Uso del contenido de fluido torácico para la predicción del balance hídrico y las complicaciones pulmonares postoperatorias tras cirugía abdominal mayor / Use of thoracic fluid content for prediction of fluid balance and postoperative pulmonary complications after major abdominal surgery: An observational study

Antecedentes y objetivos: Los efectos nocivos del exceso de líquidos se manifiestan frecuentemente en los pulmones. El contenido de fluido torácico (thoracic fluid content [TFC]) es una variable que proporciona el monitor por biorreactancia STARLING™, que representa el volumen total de líquido en el tórax. El objetivo es analizar la asociación entre la variación de los valores del TFC (TFCd0%) a las 24horas postoperatorias, el balance hídrico postoperatorio y las complicaciones pulmonares postoperatorias. Material y métodos: Estudio observacional prospectivo y analítico. Se incluyeron pacientes programados para cirugía abdominal mayor en un hospital universitario de tercer nivel. Fueron monitorizados durante la intervención y las 24 primeras horas postoperatorias con el monitor STARLING™, midiendo el TFC y su variación en distintas etapas del perioperatorio. Se realizaron ecografías pulmonares seriadas y se recogieron las complicaciones pulmonares postoperatorias. Se realizó una regresión logística para predecir la aparición de atelectasias y congestión pulmonar. Se calculó el coeficiente de correlación de Pearson para comprobar la asociación entre TFC y balance hídrico. Resultados: Se analizaron 50 pacientes. El TFCd0% medido en la mañana del primer día postoperatorio aumentó una mediana del 27,1% [IQR: 20,3-37,5] y se correlacionó con una r=0,44 con el balance postoperatorio de 677ml [IQR: 125,5-1.412]. El aumento del TFC se relacionó con un mayor riesgo de sufrir atelectasias (OR=1,24) y congestión pulmonar (OR=1,3). Conclusiones: El TFCd0% medido a las 24horas de la cirugía presenta una correlación moderada con el balance hídrico postoperatorio. Su incremento es un factor de riesgo para la aparición de complicaciones pulmonares postoperatorias.(AU)

Background and objectives: The harmful effects of excess fluids frequently manifest in the lungs. Thoracic fluid content (TFC) is a variable provided by the STARLINGTM bioreactance monitor, which represents the total volume of fluid in the chest. The objective is to analyze the association between the variation in TFC values (TFCd0%) at 24 hours postoperatively, postoperative fluid balance, and postoperative pulmonary complications. Material and methods: Prospective and analytical observational study. Patients scheduled for major abdominal surgery at a tertiary teaching hospital were included. They were monitored during the intervention and the first 24 postoperative hours with the monitor. STARLINGTM, measuring TFC and its variation in different stages of the perioperative period. Serial lung ultrasounds were performed and postoperative pulmonary complications were recorded. Logistic regression was performed to predict the occurrence of atelectasis and pulmonary congestion. The Pearson correlation coefficient was calculated to verify the association between TFC and water balance. Results: 50 patients were analyzed. TFCd0% measured on the morning of the first postoperative day increased by a median of 27.1% [IQR: 20.3-37.5] and was correlated at r=0.44 with the postoperative balance of 677 ml [IQR: 125.5-1,412]. Increased TFC was related to a higher risk of atelectasis (OR=1.24) and pulmonary congestion (OR=1.3). Conclusions: TFCd0% measured 24 hours after surgery presents a moderate correlation with postoperative fluid balance. Its increase is a risk factor for the appearance of postoperative pulmonary complications.(AU)

Background rates of 41 adverse events of special interest for COVID-19 vaccines in 10 European healthcare databases - an ACCESS cohort study.

BACKGROUND: In May 2020, the ACCESS (The vACCine covid-19 monitoring readinESS) project was launched to prepare real-world monitoring of COVID-19 vaccines. Within this project, this study aimed to generate background incidence rates of 41 adverse events of special interest (AESI) to contextualize potential safety signals detected following administration of COVID-19 vaccines. METHODS: A dynamic cohort study was conducted using a distributed data network of 10 healthcare databases from 7 European countries (Italy, Spain, Denmark, The Netherlands, Germany, France and United Kingdom) over the period 2017 to 2020. A common protocol (EUPAS37273), common data model, and common analytics programs were applied for syntactic, semantic and analytical harmonization. Incidence rates (IR) for each AESI and each database were calculated by age and sex by dividing the number of incident cases by the total person-time at risk. Age-standardized rates were pooled using random effect models according to the provenance of the events. FINDINGS: A total number of 63,456,074 individuals were included in the study, contributing to 211.7 million person-years. A clear age pattern was observed for most AESIs, rates also varied by provenance of disease diagnosis (primary care, specialist care). Thrombosis with thrombocytopenia rates were extremely low ranging from 0.06 to 4.53/100,000 person-years for cerebral venous sinus thrombosis (CVST) with thrombocytopenia (TP) and mixed venous and arterial thrombosis with TP, respectively. INTERPRETATION: Given the nature of the AESIs and the setting (general practitioners or hospital-based databases or both), background rates from databases that show the highest level of completeness (primary care and specialist care) should be preferred, others can be used for sensitivity. The study was designed to ensure representativeness to the European population and generalizability of the background incidence rates. FUNDING: The project has received support from the European Medicines Agency under the Framework service contract nr EMA/2018/28/PE.

Prevalencia de las hemoglobinopatías en gestantes de la provincia Sancti Spíritus

Introducción:las hemoglobinopatías son un conjunto de enfermedades genéticas, causadas por trastornos en la estructura de las cadenas globinas de la hemoglobina. Es prioridad del Sistema de Nacional de Salud cubano el diagnóstico precoz de estas enfermedades.Objetivos:caracterizar el comportamiento de las hemoglobinopatías en las embarazadas de la provincia Sancti Spíritus en el período de 2011 a 2018.Métodos:se realizó un estudio observacional, descriptivo, longitudinal y retrospectivo utilizando las bases de datos del Centro Provincial de Genética Médica de Sancti Spíritus. El universo estuvo conformado por 28 461 embarazadas que se estudiaron y la muestra fue de 756 embarazadas que presentaron algún tipo de hemoglobinopatía.Resultados:del total de embarazadas estudiadas, el 2,56 porciento resultaron ser portadoras de hemoglobinopatías. Se estudió el 90,60 porciento de las parejas, diagnosticándose un total de 32 parejas riesgo a las cuales se les asesoró genéticamente. Las variantes más comunes de hemoglobinopatías fueron la AS (79,89 porciento) y la AC (14,42 porciento). Los municipios con mayor número de portadoras de hemoglobinopatías fueron Sancti Spíritus (30,03 porciento) y Trinidad (28,70 porciento).Conclusiones:se describió la prevalencia de las hemoglobinopatías en las embarazadas de la provincia Sancti Spíritus. Se muestra una baja prevalencia de hemoglobinopatías en las gestantes espirituanas.[AU]

Occurrence, prevalence, and explanatory environmental variables of Spirocerca vulpis infestation in the foxes of western Spain.

The main aim of this study was to not only establish the prevalence of the recently described Spirocerca vulpis parasite in the wild-life cycle of carnivores in western Spain but to also elaborate a model to explain the risk of infestation based on 16 topo-climatic and habitat variables. During the period from June 2016 to November 2017, 1644 carcasses of red foxes (Vulpes vulpes) and another 105 wild mammals, legally hunted or killed in car accidents, were analyzed. Parasitic nodules of Spirocerca were found in 6% of the foxes, and the molecular analyses established a homology of our samples with the species S. vulpis. There were no differences in the occurrence of the infestation between sexes, but there were differences in terms of age, such that infestation was proportionally more frequent among young individuals. In terms of temporality, a higher percentage of positive cases was observed during the late-autumn and winter months, especially between December and February. This study provides new data on the factors that predispose S. vulpis infection in the red fox. Model results indicate that a spatial pattern exists in the occurrence and prevalence of this species in the studied area (higher probabilities to the west), and that this pattern seems to mainly be associated with topo-climatic variables.

Schwannoma of the biliary tract resembling cholangiocarcinoma: A case report and review.

Schwannomas are benign tumours derived from Schwann cells and are extremely rare in the biliary tract. We present the case of a 62-year-old patient with a common bile duct schwannoma that resembled a cholangiocarcinoma. We also review all 17 previously published cases of schwannoma of the biliary tract and discuss the challenges of preoperative diagnosis.

Predictors of medication use in the Roma population in Spain: a population-based national study.

OBJECTIVES: To describe the prevalence of prescribed and self-medicated use of medication in the Spanish Roma population, and identify the associated factors. STUDY DESIGN: Descriptive cross-sectional study. METHODS: Data from the first National Health Survey conducted on the Roma population in Spain were used. The sample comprised 1000 Spanish Roma adults of both sexes aged ≥16 years. Answers (yes/no) to the question, 'In the last two weeks have you taken the following medicines [in reference to a list of medicines that might be used by the population] and were they prescribed for you by a doctor?' were used to ascertain 'medication use'. 'Self-medication' referred to use of these medicines without medical prescription. Using multivariate logistic regression models, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to identify associated factors. RESULTS: The overall prevalence of medication use in the Roma population for both sexes was 69.1%, and 38.7% was self-medicated. Females reported higher use of medication than males (75.1% vs 62.3%); however, self-medication was higher among males. Analgesics and antipyretics were used most often (35.8%). Among males, the variables that were independently and significantly associated with a higher probability of medication use were: age; negative perception of health; presence of chronic disease (OR 2.81; 95% CI 1.67-4.73); and medical visits (OR 4.51; 95% CI 2.54-8.01). The variables were the same among females, except for age. CONCLUSION: A high percentage of the Spanish Roma population use medication, and a significant proportion of them self-medicate. The presence of chronic diseases, a negative perception of health and medical consultations were associated with increased use of medication in the study population.

Beneficial effects of sustained activity on the use of dietary protein and carbohydrate traced with stable isotopes 15N and 13C in gilthead sea bream (Sparus aurata).

To determine the effects of sustained swimming on the use and fate of dietary nutrients in gilthead sea bream, a group of fish were forced to undertake moderate and sustained swimming (1.5 BL s(-1)) for 3 weeks and compared with a control group undertaking voluntary activity. The exercise group showed a significant increase in specific growth rate (C: 1.13 ± 0.05; E: 1.32 ± 0.06 % day(-1), P < 0.05) with no significant change in food intake (C: 3.56 ± 0.20; E: 3.84 ± 0.03 % of body weight). The addition of (13)C-starch and (15)N-protein to a single meal of 1 % ration allowed analysis of the fate of both nutrients in several tissues and in their components, 6 and 24 h after force-feeding. In exercised fish improved redistribution of dietary components increased the use of carbohydrates and lipid as fuels. Gilthead sea bream have a considerable capacity for carbohydrate absorption irrespective of swimming conditions, but in trained fish (13)C rose in all liver fractions with no changes in store contents. This implies higher nutrient turnover with exercise. Higher retention of dietary protein (higher (15)N uptake into white muscle during the entire post-prandial period) was found under sustained exercise, highlighting the protein-sparing effect. The combined effects of a carbohydrate-rich, low-protein diet plus sustained swimming enhanced amino acid retention and also prevented excessive lipid deposition in gilthead sea bream.

[Cherubism: diagnosis and treatment in the pediatric age]. / Querubismo: diagnóstico y tratamiento en la edad pediátrica.

Cherubism is a benign bone dysplasia of childhood, exclusively involving maxillary bones and spontaneous resolving after puberty in different grades. Approximately, 280 cases have been reviewed in the literature. It is an autosomal dominant disorder in which the normal bone is replaced by cellular fibrous and immature bone, resulting in painless symmetrical enlargement of the jaws. Diagnosis is based in clinical and radiological findings, confirmed by histology. Treatment is a controversial issue, and it is recommended surgical management as conservative as possible during the rapid growth phases. An aggressive case of cherubism is reported, diagnosed and followed since early childhood until puberty, with progressive involvement of facial bones developing in a disruption of facial contours and occlusion. The patient is treated by several surgical interventions oriented to minimize the aesthetic impact of the disease being as conservative as possible. The highlights of this case are the great proportion of the lesions, the functional and emotional disturbances brought out by these lesions and the difficulty to choose the most appropriate age and form of treatment.

Querubismo: diagnóstico y tratamiento en la edad pediátrica / Cherubism: diagnosis and treatment in the pediatric age

El querubismo es una displasia ósea benigna de la infancia, que afecta exclusivamente a los huesos maxilares y se resuelve en gradovariable de forma espontánea durante la pubertad. Se han descrito aproximadamente 280 casos en la literatura, la mayoría en varones. Es una enfermedad hereditaria autosómica dominante en la que el hueso normal es sustituido por hueso fibroso e inmaduro, dando lugar a una expansión indolora simétrica de los maxilares. El diagnóstico es clínico y radiológico, confirmado por la histología. El manejo es controvertido, recomendándose una actitud quirúrgica lo más conservadora posible durante la fases de crecimiento rápido. Se presenta un caso agresivo de querubismo diagnosticado y seguido desde la infancia precoz hasta la pubertad, con afectación progresiva amplia de los huesos faciales, provocando una disrupción de los contornos de la cara y la oclusión. El paciente es tratado mediante una serie de intervenciones encaminadas aminimizar el impacto estético de la enfermedad de la forma más conservadora posible. El interés del caso se centra en la amplia extensión dela enfermedad, los trastornos funcionales y emocionales que provoca y la dificultad para elegir el momento adecuado y el tipo de intervención (AU)

Cherubism is a benign bone dysplasia of childhood, exclusively involving maxillary bones and spontaneous resolving after puberty indifferent grades. Approximately, 280 cases have been reviewed in the literature. It is an autosomal dominant disorder in which the normal bone is replaced by cellular fibrous and immature bone, resulting in painless symmetrical enlargement of the jaws. Diagnosis is based inclinical and radiological findings, confirmed by histology. Treatment is a controversial issue, and it is recommended surgical management as conservative as possible during the rapid growth phases. An aggressive case of cherubism is reported, diagnosed and followed since early childhood until puberty, with progressive involvement of facial bones developing in a disruption of facial contours and occlusion. The patient is treated by several surgical interventions oriented to minimize the aesthetic impact of the disease being as conservative as possible. The highlights of this case are the great proportion of the lesions, the functional and emotional disturbances brought out by these lesions and the difficulty to choose the most appropriate age and form of treatment (AU)

Supresión tiroidea en pacientes con hiperparatiroidismo primario: ¿mejora la localización gammagráfica preoperatoria? / Thyroid suppression in patients with primary hyperparathyroidism: does it improve the pre-surgical scintigraphy localisation?

IntroducciónLa gammagrafía con tecnecio-sestamibi (MIBI) es la prueba de elección para la localización de los adenomas en pacientes con hiperparatiroidismo primario (HPTP). En algunos estudios se ha sugerido que el aumento de la sensibilidad de esta prueba podría estar en relación con una disminución de la captación del radiotrazador por parte de la glándula tiroidea. El objetivo de este estudio es analizar nuestra experiencia en pacientes con gammagrafías con MIBI negativas en los que se repitió el estudio tras la supresión de la función tiroidea con tiroxina.Material y métodosEntre enero de 2006 y abril de 2011 se evaluaron de forma prospectiva 17 pacientes con HPTP e imagen gammagráfica con MIBI negativa en los que se repitió dicha prueba tras la administración de tiroxina. Se revisan los datos gammagráficos y la correlación con los hallazgos en la intervención quirúrgica.ResultadosLa media de TSH en el momento de repetir la MIBI fue de 0,12 + 0,1mlU/L. De los 17 pacientes incluidos, en 13 de ellos (76,5%) la gammagrafía bajo supresión de la función tiroidea fue positiva, y en los otros 4 pacientes (23,5%) no se encontró imagen sugestiva de adenoma. En los casos en los que el MIBI fue positivo tras la supresión, el valor predictivo positivo (VPP) fue del 100%.ConclusiónLa supresión de la función tiroidea mediante la administración de tiroxina puede ayudar a mejorar la sensibilidad del MIBI en pacientes con estudios gammagráficos previos negativos y ayudar a tratar de una forma mínimamente invasiva a pacientes con HPTP (AU)

IntroductionScintigraphy with technetium-sestamibi (MIBI) is the test of choice for localising adenomas in patients with primary hyperparathyroidism (PHPT). In some studies it has emerged that the increase in sensitivity of this test could be associated with a decrease in the uptake of the radiotracer by the thyroid gland. The aim of this study is to analyse our experience in patients with a negative scintigraphy with MIBI, and in whom the study was repeated after suppression of thyroid function with thyroxine.Material and methodsA prospective evaluation was performed on 17 patients who, between January 2006 and April 2011, had PHPT and negative imaging using scintigraphy with MIBI and who had the test repeated after the administration of thyroxine. The scintigraphy data and the correlation with the findings in the surgical intervention are reviewed.ResultsThe mean TSH at the time of repeating the MIBI was 0.12+0.1mlU/L. Of the 17 patients included, the scintigraphy under thyroid suppression was positive in 13 of them (76.5%), and in the other 4 (23.5%) patients no image suggestive of adenoma was found. In the cases where the MIBI was positive after suppression, the positive predictive value (PPV) was 100%.ConclusionSuppression of thyroid function by giving thyroxine can help to improve the sensitivity of MIBI in patients with previously negative scintigraphy studies and help in the minimally invasive treatment of patients with PHPT (AU)

Tratamiento integral del Trastorno Límite de Personalidad / Comprehensive treatment of Borderline Personality Disorder

Los Trastornos de Personalidad (TP) en general y el Trastorno Límite de Personalidad (TLP) en particular, son de difícil abordaje ya que los trastornos de personalidad no están considerados una enfermedad mental como tal al tratarse de patología de eje II; se necesita un tratamiento psicofarmacológico y psicoterapéutico («abordaje integral») en muchas ocasiones de forma crónica, evidenciándose una falta de recursos y estudios sobre el mismo a largo plazo. También hay que señalar las dificultades en la práctica clínica de manejo del TLP, en particular por las propias características de éste (impulsividad, inestabilidad,...) que en muchas ocasiones provocan fenómenos de contratransferencia difíciles de controlar por el profesional. Este artículo pretende ser una revisión del TLP y su tratamiento integral en los diferentes niveles asistenciales pero centrado en hospitales de día, ya que en general es en estos dispositivos donde se tratan los casos más graves y donde más implantados están los programas específicos (si no para los TLP en particular sí para los TP en general). Finalmente en los Centros de Salud Mental, se están realizando ya grupos específicos para TP como parte de su tratamiento integral a este nivel (AU)

In general Personality Disorders (PD) and Borderline Personality (BP) especially, don't have an easy boarding since: personality disorders are not considered a mental illness as such; a psychopharmacologic and psychotherapeutic («integral boarding») treatment is needed, frequently in chronic form; and by the other side, is demonstrated a lack of resources and studies at long-term. Also, there are difficulties in clinical practice for the managing patients with BP, especially for their own characteristics (impulsiveness, instability, ...) that, in many occasions, provoke counter transfer phenomena's difficult to control for the professional. This article tries to be a review of the BP and its integral treatment in the different levels welfare but centred on day hospitals. Generally, is in these devices where the most serious cases are treated and where the specific programs are well-established (but for the BP especially yes for the PD in general). Finally to mention that in ambulatory level, in Mental Health Centers, specific groups for PD are realized as a part of its integral treatment in this level (AU)

Analysis of 27,248 hospital discharges for heart failure: a study of an administrative database 1998-2002.

AIMS: To describe the epidemiology of hospital admissions for heart failure in 32 hospitals. To define the profile of those attended by Internal Medicine (IM). METHODS AND RESULTS: Analysis of the Minimum-Basic-Data-Set registry of 32 public Spanish hospitals, during 1998-2002, identifying those cases whose main or secondary diagnosis was heart failure, with attention to age, sex, length of stay, season, outcome, number of diagnoses, Diagnostic Related Groups (DRG), and coded procedures. There were 2,787,008 discharges, 27,248 with heart failure (15,737 IM, 7,735 Cardiology and 3,776 other services). Discharges for heart failure increase from 1998 to 2002 (r(2) = 0.7232). Of the total, 44% were men (average age 70.98 years; 95% CI 70.08-70.47) and 56% were women (74.77 years; 95% CI 74.61-74.93; p < 0.0001). The global in-hospital mortality rate was 11.1% and we found differences between Cardiology and MI. MI patients were older (74 years compared to 69, p < 0.0001), had greater comorbidity, a similar length of stay (11.1 days), and a lower number of coded diagnostic procedures. Associated pathologies were different. Seasonal variation is clear. CONCLUSION: The incidence of discharges for heart failure is high and steadily increasing, although this is more evident in IM. The populations attended by the two services are different, which makes it difficult to ascertain differences in handling. The results are slightly different from those reported in other countries.

Analysis of 27, 248 hospital discharges for heart failure: a study of an administrative database 1998-2002

Objetivos. Conocer la epidemiología de lahospitalización por insuficiencia cardiaca (IC) enlos hospitales de Andalucía (España). Definir elperfil de los pacientes asistidos en MedicinaInterna (MI).Métodos y resultados. Análisis del ConjuntoMínimo Básico de Datos (CMBD) de los 32hospitales públicos de Andalucía (España) durante1998-2002, identificando los casos con diagnósticoprincipal o secundario de IC analizando edad, sexo,estancia, estacionalidad, destino, número dediagnósticos, GDR, procedimientos codificados. Seprodujeron 2.787.008 altas, 27.248 de ICC,(15.737 MI, 7.735 Cardiología y 3.776 otrosservicios). Las altas por IC crecieron desde 1998 a2003 (r2 = 0,7232). El 44% fueron hombres conedad media de 70,98 años (IC 95% 70,08-70,47) yel 56% mujeres con 74,77 (IC 95% 74,61-74,93)(p<0,0001). La tasa de mortalidad intrahospitalariaglobal fue del 11,1% y encontramos diferenciasentre Cardiología y MI. Los pacientes queingresaron en MI tenían mayor edad (74 años frentea 69, p<0,0001), mayor comorbilidad, estanciamedia similar (11,1 días) y menor número deprocedimientos diagnósticos codificados. Lapatología asociada fue diferente. La estacionalidades evidente.Conclusión. La incidencia de IC es elevada yaumenta progresivamente, aunque más en MI.Las poblaciones de uno y otro servicio sondiferentes, por lo que es difícil asegurar diferenciasde manejo. Los resultados difieren ligeramente delos comunicados en otros países

Aims. To describe the epidemiology of hospital admissions for heart failure in 32 hospitals. To define the profile of those attended by Internal Medicine (IM).Methods and results. Analysis of the Minimum-Basic-Data-Set registry of 32 public Spanish hospitals, during 1998-2002, identifying those cases whose main or secondary diagnosis was heart failure, with attention to age, sex, length of stay, season, outcome, number of diagnoses, Diagnostic Related Groups (DRG), and coded procedures.There were 2,787,008 discharges, 27,248 with heart failure (15,737 IM, 7,735 Cardiology and 3,776 other services). Discharges for heart failure increase from 1998 to 2002 (r2 = 0.7232). Of the total, 44% were men (average age 70.98 years; 95% CI 70.08-70.47) and 56% were women (74.77 years; 95% CI 74.61-74.93; p < 0.0001).The global in-hospital mortality rate was 11.1% andwe found differences between Cardiology and MI.MI patients were older (74 years compared to 69,p < 0.0001), had greater comorbidity, a similarlength of stay (11.1 days), and a lower number ofcoded diagnostic procedures. Associated pathologieswere different. Seasonal variation is clear.Conclusion. The incidence of discharges for heartfailure is high and steadily increasing, although thisis more evident in IM. The populations attended bythe two services are different, which makes itdifficult to ascertain differences in handling. Theresults are slightly different from those reported inother countries

[Epidemiological characteristics and mortality risk factors in patients admitted in hospitals with soft tissue infections. A multicentric STIMG (Soft Tissue Infections Malacitan Group) study results]. / Características clínicas, epidemiológicas y factores asociados a mortalidad en los pacientes hospitalizados por infecciones de piel y partes blandas. Resultados del estudio multicéntrico STIMG.

OBJECTIVES: To describe the characteristics of patients admitted in hospitals with soft tissue infections, and analyse the variables whose died, in order to define risk groups. METHOD: retrospective analysis of medical reports of all patient admitted during 2002 year for soft tissue infections in public malacitans hospitals. We excluded the patient with soft tissue infections associated with burns, surgery, pressure ulcers, and orbit cellulitis. We analysed clinical, biochemical variables and indications for yields and imaging tests, so the empiric antibiotic treatment established and its correlations with practice guidelines. RESULTS: We analysed 391 admissions of 374 patients. Cellulitis was the most frequent diagnosis (69.3%). We did imaging tests in 51.6%. In 94.3% of cases were treated with empirics antibiotics. The most prescribed drug was amoxiciline plus clavulanate (39%). 27 patients died, 40.7% of them for septic cause. All deceased patients had chronic diseases. The only biochemical parameters associated with mortality were serum proteins and albumina (55 +/- 9 g/L vs. 63 +/- 8 g/L; p = 0.0231) and (22 +/- 7 g/L vs. 29 +/- 7 g/L; p = 0.0125) respectively. CONCLUSIONS: Cellullitis are the most frequent soft tissue infections that requires admissions in hospitals. We overuse imaging test and don t follow the practice guidelines recommendations in antibiotic therapy. Primary soft issue infection s mortality is low and it s restricted to people with chronic illness, deep infections and bad nutritional status.

[Unilateral facial and cerebral hyperplasia associated with neurofibromatosis type 1. Report of four patients]. / Hiperplasia facial y cerebral unilateral asociada a neurofibromatosis tipo 1. Presentacion de cuatro pacientes.

INTRODUCTION: Plexiform neurofibroma in any location is one of the commonest complications associated with neurofibromatosis type 1 (NF1). Plexiform neurofibroma of the upper eyelid and orbit is usually associated with ipsilateral hemifacial hyperplasia. We present four patients with NF1 and plexiform neurofibroma of the eyelid and orbit associated with hemifacial hyperplasia, who also showed hyperplasia of the unilateral cerebral hemisphere. CASE REPORTS: There are four patients, three females and one male, who consulted because of NF1 with plexiform neurofibroma of upper eyelid and hemifacial hyperplasia. Upper eyelid involvement was observed since birth and progressed during the first years of life. The patients showed normal neurological and mental development without motor or cerebellar disorders. Magnetic resonance studies demonstrated the asymmetric hyperplasia of the ipsilateral hemisphere in all four cases and of the cerebellar hemisphere in one case. The degree of hemispheric hyperplasia was related to the size and extension of the plexiform neurofibroma, as well as to the severity of the hemifacial hyperplasia. In our case which had the plexiform neurofibroma extended to the neck and the upper thorax, the hyperplasia not only affected the cerebral hemisphere but also the ipsilateral cerebellar hemisphere. All parts of the hemisphere showed increased size. The cortex of the entire hemisphere showed normal differentiation of the subcortical white matter. CONCLUSION: NF1 appears to be related with facial and cerebral ipsilateral hemihyperplasia. The relation between the size and extension of the orbital, eyelid and facial plexiform neurofibroma and the degree of asymmetry of the hemispheric hyperplasia suggest that different influences of a still unknown agent, possibly a gene, obviously related to NF1, causes both the intracranial and extracranial abnormalities.

Hiperplasia facial y cerebral unilateral asociada a neurofibromatosis tipo 1. Presentación de cuatro pacientes / Unilateral facial and cerebral hyperplasia associated with neurofibromatosis type 1. Report of four patients

Introducción. Una de las complicaciones más frecuentesasociadas a la neurofibromatosis tipo 1 (NF1) es el neurofibromaplexiforme en cualquier localización. El neurofibroma plexiformedel párpado superior de la órbita va usualmente asociado a hiperplasiahemifacial ipsilateral. Presentamos a cuatro pacientes conNF1 y neurofibroma plexiforme del párpado y de la órbita asociadocon hiperplasia hemifacial, que también mostraban hiperplasiadel hemisferio cerebral unilateral. Casos clínicos. Cuatro pacientes,tres mujeres y un varón, consultaron por un neurofibroma plexiformedel párpado superior y de la órbita, presente desde el nacimientoy que progresaba durante los primeros años de vida. Lospacientes también mostraban hiperplasia hemifacial ipsilateral ydesarrollo mental normal sin alteraciones motrices ni cerebelosas.En uno de los pacientes, el neurofibroma plexiforme se extendía,además, por toda la hemifacies, partes anterior del cuello y anteriory superior del tórax. La resonancia magnética demostró asimetríahemisférica con hiperplasia del hemisferio ipsilateral en loscuatro casos y también del hemisferio cerebeloso en el caso en elque el neurofibroma plexiforme se extendía por toda la cara, elcuello y el tórax. Todas las partes del hemisferio cerebral mostrabanun aumento de tamaño. La corteza de todo el hemisferio hiperplásicoevidenciaba una diferenciación normal de la sustanciablanca subcortical. Conclusión. Parece indudable la relación entrela NF1 y la hemihiperplasia facial y cerebral. La relación entre eltamaño y extensión del neurofibroma plexiforme del párpado superior,órbita y hemifacies y el grado de asimetría de la hiperplasiahemisférica sugiere la existencia de influencias diversas de algúnagente todavía desconocido –posiblemente un gen, obviamente relacionadocon la NF1– que cause las anormalidades intracranealesy extracraneales

Introduction. Plexiform neurofibroma in any location is one of the commonest complications associated with neurofibromatosistype 1 (NF1). Plexiform neurofibroma of the upper eyelid and orbit is usually associated with ipsilateral hemifacialhyperplasia. We present four patients with NF1 and plexiform neurofibroma of the eyelid and orbit associated withhemifacial hyperplasia, who also showed hyperplasia of the unilateral cerebral hemisphere. Case reports. There are fourpatients, three females and one male, who consulted because of NF1 with plexiform neurofibroma of upper eyelid andhemifacial hyperplasia. Upper eyelid involvement was observed since birth and progressed during the first years of life. Thepatients showed normal neurological and mental development without motor or cerebellar disorders. Magnetic resonancestudies demonstrated the asymmetric hyperplasia of the ipsilateral hemisphere in all four cases and of the cerebellarhemisphere in one case. The degree of hemispheric hyperplasia was related to the size and extension of the plexiformneurofibroma, as well as to the severity of the hemifacial hyperplasia. In our case which had the plexiform neurofibromaextended to the neck and the upper thorax, the hyperplasia not only affected the cerebral hemisphere but also the ipsilateralcerebellar hemisphere. All parts of the hemisphere showed increased size. The cortex of the entire hemisphere showed normaldifferentiation of the subcortical white matter. Conclusion. NF1 appears to be related with facial and cerebral ipsilateralhemihyperplasia. The relation between the size and extension of the orbital, eyelid and facial plexiform neurofibroma and thedegree of asymmetry of the hemispheric hyperplasia suggest that different influences of a still unknown agent, possibly a gene,obviously related to NF1, causes both the intracranial and extracranial abnormalities

Características clínicas, epidemiológicas y factores asociados a mortalidad en los pacientes hospitalizados por infecciones de piel y partes blandas. Resultados del estudio multicéntrico STIMG / Epidemiological characteristics and mortality risk factors in patients admitted in hospitals with soft tissue infections. A multicentric STIMG (soft tissue infections malacitan group) study results)

Objetivos: Describir las características de los pacientes hospitalizados con infecciones de piel y partes blandas (IPPB) y analizar las variables de los que fallecen durante el ingreso para definir grupos de riesgo. Metodo: Análisis retrospectivo de las historias clínicas de todos los pacientes que fueron dados de alta con IPPB durante el año 2002, en los hospitales públicos de la provincia de Málaga. Se excluyen infecciones secundarias a pie diabético, cirugía, quemados, úlceras por decúbito y la celulitis orbitaria. Se analizaron variables clínicas, bioquímicas, indicación y validez diagnóstica de pruebas microbiológicas y de imagen, así como el tratamiento antibiótico empírico iniciado y su correlación con las recomendaciones terapéuticas establecidas. Resultados: Analizamos 391 ingresos de 374 pacientes. La celulitis fue el diagnóstico más frecuente (69,3%). Se realizaron pruebas de imagen en el 51,6% de los casos. El antibiótico más empleado fue la amoxicilina con ácido clavulánico (39%). Fallecieron 27 (6,7%), el 40,7% por el proceso séptico en sí. Todos los fallecidos, tenían algún tipo de enfermedad crónica asociada. Las únicas variables analíticas que se asociaron de forma significativa a mayor mortalidad fueron las proteínas totales (55 ± 9 g/L vs. 63 ± 8 g/L; p = 0,0231) y los concentraciones séricas de albúmina (22 ± 7 g/L vs. 29 ± 7 g/L; p = 0,0125). Conclusiones: Las celulitis es la IPPB que mayor número de ingresos genera en nuestro medio. Apreciamos una sobreutilización de pruebas de imagen y una desviación sobre las recomendaciones terapéuticas y el tratamiento aplicado en nuestros hospitales. La mortalidad global observada es baja y afecta de manera exclusiva a pacientes con mal estado nutricional al ingreso, enfermedades crónicas o infecciones profundas

Objectives: To describe the characteristics of patients admitted in hospitals with soft tissue infections, and analyse the variables whose died, in order to define risk groups. Method: retrospective analysis of medical reports of all patient admitted during 2002 year for soft tissue infections in public malacitans hospitals. We excluded the patient with soft tissue infections associated with burns, surgery, pressure ulcers, and orbit cellulitis. We analysed clinical, biochemical variables and indications for yields and imaging tests, so the empiric antibiotic treatment established and its correlations with practice guidelines. Results: We analysed 391 admissions of 374 patients. Cellulitis was the most frequent diagnosis (69.3%).We did imaging tests in 51.6%. In 94.3% of cases were treated with empirics antibiotics. The most prescribed drug was amoxiciline plus clavulanate (39%). 27 patients died, 40.7% of them for septic cause. All deceased patients had chronic diseases. The only biochemical parameters associated with mortality were serum proteins and albumina (55 ± 9 g/L vs. 63 ± 8 g/L; p = 0.0231) and (22 ± 7 g/L vs. 29 ± 7 g/L; p = 0.0125) respectively. Conclusions: Cellullitis are the most frequent soft tissue infections that requires admissions in hospitals. We overuse imaging test and don’t follow the practice guidelines recommendations in antibiotic therapy. Primary soft issue infection’s mortality is low and it’s restricted to people with chronic illness, deep infections and bad nutritional status