Compassion fatigue and anxiety in critical care emergency nurses: In between efficiency and humanity.

OBJECTIVES: To determine the emotional impact of permanent proximity to trauma and death in the Emergency and ICU's nurses establishing prevalence of Compassionate Fatigue (burnout and Secondary Traumatic Stress) and anxiety. Analyze its relationship with sociodemographic, training, workplace and psychological variables. METHODS: Descriptive, cross-sectional and multicentre study. The validated ProQOL v. IV and STAI scales and an ad-hoc questionnaire with the variables of the second objective were used in 710 nurses from nine highly complex hospitals in Catalonia (Spain). RESULTS: In both units, the prevalence of professionals affected with high scores of burnout was higher than 20%, on Secondary Traumatic Stress was 30% and, 12% on anxiety. Each subscale was significantly associated with the intention to leave units and the career. 97% of participants stated that they needed to be trained in emotional management. CONCLUSION: The prevalence of burnout and Secondary Traumatic Stress were higher in our study than those offered in the reference literature in emergency and ICU nurses. The prevalence of each construct was individually related to the desire to leave work units and career. This fact, together with the participants' desire to be better trained in emotional management exposes the need to establish educational plans, as well as institutional measures to prevent and support nurses for Compassion Fatigue.

Fatiga por compasión y ansiedad en enfermeras de cuidados críticos y emergencias. Entre eficiencia y humanidad / Compassion fatigue and anxiety in critical care emergency nurses: In between efficiency and humanity

Objetivos: Determinar el impacto emocional de la proximidad al trauma y la muerte en enfermeras de urgencias y de UCI mediante las prevalencias de fatiga de compasión (burnout y estrés traumático secundario) y ansiedad. Analizar su relación con variables de tipo sociodemográfico, formativas, laborales y psicológicas. Método: Estudio descriptivo, transversal y multicéntrico. Se utilizaron las escalas validadas ProQOL v.IV y STAI y un cuestionario ad-hoc con las variables del segundo objetivo, en 710 enfermeras de nueve hospitales de alta complejidad de Cataluña (España). Resultados: En ambas unidades, la proporción de profesionales afectados en alto grado de burnout fue superior al 20%, al 30% en estrés traumático secundario y al 12% en ansiedad. Cada subescala se asoció con la intención de abandonar la unidad y la profesión. El 97% de participantes manifestaron que era necesario recibir formación en gestión emocional. Conclusiones: Las prevalencias de burnout y de estrés traumático secundario fueron superiores en nuestro estudio respecto a la literatura de referencia en las enfermeras de urgencias y en las de UCI. La prevalencia de cada constructo se relacionó individualmente con el deseo de abandono de las enfermeras de sus unidades y de su profesión. Este hecho, junto al deseo de recibir formación de los participantes, expone la necesidad de establecer planes formativos, así como medidas institucionales de prevención y apoyo para la fatiga por compasión.(AU)

Objectives: To determine the emotional impact of permanent proximity to trauma and death in the Emergency and ICU's nurses establishing prevalence of Compassionate Fatigue (burnout and secondary traumatic stress) and anxiety. Analyze its relationship with sociodemographic, training, workplace and psychological variables. Methods: Descriptive, cross-sectional and multicentre study. The validated ProQOL v.IV and STAI scales and an ad-hoc questionnaire with the variables of the second objective were used in 710 nurses from nine highly complex hospitals in Catalonia (Spain). Results: In both units, the prevalence of professionals affected with high scores of burnout was higher than 20%, on secondary traumatic stress was 30%, and 12% on anxiety. Each subscale was significantly associated with the intention to leave units and the career. 97% of participants stated that they needed to be trained in emotional management. Conclusion: The prevalence of burnout and secondary traumatic stress were higher in our study than those offered in the reference literature in emergency and ICU nurses. The prevalence of each construct was individually related to the desire to leave work units and career. This fact, together with the participants’ desire to be better trained in emotional management exposes the need to establish educational plans, as well as institutional measures to prevent and support nurses for Compassion Fatigue.(AU)

Aportación de la tomografia por emisión de fotón Simple/tomografía computadorizada a la biopsia selectiva del ganglio centinela en pacientes diagnosticados de melanoma de cabeza y cuello / Role of SPECT-CT in sentinel lymph node biopsy in patients diagnosed with head and neck melanoma

Objetivo. Valorar la aportación de la SPECT-TC a la biopsia selectiva del ganglio centinela (GC) en la correcta localización anatómica de este, en pacientes diagnosticados de melanoma cutáneo de cabeza y cuello. Material y métodos. Estudio retrospectivo entre febrero de 2010 y junio de 2013 que incluyó 22 pacientes consecutivos diagnosticados de melanoma cutáneo de cabeza y cuello (9 mujeres y 13 hombres), con una edad media de 55 años y criterios de inclusión de biopsia selectiva del GC. A todos ellos se les realizó una linfogammagrafía preoperatoria tras la inyección pericicatricial de nanocoloides de albúmina marcados con 99mTc, y posteriormente se obtuvieron imágenes planares sectoriales del lugar de inyección y de cuerpo completo, así como SPECT-TC. Resultados. La tasa de detección del GC fue del 91% (20 de 22 pacientes) para la linfogammagrafía planar y del 95,4% (21 de 22 pacientes) para SPECT-TC. En 14 de 22 pacientes la SPECT-TC mostró información relevante sobre la localización del GC modificando la vía de abordaje quirúrgica, siendo el impacto clínico de un 63,6%. En un 9,1% de los pacientes el GC fue positivo para metástasis de melanoma. Conclusión. La SPECT-TC proporciona información anatómica relevante sobre la localización del GC y detecta un mayor número de ganglios linfáticos que la linfogammagrafía. Se recomienda el uso rutinario de SPECT-TC en la linfogammagrafía del melanoma de cabeza y cuello para optimizar la localización y el número de GC en esta área (AU)

Objective. Assess the role of SPECT-CT in sentinel lymph node (SLN) biopsy in the accurate anatomical location of the SNL in patients with cutaneous head and neck melanoma. Material and methods. A retrospective study was conducted from February 2010 to June 2013 on 22 consecutive patients with a diagnosis of cutaneous head and neck melanoma (9 female, 13 male), with a mean age of 55 years old and who met the inclusion criteria for SLN biopsy. Patients underwent preoperative scanning after peri-scar injection of 99mTc-labeled-nanocolloid. Planar images of the injection-site, whole-body, and SPECT-CT scanning were acquired. Results. Detection rate of SLN reached up to 91% (20/22 patients) by planar lymphoscintigraphy and 95.4% (21/22 patients) by SPECT-CT. SPECT-CT provided an accurate location of SLN in 14/22 patients, enabling to improve the surgical approach (clinical impact: 63.6%). SLN was positive for metastatic cells in 9.1% patients. Conclusion. SPECT-CT provides detailed anatomical SLN location and allows detecting a higher number of SLN than planar lymphoscintigraphy. Routine use of SPECT-CT is recommended in order to optimise the SLN detection and location in patients with head and neck melanoma (AU)

Role of SPECT-CT in sentinel lymph node biopsy in patients diagnosed with head and neck melanoma.

OBJECTIVE: Assess the role of SPECT-CT in sentinel lymph node (SLN) biopsy in the accurate anatomical location of the SNL in patients with cutaneous head and neck melanoma. MATERIAL AND METHODS: A retrospective study was conducted from February 2010 to June 2013 on 22 consecutive patients with a diagnosis of cutaneous head and neck melanoma (9 female, 13 male), with a mean age of 55 years old and who met the inclusion criteria for SLN biopsy. Patients underwent preoperative scanning after peri-scar injection of (99m)Tc-labeled-nanocolloid. Planar images of the injection-site, whole-body, and SPECT-CT scanning were acquired. RESULTS: Detection rate of SLN reached up to 91% (20/22 patients) by planar lymphoscintigraphy and 95.4% (21/22 patients) by SPECT-CT. SPECT-CT provided an accurate location of SLN in 14/22 patients, enabling to improve the surgical approach (clinical impact: 63.6%). SLN was positive for metastatic cells in 9.1% patients. CONCLUSION: SPECT-CT provides detailed anatomical SLN location and allows detecting a higher number of SLN than planar lymphoscintigraphy. Routine use of SPECT-CT is recommended in order to optimise the SLN detection and location in patients with head and neck melanoma.

Biopsia selectiva de ganglio centinela de melanoma en niños. Serie de casos / Sentinel lymph node biopsy in paediatric melanoma. A case series

La incidencia del melanoma en la edad pediátrica es baja, siendo particularmente raro en menores de 10 años. No obstante, se ha constatado un aumento de la misma con un incremento promedio del 2% por año. Al igual que en los adultos, la afectación ganglionar es el factor pronóstico más relevante, por ello es fundamental la realización de la biopsia selectiva del ganglio centinela (BSGC). Presentamos 3 casos de pacientes en edad pediátrica de 3, 4 y 8 años, en los que se realizó BSGC, por melanoma maligno. La edad pediátrica confiere una mayor dificultad técnica al estudio linfogammagráfico por la escasa colaboración del paciente, precisando en algunos casos sedación superficial para su realización y pudiéndose adquirir únicamente en la mayoría de los casos imágenes sectoriales. Solamente en la paciente de mayor edad pudo practicarse SPECT/TC complementario. En nuestros casos la BSGC fue eficaz para poder seleccionar el tratamiento quirúrgico menos invasivo reduciendo así la morbilidad (AU)

The incidence of melanoma in children is uncommon, being particularly rare in children under 10 years-old. However, this disease is increasing by a mean of 2% per year. As in adults, the lymph node status is the most important prognostic factor, crucial to performing the selective sentinel lymph node biopsy (SLNB). We report 3 cases of paediatric patients of 3, 4 and 8 years-old, in which SLNB was performed for malignant melanoma. Paediatric age implies greater technical difficulty to the scintigraphy scan due to poor patient cooperation, with mild sedation required in some cases, and only being able to acquire planar images in other cases. SPECT/CT was only performed in the oldest patient. In our cases, SLNB was useful for selecting the least invasive surgery in order to reduce morbidity (AU)

Sentinel lymph node biopsy in paediatric melanoma. A case series.

The incidence of melanoma in children is uncommon, being particularly rare in children under 10 years-old. However, this disease is increasing by a mean of 2% per year. As in adults, the lymph node status is the most important prognostic factor, crucial to performing the selective sentinel lymph node biopsy (SLNB). We report 3 cases of paediatric patients of 3, 4 and 8 years-old, in which SLNB was performed for malignant melanoma. Paediatric age implies greater technical difficulty to the scintigraphy scan due to poor patient cooperation, with mild sedation required in some cases, and only being able to acquire planar images in other cases. SPECT/CT was only performed in the oldest patient. In our cases, SLNB was useful for selecting the least invasive surgery in order to reduce morbidity.

Utilidad de la tomografía de emisión de fotón único-tomografía computarizada en la biopsia selectiva del ganglio centinela en pacientes con melanoma / Utility of single photon emission computed tomography-computed tomography in selective sentinel lymph node biopsy in patients with melanoma

Objetivo: Evaluar la aportación de la linfogammagrafía con SPECT-TAC en la biopsia selectiva del ganglio centinela (BSGC) en pacientes con melanoma. Material y métodos: Estudio prospectivo (julio de 2009 a octubre de 2010) incluyendo 63 pacientes diagnosticados de melanoma (32 hombres y 31 mujeres), con edad media de 55 años y criterios de inclusión de BSGC. La localización de los melanomas fue: 28 en el tronco, 5 en la cabeza y el cuello, 16 en los miembros superiores y 17 en los miembros inferiores. Tres pacientes presentaban 2 melanomas. Se realizó linfogammagrafía preoperatoria tras la inyección pericicatricial/perilesional de 74 MBq de nanocoloide de albúmina humana marcada con99mTc, obteniéndose imágenes planares precoces, estudio tardío de cuerpo completo, imágenes sectoriales y SPECT-TAC de la zona de interés. Se compararon los hallazgos de la gammagrafía planar y la SPECT-TAC. Resultados: El ganglio centinela (GC) fue localizado mediante las imágenes planares en 62/63 (98%) pacientes. La SPECT-TAC localizó el GC en los 63 pacientes (100%). El número de GC detectados con SPECT-TAC fue superior al estudio planar en 27 pacientes. El estudio SPECT-TAC aportó información adicional (cambio de localización y/o precisión de la misma en GC de ubicación incierta) en 14/63 (22,2%) pacientes, implicando cambios en el abordaje quirúrgico y en la estadificación ganglionar. Conclusión: La SPECT-TAC detecta mayor número de GC que la gammagrafía planar, siendo más relevante su aportación en los melanomas de tronco y cabeza y en los de cuello. En un 22% modificó la localización del GC respecto a los hallazgos de la gammagrafía planar, facilitando un correcto abordaje quirúrgico (AU)

Objective: To assess the contribution of SPECT-CT lymphoscintigraphy in selective sentinel lymph node biopsy (SLNB) in patients with newly diagnosed malignant melanoma. Material and methods: A prospective study was made between July 2009 and October 2010. It included 63 patients diagnosed with melanoma (32 men and 31 women) with mean age of 55 years (range: 25–88) and inclusion criteria for SLNB. The melanomas were located as follows: 28 in trunk, 5 in head and neck, 16 in upper limbs and 17 in lower limbs. Three patients had two melanomas. Preoperative lymphoscintigraphy was performed after pericicatricial/perilesional injection of 74 MBq of 99mTc-labeled nanocolloid human serum albumin, obtaining early planar images, late whole body study and sectorial images and SPEC-CT in the area of interest. Planar scintigraphy findings were compared with SPECT-CT. Results: The sentinel node (SN) was localized by planar imaging in 62/63 (98%) patients. SPECT-CT study located the SN in all the patients with a detection rate of 100%. The number of SNs detected with SPECT-CT was higher than that with the planar study in 27 patients. The SPECT-CT provided additional information (change in location and/or in its accuracy in the localization of location uncertain SN) in 14/63 (22.2%) patients, involving changes in the surgical approach and lymph node staging. Conclusion: SPECT-CT detects a higher number of SN than planar lymphoscintigraphy in patients with melanoma. Its contribution is more relevant in the melanomas located on the trunk, head and neck. SPECT-CT modified the SN location by 22% compared to planar scan findings, facilitating a correct surgical approach (AU)

[Utility of single photon emission computed tomography-computed tomography in selective sentinel lymph node biopsy in patients with melanoma]. / Utilidad de la tomografía de emisión de fotón único-tomografía computarizada en la biopsia selectiva del ganglio centinela en pacientes con melanoma.

OBJECTIVE: To assess the contribution of SPECT-CT lymphoscintigraphy in selective sentinel lymph node biopsy (SLNB) in patients with newly diagnosed malignant melanoma. MATERIAL AND METHODS: A prospective study was made between July 2009 and October 2010. It included 63 patients diagnosed with melanoma (32 men and 31 women) with mean age of 55 years (range: 25-88) and inclusion criteria for SLNB. The melanomas were located as follows: 28 in trunk, 5 in head and neck, 16 in upper limbs and 17 in lower limbs. Three patients had two melanomas. Preoperative lymphoscintigraphy was performed after pericicatricial/perilesional injection of 74MBq of (99m)Tc-labeled nanocolloid human serum albumin, obtaining early planar images, late whole body study and sectorial images and SPECT-CT in the area of interest. Planar scintigraphy findings were compared with SPECT-CT. RESULTS: The sentinel node (SN) was localized by planar imaging in 62/63 (98%) of patients. SPECT-CT study located the SN in all the patients with a detection rate of 100%. The number of SNs detected with SPECT-CT was higher than with the planar study in 27 patients. The SPECT-CT provided additional information (change in location and/or in its accuracy in the localization of location uncertain SN) in 14/63 (22.2%) patients, involving changes in the surgical approach and lymph node staging. CONCLUSION: SPECT-CT detects a higher number of SN than planar lymphoscintigraphy in patients with melanoma. Its contribution is more relevant in the melanomas located on the trunk, head and neck. SPECT-CT modified the SN location by 22% compared to planar scan findings, facilitating a correct surgical approach.

The impact of supportive nursing care on the needs of men with prostate cancer: a study across seven European countries.

BACKGROUND: Prostate cancer is for many men a chronic disease with a long life expectancy after treatment. The impact of prostate cancer therapy on men has been well defined, however, explanation of the consequences of cancer treatment has not been modelled against the wider variables of long-term health-care provision. The aim of this study was to explore the parameters of unmet supportive care needs in men with prostate cancer in relation to the experience of nursing care. METHODS: A survey was conducted among a volunteer sample of 1001 men with prostate cancer living in seven European countries. RESULTS: At the time of the survey, 81% of the men had some unmet supportive care needs including psychological, sexual and health system and information needs. Logistic regression indicated that lack of post-treatment nursing care significantly predicted unmet need. Critically, men's contact with nurses and/or receipt of advice and support from nurses, for several different aspects of nursing care significantly had an impact on men's outcomes. CONCLUSION: Unmet need is related not only to disease and treatment factors but is also associated with the supportive care men received. Imperative to improving men's treatment outcomes is to also consider the access to nursing and the components of supportive care provided, especially after therapy.

Chemotherapy-induced nausea and vomiting in clinical practice: impact on patients' quality of life.

BACKGROUND: Chemotherapy-induced nausea and vomiting (CINV) in cancer patients are common symptoms most feared by patients. The aim of this study was to analyze the impact of CINV associated to moderate/highly emetogenous chemotherapy regimens on patients' quality of life (QoL). PATIENTS AND METHODS: Open, multicenter, prospective observational study was performed. Each patient filled out a patient diary for each cycle from the day before chemotherapy and for the next 5 days that included the number of emetic episodes, the intensity of nausea, and QoL evaluation (functional living index-emesis questionnaire). RESULTS: Data from 202 consecutive patients from nine university hospitals were collected, but only data from 160 were analyzed (79.2 %). Most of the participants (70 %) were women with a mean age of 50 years (SD 1.2 years). The most frequent cancer site was breast (44 %) followed by lung (16 %) and 76.3 % were receiving highly emetogenous chemotherapy. Despite the use of antiemetic prophylaxis, patients experienced significant nausea and vomiting during 31 % (3.2 % during acute, 15.0 % during delayed phase, and 13.2 % during both phases) and 45.1 % (5.1 % only during the acute phase, 23.5 % only during the delayed phase and 16.5 % during both phases) of the cycles, respectively, having 44.5 % (nausea) and 39.3 % (emesis) of the cycles an impact on patients' QoL. CONCLUSIONS: The results of the study confirm the detrimental effect of CINV on patients' QoL despite the use of antiemetic prophylaxis (5HT(3) receptor antagonist, steroids, and dopamine receptor antagonists). It is mandatory to intensify the detection of CINV in order to improve the management of these important, albeit frequent, side effects of cancer treatments.

Evidence-based management of chemotherapy-induced nausea and vomiting: a position statement from a European cancer nursing forum.

Chemotherapy-induced nausea and vomiting (CINV) is a common, but now often overlooked side effect of cancer treatment, and one that can be largely prevented through the implementation of international evidence-based guidelines. The European CINV Forum, comprising nurses from France, Germany, Portugal, Spain and the UK, discussed the use of CINV preventive strategies in routine practice, and the factors that affect optimal delivery of antiemetic therapies. Based on these discussions, they developed a series of recommendations for optimal, evidence-based management of CINV. These state that all patients receiving chemotherapy should undergo full assessment of their risk of CINV and receive appropriate prophylactic treatment based on guidelines from the Multinational Association of Supportive Care in Cancer (MASCC) and the National Comprehensive Cancer Network (NCCN), which were both updated in 2011. Other recommendations, aimed at raising awareness of CINV and its management, include timely updates of relevant local practice guidelines and protocols, translation of the MASCC and NCCN guidelines into all European languages and their dissemination through accessible articles in nursing journals and newsletters and via nursing conferences and study days, improved training for nurses on CINV, collaboration between the European Oncology Nursing Society and national nursing organisations to promote consistent practice, the development of a CINV toolkit, information provision for patients, local audits of CINV management, and a survey of CINV management between and within European countries.

[Necrobiotic xanthogranuloma: efficacy of surgery in 2 patients]. / Xantogranuloma necrobiótico: eficacia de la cirugía en dos casos clínicos.

Necrobiotic xanthogranuloma is a rare disease characterized by indurated nodules and yellowish-red plaques in the dermis or subdermal tissues particularly in the periorbital region; the lesions are often ulcerated. This disease is frequently associated with hematological disorders such as monoclonal gammopathy and lymphoproliferative disorders. Its pathogenesis is unknown and the small number of cases makes long-term studies difficult. We present 2 cases of periorbital lesions in which the biopsies established a diagnosis of necrobiotic xanthogranuloma. Both patients were treated with corticosteroids and cyclophosphamide, with no improvement. The lesions were excised and the periorbital regions were reconstructed with skin grafts. After 1 year of follow-up there are no signs of recurrence.

Xantogranuloma necrobiótico: eficacia de la cirugía en dos casos clínicos / Necrobiotic Xanthogranuloma: Efficacy of Surgery in 2 Patients

El xantogranuloma necrobiótico es una enfermedad poco frecuente que se caracteriza por la presencia de nódulos indurados y placas rojo-amarillentas en los tejidos dérmicos o subdérmicos, a menudo ulceradas ,que asientan preferentemente en la región periorbitaria. Suele asociarse con alteraciones hematológicas como gammapatía monoclonal y trastornos linfoproliferativos. Su patogenia es desconocida y el escaso número de casos existentes hace difícil la publicación de estudios a largo plazo. Presentamos dos casos de lesiones periorbitarias cuyas biopsias establecieron el diagnóstico de xantogranuloma necrobiótico. Los pacientes se sometieron a tratamiento con corticoides y ciclofosfamida sin mejoría. Las lesiones fueron tratadas quirúrgicamente mediante escisión y reconstrucción con injertos de piel. Tras un año de seguimiento no hay evidencias de recurrencia de la enfermedad (AU)

Necrobiotic xanthogranuloma is a rare disease characterized by indurated nodules and yellowish-red plaques in the dermis or subdermal tissues particularly in the periorbital region; the lesions are often ulcerated. This disease is frequently associated with hematological disorders such as monoclonal gammopathy and lymphoproliferative disorders. Its pathogenesis is unknown and the small number of cases makes long-term studies difficult. We present 2 cases of periorbital lesions in which the biopsies established a diagnosis of necrobiotic xanthogranuloma. Both patients were treated with corticosteroids and cyclophosphamide, with no improvement. The lesions were excised and the periorbital regions were reconstructed with skin grafts. After 1 year of follow-up there are no signs of recurrence (AU)

Complementary and alternative medicine use in patients with gynecological cancers in Europe.

The aim of the present study was to assess the use of complementary and alternative medicine (CAM) specifically in women with gynecological cancer. The design of the study was of a descriptive cross-sectional survey using a 27-item questionnaire. The study was conducted in 11 countries in Europe as part of a larger project. Data were available from 72 gynecological cancer patients. Among the participants, 40.3% used CAM after the diagnosis with cancer. The most popular CAM modalities used were herbal medicine (34.5%), relaxation techniques (21.4%), and vitamins/minerals (20.7%). A very high level of satisfaction with CAM use was reported. Patients used CAM to increase the body's ability to fight the cancer or to improve physical and emotional well-being. The main sources of information about CAM were informal (friends/family or the media). It is important to discuss CAM use with gynecological cancer patients, as they frequently use it and such use may have implications for clinical practice.

Complementary and alternative medicine use in patients with head and neck cancers in Europe.

The aim of the present study was to examine the patterns of complementary and alternative medicine (CAM) use in a sample of head and neck cancer patients, forming part of a larger study. A cross-sectional survey design was used collecting data through a descriptive 27-item questionnaire in nine countries in Europe. The participants were 75 patients with head and neck cancers. The prevalence rate of CAM use was 22.7%. The most common therapies used were herbal medicine (47%), medicinal teas (23.5%), use of vitamins/minerals (11.8%) and visualization (11.8%). Use of CAM dramatically increased after the diagnosis with cancer (i.e. eightfold increase in the use of herbs). A profile of CAM users was not evident in this sample. Patients used CAM for a variety of reasons together, with counteracting the ill effects from cancer and its treatment being the most common one. Information about CAM was obtained mostly from friends and family. As one in five head and neck cancer patients use CAM it is important that clinicians explore practices with their patients, improve communication about CAM with them and assist those who want to use CAM in using appropriate and safe therapies.

Use of complementary and alternative medicine in cancer patients: a European survey.

BACKGROUND: The aim of this study was to explore the use of complementary and alternative medicine (CAM) in cancer patients across a number of European countries. METHODS: A descriptive survey design was developed. Fourteen countries participated in the study and data was collected through a descriptive questionnaire from 956 patients. RESULTS: Data suggest that CAM is popular among cancer patients with 35.9% using some form of CAM (range among countries 14.8% to 73.1%). A heterogeneous group of 58 therapies were identified as being used. Herbal medicines and remedies were the most commonly used CAM therapies, together with homeopathy, vitamins/minerals, medicinal teas, spiritual therapies and relaxation techniques. Herbal medicine use tripled from use before diagnosis to use since diagnosis with cancer. Multivariate analysis suggested that the profile of the CAM user was that of younger people, female and with higher educational level. The source of information was mainly from friends/family and the media, while physicians and nurses played a small part in providing CAM-related information. The majority used CAM to increase the body's ability to fight cancer or improve physical and emotional well-being, and many seemed to have benefited from using CAM (even though the benefits were not necessarily related to the initial reason for using CAM). Some 4.4% of patients, however, reported side-effects, mostly transient. CONCLUSIONS: It is imperative that health professionals explore the use of CAM with their cancer patients, educate them about potentially beneficial therapies in light of the limited available evidence of effectiveness, and work towards an integrated model of health-care provision.

Mastitis por inyección de silicona en un transsexual. Caso Clínico / Mantitis after silicone inyection in a transexual. Clinical note

El amplio uso de que ha sido objeto la silicona en los últimos años, ha originado un importante avance en la Cirugía Plástica y Estética. Sin embargo su uso indiscriminado o abusivo también ha ocasionado numerosos efectos indeseables sobre todo cuando ha sido aplicada por personal paramédico sin cualificar. Presentamos un caso de mastitis bilateral en un transexual tras someterse, varios años antes, a la inyección de una cantidad indeterminada de silicona líquida en las mamas con el objeto de conseguir aumento mamario. Como circunstancia acompañante destacamos la presencia de fenómeno migratorio de la silicona a distancia del Jugar de la inyección. Por último se realiza una revisión de la literatura al respecto elaborando una discusión de la fisiopatología, clínica y tratamiento del siliconoma (AU)

The widespread use of silicone in the last years has given rise to an important advance in Plastic and Aesthetic Surgery. However, numerous u.ndesirable effects have been caused by its indiscriminate or improper use, particularly, when performed by non­medica! personnel or unqualified physicians. The pre­ sent case consists on a bilateral mastitis in a male­to­female transexual, who was injected liquid silicone in his breasts, several years before, with the aim of breast augmentation. We emphasize the migratory phenornenon of free silicone far from the site of punction. At last, we review the relative literature and discuss about the physiopathology, clinical symptoms, and therapy of the siliconoma (AU)

Lesiones por Picadura de Araña. Presentación de dos Casos y Revisión del Manejo Terapéutico / Spider Bit lesions. Report of two Cases and Treatment Review

Las picaduras de araña sin trascendencia clínica son frecuentes, manifestándose en forma de eritema, edema local y dolor. Generah11ente los pacientes no identifican a la araña en el momento de la lesión. El término loxoscelismo hace referencia a las lesiones locales dedermonecrosis y las manifestaciones generales (hemólisis, fallo renal agudo, coagulación .intravascular diseminada) producidas por la picadura de un tipo de araña doméstica, la Loxosceles reclusa. Se presentan dos casos clínicos de pacientes que sufrieron una picadura de araña común, desarrollando posteriormente necrosis cutánea de rápida evolución que requirió tratamiento quirúrgico. Analizamos la fisiopatología y los mecanismos implicados en este tipo de lesiones y efectuamos una revisión y puesta al día del manejo terapéutico de las mismas (AU)

Most spider bites involving humans cause minimal medica! problems and result in erythema, local edema and pain. Patients infrcquently present with a positive identification after potential envenomation. Loxoscelism is used to describe dermonecrosis lesions and general reactions (haemolysis, acure renal failure, disseminated intravascular coagulation) induced by domestic spiders bite (Loxosceles reclusa). Two cases of spiders bite that develop a fast dermonecrosis and need surgical treatment are reported. We analized the fisiopathology and mecanism of these kind of Iession and present a treatment review (AU)