[Health service needs of migrant women from a basic health area: A qualitative study]. / Necesidades sentidas de salud en mujeres migrantes de una zona básica de salud: estudio cualitativo.

OBJECTIVES: To know the needs and lack of information on health issues of Maghrebi women. SUBJECTS, MATERIAL AND METHOD: Design: Qualitative study technique nominal group (TGN). SUBJECTS: 14 North African women from Association for Solidarity and Rapprochement of Cultures (ASAC) from the rural clinic of La Aljorra who knew and understood Spanish, older age, and lived in the town for more than 3 years. Material and method TGN asks: «What daily health issues for you and your family worry you the most and do you need answers?¼ Individual reflection and list that were discussed among them, joining the group consensus. Subsequently, they were prioritized individually and a definitive list of their prioritized health needs was made. RESULTS: Thirty-six percent of the ASAC associates attended. At first, 17 topics were written on health needs for which they wanted a response. The final topics chosen and grouped by them were 6: 1) Contraceptive methods; 2) Relationship problems; 3) Thyroid; 4) How to cure the sciatic nerve?; 5) Anemia and 6) Stress. 70% related to the area of sexuality. CONCLUSIONS: 1) Qualitative research is an adequate consensus method to obtain information on little-known topics and directly from the person involved; 2) The Moroccan migrant woman considers information about sexuality and couple relationships very important; 3) Another pathology unknown to them and emerging in the area is thyroid; 4) Stress and its repercussions; 5) Sciatica and its consequences are also important when being agricultural workers.

Evaluación de la calidad de vida en Esclerosis Múltiple a través del MSQOL-54 y su relación con la salud de la persona / Assessment of Quality of Life in Multiple Sclerosis through the MSQOL-54 and its relation to the health of the caregiver

Objetivo: El objetivo del presente estudio fue evaluar la Calidad de Vida Relacionada con la salud (CVRS) en personas con Esclerosis Múltiple (EM) mediante el cuestionario MSQOL-54 y analizar su relación con la salud de las personas cuidadoras principales a través del cuestionario GHQ-12 y un cuestionario de salud física autopercibida. Metodología: Se evaluó a 115 personas con diagnóstico de EM y a 79 personas cuidadoras principales. Resultados: Los resultados obtenidos señalan la significativa afectación de la CVRS de las personas con EM y su relación con la salud de las personas cuidadoras principales. Se encontraron relaciones significativas entre la salud física y mental de la persona con EM y un mayor número de enfermedades, peor salud mental y menor autopercepción de salud en la persona cuidadora. Conclusiones: Los resultados obtenidos señalan la significativa afectación de la CVRS de las personas con EM y su relación directa con la salud de las personas cuidadoras principales. (AU)

[Clinical and radiological features of cerebral venous thrombosis in a children cohort]. / Características clínicas y radiológicas de una cohorte de niños con trombosis venosa intracraneal.

INTRODUCTION: Cerebral venous thrombosis (CVT) is an uncommon and poorly studied condition in the pediatric population. OBJECTIVES: To describe and compare the clinical and radiological features of non-neonatal children with CVT according to age and to analyze their association with functional impairment or mortality at hospital discharge. METHODOLOGY: An observational cohort study of chil dren older than 30 days with a first CVT diagnosed with imaging/venography by magnetic resonance (IMR/VMR). We measure functionality with the modified Rankin scale defining marked impairment with 3 to 5 points. We used U-Mann-Whitney test to compare ages averages between groups with and without the different studied variables (significance < 0.05). We used logistic regression analyses to estimate the risk of adverse outcome for each variable expressed in Odds Ratios (ORs) and 95% confidence intervals (CI). RESULTS: Among 21 patients recruited, 42.8% were girls, median age 6.27 years (Interquartile range: 0.74-10). The average age was lower in children with diagnostic delay > 48 hours (p = 0.041), score < 12 in the Glasgow coma scale (p = 0.013), seizures (p = 0.041), sinus rectus thrombosis (p = 0.011), and intracranial hemorrhage (p = 0.049); while it was significantly higher in children with intracranial hypertension syndrome (p = 0.008). The presence of some chro nic systemic condition (OR = 11.2; CI = 1.04-120.4), deep CVT (OR = 14; CI = 1.3-150.8), and brain ischemia (OR = 15.8; CI = 1.4-174.2) was associated with marked functional impairment or mor tality at discharge. CONCLUSIONS: Clinical and radiological features of CVT are age-related. Chronic illnesses, deep venous system involvement, and brain ischemia predict adverse short-term outcomes.

Características clínicas y radiológicas de una cohorte de niños con trombosis venosa intracraneal / Clinical and radiological features of cerebral venous thrombosis in a children cohort

Resumen: Introducción: La trombosis venosa intracraneal (TVI) es una condición infrecuente y poco estudiada en población pediátrica. Objetivos: Describir y comparar características clínicas/radiológicas de ni ños no neonatos con TVI según edad y analizar la asociación de estas variables con deterioro funcio nal al alta o mortalidad aguda. Metodología: Estudio observacional de una cohorte de niños > 30 días con una primera TVI diagnosticada con imágenes/venografía por resonancia magnética encefálica. Medimos funcionalidad con la escala modificada de Rankin definiendo compromiso funcional mar cado con 3 a 5 puntos. Comparamos los promedios de edades entre grupos con y sin las diferentes variables estudiadas con la prueba U-Mann-Whitney (significancia < 0,05). Realizamos análisis de regresión logística para estimar el riesgo de resultado adverso de cada variable expresado en Odds Ra tios (ORs) e intervalos de confianza (IC) al 95%. Resultados: De 21 pacientes, 42.8% eran niñas, me diana de edad 6,27 años (rango intercuartil: 0,74-10). El promedio de edad fue menor en niños con retardo diagnóstico > 48 h (p = 0,041), puntaje < 12 en la escala coma de Glasgow (p = 0,013), crisis epilépticas (p = 0,041), trombosis de seno recto (p = 0,011) y hemorragia intracraneal (p = 0,049); mientras que fue mayor en niños con síndrome de hipertensión endocraneal (p = 0,008). La presen cia de alguna condición crónica sistémica (OR = 11,2; IC = 1,04-120,4), TVI profunda (OR = 14; IC = 1,3-150,8) e infarto encefálico (OR = 15,8; IC = 1,4-174,2) se asoció a compromiso funcional marcado o mortalidad al alta. Conclusiones: Las características clínicas/radiológicas de la TVI varían según la edad. Las patologías crónicas, compromiso del sistema venoso profundo e infarto encefálico predicen mal pronóstico a corto plazo.

Abstract: Introduction: Cerebral venous thrombosis (CVT) is an uncommon and poorly studied condition in the pediatric population. Objectives: To describe and compare the clinical and radiological features of non-neonatal children with CVT according to age and to analyze their association with functional impairment or mortality at hospital discharge. Methodology: An observational cohort study of chil dren older than 30 days with a first CVT diagnosed with imaging/venography by magnetic resonance (IMR/VMR). We measure functionality with the modified Rankin scale defining marked impairment with 3 to 5 points. We used U-Mann-Whitney test to compare ages averages between groups with and without the different studied variables (significance < 0.05). We used logistic regression analyses to estimate the risk of adverse outcome for each variable expressed in Odds Ratios (ORs) and 95% confidence intervals (CI). Results: Among 21 patients recruited, 42.8% were girls, median age 6.27 years (Interquartile range: 0.74-10). The average age was lower in children with diagnostic delay > 48 hours (p = 0.041), score < 12 in the Glasgow coma scale (p = 0.013), seizures (p = 0.041), sinus rectus thrombosis (p = 0.011), and intracranial hemorrhage (p = 0.049); while it was significantly higher in children with intracranial hypertension syndrome (p = 0.008). The presence of some chro nic systemic condition (OR = 11.2; CI = 1.04-120.4), deep CVT (OR = 14; CI = 1.3-150.8), and brain ischemia (OR = 15.8; CI = 1.4-174.2) was associated with marked functional impairment or mor tality at discharge. Conclusions: Clinical and radiological features of CVT are age-related. Chronic illnesses, deep venous system involvement, and brain ischemia predict adverse short-term outcomes.

Humanization in healthcare arises from the need for a holistic approach to illness. / Implantación de un proyecto de humanización en una Unidad de Cuidados Intensivos.

Suffering is not only exclusive to patients or their relatives, but also to the health professionals, who feel to be at the center of the depersonalization process. Over-technification and the fact that the disease process is sometimes the only focal point of our activities, together with the ever-increasing influence of institutional power seen in recent times, all cause the health professional to be the first in demanding a change in health institution dynamics. Following initial reflection from one of the most technified medical specialties (Intensive Care Medicine), classically isolated from the rest of the Hospital and from the community, we implemented a project aimed at securing integration and empathy in our approach to patients and their relatives in the Intensive Care Unit (ICU) of Infanta Margarita Hospital. The project was designed to incorporate tools for working on the most important elements of a humanization plan, i.e., the patients, their relatives, the health professionals and the community, attempting to disclose the work done in the ICU over a period of 12 months. This project is referred to as the Project ICU Infanta Margarita: 1 year: 12 months for 12 commitments.

Factores de riesgo para accidente vascular encefálico en un hospital universitario. Respuesta de los autores / Risk factors for cerebrovascular accident in a university hospital. Author's response

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Factores de riesgo para accidente vascular encefálico en un hospital universitario / Cerebrovascular risk factors seen in a university hospital

INTRODUCCIÓN: Los factores de riesgo (FR) para accidente vascular encefálico (AVE) pediátrico difieren del adulto e incluyen un amplio rango de enfermedades, como pueden ser cardiopatías, infecciones, leucemias y errores congénitos del metabolismo. OBJETIVOS: Describir FR en AVE isquémico en población pediátrica y explorar asociación de los FR con edad, sexo y tipo de AVE. Pacientes y método: Se analizaron 114 casos pediátricos con AVE isquémico ocurridos entre enero del 2003 y julio del 2012. Los FR se estratificaron en 6 categorías, los AVE isquémicos se clasificaron como arterial y venoso. Se compararon los FR con edad, sexo y tipo de infarto (chi al cuadrado y odds ratio). RESULTADOS: La mediana de edad fue 2,5 años, 74 (62,2%) hombres. El 7,9% de los pacientes no tenía FR identificable y el 67% tenía más de uno. La mayor frecuencia de FR fue: enfermedades sistémicas agudas (56,1%), cardiopatías (35,1%) y enfermedades crónicas sistémicas (29,8%). Hubo asociación estadísticamente significativa entre FR enfermedad sistémica aguda y edad menor de 5 años (p < 0,001) y entre enfermedad crónica sistémica y edad mayor o igual a 5 años (p < 0,02). El FR cardiopatía se asoció a infarto arterial (p < 0,05) y el FR enfermedad aguda de cabeza y cuello con infarto venoso (p < 0,05). CONCLUSIONES: Los FR de AVE isquémico en la población pediátrica son múltiples y algunos de ellos se asocian a edades específicas y tipo de AVE. La detección de estos factores permitirá la prevención primaria en la población de riesgo así como un diagnóstico y tratamiento precoz, haciendo igualmente posible la prevención de recurrencias

INTRODUCTION: Risk factors (RF) in pediatric stroke differ from those of adults, and they include a wide range of diseases such as heart disease, infections, leukemias, and inborn errors of metabolism. OBJECTIVES: To describe RF for ischemic stroke in a pediatric population, and to examine the relationship of RF with age, sex and type of stroke. PATIENTS AND METHODS: An analysis was made of database of 114 children and adolescents with ischemic stroke from January 2003 to July 2012. Risk factors were stratified into 6 categories and ischemic strokes were classified as arterial and venous. We compared the RF with age, sex, and type of stroke (chi2 and OR). RESULTS: The median age was 2.5 years, with 74 (62.2%) males. No RF was identified in 7.9% of patients, and 67% had more than one RF. The most common RF were acute systemic diseases (56.1%), heart disease (35.1%), and chronic systemic diseases (29.8%). There was a statistically significant association between acute systemic disease and age less than 5 years (P<0.001), and between chronic systemic disease and age 5 years or more (P<.02). The RF of heart disease was associated with arterial infarction (P<0.05), and the acute head and neck disease RF was associated with venous infarction (P<0.05). CONCLUSIONS: The RF for ischemic stroke are multiple in the pediatric population, and some of them are associated with a specific age and type of stroke. The detection of these factors may help in the primary prevention of people at risk, an early diagnosis, and treatment and prevention of recurrences

Alterations in the antioxidant defense system in prepubertal children with a history of extrauterine growth restriction.

PURPOSE: The role of oxidative stress is well known in the pathogenesis of acquired malnutrition. Intrauterine growth restriction has been associated with an imbalance in oxidative stress/antioxidant system. Therefore, early postnatal environment and, consequently, extrauterine growth restriction might be associated with alterations in the antioxidant defense system, even in the prepubertal stage. METHODS: This is a descriptive, analytical, and observational case-control study. The study included two groups; 38 Caucasian prepubertal children born prematurely and with a history of extrauterine growth restriction as the case group, and 123 gender- and age-matched controls. Plasma exogenous antioxidant (retinol, ß-carotene, and α-tocopherol) concentrations were measured by HPLC; antioxidant enzyme activities of catalase, glutathione reductase, glutathione peroxidase, and superoxide dismutase were determined in lysed erythrocytes by spectrophotometric techniques. RESULTS: Catalase and glutathione peroxidase concentrations were significantly lower in extrauterine growth restriction children than in controls (P < 0.001). Lower plasma retinol concentrations were found in the case group (P = 0.029), while concentrations of ß-carotene and α-tocopherol were higher (P < 0.001) in extrauterine growth restriction prepubertal children as compared with controls. After correction by gestational age, birth weight, and length, statistically significant differences were also found, except for retinol. CONCLUSIONS: Prepubertal children with a history of extrauterine growth restriction present alterations in their antioxidant defense system. Knowing these alterations may be important in establishing pharmacological and nutritional treatments as this situation might be associated with higher metabolic disorders in adulthood.

[Cerebrovascular risk factors seen in a university hospital]. / Factores de riesgo para accidente vascular encefálico en un hospital universitario.

INTRODUCTION: Risk factors (RF) in pediatric stroke differ from those of adults, and they include a wide range of diseases such as heart disease, infections, leukemias, and inborn errors of metabolism. OBJECTIVES: To describe RF for ischemic stroke in a pediatric population, and to examine the relationship of RF with age, sex and type of stroke. PATIENTS AND METHODS: An analysis was made of database of 114 children and adolescents with ischemic stroke from January 2003 to July 2012. Risk factors were stratified into 6 categories and ischemic strokes were classified as arterial and venous. We compared the RF with age, sex, and type of stroke (chi2 and OR). RESULTS: The median age was 2.5 years, with 74 (62.2%) males. No RF was identified in 7.9% of patients, and 67% had more than one RF. The most common RF were acute systemic diseases (56.1%), heart disease (35.1%), and chronic systemic diseases (29.8%). There was a statistically significant association between acute systemic disease and age less than 5 years (P<.001), and between chronic systemic disease and age 5 years or more (P<.02). The RF of heart disease was associated with arterial infarction (P<.05), and the acute head and neck disease RF was associated with venous infarction (P<.05). CONCLUSIONS: The RF for ischemic stroke are multiple in the pediatric population, and some of them are associated with a specific age and type of stroke. The detection of these factors may help in the primary prevention of people at risk, an early diagnosis, and treatment and prevention of recurrences.

Alteraciones metabólicas en prepúberes con retraso del crecimiento extrauterino / Metabolic changes in prepuberty children with extrauterine growth restriction

Introducción: El crecimiento extrauterino retrasado (CER) se asocia al déficit nutricional severo en las primeras semanas de vida, lo que podría, al igual que en el crecimiento intrauterino retrasado, condicionar alteraciones metabólicas en etapas posteriores. Pacientes y métodos: Se seleccionaron un grupo de 38 niños prepúberes con antecedentes de CER y un grupo control de 123 niños de edad y género similares. Se valoró la etapa perinatal en el grupo CER. Se evaluaron en ambos grupos los parámetros antropométricos, la presión arterial, la concentración sérica de marcadores bioquímicos del metabolismo hidrocarbonado y el perfil lipídico. Resultados; En el grupo CER se observaron valores de talla e índice de masa corporal significativamente menores que en el grupo control (p<0,001) y mayores niveles de presión arterial sistólica y diastólica (p<0,001). El 70% de los niños con CER se encontraron por debajo del percentil 50 para peso y talla, y el 55% por debajo del percentil 25 para el índice de masa corporal (p<0,001), así como el 46 y el 37% por encima del percentil 95 de presión arterial sistólica y diastólica, respectivamente (p<0,001). El grupo CER presentó mayores niveles de glucosa (p<0,001) y menor concentración de colesterol ligado a lipoproteínas de alta densidad (cHDL) (p<0,001) respecto del grupo control, aunque sin relevancia clínica. Conclusiones: Los niños con antecedentes de CER presentan alteraciones antropométricas, en la presión arterial y metabólicas ya en la prepubertad. Sería conveniente controlar la nutrición que reciben en la etapa perinatal y realizar un seguimiento en la infancia, ya que podrían aparecer alteraciones en el futuro(AU)

Introduction: Extrauterine growth restriction (EUGR) is associated with severe nutritional deficit during the first weeks of life, which, as intrauterine growth restriction, may lead to metabolic anomalies in later stages of life. Patients and methods: A group of 38 prepuberty children with a history of EUGR were selected, along with a control group of 123 children with similar age and gender. Perinatal stage was assessed in the EUGR group. Anthropometric parameters, blood pressure, serum biochemical markers of carbohydrate metabolism, and lipid profile were measured in both groups. Results: The EUGR group had height and body mass index values significantly lower than in the control group (P<0.001) and higher systolic and diastolic blood pressure (P<0.001). The majority (70%) of EUGR children were below the 50th percentile for weight and height, and 55% were below the 25th percentile for body mass index (P<0.001), as well as 46% and 37% above the 95% percentile for systolic and diastolic blood pressure, respectively (P<0.001). The EUGR group had higher glucose levels (P<0.001) and lower high density lipoprotein cholesterol (HDLc) (P<.001) than the control group, although without clinical relevance. Conclusions: Children with a history of EUGR have anthropometric, blood pressure and metabolic alterations in the prepuberty stage. It would be desirable to control the nutrition they receive in the perinatal period, and follow them up in childhood as alterations may occur in the future(AU)

[Metabolic changes in prepuberty children with extrauterine growth restriction]. / Alteraciones metabólicas en prepúberes con retraso del crecimiento extrauterino.

INTRODUCTION: Extrauterine growth restriction (EUGR) is associated with severe nutritional deficit during the first weeks of life, which, as intrauterine growth restriction, may lead to metabolic anomalies in later stages of life. PATIENTS AND METHODS: A group of 38 prepuberty children with a history of EUGR were selected, along with a control group of 123 children with similar age and gender. Perinatal stage was assessed in the EUGR group. Anthropometric parameters, blood pressure, serum biochemical markers of carbohydrate metabolism, and lipid profile were measured in both groups. RESULTS: The EUGR group had height and body mass index values significantly lower than in the control group (P<.001) and higher systolic and diastolic blood pressure (P<.001). The majority (70%) of EUGR children were below the 50th percentile for weight and height, and 55% were below the 25th percentile for body mass index (P<.001), as well as 46% and 37% above the 95% percentile for systolic and diastolic blood pressure, respectively (P<.001). The EUGR group had higher glucose levels (P<.001) and lower high density lipoprotein cholesterol (HDLc) (P<.001) than the control group, although without clinical relevance. CONCLUSIONS: Children with a history of EUGR have anthropometric, blood pressure and metabolic alterations in the prepuberty stage. It would be desirable to control the nutrition they receive in the perinatal period, and follow them up in childhood as alterations may occur in the future.

¿Existe el síndrome de burnout en los profesionales de la salud de las unidades de hemodiálisis de la región de Murcia? / Does burnout syndrome exist in healthcare professionals in the haemodialysis units in the Murcia region?

El contacto directo y continuo con pacientes renales en tratamiento sustitutivo con hemodiálisis así como con situaciones dónde el dolor, sufrimiento y desesperanza están presentes puede convertirse en una fuente de estrés y conducir al desarrollo de lo que se ha denominado "síndrome de estar quemado" o Burnout. El objetivo principal de este estudio fue medir el nivel de Burnout, la ansiedad y depresión en los profesionales de todas las unidades de diálisis de la Región de Murcia, así como su relación con la edad, tipo de unidad en la que se trabaja (pública o privada concertada) y tiempo en la profesión. Resulta necesaria la prevención y detección de este síndrome por las consecuencias que puede llegar a tener en el profesional. El estudio realizado es de tipo descriptivo, transversal y multicéntrico. Los instrumentos utilizados fueron el Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo de Gil-Monte, el Inventario de Ansiedad Rasgo-Estado de Spielberger y el Inventario de Depresión de Beck. El análisis de los resultados obtenidos pone de manifiesto que el nivel global de burnout entre los profesionales de la nefrología de la Región de Murcia se sitúa en un nivel medio-bajo (Mdn=1.13), encontrándose diferencias marginalmente significativas (p=.082) entre aquellos que trabajan en unidades públicas y los que desarrollan su profesión en clínicas concertadas, que presentaron un promedio ligeramente superior. Asimismo se constatan diferencias significativas (p<.0001) entre los distintos centros de diálisis de la Región (AU)

Direct, continuous contact with renal patients undergoing replacement therapy involving haemodialysis and with situations where pain, suffering and despair are present can become a source of stress and lead to the development of what has been called "burnout syndrome". The main object of this study was to measure the level of burnout, anxiety and depression in the professionals in all the dialysis units in the Murcia Region, and the relationship with age, type of unit where the professional works (public or publiclycontracted private) and time in the profession. The prevention and detection of this syndrome is necessary on account of the consequences it can have for the professional. The study carried out is descriptive, transversal and multicentric. The instruments used were the Gil-Monte Questionnaire for Evaluation of Burnout Syndrome, the Spielberger State-Trait Anxiety Inventory and the Beck Depression Inventory . The analysis of the results obtained shows that the overall level of burnout among nephrology professionals in the Murcia Region is medium-low (Mdn=1.13), with marginally significant differences being found (p=.082) between those who work in public units and those employed in publiclycontracted private clinics, who showed a slight higher mean. Significant differences (p<.0001) were also observed between the different dialysis centres in the Region (AU)

[Radiosurgery as adjuvant treatment of a recurrent adult medulloblastoma. Ultra-early response]. / Radiocirugía como tratamiento complementario del meduloblastoma recidivadodel adulto: respuesta ultratemprana.

The role of radiosurgery after multimodality treatment of recurrent desmoplastic adult medulloblastoma is analyzed. The ultra-early clinical and pathological response of this tumor to adjunctive radiosurgery is stressed.

[Bone marrow stem cell transplantation in amyotrophic lateral sclerosis: technical aspects and preliminary results from a clinical trial]. / Terapia celular para la esclerosis lateral amiotrófica: aspectos técnicos y resultados preliminares del estudio CMN/ELA.

Patients with amyotrophic lateral sclerosis (ALS) experience progressive and irreversible paralysis as a result of the continued loss of motor neurons, which leads to death in less than five years. To date, there is no treatment that can change the progression of this disease. Bone marrow stem cells have shown neural regenerative and neural repairing properties. Specifically, our group showed in a murine model of the disease that these cells, when injected in the spinal cord, can rescue motor neurons through the secretion of GDNF. Based on these results, we designed a phase I/II clinical trial for the purpose of demonstrating the viability of the intraspinal injection of autologous bone marrow mononuclear cells in patients with bulbar onset ALS, with an evolution between 6 and 36 months, with a forced vital capacity (FVC) 50% and T90 29%. This article describes the technique for extracting 60 mL of bone marrow used for the intervention, processing it by density gradient, and the neurosurgical technique used for implanting it. After 6 months of follow-up, the few adverse events reported in the first seven patients included seem to show that the procedure is safe and viable. Most of these patients, including two with a rapid deterioration, have stabilized the progression of their FVC and the neurologic scales measured. The data obtained so for seem to justify the design of new trials more oriented toward the efficacy of the procedure.

[Usefulness of hyperbaric oxygen in the treatment of radionecrosis and symptomatic brain edema after LINAC radiosurgery]. / Eficacia del oxígeno hiperbárico en el tratamiento de la radionecrosis y el edemacerebral sintomáticos tras radiocirugía con acelerador lineal.

Radionecrosis with brain edema is a complication of radiosurgery. Three female patients harbouring a frontal pole, petrous and parasagital parietoocipital meningiomas respectively who had been treated with LINAC radiosurgery are presented. Those patients developed, between two and eight months later, a severe symptomatic radionecrosis with a huge brain edema resistant to the usual steroid therapy. Only after 40 sessions of hyperbaric oxygen, a good remission of the lesions was obtained. There are few cases reported in the literature with such a good outcome. Consequentely, this therapy must be taken into account to treat this type of radiosurgical complication before considering surgery.

Tendinitis aquílea bilateral por ciprofloxacino en ausencia de factores de riesgo / Ciprofloxacin-associated bilateral Achilles tendinitis in absence of risk factors

El ciprofloxacino es la quinolona más usada; debido a esto, el mayor número de casos de tendinopatías comunicados se deben a su uso. El cuadro clínico de la tendinitis producida por quinolonas se caracteriza por su instauración rápida y por afectar como localización preferente al tendón de Aquiles. La aparición de la tendinitis puede suceder desde el segundo o tercer día hasta la quinta o sexta semana de iniciado el tratamiento, siendo con frecuencia la afectación bilateral y soliendo desaparecer la sintomatología al retirar el antibiótico. Como factores de riesgo asociados podemos citar la edad avanzada, el tratamiento prolongado con corticoides, la insuficiencia renal, la tuberculosis multirresistente, la hemodiálisis, la vasculopatía periférica y la enfermedad reumática asociada. Para el diagnóstico no existe ningún método complementario efectivo, siendo en todos los casos el diagnóstico clínico. La retirada del fármaco es esencial para el restablecimiento a la normalidad de la patología tendinosa, aunque el manejo adecuado y temprano no previene de un tiempo de recuperación prolongado, existiendo siempre el riesgo de una secuela funcional. Cada vez están apareciendo nuevas quinolonas y está aumentando su utilización, siendo esta reacción común de grupo, por lo que sería recomendable el seguimiento de los pacientes a los que se les administran quinolonas (AU)

Ciprofloxacin is the quinolone used most, which is why there are more cases of tendon disease reported for this drug. The quinolone-induced clinical picture of tendinitis is characterized by its rapid initiation and its preferentially affected site is the Achilles tendon. The appearance of tendinitis may occur from the second-third day until the fifth or sixth week of treatment initiation, the involvement frequently being bilateral. The symptoms generally disappear after withdrawing the antibiotic. As associated risk factors, we can mention elderly age, prolonged treatment with corticosteroids, renal failure, multiresistant tuberculosis, hemodialysis, peripheral vascular disease and associated rheumatic disease. There is no effective complementary method for its diagnosis, the diagnosis always being clinical. Withdrawal of the drug is essential for the reestablishment of normality of the tendinous condition, although adequate and early management does not prevent a long recovery time and there is always risk of functional sequel. New quinolones are continuing appearing and their use is increasing. This reaction is common to the group so that follow-up of the patients who are going to be administered quinolones would be recommendable (AU)

[Biofeedback and electrostimulation in the treatment of non monosymptomatic enuresis]. / Biofeedback y electroestimulación como tratamiento de la enuresis no monosintomática.

AIM: To show our experience with biofeedback and electrostimulation techniques in the treatment of non monosymptomatic enuresis. METHODS: We reviewed biofeedback and electrostimulation techniques in the treatment of complicated enuresis carried out in our institution between 1995 and 2000. We report 99 patients (65 girls and 34 boys) with ages ranging from 5 to 14 years old. A complete urodinamy study divided the patients into 5 groups: detrusor-sphincter dysfunction (DSD) (47 patients), detrusor overactivity (DO) (25 patients), urge syndrome (US) (15 patients), sphincter hypertony (SH) (10 patients) and "retentionist" bladder (RB) (2 patients). Success was defined as less than three wet nights in a month. Biofeedback and electrostimulation program was designed in 10 sessions per week (20 minutes each session) with SIGMAX-Biomedical software. Tibial electrostimulation with SANS-UroSurge equipment was indicated when biofeedback and electrostimulation techniques failed (12 sessions per week, 30 minutes each session). RESULTS. The success rate has been 78.9% in DSD group, 80% in DO group, 85% in US group, 75% in SH group, 100% in RB group. CONCLUSIONS: Effectiveness of biofeedback and electrostimulation techniques in the treatment of non monosymptomatic enuresis has been reported and seems to be permanent in time.

Cavernomas in children with brain tumors: a late complication of radiotherapy.

BACKGROUND: Delayed complications of radiation therapy comprise cerebral atrophy, radionecrosis and induction of tumors. Recent reports indicate the possibility of the "de-novo" formation of intracranial cavernomas in patients submitted to radiation therapy to the brain. OBJECTIVES: To report three children, two with medulloblastomas and one with a pineal germinoma, treated with radiotherapy that developed intracerebral cavernous hemangiomas some years after treatment. With this work, we aim to draw attention to this occurrence in the neurosurgical community. RESULTS: The patients were two girls and one boy with ages comprised between 2.5 and 7 years (mean 5.2 years). The average interval from irradiation to the appearance of cavernoma was of 5.3 years (range 5-6 years). The lesions were found during the routine neuroimaging studies performed for the follow-up of their primary neoplasms. No patient showed signs or symptoms related to the cavernomas. However, the three children will need both clinical and neuroimaging surveillance to monitor the evolution of these incidentally discovered lesions. CONCLUSIONS: Intracranial cavernomas can occur years after cerebral radiation therapy. In spite of previous reports that show a high incidence of bleeding lesions, cavernomas may be found incidentally during the neuroimaging surveillance studies that are performed to children with brain tumors previously treated with radiotherapy. In these cases, a conservative attitude seems to be advisable, reserving surgery only for those lesions that grow or bleed.

[Brain abscess. Evaluation of prognostic factors: does the use of antibiotic prescribing protocols improve outcome?]. / Abscesos cerebrales: análisis de factores pronóstico e influencia del tratamiento antibiótico protocolizado en su evolución.

BACKGROUND: the aim of this study was to evaluate prognostic factors in brain abscess (AB) and influence of management with antibiotic prescribing protocols (APP). PATIENTS AND METHODS: observational study of a cohort of non-paediatric patients with BA admitted at a 944-bed hospital (1976-2005). Data collection from clinical records has been done according to a standard protocol. We analysed epidemiological, clinical, radiological, microbiological and laboratory data associated with mortality. From 1976 to 1983 (Period I), antibiotic treatment was not done according to any internal APP; from 1983 (Period II), antibiotic management was done according to a APP designed by infectious diseases specialists and neurosurgeons. Predictors of mortality were identified by univariate analysis. The influence of the use of APP in outcome was assessed. RESULTS: 104 patients with BA were included (mean age 45 years; range 12-86); presumed primary pathogenic mechanism of BA was identified in 89%; microbiologic diagnosis was made in 76%. Overall mortality was 16.3%. Factors statistically associated with higher mortality were: age > 40 years, ultimately fatal underlying disease, acute severe clinical condition at the onset of BA, altered mental status and inadequate empirical treatment; 33 patients were treated in Period I and 71 in Period II; no statistically significant differences were found between epidemiological, clinical, radiological or microbiological characteristics of the groups except for mean age (> 40 years in 36% and 62% respectively in Period I and II). Rates of resolution of BA were 60 vs. 77.4% (p < 0.05); relapses 21 vs. 7% (p < 0.05) and mortality 18 vs. 15.4% (p > 0.05), in Period I and II respectively. CONCLUSIONS: main prognostic factors associated with mortality in patients with BA are age, rapidly fatal underlying disease, acute severe clinical condition at the onset of BA, altered mental status and inadequate empirical treatment. Empiric treatment according to APP was associated with greater resolution and lower relapse rates.