Diagnosis and treatment of primary thyroid lymphoma from a surgical perspective: a multi-institutional study.

PURPOSE: Surgery of primary thyroid lymphoma (PTL) has been mostly limited to diagnostic work-up. This study aimed to further study its potential role. METHODS: This was a retrospective study from a multi-institutional registry of PTL patients. Clinical, diagnostic work-up (fine needle aspiration, FNA; core needle biopsy, CoreNB), contribution of surgery (open surgical biopsy, OpenSB; thyroidectomy), histology subtype, and outcome data were evaluated. RESULTS: Some 54 patients were studied. Diagnostic work-up included FNA in 47 patients, CoreNB in 11, and OpenSB in 21. CoreNB yielded the best sensitivity (90.9%). Thyroidectomy was performed in 14 patients with other diagnosis (incidental PTL), in 4 for diagnosis and in 4 for elective treatment of PTL. Incidental PTL was associated with not performed FNA nor CoreNB (OR 52.5; P = 0.008), mucosa-associated lymphoid tissue (MALT) subtype (OR 24.3; P = 0.012), and Hashimoto's thyroiditis (OR 11.1; P = 0.032). Lymphoma-related death (10 cases) mostly occurred within the first year after diagnosis and was associated with diffuse large B-cell (DLBC) subtype (OR 10.3; P = 0.018) and older patients (OR 1.08 for every 1-year increase; P = 0.010). There was a trend towards lower mortality rate in patients receiving thyroidectomy (2/22 versus 8/32, P = 0.172). CONCLUSION: Incidental PTL accounts for most of thyroid surgery cases and are associated with incomplete diagnostic work-up, Hashimoto's thyroiditis and MALT subtype. CoreNB appears to be the best tool for diagnosis. Most of PTL deaths occurred during the first year after diagnosis and mostly related to systemic treatment. Age and DLBC subtype are poor prognostic factors.

[Impact of the Covid-19 pandemic on specialized healthcare training in a teaching center]. / Impacto de la pandemia COVID-19 en la formación sanitaria especializada en un centro docente.

OBJECTIVE: Evaluation of the impact of the health crisis caused by the Covid-19 pandemic on specialized healthcare training in a teaching center. METHODS: Cross-sectional descriptive study, by means of an electronic questionnaire sent to 167 residents in June 2020, to evaluate the burden of care, suspension of rotations and Covid-19 symptoms. The impact on the acquisition of professional competencies was measured using a four-level Likert scale (none, a little, quiet, a lot). The profile of acquired competencies was constructed and its association with the professional profile was studied using Generalized Linear Models. The qualitative approach was carried out through an open question on how it influenced their learning and the different categories were extracted through triangulation. RESULTS: The impact on learning was important for 94.8% of the residents. A total of 81.4% left the rotations they were doing and reported high workload, loss of training opportunities, uncertainty and ethical conflicts. They appreciated significant learning in the competencies of teamwork (93.2%), professionalism (86.2%), ethics (79.9%) and communication (78%). Technical competencies were deficient. The final balance of learning was perceived as positive by 54.4%, especially residents in central services and medical specialties. A total of 67.8% felt overwhelmed at times due to fatigue-emotional impact, care overload, ethical conflicts and lack of resources. CONCLUSIONS: The Covid-19 pandemic had an exceptional impact on specialized health care training. It is necessary to re-evaluate training programs to ensure the acquisition of the technical competencies that are lacking.

Analysing body composition as compositional data: An exploration of the relationship between body composition, body mass and bone strength.

Human body composition is made up of mutually exclusive and exhaustive parts (e.g. %truncal fat, %non-truncal fat and %fat-free mass) which are constrained to sum to the same total (100%). In statistical analyses, individual parts of body composition (e.g. %truncal fat or %fat-free mass) have traditionally been used as proxies for body composition, and have been linked with a range of health outcomes. But analysis of individual parts omits information about the other parts, which are intrinsically co-dependent because of the constant sum constraint of 100%. Further, body mass may be associated with health outcomes. We describe a statistical approach for body composition based on compositional data analysis. The body composition data are expressed as logratios to allow relative information about all the compositional parts to be explored simultaneously in relation to health outcomes. We describe a recent extension to the logratio approach to compositional data analysis which allows absolute information about the total of the compositional parts (body mass) to be considered alongside relative information about body composition. The statistical approach is illustrated by an example that explores the relationships between adults' body composition, body mass and bone strength.

The adiposity of children is associated with their lifestyle behaviours: a cluster analysis of school-aged children from 12 nations.

BACKGROUND: The relationship between children's adiposity and lifestyle behaviour patterns is an area of growing interest. OBJECTIVES: The objectives of this study are to identify clusters of children based on lifestyle behaviours and compare children's adiposity among clusters. METHODS: Cross-sectional data from the International Study of Childhood Obesity, Lifestyle and the Environment were used. PARTICIPANTS: the participants were children (9-11 years) from 12 nations (n = 5710). MEASURES: 24-h accelerometry and self-reported diet and screen time were clustering input variables. Objectively measured adiposity indicators were waist-to-height ratio, percent body fat and body mass index z-scores. ANALYSIS: sex-stratified analyses were performed on the global sample and repeated on a site-wise basis. Cluster analysis (using isometric log ratios for compositional data) was used to identify common lifestyle behaviour patterns. Site representation and adiposity were compared across clusters using linear models. RESULTS: Four clusters emerged: (1) Junk Food Screenies, (2) Actives, (3) Sitters and (4) All-Rounders. Countries were represented differently among clusters. Chinese children were over-represented in Sitters and Colombian children in Actives. Adiposity varied across clusters, being highest in Sitters and lowest in Actives. CONCLUSIONS: Children from different sites clustered into groups of similar lifestyle behaviours. Cluster membership was linked with differing adiposity. Findings support the implementation of activity interventions in all countries, targeting both physical activity and sedentary time.

Pioderma gangrenoso postlaparoscópico. Una complicación poco frecuente de la cirugía / Pyoderma gangrenosum after laparoscopic surgery an uncommon complication

Introducción. El pioderma gangrenoso (PG) es una dermatosis neutrofílica de etiología desconocida (asociada hasta en un 70% a enfermedades sistémicas) definida por una pústula dolorosa de curso rápidamente progresivo finalizando en la forma ulcerativa. El diagnóstico es de exclusión basado en las características clínicas y el curso rápidamente progresivo. El gold standard del tratamiento son los corticoides orales, no siendo recomendable la actitud quirúrgica. Material y Métodos. Se presenta el caso clínico de un postoperatorio de segmentectomía hepática laparoscópica. Tras una rápida evolución hacia una lesión ulcerativa e invasión en profundidad a pesar de tratamiento quirúrgico mediante desbridamiento se diagnostica por presencia de fenómeno de patergia de PG. Tras tratamiento corticoideo intensivo se produce gran mejoría clínica de la lesión. Resultados. Se ha documentado casos de PG con inicio postraumático o en pacientes con antecedentes autoinmunes, pero sólo existen seis artículos con antecedente laparoscópico. Se concluye que el manejo del PG debe excluir el desbridamiento quirúrgico basándose en el uso sistémico de corticoides, distanciándose así de infecciones tipo fascitis necrotizante. El diagnostico eminentemente clínico, teniendo a la biopsia anotomopatológica únicamente como apoyo histológico, es fundamental por su dificultad tras la cirugía en procesos con incisiones mínimas y por ser una entidad potencialmente mortal alcanzando cifras del 30% según series. Conclusión. El PG es un trastorno cutaneo de dificil diagnostico por su baja frecuencia y etiología desconocida. Ejerce un papel fundamental el uso de corticoides como tratamiento de la enfermedad y criterio diagnóstico a su respuesta)

Introduction. Pyoderma gangrenosum (PG) is a neutrophilic dermatosis of unknown etiology (associated up to 70% to systemic diseases) defined by a painful pustule of rapidly progressive course ending in the ulcerative form. The diagnosis is based on the clinical characteristics and the rapidly progressive course. The gold standard of treatment are oral corticosteroids, not being recommended any surgery. Material and Methods. We presents the clinical case of a postoperative laparoscopic hepatic segmentectomy. After a fast evolution towards an ulcerative lesion and invasion in depth despite surgical treatment, it is diagnosed by the presence of patergia phenomenon. After intensive corticoid treatment, great clinical improvement of the lesion occurs. Results. There have been documented cases of PG with post-traumatic onset or in patients with autoimmune history, but there are only six articles with a laparoscopic background. The management of PG should exclude surgery based on the systemic use of corticosteroids, distancing itself from necrotizing fasciitis type infections. The eminently clinical diagnosis, taking the anotomopathological biopsy only as support, is basic for its difficulty after surgery in processes with minimal incisions and for being a potentially fatal entity reaching rates of 30% according to series. Conclusion. PG is a skin disorder difficult to diagnose due to its low frequency and unknown etiology. The use of corticosteroids plays a fundamental role as a treatment for the disease and a diagnostic criterion for its response

[Progressive encephalitis due to anti-DPPX antibodies: a case with good response to treatment with rituximab]. / Encefalitis progresiva por anticuerpos anti-DPPX: un caso con buena respuesta al tratamiento con rituximab.

TITLE: Encefalitis progresiva por anticuerpos anti-DPPX: un caso con buena respuesta al tratamiento con rituximab.

Recycling of plastic waste: Presence of phthalates in plastics from households and industry.

Plastics recycling has the potential to substitute virgin plastics partially as a source of raw materials in plastic product manufacturing. Plastic as a material may contain a variety of chemicals, some potentially hazardous. Phthalates, for instance, are a group of chemicals produced in large volumes and are commonly used as plasticisers in plastics manufacturing. Potential impacts on human health require restricted use in selected applications and a need for the closer monitoring of potential sources of human exposure. Although the presence of phthalates in a variety of plastics has been recognised, the influence of plastic recycling on phthalate content has been hypothesised but not well documented. In the present work we analysed selected phthalates (DMP, DEP, DPP, DiBP, DBP, BBzP, DEHP, DCHP and DnOP) in samples of waste plastics as well as recycled and virgin plastics. DBP, DiBP and DEHP had the highest frequency of detection in the samples analysed, with 360µg/g, 460µg/g and 2700µg/g as the maximum measured concentrations, respectively. Among other, statistical analysis of the analytical results suggested that phthalates were potentially added in the later stages of plastic product manufacturing (labelling, gluing, etc.) and were not removed following recycling of household waste plastics. Furthermore, DEHP was identified as a potential indicator for phthalate contamination of plastics. Close monitoring of plastics intended for phthalates-sensitive applications is recommended if recycled plastics are to be used as raw material in production.

[Prevalence of multiple sclerosis in the Region of Murcia]. / Prevalencia de la esclerosis multiple en la Region de Murcia.

INTRODUCTION: Multiple sclerosis (MS) is a demyelinating inflammatory disease of the central nervous system with immune-mediated pathogenesis. Recent research points to an increase in its prevalence, and a number of studies relate Epstein-Barr virus (EBV) with its aetiology. AIMS: This study seeks to analyse the prevalence of MS in the Region of Murcia, and includes a description of the clinical characteristics at the time of onset of the disease, and of the EBV serological status of patients with MS. PATIENTS AND METHODS: We conducted a retrospective epidemiological study based on a sample consisting of the population living within the central-west healthcare area of the Region of Murcia (257,865 inhabitants). Clinical and serological data extracted from different sources were analysed. RESULTS: Prevalence of MS in the population under study: 88 cases/100,000 inhabitants. Prevalence of MS together with isolated demyelinating syndrome: 98.4 cases/100,000 inhabitants. Mean incidence of MS: 5.8 cases/100,000 inhabitants/year. At the onset of MS, 67.8% were females, 81.9% presented a relapsing-remitting course, the mean age was 31.4 years, the sensory system was the most frequently compromised (45.1%), onset was monofocal in 55.4% and the degree of disability on the Expanded Disability Status Scale was 2.1 points. The seroprevalence of EBV was 99.3%. The reactivation of EBV infection was related to the clinical activity of MS in 10 patients (45.4%). CONCLUSIONS: Currently, the prevalence of MS in the Region of Murcia is similar to that estimated in other Spanish autonomous regions. The study confirms the trend of increased prevalence observed over the last few decades.

TITLE: Prevalencia de la esclerosis multiple en la Region de Murcia.Introduccion. La esclerosis multiple (EM) es una enfermedad inflamatoria desmielinizante del sistema nervioso central con patogenia inmunomediada. Recientes estudios indican un aumento de su prevalencia, y numerosos trabajos relacionan el virus de Epstein-Barr (VEB) con su etiologia. Objetivo. Analisis de prevalencia de la EM en la Region de Murcia, incluyendo la descripcion de las caracteristicas clinicas en el momento del inicio de la enfermedad, y del estado serologico del VEB de los pacientes con EM. Pacientes y metodos. Estudio epidemiologico retrospectivo, tomando como muestra la poblacion residente en el area sanitaria centro-oeste de la Region de Murcia (257.865 habitantes). Se analizan datos clinicos y serologicos extraidos de diferentes fuentes. Resultados. Prevalencia de la EM en la poblacion estudiada: 88 casos/100.000 habitantes. Prevalencia de la EM junto con el sindrome desmielinizante aislado: 98,4 casos/100.000 habitantes. Incidencia media de la EM: 5,8 casos/100.000 habitantes/año. En el inicio de la EM, el 67,8% eran mujeres, el 81,9% presentaba un curso recurrente-remitente, la edad media era de 31,4 años, el sistema funcional mas frecuentemente afectado era el sensitivo (45,1%), el inicio fue monofocal en el 55,4% y el grado de discapacidad en la Expanded Disability Status Scale era de 2,1 puntos. La seroprevalencia del VEB fue del 99,3%. La reactivacion de la infeccion por VEB se relaciono con actividad clinica de EM en 10 pacientes (45,4%). Conclusiones. Actualmente, la prevalencia de la EM en la Region de Murcia es similar a la estimada en otras comunidades autonomas españolas. El estudio confirma la tendencia de incremento de prevalencia observada en las ultimas decadas.

Satisfacción con la enfermera en atención primaria: herramientas de medida y factores explicativos / Satisfaction with primary care nursing: Use of measurement tools and explanatory factors

Objetivos: Analizar las propiedades psicométricas de 2 herramientas de medida de la satisfacción con la atención recibida de la enfermera en atención primaria y estimar los valores de esta satisfacción y las características del paciente y el servicio asociadas con su variabilidad. Métodos: Los sujetos fueron elegidos aleatoriamente en 23 centros de salud de la Comunidad de Madrid. Se midió la satisfacción con los cuestionarios AMABLE y de Baker, cuyas propiedades psicométricas fueron evaluadas. Se recogieron variables sociodemográficas y otras relativas al estado de salud, o al proceso de atención. Se construyó un modelo explicativo mediante Generalized Estimating Equations. Resultados: Los 662 sujetos expresaron una satisfacción media de 4,95/5 (DE 0,25) con AMABLE y 4,83/5 (DE 0,42) con el cuestionario Baker. AMABLE se explicaba en una única dimensión (alfa Cronbach 0,85), y Baker en 3: cuidados profesionales (media 4,76 [DE 0,48], alfa Cronbach 0,74), profundidad de la relación (media 3,76 [DE 1,18], alfa Cronbach 0,73) y tiempo dedicado (media 4,42 [DE 0,86], alfa Cronbach 0,47). La edad, una mejor percepción del estado de salud y la consulta concertada por la enfermera se asociaban con una mayor satisfacción expresada. La atención en el domicilio, los ingresos hospitalarios, el retraso en la consulta, la familia más extensa o la renta familiar elevada se asociaban con una menor satisfacción. Conclusiones: La satisfacción con la consulta de la enfermera en atención primaria era muy alta y se asociaba con características personales y de la propia consulta. Las herramientas evaluadas eran adecuadas para medir este resultado (AU)

Objectives: This study aims to assess the psychometric properties of two measurement tools for patient satisfaction with nursing care in Primary Care, the satisfaction level, and the personal and consultation characteristics associated with its variability. Methods: Subjects randomly selected in 23 Health Care centres in the Community of Madrid were included. Satisfaction was measured by means of the AMABLE and Baker questionnaires, in which the psychometric properties were evaluated. Sociodemographic characteristics of the consultations, variables related to health status, and other related to the consultation process were collected. An explanatory model using Generalized Estimating Equations was constructed. Results: The 662 subjects expressed a mean satisfaction of 4.95/5 (SD .25) with AMABLE, and 4.83/5 (SD .42) with the Baker questionnaire. AMABLE had a single dimension (Cronbach's alpha .85), and Baker three: professional care (mean 4.76, SD .48 Cronbach's alpha .74), depth of relationship (mean 3.76, SD 1.18, Cronbach's alpha .73), and perceived time (mean 4.42, SD .86, Cronbach's alpha .47). Ageing, a better perception of health status, and appointments arranged by nurses were associated with higher expressed satisfaction. Home care, hospital admissions, delayed consultation, extended family, or high family income were associated with lower satisfaction. Conclusions: Satisfaction with nurse consultations in Primary Care was very high, and varied depending on personal characteristics and on the type of consultation. The assessed tools allowed this outcome to be measured properly (AU)

[Satisfaction with primary care nursing: use of measurement tools and explanatory factors]. / Satisfacción con la enfermera en atención primaria: herramientas de medida y factores explicativos.

OBJECTIVES: This study aims to assess the psychometric properties of two measurement tools for patient satisfaction with nursing care in Primary Care, the satisfaction level, and the personal and consultation characteristics associated with its variability. METHODS: Subjects randomly selected in 23 Health Care centres in the Community of Madrid were included. Satisfaction was measured by means of the AMABLE and Baker questionnaires, in which the psychometric properties were evaluated. Sociodemographic characteristics of the consultations, variables related to health status, and other related to the consultation process were collected. An explanatory model using Generalized Estimating Equations was constructed. RESULTS: The 662 subjects expressed a mean satisfaction of 4.95/5 (SD .25) with AMABLE, and 4.83/5 (SD .42) with the Baker questionnaire. AMABLE had a single dimension (Cronbach's alpha .85), and Baker three: professional care (mean 4.76, SD .48 Cronbach's alpha .74), depth of relationship (mean 3.76, SD 1.18, Cronbach's alpha .73), and perceived time (mean 4.42, SD .86, Cronbach's alpha .47). Ageing, a better perception of health status, and appointments arranged by nurses were associated with higher expressed satisfaction. Home care, hospital admissions, delayed consultation, extended family, or high family income were associated with lower satisfaction. CONCLUSIONS: Satisfaction with nurse consultations in Primary Care was very high, and varied depending on personal characteristics and on the type of consultation. The assessed tools allowed this outcome to be measured properly.

Values below detection limit in compositional chemical data.

Samples representing part of a whole, usually called compositional data in statistics, are commonplace in analytical chemistry--say chemical data in percentage, ppm, or µg g(-1). Their distinctive feature is that there is an inherent relationship between all the analytes constituting a chemical sample as they only convey relative information. Some compositional data analysis principles and the log-ratio based methodology are outlined here in practical terms. Besides, one often finds that some analytes are not present in sufficient concentration in a sample to allow the measuring instruments to effectively detect them. These non-detects are usually labelled as "

Pancreaticoduodenectomy for metastasis of uterine leiomyosarcoma to the pancreas

Metastasis of uterine leiomyosarcoma to the pancreas is rare. A 46-year-old woman was diagnosed with uterine leiomyosarcoma and underwent surgery. Thereafter, recurrences in the lung and subsequently in the pancreas were diagnosed. These lesions were resected and diagnosed as metastasis of uterine leiomyosarcoma. We report a rare case of uterine leiomyosarcoma with metastasis to the lung and pancreas, both of which were resected using aggressive surgery (AU)

Adrenalectomía y cirugía mayor ambulatoria. ¿Es posible? / No disponible

Objetivo: El propósito de nuestro estudio fue determinar la factibilidad y seguridad de un programa de adrenalectomía laparoscópica (AL) en régimen ambulatorio (CMA) en el Hospital General de Ciudad Real (HGCR).Material y método: Realizamos una revisión retrospectiva de las adrenalectomías realizadas en el HGCR desde enero de 2006a junio de 2008. La morbilidad y las características de las mas asadrenales extirpadas fueron evaluadas, al igual que la estancia hospitalaria y las complicaciones postoperatorias para ver si podrían haber sido incluidos en un programa de CMA según estrictoscriterios de selección. Resultados: Se realizaron 16 adrenalectomías durante esteperiodo; 12 por vía laparoscópica. Aplicando los criterios de Gill para cirugía ambulatoria, el grupo de candidatos consistiría en 6 pacientes que presentaban las siguientes características: la edad media fue de 51,67 años (44-65), 3 eran funcionantes y 3 incidentalomas. El ratio izquierdas/derechas fue 2:1. El tamaño tumoral medio fue de 3,75 cm (1-5 cm). En todos los casos se practicó AL transperitoneal lateral con tiempo operatorio medio de 83 minutos(30-150 minutos). No se registraron complicaciones postoperatorias. La estancia media fue de 2,83 días (2-3 días), con requerimientos de analgesia oral habitual durante 1-3 días. Conclusión: Nuestros resultados muestran que aplicando estrictos criterios de selección, es seguro y factible iniciar un programa ambulatorio de adrenalectomías por cirujanos expertos en técnicas laparoscópicas avanzadas, con alta satisfacción y nula morbilidad. Aún se necesitan estudios controlados que propicien criterios adecuados para unos resultados óptimos (AU)

Objective: The purpose of our study was to determine the feasibility and safety of a program for laparoscopic adrenalectomy(LA), on an ambulatory basis, at the General Hospital of Ciudad Real (HGCR).Material and method: A retrospective study was undertaken from January 2006 to June 2008. Co-morbidity and characteristics of the adrenal masses to be excised were assessed, as well as hospital length of stay and postoperative complications, to see whether they could have been included in an outpatient program according to strict selection criteria. Results: During the study period 16 adrenalectomies were performed at our institution; 12 of them by laparoscopy. Applying Gill’s criteria for outpatient surgery, the group of candidates consisted of 6 patients who met the following characteristics: mean age was 51.67 years (44-65), 3 tumours were functioning and the other 3 incidental findings. The ratio left/right was 2:1.The mean tumour size was 3.75 cm (1-5 cm). All cases underwent a lateral transperitoneal LA approach, the mean operative time was 83 minutes (30-150). No postoperative complications occurred.The average length of stay was 2.83 days (2-3), with regularoral analgesia requirements for 1-3 days.Conclusion: Our results show that, by applying strict selectioncriteria, it would be safe and feasible to under go an ambulatory program of adrenalectomy by experienced surgeons in advanced laparoscopic techniques, achieving high patients’ satisfaction and no morbidity. Controlled studies are still required to provide appropriate criteria for optimal results (AU)

Investigación en la Unidad de Cirugía Mayor Ambulatoria / No disponible

Fundamento: El concepto de la Cirugía Mayor Ambulatoria(CMA) presenta fundamentalmente un enfoque terapéutico, existiendo la posibilidad en el contexto de este modelo asistencial de efectuar procesos de investigación. El objetivo que se pretende es analizar la utilización de la unidad de CMA como modelo referencial para la realización de estudios clínicos, por lo que se presenta una revisión descriptiva de las comunicaciones más recientes a los congresos de Cirugía Mayor Ambulatoria. Métodos: Estudio descriptivo de las comunicaciones a las Reuniones Nacionales e Internacionales durante los años 2007 y2008, contabilizándose las comunicaciones orales y de tipo póster que describían un estudio prospectivo o retrospectivo. Resultados: Se revisaron las comunicaciones pertenecientes al 7th International Congress of Ambulatory Surgery (IAAS), VII Congreso Nacional de Cirugía Mayor Ambulatoria y VII Simposio de la Asociación Española de Cirugía Mayor Ambulatoria. Se revisaron un total de 503 comunicaciones deslindadas en: 51 estudios prospectivos (10,12%) y 57 estudios retrospectivos (11,33%).Conclusiones: Aun cuando la realización de procesos de investigación resulta perfectamente compatible con determinados modelos organizativos asistenciales como la CMA, se constata una marcada infrautilización de este tipo de organización sanitaria en relación con las actividades investigadoras (AU)

Background: The Ambulatory Surgical Unit has an essentially therapeutic approach, although it is possible, within this organizational model, to develop investigation procedures. The purpose of this study is to analyze the use of the ambulatory surgical unit for the development of clinical studies, so we undertook a descriptive study of the papers sent to the most recent congresses on ambulatory surgery.Methods: A descriptive study of the papers sent to the national and international meetings of 2007-2008, including oral communications and posters describing a prospective or retrospective study. Results: We checked the communications sent to the IAAS7th International Congress of Ambulatory Surgery, VII Congreso Nacional de Cirugía Mayor Ambulatoria and VII Simposio de la Asociación Española de Cirugía Mayor Ambulatoria. Were viewed 503 communications, of which 51 were prospective studies (10.12%) and 57 retrospective studies (11.33%).Conclusions: Although investigation studies are perfectly compatible with certain organizational models of care such as the ambulatory surgical unit, there is a marked under-utilization of this type of health organization in connection with investigation activitie (AU)

Pancreatitis crónica autoinmune: una entidad de difícil diagnóstico diferencial / Chronic autoimmune pancreatitis: an entity of difficult differential diagnosis

No disponible