Frailty, Falls and Osteoporosis: Learning in Elderly Patients Using a Theatrical Performance in the Classroom.

OBJECTIVE: To ascertain the usefulness of a simulated clinical scene with actors in the classroom (theatrical performance) as a teaching tool for the management of falls and their related injuries. DESIGN: Experimental design of two related groups. SETTING: Spain. PARTICIPANTS: A group of 12 students attended a seminar in which the approach to a clinical case was made using a simulated scene with actors in the classroom (scene group); a non-scene group of 34 students attended the seminar, without a theatrical performance (the same clinical case was read and presented in a traditional manner, oral presentation). MEASUREMENTS: Before and after the seminar, students answered a questionnaire [five questions on theoretical knowledge of falls and osteoporosis (score 0-10) and two on subjective learning perception (linear scale: 0-10) (score 0-20)]. In the scene group were two further questions included at the end on their opinion of the scene and on the seminar overall. RESULTS: Both groups significantly improved in all questionnaire scores after the seminar (p=0.001). The scene group had a greater rise in mean points of the questionnaire before and after the seminar than the non-scene group: theoretical knowledge [3.81±1.69 versus 2.75±1.33 (p=0.033)], subjective questions [6.08±4.10 versus 4.97±2.24 (p=0.247)], and the questionnaire overall [9.89±4.98 versus 7.72±2.66 (p=0.060)]. The scene group had a very good opinion of the usefulness of the scene and of the overall opinion of the seminar: 9.08±0.95 and 9.41±0.79. CONCLUSIONS: Theatrical performance in the classroom seems to promote better learning than classic oral presentation, providing qualitative value by adding creativity and different approaches to the teaching of medicine.

Diverticulectomía laparoscópica: técnica sistematizada / Laparoscopic diverticulectomy: a systemised technique

Objetivos: Presentar una técnica original para la diverticulectomía vesical laparoscópica sin necesidad de disecar la pared diverticular, haciendo el procedimiento seguro y significativamente más simple. Material y métodos: Entre septiembe de 2014 a abril de 2016 se intervinieron 4 pacientes. El diagnóstico se realizó en todos los casos por ecografía, y el estudio incluyó un análisis de sangre y orina con urocultivo, citologías urinarias, TAC con contraste, cuestionario de síntomas prostáticos (IPSS), flujometría y cistoscopia. Un caso precisó resección transuretral de próstata en un primer tiempo. Resultados: La edad media de los pacientes fue de 64 años (rango: 56-71). El tamaño diverticular medio fue de 4 cm (rango: 3-6). La localización fue retrotrigonal en todos los casos, 2 de ellos en el lado izquierdo, uno retromeático derecho y un cuarto próximo a la línea media. El tiempo quirúrgico medio fue de 146 min (rango: 120-180), acortándose en cada nuevo caso. No hubo sangrado significativo, complicaciones o conversión a cirugía abierta en ningún caso. El postoperatorio cursó sin incidencias. La estancia hospitalaria fue de 3 días en 3 casos y 48h en el otro (media 3,5 días). La sonda se retiró ambulatoriamente a los 14 días. Conclusiones: La experiencia inicial con la técnica descrita demuestra ser segura y reproducible, con resultados similares a otras técnicas laparoscópicas actuales. Eludir la disección de la pared diverticular reduce la dificultad técnica del procedimiento de forma significativa

Objectives: To present an original technique for laparoscopic vesical diverticulectomy without the need for dissecting the diverticular wall, thereby making the procedure safe and significantly simpler. Material and methods: Four patients were operated on between September 2014 and April 2016. The diagnosis was made by ultrasonography in all cases, and the study included blood and urine analyses with urine cultures, urine cytology, contrast-enhanced CT scans, prostate symptom questionnaire (International Prostate Symptom Score), flowmetry and cystoscopy. One case required transurethral prostate resection in a first time. Results: The mean age of the patients was 64 years (range: 56-71). The mean diverticulum size was 4cm (range: 3-6). The location was retrotrigonal in all cases, on the left side in 2 cases, right retromeatic in 1 case and near the midline in 1 case. The mean surgical time was 146min (range, 120-180), shortening for each new case. There were no significant bleeding, complications or conversion to open surgery in any of the cases. The postoperative period had no incidences. The hospital stay was 3 days in 3 cases and 48h in the other case (mean, 3.5 days). The catheter was withdrawn in the outpatient clinic at 14 days. Conclusions: The initial experience with the technique described above shows it to be safe and reproducible, with results similar to other current laparoscopic techniques. Avoiding the dissection of the diverticular wall significantly reduces the technical difficulty of the procedure

Laparoscopic diverticulectomy: A systemised technique. / Diverticulectomía laparoscópica: técnica sistematizada.

OBJECTIVES: To present an original technique for laparoscopic vesical diverticulectomy without the need for dissecting the diverticular wall, thereby making the procedure safe and significantly simpler. MATERIAL AND METHODS: Four patients were operated on between September 2014 and April 2016. The diagnosis was made by ultrasonography in all cases, and the study included blood and urine analyses with urine cultures, urine cytology, contrast-enhanced CT scans, prostate symptom questionnaire (International Prostate Symptom Score), flowmetry and cystoscopy. One case required transurethral prostate resection in a first time. RESULTS: The mean age of the patients was 64 years (range: 56-71). The mean diverticulum size was 4cm (range: 3-6). The location was retrotrigonal in all cases, on the left side in 2 cases, right retromeatic in 1 case and near the midline in 1 case. The mean surgical time was 146min (range, 120-180), shortening for each new case. There were no significant bleeding, complications or conversion to open surgery in any of the cases. The postoperative period had no incidences. The hospital stay was 3 days in 3 cases and 48h in the other case (mean, 3.5 days). The catheter was withdrawn in the outpatient clinic at 14 days. CONCLUSIONS: The initial experience with the technique described above shows it to be safe and reproducible, with results similar to other current laparoscopic techniques. Avoiding the dissection of the diverticular wall significantly reduces the technical difficulty of the procedure.

Optimized ultrasonic attenuation measures for non-homogeneous materials.

In this paper the study of frequency-dependent ultrasonic attenuation in strongly heterogeneous materials is addressed. To determine the attenuation accurately over a wide frequency range, it is necessary to have suitable excitation techniques. Three kinds of transmitted signals have been analysed, grouped according to their bandwidth: narrowband and broadband signals. The mathematical formulation has revealed the relation between the distribution of energy in their spectra and their immunity to noise. Sinusoidal and burst signals have higher signal-to-noise ratios (SNRs) but need many measurements to cover their frequency range. However, linear swept-frequency signals (chirp) improve the effective bandwidth covering a wide frequency range with a single measurement and equivalent accuracy, at the expense of a lower SNR. In the case of highly attenuating materials, it is proposed to use different configurations of chirp signals, enabling injecting more energy, and therefore, improving the sensitivity of the technique without a high time cost. Thus, if the attenuation of the material and the sensitivity of the measuring equipment allows the use of broadband signals, the combination of this kind of signal and suitable signal processing results in an optimal estimate of frequency-dependent attenuation with a minimum measurement time.

Characterization of the complexity in short oscillating time series: An application to seismic airgun detonations.

Extracting frequency-derived parameters allows for the identification and characterization of acoustic events, such as those obtained in passive acoustic monitoring applications. Situations where it is difficult to achieve the desired frequency resolution to distinguish between similar events occur, for example, in short time oscillating events. One feasible approach to make discrimination among such events is by measuring the complexity or the presence of non-linearities in a time series. Available techniques include the delay vector variance (DVV) and recurrence plot (RP) analysis, which have been used independently for statistical testing, however, the similarities between these two techniques have so far been overlooked. This work suggests a method that combines the DVV method with the recurrence quantification analysis parameters of the RP graphs for the characterization of short oscillating events. In order to establish the confidence intervals, a variant of the pseudo-periodic surrogate algorithm is proposed. This allows one to eliminate the fine details that may indicate the presence of non-linear dynamics, without having to add a large amount of noise, while preserving more efficiently the phase-space shape. The algorithm is verified on both synthetic and real world time series.

Ultrasonic characterization of GRC with high percentage of fly ash substitution.

New applications of non-destructive techniques (NDT) with ultrasonic tests (attenuation and velocity by means of ultrasonic frequency sweeps) have been developed for the characterization of fibre-reinforced cementitious composites. According to new lines of research on glass-fibre reinforced cement (GRC) matrix modification, two similar GRC composites with high percentages of fly ash and different water/binder ratios will be studied. Conventional techniques have been used to confirm their low Ca(OH)(2) content (thermogravimetry), fibre integrity (Scanning Electron Microscopy), low porosity (Mercury Intrusion Porosimetry) and good mechanical properties (compression and four points bending test). Ultrasound frequency sweeps allowed the estimation of the attenuation and pulse velocity as functions of frequency. This ultrasonic characterization was correlated successfully with conventional techniques.

Does breathing type influence electromyographic activity of obligatory and accessory respiratory muscles?

Craniomandibular electromyographic (EMG) studies frequently include several parameters, e.g. resting, chewing and tooth-clenching. EMG activity during these parameters has been recorded in the elevator muscles, but little is known about the respiratory muscles. The aim of this study was to compare EMG activity in obligatory and accessory respiratory muscles between subjects with different breathing types. Forty male subjects were classified according to their breathing type into two groups of 20 each: costo-diaphragmatic breathing type and upper costal breathing type. Bipolar surface electrodes were placed on the sternocleidomastoid, diaphragm, external intercostal and latissimus dorsi muscles. EMG activity was recorded during the following tasks: (i) normal quiet breathing, (ii) maximal voluntary clenching in intercuspal position, (iii) natural rate chewing until swallowing threshold, (iv) short-time chewing. Diaphragm EMG activity was significantly higher in the upper costal breathing type than in the costo-diaphragmatic breathing type in all tasks (P < 0·05). External intercostal EMG activity was significantly higher in the upper costal breathing type than in the costo-diaphragmatic breathing type in tasks 3 and 4 (P < 0·05). Sternocleidomastoid and latissimus dorsi EMG activity did not show significant differences between breathing types in the tasks studied (P > 0·05). The significantly higher EMG activity observed in subjects with upper costal breathing than in the costo-diaphragmatic breathing type suggests that there could be differences in motor unit recruitment strategies depending on the breathing type. This may be an expression of the adaptive capability of muscle chains in subjects who clinically have a different thoraco-abdominal expansion during inspiration at rest.

Contacto precoz con la realidad asistencial: una experiencia piloto en medicina / Early contact with medical practice: a pilot experience in medical students

Introducción. Varios estudios han sugerido que el contacto precoz del estudiante de medicina con la realidad asistencial puede tener unos efectos beneficiosos sobre su motivación, el conocimiento de la relación médico-paciente y la aceptación de la importancia de las materias médicas básicas. En el nuevo grado conjunto de Medicina de la Universitat Autònoma de Barcelona y la Universitat Pompeu Fabra se ha incorporado una asignatura denominada ‘Prácticas de Grado’ que se imparte durante los tres primeros años, destinada a permitir el contacto de los estudiantes con la asistencia primaria, los equipos de enfermería y los centros sociosanitarios. El presente artículo describe la experiencia y la opinión de los estudiantes que la cursaron durante el primer año. Materiales y métodos. El artículo describe las características académicas de la asignatura. Se realizó una encuesta a los estudiantes al finalizar la asignatura para evaluar su grado de satisfacción y su percepción sobre el cumplimiento de los objetivos y las competencias que debían alcanzarse. Resultados. Existió una elevada satisfacción con la nueva actividad y una percepción entre los estudiantes de que las competencias preestablecidas se habían alcanzado en su mayor parte. Conclusión. El contacto precoz con la realidad asistencial es un elemento esencial para la comprensión de la actividad médica por los estudiantes de medicina de primer año (AU)

Introduction. Several studies have suggested that early contact of medical students with medical care may have beneficial effects on their motivation, knowledge of doctor-patient relationship and acceptance of the interest of biomedical sciences. In the new joint degree of Medicine of Autonomous University of Barcelona and Pompeu Fabra University we have incorporated the subject ‘Prácticas de Grado’ during the first three years. It is devoted to permit the early contact of medical students with primary care, nursing teams and chronic care facilities. The present paper describes its academic features as well as the opinion of students during the first year of the experience. Materials and methods. The characteristics of the subject are described in this section. A survey was performed in the students who completed the first year of the experience to get their degree of satisfaction and the perception with the achievement of pre-established competencies and educative objectives. Results. Students were highly satisfied with the new subject and they believed that planned competencies and objectives were fully achieved in most of cases. Conclusion. The early contact with health care is an important contribution to the understanding of the medical professions by medical students of first year (AU)

Después de cien años de uso: ¿las férulas oclusales tienen algún efecto terapéutico? / After a century of use: do the occlusal appliances have any therapeutic effects?

Las férulas o planos oclusales han sido utilizadas desde hace más de un siglo, generando controversia acerca de su verdadero valor terapéutico. Esto motivó una revisión histórica y actualizada que permitiera evaluar sus efectos de acuerdo a la evidencia científica. Se discuten múltiples aspectos como el concepto de relación céntrica y su determinación como punto de inicio de tratamiento en la rehabilitación oral; el uso de las férulas para deprogramar; su efecto sobre la conducta motora oral que conocemos como bruxismo; su efecto en la actividad electromiográfica tónica, durante la deglución y el máximo apriete en los músculos masticatorios y cervicales; su influencia en la eficiencia muscular; su efecto en la carga articular y las evidencias experimentales del uso de distintas férulas sobre signos y síntomas especíicos como dolor y ruido articular. Se plantean desafíos para la investigación sobre cambios degenerativos en las articulaciones, en la relación craneovertebral y en la curvatura e inclinación de la columna cervical. Se concluye que es necesario utilizar una férula diseñada para el trastorno específico del paciente y que su verdadero valor terapéutico queda demostrado al mejorar algunos signos y síntomas, en músculos masticatorios y cervicales. El conocimiento parcial del mecanismo de acción de las férulas contribuye a que persista la controversia de su utilización en el tratamiento de ruidos articulares y para revertir cambios degenerativos en las articulaciones. Persiste el desafío de nuevas investigaciones, que sustenten el uso de estos dispositivos como un método eficaz para tratar a nuestros pacientes, utilizando protocolos de manejo y controles periódicos.

Occlusal appliances or splints have been used for over a century, generating controversy about their real therapeutic value. This led to an updated review to assess their effects according to scientific evidence. The concept of centric relation and its determination as a starting point of treatment; the use of splints to deprogram; their effect on the oral motor behaviour known as bruxism are discussed. Their effect on EMG activity during resting, swallowing and maximal clenching in the masticatory and neck muscles; their effect on muscular eficiency; their effect decreasing the joint overload; and experimental evidence of the use of several appliances on speciic symptoms such as pain and joint noise, are also treated. The true challenge is to generate new knowledge about joint degenerative changes, the craniocervical relationships, tilt and curvature of the cervical spine. In conclusion, it's necessary to use an occlusal appliance designed for the specific condition of the patient, and its real therapeutic value is demonstrated by the improvement of some signs and symptoms in masticatory and cervical muscles. However, the action mechanisms of occlusal appliances are not fully understood. The lack of scientiic support contributes to the persistent controversy of the use of these appliances in the treatment of temporomandibular joint sounds and reversing degenerative changes. It is still a challenge to carry out new researches supporting the use of these appliances as an effective method to treat our patients using management protocols and periodic evaluations.

Vólvulo cecal: características en imagen / Cecal volvulus: imaging features

Objetivo. El objetivo de este estudio es analizar la sensibilidad de los hallazgos de la radiografía simple y de la tomografía computarizada (TC) en el diagnóstico del vólvulo cecal. Material y métodos. Se revisaron las historias clínicas de 11 pacientes con diagnóstico endoscópico o quirúrgico de vólvulo cecal. Dos radiólogos analizaron por consenso los hallazgos en la radiografía simple y en la TC y calcularon la sensibilidad. Se realizó de forma retrospectiva un diagnóstico de certeza, probable o indeterminado de vólvulo cecal sobre la base de la presencia o ausencia de signos previamente descritos. Los signos de sufrimiento parietal en la TC se compararon con los hallazgos anatomopatológicos. Resultados. Los hallazgos más sensibles en la radiografía simple fueron la presencia de un asa desproporcionadamente dilatada y un patrón de oclusión de intestino delgado distal (91%), seguidos de un nivel hidroaéreo único en el ciego y colapso del colon distal (82%). En la TC, el signo del grano de café con un único nivel hidroaéreo y el colapso de colon izquierdo mostraron una sensibilidad del 100%. El signo del remolino se observó en el 86%. De forma retrospectiva se pudo realizar un diagnóstico de certeza en el 36 y el 86% de los casos en la radiografía simple y en la TC, respectivamente. Aunque todos los casos con isquemia tenían signos de deterioro vascular en la TC, no se encontró correlación significativa entre ambos parámetros. Conclusiones. La utilización de los signos descritos de vólvulo cecal permite hacer un diagnóstico de certeza con la radiografía simple en un tercio de los pacientes y en la mayoría de los casos con la TC. La valoración de otros hallazgos adicionales incrementa la posibilidad de realizar un diagnóstico correcto (AU)

Objective. To determine the sensitivity of plain-film radiography and computed tomography (CT) in the diagnosis of cecal volvulus. Material and methods. We reviewed the clinical histories of 11 patients diagnosed with cecal volvulus at endoscopy or surgery. Two radiologists working in consensus analyzed the findings at plain-film radiography and at CT and calculated the sensitivities. The plain-film and CT studies were retrospectively classified as certain, probable, or indeterminate for cecal volvulus on the basis of the presence or absence of previously reported signs. Signs of wall suffering at CT were compared to the histologic findings. Results. The most sensitive findings at plain-film radiography were the presence of a disproportionately dilated bowel loop and a pattern of distal small bowel occlusion (91%), followed by a single air-fluid level in the cecum and collapse of the distal colon (82%). At CT, the “coffee bean” sign with a single air-fluid level and collapse of the left colon had a sensitivity of 100%. The whirl sign was present in 86%. Retrospectively, 36% of the plain-film studies and 86% of the CT studies were classified as certain for cecal volvulus. Although all cases with ischemia had signs of vascular compromise on CT, no significant correlation was observed between these variables. Conclusions. The plain-film signs reported for cecal volvulus enable a certain diagnosis in a third of all cases; the CT signs enable a certain diagnosis in most cases. The evaluation of additional findings increases the chances of reaching the correct diagnosis (AU)

[Cecal volvulus: imaging features]. / Vólvulo cecal: características en imagen.

OBJECTIVE: To determine the sensitivity of plain-film radiography and computed tomography (CT) in the diagnosis of cecal volvulus. MATERIAL AND METHODS: We reviewed the clinical histories of 11 patients diagnosed with cecal volvulus at endoscopy or surgery. Two radiologists working in consensus analyzed the findings at plain-film radiography and at CT and calculated the sensitivities. The plain-film and CT studies were retrospectively classified as certain, probable, or indeterminate for cecal volvulus on the basis of the presence or absence of previously reported signs. Signs of wall suffering at CT were compared to the histologic findings. RESULTS: The most sensitive findings at plain-film radiography were the presence of a disproportionately dilated bowel loop and a pattern of distal small bowel occlusion (91%), followed by a single air-fluid level in the cecum and collapse of the distal colon (82%). At CT, the "coffee bean" sign with a single air-fluid level and collapse of the left colon had a sensitivity of 100%. The whirl sign was present in 86%. Retrospectively, 36% of the plain-film studies and 86% of the CT studies were classified as certain for cecal volvulus. Although all cases with ischemia had signs of vascular compromise on CT, no significant correlation was observed between these variables. CONCLUSIONS: The plain-film signs reported for cecal volvulus enable a certain diagnosis in a third of all cases; the CT signs enable a certain diagnosis in most cases. The evaluation of additional findings increases the chances of reaching the correct diagnosis.

Fetal cortisol response to intrauterine microbial colonisation identified by the polymerase chain reaction and fetal inflammation.

OBJECTIVE: To determine the fetal cortisol response to intrauterine infection. STUDY DESIGN: 16s ribosomal RNA genes or the urease genes of Ureaplasma spp were identified by the polymerase chain reaction in intrauterine samples. Cord blood cortisol, interleukin 6 (IL6) and IL8 were measured in samples from 31 infants born at <32 weeks gestation. RESULTS: 13 infants (median gestation 30 weeks, birth weight 1350 g) had at least one positive intrauterine sample for microbial genes and 18 infants (31 weeks, 1320 g) did not. The cord blood cortisol concentration was significantly higher in fetuses exposed to intrauterine infection and significantly increased in fetuses/mothers presenting in preterm labour with intact membranes compared with infants delivered by elective prelabour caesarean section (p<0.05). The cord blood cortisol concentration was increased in the mothers with prelabour premature rupture of membranes but this was not significant compared with the caesarean section group. The cord blood cortisol concentration was significantly increased in the presence of chorioamnionitis or funisitis and was moderately correlated with cord blood IL6 (r = 0.64, p<0.01) and IL8 (r = 0.52, p<0.01). CONCLUSIONS: In this study, cord blood cortisol was increased in the colonised group compared with non-colonised infants. It is unclear if infants born following prelabour premature rupture of the membranes mount an adequate anti-inflammatory response.

On practical issues about interference in telecare applications based on different wireless technologies.

Telemedicine systems have been progressively paying more and more attention to wireless technologies for personal area network (PAN). Depending on the features of the system to be developed, different technologies need to be deployed. These technologies are supposed to coexist, even though many of them operate in the same 2.4-GHz band. In case of interference, there are safety mechanisms included in the standard. However, these mechanisms do not work exactly as expected in theory. This paper presents an experiment with a real Bluetoothbased ECG system and Zigbee temperature sensors in an environment where a WiFi network is operating. The main novelty of the paper is the real implementation and experiments of all three wireless technologies for both continuous and discrete medical signals. Conclusions and recommendations for reliable operation are given for all three involved technologies.

Crosectomía y escleroterapia con espuma frente a safenectomía como tratamiento de las varices producto de reflujo en la unión safenofemoral / Crossectomy and foam sclerotherapy versus saphenectomy as treatment for varicose veins produced by reflux at the saphenofemoral

Introducción. El tratamiento de la enfermedad varicosa producto del reflujo de la unión safenofemoral ha variadoen los últimos años con el advenimiento de novedosas técnicas menos traumáticas. En el presente estudio se describeuna técnica y se describen sus ventajas en relación con otros procedimientos actuales. Pacientes y métodos. Se tratade un estudio prospectivo, comparativo, de una muestra seleccionada de 36 casos. Se realizó una crosectomía y unaescleroterapia con espuma de etoxiesclerol en 18 casos y una safenectomía convencional en los restantes. Resultados.Para la técnica descrita, el tiempo quirúrgico promedio fue de 30 minutos. El tiempo promedio de hospitalización fue deun día, con un reintegro a las actividades cotidianas en la segunda semana en todos los casos y una elevada tasa de satisfacción(94,4%). En el seguimiento durante un período de 3 a 12 meses no se encontraron recurrencias. Se describióun caso de hiperpigmentación como única complicación postoperatoria asociada con el procedimiento. Se demostró unbeneficio con respecto a la safenectomía convencional en cuanto a tasa de complicaciones menores postoperatorias (5,5frente a 33,3%, p < 0,05). Conclusión. La escleroterapia con espuma en el tratamiento de la insuficiencia venosa superficiales una técnica que ha demostrado su eficacia. La técnica propuesta, es decir, la crosectomía y la esclerosis con espumaes una técnica factible, con una tasa de éxito comparable a la safenectomía, que ofrece las ventajas del tratamientomínimamente invasivo sin la necesidad de requerir en el área quirúrgica equipos de alto coste, lo cual la hace más accesiblepara centros no especializados

Introduction. Treatment of varicose vein disease resulting from reflux in the saphenofemoral junction haschanged in recent years with the advent of novel, less traumatic techniques. In this study we outline one such technique anddescribe its advantages compared to other procedures currently in use. Patients and methods. We conducted a prospective,comparative study of a selected sample of 36 cases. Crossectomy and ethoxysclerol foam sclerotherapy were performed in18 cases and the others were treated by means of a conventional saphenectomy. Results. For the technique reported here,average surgery time was 30 minutes. Average hospitalisation time was one day, with return to daily activities during thesecond week in all cases and a high rate of satisfaction (94.4%). No relapses were found during the 3 to 12-month followupperiod. One case of hyperpigmentation was reported as the only post-operative complication associated to theprocedure. The benefits of this procedure over those obtained using conventional saphenectomy were proved by the lowerrate of post-operative complications (5.5 versus 33.3%, p < 0.05). Conclusions. Foam sclerotherapy in the treatment ofsuperficial venous insufficiency is a technique that has been shown to be effective. The technique proposed here, that is tosay, crossectomy and foam sclerosis is a feasible technique, with a success rate comparable to that of saphenectomy. Thefact that it offers the advantages of minimally invasive treatment without requiring high-cost equipment in the surgicalarea makes it more readily available for use in non-specialised centres

Análisis de los factores que motivan la reconversión a laparotomía en los quistes de ovario tratados inicialmente por laparoscopia / Analysis of factors leading to conversion to laparotomy in adnexal cysts initially treated by laparoscopy

Se realiza un estudio retrospectivo, observacional y descriptivo del total de los quistes de ovario reconvertidos en el mismo acto quirúrgico de laparoscopia a laparotomía en los últimos 7 años (1999-2005) en el Hospital Universitario Joan XXIII de Tarragona. Se analizan las características de las pacientes y los posibles factores que contribuyen a un mayor riesgo para la reconversión, como la cirugía previa y afecciones como la endometriosis y el tamaño del quiste. El porcentaje de reconversión es de un 8,6%. Las causas fueron cuadros adherenciales, 81%; hemorragia incoercible, 5,4%; dificultad anestésica, 5,4%; imposibilidad de realizar el neumoperitoneo, 5,4%, y fallo en el material, 2,7%. La anatomía patológica más frecuente en estos casos fue de endometriosis en un 67,5% de los casos (AU)

A descriptive, observational, retrospective study was performed of patients with cystic adnexal masses who required conversion from laparoscopic to open surgery in the same intervention in a 7-year period (1999-2005). The study was carried out in the Joan XXIII University Hospital in Tarragona, Spain. Patient characteristics and the possible factors contribut ing to a higher risk of failed laparoscopy, such as prior surgery, the presence of endometriosis, and cyst size, were analyzed. Conversion to laparotomy occurred in 8.6% of all patients and was associated with adhesions in 81%, incoercible bleeding in 5.4%, anesthetic difficulties in 5.4%, impossibility of performing pneumoperitoneum in 5.4% and equipment failure in 2.7%. Endometriosis was found in 67.5% of the total number of cysts (AU)

Histerectomía vaginal asistida por laparoscopia (HVAL). Indicaciones y técnica / Laparoscopic assisted vaginal hysterectomy. Indications and technical procedure

Se discuten en este capítulo las indicaciones y técnica de la histerectomía vaginal asistida por laparoscopia

Indications and technical procedure of laparoscopic assisted vaginal hysterectomy are discussed in this chapter

Laterotrusive occlusal schemes and their effect on supra- and infrahyoid electromyographic activity.

The objective of this study was to determine the effects of canine guidance and group function on supra- and infrahyoid electromyographic (EMG) activity. The sample included 40 healthy subjects, 20 with bilateral canine guidance and 20 with bilateral group function. Surface electrodes were used to record the integrated EMG (IEMG) activity of the left supra- and infrahyoid muscles during (1) grinding from intercuspal position to lateral edge-to-edge contact position (with canine guidance or group function), (2) static clenching in edge-to-edge lateral contact position with canine guidance or group function, and (3) grinding from lateral edge-to-edge contact position (with canine guidance or group function) to intercuspal position. IEMG activity in the suprahyoid or infrahyoid muscles was not significantly different with canine guidance or group function. Supra- and infrahyoid IEMG activity in condition 2 was significantly higher than in condition 3, which was significantly higher than in condition 1. Supra- and infrahyoid IEMG activity was not significantly different with canine guidance and group function. Supra- and infrahyoid IEMG activity during the static recording (clenching) was significantly higher than during the dynamic recordings (grinding). Activity during grinding from the lateral edge-to-edge contact position to the intercuspal position was higher than vice versa.

Breathing type and body position effects on sternocleidomastoid and suprahyoid EMG activity.

The objective of this study was to determine the effects of breathing type and body position on sternocleidomastoid and suprahyoid electromyographic (EMG) activity. The sample included 18 subjects with upper costal breathing type (study group) and 15 subjects with costo-diaphragmatic breathing type (control group). All individuals had natural dentition and bilateral molar support. EMG recordings at rest and while swallowing saliva were carried out by placing surface electrodes on the left sternocleidomastoid and left suprahyoid muscles. EMG activity was recorded while standing, seated upright, and in the lateral decubitus position. Upper costal breathing type subjects showed a significantly higher suprahyoid EMG activity at rest than costo-diaphragmatic subjects in all body positions studied (mixed model with unstructured covariance matrix). In the lateral decubitus position, both breathing types showed a significantly higher sternocleidomastoid EMG activity at rest and while swallowing saliva. The suprahyoid muscles demonstrated a significantly higher EMG activity at rest as well as in the lateral decubitus position (mixed model with unstructured covariance matrix). These results are relevant because sternocleidomastoid and suprahyoid muscles play an important role in controlling the head posture and mandible dynamics. The neurophysiological mechanisms involved are discussed.

Metástasis endometrial de carcinoma lobulillar de mama / Endometrial metastases from lobular carcinoma of the breast

El sangrado de origen uterino en la mujer posmenopáusica nos hace pensar, de forma inmediata, en descartar un proceso maligno. En el caso de mujeres con antecedente de neoplasia primaria de otro origen hay que descartar la posibilidad de la metástasis uterina. Se presentan 2 casos de neoplasia de mama conocida, carcinoma lobulillar de tipo clásico, que evolucionaron con metástasis uterina. Uno de ellos presentó la forma clínica habitual, el sangrado genital; pero el segundo caso se diagnosticó de forma casual en un control del cáncer de mama. Se comenta el diagnóstico diferencial, así como la necesidad de la utilización rutinaria de las técnicas de imagen en las pacientes con cáncer de mama

Vaginal bleeding in postmenopausal women automatically suggest the presence of a malignant process. In women with a history of cancer, the possibility of uterine metastases must be ruled out. We report 2 cases of lobular carcinoma of the breast metastatic to the uterus. The first case presented as vaginal discharge, but the other was a chance finding in a routine follow-up visit. We discuss the differential diagnosis of this process and the need for the routine use of imaging modalities in the follow-up of patients with breast cancer