First insight into plastics ingestion by fish in the Gulf of California, Mexico.

Plastic particle occurrence in the digestive tracts of fishes from a tropical estuarine system in the Gulf of California was investigated. A total of 1095 fish were analysed, representing 15 species. In total 1384 particles of plastic debris were recovered from the gastrointestinal tracts of 552 specimens belonging to 13 species, and all consisted of threads, the majority of which were small microplastics (0.23 to 1.89), followed by large microplastics (2.07 to 4.49), and few mesoplastics (5.4 to 19.86). Plastic particles were identified using ATR-FTIR spectroscopy. The mean frequency of occurrence of plastics in the gastrointestinal tracts of fishes from this system was 50.5%, which is higher than frequencies reported in similar systems in other areas. The polymers identified by ATR-FTIR were polyamide (51.2%), polyethylene (36.6%), polypropylene (7.3%), and polyacrylic (4.9%). These results show the first evidence of plastic contamination for estuarine biota in the Gulf of California.

[Management of multiple cerebral cavernomatosis]. / Tratamiento de la cavernomatosis cerebral multiple.

INTRODUCTION: Cavernous angiomas are angiographically occult vascular malformations that are present in 0.4% of people, and represent 5 13% of all cerebrovascular malformations. They can be alone or multiple, and sporadic or familial. The presence of multiple lesions is more frequent in familial cavernomatosis. OBJECTIVES: Improve our knowledge of the natural history of multiple cavernomatosis in order to improve our diagnostic and therapeutic management of this entity. PATIENTS AND METHODS: We have retrospectively reviewed 18 cases of multiple cerebral cavernomatosis; 4 of them belonged to the same family and 2 belonged to another family. Number, size, characteristics and evolution of the lesions, symptoms, treatment and clinical outcome have been analysed during a follow up period longer than 5 years. RESULTS: 31.5% of the cavernous angiomas reviewed by our department were multiple (at least three lesions). During the 5 year follow up period only four (4/18) patients underwent surgical treatment. 50% of patients suffered at least one hemorrhagic event with clinical impairment, and the most frequent manifestations were headache, focal deficit and seizures. The hemorrhagic rate per lesion per year was under 1%, for the more than 200 lesions and the low frequency of hemorrhagic events with clinical impairment in the time. CONCLUSIONS: Surgical treatment must be considered in patients with accessible lesions that have produced symptoms several or progressive symptoms. The non surgical patients should be followed with yearly MRI. When more than one first degree relative has a cavernous malformation or familial antecedent with cerebral hemorrhage or epilepsy, serial follow up monitoring consisting of physical examinations and MRI should be suggested to family members.

Tratamiento de la cavernomatosis cerebral múltiple / Management of the multiple cerebral cavernomatosis

Introducción. Los angiomas cavernosos son malformaciones vasculares angiográficamente ocultas, presentes en el 0,4 por ciento de los individuos, y que suponen el 5-13 por ciento de las malformaciones vasculares. Pueden ser únicos o múltiples, y esporádicos o familiares. El carácter múltiple de las lesiones es más frecuente en las formas familiares. Objetivos. Un mayor conocimiento de la historia natural de la cavernomatosis múltiple, que nos permita realizar un correcto manejo diagnóstico y terapéutico de esta patología. Pacientes y métodos. Hemos revisado retrospectivamente 18 casos de cavernomatosis cerebral múltiple, cuatro de los cuales pertenecían a una misma familia y dos a otra. Se ha analizado el número, tamaño, características y evolución de las lesiones, sintomatología del paciente, período de seguimiento, tratamiento realizado y evolución clínica a lo largo del tiempo. Resultados. Según los datos de nuestro servicio, en el 31,5 por ciento de los casos de cavernomas, éstos presentan un carácter múltiple (al menos tres lesiones). El seguimiento se ha efectuado durante un período medio de cinco años, durante el cual sólo cuatro pacientes se sometieron a tratamiento quirúrgico. El 50 por ciento de los pacientes presentaron al menos un episodio hemorrágico con repercusión clínica, y las manifestaciones más frecuentes fueron cefalea, focalidad neurológica y crisis comiciales. La incidencia de hemorragia por lesión por año es inferior al 1 por ciento, dado el elevado número de lesiones (más de 200 en total) y la escasa frecuencia de hemorragia con repercusión clínica a lo largo del tiempo. Conclusiones. El tratamiento quirúrgico debe plantearse en casos de lesiones de localización accesible que hayan producido síntomas en repetidas ocasiones o de forma progresiva. En el resto de casos se debe realizar un seguimiento con resonancia magnética (RM) anual. Cuando más de un familiar de primer grado tiene algún cavernoma o existen antecedentes familiares de hemorragias cerebrales o crisis comiciales, se debe ofrecer la posibilidad de seguimiento clínico y radiológico con RM a los miembros de la familia (AU)

[Design, implementation, and results of the clinical pathway for herniated lumbar disk]. / Diseño, implantación y resultados de la vía clínica para la cirugía de la hernia de disco lumbar.

INTRODUCTION: Clinical or critical pathways are a useful tool in the continuous quality improvement. They develop the main characteristics of the quality programs: implementation of the evidence based medicine, increase staff and patient satisfaction and adequacy in hospital costs. This is the application of evidence-based medicine to a process management and it promotes integration of clinical guides, protocols and algorithms. OBJECTIVE: We present our experience in the design, and first nine month's implementation and development of a clinical pathway for lumbar hemilaminectomy. PATIENTS AND METHODS: This clinical pathway consists on four documents: main guide and check sheet, preprinted treatment orders and variation sheet, iconographic information for the patients and patient satisfaction questionnaire. After desing, development and a pilot study, the hemilaminectomy critical pathway was permanently adopted by our Service. A total of 106 patients underwent programmed lumbar disc hemilaminectomy in our Service between April and December-1999. Patients' average age was 44.7 years (SD = 11.2), 55.3% were men and 43.7% women. Twelve were hospitalized in a ward other than Neurosurgery unit and therefore were excluded from the study. This evaluation is based on the initial results obtained from both the pathway documents and the general data collected as usual during hospital care. The impact of the critical pathway on hospital stay has been assessed by comparing the average stay of critical pathway patients to the average of the 70 hemilaminectomies performed at our Service in the period April-December 1998. RESULTS: Clinical pathway coverage has been 68% (standard > 80%). The patients' average stay was 4 days (SD = 1.1), one day more than planned. The pathway establishes a 4 day hospital stay (3 bed-days), a time that was fulfilled by 49% of the patients. The average stay of the 1998 patients was 5.6 days (SD = 2.7), 1.6 days more than the clinical pathway patients (p < 0.0001). Additionally, undesirable variability in the length of hospital stays was also reduced. Analysis of variations identified those corresponding to patient's condition, increases in medication beyond that originally specified due to patient needs, and unjustified prolonged stays. There were no systematic variations. There was a 2.2% incidence of adverse effects. Although satisfaction questionnaire was only returned by 51% of the patients (instead of > 70%), satisfaction index were 93% (vs 90%). CONCLUSIONS: Critical pathways are still under development and changing continuously. Nevertheless their impact on improving patient care and satisfaction, and resource consumption is already evident, and it constitutes a major aim to work in its complete development.