Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC-SENPE: Cardiac patient

Patients with cardiac disease can develop two types of malnutrition: cardiac cachexia, which appears in chronic congestive heart failure, and malnutrition due to the complications of cardiac surgery or any other type of surgery in patients with heart disease. Early enteral nutrition should be attempted if the oral route cannot be used. When cardiac function is severely compromised, enteral nutrition is feasible, but supplementation with parenteral nutrition is sometimes required. Sustained hyperglycemia in the first 24 hours in patients admitted for acute coronary syndrome, whether diabetic or not, is a poor prognostic factor for 30-day mortality. In critically-ill cardiac patients with stable hemodynamic failure, nutritional support of 20-25 kcal/kg/day is effective in maintaining adequate nutritional status. Protein intake should be 1.2-1.5 g/kg/day. Routine polymeric or high protein formulae should be used, according to the patient's prior nutritional status, with sodium and volume restriction according to the patient's clinical situation. The major energy source for myocytes is glutamine, through conversion to glutamate, which also protects the myocardial cell from ischemia in critical situations. Administration of 1 g/day of omega-3 (EPA+DHA) in the form of fish oil can prevent sudden death in the treatment of acute coronary syndrome and can also help to reduce hospital admission for cardiovascular events in patients with chronic heart failure.

2D-immunoblotting analysis of Sporothrix schenckii cell wall

We utilized two-dimensional gel electrophoresis and immunoblotting (2D-immunoblotting) with anti-Sporothrix schenckii antibodies to identify antigenic proteins in cell wall preparations obtained from the mycelial and yeast-like morphologies of the fungus. Results showed that a 70-kDa glycoprotein (Gp70) was the major antigen detected in the cell wall of both morphologies and that a 60-kDa glycoprotein was present only in yeast-like cells. In addition to the Gp70, the wall from filament cells showed four proteins with molecular weights of 48, 55, 66 and 67 kDa, some of which exhibited several isoforms. To our knowledge, this is the first 2D-immunoblotting analysis of the S. schenckii cell wall.

Evaluation of two coproscopic techniques for the diagnosis of schistosomiasis in a low-transmission area in the state of Minas Gerais, Brazil

This population study, which evaluated two parasitological methods for the diagnosis of schistosomiasis mansoni, was performed in a low-transmission area in Pedra Preta, Montes Claros, Minas Gerais, Brazil. A total of 201 inhabitants of the rural area participated in this research. Four stool samples were obtained from all participants and analysed using the Kato-Katz method (18 slides) and a commercial test, the TF-Test®, which was performed quantitatively. The data were analysed to determine prevalence, the sensitivity of the diagnostic methods, the worm burden and the definition of the "gold standard", which was obtained by totalling the results of all samples examined using the Kato-Katz technique and the TF-Test®. The results showed that the prevalence obtained from the examination of one Kato-Katz slide (the methodology adopted by the Brazilian control programme) was 8% compared to 35.8% from the "gold standard", which was a 4.5-fold difference. This result indicates that the prevalence of schistosomiasis in so-called low-transmission areas is significantly underestimated.

Compliance with dietary and nutrient recommendations in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Granada cohort at recruitment

BACKGROUND: The overall intake of energy and nutrients in the Granada EPIC-cohort (European Prospective Investigation into Cancer and Nutrition) is examined in order to assess compliance with the Spanish Nutritional Objectives (NO) and the Recommended Intakes (RI). METHODS: During recruitment (1992-1996), 7,789 participants, aged 35-69, were asked about diet through a validated diet history questionnaire. Nutrient intake is compared to the NO and RI that were valid at that time. Risk of inadequate intake is estimated as the percentage of the sample with intakes: ≤ 1/3 RI (high risk), ≤ 2/3 RI- > 1/3 RI (moderate risk), ≤ RI- > 2/3 RI, > RI. Differences in intakes have been analyzed by sex and age, and by smoking status and BMI. RESULTS: The daily intake of nutrients did not meet the NO as the total contribution of energy from proteins and fats exceeded these guidelines. Whilst intake of most nutrients was above the RI, the amount of iron, magnesium and vitamins D and E provided by the diet was not enough to meet the RI: in women aged 20-49 years, about 55% were at moderate risk for iron inadequacy, and a 20% of women for magnesium. Both sexes were at high risk of inadequacy for vitamin D, although sunlight exposure may supply adequate amounts. Never smokers showed a higher compliance to the NO. CONCLUSION: At recruitment, the nutrient profile of the diet was unbalanced. The observed nutrient inadequacy for iron, magnesium and vitamin E might be attributed to inappropriate dietary habits, and may have implications for future disease risk.

Collectio sermonum de dominicis, de festis et de sanctis, ad usum Fratrum Minorum.

« Sermo adaptabillis b. Laurentio... Dispersit, dedit pauperibus... Quia secundum b. Dionixium in De ecclesiastica Yerarchia... » (1-2) ; — « Sermo de assumptione b. Marie... Quid hoc audio de te... Quid nos tantilly... » (2v-3), suivi d'une note à l'usage des prédicateurs : « Nota quod ne sermo sit deffectuosus... » (3) ; — « Sermo de conceptione b. Marie. Que est ista que progreditur... Karissimi, predicator evangelicus, beatitudinis eterne preco... » (3v-4v) ; — « Sermo de quatuor festis principalibus b. Marie... Que est ista que progreditur... Verba ista sunt tocius curie celestis... » (4v-5v) ; — « Sermo de Purificatione. In mansuetudine suscipite... Secundum b. Gregorium, Mor. 23... » (6-7) ; — « Sermo de b. Francischo... Cujus est ymago hec et superscriptio... Secundum b. Gregorium, omelia 30... » (7v-8v) ; — « Sermo in dominica [in Quinquagesima]. Ecce ascendimus Jerosolimam... Karissimi, sicut scitis, finis est... » (9-10) ; — [Sermo in dominica IIa post Epiphaniam] « Tu servasti vinum bonum usque adhuc... In verbis istis spiritualiter intellectus... » (10-10v) ; — « Sermo de b. Francischo. Ad ymaginem similitudinis sue... Verba ista ad litteram scripta... » (11-12) ; — « Sermo de b. Johane Baptista. Magnus es tu et faciens mirabilia... Secundum Gregorium quia tute... » (12v-13) ; — « Sermo de angelis. Inmittit angelus Domini... Sanctus ille David, acceptus de ovibus... » (13v-14) ; — « In ascensione Domini. Exultavit ut gigas... Duo sunt inter cetera Christi misteria... » (14v-16) ; — « De asumpcione Domine nostre. Ad preceptum tuum elevabitur aquila... Quia, karissimi, Mater Domini... » [FRANCISCUS DE MAYRONIS] ; cf. éd. Bâle, 1498, f. CIV-CIIIV, avec variantes (16v-18) ; — « De Maria Magdalena. Permittuntur [sic pro : Remittuntur] tibi peccata tua... Sicut solent maximi principes... » [Idem], sermon abrégé ; cf. éd. cit., f. LXXXVIIIV-XCI (18-19v) ; — « De s. Johane Evangelista. Dillectus meus michi... Ostenditur b. Johannes prout inflamatus... » [Idem], résumé ; cf. éd. cit., f. XXIX-XXIXV (20) ; — « In festo apostolorum Petri et Pauli. Accepimus gratiam et apostolatum... Gloriosissimi christiane fidei religionis... » (20v-23v) ; — « Sermo de gratia divina acquirenda. Accepimus gratiam etc. Vivat, obsecro, anima mea ... quoniam... » (24) ; — « Accepimus gratiam etc. Restat ostendere via physionomica... » (24v-26) ; — « Sermo de beatitudine, sive gloria celesti, sive in festo Omnium sanctorum. Fons sapientie verbum Dei... Ecce ego sto prope fontem... In hoc festo precipue et anno... » (26-29) ; — « De nativitate Domine nostre. Egredietur virga de radice Jesse... Percutiet terram virga... Clementissimus pastor ovium... » (29v-32) ; — « Sermo de uno confessore pontifice. Rector fratrum et stabilimentum populi... Inter viros eximie sanctitatis... » (32v) ; — « De nativitate Domini. Transeamus usque Bethelem... Innocencius in quodam sermone de predicatione... » (34v-36) ; — « In die nativitatis Domini. Sol ortus est et humiles exaltati sunt... Beatus Augustinus, De Civitate Dei : Anima participacione... » (36-37v) ; — « Dominica infra octavas Nativitatis. Ecce positus est hic in ruinam... Secundum doctrinam Philosophi in diversis locis... » (38-38v) ; — « Dominica quarta in quadragesima. Sequebatur eum multitudo magna... Secundum Damascenum libro primo, capitulo XV°, diversitas actionum... » (39-40v) ; — « De Canane[a], dominica secunda [sic] in quadragesima [Feria 5a post dom. Ia in XLa]. Dimitte illam quia clamat... Si attendamus ordinem generacionis... » (41-42v) ; — « Dominica de Passione. Si veritatem dico vobis... Secundum sententiam Phylosophi primo Metaphysice... » (43-43v) ; — « In cena Domini. Hodie est rex et cras morietur... Omne agens ordinate prius inquirit... » (44-45) ; — « De resurectione. Hec dies quam fecit Dominus... Scilicet est ex dictis Philosophi in diversis locis... » (45v-47) ; — « Dominica in Quadragesima. Ecce nunc tempus acceptabile... Ut dicit Philosophus, secundo de Celo et mundo... » (47-48v) ; — « De b. Clara. Sicut lux meridiana clara est... Secundum Philosophum tertio Methaphysice, si res creatas... » (48v-49v) ; — « Sermo de Cruce. Vidit mulier quod bonum esset lignum... Sicut ex doctrina Philosophi primo Ethicorum... » (50-51) ; — « De s. Anthonio. Misit servum suum hora cene... Sicut in rebus naturalibus docet experiencia... » (51v-52v) ; — « De b. Johane Batista. Tu puer propheta Altissimi... Secundum doctrinam Hugonis in commento de angelica Jerarchia... » (53-54) ; — « De b. Bertholameo [sic]. Dedit illi contra inimicos potenciam... Racio docet et experiencia manifestat... » (54v-55) ; — « De b. Francischo. Amice, ascende superius... Dicit Philosophus quinto Physicorum quod motus... » (55v-56) ; — [De b. Bernardo] « Omnia parata sunt, venite ad nupcias... Sicut videmus in motu naturali... » (56v-57) ; — « De sacerdote novo. Vos elegit Dominus... Ut potest haberi ex dictis Dyonisii... » (57v-58v) ; — « De assumpcione Virginis gloriose. Elevetur tronus David super Israel... Videmus quod triplici racione aliqua corpora... » (58v-59v) ; — « De assumpcione Virginis. Veni de Libano sponsa mea... Secundum testimonium Scripturarum et humane consuetudinis... » (59v-61) ; — « De Trinitate. Tripliciter sol exurens montes... Secundum quod dicit Philosophus, tota nostra noticia... » (61-61v) ; — « De b. Francischo. Hic beatus in facto suo erit... Post doctrinam philosophorum et experienciam... » (62-62v) ; — [De b. Eligio] « Provideat rex virum sapientem... Secundum sententiam (secundum) sapientis primo Metaphysice . » (63-64) ; — « De resurrectione Domini. Tercia dies est hodie... Tripliciter alicujus rei non vise accipimus fidem certam... » (64-65) ; — «Stetit in medio discipulorum et dixit : Pax vobis... Ut dicit b. Augustinus undevicesimo de Civitate Dei... » (65v-67) ; — « De Omnibus sanctis... Gloriosa dicta sunt de te... Aperta est civitas... Doctore egregio Bernardo scilicet attestante... » (67-69) ; — « De b. Johane Batista. Hic venit in testimonium... Sicut potest probari ex dictis Philosophi et exemplis... » (69v-70) ; — « De b. Petro apostolo. Tu pasce populum meum Israel... Secundum sententiam Philosophi tertio Politicorum... » (70v-71) ; — « De assumpcione Virginis gloriose. Transibo in locum tabernaculi... Triplici ratione secundum philosophorum doctrinam aliqua moventur... » (71v-72v) ; — [De b. Francisco] « Adolescens, tibi dico surge... Consideranti sciderum revolucionem... » (73-74v) ; — [De s. Michaele] « Michael et angeli preliabantur... Sicut ex doctrina Phylosophi in pluribus locis patet... » (74v-76) ; — « De b. Nicholao. Petra fundebat michi rivos olei... Secundum philosophicam doctrinam, diversitas effectuum... » (76-77) ; — « In festo apostolorum Petri et Pauli. Fecit Deus duo luminaria magna... Secundum sententiam Philosophi secundo Methaphysice... » (77v-78) ; — « De b. Bertholameo. Vidi angelum fortem... Secundum dictum Philosophi, omnes transferentes... » (78v-79) ; — « Dominica in Quadragesima. Ductus est Jhesus in desertum... Sicut naturalium operationum multiplex experiencia... » (79v-80v) ; — « De s. Thoma apostolo. Ecce cognovi quoniam Deus meus es... Bernardus in sermone : Deus noverim me... » (81-81v) ; — « De sacerdote novo. Misit Dominus servum suum... Secundum quod dicit Philosophus primo Ethicorum, diversarum operationum... » (82-82bis) ; — « In purificatione Virginis. Parasti ante faciem omnium populorum... Si attendamus formationem rerum temporalium... » (82bisv-83v) ; — « De uno martire. Esto vir fortis, et prelia bella Domini... Secundum consuetudinem hominum... » (84-85) ; — « De festo Purificacionis. Lucerna splendens super candelabrum... Doctrina philosophorum et tradit... » (85v-86v) ; — « Feria quarta Cinerum. Cum jejunas unge caput tuum... Morum Philosophi doctrinam perlegens et attendens... » (87-88v) ; — « In quarta feria Cinerum. Cum jejunatis, nolite fieri sicut ypocrite... Sicut ex doctrina Philosophi primo Ethicorum potest colligi... » (88v-89v) ; — « In festo b. Lodovici [episcopi]. Surrexit rex de solio suo... Ut dicit Philosophus quarto Methaphysicorum... » (90-91v) ; — « De b. Jacobo. Vox tonitrui tui in rota... Secundum doctrinam philosophicam formarum naturalium... » (91v-92v) ; — [In festo Annunciationis] « Ecce concipies in utero... Secundum doctrinam Philosophi septimo de Animalibus, ad generationem... » (93-94) ; — « De s. Ludovico [episcopo]. Reposita est michi corona justitie... Secundum sententiam Philosophi secundo Phisicorum, omne agens... » (94-96).

A population-based study of first and second-line drug-resistant tuberculosis in a high-burden area of the Mexico/United States border

The resistance of 139 Mycobacterium tuberculosis (MTB) isolates from the city of Monterrey, Northeast Mexico, to first and second-line anti-TB drugs was analysed. A total of 73 isolates were susceptible and 66 were resistant to anti-TB drugs. Monoresistance to streptomycin, isoniazid (INH) and ethambutol was observed in 29 cases. Resistance to INH was found in 52 cases and in 29 cases INH resistance was combined with resistance to two or three drugs. A total of 24 isolates were multidrug-resistant (MDR) resistant to at least INH and rifampicin and 11 MDR cases were resistant to five drugs. The proportion of MDR-TB among new TB cases in our target population was 0.72% (1/139 cases). The proportion of MDR-TB among previously treated cases was 25.18% (35/139 cases). The 13 polyresistant and 24 MDR isolates were assayed against the following seven second-line drugs: amikacin (AMK), kanamycin (KAN), capreomycin (CAP), clofazimine (CLF), ethionamide (ETH), ofloxacin (OFL) and cycloserine (CLS). Resistance to CLF, OFL or CLS was not observed. Resistance was detected to ETH (10.80%) and to AMK (2.70%), KAN (2.70%) and CAP (2.70%). One isolate of MDR with primary resistance was also resistant to three second-line drugs. Monterrey has a high prevalence of MDR-TB among previously treated cases and extensively drug-resistant-MTB strains may soon appear.

Macronutrient composition of the diet and prospective weight change in participants of the EPIC-PANACEA study.

BACKGROUND The effect of the macronutrient composition of the usual diet on long term weight maintenance remains controversial. METHODS 373,803 subjects aged 25-70 years were recruited in 10 European countries (1992-2000) in the PANACEA project of the EPIC cohort. Diet was assessed at baseline using country-specific validated questionnaires and weight and height were measured at baseline and self-reported at follow-up in most centers. The association between weight change after 5 years of follow-up and the iso-energetic replacement of 5% of energy from one macronutrient by 5% of energy from another macronutrient was assessed using multivariate linear mixed-models. The risk of becoming overweight or obese after 5 years was investigated using multivariate Poisson regressions stratified according to initial Body Mass Index. RESULTS A higher proportion of energy from fat at the expense of carbohydrates was not significantly associated with weight change after 5 years. However, a higher proportion of energy from protein at the expense of fat was positively associated with weight gain. A higher proportion of energy from protein at the expense of carbohydrates was also positively associated with weight gain, especially when carbohydrates were rich in fibre. The association between percentage of energy from protein and weight change was slightly stronger in overweight participants, former smokers, participants ≥60 years old, participants underreporting their energy intake and participants with a prudent dietary pattern. Compared to diets with no more than 14% of energy from protein, diets with more than 22% of energy from protein were associated with a 23-24% higher risk of becoming overweight or obese in normal weight and overweight subjects at baseline. CONCLUSION Our results show that participants consuming an amount of protein above the protein intake recommended by the American Diabetes Association may experience a higher risk of becoming overweight or obese during adult life.

Risk of type 2 diabetes according to traditional and emerging anthropometric indices in Spain, a Mediterranean country with high prevalence of obesity: results from a large-scale prospective cohort study.

Background: Obesity is a major risk factor for type 2 diabetes mellitus (T2DM). A proper anthropometric characterisation of T2DM risk is essential for disease prevention and clinical risk assessement. Methods: Longitudinal study in 37 733 participants (63% women) of the Spanish EPIC (European Prospective Investigation into Cancer and Nutrition) cohort without prevalent diabetes. Detailed questionnaire information was collected at baseline and anthropometric data gathered following standard procedures. A total of 2513 verified incident T2DM cases occurred after 12.1 years of mean follow-up. Multivariable Cox regression was used to calculate hazard ratios of T2DM by levels of anthropometric variables. Results: Overall and central obesity were independently associated with T2DM risk. BMI showed the strongest association with T2DM in men whereas waist-related indices were stronger independent predictors in women. Waist-to-height ratio revealed the largest area under the ROC curve in men and women, with optimal cut-offs at 0.60 and 0.58, respectively. The most discriminative waist circumference (WC) cut-off values were 99.4 cm in men and 90.4 cm in women. Absolute risk of T2DM was higher in men than women for any combination of age, BMI and WC categories, and remained low in normal-waist women. The population risk of T2DM attributable to obesity was 17% in men and 31% in women. Conclusions: Diabetes risk was associated with higher overall and central obesity indices even at normal BMI and WC values. The measurement of waist circumference in the clinical setting is strongly recommended for the evaluation of future T2DM risk in women.

Nontuberculous mycobacteria in respiratory samples from patients with pulmonary tuberculosis in the state of Rondonia, Brazil

The main cause of pulmonary tuberculosis (TB) is infection with Mycobacterium tuberculosis (MTB). We aimed to evaluate the contribution of nontuberculous mycobacteria (NTM) to pulmonary disease in patients from the state of Rondônia using respiratory samples and epidemiological data from TB cases. Mycobacterium isolates were identified using a combination of conventional tests, polymerase chain reaction-based restriction enzyme analysis of hsp65 gene and hsp65 gene sequencing. Among the 1,812 cases suspected of having pulmonary TB, 444 yielded bacterial cultures, including 369 cases positive for MTB and 75 cases positive for NTM. Within the latter group, 14 species were identified as Mycobacterium abscessus, Mycobacterium avium, Mycobacterium fortuitum, Mycobacterium intracellulare, Mycobacterium gilvum, Mycobacterium gordonae, Mycobacterium asiaticum, Mycobacterium tusciae, Mycobacterium porcinum, Mycobacterium novocastrense, Mycobacterium simiae, Mycobacterium szulgai, Mycobacterium phlei and Mycobacterium holsaticum and 13 isolates could not be identified at the species level. The majority of NTM cases were observed in Porto Velho and the relative frequency of NTM compared with MTB was highest in Ji-Paraná. In approximately half of the TB subjects with NTM, a second sample containing NTM was obtained, confirming this as the disease-causing agent. The most frequently observed NTM species were M. abscessus and M. avium and because the former species is resistant to many antibiotics and displays unsatisfactory cure rates, the implementation of rapid identification of mycobacterium species is of considerable importance.

Digital inmigrants and digital natives expectation collection in the Andalusian Public Health System Virtual Library: communication with our users

The Andalusian Public Health System Virtual Library (Biblioteca Virtual del Sistema Sanitario Público de Andalucía, BV-SSPA) provides access to health information resources and services to healthcare professionals through its Website. This virtual environment demands higher users’ knowledge in order to satisfy of the need of information of our users, as digital natives as digital immigrants, improving at the same time the communication with all of them. 1. To collect clients' views and expectations according to their nature of digital natives and immigrants. 2. To know our online reputation. A Collecting User Expectation Questionnaire will be built, taking into account the segmentation of the BV-SSPA users’ professional groups of the Andalusian Public Health System. A pilot test will be run to check the survey dimensions and items about practices, attitudes and knowledge of our users. Two Quality Function Deployment (QFD) matrices will enable the BV-SSPA services to be targeted to our digital natives or digital immigrants, according to their nature, finding the best way to satisfy their information needs. We provide feedback on BV-SSPA: users can have the opportunity to post feedback about the site via the 'Contact us' section and comment about their experience. And Web 2.0 is a shop window, providing the opportunity to show the comments; and through time, our online reputation will be built, but the BV-SSPA must manage its own personal branding. Web 2.0 tools are a driver of improvement, because they provide a key source of insight into people's attitudes. Besides, the BV-SSPA digital identity will be analyzed through indicators like major search engine referrals breakdown, top referring sites (non search engines), or top search engine referral phrases, among others. Definition of digital native and digital immigrant profiles of the BV-SSPA, and their difference, will be explained by their expectations. The design of the two QFD matrices will illustrate in just one graph the requirements of both groups for tackling digital abilities and inequalities. The BV-SSPA could deliver information and services through alternative channels. On the other hand, we are developing a strategy to identify, to measure and to manage a digital identity through communication with the user and to find out our online reputation. With the use of different tools from quantitative and qualitative methodology, and the opportunities offered by Web 2.0 tools, the BV-SSPA will know the expectations of their users as a first step to satisfy their necessities. Personalization is pivotal to the success of the Site, delivering tailored content to individuals based on their recorded preferences. The valuable user research can be used during new product development and redesign. Besides positive interaction let us build trust, show authenticity, and foster loyalty: we improve with effort, communication and show.

Application of colon capsule endoscopy (CCE) to evaluate the whole gastrointestinal tract: a comparative study of single-camera and dual-camera analysis.

BACKGROUND AND STUDY AIMS Colon capsule endoscopy (CCE) was developed for the evaluation of colorectal pathology. In this study, our aim was to assess if a dual-camera analysis using CCE allows better evaluation of the whole gastrointestinal (GI) tract compared to a single-camera analysis. PATIENTS AND METHODS We included 21 patients (12 males, mean age 56.20 years) submitted for a CCE examination. After standard colon preparation, the colon capsule endoscope (PillCam Colon™) was swallowed after reinitiation from its "sleep" mode. Four physicians performed the analysis: two reviewed both video streams at the same time (dual-camera analysis); one analyzed images from one side of the device ("camera 1"); and the other reviewed the opposite side ("camera 2"). We compared numbers of findings from different parts of the entire GI tract and level of agreement among reviewers. RESULTS A complete evaluation of the GI tract was possible in all patients. Dual-camera analysis provided 16% and 5% more findings compared to camera 1 and camera 2 analysis, respectively. Overall agreement was 62.7% (kappa = 0.44, 95% CI: 0.373-0.510). Esophageal (kappa = 0.611) and colorectal (kappa = 0.595) findings had a good level of agreement, while small bowel (kappa = 0.405) showed moderate agreement. CONCLUSION The use of dual-camera analysis with CCE for the evaluation of the GI tract is feasible and detects more abnormalities when compared with single-camera analysis.

Osteosarcoma extraóseo en extremidad inferior

INTRODUCTION: Extraoseus osteosarcoma is a rare tumor confined in soft tissues but with histological features similar to bone osteosarcoma. CLINICAL CASE: We report the case of a young male affected extraosseous osteosarcoma. A detailed analysis of the clinical symptoms and evolution from the beginning of the process to the death of the patient, three years later, is performed. DISCUSSION: The different types of treatment and prognostic factors involving this disease are discussed CONCLUSIONS: Radical surgery followed by chemotherapy is the preferred form of treatment in extraosseus osteosarcoma.The latest advances in chemotherapy have improved the prognosis in this type of tumor

Recambios en un solo tiempo de prótesis de cadera y rodilla sobre terreno contaminado: nuestra experiencia

Objective: Evaluate the results obtained in the simultaneous replacement of a septic arthroplasty or a second septic replacement (implanting the prosthesis in a contaminated eld). Material and method: Series of 17 cases, with a mean age of 66.8 years and average follow-up of 49 months. The exclusion criteria were serious immunological depression and unknown germ or not sensitive to at least three antibiotics. After the intervention, the corresponding antibiotics were administered between six weeks and three months. Recovery was established as the normality for infection indicator variables at least nine months after the replacement. Results: 14 patients developed towards total recovery (follow-up at least 9 months and maximum 84 months). 3 cases presented relapse, all three carriers of Staphylococcus epidermidis (at 1, 3 and 7 months of follow-up respectively). The success percentage is 82.41% (average follow-up of 49 months). Conclusions: Simultaneous replacements is an interesting option for patients with plural pathologies as it o"ers a single operation, less morbidity, quicker return to activities to restore normal function and less associated costs

Dolor crónico no oncológico: proceso asistencial integrado. 2ª ed

Publicado en la página web de la Consejería de Igualdad, Salud y Políticas Sociales: www.juntadeandalucia.es/salud (Consejería de Igualdad, Salud y Políticas Sociales/ Profesionales / Nuestro Compromiso por la Calidad / Procesos Asistenciales Integrados). Este proceso reemplaza a la 1ª edición, editada en 2007: http://hdl.handle.net/10668/1350.