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En el último tercio del siglo XIX se produjo una cierta polémica acerca del carácter megalítico de la ermita de San MIguel de Arrechinaga. Hemos recogido más de cincuenta testimonios publicados entre 1871 -inicio de la polémica- y 1899, debido a autores vascos, catalanes, castellanos, andaluces, valencianos, gallegos, irlandeses. norteamericanos, franceses, belgas, ingleses, alemanes, suecos y portugueses. La mitad de los autores abogan por su carácter megalítico (generalmente los que no han visitado el monumeto y sólo lo conocen "de oidas") frente a la otra mitad que no opina sobre el tema o considera que la disposición de las piedras que cubren el altar se debe a la acción de la naturaleza (la gran mayoría de los autores vascos).

Introduction: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and its incidence and prevalence increase with age, as does cognitive impairment (CI)., Development: Prospective observational studies have shown that AF can significantly increase the risk of stroke, which is an important cause of CI, but it has also been established that the association between the two diseases may be independent of stroke and other shared risk factors. However, the pathophysiological mechanism linking the two entities is still unclear as it is likely to be a multifactorial process (cardioembolic silent strokes, proinflammatory states and cerebral hypoperfusion), with preliminary evidence of a link between atrial cardiomyopathy without AF and cognitive dysfunction. The association between AF and CI raises the possibility that therapeutic interventions aimed at managing this arrhythmia may prevent or delay the onset of CI. Anticoagulation has been shown to significantly reduce the risk of stroke in patients with AF and, with it, the risk of CI, but the effect of other therapeutic interventions such as rhythm and rate control is inconclusive., Conclusions: AF and CI are an important health problem worldwide and the demographic trend predicts exponential growth of both conditions in the coming years. Therefore, it seems necessary to increase our knowledge of the pathophysiological mechanisms related to them in order to establish effective preventive strategies.

Objective: To evaluate long-term quality of life (QoL) in patients who have experienced a stroke and to analyse differences in QoL between sexes., Methods: We conducted a descriptive, cross-sectional, observational study to gather sociodemographic variables and risk factors; data were also obtained on QoL, mood, and functional status using validated scales. The study was approved by our centre's ethics committee., Results: Our final sample included 124 patients; mean age was 71.30±11.99 years. In the QoL study, the EuroQol-5D dimensions in which participants presented most problems were anxiety/depression (66.7%) and pain/discomfort (62.2%). We found significant inter-sex differences in the dimensions of mobility and usual activities (P=.016 and P=.005, respectively). Women also achieved substantially poorer EuroQoL-5D index values than men (0.45±0.45 vs. 0.65±0.38; P=.013). QoL was found to be associated with dependence for the activities of daily living (r=0.326; P=.001) and depressed mood (r=-0.514; P<.0001). According to the predictive model for the EQ-5D index, 72% of the score on QoL items is explained by functional status, dependence for the activities of daily living (basic and instrumental), and depressed mood. Being married, in contrast, seems to be a protective factor., Conclusion: Stroke survivors have poor long-term QoL; this is more marked in women than in men, especially in the dimensions of mobility and usual activities., (Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)

We present a review of bioethical aspects of limiting patients 65 years or older to lung transplantation. Lung transplantation is a therapeutic option in patients with severe advanced respiratory diseases, progressive despite medical treatment to prolong the expected survival. It is an aggressive surgical treatment, and the patient must complete a lifelong immunosuppressive treatment. Given the donor shortage, access to this treatment is regulated by organ transplant societies, which develop patient selection guidelines. One contraindication to transplantation has been the age of 65 years, sustained by the poor results of older patients and following utilitarian bioethics concept. For the time being there is no unified selection criteria to identify older patients susceptible to have a worse outcome after transplantation. Applying a personalist bioethics, we propose to use selection criteria based on frailty scales to identify those frail patients more likely to die after the transplant procedure.

Introduction: Evidence supports that admitting patients with stroke during different hospital work periods is related to distinct outcomes. We aimed to analyse outcomes in patients according to the period and time of admission to the stroke unit., Methods: Retrospective study. For purposes of data analysis, patients were grouped according to the following time periods: a) day of the week, b) period of the year, c) shift. We analysed demographic characteristics, stroke type and severity, and the percentage undergoing thrombolysis in each group. The measures used to evaluate early outcomes were the National Institutes of Health Stroke Scale (NIHSS), neurological complications (NC), and in-hospital mortality. Functional outcome at 3 months was determined using the modified Rankin scale., Results: The stroke unit admitted 1250 patients. We found NC to be slightly more frequent for weekend admissions than for weekday admissions, but this trend does not seem to have influenced in-hospital mortality. Regarding functional outcome at 3 months, 67.0% of weekday vs. 60.7% of weekend admissions were independent (P=.096), as were 65.5% of patients admitted during the academic months vs. 63.5% of those admitted during summer holidays (P=.803). We identified no significant differences in 3-month mortality linked to the day or period of admission; however, for the variable 'shift', 13.2% of the patients died during the morning shift, 11.5% during the afternoon shift, and 6.0% during the night shift (P=.017). We identified a trend toward higher rates of thrombolysis administration on weekdays, during the morning shift, and during the academic months., Conclusions: Time of admission to the stroke unit did not affect early outcomes or functional independence at 3 months., (Copyright © 2015 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To compare the methods of right ventricle segmentation in the short-axis and 4-chamber planes in cardiac magnetic resonance imaging and to correlate the findings with those of the tricuspid annular plane systolic excursion (TAPSE) method in echocardiography., Material and Methods: We used a 1.5T MRI scanner to study 26 patients with diverse cardiovascular diseases. In all MRI studies, we obtained cine-mode images from the base to the apex in both the short-axis and 4-chamber planes using steady-state free precession sequences and 6mm thick slices. In all patients, we quantified the end-diastolic volume, end-systolic volume, and the ejection fraction of the right ventricle. On the same day as the cardiac magnetic resonance imaging study, 14 patients also underwent echocardiography with TAPSE calculation of right ventricular function., Results: No statistically significant differences were found in the volumes and function of the right ventricle calculated using the 2 segmentation methods. The correlation between the volume estimations by the two segmentation methods was excellent (r=0,95); the correlation for the ejection fraction was slightly lower (r=0,8). The correlation between the cardiac magnetic resonance imaging estimate of right ventricular ejection fraction and TAPSE was very low (r=0,2, P<.01)., Conclusion: Both ventricular segmentation methods quantify right ventricular function adequately. The correlation with the echocardiographic method is low., (Copyright © 2012 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Stroke patients have a high risk of presenting complications, the appearance of which can condition the prognosis of the stroke. We studied the frequency and impact of the onset of several different complications on the early and mid-term prognosis of these patients., Patients and Methods: We conducted an observation-based study of the patients admitted to a stroke unit. The complications that occurred while hospitalised were recorded, a distinction being drawn between neurological and medical complications. The study examined their influence, according to the subtype of stroke, on intra-hospital mortality and that at 90 days, as well as on the functional situation at 90 days, by analysing the clinical factors that are predictive for the appearance of complications., Results: The sample consisted of 847 patients. Altogether, 29.5% of the patients presented complications, which were more frequent in haemorrhagic stroke (50.5% versus 26.6%; p < 0.0001). The most usual complications were of a neurological nature (21%). For both subtypes, the presence of complications was associated with a higher rate of mortality both in hospital (2.1% versus 12.6%; p < 0.0001) and at 90 days (5.7% versus 29.6%; p < 0.0001), and a lower probability of independence at 90 days (72.9% versus 30.4%; p < 0.0001). The severity of the stroke on admission revealed itself as the most powerful predictor of the onset of any type of complication., Conclusions: The appearance of complications during the acute phase of the stroke has an adverse influence on mortality and on the functional prognosis. The identification of predictive factors could reduce the impact upon the progress of acute stroke patients.

Objective: Patients with acute stroke are more likely to survive and achieve independence if they are treated in a stroke unit. Available information in our setting is scarce. We analyse the outcomes of our patients on the basis of cumulative experience in a stroke unit., Patients and Methods: A retrospective cohort study of patients admitted to a stroke unit. We differentiate between two groups according to the year of admission: group A (July 2007-December 2009) and group B (January 2010-December 2011), analysing early outcome based on the score on the National Institute of Health stroke scale and mortality at discharge, and medium-term outcome in terms of mortality and functional status according to the modified Rankin scale at three months., Results: A total 1070 patients were included. There were no differences between groups with respect to favourable outcome (68.3% vs 63.9), hospital mortality (5.1% vs 6.6%), or 90-day mortality (12.8% vs 13.1%). The percentage of patients who were independent at 90 days was greater in group B (56.3% vs 65.5%, P=.03). In the multivariate analysis adjusted for stroke subtype and fibrinolytic therapy, the association between patient independence and admission period remained present., Conclusions: The probability of functional independence in our patients increased alongside accumulated experience in our stroke unit with no differences in mortality., (Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.)

Introduction: Type 1 neurofibromatosis is the most common neurocutaneous syndrome. Most published case series study the paediatric population., Material and Methods: Cross-sectional study of cases of type 1 neurofibromatosis from neurology departments that were recorded in a database. We analysed the different clinical variables providing the diagnosis as well as demographic and neuroradiological variables., Results: We found a total of 31 patients with type 1 neurofibromatosis. The mean age was 28.9 years and 58.4% were women. Subjects with unidentified bright objects (UBOs) were younger than those without them (22.45±8.22 years vs. 32.5±10.64; P=.011). In contrast, subjects with neurofibromas were older than those without them (30.56±10.68 years vs. 18.25±4.34; P=.032). No sex differences were found in the presentation of clinical or radiological variables. Seven patients (22.6%) had tumours; 3 were optic pathway gliomas (1 bilateral), 3 were plexiform neurofibromas, and 1 was a pilocytic astrocytoma in the brainstem., Conclusions: Patients with type 1 neurofibromatosis presented both peripheral neurofibromas and tumorous lesions of the central nervous system. Subjects with neurofibromas were older than those who did not present them, while subjects with UBOs were younger than those without such lesions., (Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.)

Multiple Endocrine Neoplasia type 1 syndrome (MEN1) is characterized by the presence of tumors in parathyroid glands, anterior pituitary gland, endocrine pancreas and duodenum. However, other tumors may also occur. One of them is the carcinoid tumor, which in this context, is more common in the gastrointestinal tract. Less common is the presence of carcinoid tumors of bronchial origin, which with histologic confirmation, may occur in 5-8% of cases and that appears more frequently in patients with hypergastrinemia. We report a patient with MEN1 syndrome, hypergastrinemia and an incidental finding in a somatostatin receptor scintigraphy of an unsuspected bronchial carcinoid tumor that was confirmed histologically., (Copyright © 2012 Elsevier España, S.L. y SEMNIM. All rights reserved.)

Objective: This study has aimed to analyze the evolution of patients diagnosed with differentiated thyroid carcinoma (DTC) with a negative (131)I-Na whole body scan (WBS), high levels of serum thyroglobulin (Tg) and negative (18F)fluorodeoxyglucose positron emission tomography (PET-FDG) study., Material and Methods: Twenty-three patients diagnosed and treated for DTC were studied retrospectively. Patients were aged between 23 and 83 and had shown, between January 2001 and December 2002, negative WBS, Tg values in a range of suspected recurrence or metastasis (Tg>2 ng / mL with thyroid hormone withdrawal) and a negative PET-FDG study. The patients were monitored clinically, radiologically and analytically for a minimum period of 4 years. After this, a new evaluation was made of their state of disease with a control WBS, also observing the evolution of Tg. All WBS were performed with a 185 MBq diagnostic dose of (131)I-Na., Results: In 18/23 patients, Tg decreased and in 5 it increased. Four patients (17%) were free of active disease (negative WBS Tg<2 ng / mL). A total of 16 patients (70%) were free of disease according to the WBS but had elevated Tg. Three patients (13%) had disease and high levels of Tg, two of them with positive WBS and the third with (99m)Tc-MIBI scan and CT positive., Conclusions: Most patients with a negative WBS, high Tg serum levels and negative FDG PET had good evolution, with descending Tg levels, normal levels even being reached in a significant percentage of them., (Copyright © 2011 Elsevier España, S.L. y SEMNIM. All rights reserved.)

Aim: To evaluate the efficacy and clinical impact of the FDG-PET in the diagnosis of suspicion of recurrence of medullary thyroid cancer (MTC) in patients with elevated serum calcitonin and negative imaging test., Material and Methods: We performed a retrospective study of 31 consecutive cases from february 2001 to october 2007 of 17 women and 14 men, mean age 56.2 years (range: 26-88), with anatomical-pathology diagnosis of medullary thyroid cancer and suspicion of recurrence due to abnormal elevation of calcitonin and negative imaging tests. All of the patients underwent whole body FDG-PET scan with a dedicated PET or PET-CT 60 minutes after intravenous injection of 333-434 MBq of (18)F-FDG. Results were confirmed by pathology study in 45.2% of the patients and by clinical follow-up with a mean of 4 years (range: 16 m-8 years), Results: Sensitivity was 88%, specificity 84.6%, positive predictive value 88%, negative predictive value 84.6% and diagnostic accuracy 87%. The results of the FDG PET modified the therapeutic strategy in 14 cases (45.2%). A comparison was made of the mean values of calcitonin using the Student's "t" test between positive PET studies for the disease and negative ones. No significant differences were found (P=.3)., Conclusions: In patients with MTC and suspected recurrence with elevated calcitonin and negative imaging test, the FDG is the best test for the diagnosis of occult recurrence in MTC with elevated calcitonin and negative imaging techniques with elevated clinical impact. It facilitates the therapeutic management of the patients with MTC recurrence, and should be included in the diagnosis algorithm in these patients., (Copyright © 2011 Elsevier España, S.L. y SEMNIM. All rights reserved.)

Objectives: Clinical and functional outcome of the knee after Unicompartmental Knee Arthroplasty (UKA) and its correlation with lower limb mechanical axis correction., Material and Methods: We have reviewed the outcome of 29 UKA, corresponding to 29 patients, with an average follow-up of 4.5 years (3-6 years). The distribution was, 21 women and 8 men, 11 unicompartmental osteoarthritis, 17 femoral condyle necrosis and 1 tibial plateau necrosis, and 27 medial versus 2 lateral affected compartments. The clinical-functional situation of the knees was assessed through the Knee Society Score (KSS), and the mechanical axis through long standing film. To calculate the statistical non-parametric correlation between the different parameters, Spearman's coefficient was used., Results: In the last review, the increases in the mean clinical KSS and functional KSS were significantly different, with +31.24 (±15.7) and +43.66 (±18.4) points, respectively. The mean change in the femorotibial angle was 2°±4°. We did not find any correlation with statistical significance between the average increases obtained in KS scores and: the alignment of the knee before and after the surgery; the thickness of the inserted polyethylene; the variation of the posterior tibial inclination; Insall-Salvati's index. There was no statistically significant association between the variation in the total KS score and the type of implant or the surgical technique used., Conclusion: We did not find any correlation between the clinical results and the radiological measurements in this population., (Copyright © 2011 SECOT. Published by Elsevier Espana. All rights reserved.)

Objectives: To describe the activity in the stroke unit (SU) of the Hospital de Caceres as well as the demographic characteristics and cardiovascular risk factors in our patients. To determine the patient's functional status at discharge., Material and Methods: A descriptive study of 432 patients admitted consecutively in the SU of the Hospital de Caceres from October, 2008 to May, 2010 was carried out. The different study variables (demographic, risk factors, dependence) were determined and analyzed., Results: The patient prototype was a 71-year old-man from the rural environment, with hypertension, hyperlipidemia, diabetes, who had an ischemic stroke. On medical discharge from the stroke unit (SU), the patient had a mild functional dependence, after and average stay of 2.8 days in the SU., Conclusions: All patients who suffers a stroke should be attended by and benefit from the care provided in a SU. These units are organizational models that improve patient care in the acute phase, this resulting in lower mortality and disability in these patients., (Copyright © 2010 Elsevier España, S.L. y SEEIUC. All rights reserved.)

Objectives: The aim of this study was to compare a semiautomatic segmentation method to quantify the function of both ventricles in magnetic resonance imaging (MRI) with the manual tracing method., Material and Methods: We examined 17 patients with diverse cardiovascular diseases on a 1.5 Tesla MRI unit (Magnetom Symphony Quantum; Siemens Medical Systems, Erlangen, Germany) using the following parameters: maximum gradient, 30 mT/m; and slew rate, 125 T/m/s. In all studies, we acquired images in cine mode in the short axis (SSFP, 6mm slice thickness, from the base to the ventricular apex) with breath holding. To reduce the user interaction, we used only one image per patient to initiate the semiautomatic method. The semiautomatic method was based on a specifically designed algorithm of regional growth and border detection. We quantified the end-diastolic volume (EDV), end-systolic volume (ESV), and the ejection fraction (EF) for both ventricles in all patients., Results: No significant differences between the two segmentation techniques were found in the quantification of either ventricle (p>0.05). The difference in the volumes, although nearly significant, are clinically irrelevant. The correlation for the estimation of left ventricular function was excellent (r>0.9), and the correlation for the estimation of right ventricular function was good (r>0.7)., Conclusions: Our semiautomatic segmentation method enables the function of both ventricles to be quantified as accurately as the conventional method., (Copyright © 2010 SERAM. Published by Elsevier Espana. All rights reserved.)

Introduction: Arteriosclerosis of the extra-cranial arteries is believed to be responsible for almost one-third of all ischaemic strokes. The sound diagnosis of the degree of stenosis is essential in deciding the best therapeutic strategy. Although cerebral angiography is considered the reference technique, ultrasound study (UST) is a more readily available, non-invasive and well-established procedure for quantifying carotid stenosis. However, on being a dependent exploratory technique, it is recommended that each laboratory validates its results against angiography., Objectives: To establish the validity of the neuro-ultrasound study in our laboratory for use in the diagnosis of extracranial atheromatous disease, and determine its capacity to quantify the degree of stenosis in the internal carotid artery., Material and Methods: A retrospective study of patients with extracranial carotid atheromatous disease, in whom the diagnostic process was carried out with carotid ultrasound as well as supra-aortic trunk digital-subtraction angiography., Results: A total of 254 carotids were evaluated and the degree of stenosis being classified into > 50%, 70-99% and 100%. The UST for the first group had a sensitivity (Se) of 97%, a specificity (Sp) of 90%, a positive predictive value (PPV) of 94.6% and a negative predictive value (NPV) of 94.2%. The second group had an Se of 96.4%, Sp 93%; PPV 94.4% and NPV 95.4%. The respective values for carotid occlusion were, 85%, 96.8%, 80% and 97.8%., Conclusions: Our data validates the ability of UST performed in our Laboratory to diagnose the degree of carotid stenosis.

Serotonin (5-hydroxytryptamine; 5-HT) has been shown to produce vascular sympatho-inhibition in a wide variety of isolated blood vessels by activation of prejunctional 5-HT1 receptors. After considering the mechanisms involved in modulating neuroeffector transmission, the present review analyzes the experimental findings identifying the pharmacological profile of the 5-HT receptors that inhibit the sympathetically-induced vasopressor responses in pithed rats. Thus, 5-HT-induced sympatho-inhibition has been shown to be: (i) unaffected by physiological saline or by the selective antagonists ritanserin (5-HT2), MDL72222 (5-HT3) or tropisetron (5-HT3/4); (ii) blocked by methysergide, a non-selective 5-HT1/2 receptor antagonist; and (iii) potently mimicked by 5-carboxamidotryptamine (5-CT), a non-selective 5-HT1 receptor agonist, as well as by the selective agonists 8-OH-DPAT (5-HT1A), indorenate (5-HT1A), CP93,129 (5-HT1B), and sumatriptan (5-HT1B/1D). These findings show the involvement of prejunctional 5-HT1 receptors. With the use of selective antagonists, it has been shown subsequently that the sympatho-inhibition induced by indorenate, CP93, 129, and sumatriptan was selectively antagonized by WAY100635 (5-HT1A), cyanopindolol (5-HT1A/1B), and GR127935 (5-HT1B/1D), respectively. These results demonstrate that the 5-HT1 receptors mediating sympatho-inhibition on the systemic vasculature of pithed rats resemble the pharmacological profile of the 5-HT1A, 5-HT1B, and 5-HT1D subtypes.

Aim: To evaluate the efficacy and clinical impact of FDG-PET in patients with suspected recurrent ovarian cancer., Methods: Between October 2001 and October 2006, we retrospectively studied 49 FDG-PET performed in 40 women (age: 52.4 +/- 12.2 years) with ovarian cancer, who had suspicion of recurrent disease by positive morphologic imaging tests (MIT) or increased tumour markers and negative MIT. All patients underwent whole body FDG-PET after the injection of 370-434 MBq of (18)FDG. The results were confirmed by histology in 31 cases, and by clinical-radiological follow-up in 18., Results: Prevalence of disease was 79.6 %. We obtained a global sensitivity and positive predictive value of 87.2 % and 87.2 %, and an accuracy of 79.6 %. Results led to a change in the patient's management in 25 cases (51 %). Subgroup results were: Sensitivity of 81.8 % in patients with increased tumour markers and negative MIT, and 89.3 % in patients with operable malignant lesions., Conclusions: FDG-PET has high sensitivity and clinical impact in patients with suspicion of recurrent ovarian cancer. Better results were obtained in patients with increased tumour markers and negative MIT.

Objectives: Recent years have seen growing interest in the development of algorithms for computer-assisted diagnosis (CAD) for the detection of pulmonary nodules on both plain-film radiographs and computed tomography (CT) studies. The purpose of CAD algorithms in this context is to alert radiologists to suspicious radioopacities that might represent cancer in the images. We are developing a CAD system for the detection of pulmonary nodules on helical CT images., Material and Methods: We collected cases of patients with pulmonary nodules examined with helical CT. A total of 64 nodules, including both calcified and noncalcified lesions, ranging from 3 to 30 mm in diameter were included in the study. Studies were acquired on one 4-slice and one 64-slice CT scanners. Three chest radiologists at two institutions interpreted the studies to determine whether pulmonary nodules were present. We calculated the sensitivity and the number of false positives per image to evaluate the CAD system., Results: We have developed and evaluated an algorithm for the automatic detection of pulmonary nodules on CT images. For a sensitivity of 76%, the false-positive rate was 1.3 per image., Conclusions: Our preliminary results suggest that the system might be useful for radiologists in the detection of pulmonary nodules on helical CT images.

Introduction: (131)I whole body scanning (WBS) is useful in the follow-up of patients with differentiated thyroid carcinoma (DTC). The need to follow a low-iodide diet (LID) to optimize WBS is widely recognized but there are few reports that justify this practice. The aim of this study was to assess levels of urinary iodide in patients who underwent WBS in our service and the possible impact of some changes to the diet on these levels., Patients and Method: Between January 2004 and December 2005, we measured iodide levels in 12-h urine samples by paired-ion-reversed-phase HPLC with electrochemical detection (sensitivity, 0.1 μg/dl) in 371 patients with DTC referred to our service for ablation or follow-up. The patients were divided into 2 groups: patients on hormone withdrawal and strict LID (group A) and those on hormone withdrawal and generic LID (group B). Urinary iodide excretion below 10 μg/dl was considered low. Data were analyzed by ANOVA and χ(2) tests., Results: The mean±standard deviation urinary iodide excretion was 4.3±3 μg/dl in group A and 5.8±3.2 μg/dl in group B. The mean urinary iodide excretion in A group was significantly lower than that in group B (p<0.05)., Conclusions: Following a strict LID significantly decreased urinary iodide excretion in patients undergoing WBS., (Copyright © 2008 Sociedad Española de Endocrinología y Nutrición. Published by Elsevier Espana. All rights reserved.)

Introduction and Objectives: The relationship between the annual number of cardiac procedures at a particular center (i.e., volume) and surgical outcome is controversial. Several studies in western countries indicate that there is an inverse relationship between surgical volume and mortality. We studied the number of procedures carried out at several cardiac surgery units in Spain and their relationship to overall and risk-adjusted mortality., Methods: This prospective observational study carried out in 6054 patients undergoing cardiac surgery at 16 hospitals represents 34% of all cardiac surgery performed in Spain during 2004. Data on risk factors and outcomes for each patient treated at participating institutions were analyzed. Data from each center were checked by an external referee. Surgical risk was evaluated for each patient using the Parsonnet and EuroSCORE methods, with the aim of determining risk-adjusted mortality., Results: Overall mortality was 7.7% (95% confidence interval, 7.0%-8.4%). The risk-adjusted mortality index was calculated to be 0.81 using the Parsonnet method, and 1.12 using EuroSCORE. The Pearson correlation coefficient for the relationship between the number of procedures carried out at a center and mortality was 0.065 for overall mortality, 0.092 for risk-adjusted mortality (Parsonnet method), and 0.111 for risk-adjusted mortality (EuroSCORE method). After discarding data from the two centers with highest and lowest mortality rates, respectively, the correlations were -0.464, -0.420 and -0.267, respectively., Conclusions: No statistically significant relationship was found between the number of cardiac procedures carried out at a particular center in Spain and inhospital mortality.

A 60-year-old woman presented with noncardiac chest pain over months and negative laboratory findings. Conventional imaging methods and bone scintigraphy detected bone lesions suggesting metastatic disease from an unknown primary tumor. An 18FDG-PET scan performed to orient the search for the primary tumor found focal lesions suggesting lymphoma and identified a focal thyroid lesion and a cervical lymph node accessible for biopsy. The biopsy of this lymph node incidentally detected a papillary differentiated thyroid cancer (DTC), since the existence of a non-Hodgkin's lymphoma was confirmed after a new biopsy. After confirming the presence of a lymphoma, 18FDG-PET enabled the initial staging of the tumor, the evaluation of the response to treatment, and follow-up for detection of recurrence. On the other hand, 18FDG-PET incidentally detected a DTC.

Introduction: Emesis gravidarum is a common pathology rarely requiring hospitalization to control hydroelectrolytic and metabolic alterations. Although it is typical in the first quarter of pregnancy, it can appear in any moment of the gestation. On the other hand, venous angioma (VA) is the most frequent cerebral vascular malformation. In fact, it is a variant of the normal venous drainage of the brain and it is usually an incidental finding. VA is rarely symptomatic, unless associated with cavernous angiomas. Although uncommon, the clinical complications are very varied, bleeding being the most severe one., Case Report: We describe a 27 weeks pregnant healthy woman, with repetitive vomiting that was classified like emesis gravidarum. The study was enlarged due to the reappearance of vomiting, accompanied by migraine, bradypsychia and confusional state. Neuroradiological studies showed a choroid plexus haematoma from left lateral ventricle to third ventricle, secondary to the existence of a left parietal VA, without demonstration of associated cavernous angioma., Conclusions: Although it is rare, a supratentorial VA, without associated cavernous angioma, may lead to intraventricular hemorrhage. Gestation is the only risk factor associated to VA. By itself, it supposes a tendency to develop ischemic and hemorrhagic, arterial and venous vascular complications.

Although coronary surgery was first carried out without the use of extracorporeal circulation more than 40 years ago, it was not until the second half of the 1990s and thanks to an important technological development that it became a standardized reproducible technique. There is significant terminological confusion between the different forms of so-called minimally invasive technique. There are even important technical variations in off-pump coronary surgery involving median sternotomy. The present article reviews the reasons for this renaissance, the terminology used, current progress, key technical requirements, and new developments in anesthesia and postoperative management. Our approach to the technique has resulted in us carrying out full arterial revascularization in the beating heart using both internal mammary arteries. Part of this article is devoted to the specific technical details of this form of revascularization and to the results obtained in our first 1000 patients. Finally, we comment on the scientific evidence concerning coronary surgery without extracorporeal circulation that was reviewed at the ISMICS Consensus Conference in Paris in 2004: in expert hands, coronary surgery without extracorporeal circulation is just as safe and effective as conventional surgery, reduces some forms of morbidity, and, according to nonrandomized but adjusted studies, decreases mortality in high-risk patients.

Actinomycosis is a chronic, suppurative, fibrotic infection produced by a gram-positive anaerobic bacteria of the normal mouth flora, the infection having tendency to fistulate and to extend without respecting tissue layers. Initial diagnosis is usually delayed due to its painless evolution. Three clinical forms are known: cervicofacial, abdominal and thoracic. Occasionally, there is vascular involvement which is mainly associated with venous thrombotic phenomena with low clinical expresion and hematogenous dissemination that can result in a formation of abscess or meningitis in the central nervous system. We report the case of a 28 year old female patient with type I diabetes and microangiopathyc complication with a internal carotid artery stenosis adjacent to mandibular angle actinomicosis. A few months later and after a miscarriage she suffered from ischemic stroke. The anticardiolipin antibody were positive at the time of stroke with post-operative period and over the next two years. To our knowledge (Medline, 1984-2004), it is the first report of internal carotid vasculitis originated by cervicofacial actinomicosis. We discuss the neuroradiological aspects of our case.

Case Report: We report the case of a spider bite in a 7 years-old girl that develop a dermonecrosis and did not need surgical treatment., Discussion: We analize the mechanisms of these kind of lesions review and update therapeutic management of these kind of lesions.

Objective: To determine the effect of risk factors for allogenic blood transfusion in surgery for trochanteric hip fractures., Patients and Methods: A retrospective study of all the trochanteric hip fracture patients older than 65 years who underwent surgery to repair trochanteric hip fracture related to osteoporosis in 2000 and 2001 in a regional hospital. Data recorded were age; gender; type of fracture (international AO classification); level of anesthetic risk (ASA classification); hemoglobin concentration and hematocrit upon admission, on the day of surgery and 2 days later; time elapsing between admission and surgery; blood transfusion and blood product use., Results: One hundred two patients (29 men and 73 women) with trochanteric hip fractures were studied. Mean (+/- SD) patient age was 82.9 +/- 8.8 years (range, 65-99 years). Upon admission, mean hemoglobin was 123 +/- 18.1 g/L (range, 56-154 g/L), hematocrit was 37% +/- 5% (range, 10%-40%). Time elapsing until surgery was 3.5 +/- 1.6 days (range, 0-8 days). Admission hemoglobin concentration was lower in patients who required transfusion (116 g/L) than in patients who did not (133 g/L) (P < 0.001). Logistical regression analysis identified only AO classification of fracture type (P < 0.05) and admission hemoglobin concentration (P < 0.001) as independent risk factors for transfusion., Conclusions: The hemoglobin level at admission and the trochanteric fracture type bear a relation to transfusion needs. These results suggest that in elderly patients we should improve hemoglobin levels and initiate blood salvage measures in order to reduce the need for allogenic blood transfusion, with its inherent risks.

Hypothesis and Objectives: the hypothesis of this study is that genes involved in the regulation of the immune system, expressed by HLA antigens and anti-neutrophil cytoplasmic antibodies (ANCA), could be determinants of disease susceptibility and behavior in inflammatory bowel disease (IBD)., Material and Method: seventy patients with a diagnosis of inflammatory bowel disease, 46 with ulcerative colitis and 24 with Crohn"s disease were included. HLA class I (A and B) and II (DR) antigens were studied by serological techniques. Detection of ANCA was carried out in all patients by an indirect immunofluorescence method. The relative frequencies of HLA antigens were compared with a control group made up of 156 blood donors. The control group for the ANCA study was made up of 100 individuals., Results: we found a significant increased frequency of HLA-DR2 in patients with ulcerative colitis. No significant differences were found between patients with Crohn"s disease and controls regarding HLA typing. We detected a significant increase of HLA-DR3 in extensive forms of ulcerative colitis. Detection of ANCA was positive in 46% of the patients with ulcerative colitis and in 12% of the patients with Crohn"s disease (p <0.05). We observed an increased frequency of ANCA in patients with UC and HLA-DR2 (p = 0.15)., Conclusions: the association found between HLA-DR3 and extensive forms of ulcerative colitis provides evidence of genetic heterogeneity. The relationship between ANCA and HLA phenotype (although not significant) supports this concept.