New trends in breast cancer surgery: a therapeutic approach increasingly efficacy and respectful of the patient.

The surgical management of breast cancer has undergone continuous and profound changes over the last 40 years. The evolution from aggressive and mutilating treatment to conservative approach has been long, but constant, despite the controversies that appeared every time a new procedure came to light. Today, the aesthetic satisfaction of breast cancer patients coupled with the oncological safety is the goal of the modern breast surgeon. Breast-conserving surgery with adjuvant radiotherapy is considered the gold standard approach for patients with early stage breast cancer and the recent introduction of "oncoplastic techniques" has furtherly increased the use of breast-conserving procedures. Mastectomy remains a valid surgical alternative in selected cases and is usually associated with immediate reconstructive procedures. New surgical procedures called "conservative mastectomies" are emerging as techniques that combine oncological safety and cosmesis by entirely removing the breast parenchyma sparing the breast skin and nipple-areola complex. Staging of the axilla has also gradually evolved toward less aggressive approaches with the adoption of sentinel node biopsy and new therapeutic strategies are emerging in patients with a pathological positivity in sentinel lymph node biopsy. The present work will highlight the new surgical treatment options increasingly efficacy and respectful of breast cancer patients.

Measurement of the intensities of the long-range alpha particles from 212Po.

212Bi partially decays by ß- populating excited levels of 212Po. Some of these excited states of 212Po decay with very low probability by direct alpha-particle emissions instead of a gamma-alpha cascade. This effect was known since the earliest times after the discovery of radioactivity. Emission energies of these long-range alpha particles were measured in the past, but the activity ratios were not accurately determined. Relative intensities for these decays have now been experimentally determined. Results agree with data previously reported. It is the first time that an uncertainty estimate is provided for such experiment.

Conversion factor and other variables in the indoor retrospective radon activity concentration studies.

Estimation of indoor retrospective radon activity concentration can be performed by measuring the 210Po surface activity concentration of the radon progeny on mirrors. The conversion factor between the surface activity concentration of 210Po on mirrors and the retrospective activity concentration of 222Rn in the air was determined. Several places and some variables have been considered. Exposures were performed in places with moderate and high concentrations of 222Rn. The repeatability of results has been investigated. The dependence of concentration on exposure time has been checked. The effect of cleaning the mirror surfaces has been analyzed. The experimental results obtained for the possible 210Pb-210Po equilibrium inside the mirrors have also been studied and compared with the theoretically expected values.

Factors impacting on length of stay and mortality of community-acquired pneumonia.

A 1-year retrospective multicentre study was performed to identify factors influencing hospital length of stay (LOS) and mortality of patients (n = 3233) admitted to hospital because of community-acquired pneumonia (CAP). Pneumonia severity index (PSI) high-risk classes (IV and V), positive blood culture, admission to an intensive care unit (ICU), multi-lobar involvement and alcohol consumption were associated independently with prolonged LOS. Tobacco smoking was associated with a reduced LOS. The LOS varied markedly among centres. Only PSI high-risk class, admission to ICU and multi-lobar involvement were associated with early, late and global mortality. Positive blood cultures, antimicrobial therapy according to treatment guidelines and the establishment of an aetiological diagnosis were linked to reduced late and global mortality. These data suggest that early mortality associated with CAP is highly dependent on the clinical status of the patient at presentation. Conversely, late mortality seems to be associated more closely with clinical management factors; hence, an aetiological diagnosis and compliance with appropriate therapeutic guidelines have a significant influence on outcome.

Present status of 222Rn in groundwater in Extremadura.

Radon-222 was measured in groundwater sources of Extremadura (Spain), analyzing 350 samples from private and public springs, wells, and spas by liquid scintillation counting (LSC) and gamma spectrometry. The 222Rn activity concentrations ranged from 0.24 to 1168 Bq L(-1). The statistical analysis showed a log-normal distribution with a mean of (111+/-7) Bq L(-1) and a median of (36+/-3) Bq L(-1). A hydrogeological study revealed correlations between the activity concentration and the aquifer material's characteristics. A map of 222Rn in groundwater was elaborated and compared with the natural gamma radiation map for this region. About 35% of the samples showed 222Rn activity concentrations above the Euratom recommended limit of 100 Bq L(-1). Three uranium series radionuclides (238U, 234U, and 226Ra) were also assayed by alpha-particle spectrometry, estimating the annual effective dose due to the presence of these natural radionuclides in drinking water.

Design and construction of a new chamber for measuring the thickness of alpha-particle sources.

The thickness of charged-particle emitting sources can be determined by varying the incidence angle of particles using silicon semiconductor detectors. The differences in energy between the peaks for an alpha emission measured with different incident angles are due to the energy loss of alpha particles in the source. These shifts can thus be used to estimate the source thickness. A new detection chamber has been constructed for this purpose. Its advantage is the registration of the alpha particles emitted from a given source using up to three different detectors simultaneously. Monte Carlo simulation was used to help to determine the best measurement conditions and interpret the results.

Study of the 243Am decay.

Gamma-ray emission probabilities for 243Am were published in 1996. Three new gamma transitions were then found: 46.84, 98.36 and 102.02keV. In the last evaluation by the Decay Data Evaluation Project, the emission probabilities of 46.84 and 102.02keV transitions were not included. Alpha-gamma coincidence measurements have been now used to check and revise the values for these two transitions and their emission probabilities. The emissions of the 31.13, 43.53, 74.66, 86.71 and 141.89keV transitions were also studied.

Study about the radionuclides implanted on glass surfaces for the estimation of retrospective indoor radon concentrations.

Indoor radon retrospective dosimetry can be performed by measuring the 210Po activity concentration deposited on surfaces. An experimental study about the implantation of 210Po on mirrors exposed to radon has been performed. Two cases were studied: exposure to high and low 222Rn concentrations. Results were compared with those calculated by using the activity evolution equations. Experimental results can be only explained assuming additional deposition of the long-lived 222Rn descendants.

Multi-technique characterization of a nuclear bomb particle from the Palomares accident.

A January 1966 accident dispersed Pu and other nuclear bomb materials in the vicinity of Palomares, a village in southeastern Spain. Radioactive particles were identified in a soil sample collected in 1998 and analytical results obtained from one of the isolated particles are presented here. Isolation of the particle was performed using gamma-ray spectrometry and imaging plates. Scanning electron microscopy with X-ray microanalysis revealed the presence of U and Pu as well as Pb and Fe in the particle of approximately 10microm diameter. Radioisotopes of U, Pu, and Am were quantified using radiometric methods, inductively coupled plasma mass spectrometry and secondary ion mass spectrometry. The elevated (235)U/(238)U atom ratio indicates enriched U, and the Pu atom ratios are consistent with weapons-grade material. This work demonstrates that the analysis of individual particles provides information not available through bulk sample analysis.

[Demographic and clinical features of diagnosed individuals of enterobiasis in the southern Gran Canaria: sampling assessment]. / Características clínico-demográficas de la población del Sur de Gran Canaria con diagnóstico de enterobiasis: valoración de la toma de muestras.

OBJECTIVE: Enterobius vermicularis, also known as pinworn, is the responsible agent for Human Enterobiasis. It is one of the most prevalent, but underrated, parasitic disease in children population. Diagnosis involves demonstration of either eggs or adult worms by Graham test. The aim of this study is to describe the clinical, demographic and microbiological features of patients with suspected diagnosis of Enterobiasis in southern Gran Canaria. METHODS: Descriptive and prospective study of perianal samples evaluated by Graham test in the Microbiology Department of `Insular de Gran Canaria´ University Hospital between November 2014 and November 2015. Descriptive analysis to evaluate the correlation between clinical and demographic variables and the results of Graham test microbiological observation. RESULTS: 1,128 samples were analyzed. E. vermicularis was found in 11.4% of the samples. Among the positives samples, 88.4% belonged to children under 14 years, and 53.5% were male. Abdominal pain (18.6%), anal itching (11.6%), eosinophilia (8.5%) and intestinal parasitosis suspicion (7.8%) were the reasons of parasitological investigation request in positive samples. Nevertheless, a high proportion of the requests was not founded in a suspicious diagnosis or was unrelated to Enterobiasis. CONCLUSIONS: Enterobiasis is a common disease in primary health care and is of great importance in Gran Canaria. Quality in sample collection as well as diagnosis suspicious information are necessary for a good microbiological analysis.

Measuring radon concentrations and estimating dose in tourist caves.

Caves and mines are considered to be places of especial risk of exposure to (222)Rn. This is particularly important for guides and workers, but also for visitors. In the Extremadura region (Spain), there are two cave systems in which there are workers carrying out their normal everyday tasks. In one, visits have been reduced to maintain the conditions of temperature and humidity. The other comprises several caves frequently visited by school groups. The caves were radiologically characterised in order to estimate the dose received by workers or possible hazards for visitors.

Radon in underground waters as a natural analogue to study the escape of CO2 in geological repositories.

Activity concentrations of dissolved (222)Rn and (226)Ra were measured in several underground aquifers, which are candidates for repositories or for the study of analogue natural escapes of CO2. The concentration of both radionuclides in water was determined using liquid scintillation counting. The values obtained for the (222)Rn concentrations varied from 0 to 150 Bq l(-1), while the levels of (226)Ra were in general very low. This indicates that (222)Rn is coming from the decay of the undissolved (226)Ra existing in the rocks and deep layers of the aquifers, being later transported by diffusion in water.

Decreased production of AmpC-type beta-lactamases associated with the development of resistance to quinolones in Citrobacter freundii strains.

The effect of fluoroquinolones in Citrobacter freundii strains that results in a decreased expression of cephalosporin-hydrolysing beta-lactamases was studied. Resistance to broad-spectrum cephalosporins and penicillins in two C. freundii clinical isolates was associated with moderate production of chromosomal AmpC-type-beta-lactamase in addition to changes in the outer membrane proteins profile with respect to wild-type C. freundii strains. Ten quinolone-resistant mutants were derived from the two clinical isolates using increasing fluoroquinolone concentrations. The level of susceptibility to cephalosporins and meropenem of these 10 mutants was increased and was associated with a 3.6-32% diminution in the hydrolyzing activity of their periplasmic extracts containing beta-lactamases on cephaloridine as compared with those from their parent strains. Susceptibility to cephalosporins and meropenem, as well as the expression of chromosomal AmpC-type-beta-lactamase in C. freundii strains, was influenced by the exposure to quinolones.

Decreased permeability and enhanced proton-dependent active efflux in the development of resistance to quinolones in Morganella morganii.

Five quinolone-resistant strains were developed from a clinical Morganella morganii isolate (M1 strain) which was susceptible to nalidixic acid and fluoroquinolones. All five in vitro selected mutants showed diminished norfloxacin accumulation and two of them also decreased the expression of the AgO in the outer membrane lipopolysaccharide with respect to their parent strain and to the M. morganii NCTC-235 type strain. Likewise, the M1 strain did not express a 37-38 kDa protein and accumulated less norfloxacin than the M. morganii NCTC-235 strain. The decreased norfloxacin uptake in the five mutants compared with the M. morganii NCTC-235 strain was due to an enhanced proton-dependent active efflux plus a pre-existent decreased expression of a 37-38 kDa protein in the parent strain.

Mediterranean spotted fever in Salamanca, Spain. Epidemiological study in patients and serosurvey in animals and healthy human population.

Mediterranean spotted fever is a spotted fever group rickettsiosis caused by Rickettsia conorii. The fever has a recognized incidence in large geographic areas, and its presence in Salamanca Province (Spain) has been well documented since 1981. This work presents the results of the centralized prospective survey carried out in this area and was designed to study the epidemiological behavior of the disease and the prevalence of antibodies against R. conorii among animals and healthy human population. In 110 patients with confirmed diagnosis by an immunofluorescent antibody test we have observed a bimodal temporal curve of incidence of Mediterranean spotted fever in our zone and their predominant origin in villages under 2000 inhabitants. The serosurvey in a statistically representative sample of the human population of Salamanca shows a rate of 73.5% of reactive sera and percentages as high as 82% in samples from small villages. The seroepidemiological study of 300 animals reveals a widespread response to rickettsial antigens throughout the province. Immunofluorescent antibody titers of greater than or equal to 1:40 are present in 93% of dogs and high rates and titers are detected in other domestic mammals, suggesting their feasible epidemiological role in Mediterranean spotted fever.

Resolution of high-molecular-weight components in lipopolysaccharides of Escherichia coli, Morganella morganii, Citrobacter freundii and Citrobacter diversus strains with sodium dodecyl sulfate polyacrylamide gels.

The use of 0.5% sodium dodecyl sulfate in polyacrylamide separation gels allowed the resolution in several bands of high-molecular-mass components in smooth lipopolysaccharide of bacterial outer membrane from Escherichia coli, Morganella morganii, Citrobacter freundii and Citrobacter diversus. With or without 0.1% SDS, however, such a result was not possible.

Isolated renoureteric aspergilloma due to Aspergillus flavus: case report and review of the literature.

In this paper we describe a case in which acute renal colic was associated with elimination of multiple hyphal masses of Aspergillus flavus. Also, we reviewed the literature on similar cases and we found a similar pattern characterized by a marked male predominance, association with at least one underlying medical condition that predisposes to fungal infection, the presence of local symptoms resembling acute ureteral colic, and the absence of systemic manifestations. Moreover, our data suggest that Aspergillus balls must be suspected when a diabetic and intravenous drug user presents with acute renal colic and that non-obstructive renal aspergillosis may be initially treated with itraconazole.

Plutonium contamination from accidental release or simply fallout: study of soils at Palomares (Spain).

The activity concentration of plutonium in an environmental sample does not usually constitute sufficient information to determine if it is due only to fallout. Alpha and gamma spectrometry are used here conjointly in the study of environmental soil samples to distinguish between samples showing plutonium contamination due to fallout exclusively, and samples contaminated with plutonium from another source. The method was applied to soil samples collected in Palomares (Spain), where an accidental release of aerosols contaminated with plutonium occurred. The two contributions (fallout and accidentally released plutonium) were separated by means of the activity ratios between various radionuclides present in the samples analyzed. The fallout level was estimated from the 239 + 240Pu/137Cs activity ratio. For samples showing contamination due to the accident, the 238Pu/239 + 240Pu and 239Pu/240Pu activity ratios were also calculated to determine the grade of plutonium of this contamination.

Activity of (239 + 240)Pu and 238Pu in atmospheric deposits.

Radioactive concentrations of (239 + 240)Pu and 238Pu were determined in rainwater samples collected at Badajoz (in a semi-arid zone in the south-west of Spain) from 1992 to 1996. Total plutonium deposition (including dry and wet deposition) was investigated during dry and wet periods. Anomalously high depositions of (239 + 240)Pu ((6.8 +/- 0.4) mBq/m2) and 238Pu ((2.2 +/- 0.2)mBq/m2) were found in the second-half of 1995. The 238Pu/(239 + 240)Pu activity ratio (0.32 +/- 0.04) obtained for that sample was higher than in global fallout.

The effect of energy losses in alpha-particle sources on the shape of peaks in spectra obtained with wide-angle geometry.

It has been shown that two main effects contribute to the tailing in the shapes of alpha-peaks measured with silicon detectors: the ionization loss in the source and the response of the detector. We studied the relative influence of both factors in measurements with small source-to-detector distances. The computer simulation code 'the stopping and range of ions in matter' has been used to obtain the energy spectra of a 226Ra source as a function of the source thickness. Results of the simulation are compared with experimental measurements.