Saccular aneurysms of the extracranial internal carotid artery. Experience and review of the literature.

The aim of this study was to describe the surgical technique employed and our results in the treatment of saccular aneurysms of the internal carotid artery at the extracranial level. We describe 3 cases of patients with saccular aneurysms of the extracranial internal carotid who underwent surgery at our unit within the last 3 years. We report on indications for treatment, surgical technique and results in terms of morbidity-mortality and also review the pertinent literature. Surgical treatment was indicated on the grounds of the patients being symptomatic: 2 had a history of cerebral ischemia, and 1 showed local compression symptoms. The surgical approach was presternocleidomastoid cervicotomy extended distally, and in 2 patients was accompanied by nasotracheal intubation to achieve adequate exposure. In 2 cases, we performed an aneurysmectomy with end-to-end anastomosis. In the third patient, the aneurysm neck was ligated from within the sac followed by aneurysmectomy. There was no mortality or neurological morbidity (local or general). The patients remain free from neurological symptoms with a patent carotid axis. Our clinical experience suggests that, despite the anatomically unfavorable location of this type of aneurysm and the greater complexity of the surgical technique, this patient group can be effectively treated. The frequent presence of an elongated carotid axis and an aneurysmal neck means the surgeon can easily restore arterial continuity by direct procedures.

Regional reconstruction of flash flood history in the Guadarrama range (Central System, Spain).

Flash floods are a common natural hazard in Mediterranean mountain environments and responsible for serious economic and human disasters. The study of flash flood dynamics and their triggers is a key issue; however, the retrieval of historical data is often limited in mountain regions as a result of short time series and the systematic lack of historical data. In this study, we attempt to overcome data deficiency by supplementing existing records with dendrogeomorphic techniques which were employed in seven mountain streams along the northern slopes of the Guadarrama Mountain range. Here we present results derived from the tree-ring analysis of 117 samples from 63 Pinus sylvestris L. trees injured by flash floods, to complement existing flash flood records covering the last ~200years and comment on their hydro-meteorological triggers. To understand the varying number of reconstructed flash flood events in each of the catchments, we also performed a comparative analysis of geomorphic catchment characteristics, land use evolution and forest management. Furthermore, we discuss the limitations of dendrogeomorphic techniques applied in managed forests.

Lactancia materna en la Región de Murcia. ¿Seguimos con el problema? / Maternal breastfeeding in the Region of Murcia, does the

Objetivo: Conocer la prevalencia y la duración de la lactancia materna (LM) en la Región de Murcia. Método: Estudio transversal (junio de 2007), mediante encuestas a madres de niños menores de 24 meses realizadas en centros de vacunación. El ámbito de estudio estuvo comprendido por 77 zonas de salud de 6 áreas sanitarias de la región, y el muestreo fue proporcional al número de niños nacidos en el área. Se recogieron datos sociosanitarios del niño, de la madre y de la alimentación del niño. Se calculó la prevalencia de LM según las categorías definidas por la Organización Mundial de Salud (OMS) y se estudiaron los motivos de no iniciar y de abandonar la LM. Resultados: Se obtuvieron datos de 1.836 niños, con una tasa de respuesta del 95,2%. Al alta del hospital, un total de 1.643 niños (89,7%) fueron alimentados con LM; de éstos, el 76,7% (n= 1.405) lo hicieron sin suplementos nutritivos. Al tercer mes mantenían la LM completa el 44,4% y al sexto mes el 36,3%. La mediana de duración de LM exclusiva fue de 75 días y para la LM parcial de 129 días. Los motivos de no alimentar con LM fueron: enfermedad/ingreso (46,7%), falta de leche (28,6%) y decisión de la madre (19,3%). Entre las causas de abandono, cabe citar las siguientes: hipogalactia e insaciabilidad (29,3%) y escasa ganancia de peso (11%). Las variables que mostraron una asociación estadísticamente significativa (p <0,05) con la LM fueron el peso del niño, el tipo de parto y el área sanitaria, y, en relación con la madre, la edad, la paridad, la actividad laboral, el lugar de procedencia y el nivel de estudios. Conclusiones: Las cifras de LM en la Región de Murcia son similares a las de nuestro entorno, pero se alejan de las recomendadas por la OMS (AU)

Title: Maternal breastfeeding in the Region of Murcia, does the problem persist? Objective: To study the prevalence and duration of maternal breastfeeding (MB) in the Region of Murcia. Methods: Cross-sectional study (June, 2007). Mothers of infants under 24 months old were surveyed in immunization centers. The study was conducted through the 77 health zones of the 6 health areas of the Region. The sample size was proportion alto the number of newborns in these areas. Breast-fed baby, mother and child feeding social and health data were collected. The MB prevalence was calculated in accordance with the categories defined by the World Health Organization (WHO) and the reasons for not starting and for stopping MB were studied. Results: Data from 1,836 infants (response rate of 95.2%) has been obtained. Upon hospital discharge, the percentage of children fed with MB was of 89.7% (1,643), 76.7% (1,405) of which were breastfed without nourishing supplements. 44.4%of infants exclusively MB at 3 months and 36.3% at 6 months. The median duration of exclusive MB was of 75 days and of129 days for partial MB. The reasons for not being fed by MB were: disease/admission (46.7%), lack of milk (28.6%), and mother’s decision (19.3%). The reasons for discontinuing breastfeeding were: hypogalactia and insatiable appetite (29.3%), and not to put on weight (11%). The variables that showed statistically significant association (p < 0.05) regarding MB were child weight, type of childbirth, and health area, and, regarding the mother, age, parity, occupation, place of origin, and education. Conclusions: The MB figures in the Region of Murcia are similar to those in our environment, but are far from those recommended by the WHO (AU)