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Introduction: Tumor budding (TB), defined as the presence of individual neoplastic cells or isolated groups of up to 4 cells at the front of tumor invasion, has become an adverse prognostic marker in colorectal cancer (CRC) in recent decades. The prognostic impact of TB in CRC remains not clearly defined and histological methods for its evaluation vary depending on the center. The objective of this study is to investigate the association between TB and CRC, in terms of oncological evolution and pathological stage., Methods: A retrospective observational study was conducted, including patients undergoing curative oncological surgery for CRC between January 2017 and December 2022. The effects of TB on disease-free survival (DFS) and overall survival (OS) were evaluated according to the Kaplan-Meier curves., Results: In 78 cases TB was described in the pathology report. TB was present in 56 patients (71.8%), divided into the following categories: low grade in 22 (39.3%), intermediate grade in 17 (30.4%) and high grade in 17 (30.4%). The proportion of patients who presented lymph node metastases, lympho-vascular and perineural invasion was significantly higher in patients with TB (26.8% vs 0%, P=.008; 41.1% vs 4.5%, P=.002; 16.1% vs 0% P=.054; respectively). DFS was 86.3% in low-grade TB, 75.3% in intermediate-grade TB, and 70.3% in high-grade TB. Cases with intermediate and high grade were associated with a shorter OS compared to the low grade group (93.7% and 75.4% vs 100% P=.012, respectively)., Conclusion: These results suggest that TB expression may be a useful risk factor as a prognostic factor for the detection of lymph node metastasis, local recurrence, and distant metastasis in CRC., (Copyright © 2024 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Aim: To ascertain to what extent it is possible to stop being obese (to normalize body mass index [BMI], waist circumference [WC] and/or body fat percentage [BFP])., Design: Longitudinal observational and retrospective study. SITE: Eleven Spanish health centers., Participants: Men and women with BMI≥30kg/m 2 (n=1246) or general obesity (GO), with WC>102cm and >88cm, respectively (n=2122) or abdominal obesity (AO) and with BFP>25% and >35%, respectively (n=2436) or excess body fat (EBF), from the PEPAF Study cohort of 4927 participants aged 20-80years., Main Measurements: Data from the PEPAF study at baseline and at 6, 12 and 24months: gender, age, diagnoses of diabetes, hypertension and dyslipidemia, smoking, levels of and compliance with physical activity recommendations, maximum oxygen consumption, weigh, height, WC and three skin-folds (thoracic, umbilical and anterior thigh for men and triceps, suprailiac and anterior thigh for women)., Results: Of 2054 participants with any type of obesity at baseline and valid data at 2years, 240 (11.6%) had normalized all of their obesity diagnostic indexes. 19.5% (95% confidence interval (95%CI: 17.6-21.4) ceased to have EBF, 12.0% (95%CI: 10.4-13.7) ceased to have AO and 10.5% (95%CI: 8.5-12.7) ceased to have GO., Conclusions: Obesity differs from other chronic diseases in that it can be «cured» by normalizing the amount of body fat., (Copyright © 2022 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: The main objective is to establish the overall survival and disease-free survival profiles regarding the patients with retroperitoneal liposarcoma, making a comparison based on the well-differentiated and dedifferentiated histological subtypes. The secondary objectives are to descriptively analyze the clinical characteristics of said patients and to identify and analyze other independent variables that might modify these survival profiles significantly., Methods: An observational and analytical study was performed using a retrospective historical cohort that was followed prospectively. The inclusion criteria consisted of: the procedure of liposarcoma located in the retroperitoneum, the well-differentiated and dedifferentiated histological subtypes, between January of 2002 and May of 2019. As a result, 32 patients took part in this study's sample. Kaplan-Meier estimator was used to summarise the results and log-rank test was used in the comparative analysis., Results: The overall survival at 5 years was around 59%. No differences were found between the patients with a well-differentiated subtype compared to the dedifferentiated ones (p = 0.834). The disease-free survival at 2 years was 59% regarding the well-differentiated and 26% regarding the dedifferentiated, with these differences being statistically significant (p = 0.005). None of the other studied variables modified these survival profiles significantly., Conclusions: Dedifferentiated retroperitoneal liposarcomas show less disease-free survival than well-differentiated liposarcomas. However, regarding overall survival no differences can be claimed., (Copyright © 2021 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Objectives: The main objective is to establish the overall survival and disease-free survival profiles regarding the patients with retroperitoneal liposarcoma, making a comparison based on the well-differentiated and dedifferentiated histological subtypes. The secondary objectives are to descriptively analyze the clinical characteristics of said patients and to identify and analyze other independent variables that might modify these survival profiles significantly., Methods: An observational and analytical study was performed using a retrospective historical cohort that was followed prospectively. The inclusion criteria consisted of: the procedure of liposarcoma located in the retroperitoneum, the well-differentiated and dedifferentiated histological subtypes, between January 2002 and May 2019. As a result, 32 patients took part in this study's sample. Kaplan-Meier estimator was used to summarize the results and log-rank test was used in the comparative analysis., Results: The overall survival at 5 years was around 59%. No differences were found between the patients with a well-differentiated subtype compared to the dedifferentiated ones (p=0.834). The disease-free survival at 2 years was 59% regarding the well-differentiated and 26% regarding the dedifferentiated, with these differences being statistically significant (p=0.005). None of the other studied variables modified these survival profiles significantly., Conclusions: Dedifferentiated retroperitoneal liposarcomas show less disease-free survival than well-differentiated liposarcomas. However, regarding overall survival no differences can be claimed., (Copyright © 2021 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Scales for predicting venous thromboembolism (VTE) recurrence are useful for deciding the duration of the anticoagulant treatment. Although there are several scales, the most appropriate for our setting has not been identified. For this reason, we aimed to validate the DASH prediction score and the Vienna nomogram at 12 months., Methods: This was a retrospective study of unselected consecutive VTE patients seen between 2006 and 2014. We compared the ability of the DASH score and the Vienna nomogram to predict recurrences of VTE. The validation was performed by stratifying patients as low-risk or high-risk, according to each scale (discrimination) and comparing the observed recurrence with the expected rate (calibration)., Results: Of 353 patients evaluated, 195 were analyzed, with an average age of 53.5 ± 19 years. There were 21 recurrences in 1 year (10.8%, 95% CI: 6.8%-16%). According to the DASH score, 42% were classified as low risk, and the rate of VTE recurrence in this group was 4.9% (95% CI: 1.3%-12%) vs. the high-risk group that was 15% (95% CI: 9%-23%) (p <.05). According to the Vienna nomogram, 30% were classified as low risk, and the rate of VTE recurrence in the low risk group vs. the high risk group was 4.2% (95% CI:0.5%-14%) vs. 16.2% (95% CI: 9.9%-24.4%) (p <.05)., Conclusions: Our study validates the DASH score and the Vienna nomogram in our population. The DASH prediction score may be the most advisable, both because of its simplicity and its ability to identify more low-risk patients than the Vienna nomogram (42% vs. 30%)., (Copyright © 2019 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.)

Spinal angiolipomas are fairly infrequent benign tumours that are usually located in the epidural space of the thoracic column and represent 0.14% to 1.3% of all spinal tumours. Lumbar angiolipomas are extremely rare, representing only 9.6% of all spinal extradural angiolipomas. We report the case of a woman who complained of a lumbar pain of several months duration with no neurological focality and that had intensified in the last three days without her having had any injury or made a physical effort. The MR revealed an extradural mass L1-L2, on the posterior face of the medulla, decreasing the anteroposterior diameter of the canal. The patient symptoms improved after surgery. Total extirpation of the lesion is possible in most cases, and the prognosis is excellent even if the lesion is infiltrative. For this reason, excessively aggressive surgery is not necessary to obtain complete resection., (Copyright © 2016 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.)

We report the case of a 32-year-old patient complaining of chronic low back pain radiating to his left thigh. His MRI showed a lytic L1 vertebral body injury. A transpedicular biopsy confirmed the diagnosis of giant cell tumor. He underwent a L1 vertebrectomy and vertebral body replacement with a titanium cylinder using anterior approach, followed by the removal of the L1 posterior arch and the placement of pedicle screws through a posterior approach. The giant cell tumor is a rare benign primary bone tumor that can be locally aggressive and can potentially spread to other areas, usually to the lungs. Although it most frequently affects long bones, approximately 10% of tumors are located in the spine. To minimise the risk of recurrence, the elective management option is surgery., (Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.)

Supratentorial liponeurocytoma is a rare tumor, predominantly appearing in young males. It most commonly affects the lateral ventricles, with involvement of the third ventricle being exceptional. It is defined as a low-grade neuroglial tumor, with areas of associated lipomatosis. The most common clinical manifestation is that resulting from the presence of secondary intracranial hypertension and hydrocephalus. We present the first case reported in Spain of this tumor type and one of the few appearing in the literature so far. We report the case of a 33-year-old male patient, suffering from crural sensitive symptoms and recent onset headache. The radiographic study revealed the presence of a large supratentorial tumor; intraventricular, multicystic, heterogeneous and with areas of associated lipomatosis. The patient underwent surgery and complete tumor resection was achieved. The definitive diagnosis was of supratentorial liponeurocytoma. The presence of a supratentorial intraventricular tumor with areas of fatty degeneration should lead us to consider this type of tumor in the differential diagnosis. Complete tumor resection is considered to be the treatment of choice., (Copyright © 2011 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.)

Objective: To determine ICT accessibility and use among the adolescents attending High School and to analyse related factors., Design: Cross-sectional multicentric study., Setting: High Schools participating in the Community Health «Salut i Escola» Programme., Participants: 5,538 students from first to fourth degree at 28 centres in the area of Barcelona., Main Measurements: Self administered questionnaire including sociodemographic information, ICT use and accessibility., Results: Missing answers were below 1% in all items except in school performance (3,13%); 48,6% were female, mean age 14years (range 11-20); 15,5% foreigners; 23% reported low school performance; 75,2% took extracurricular activities; 88,9% refers a good relationship with their parents. ICT access is homogeneously massive: 98% had a computer at home, 44,8% used it for two or more hours daily. 98,6% could access Internet, 47,2% without parental control. 90% owned a mobile phone (83% in first grade, 95% in fourth); 45,6% owned one before 12years old. Girls use it for social relationships and boys for playing. 68,4% played videogames, 36,5% for three or more hours a week and 66,8% without parental control. Their use decreases with age. The ICT parental control is associated with better school performance., Conclusions: Our high scholars gain access to the ICT at younger ages and they use them in almost every aspect of their lives. There have been detected some gender differences in their use, as well as in the age of the users and between the type of school., (Copyright © 2013 Elsevier España, S.L. All rights reserved.)

Introduction and Objectives: The metabolic syndrome is an association of closely related alterations. The main objective of this study is to know the frequency of the metabolic syndrome and insulin resistance, and their role as cardiovascular risk indicators in an adult population assigned to Primary Care centers in Spain., Methods: Subjects > or = 45 years with basal glycemia > or = 90 mg/dl and abdominal circumference > or = 94 cm (men) or > or = 80 cm (women). ATP III modified-criteria were used for the metabolic syndrome and HOMA index > 3.29 was used for insulin resistance. Cardiovascular risk was estimated by the Framingham and SCORE models., Results: A total of 2,341 subjects (62 +/- 10 years; 44.6% males) were included. Frequency of metabolic syndrome and insulin resistance was 54.6% (52.5; 56.8) and 56.6% (54.5; 58.7) respectively. Metabolic syndrome was associated to a higher cardiovascular risk score with both Framingham (16 [15; 16] vs 11 [11; 12] p < 0.0001) and SCORE (2.7 [2.4; 3] vs 2.4 [2.1; 2.8]; p = 0.006) models. The results were similar for the presence of insulin resistance., Conclusions: Metabolic syndrome and insulin resistance are cardiovascular risk predictors. Early identification of metabolic syndrome by the use of simple clinical measures (basal glycemia and waist circumference) would make the intervention on the different disorders of metabolic syndrome possible.

Purpose: Cross-sectional study to validate a Spanish version of the 5 and 15 items Geriatric Depression Scale (GDS 5 and 15) in a non-selected community dwelling older population, compared with the clinical diagnosis of depression (using DSM-IV criteria) as gold standard., Patients and Method: A total of 301 subjects randomly selected from the >64 years old population served by a public Primary Care Center in Madrid were included. Severe cognitive impairment (MMSE < 20/30), severe hearing impairment and denial to participate were exclusion criteria. A descriptive and a screening study were performed., Results: The prevalence of depression in this population was 14.6%. The 5- item GDS had a sensitivity of 0.864 (0.762-0.965), specificity of 0.856 (0.813-0.899), PPV 0.507 (0.394-0.62), NPV 0.973 (0.952-0.994), and positive likelihood ratio 6 (4.34-8.26). The 15-item GDS had a sensitivity of 0.818 (0.704-0.932), specificity of 0.977 (0.958-0.995), PPV 0.857 (0.751-0.963), NPV 0.969 (0.948-0.99), and positive likelihood ratio 35.03 (28.76-40.77)., Conclusions: GDS-5 may be useful screening test for depression in non selected elderly patients in primary care. It has better sensitivity than GDS-15 and similar area under curve.

We report 3 patients with fibrous solitary tumor of meningeal location where we described the histological study, as well as evolution after the surgical treatment. The described patients presented ages of 37, 52 and 65 years, after the resection has not appeared an objective sign of recurrence in any case after 4, 6 and 7 years of follow-up respectively. Checking the literature the tumor is indistinguishable clinical and radiolocally of the typical meningioma, doing necessary the use of inmunohistochemistry to do the differential diagnosis, where positiveness for CD34 and the negativeness for EMA define the fibrous solitary tumor. It is about a benign tumor, where total removing is the principal factor in prognosis, nevertheless there are cases of local recurrences and long-distance metastasis. We can find all these characteristics in the showed cases of the present article, having the uncertainty of its local or systemic relapse ability in the future.

The European Directive 2001/20/EC was intended, among other things, to simplify and accelerate the start of multicenter clinical trials (MCT) in all European Union countries. The Spanish regulation in force since May 2004 has failed to achieve this. Because there is not a real single opinion in Spain, as given by a single Research Ethics Committee, a key point to accelerate the MCT assessment, less than 50% of the protocols are assessed in the maximum time of 60 days established by the Directive. As a consequence in 2005 up to 29% of investigators (twice as much as in 2003 percentage) had no time to recruit patients in the MCT, since when the ethical-administrative process is finally completed, the recruitment period has almost concluded, or even has finalized internationally. Likewise, a 37% reduction in the percentage of investigators recruiting > 90% of committed cases in MCT was observed between 2003 and 2005. All these differences are statistically significant (p < 0.0001). These figures clearly show that Spain needs urgent changes in the current regulation of MCT to be competitive in clinical research in Europe.

Objectives: To estimate the proportion of benzodiazepine prescriptions that comply with the guidelines for appropriate prescription. To identify the variables associated with appropriate prescription., Design: Observational, cross-sectional study., Setting: Monóvar Health Centre in Area IV, Madrid, Spain., Subjects: Random sample of 270 active benzodiazepine prescriptions in adult patients from the prescriptions record of the OMI-AP V. 5.0 computer system., Measurements: The chosen dimensions for appropriate prescription were: a) correct diagnostic indication; b) absence of benzodiazepines with long half-life in the elderly; c) existence of support or monitoring visits; d) overall appropriateness or coexistence of correct diagnostic indications and monitoring visits. Independent variables were recorded in relation to patient, person prescribing and prescription., Results: Diagnostic indication, 75.6%; absence of benzodiazepines with long half-life in the elderly, 79.8%; existence of support visits, 63.3%; overall appropriateness, 53%. Main diagnoses: pure anxiety, 29%; anxiety related to other illness, 18.6%; insomnia, 14.8%; cardiovascular illness, 14.8%; alcohol and drug abuse, 4.5%; osteo-muscular illness, 4.4%; schizophrenia, 4.4%. Most prescribed substances: lorazepam, 27.8%; bromazepam, 23.7%. Average life of prescriptions: 18.58 months. Origins: health centre, 68.5%; out-patient psychiatry, 10%; hospital, 10%. The variable that is most closely associated with overall appropriateness, fitted with the rest of the variables, is out-patient psychiatry prescription (OR, 6.67; 95% CI, 1.92-23.18)., Conclusions: The mean duration of the prescriptions infringes all standards. The overall appropriateness or correct coexistence of adequate diagnostic indication with follow-up visits is associated with out-patient Psychiatry prescription.

Tumours of the middle ear are rare. Among them glomus tympanicum is the most frequent, followed by adenoma of the middle ear (AME). This insidious pathology entity displays unspecific clinical and audiological features. Advances in histology and immunohistochemistry have greatly contributed to an accurate diagnosis. We report our experience with two patients, a middle-aged man and a woman, diagnosed in our hospital. Both patients underwent surgical treatment and have shown no signs of recurrence after a 27- and 28-month follow-up. In both cases an accurate diagnosis was confirmed by histological and immunohistochemical analysis.

Objective: In present study we analyze the causes leading to reoperation patients treated for lumbar spinal stenosis with laminectomy and lumbar instrumentation., Material and Methods: 74 patients operated between January of 1996 and December of 2000 with a minimum 4 year follow-up were seleted for the study., Results: 16 patients (21.1%) underwent a new surgical intervention. The main cause for reoperation was stenosis of the adjacent level superiorly to the instrumentation (in 50%). Other causes were radicular fibrosis, persistence of stenosis after the surgery, neuropatic pain, failure of the instrumentation system, transpedicular screws misplacement and break of screws., Conclusions: Complications related with the initial surgical procedure are low, as half of the reoperations were due to stenosis of the segment superior to the fixation.

Objective: To investigate whether running influences smoking habits., Design: Study of cases and controls, with 1:1 pairing. Retrospective longitudinal observational study., Setting: Primary care. City of Toledo, Spain., Cases: 48 healthy volunteer runners of 47+/-7.8 years of age., Controls: 48 healthy subjects, paired by gender and year of birth, chosen at random from the medical list assigned to the medical researcher., Principal Measurements: Smoking habits and alcohol consumption in grams per week using a questionnaire, weight, height, blood pressure, and heart rate at rest. The odds ratio (OR) was obtained on the proportion of subjects who smoked or smoked at some time, those who continued smoking and the probabilities of giving up tobacco in each group., Results: The OR of the proportion of subjects who smoked or had smoked between the groups of runners (54.2%) and controls (70.9%) was 0.486 (95% confidence interval [CI], 0.205-1.149; chi(2)=2.8; P=.093). The OR for continuing the habit between groups of runners (8.4%) and controls (41.7%) was 0.127 (95% CI, 0.035-0.456; chi(2)=14.0; P=.0002). In the group of runners, 45.8% had stopped smoking, as well as 31.2% of the controls (OR=7.85; 95% CI, 1.89-32.52; chi(2)=11.8; P=.0007); 50% of the runners who smoked had given it up since starting to run and 76.9% of these had given it up just at the time of starting to run., Conclusions: There is a negative association between running and tobacco. If a smoker decides to run regularly he/she has high probabilities of giving up smoking and continue to do so.

Background and Objective: In the assessment of every clinical trial protocol, one of the critical tasks performed by research ethics committees (RECs) is an in depth review of the patient's information sheet (PIS). The objective of the study was to review the assessment of RECs in Spain regarding the PIS through the changes to be done in them in order to obtain RECs approval. Differences between changes requested by different RECs may provide some measure of the existing homogeneity amongst RECs as far as evaluation of PIS is concerned., Material and Method: This was a prospective study of 187 applications of multinational clinical trials (MCT) submitted in 2002-03 and for which the RECs and Spanish Medicines Agency evaluation process was completed by July 2003, reviewed by 62 RECs, for 85 hospitals and 29 primary care centres. The main assessment measures were PIS-related features and type of changes asked by RECs to be done in PIS., Results: One hundred and one of 183 approved applications of 24 protocols submitted had 307 queries raised from 41 RECs, of which 118 were related with changes in PIS. These 118 queries were raised by 38 RECs (61%; 38/62) in 66 applications (36%; 66/183). There were queries for all 24 protocols, but only for 2 studies (8%; 2/24) there were no queries related with PIS. In seven protocols all queries were associated with the PIS (29%; 7/24). 22% of RECs asked for a median of 14.5 copies of a separate PIS (in addition to those submitted with the protocol and the rest of documentation) for the assessment of the MCT. The number of pages of the PIS ranged from 3 to 6 with a mean number of 2,082 words. The type of changes in the PIS requested by the RECs were related with: risk/benefit and adverse events (27.1%), typographic changes and logistics information (19.5%), personal data protection (16.9%), explanation of procedures (11.9%), add some information (11.9%), word/sentence difficult to understand (8.5%) and delete some information (4.2%)., Conclusions: In this study, the general content and quality of the PIS were correct enough. Indeed, although the number of RECs asking for changes in the PIS was not low (61%), most of these changes were minor and affected only 36% of the submissions, with a median of 1 change per submission. Therefore, these data also suggest that there is a remarkable homogeneity across RECs in their evaluation of PIS. RECs have special interest in such aspects as benefit/risk information and confidentiality and data protection; in fact, almost half of the changes in PIS requested by RECs referred to those two items.

The Burkitt's lymphoma is a haematological neoplasia typical of early ages. In our country, the lymphatic nodes affectation is the most usual. We present a case report with a 12 year-old boy who consults for a asymptomatic cervical mass. The ultimate diagnosic was a nasopharyngeal Burkitt's lymphoma with neck extension.

In this article we review the main results of historical-social research on gender and medical practice, propose a model for applying a gender perspective to the study of healthcare professions, and analyze some current forms of gender bias in Spanish public health societies and publications. The main conclusions indicate: the historic construction of gendered professional identities; the existence of vertical segregation by sex in scientific societies and in journal editorial boards; the existence of androcentric practices in the scientific journals, exemplified by the style of using the initial letter of the authors' first name; the fact that scientific societies do not collect data by sex; the difficulties that all of this implies for quantitative investigations that study the sex variable and adopt a gender perspective; and the need to promote qualitative research on the issue.

Objective: The objective of this study was to assess the association between employment, educational level, marital status, and smoking in a large cohort of Spanish university graduates (3- and 5-year degrees), with a predominance of health professionals., Methods: A cross-sectional analysis of the baseline data of the first 7,508 participants in the follow-up study of the University of Navarre (SUN Project) was performed. The subjects were classified according to their smoking status. Independent variables were: employment, marital status, highest educational level attained, number of children, alcohol consumption (g/day), body mass index, and age. In the multivariate analysis, 3 non-conditional logistic regression models were built using the following outcomes: a) smokers vs never-smokers plus ex-smokers; b) smokers vs never-smokers; c) smokers of 15 or more cigarettes a day vs smokers of less than 15 cigarettes a day plus never-smokers and ex-smokers., Results: Among men, no association was found between employment and smoking status in any of the comparisons. In contrast, among women, being a nurse was associated with a higher prevalence of smoking. The prevalence of current smokers among nurses was 48.5%. Female students were also more likely to smoke and had a higher risk of being heavy smokers (OR = 1.81; 95% CI, 1.28-2.57). A lower prevalence of smoking was found among participants of both sexes who had completed a doctorate., Conclusions: Among a large Spanish collective with higher education, the prevalence of smoking was higher in women with a shorter college degree. The prevalence of smoking among nurses was higher than the average among women graduates, which is a cause for concern.

Objective: To evaluate the effectiveness of an innovative programme to promote physical activity (PEPAF) introduced into the daily consultations of the family doctor., Design: Clinical trial with control, randomised for groups of 100 patients seen by one of the 70 doctors taking part, allocated to two parallel groups and monitored for 24 months.Setting. 13 primary care centres coordinated through the Network of Research into Preventive and Health Promotion Activities conducted in primary care., Participants: Sample with probability of 7000 sedentary patients, selected from among those who consulted for any reason their family doctor during the third quarter of 2003. Patients with cardiovascular disease or other problems meaning that exercise could cause adverse effects will be excluded., Interventions: The doctors allocated to the PEPAF will design a plan of physical activity with those patients prepared to make the change. Those not prepared to will be briefly counselled and given material to help them. All will be monitored at random. The control group doctors will postpone any systematic intervention on exercise until after 2005, excepting those patients whose health problem is directly related to a sedentary life-style., Measurements: The main measurement of results will be the increase in the level of physical activity from the base measurement to those at 3, 6, 12 and 24 months, using 7-day physical activity recall. Health-related quality of life (SF 36) and physical fitness will also be measured. Variables that might be predictive or confusing, such as sex, age, comorbidity, social class, etc., will be considered. Analysis. The average changes observed in the two groups will be compared, on the basis of intention to treat, through analysis of covariance. We will use mixed-effect models able to cover the intra-patient, intra-doctor and intra-centre correlation.

The testicular infarction can be a rare complication of the orchiepididymitis. The ultrasonography appearance of the partial infarctions creates confusion with expansive intratesticular processes. We present three cases of focal testicular infarction associated with orchiepididymitis, stressing the usefulness of the Color doppler sonography for detecting the avascular nature o these lesions. The determination of de indeces of resistance (IR) in the doppler spectrum of intratesticular arteries showed a highly increased vascular resistance in respect of the healthy testicle. In patients with grave orchiepididymitis vein drainage can be affected due to compressive edema or to thrombosis, causing the raising of the resistance indeces. Acknowledging the avascular resistance of the focal post-orchiepididymitis infarction we can prevent unnecessary orchiectomy.

In this case report the patient had a giant saccular aneurysm caused by arteriosclerosis, located in the ascending aorta and protruding through the anterior thoracic wall, with osteolysis of the two adjacent ribs. Costal involvement in arteriosclerotic aneurysms has not been described in the literature. We review the incidence, types and clinical signs of aneurysms of the ascending aorta, emphasizing the complications caused by arteriosclerotic aneurysms.

Background: Performance and efficiency in patient selection are essential for conducting clinical trials. Data on these are presented from a multinational trial., Patients and Methods: A randomized, double-blind, placebo-controlled, parallel-group study in asthma, with a screening phase followed after randomization by a treatment period, was selected. Number of patients screened and randomized by centre and country, centres achieving the minimum recruitment (> or = 10 patients randomized), and efficiency of investigators (randomized/screened x 100) were determined and compared., Results: 564 patients, out of 836 screened, were randomized at 69 centres in 11 countries. Twenty-four centres (35%) randomized > or = 10 patients each, accounting for 70% (n = 395) of the total number recruited. Efficiency was significantly higher among these "high-performance" centres (81.4%; p < 0.001; OR, 4.7; CI 95%, 3.4-6.5) than in the remaining ones (48.1%). Five countries had > or = 2 "high-performance" centres. Efficiency was also significantly higher (p < 0.001) among those (370 randomized/455 screened, 82.1%) than in the remaining centres of the same countries (82/140; 58.6%; OR, 3.0; CI 95%, 2.7-4.7). A relevant number of centres (n = 17; 25%) randomized 0-1 patient (7 randomized/58 screened)., Conclusion: The analysis of patient selection in clinical trials showed that a minority of centres accounted for most of the patients recruited. Those are not only the most productive (more patients randomized) but also the more efficient (better quality of screening process).

Background: The appearance of episodes of arthritis has been detected in beekeepers in the Siberia Extremadura (Spain) related to working with the hives. This present work describes the clinical features of such arthritic syndrome., Methods: Sixty cases were selected at random from a previous epidemiological study to undergo a clinical protocol that included, anamnesis, physical signs, haematological, biochemical and immunological analyses, and radiological exploration of hands, wrists, feet, and pelvis., Results: The picture is characterized by episodes of oligoarthritis associated with bee-stings in the affected joints or nearby. The most frequent radiologic lesions are pinched articular lines, sclerosis, and the presence of geodes. Analytically, there was frequent eosinophilia, abnormalities in haemostasis tests, and a rise in serum alkaline phosphatase., Conclusions: An acute inflammatory oligoarthritis of unknown cause has been described which affects the hands asymmetrically, and which is found in beekeepers in relation to their work with the hives. It occasionally involves into a chronic localized arthropathy capable of provoking ankylosis and permanent articular disability.

Objective: To assess the results of check-ups carried out on children when putting into practice the Programme for Healthy Children and various screenings., Design: Crossover, descriptive study of the check-ups of healthy children carried out over a year (January to December, 1991)., Setting: Primary Care: the Pediatric Clinics of Soria Norte Health Centre, Soria., Patients: All the children who had one or more check-ups during the study period., Measurements and Main Results: The check-ups identified 0.78 problems per child. The greatest number of problems were found in the 15 day check-up, due to perinatal pathologies, followed by those at ages 3 and 6. The number of problems/number of check-ups relationship is 0.79 in children under 2 and 1.42 in those over 2. The problems occurring most often correspond to groups XV1, X1V and X11 (WONCA CIPSAP 11 Code). Groups V and V1 problems occurred most often at the ages when specific screenings were carried out., Conclusions: A high percentage of problems are found when checking healthy children, although many of them have very little clinical implication. The introduction of screening procedures at these check-ups assists the early identification of illnesses among this sector of the population.

The weight, height, body mass index (BMI) and deviation from the ideal weight according to tables were measured in the patients over 24 years who spontaneously attended a demand clinic. These data permitted to calculate the prevalence of obesity in the demand clinic, and its relation with age, sex, frequentation rate and type of consultation were evaluated. 301 subjects were included, 113 males and 188 females, with a mean age of 53.43 +/- 10.68 years. According to their BMI, 52.62% were obese. It was concluded that: the prevalence of obesity in the demand clinic amounted to about 50% (65% in females); age was related with obesity only in females; weight and age influenced frequentation and type of consultation in females, whereas in males only the age had an influence.