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Improvements in survival among cancer patients have revealed the clinical impact of cardiotoxicity on both cardiovascular and hematological and oncological outcomes, especially when it leads to the interruption of highly effective antitumor therapies. Atrial fibrillation is a common complication in patients with active cancer and its treatment poses a major challenge. These patients have an increased thromboembolic and hemorrhagic risk but standard stroke prediction scores have not been validated in this population. The aim of this expert consensus-based document is to provide a multidisciplinary and practical approach to the prevention and treatment of atrial fibrillation in patients with active cancer. This is a position paper of the Spanish Cardio-Oncology working group and the Spanish Thrombosis working group, drafted in collaboration with experts from the Spanish Society of Cardiology, the Spanish Society of Medical Oncology, the Spanish Society of Radiation Oncology, and the Spanish Society of Hematology., (Copyright © 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: There is a major gap in knowledge about the epidemiology of epilepsy in Mediterranean countries. The EPIBERIA group was formed with the aim of promoting the conducting of epidemiological studies in this region in order to improve this situation. This paper deals with the validation of a brief questionnaire for screening patients with epilepsy in the general population., Methods: We selected an English-language questionnaire previously validated by the Ottman group. It was translated, modified to suit the characteristics of the Spanish population, and administered to a sample of 200 patients (93 epileptics and 107 non-epileptic patient controls) sampled consecutively from 5 epilepsy units in different cities in Spain. Both groups were homogeneous in demographic variables and the control group was representative of the general population., Results: We obtained a sensitivity of 100% and a specificity of 74.77% for the least rigorous correction model for the questionnaire, with a sensitivity of 94.62% and a specificity of 99.07% for the most stringent correction model. The PPV ranged from 7.48% for the first case to 69.49% in the second, assuming an epilepsy prevalence of 2%., Conclusions: The questionnaire EPIBERIA is a valid Spanish tool for epilepsy screening in the general population in Spain., (Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.)

Introduction: Under Charcot's leadership, La Salpêtrière was transformed into one of the world's top neurology centres. However, there is little information regarding the patient care facilities which Charcot would have encountered upon his arrival in 1862., Development: A paper published in 1860 by Spanish physician Pedro González Velasco following a visit to that famous hospital is a valuable testimony to the quality of patient care just prior to Charcot's arrival. Although it essentially praises the institution, the article also describes the largely unsatisfactory conditions endured by patients with severe mental disorders, epilepsy and paralysis, who were locked inside cages with simple straw pallets on the floor for beds and open holes for toilets. Rather than an alienist, Velasco was a well-known surgeon and passionate advocate of positivism. As a personal friend and hospital fellow of Jose Maria Esquerdo's, with similar political affiliations, he had first-hand knowledge of the struggle to improve neuropsychiatric care in Madrid., Conclusions: Publishing his paper ultimately provided Velasco with a pretext for denouncing the deplorable care conditions endured by similar patients in Hospital General de Madrid. Meanwhile, Charcot would go on to improve the living conditions of inpatients at La Salpêtrière and found the specialty of neurology., (Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.)

Introduction: The Boston Naming Test (BNT) and the Token Test (TT) are frequently used in clinical practice to assess naming and comprehension., Objective: The aim of this paper is to present normative data for the BNT and for the TT as part of the NEURONORMA young adults Project., Material and Methods: A total of 179 Spanish healthy subjects from 18 to 49 years old were evaluated. Tables to convert raw scores to scaled scores are provided. Age- and education- adjusted scores are obtained by applying linear regressions., Results: The results show an effect of education in both tests, and a minimal effect of age and sex., Conclusions: The normative data obtained will be useful in the clinical evaluation of young Spanish adults., (Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier España. All rights reserved.)

Introduction: In clinical neuropsychology, normative data are necessary to relate the performance of a subject to a reference group. These normative data should be collected from a pertinent population taking into account sociodemographic and cultural factors., Objective: This paper describes the methods and sample characteristics of a series of Spanish normative studies on young adults (NEURONORMA young adults Project). The normative information was based on a series of selected, commonly used, neuropsychological tests covering attention, language, visual-perceptual abilities, constructional tasks, memory, and executive functions., Material and Methods: A sample of 179 cognitively normal subjects from 18 to 49 years was studied. Demographics, socio-cultural, and medical data were collected. The statistical procedure used in the normative studies is described., Results: Sociodemographic, family background, health habits, medical history and use of drugs are presented., Conclusions: The use of these norms should improve neuropsychological diagnostic accuracy in young Spanish subjects. These data may also be of considerable use for comparisons with other normative studies., (Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.)

Introduction and Objectives: Acute myocardial infarction is responsible for most of the deaths in developed countries and for a very large number of hospital admissions. Specifically in Spain, each year about 140,000 deaths and 5 million hospital stays are due to acute myocardial infarction, corresponding to health care costs reaching 15% of total expenditure. Therefore, this paper presents an exhaustive analysis of acute myocardial infarction and the related prognosis, such as recurrence and mortality., Methods: This observational study was carried out in Spain. Data were obtained using the Hospital Discharge Administrative Database from 2000 through 2007, inclusive. Specifically, 12,096 cases of acute myocardial infarction (8606 women and 3490 men) were reported during this period, with 2395 readmissions for this diagnosis. Readmissions were analyzed for frequency and duration using logistic regression and the Wang survival model. Mortality was analyzed using logistic regression., Results: Readmission rates were 50% for patients younger than 45 years and 38% for those older than 75 years (P<.001). Men were readmitted more frequently than women throughout the follow-up period. Variables related to hospital mortality from acute myocardial infarction were the presence of diabetes, previous ischemic heart disease, and cerebrovascular disease., Conclusions: Mid-term hospital readmissions are highly frequent in acute myocardial infarction survivors. Male sex, previous coronary heart disease, and the number of classical cardiovascular risk factors are the major risk predictors of this readmission. Our results highlight the need for improved medical care during acute myocardial infarction admission, integrated into secondary prevention programs., (Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Introduction and Objectives: The MOVI physical activity program has been shown to reduce adiposity and to improve serum lipid profiles in schoolchildren. However, MOVI may have not achieved its maximum potential effectiveness, as increased physical activity on weekdays may have been offset by more sedentary behavior at weekends. We therefore developed the MOVI-2 program, which includes physical activity at weekends as well. This paper reports the rationale and methods of a trial to assess the effectiveness of MOVI-2 in preventing overweight and reducing cardiovascular risk in 1200 4th- and 5th-grade primary schoolchildren in Cuenca, Spain., Methods: Ten schools were randomly assigned to MOVI-2 and 10 schools to the control group. MOVI-2 consisted of recreational physical activity in after-school time, including two 90-min sessions on weekdays and one 150-min session on Saturdays, during each week of one academic year. The control group was expected to follow their usual patterns of physical activity. The primary end points, which were assessed at the start and the end of the MOVI-2 program, were weight and height, waist circumference, skinfold thickness, body fat percentage, blood pressure, lipid profile, and insulin resistance. Secondary end points were physical activity, fitness, health-related quality of life, sleep quality, academic performance, enjoyment with physical activity, and physical self-concept., Conclusions: This study will assess whether MOVI-2 overcomes some potential limitations of physical activity interventions in children (Clinicaltrials.gov number NCT01277224)., (Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

The study of the long-term safety of biological therapies has been made possible because of the creation of several national registries. These have resolved some of the safety-derived doubts from the initial clinical trials, observational studies and meta-analyses. The main problem associated with biological therapy use is a moderate increase in the risk of serious infections when compared to conventional therapies. However, this risk can be reduced with adequate preventative measures. It seems that there is neither an increased risk of cancer nor elevated mortality with the use of biological drugs. These adverse events, along with others such as paradoxical induction of psoriasis, demyelinating diseases and administration-related reactions, have been studied in BIOBADASER, the Spanish Registry of Biological Therapies. This paper reviews the safety of biological agents with a special focus on BIOBADASER studies., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Purpose: The purpose of this paper is to describe the frequency and characteristics of uveitis associated with juvenile idiopathic arthritis at a tertiary referral centre in Spain., Methods: Review of clinical records. 205 children diagnosed with chronic juvenile arthritis over the last 15 years, of whom 26 presented anterior uveitis. Patients were classified according to their pattern of evolution, the time the uveitis was diagnosed with respect to the onset of arthritis, and the severity of uveitis at diagnosis., Results: The prevalence of uveitis was 12.7%. Of the patients affected with uveitis 71% were girls. The average age at which the arthritis was diagnosed was significantly earlier in the group of patients who developed uveitis (4.06 years). No differences were observed in the incidence of uveitis in girls and boys, nor in pauci/polyarticular affectation. ANA positivity was found in 84.6% of the uveitis-affected patients, this being significantly different to the ANA- group. The average age at which uveitis was diagnosed is 5.87 years. 48.1% of uveitis patients develop uveitis within 12 months of the onset of arthritis. This group presented more complications during the evolution of the condition. A total of 84.7% of the uveitis-affected patients presented with a final visual acuity of >0.5 during the observation period., Conclusions: In our study, the development of uveitis was significantly associated with an earlier age of diagnosis of the arthritis and with the presence of ANA positivity. No differences were observed between boys and girls, or between pauci and polyarticular groups. A greater prevalence of complications was observed in cases presenting with a shorter time interval between the diagnosis of arthritis and uveitis and in those that presented with complications on diagnosis.

Introduction: Many studies show that subjects with sequelae after stroke have a worse health perception in western societies. Due to the shortage of papers on the Spanish population in this regard, a study was carried out to assess health perception in hemiplegic patients 2 years after stroke in comparison with that of the general population and correlate health perception with demographic, clinical and functional variables., Methods: Cross-sectional study of 212 community stroke survivors. The main variables collected were: health perception assessed with the Short Form 36 (SF-36), disability assessed with the motor Functional Independence Measure (FIM) and Geriatric Depression Scale (GDS). Statistical tests used: chi2, Student t test and Spearman correlation coefficient., Results: In comparison with the Spanish general population, health perception in hemiplegic male stroke patients is diminished in all areas. In hemiplegic female patients, physical function is the only subscale significantly affected in all age groups. Variables related to worse health perception are: presence of depression, dependence and the belief of the need for kind of social support, A significant correlation was observed between SF-36 values and the motor FIM (r = 0.737 with physical function) and the GDS (r = -0.821 with mental health)., Conclusions: Health perception in hemiplegic patients 2 years after stroke is diminished in comparison with that 348 of the general population. Factors which determine worst health perception are depression, motor dependence, need of caregiver assistance and need of social support.

Objective: To quantify and analyze the information available internationally on Spanish scientific productivity in anesthesiology from 1983 through 1995., Material: Publications by Spanish authors indexed in three electronic databases: the Spanish Indice Médico (SIM), MedLine, and Embase (belonging to Excerpta Médica)., Method: A bibliometric study of productivity as reflected by entries in the 3 databases, quantifying documents in circulation, change over time in circulating documents, overlap, and article's characteristics., Results: During the period studied, a total of 2608 papers by Spanish anesthesiologists were indexed in the 3 databases (SIM 79%, Medline 54%, Excerpta Médica 29.5%). Annual growth was 16.7%, with a period of 10.2 years until duplication., Conclusion: Growth is exponential in anesthesiology, as in other disciplines, and the distribution satisfies Price's law. The 3 databases are the major collectors of the papers of Spanish anesthesiologists. The SIM and MedLine are the main indexers of Spanish-authored articles in the literature. Excerpta presents the largest growth on the compilation of articles. The inclusion of the three databases is essential in bibliographic searches and bibliometric studies on Spanish anesthesiology.

Unlabelled: Test Barcelona. Bilingüismo catalán-castellano. Adaptación lingüística de instrumentos neuropsicológicos., Background and Objectives: The present paper develops the Catalan version of the language subtests of the Barcelona Test (Peña-Casanova,1986) the original version of which was published in Spanish., Methods: To reach the Catalan version of the test it has been necessary to analyse the psycholinguistic variables of every item to then establish linguistically equivalent correlations., Results: There are some subtests for which no modifications have been needed. Nevertheless, and because of some psycholinguistic features of Catalan (Catalan's spelling is not completely free of ambiguity) some subtests have suffered substantial modifications. The following paper presents the justification of every modification based on the features of the Catalan language and also based on the original goals of the test. An appendix contains the final version of the Catalan adaptation for the language subtests of the Barcelona Test., Conclusion: The present paper represents an advance in the assessment of neurological patients with language disfunctions. It will permit an appropiate assessment for the Spanish-Catalan bilingual patients.

Patients about to undergo surgery are often taking drugs that alter hemostasis and affect anesthesia, particularly when neuroaxial techniques are used for subarachnoid or epidural anesthesia. The aim of this paper is to provide safety guidelines for regional anesthesia in patients receiving hemostasis-altering drugs, in order to reduce the risk of bleeding. We offer a detailed discussion of patients treated with inhibitors of platelet aggregation (emphasizing that such treatment alone is not a contraindication for neuroaxial blockade although certainly guidelines must be followed), unfractionated heparin (anesthesia should be started at least 4 hours after administration of this drug or 30 minutes before, provided pulmonary arterial pressure is normal), low molecular weight heparin (which should be administered 12 hours before or 12 hours after the anesthetic technique), and oral anticoagulants (provision of regional anesthesia depends mainly on International Normalized Ratio monitoring). We also stress that removal of catheters should follow criteria similar to those listed above, that the risk of complications due to bleeding increases considerably in association with these drugs, and that adequate neurological monitoring is essential during postoperative recovery. Overall, the final decision to use regional anesthesia in patients receiving drugs that alter hemostasis must be made on an individual basis after assessment of benefit and risk.

Purpose: To analyze the anatomical and functional results obtained in post- surgical suprachoroidal hemorrhages treated from 1998 to 2000 and to review the information on the series of this complication that have been published during the last five years and which included at least 10 patients., Methods: A retrospective analysis of the medical records of patients with suprachoroidal hemorrhages at the Instituto Universitario de Oftalmobiología Aplicada (IOBA) - University Hospital of Valladolid. Bibliographic search by Med-Line/Pub Med from 1995 to 2000 was performed., Results: 8 patients who fulfill these criteria have been treated and 8 papers, also complying with the criteria, have been found., Conclusions: The functional and anatomic results of post-surgical suprachoroidal hemorrhages are still poor, even though the prognosis seems to have improved in the last 20 years. The standardized classification of massive suprachoroidal hemorrhages based on severity and the standardization of the follow-up would improve these results.

Through his visit to Spain in 1946, Robert R. Macintosh exercised considerable influence on the introduction and development of modern anesthesia in this country. This paper reviews the technical advances Mackintosh introduced and considers how his visit was one of the most important factors in unleashing the development of the profession here. Also reviewed are the other visits Mackintosh made in the course of his career. Those trips were less important, with the exception of a 1937 visit that inspired the design of the Oxford vaporizer, a technical concept based on simplicity, safety and the anesthesiologist's experience.

Background: The development reached by many countries of our planet has allowed that in them most of the infectious diseases have diminished and that the life expectancy is over the 75 years of life. As a result of this, degenerative and chronic diseases are every day more prevalent and their treatments are longer and complex. To value quality of life in these patients and the effect of the therapy on health is at the moment a main goal of public health., Objectives: To know the origin, the evolution, and the theoretical foundation of the concept of the quality of life, as well as their measurement methods. On the other hand, to describe the characteristics of the different available questionnaires in Spain to measure the quality of life, either of generic or specific for neurologic illness., Material and Methods: The most important questionnaires which have been adapted and validated into Spanish have been revised. An exhaustive revision of the bibliography related with quality of life and neurology was carried out, and all the questionnaires described in these processes were revised., Results: We describe the philosophy and concepts of health, quality of life (QOL) and health related quality of life (HRQL). The following generic questionnaires are described: the Nottingham Health Profile (NHP), the Sickness Impact Profile (SIP), the Medical Outcomes Study Short Form (SF-36), the European Profile of Quality of Life (EuroQoL), the Questionnaire of Quality of Life (CCV) and the Profile of Life quality in the Chronically ill (PLC). In an exhaustive bibliographical revision on quality of life and neurology, 52 indexed papers appeared, of those which only twelve were related with those subject. The following specific questionnaires are described: Qualité de Vie et Migraine (QVM), the Parkinson's Disease Questionnaire (PDQ-39), the Functional Status Questionnaire (FSQ), the Quality of Life in Epilepsy Inventory (QOLIE-89) and their variant of 31 items. Finally two questionnaires ad hoc are described to study migraine and epilepsy., Conclusions: The incorporation of HRQL measures in patients with neurological illnesses is an increasing and valued practice by its specialists. We observe that the availability of generic tools to measure the HRQL in Spanish is wider every day, although most of these come from other cultures. The process continued in their transcultural adaptation and validation allows us to have some tools of great reliability and effectiveness that facilitate its use. In relation to the specific questionnaires on neurologic process, the supply is considerably smaller due to the recent appearance of these methods in this clinic area.

Objective: To describe the original research articles published in Revista Española De Anestesiología y Reanimación (REAR) from 1987 through 1996, as well as to characterize the citations included in those articles., Material and Methods: The 299 articles published as original research in REAR over the past 10 years (1987 through 1996) were analyzed. The bibliographic aspects examined were coauthorship (authors/paper index), citations per article, isolation in function of language of publication of references, degree of obsolescence of articles based on year of references cited ("half-life"), self-citation and degree of dispersion of citations., Results: The authors/paper index was 5.16 +/- 1.62. No statistically significant difference was found in number of authors over the 10-year study period. Mean number of references cited per article was 24.05 +/- 12.02. We found statistically significant differences for 1993 and the period 1987 to 1988, and 1994 and the year 1987 (p < 0.001). The "half-life" of articles was 6 when analyzing on a year-by-year basis; this index ranged from 5.5 to 7, with no significant annual differences. REAR articles accounted for 4.02% of all citations. English was the most frequent language of cited publications, with 6,240 references (86.8%), followed by Spanish with 621 (8.64%), French with 223 (3.1%) and German with 74 (1.03%). Of the 7,191 references analyzed, 6,447 (89.65%) were of scientific journals. Books are the second most commonly cited type of document, with 623 (8.66%) citations. Analyzing journals cited 25 or more times, we found that 74.19% of the articles (4,783/6,447) had been published in 5.3% of the journals (36/678). Seven journals of anesthesia, which represented 1.03% of all journals (7/678) appeared in 52.81% of references of this type (3,405/6,447)., Conclusions: The number of authors of original research articles published in REAR in the last 10 years was high. Spanish authors in anesthesiology cite mainly literature in English; use up-to-date sources of information, mainly journals; and take a large proportion of information from a small number of journals, which are those of greatest international impact in our specialty.

Parkinson's disease is one of the most frequent chronic diseases. Prevalence varies widely across geographic areas and studies. Although geographic variation could be produced by environmental factors, most of the studies have different methodology, and the diagnostic criteria which have been used are not homogeneous. Population-based door-to-door studies are an accurate method for determining disease frequency in a community. This paper analyses diagnostic criteria in Parkinson's disease and its influence on the prevalence estimated by this type of studies.

This paper reviews the circumstances surrounding the first prize given in Barcelona in 1849 for a report on anesthesia. The two winning studies by the Barcelona physicians Emilio Pi y Molist and José Antonio Reynés are summarized, evaluated and compared with other similar contemporary works.

Based on the importance of document files and first-hand bibliographic sources for studying the history, we have recently investigated the chapter of Doctoral Thesis and Reports on anesthetic topics since we believe that these are fundamental to gain insight into the knowledge of our history. This investigation was planned to find such documents by reviewing the data of several Spanish archives and libraries. We collected 80 works: 14 Reports and 66 Doctoral Theses performed during a period of 95 years (heuristic limits 1847-1942). These papers were classified in several subgroups according to the subjects they deal with: 21 works on inhalation anesthesia, 7 on intravenous general anesthesia, 20 on spinal anesthesia, 10 on locoregional, 7 on anesthesia and metabolism, 12 on obstetric anesthesia, and 3 works on varied anesthesia issues. Analysis of these documents revealed that the authors (physicians and Spanish medical corporations) undertook an accurate consideration of the more relevant scientific subjects at the time of their investigation. We conclude that the works analyzed in the present study represented the beginning of the Spanish investigation on anesthesia. Further investigations may contribute to enrich our historiography.

A 31 years old woman with a terminal phase dilated cardiomyopathy and a ventricular ejection fraction of 0.12 was admitted to our hospital to be included in the cardiac transplantation program. When entering the hospital her condition worsened and she suffered an electromechanical dissociation that needed cardiopulmonary resuscitation. Few hours later, energetic medical treatment could not improve her haemodynamic situation. Having no adequate organ available for emergency transplantation, a total orthotopic prosthesis (Jarvik-7-70) implantation was decided. Anesthesia was maintained with fentanyl (50 micrograms/kg), droperidol (0.23 mg/kg) and diazepam (0.25 mg/kg). There were no incidents during or after extracorporeal circulation bypass; despite the use of furosemide (100 mg) and mannitol (1 g/kg) diuresis was less than 40 ml/h. After by-pass, pulmonary hypertension was observed and treated with sodium nitroprusside (1 microgram/kg/min) and isoproterenol (5 micrograms/kg/min), as well as increasing the right ventricle working pressure of the device from 40 to 70 mmHg, obtaining haemodynamic stabilization and good tissular perfusion. After operation, the patient arrived to the Recovery Unit in a steady situation, with a cardiac index of 2.87 l/min/m2 and a diuresis of 150 ml/h. Some other aspects of the anaesthetic management are also discussed in this paper.