing negative effects on lipid, carbohydrate or renal profiles. Therefore, it could be used as a first-line drug in elderly patients with hypertension and hyperuricemia

[Utility of routine use of reversion after sedation in outpatient colonoscopy]. / Utilidad en la práctica clínica habitual de la reversión tras sedación en colonoscopia ambulatoria.

INTRODUCTION: Randomized clinical trials have demonstrated the effectiveness of flumazenil in reducing recovery time in the endoscopy unit after conscious sedation with midazolam and meperidine. However, its effectiveness in routine clinical practice has not been proved and therefore its use is debated. AIM: To determine the effectiveness of reversion with flumazenil after conscious sedation with midazolam and pethidine in outpatient colonoscopy and to evaluate its cost-effectiveness. MATERIAL AND METHOD: Two hundred consecutive outpatients scheduled for colonoscopy with conscious sedation with midazolam and pethidine in 2 endoscopy units were prospectively included. According to routine clinical practice in each unit, 100 patients were reverted with flumazenil and 100 were not. Medical and demographic data, indications for endoscopy, doses of the medications used and endoscopic findings were collected. Three weeks after the colonoscopy each patient was interviewed by telephone to determine discomfort and complications associated with the endoscopy and/or with the use of sedation. The cost-effectiveness of the use of flumazenil was analyzed. RESULTS: There were no differences between the two groups in age (52.9 +/- 15.5 vs 52.7 +/- 18.3, p = NS), indications for colonoscopy, findings, percentage of full colonoscopies (93 vs 95%; p = NS) or in the doses of sedatives used. The recovery time in each endoscopy unit was similar (19.2 +/- 11.7 vs 15.5 +/- 10.1 minutes, p = NS). In the reversion group there were fewer patients with prolonged stays, defined as those > 20 minutes (23 vs 11%, p < 0.001). The number of patients who remembered discomfort during the colonoscopy was significantly greater in the reversion group (23 vs 13%; p < 0.05). There were no differences in the number of patients who reported discomfort in the days following the endoscopy. The best cost-effectiveness ratio was obtained for a mean stay of 25 min. CONCLUSION: Routine use of reversion does not decrease the mean stay in the endoscopy unit but does decrease the number of prolonged stays. Unpleasant memories of the colonoscopy were more frequent in reverted patients. The effectiveness of the routine use of reversion with flumazenil after conscious sedation with midazolam and pethidine depends on the ratio between the number of daily colonoscopies and the capacity of the recovery room.

Utilidad en la práctica clínica habitual de la reversión tras sedación en colonoscopia ambulatoria / Utility of routine use of reversion after sedation in outpatient colonoscopy

Introducción: La reversión con flumazenilo ha demostrado, en ensayos clínicos aleatorizados, su eficacia para disminuir el tiempo de estancia de los pacientes en la sala de recuperación tras sedación con midazolam y meperidina. Sin embargo, su efectividad en la práctica clínica diaria no ha sido demostrada, por lo que su uso es muy debatido. Objetivo: Determinar la efectividad de la reversión con flumazenilo tras la sedación consciente con midazolam y petidina en colonoscopia ambulatoria y valorar su relación coste-efectividad. Material y método: Se estudió prospectivamente a 200 pacientes ambulatorios remitidos para colonoscopia y sedados con midazolam y meperidina, procedentes de 2 unidades de endoscopia. Siguiendo la práctica habitual de cada una de las unidades, 100 pacientes fueron revertidos con flumazenilo y 100 no. Se recogieron los datos demográficos y médicos, las indicaciones de la colonoscopia, la dosis de fármacos utilizada y los hallazgos de la endoscopia. Tres semanas después se realizó una encuesta telefónica para determinar las molestias y complicaciones asociadas a la endoscopia o la sedación. Se estudió la relación coste-efectividad. Resultados: No hubo diferencias entre ambos grupos en la edad (52,9 ± 15,5 frente a 52,7 ± 18,3 años; p = NS), en las indicaciones de la colonoscopia, en los hallazgos de la prueba, en el porcentaje de colonoscopias completas (el 93 frente al 95%; p = NS) ni en las dosis de midazolam y meperidina utilizadas. La estancia media en la unidad tras la exploración fue similar (19,2 ± 11,7 frente a 15,5 ± 10,1 min; p = NS). En el grupo de reversión había menos pacientes con estancias prolongadas –estancias de más de 20 min– (el 23 frente al 11%; p < 0,001). El número de pacientes que recordaban molestias durante la exploración era significativamente mayor en el grupo de reversión (el 23 frente al 13%; p < 0,05). No existían diferencias en el número de pacientes con molestias en días posteriores. La mejor relación coste-efectividad se conseguía cuando se buscaba una estancia media de 25 min. Conclusión: La reversión no disminuyó la estancia media en la unidad de endoscopia, pero bajó el número de estancias prolongadas. Los pacientes revertidos experimentan mayores recuerdos desagradables de la exploración. La efectividad del uso de la reversión con flumazenilo tras la sedación con midazolam y meperidina depende de la relación entre el número de exploraciones diarias de la unidad de endoscopia y la capacidad de su unidad de recuperación

Introduction: Randomized clinical trials have demonstrated the effectiveness of flumazenil in reducing recovery time in the endoscopy unit after conscious sedation with midazolam and meperidine. However, its effectiveness in routine clinical practice has not been proved and therefore its use is debated. Aim: To determine the effectiveness of reversion with flumazenil after conscious sedation with midazolam and pethidine in outpatient colonoscopy and to evaluate its cost-effectiveness. Material and method: Two hundred consecutive outpatients scheduled for colonoscopy with conscious sedation with midazolam and pethidine in 2 endoscopy units were prospectively included. According to routine clinical practice in each unit, 100 patients were reverted with flumazenil and 100 were not. Medical and demographic data, indications for endoscopy, doses of the medications used and endoscopic findings were collected. Three weeks after the colonoscopy each patient was interviewed by telephone to determine discomfort and complications associated with the endoscopy and/or with the use of sedation. The cost-effectiveness of the use of flumazenil was analyzed Results: There were no differences between the two groups in age (52.9 ± 15.5 vs 52.7 ± 18.3, p = NS), indications for colonoscopy, findings, percentage of full colonoscopies (93 vs 95%; p = NS) or in the doses of sedatives used. The recovery time in each endoscopy unit was similar (19.2 ± 11.7 vs 15.5 ± 10.1 minutes, p = NS). In the reversion group there were fewer patients with prolonged stays, defined as those > 20 minutes (23 vs 11%, p < 0.001). The number of patients who remembered discomfort during the colonoscopy was significantly greater in the reversion group (23 vs 13%; p < 0.05). There were no differences in the number of patients who reported discomfort in the days following the endoscopy. The best cost-effectiveness ratio was obtained for a mean stay of 25 min. Conclusion: Routine use of reversion does not decrease the mean stay in the endoscopy unit but does decrease the number of prolonged stays. Unpleasant memories of the colonoscopy were more frequent in reverted patients. The effectiveness of the routine use of reversion with flumazenil after conscious sedation with midazolam and pethidine depends on the ratio between the number of daily colonoscopies and the capacity of the recovery room

[Laryngeal radionecrosis as a complication of radiotherapy]. / Radionecrosis laríngea como complicación del tratamiento radioterápico.

The laryngeal cartilage radionecrosis is an infrequent treatment complication with radiotherapy of head and neck tumoral lesions and it can present since a few months to many years later its application. We present the different evolution of two patients with laryngeal carcinoma treated with radiotherapy who developed laryngeal radionecrosis. The differential diagnosis with the recidiva and the primitive tumoral lesion are very important, as well as the diagnosis difficulty and its treatment.

[Middle facial necrosis secondary to cocaine abuse]. / Necrosis mediofacial secundaria a abuso de cocaína.

The middle facial necrosis is a rare pathology that can be found related to multiple processes that can provoque it: traumatic, chemical, infections, inflammatory and tumorals. So for its diagnosis we require a wide differential diagnosis. We present a clinic case of a nose aspirated cocaine female patient who came to our department with a middle-facial necrosis not telling to us in the anamnesis the cocaine use. We were obliged to do multiple diagnostic tests searching other possible causes.

Radionecrosis laríngea como complicación del tratamiento radioterápico / Laringeal radionecrosis as a complication of the radiotherapic treatment

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Necrosis mediofacial secundaria a abuso de cocaína / Middle facial necrosis secundary to cocaine

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Gestión clínica y urológica / Clinical management and Urology

El concepto de gestión clínica procura incorporar en los clínicos la trascendencia de sus decisiones respecto al complejo y dinámico proceso del gasto sanitario y eficiencia. En este artículo los autores efectúan un análisis reflexivo de la verdadera repercusión de este proceso en los profesionales sanitarios, autoridades gubernamentales y marco asistencial de los pacientes. Se establece la implicación del médico en la gestión, gestión clínica y se concluye su papel regulador para alcanzar la verdadera eficiencia clínica que armoniza la relación entre proceso asistencial y el correspondiente consumo de recursos (AU)

[Post-traumatic carotid cavernous fistula as a cause of objective tinnitus]. / Fístula carotidocavernosa postraumática: origen de acúfenos objectivos.

Reporting the case of a patient, seen in our Hospital Consulting Department, enduring heavy pulsatile tinnitus, following a craniocerebral traumatism. ENT examination was negative, but having the feeling of a carotid-cavernous fistula, angiographies confirmed this pathology. Embolisation of the fistula as treatment stopped the patient's symptomatology. We take the advantage of this case in order to review the etiology, the pathology, diagnostic measure and treatment of this condition.

[Clinical and urologic management]. / Gestión clínica y urológica.

The concept of clinical management try to incorporate to the physicians the importance of their decessions regarding the dinamical and complex process of efficiency and health expenses. In this article the authors carry out a reflexive analysis of the reliable repercussion of this process into the healthy people, governmental authorities and assistencial setting of patients. It establish the involvement of the doctor in management, clinical management and it concludes the regulatory function to achieve the true clinical efficiency which harmonizes the relationship between the assistencial process and the corresponding resources consumption.

[Sarcoidosis in otorhinolaryngology]. / Sarcoidosis en O.R.L.

Sarcoidosis is a disease affecting the reticulo-histiocytary system and characterized by its several manifestations, always linked to the same lesion: the epithelioid granuloma without caseous necrosis. We make a review of this disease so scarce in our consulting rooms, and consider all patients diagnosed in our Hospital during one year-term, with their manifestations in ENT-area as well in other specialties and compare our inventory with other published series.

[Deep neck infections: complications of acute pharyngitis]. / Infección cervical profunda: complicación de faringitis aguda.

Deep neck infections develop as aftermath of spreading infections from an initial focus to the neighbourhood and soft tissues of the neck, through routes offering lesser resistance as fascial sheets. These cervical pictures are not numerous and generally after infective focus bad treated, linked with concomitant factors easing the rapid spread. The presence of complications as the involvement of great blood vessels, mediastin or jeopardizing the air-way may darken the prognosis, for which reason its precocious diagnosis and correct behaviour are very decisive. The paper deals with one case of neck infect, following an acute banal pharyngitis without predisposing circumstances. Follows a review of the published bibliography.

[Subcutaneous cervico-thoracic emphysema and pneumo-mediastinum following a tracheostomy]. / Enfisema subcutáneo cervico-torácico y neumomediastino tras traqueotomía.

Reporting the case of a man, 70-year-old, suffering a chronic obstructive lung disease of moderate degree linked to important Reinke's oedema, who underwent a tracheotomy, being troubled the immediate postoperative period with subcutaneous emphysema and pneumomediastinitis, complications resolved favourably in a ten days term, and the patient could be decannulated.

Importancia del método de estimación de costes en diálisis y trasplante renal / Significance of the cost assessment method in dialysis and renal transplantation

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