Predisposición de los aspirantes a médico internoresidente (MIR) a escoger la especialidad de Medicina de Urgencias y Emergencias y factores relacionados / Medical residency training candidates’ interest in choosing emergency medicine and factors related to choice

Objetivos: Valorar el interés que despierta la especialidad de Medicina de Urgencias y Emergencias (MUE) entre los aspirantes a una plaza en el programa de formación MIR (médico interno residente) y los factores que condicionan la elección de esta especialidad. Método: Estudio descriptivo transversal mediante una encuesta estructurada con preguntas cerradas. La variable de interés principal fue la intención de optar por la MUE y el puesto en que la elegirían en el caso de existir dicha especialidad. Resultados: Se realizaron 1.006 encuestas, el 87% (IC 95%: 84,7-89,0) de los aspirantes MIR manifiestaron la conveniencia de crear la especialidad de MUE. El 9% (IC 95%:7,3-11,0) de los encuestados optaría por MUE en primer lugar y el 40,5% (IC 95%:37,4-43,6) estarían dispuestos a realizar la residencia en la especialidad de MUE. Los factores relacionados con una mayor predisposición a la posible elección de la especialidad de MUE si existiera son: la procedencia de un país no comunitario, haber realizado una asignatura de Medicina de Urgencias (MU), tener una edad superior a 26 años, y como factor de menor disposición el pertenecer al grupo de aspirantes con mejores puntuaciones (número de orden de 1-2.500). Los médicos que finalmente han optado por Medicina Familiar y Comunitaria (MFyC) y Medicina Intensiva (MI) son los que con mayor frecuencia han manifestado su intención de solicitar MUE. Conclusión: Los resultados de la encuesta ponen de manifiesto el gran interés de los aspirantes a MIR por la MUE y el elevado número de médicos que solicitarían esta especialidad en primer lugar. El factor que más se relaciona con la opción de escoger la MUE es el conocimiento previo de la especialidad (AU)

Objectives: To assess medical graduates’ interest in opting for residency training in emergency medicine in Spain and to study factors associated with the choice of this specialty. Methods: Descriptive cross-sectional study based on a structured questionnaire with closed questions. Intention to list emergency medicine among the preferences for residency training and the rank that would be given to that specialty were the dependent variables. Results: A total of 1006 completed questionnaires were received; 87% (95% CI, 84.7%-89.0%) of the respondents thought it would be useful to create a residency program in emergency medicine. This specialty would be ranked as first choice by 9% (95% confidence interval [CI], 7.3%-11.0%); 40% (95% CI, 37.4%-43.6%) would be interested in doing residency training in emergency medicine. Factors related to greater interest in an emergency medicine residency were being from a non-European Union country, having taken a university course in emergency medicine, and age older than26 years. Candidates with higher scores for residency placement (rank between 1 and 2500) were less likely to choose emergency medicine. Physicians who chose a residency position in family and community medicine or intensive care medicine were the ones who most often expressed an interest in emergency medicine. Conclusion: The survey showed that candidates express great interest in an emergency medicine residency and that a large number would choose this specialty as their first choice. Familiarity with the specialty was the factor that was most strongly associated with interest in an emergency medicine residency (AU)

[Ultrasonographic and power Doppler appearance of locoregional metastases from cutaneous melanoma]. / Aspecto ecográfico y en power doppler de las metástasis macroscópicas locorregionales del melanoma cutáneo.

OBJECTIVE: To describe the morphological and vascular ultrasound findings of cutaneous melanoma locoregional metastasis, both in lymph nodes and in superficial soft tissues. To see if detection of these findings allows a sure diagnosis. MATERIALS AND METHODS: The morphological aspects of melanoma metastasis were evaluated with high-resolution ultrasound, and vascularisation by power color, by means the malignancy criteria previously described. RESULTS: 71 loco-regional metastasis were found, in 32 patients: 15 lymph node metastases (21.2%) and 56 soft tissues metastases (78.8%). All of them were histologic confirmation. In 19 cases metastasis were not detected by clinical evaluation. The lymph node metastasis had: low echogenicity (100%) with heterogeneous texture (66.7%); absence of echogenic hilus (93.3%); a ratio between longitudinal and transverse diameters<2 in most cases (86.2%); and peripheral or mixed vascularisation (86.6%). A statistic signification (p=0.049) was proved between L/T ratio and vascularisation type. Soft tissues metastases presented: a maximal diameter between 3-27 mm (mean: 6.91); oval or round shape, sometimes lobulate; well-defined margins (100%); low echogenicity (100%); heterogeneous texture (64.3%); and they showed vascularisation even in the smallest lesions (<5 mm). A statistic signification (p=0.006) was proved between the size and the vascularisation degree. CONCLUSION: US findings allow a suspicion diagnosis of melanoma locoregional metastasis even when metastasis was not detected in physical exam.

Aspecto ecográfico y en power doppler de las metástasis macroscópicas locorregionales del melanoma cutáneo / Ultrasonographic and power Doppler appearance of locoregional metastases from cutaneous melanoma

Objetivo. Describir las características ecográficas morfológicas y vasculares de las metástasis locorregionales del melanoma cutáneo, tanto ganglionares como en tejidos superficiales; observar si el reconocimiento ecográfico de estas lesiones permite el diagnóstico con alto grado de certeza. Material y métodos. Se valoró el aspecto morfológico en ecografía de alta resolución y la vascularización mediante power color, de las metástasis locorregionales de melanoma, aplicando los criterios de malignidad propios de estas lesiones, descritos en la literatura. Resultados. Se encontraron 71 metástasis locorregionales en 32 pacientes, 15 metástasis ganglionares (21,2%) y 56 metástasis de partes blandas (78,8%), que se confirmaron anatomopatológicamente. En 19 casos no fueron sospechadas clínicamente. Las metástasis ganglionares presentaron ecogenicidad baja (100%) con textura heterogénea (66,7%), ausencia de hilio ecogénico (93,3%), una relación entre el diámetro longitudinal y transverso < 2 (86,6%) y vascularización periférica o mixta (86,6%). Se demostró una relación estadística significativa (p = 0,049) entre el L/T ratio y el tipo de vascularización. Las metástasis de partes blandas presentaron un diámetro máximo entre 3-27 mm (media: 6,91), forma ovalada o redondeada, a veces lobulada, márgenes bien definidos (100%), ecogenicidad baja (100%), textura heterogénea (64,3%) y presencia de vascularización (100%), incluso en las lesiones más pequeñas (< 5 mm). Se demostró una relación estadística significativa (p = 0,006) entre el tamaño y el grado de vascularización. Conclusión. Las características ecográficas permiten el diagnóstico de sospecha de las metástasis locorregionales del melanoma cutáneo, incluso en aquéllas que no pueden ser sospechadas clínicamente

Objetive. To describe the morphological and vascular ultrasound findings of cutaneous melanoma locoregional metastasis, both in lymph nodes and in superficial soft tissues. To see if detection of these findings allows a sure diagnosis. Materials and methods. The morphological aspects of melanoma metastasis were evaluated with high-resolution ultrasound, and vascularisation by power color, by means the malignancy criteria previously described. Results. 71 loco-regional metastasis were found, in 32 patients: 15 lymph node metastases (21,2%) and 56 soft tissues metastases (78,8%). All of them were histologyc confirmation. In 19 cases metastasis were not detected by clinical evaluation. The lymph node metastasis had: low echogenicity (100%) with heterogeneous texture (66,7%); absence of echogenic hilus (93,3%); a ratio between longitudinal andtransverse diameters < 2 in most cases (86,2%); and peripheral or mixed vascularisation (86,6%). A statistic signification (p = 0,049) was proved between L/T ratio and vascularisation type. Soft tissues metastases presented: a maximal diameter between 3-27 mm (mean: 6,91); oval or round shape, sometimes lobulate; well-defined margins (100%); low echogenicity(100%); heterogeneous texture (64,3%); and they showedvascularisation even in the smallest lesions (< 5 mm). A statisticsignification (p = 0,006) was proved between the sizeand the vascularisation degree.Conclusion. US findings allow a suspicion diagnosis ofmelanoma locoregional metastasis even when metastasiswas not detected in physical exam (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.

[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.