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This work aims to analyze if hospitalization in short-stay units (SSU) of patients diagnosed in the emergency department with acute heart failure (AHF) is effective in terms of the length of hospital stay and if it is associated with differences in short-term progress.Patients from the EAHFE registry diagnosed with AHF who were admitted to the SSU (SSU group) were included and compared to those hospitalized in other departments (non-SSU group) from all hospitals (comparison A) and, separately, those from hospitals with an SSU (comparison B) and without an SSU (comparison C). For each comparison, patients in the SSU/non-SSU groups were matched by propensity score. The length of hospital stay (efficacy), 30-day mortality, and post-discharge adverse events at 30 days (safety) were compared.A total of 2,003 SSU patients and 12,193 non-SSU patients were identified. Of them, 674 pairs of patients were matched for comparison A, 634 for comparison B, and 588 for comparison C. The hospital stay was significantly shorter in the SSU group in all comparisons (A: median 4 days (IQR = 2-5) versus 8 (5-12) days, p 0.001; B: 4 (2-5) versus 8 (5-12), p 0.001; C: 4 (2-5) versus 8 (6-12), p 0.001). Admission to the SSU was not associated with differences in mortality (A: HR = 1.027, 95%CI = 0.681-1.549; B: 0.976, 0.647-1.472; C: 0.818, 0.662-1.010) or post-discharge adverse events (A: HR = 1.002, 95%CI = 0.816-1.232; B: 0.983, 0.796-1.215; C: 1.135, 0.905-1.424).The hospitalization of patients with AHF in the SSU is associated with shorter hospital stays but there were no differences in short-term progress.

Resumen Objetivo Evaluar la utilidad de la escala de cribado de la fragilidad (Identification of Senior at Risk [ISAR]) para predecir la mortalidad a los 30 dias en los pacientes mayores atendidos por insuficiencia cardiaca aguda (ICA) en los servicios de urgencias hospitalarios (SUH). Diseno Estudio multicentrico observacional de cohorte multiproposito. Ambito Registro OAK-3. Participantes Pacientes ≥ 65 anos atendidos por ICA en 16 SUH espanoles de enero a febrero del 2016. Intervencion Ninguna. Variables La variable de estudio fue la escala ISAR. La variable de resultado fue la mortalidad por cualquier causa a los 30 dias. Resultados Se incluyo a 1.059 pacientes (edad media 85 ± 5,9 anos). Ciento sesenta (15,1%) casos tuvieron 0-1 puntos, 278 (26,3%) 2 puntos, 260 (24,6%) 3 puntos, 209 (19,7%) 4 puntos y 152 (14,3%) 5-6 puntos de la escala ISAR. Noventa y cinco (9,0%) pacientes fallecieron a los 30 dias. La frecuencia de mortalidad se incremento en relacion a la categoria del ISAR (p tendencia lineal Conclusiones La escala ISAR es una herramienta breve y sencilla que deberia ser considerada para el despistaje de la fragilidad en la valoracion inicial de los pacientes mayores con insuficiencia cardiaca aguda de cara a predecir la mortalidad a 30 dias.

This work aims to determine the prevalence, characteristics, and impact on prognosis of right bundle branch block (RBBB) in a cohort of acute heart failure (AHF) patients.We prospectively analyzed 3,638 AHF patients included in the RICA registry (National Heart Failure Registry of the Spanish Internal Medicine Society). We independently analyzed the relationship between baseline and clinical characteristics and the presence of RBBB as well as the potential impact of RBBB on 1-year all-cause mortality and a composite endpoint of 90-day post-discharge hospitalization or death.The prevalence of RBBB was 10.9%. Patients with RBBB were older, a higher proportion were male, had more pulmonary comorbidities, had higher left ventricular ejection fraction values, and had worse functional status. There were no differences in risk for patients with RBBB, with an adjusted hazard ratio (95% confidence interval) for 1-year mortality of 1.05 (0.83-1.32), and for the composite endpoint of 90-day post-discharge hospitalization or death of 0.97 (0.74-1.25). These results were consistent on the sensitivity analyses.Few patients with AHF present with RBBB, which is consistently associated with advanced age, male sex, pulmonary comorbidities, preserved left ventricular ejection fraction, and worse functional status. Nonetheless, after considering these factors, RBBB in AHF patients is not associated with worse outcomes.

Objective: To describe the frequency, clinical characteristics and outcomes of patients with acute heart failure (AHF) transferred directly from emergency departments to home hospitalisation (HH) and to compare them with those hospitalised in internal medicine (IM) or short-stay units (SSU). Method: We included patients with AHF transferred to HH by hospitals that considered this option during the Epidemiology of Acute Heart Failure in Spanish Emergency Departments (EAHFE) 4-5-6 Registries and compared them with patients admitted to IM or SSU in these centres. We compared the adjusted all-cause mortality at 1 year and adverse events 30 days after discharge. Results: The study included 1473 patients (HH/IM/SSU: 68/979/384). The HH rate was 4.7% (95% CI, 3.8-6.0%). The patients in HH had few differences compared with those hospitalised in IM and SSUs. The HH mortality was 1.5%, and the HH median stay was 7.5 days (IQR, 4.5-12), similar to that of IM (median stay, 8 days; IQR, 5-13; p = .106) and longer than that of SSU (median stay, 4 days; IQR, 3-7; p < .001). The all-cause mortality at 1 year for HH did not differ from that of IM (HR, 0.91; 95% CI, 0.73-1.14) or SSU (HR, 0.77; 95% CI, 0.46-1.27); however, the emergency department readmission rate during the 30 days postdischarge was lower than that of IM (HR, 0.50; 95% CI, 0.25-0.97) and SSU (HR, 0.37; 95% CI, 0.19-0.74). There were no differences in the need for new hospitalisations or in the 30-day mortality rate. Conclusions: Direct transfer from the emergency department to HH is infrequent despite being a safe option for a certain patient profile with AHF. (C) 2020 Elsevier Espana, S.L.U. and Sociedad Espanola de Medicina Interna (SEMI). All rights reserved.

Objective: To assess the value of frailty screening tool (Identification of Senior at Risk [ISAR]) in predicting 30-day mortality risk in older patients attended in emergency department (ED) for acute heart failure (AHF). Design: Observational multicenter cohort study. Setting: OAK-3 register. Subjects: Patients aged >= 65 years attended with ADHF in 16 Spanish EDs from January to February 2016. Intervention: No. Variables: Variable of study was ISAR scale. The outcome was all-cause 30-day mortality. Results: We included 1059 patients (mean age 85 +/- 5,9 years old). One hundred and sixty (15.1%) cases had 0-1 points, 278 (26.3%) 2 points, 260 (24.6%) 3 points, 209 (19.7%) 4 points, and 152 (14.3%) 5-6 points of ISAR scale. Ninety five (9.0%) patients died within 30 days. The percentage of mortality increased in relation to ISAR category (lineal trend P value < .001). The area under curve of ISAR scale was 0.703 (95%Cl 0.655-0.751; P

The purpose of this consensus document was to reach an agreement among experts on the multidisciplinary care of patients with acute heart failure. Starting with a narrative review of the care provided to these patients and a critical analysis of the healthcare procedures, we identified potential shortcomings and improvements and formalised a document on recommendations for optimising the clinical and therapeutic approach for acute heart failure. This document was validated through an in-person group session guided using participatory techniques. The process resulted in a set of 36 recommendations formulated by experts of the Spanish Society of Cardiology, the Spanish Society of Internal Medicine and the Spanish Society of Urgent and Emergency Care. The recommendations are designed to optimise the healthcare challenge presented by the care of patients with acute heart failure in the context of Spain's current National Health System.

To assess the value of frailty screening tool (Identification of Senior at Risk [ISAR]) in predicting 30-day mortality risk in older patients attended in emergency department (ED) for acute heart failure (AHF).Observational multicenter cohort study.OAK-3 register.Patients aged ≥65 years attended with ADHF in 16 Spanish EDs from January to February 2016.No.Variable of study was ISAR scale. The outcome was all-cause 30-day mortality.We included 1059 patients (mean age 85±5,9 years old). One hundred and sixty (15.1%) cases had 0-1 points, 278 (26.3%) 2 points, 260 (24.6%) 3 points, 209 (19.7%) 4 points, and 152 (14.3%) 5-6 points of ISAR scale. Ninety five (9.0%) patients died within 30 days. The percentage of mortality increased in relation to ISAR category (lineal trend P value.001). The area under curve of ISAR scale was 0.703 (95%CI 0.655-0.751; P.001). After adjusting for EFFECT risk categories, we observed a progressive increase in odds ratios of ISAR scale groups compared to reference (0-1 points).scale is a brief and easy tool that should be considered for frailty screening during initial assessment of older patients attended with AHF for predicting 30-day mortality.

We have been using radiofrequency ablation for the percutaneous treatment of osteoid osteoma since 2001. Frequently, lesions are located near the joint surface, involve the vertebral body or are close to major nerves. We seek to determine whether radiofrequency ablation (RFA) can be used safely in these cases.A total of 65 lesions were induced in 4 dogs. Each dog underwent RFA on the diaphysis of long bones, as well as femoral and humeral heads. Four different sessions were carried out by using 1- and 2-cm probes with or without a cool-tip system and by varying the timing of the procedure. Plain film, CT, and MRI were obtained. All bone samples were examined histologically.The dogs' activity after the procedure was normal. No pathologic fractures occurred despite unrestricted activity of the animals. Cortical bone was always respected; therefore, articular cartilage has not been damaged. Radiological findings were characteristic. There were no significant differences in lesion size, probe type, and the duration of the procedure. The mean lesion diameter perpendicular to the electrode was 18.5 mm.Our study confirms the insulative effect of cortical bone. RFA can be safely performed close to the joint surface without damaging the cartilage.

Simple and accurate limb and pelvic conformation evaluation using computed tomography (CT) can be useful in planning canine hip dysplasia (CHD) treatment and in helping to understand the pathogenesis of osteoarthritis and CHD. The objectives of this study were to describe a new method for femoral neck anteversion angle (FNA-angle) measurement in CT, and to compare it to the established radiographic standard biplanar method. The hips of 23 Estrela Mountain Dogs were evaluated using radiography and CT and their FNA-angles were determined by performing two CT examinations and with one radiographic measurement session. The intra-class correlation coefficient (ICC) was used to evaluate the repeatability (agreement between the two CT sessions, ICC=0.92) and reproducibility (agreement between each CT and radiographic session, ICC=0.91 in both cases) of the CT FNA-angle measurement method. This study suggests that CT FNA-angle measurement method is reliable and can be used in CT hip studies with confidence.

A modified PennHIP procedure (MPP), using specific mechanical holding devices, was used on 70 dogs and compared to the standard PennHIP method (SPM) used on 39 dogs, in terms of technical effectiveness and the mean number of essential individuals within the X-ray room (EIXRR). The data using the Chisquared test were consistent with the null hypothesis that the technical effectiveness was equal in the groups under investigation (P > 0.05). On the contrary, using the two-sample unpaired t -test the null hypothesis, that the mean EIXRR was equal, was rejected (P < 0.001). The estimated EIXRR was 3.4 ± 0.7 and 5.7 ± 1.2 (mean ± SD) for MPP and SPM, respectively. In conclusion, the MPP needs fewer EIXXR than the SPM and complies with the new recommendations in X-ray protection, which introduce the ALARA (as-low-as-reasonably-achievable) idea.

Prognostic scales are needed in acute exacerbation of chronic heart failure to detect early mortality. The objective of this study is to create a prognostic scale (scale EAHFE-3D) to stratify the risk of death the very short term.We used the EAHFE database, a multipurpose, multicenter registry with prospective follow-up currently including 6,597 patients with acute heart failure attended at 34 Spanish Emergency Departments from 2007 to 2014. The following variables were collected: demographic, personal history, data of acute episode and 3-day mortality. The derivation cohort included patients recruited during 2009 and 2011 EAHFE registry spots (n=3,640). The classifying variable was all-cause 3-day mortality. A prognostic scale (3D-EAHFE scale) with the results of the multivariate analysis based on the weight of the OR was created. The 3D-EAHFE scale was validated using the cohort of patients included in 2014 spot (n=2,957).A total of 3,640 patients were used in the derivation cohort and 102 (2.8%) died at 3 days. The final scale contained the following variables (maximum 165 points): age≥75 years (30 points), baseline NYHA III-IV (15 points), systolic blood pressure110mmHg (20 points), room-air oxygen saturation90% (30 points), hyponatremia (20 points), inotropic or vasopressor treatment (30 points) and need for noninvasive mechanical ventilation (20 points); with a ROC curve of 0.80 (95% CI 0.76-0.84; P.001). The validation cohort included 2,957 patients (66 died at 3 days, 2.2%), and the scale obtained a ROC curve of 0.76 (95% CI 0.70-0.82; P.001). The risk groups consisted of very low risk (0-20 points), low risk (21-40 points), intermediate risk (41-60 points), high risk (61-80 points) and very high risk (80 points), with a mortality (derivation/validation cohorts) of 0/0.5, 0.8/1.0, 2.9/2.8, 5.5/5.8 and 12.7/22.4%, respectively.EAHFE-3D scale may help to predict the very short term prognosis of patients with acute heart failure in 5 risk groups.

The purpose of this consensus document was to reach an agreement among experts on the multidisciplinary care of patients with acute heart failure. Starting with a narrative review of the care provided to these patients and a critical analysis of the healthcare procedures, we identified potential shortcomings and improvements and formalised a document on recommendations for optimising the clinical and therapeutic approach for acute heart failure. This document was validated through an in-person group session guided using participatory techniques. The process resulted in a set of 36 recommendations formulated by experts of the Spanish Society of Cardiology, the Spanish Society of Internal Medicine and the Spanish Society of Urgent and Emergency Care. The recommendations are designed to optimise the healthcare challenge presented by the care of patients with acute heart failure in the context of Spain's current National Health System.

Summary We describe a case of canine thymoma in an 11-year-old pure-bred female Spanish Mastiff. On postmortem examination a big mass was found in the thoracic cavity. Histologically the neoplastic parenchyma showed great structural variability; the principal findings included the presence of tumour cells forming cords or sheets, cystic formations, Hassall-corpuscle like squamous formations, and small or intermediate calibre vessels encircled by areas with eosinophilic material and lymphocytes. In order to determine the histogenesis of the thymic neoplasia we used immunohistochemical techniques specific for different markers: cytokeratins, vimentin, desmin and neuron specific enolase. A strong positive immunoreaction of rumour cells to wide spectrum cytokeratins confirmed the epithelial origin of the neoplasia.

Analyze the clinical profile and short-term evolution of the patients attended in the Spanish Hospital Emergency Services (SHES) due to an episode of acute heart failure (AHF) based on whether these patients had undergone or not an echocardiography and on the ventricular function estimated in said ultrasonography.A total of 9 hospitals participated. They consecutively enrolled all the patients diagnosed of AHF during 2 months. Data were collected on the clinical profile and the short-term evolution (intra-hospital mortality and mortality and re-visits at 30 days). The existence of a previous echocardiography was retrospectively investigated and, if it existed, the quantification of the left ventricular ejection fraction (LVEF) as well. The ventricular function was considered to be depressed or conserved according to whether the LVEF was greater or equal to 45% or less than 45%, respectively.A total of 997 patients were enrolled. An echocardiography was available for 547 patients (54.9%). Of these, the type of ventricular function was known in 476: 273 (57.4%) had depressed function and 203 (42.6%) had conserved function. The patients who did not have an echocardiography were older, with fewer pathological backgrounds. They had less advanced forms of heart disease, used beta blockers less and, were treated less with bolus diuretics in the emergency service. The patients with depressed systolic function were more often males, younger, active smokers, with ischemic heart disease and had signs of left heart failure (orthopnea and paroxysmal nocturnal dyspnea). Less frequently, they were hypertense, with valvular heart disease, with chronic atrial fibrillation and their systolic blood pressure in the Emergency Service was lower. They were directly discharged from the SHES more frequently. Intra-hospital mortality was 5.3%, mortality at 30 days 8.9% and re-visit at 30 days 27.2%. However, no significant differences were found in any of these evolution variables based on the existence or not of an echocardiography or on the type of dysfunction found in it.The patients who had an episode of AHF did not have any previous echocardiography in a high number of cases. This fact made it necessary in these cases to carry out the therapeutic management in the SHES guided only by the signs and symptoms, such as systolic blood pressure on their arrival to the emergency service. In spite of this, the fact that the functional state of the left ventricular was not known did not affect the intra-hospital mortality, at 30-days and readmission.

A preoperative nutritional assessment including anthropometry, biochemical indices and global subjective assessment was performed for 127 patients admitted for elective gastrointestinal surgery. Of these, 24 were subjected to minor surgery, 65 to intermediate surgery and 38 to major procedures. Patients were followed postoperatively, recording complications or mortality. Intermediate and major surgery patients had lower triceps skinfold thickness and mid-arm circumference and greater weight loss than did minor surgery patients. Thirty-six percent of the patients suffered complications. No association was found between preoperative nutritional status and incidence of postoperative complications. Six patients died and they showed greater preoperative weight loss (21 +/- 6.5 vs 12 +/- 1.4%) and lower serum albumin levels (25 +/- 4 vs 35 +/- 1 g/l) than patients who survived complications. Global subjective assessment classified 43% of survivors as malnourished, compared to 100% of patients who died.

The purpose of the study was to use two palpation methods (Bardens and Ortolani), a radiographic distraction view, three computed tomography (CT) measurements (dorsolateral subluxation score, the lateral center-edge angle, and acetabular ventroversion angle) and two magnetic resonance (MR) imaging hip studies (synovial fluid and acetabular depth indices) in the early monitoring of hip morphology and laxity in 7-9 week old puppies; and in a follow-up study to compare their accuracy in predicting later hip laxity and dysplasia. The MR imaging study was performed with the dog in dorsal recumbency and the CT study with the animal in a weight-bearing position. There was no association between clinical laxity with later hip laxity or dysplasia. The dorsolateral subluxation score and the lateral center-edge angle were characterized by a weak negative correlation with later radiographic passive hip laxity (-0.26 < r < -0.38, P < 0.05) but its association with hip dysplasia was not significant. There was an association between early radiographic passive hip laxity and synovial fluid index with later passive hip laxity (0.41 < r < 0.55, P < 0.05) and this was significantly different in dysplastic vs. nondysplastic hips (P < 0.05). There was no association between the remaining variables and later hip laxity or dysplasia. The overlapping ranges of early passive hip laxity and synovial fluid index for hip dysplasia grades and the moderate correlations with the later passive hip laxity make the results of these variables unreliable for use in predicting hip laxity and dysplasia susceptibility.

Tourette's syndrome is a neurological disorder of genetic order that begins in childhood, being characterized by the presence of multiple phonic and motor tics.A male with previous dissociative and conversion psychopathology initiated motor and phonic tics in the adulthood in the context of several inter and intrapersonal conflicts beginning in childhood. No improvement was observed when drug treatment was established, there being partial response with psychotherapy oriented to coping with threatening situations.The psychopathology of the obsessive compulsive spectrum having a conversion and dissociative origin is an unusual phenomenon, this being observed in constitutionally predisposed subjects. Conversion tics are a nosologic challenge, given the fluctuations and exacerbations due to stress also manifested by their neurological homonyms. More specific criteria are necessary in order to optimize the diagnosis of this "psychogenic movement disorder".

Two hundred and fifteen Estrela Mountain Dogs (EMD) were examined using the PennHIP method between 2002 and 2006. Passive hip laxity (PHL) was estimated calculating the distraction index (DI). Pedigree information was obtained from the Portuguese Kennel Club. The heritability and breeding values were estimated using the linear Animal Model. The DI, using as reference the worst joint of each animal, ranged from 0.15 to 1.12 (0.55 ± 0.19). The PHL was equal in right and left sides, and was higher in females than in males (P > 0.05 and P < 0.01 in the t -test, respectively). The estimated heritability was 0.83 ± 0.11. The mean breeding values for PHL were stable in EMD born between 1991 and 2003, and showed an improvement in 2004 and 2005. The data confirm high PHL in breeds with high prevalence and severity of canine hip dysplasia. The high heritability indicates that the DI could be reduced in the breed if PHL were used as a selection criterion. The early favourable evolution of DI breeding values could be related with the increase of voluntary radiographic hip screening in the last years, and the subsequent introduction of hip quality as a breeding criterion.

Objectives: To determine the reliability of early passive hip laxity examination in predicting moderate and severe hip dysplasia. Methods: The passive hip laxity of 104 Estrela Mountain dogs was evaluated using the Ortolani method, conventional hip-extended radiography and the PennHIP method, when the animals were between four and 12 months of age. After the age of one, dogs were re-examined for hip dysplasia using the Federation Cynologique Internationale scoring system. The passive hip laxity results were subsequently compared with the Federation Cynologique Internationale scores for sensitivity, specificity, positive predictive value, negative predictive value and accuracy. Results: The PennHIP method achieved the best results in specificity (93 per cent), positive predictive value (91 per cent) and accuracy (88 per cent), and the Ortolani method was the best in sensitivity (92 per cent) and negative predictive value (92 per cent). Clinical Significance: The Federation Cynologique Internationale grades D and E can be predicted with confidence even before animals are one year old.

Nuestro trabajo experimental fue realizado en dientes incisivos de caballos de diferentes edades. Se realizaron un total de cuarenta y cuatro endodoncias. Se probaron cuatro pastas diferentes de relleno: kloropeka, ah26, eugenol-endomethasone y n2, estas dos ultimas junto con puntas de gutapercha. Para llegar a la cavidad pulpar accediamos por la cara vestibular y por la cara oclusal en cada incisivo. Sellabamos con composite la cara vestibular y con amalgama la cara oclusal. Los animales se mantenian un minimo de dieciocho meses tras las endodoncias. Se realizaban controles radiologicos posteriores a las intervenciones y en el momento del sacrificio. Posteriormente se hacia estudio histopatologico del diente alveolo. Todos los animales presentaron un estado general bueno en el tiempo que duro nuestra experiencia, comieron con toda normalidad sin presentar sintomas clinicos, radiologicos ni histopatologicos.

Summary Comparison of two dental implants in dogs. An Experimental Study Mandibular incisors were taken out in 13 adult dogs. Twenty days after the extraction, two implants either of titanium or hydroxylapatite were placed in a second operation. The clinical, pathological and radiological results suggest that metallic implants produce fibrous tissue around the implant. In most cases, fibrous tissue does not ossify and this facilitates the formation of a malunion and the mobilization of the implant. However, the results with hydroxylapatite implants appear to be satisfactory due to the formation of an osseous tissue mandibular bone. This tissue prevents the mobilization of the implant allowing support to a dental protheses. Resumen Trece caninos adultos fueron desdentados en la arcada incisiva inferior. Transcurridos 20 dias se les coloco dos implantes de hidroxiapatita o de titanio. Tras la obtencion de los resultados clinicos, radiologicos y anatomopatologicos, se puede concluir que los implantes metalicos, producen un tejido fibroso perimplante, que la mayoria de las veces no osifica y que facilita la movilizacion de los implantes, en cambio los resultados con los implantes de hidroxiapatita (D. A. C.) son optimos, debido a la creacion de un tejido de soldadura implante hueso mandibular. Este tejido especializado impide la movilizacion del implante y lo une fuertemente al hueso mandibular, permitiendo de esa forma el soporte de la futura protesis dentaria.

Repeatability and reproducibility of Distraction Index (DI) measurements in the PennHIP method were evaluated in 100 dogs. The PennHIP distraction views sent to the PennHIP Analysis Center (PAC) were duplicated, digitalised, and identified with a code, and an adequate computer software was used for DI measurements. One examiner performed two DI measurement sessions, evaluating individually 200 hip joints. The scoring repeatability and reproducibility were estimated calculating the Intraclass Correlation Coefficient (ICC) between the two DI measurement sessions and between the second DI measurement session and the DI in PAC reports, respectively. The ICC for repeatability was 0.97 [95% confidence interval (CI), 0.96 to 0.98], and the ICC for reproducibility was 0.95 (95% CI, 0.93 to 0.96). The results suggest that the DI measurement method described is repeatable and can reproduce the PAC reports with confidence. Distraction indices measured in different PennHIP studies, using this DI measurement method and performed by trained researchers, can be considered interchangeable.

Stand transpiration was measured during the 2003 and 2004 growing seasons using heat dissipation sap flow sensors in a Scots pine (Pinus sylvestris L.) and a pubescent oak (Quercus pubescens Willd.) forest located in a montane area of the Eastern Pyrenees (NE Spain). The first aim of the study was to assess the differences in quantitative estimates of transpiration (Ec) and the response to evaporative demand of the two stands. Over the studied period of 2003, characterised by a severe drought episode during the summer, the oak stand Ec was only 110mm compared to the 239 mm transpired by the Scots pine stand, although the ratio of transpiration to reference evapotranspiration (Ec/ET0) in the oak stand compares well with the expected values predicted for low leaf area index (LAI) oak forests in southern Europe. Scots pine showed a strong reduction in Ec/ET0 as the drought developed, whereas pubescent oak was less affected by soil moisture deficits in the upper soil. As a second objective, and given the contrasting meteorological conditions between 2003 and 2004 summer periods, the interanual variability of transpiration was studied in the Scots pine plot. Rainfall during the summer months (June-September) in 2003 was almost 40% less than in the same interval in 2004. Accordingly, transpiration was also reduced about 25% in 2003. Finally, Scots pine data from 2003 and 2004 was used to calibrate a simple transpiration model using ET0 and soil moisture deficit (SMD) as input variables, and implicitly including stomatal responses to high vapour pressure deficits (Dδ) and soil water status.

Only a minority of patients with acute stroke are eligible for fibrinolysis, and the main reason for this is that time runs out and goes beyond the therapeutic window. The chief delay occurs prior to arrival at the hospital, but there is also a nosocomial delay, which has received far less attention.The purpose of our study was to describe the data on delays occurring before and after arrival at the hospital in a sample of patients with acute stroke, and to analyse possible associated factors, including the overload on health care services in the Emergency department, an aspect that has not previously been evaluated.Epidemiological data, times of delays before and after entering the hospital, means of transport used and the health care workload in the Emergency department of the day of admission were collected for all the stroke patients admitted to the Stroke Unit of the Hospital General Universitario de Alicante throughout the period under study.From an initial sample of 460 patients, 423 were finally included in the study, with a mean delay before and after admission to hospital of 3.99 and 2.36 hours, respectively. Use of an ambulance and the haemorrhagic and transient ischemic attack subtypes were linked to a shorter delay before reaching the hospital, and arrival during the night shift was the only factor associated to a longer delay once inside the hospital.In our environment, there is a need to establish strategies aimed at shortening the times stroke patients take to reach the hospital and the time that elapses before they are attended.

Endoscopic mucosectomy is a routine treatment mode for benign and malignant gastric lesions. The prognosis of patients with endoscopically treated early gastric cancer does not differ from patients subjected to surgical gastrectomy, when the indications for endoscopic mucosectomy are respected.To report the experience in endoscopic mucosectomy for early gastric cancer.Between 1990 and 1997, 12 lesions in 10 patients, aged 48 to 107 years old, were treated with endoscopic mucosectomy. Clients were followed for 1 to 72 months after the procedure.Treated lesions ranged in size from 7 to 20 mm. Ten patients had differentiated carcinomas, one had an undifferentiated carcinoma and one had a primary gastric carcinoid. Endoscopic appearance was II a in six lesions, II c + II a in two, II a + II c in one. II c in one, I in one and II c + III in one. In two patients, the tumor persisted and were subjected to oncologic surgery. In one of these no malignant lesion was recognized in the pathological specimen. The other patient had a multicentric carcinoma that was already detected by endoscopy. Neither had lymph node metastases. Endoscopical and pathological follow up in the other 8 patients has not shown persistence or reappearance of malignant lesions during a follow up ranging from 3 to 72 months.Endoscopic mucosectomy can be a valuable therapeutic alternative in early gastric cancer.

To study the antiinflammatory capacity of topical pranoprofen in comparison with other ophthalmological nonsteroidal antiinflammatory drugs (diclofenac and flurbiprofen) in albino rabbits.We have produced an endotoxin-induced uveitis by intravitreal injection of 10 ng of Salmonella typhimurium endotoxin. We have used 48 albino rabbits (4 groups of 12 animals each), first group were control group (intravitreal saline solution), which were treated unilaterally every two hours with 2 drops of: Group II, pranoprofen (1 mg/ml). Group III, diclofenac (0.2 mg/ml). Group IV, flurbiprofen (0.3 mg/ml). We determined clinical signs of inflammation and protein concentration in the aqueous humor. The rabbits were sacrificed 24 hours after the endotoxin administration.In all treated groups we observed a significant reduction (p0.05) in all studied parameter as compared with control group, except for ciliar hyperemia. Different treatment groups did not show differences.The antiinflammatory capacity of pranoprofen is comparable to other NSAIDs derived from propionic acid such as flurbiprofen, obtaining a good control of endotoxin-induced uveitis.

Determination of plasma and tissue cytokine levels in inflammatory bowel disease have frequently resulted in conflicting data. In the present study we determined in patients with ulcerative colitis (UC), the levels of the proinflammatory cytokines interleukin (IL)-1beta, IL-6, interferon (IFN)-gamma, and tumor-necrosis factor (TNF)-alpha liberated by peripheral blood mononuclear cells (PBMC) and lamina propria mononuclear cells (LPMC) after 48-hr culture with pokeweed mitogen (PWM). IL-1beta, IL-6, IFN-gamma and TNF-alpha in the supernatant were detected by ELISA. Results show low basal levels of IL-1beta secretion by PBMC and LPMC, and a considerable increase after mitogen stimulation. Basal IL-6 production by PBMC was higher in UC patients than in controls [2029 pg/ml, CI95(-165 to 4223) vs 572 pg/ml (-383 to 1527) respectively, P = 0.05] and also after PWM activation [14,995 pg/ml (7759-22,230) vs 6598 pg/ml (3240-9956), respectively, P = 0.05]. In LPMC, no differences in IL-6 secretion were observed. TNF-alpha in activated PBMC of patients with UC was not significantly increased in relation to control (P = 0.09). No constitutive secretion of IFN-gamma was observed in mononuclear cells. IFN-gamma levels secreted by activated LPMC were lower in patients with UC than in controls [1571 pg/ml (-108 to 3251) vs 7953 pg/ml (3851-12,055), respectively, P = 0.03]. These results suggest that IL-6, IL-1beta, and TNF-alpha participate as mediators in the inflammatory phenomena observed in UC. Further studies are necessary to evaluate the role of IFN-gamma in this condition.

Cytokines are involved in the pathogenesis of inflammatory bowel diseases such as ulcerative colitis and Crohn disease.To measure cytokine release by mononuclear cells of patients with ulcerative colitis.Twelve patients subjected to a diagnostic colonoscopy were studied. Six had an ulcerative colitis and six did not have inflammatory changes in the colonic mucosa and were considered as control. Mononuclear cells were isolated from biopsies of colonic mucosa and from peripheral blood cultivated during 48 hours with pokeweed mitogen, and Interleukin 6 and interferon-gamma were measured in their supernatants.In patients with ulcerative colitis, interleukin 6 secretion by peripheral blood mononuclear cells was higher than in control subjects in the basal period (2212 +/- 424 and 443 +/- 174 pg/ml respectively p = 0.03) and after stimulation with pokeweed mitogen (16,328 +/- 1275 and 5462 +/- 322 pg/ml respectively p = 0.03). No differences in interleukin 6 secretion by colonic mucosa mononuclear cells were observed. Unstimulated cells did not liberate interferon-gamma. The secretion of this lymphokine by stimulated colonic mucosa cells was lower in patients with ulcerative colitis than in controls (1571 +/- 216 and 7953 +/- 389 pg/ml respectively p = 0.03).Local and systemic changes in interleukin 6 and interferon-gamma secretion occur in patients with ulcerative colitis. These changes could be related to the development of the disease.

Sialosyl-Tn, a mucin-associated carbohydrate antigen, is not expressed by normal mucus-producing cells of the stomach but becomes expressed in metaplastic, pre-malignant and malignant gastric tissues. Reports vary as to the frequency of STn expression and its prognostic role in gastric cancer. To determine whether these differences might be due to inter-country variations in gastric cancer biology, we immunohistochemically analyzed 340 gastric cancers from 2 countries at high-risk (high incidence) for gastric cancer (Japan and Chile), one with intermediate risk (Brazil) and one with low-risk (USA). Expression of STn was correlated with clinico-pathological features of the tumors and with cancer-related survival. Regardless of country, the frequency of STn-positive tumors was lower in non-invasive ("early") than in advanced gastric cancer. Consequently, high-risk countries where early gastric cancer is more common demonstrated a lower overall frequency of STn-positive tumors. In all 4 countries, STn expression directly correlated with depth of invasion, stage, and lymph node involvement. In addition, STn expression correlated with a poor prognosis in all 4 countries, but the effect of STn on survival was not independent of tumor stage. Our findings indicate the need to consider the inherent gastric cancer risk and prevalence of early gastric cancer in the study population when reporting frequency of STn expression in gastric cancer. Regardless of country, however, STn expression is a marker of gastric cancer progression suggesting that cancer-associated mucins play a role in the malignant behavior of this tumor.

We report the retrospective analysis of 86 patients with primary gastric lymphoma diagnosed in a period of 12 years, that constitute 5.6% of malignant gastric lesions diagnosed in that lapse. Upper gastrointestinal endoscopy diagnosed a malignant lesion in 93% and lymphoma in 36% of cases. Endoscopic biopsies disclosed malignant lesions in 79 cases (93%) and were diagnostic of lymphoma in 70 (82%). All patients were operated, including the seven subjects in which the biopsy did not show malignant lesions; the surgical indication of the latter was based in clinical grounds. The macroscopic examination of the surgical piece showed ulcerated lesions in 45 (52%) and mixed lesions (ulcerated and protruded with and without multiple erosions) in 15 (18%) patients. Seventeen patients (33%) had an early lesion of the MALT type (mucosa associated lymphoid tissue) and 87% of lesions were of low or intermediate histological type.

A total of 44 experimental endodontic treatments were performed in incisors of eight horses of different ages. Four different endodontic pastes were used: Cloropercha, AH26 De Trey, Eugenol-Endometasone, and Universal N2. Gutta-percha points were also included in the last two treatments. Access to the pulp cavity of incisors was gained through their vestibular and occlusal faces. Holes drilled in vestibular faces were sealed with composite and those drilled in occlusal faces were sealed with Amalgama. Animals were observed during eighteen months at least after endodontics. Radiographic controls were done just after surgery and before slaughtering. Treated incisors and alveoli were studied histopathologically. During the experiment all animals were in good condition. They ate apparently without trouble, and neither clinical nor radiological signs were present.