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Introduction: Palliative care in neurodegenerative diseases is useful but underused. The objective of this study is to know how palliative care (PC) is applied in Spain in order to identify limitations and unmet needs., Materials and Methods: It is a descriptive, observational, cross-sectional study, anonymous survey type of 20 questions, directed and answered by neurologists dedicated to movement disorders (MD) in Spain., Results: 58 responses were obtained from neurologists from 15 autonomous communities. 69% answered that they did not have a specialised MD nursing facility but did have a PC team in their centre (81%). No specific protocol for PC in MD was identified. All except one neurologist stated that they lacked sufficient training in PC, the main training need being the "advance directives explanation". Only 1 in 4 neurologists answered routinely explaining advance healthcare planning to their patients, recognising up to 84.5% of neurologists not knowing how to assess the patient's competence. 60.3% of those surveyed answered that between 10% and 30% of their patients would be candidates for PC, although 1 in 3 said they were not clear when to refer the patient to PC. 100% of neurologists affirmed the priority need to implement PC protocols in MD., Conclusions: Our study shows a formative deficit in PC in this area and in the care of the patient with movement disorders and their environment, and should serve as a starting point to develop consensual care protocols., (Copyright © 2021 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To describe the main factors associated with proper recognition and management of patient-ventilator asynchrony (PVA)., Design: An analytical cross-sectional study was carried out., Setting: An international study conducted in 20 countries through an online survey., Participants: Physicians, respiratory therapists, nurses and physiotherapists currently working in the Intensive Care Unit (ICU)., Main Variables of Interest: Univariate and multivariate logistic regression models were used to establish associations between all variables (profession, training in mechanical ventilation, type of training program, years of experience and ICU characteristics) and the ability of HCPs to correctly identify and manage 6 PVA., Results: A total of 431 healthcare professionals answered a validated survey. The main factors associated to proper recognition of PVA were: specific training program in mechanical ventilation (MV) (OR 2.27; 95%CI 1.14-4.52; p=0.019), courses with more than 100h completed (OR 2.28; 95%CI 1.29-4.03; p=0.005), and the number of ICU beds (OR 1.037; 95%CI 1.01-1.06; p=0.005). The main factor influencing the management of PVA was the correct recognition of 6 PVAs (OR 118.98; 95%CI 35.25-401.58; p<0.001)., Conclusion: Identifying and managing PVA using ventilator waveform analysis is influenced by many factors, including specific training programs in MV, the number of ICU beds, and the number of recognized PVAs., (Copyright © 2019 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)

Not only ae cardiac hibernomas rare, ante-mortem diagnosis is poor, due to the clinical and radiological similarity with other intracardiac masses. Furthermore, cardiac hibernomas can be asymptomatic and thus escape detection with imaging studies. We present a case of an 81-year-old woman who died as a result of pulmonary tumor embolism. This unusual case highlights the necessity for clinicians and pathologists to be familiar with intra-cardiac neoplasms. We discuss its diagnostic difficulty and the complication of pulmonary tumor embolism., (Copyright © 2018 Sociedad Española de Anatomía Patológica. Publicado por Elsevier España, S.L.U. All rights reserved.)

Metastasic priapism is a rare entity produced by tumor cell implantation or direct infiltration of corpora cavernousum of the penis. In up to 80% of cases the primary tumor has an urological origen like prostate or bladder cancers. Treatment depends on syntomatology and patient's prognosis. Generally, average survival in these patients is poor due to metastasic progression, among 1 to 1 and a half years. We present a case report of secondary priapism for direct bladder carcinoma's invasion of the corpora cavernousum. A total penectomy due to a penile infected necrosis was required.

Metastasic priapism is a rare entity produced by tumor cell implantation or direct infiltration of corpora cavernousum of the penis. In up to 80% of cases the primary tumor has an urological origen like prostate or bladder cancers. Treatment depends on syntomatology and patient's prognosis. Generally, average survival in these patients is poor due to metastasic progression, among 1 to 1 and a half years. We present a case report of secondary priapism for direct invasion of the corpora cavernousum of the penis for bladder carcinoma.

Introduction: Paratesticular tumours are rare but generally benign neoplasms, usually treated by local excission. Adenomatoid tumours of epididymis are the most common of these tumours., Objectives: Analyze paratesticular tumours treated in our center and describe dyagnosis and treatment of adenomatoid tumours of epididymis., Material and Methods: We retrospectively review 8 patients with paratesticular tumours treated from July 1997 to July 2007. We analyze clinical presentation, dyagnostic suspicion given by image technique, treatment followed and final dyagnosis., Results: Patients median age was 44.1 years (22-69), presenting most of them subacute scrotal tumour with median size by ultrasound of 2.8 cm (1.5-7). All of them were locally extirpated except one with suspicion of a malignant polyorchidism and another one with an apparently intratesticular lesion of great size. Just in two cases peroperatory biopsy was performed. Dyagnosis was in 4 cases adenomatoid tumour of epididymis, in two cases fibrous pseudotumour of epididymis, in one case leiomyoma of epididymis and in one case angiolipoma of spermatic cord. Just in one case diagnosed of adenomatoid tumour of epididymis ultrasound confirmed solid tumour suggesting the final dyagnosis., Conclusions: Adenomatoid tumors of epididymis are rare tumours which may present at any age. Ultrasound may help in dyagnosis, but its capacity to distinguish this lesions is low. Benignity of adenomatoid tumour of epididymis as well as most of the other paratesticular tumours should make local excission the treatment of choice and, when any doubt existed, peroperatory biopsy should be performed.

Introduction: To evaluate the differences between laparoscopic (LRP) and open radical prostatectomy (ORP)., Material and Methods: From 2004 to 2005 180 Radical prostatectomies (RP) were performed, 105 laparoscopical and 75 by an open approach. Different urologists have acted as first surgeon; 51% of them, fully experienced ones in OPR, and 56% in LRP. Differences in operative time, estimated blood loss (difference of pre and post operative hematocrite), and duration of hospitalization were compared. Additionally, we have also analysed surgical and oncologic control of the specimen defined by the following variables: Malignant margins (MM) (positive margin in a pT3 specimen), and benign/malign surgical incision (BSI/MSI)., Results: Groups were similar concerning age, clinical stage and Gleason score, and there are only differences in PSA. Mean operative time was significantly higher in LRP (172 minutes) versus ORP (145 minutes) (p < 0.001). Difference of pre and post operative hematocrite was also higher in the open group (10.7 vs 9.2) (p = 0.03), together with hospital stay, which was one day longer in the ORP group (p = 0.001). ORP group had a higher rate of benign surgical incisions (48.7% vs 26.7%) (p = 0.001). Regarding oncologic results, LRP presented a 5.4% of positive margins, which compared significantly with a 16.9% rate in the open group (p = 0.023). However, no differences concerning malignant surgical incisions were observed., Conclusion: With no differences in clinical and pathological stage, LRP offers a significant reduction of surgical aggressiveness on the specimen, together with a better MM control. We also observe a clear decrease in blood loss and hospital stay. Therefore, we conclude that LRP in our environment is a valid approach of surgical prostate cancer treatment in spite of a longer operative time (27 minutes) and a steep learning curve.

Introduction: Human hydatidosis is a prevalent zoonotic disease in the Castilla y León region of Spain. The aim of this study is to investigate the seroprevalence of Echinococcus granulosus infection in this region., Methods: We studied 4824 serum samples from a random, representative population of healthy individuals from each province of Castilla y León, obtained over one year. An indirect enzyme-immunoassay developed in our laboratory was used to determine the presence of IgG antibodies against Echinococcus granulosus in these samples., Results: IgG antibodies against Echinococcus granulosus were detected in 3.4% (164/4824) of samples studied, with a range of 1.26% to 7.10%, depending on the province. Antibody seroprevalence increased significantly with age, but there was no significant sex-related difference (3.66% men vs. 3.14% women)., Conclusion: The seroprevalence of Echinococcus granulosus infection in Castilla y León is still high. These data contribute to hydatidosis surveillance within the control program for this disease.

Lymphoma involving the prostate is rare, wether presenting as primary extranodal lymphoma or as a secondary spread to the prostate from other sites. There are less than 100 cases reported in the literature and accounts for 0.09-0.1%. The clinical presentation can be attributed to nodular hyperplasia or prostatic carcinoma. Criteria for primary prostatic lymphoma include: 1) tumor limited to the prostate and adjacent soft tissues. 2) the absence of lymph node involvement. 3) a lymphoma free interval of at least 1 month. The evolution is rapid and the prognosis remains poor regardless of the patient age, histologic type, treatment, or clinical stage of disease at presentation. We report a case of a 65 years old male in which the incidental diagnosis of lymphoma of the prostate was performed in the adenomectomy. The clinico-pathological criteria and the histogenesis of this entity are described.

Objective: To evaluate the effectiveness of routine biopsy of the transitional area in patients undergoing early systematic sextant biopsy., Patients and Methods: Two biopsies were taken from the transitional area further to a sextant biopsy in 164 consecutive patients. 98 cases had serum PSA levels higher than 4 ng/mL and 66 suspicious rectal digital examination., Results: Cancer was detected in 77 patients (46.9%). In 28 (36.4%) cases cancer was found only in the peripheral area, in 2 (2.6%) in the transitional area and in 47 (61%) in both areas., Conclusion: Routine biopsy of the transitional area in early systematic prostate biopsy appears to be little effective. This would probably be indicated for patients undergoing rebiopsy.

Objective: To analyze the incidence of pathoanatomical lesions seen in systematic prostate biopsies and to evaluate their influence on PSA serum levels., Material and Methods: 495 consecutive prostate biopsies, indicated by a suspicion digital rectal examination in 194 patients (39.2%) and raised serum PSA in 301 (60.8%), were evaluated. Biopsy was performed by sextant and hypoechoic nodes, and PSA serum measurements by dual monoclonal antibody radioimmunoassay, Tandem PSA., Results: Cancer was diagnosed in 42.6% biopsies and BPH in 67.4%; additionally, other associated lesions were detected in 74.6% cases, the most frequent ones being chronic prostatitis (47.3%), glandular atrophy (35.9%) and acute prostatitis (23%). All lesions were significantly related to the primary BPH diagnosis in 74.2% to 85% cases. High grade PIN (14.1%) was related to primary cancer diagnosis in 87.1% cases. The multivariate analysis showed that the main diagnosis (BPH vs cancer) was the only variable that had a significant influence on PSA serum levels. When BPH patients were considered separately, the only variable with significant influence on PSA serum levels was the prostatic volume. The univariate analysis showed a nonsignificant increase in association with acute prostatitis and high grade PIN, and a decrease in association with chronic prostatitis., Conclusions: BPH or cancer associated damage is very frequent in prostatic biopsies. However, the only factors showing a significant contribution to PSA serum levels appear to be the presence or absence of cancer, or the prostatic volume when the main diagnosis is BPH.

Clinical diagnosis of cardiac tumours is often difficult. We present the case of a 17 year-old boy in whom a left ventricular tumour was discovered during on diagnostic work-up for a syncope. The tumour was removed and histology confirmed the diagnosis of myxoma.

Diagnosis of prostate cancer has increased over the last few years both in localized and in more advanced stages. At present, several groups are working in the search and evaluation of alternative tumoral markers as the current ones do not cover all the Urologist's needs. In this context, a number of studies on the mutation of the tumour suppressor gen p53 in both localized and metastatic prostate cancer are being carried out. When a noxa acts on the DNA, protein p53 inhibits the cell cycle allowing the repair systems to operate and, if the damage is significant enough, cell apoptosis. The loss of this control mechanism secondary to the synthesis of anomalous proteins can result in the proliferation of neoplastic cells. A revision of the most representative papers in the literature is presented here, addressing the surrounding controversy and the resulting future possibilities.

Patients with severe angina pectoris, refractory to medical treatment, in which conventional revascularization (PTCA or bypass surgery) is not possible because they present advanced coronary artery disease with a poor distal bed, account for an important clinical problem due to an increasing incidence, combined with poor quality of life, an elevated risk of severe complications, repeated hospital admissions and high mortality rate. Laser transmyocardial revascularization provides a new therapeutic alternative for these patients. Although up to now there are only a few published series, with a small number of patients, the results obtained in the two ongoing multicentric studies in Europe and the United States (including more than 500 patients at present) are quite promising. It is a simple surgical procedure, but its associated mortality is not to be dismissed (in the beginning 12% and currently 5%), because patients are in an advanced evolutionary stage. In Spain this procedure has been available since April 1996 and the results have been encouraging. In our small series we have noted a significant symptomatic improvement and better quality of life.

Unlabelled: A series of 7 cases of chromophobe cell carcinoma with clinicopathological correlation is studied. The immunohistochemistry analysis was carried out evaluating in all cases: low and high cytoqueratines (AE1, AE3), membrane epithelial antigen (EMA), vimentin, carcinoembrionary antigen (CEA), proliferative cell nuclear antigen (PCNA) and the oncoproteins p53 and focal c-erbB2. In all cases a diffuse positivity for EMA, AE3 and focal for AE1 was observed, while vimentin and CEA were negative. The positivity for PCNA was always less than 25% of tumoral cells. The oncoprotein p53 was in all cases negative and only in one case a mild and focal positivity for c-erbB2 was observed., Conclusions: 1) The negativity for vimentin and positivity for EMA, AE1 and AE3 allows to differentiate this carcinoma from clear cell carcinoma. This corroborate a distinct histogenesis, thus suggesting their origin in the intercalar cells of distal collector tubules. 2) The low values of PCNA and the negativity for both oncoproteins p53 and c-erbB2 supports the low aggresivity of this tumor and a better prognostic than other types of kidney carcinomas.

Presentation of two cases of Leydig cell tumor in adult patients who presented with gynecomastia, and slightly abnormal hormonal profiles. One patient had a non palpable tumor. The pathophysiology of this entity is commented, as well as the importance of the different modalities in its diagnosis.

Objective: To quantify and describe the self-care practices for children up to 14 seeking care because of an acute pathology., Design: An observation study carried out by means of a questionnaire administered to the person accompanying the patient., Setting: Primary Care: an urban Health Centre., Patients and Other Participants: The total number of cases of acute pathology treated during April and May 1993 in the Centre's paediatric clinics., Measurements and Main Results: 248 cases were studied (53% boys and 47% girls, with an average age of 5.3 +/- 3.85). Self-care (self-medication, 84.6%; non-pharmacological measures, 11.5%; both of these, 3.9%) was practised in 61.3% of cases (CI 95%: 55.2-67.4). The most common drugs were: antipyretics-analgesics (60%), antitussives (9.6%) and antibiotics (8.1%). Self-care was practised most often on patients presenting respiratory symptoms (69.6%) (p < 0.001), with self-medication predominant (91.2%) (p < 0.001). The number of days occurring between the appearance of symptoms and the medical consultation was greater among those who did not practise self-care (4.5 +/- 5.2 as against 2.1 +/- 1.8) (p < 0.001)., Conclusions: Self-care is a very common practice among people seeking paediatric treatment. Self-medication, especially for respiratory trouble, is the most common form. Patients who practise self-care tend to be earlier in seeking a medical consultation.

Pheochromocytomas are often unnoticed, and diagnosis is performed on autopsy examination, or more rarely it is noticed during surgery or abdominal exam for a different reason. In many of these patients the lack of hypertension is a characteristic feature. We contribute a singular case of a patient with pheochromocytoma found by chance during an abdominal exam and which in spite of secreting noradrenaline, did not provoke hypertension or other symptoms. We review literature on this stage form of presentation and the different physio-pharmacological hypothesis which could condition the absence of clinical manifestations. We discuss the preoperative management in patients without hypertension.