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Objective: To identify opinions of Primary Healthcare nurses on the use and usefulness of standardised nursing care plans and traditional nursing language systems in the practice settings., Design: Multicentre, observational, cross-sectional study., Setting: Primary Healthcare centres in Catalonia., Participants: Sample size was estimated at 1,668 registered nurses. Consecutive sampling was applied., Interventions: On-line survey containing questions on ease, usefulness, and use of nursing care plans and standardised nursing language systems., Measurements: Descriptive statistics, including percentages, central tendency, and dispersion measures. Statistical significance was set at P≤.05., Results: The final analysis included 1,813 questionnaires. Participants stated that care plans have a medium added value, however their use is frequently incorrect. They stated to have a fair level of knowledge on traditional standardised nursing languages, and most were of the opinion that these languages are difficult to use in practice (81%) and not useful to represent nursing care provision and its outcomes (78%). Regardless of their education level and years of experience, the participants assessed as insufficient the clarity (P=.058), ease of use (P=.240), and usefulness (P=.039) of these language systems in practice., Conclusions: Nurses say that urgent changes are required in the use of care plans. This includes changing the language systems, and improving data and information that positively impacts on the provision of nursing care, as well as to enhance the health outcomes of the individuals receiving Primary Healthcare services., (Copyright © 2019. Publicado por Elsevier España, S.L.U.)

Technology and medicine follow a parallel path during the last decades. Technological advances are changing the concept of health and health needs are influencing the development of technology. Artificial intelligence (AI) is made up of a series of sufficiently trained logical algorithms from which machines are capable of making decisions for specific cases based on general rules. This technology has applications in the diagnosis and follow-up of patients with an individualized prognostic evaluation of them. Furthermore, if we combine this technology with robotics, we can create intelligent machines that make more efficient diagnostic proposals in their work. Therefore, AI is going to be a technology present in our daily work through machines or computer programs, which in a more or less transparent way for the user, will become a daily reality in health processes. Health professionals have to know this technology, its advantages and disadvantages, because it will be an integral part of our work. In these two articles we intend to give a basic vision of this technology adapted to doctors with a review of its history and evolution, its real applications at the present time and a vision of a future in which AI and Big Data will shape the personalized medicine that will characterize the 21st century., (Copyright © 2020 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Manage clinical risks under the integrated risk management model of the BUPA organization (British United Provident Association)., Materials and Methods: BUPA is an international group that provides health insurance and healthcare services. The project has been limited to Europe and Latin America (ELA) and this article presents the results related to hospitals. The integral risk management model was based on a governance structure, a risk management framework and the risk management itself (continuous process of identification, evaluation, management, monitoring and reporting). For the latter, a catalog of potential clinical risks was drawn up, using the Joint Commission International (JCI) standards as a reference and applied to a hospital to identify the risk to which they were exposed in their daily activity. An evaluation was conducted, based on its impact and probability of occurrence and depending on the residual and inherent score obtained, the action on each risk and the effectiveness of the controls were determined. A continuous monitoring of the risk profile and the information to share with the Board was defined., Results: The catalog consisted of 126 risks and 479 controls, divided by areas of application. In the assessment of the inherent risk, 84% of the risks were at an acceptable and assumable level, and in 16% it was necessary to establish an action plan., Conclusions: Under the conditions of the study, we believe the benefits of implementing an integrated management of clinical risk system consisted in providing services that meet the legal requirements and standards of good practice (in our case, the JCI's standards). They allowed us to advance in the organization's management of, improving its efficiency in the allocation of resources for risk management and adaptation to the environment and the patient. In addition, this strategy can facilitate decision-making and encourage the organization's transformation capacity., (Copyright © 2018. Publicado por Elsevier España, S.L.U.)

Introduction: Ceftaroline fosamil is a new-generation antimicrobial agent of cephalosporins subgroup. It is the first commercially available beta-lactam antibiotic that exhibits activity against methicillin-resistant Staphylococcus aureus (MRSA). The aim of this study is to determine the in vitro Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) values of ceftaroline against S.aureus strains (including MRSA)., Material and Methods: A multicenter study involving four hospitals representative of the Spanish geography was performed. MIC and MBC values against both the methicillin-resistant and sensitive strains of S.aureus (MRSA and methicillin-sensitive S.aureus [MSSA]) were determined using a broth microdilution method., Results: A total of 266 S.aureus strains were analyzed (95 MRSA and 171 MSSA). Ceftaroline bacterial sensitivity showed a mean MIC of 0.227 μg/ml (SD=0.146; range, 0.06 to 1 μg/ml). All MIC values of the 266 strains tested belonged to the sensitive category (value ≤ 1 μg/ml). Intermediate or resistant strains were not detected. MIC50 and MIC90 values for MRSA were 0.25 and 0.5 μg/ml, respectively (range=0.125-1 μg/ml). MSSA strains showed MIC50 and MIC90 values of 0.125 and 0.25 μg/ml, respectively (range=0.125-0.5 μg/ml). MBC50 and MBC90 values for MRSA were 0.5 and 1 μg/ml, respectively (range=0.125-1 μg/ml). MSSA strains showed MBC50 and MBC90 values of 0.25 and 0.25 μg/ml, respectively (range=0.125-0.5 μg/ml)., Conclusion: Ceftaroline shows excellent in vitro activity against S.aureus, including MRSA strains. Therefore, this antibiotic may be a promising alternative for the treatment of infections caused by this bacterium., (Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Objectives: Undiagnosed abnormal glucose metabolism is often seen in patients admitted with acute myocardial infarction, although there is no consensus on which patients should be studied with a view to establishing an early diagnosis. The present study examines the potential of certain variables obtained upon admission to diagnose abnormal glucose metabolism., Design: A prospective cohort study was carried out., Setting: The Intensive Care Unit of Arrixaca University Hospital (Murcia), Spain., Patients: A total of 138 patients admitted to the Intensive Care Unit with acute myocardial infarction and without known or de novo diabetes mellitus. After one year, oral glucose tolerance testing was performed., Main Outcomes: Clinical and laboratory test parameters were recorded upon admission and one year after discharge. Additionally, after one year, oral glucose tolerance tests were made, and a study was made of the capacity of the variables obtained at admission to diagnose diabetes, based on the ROC curves and multivariate analysis., Results: Of the 138 patients, 112 (72.5%) had glucose metabolic alteration, including 16.7% with diabetes. HbA1c was independently associated with a diagnosis of diabetes (RR: 7.28, 95%CI 1.65 to 32.05, P = .009), and showed the largest area under the ROC curve for diabetes (0.81, 95%CI 0.69 to 0.92, P = .001)., Conclusions: In patients with acute myocardial infarction, HbA1c helps identify those individuals with abnormal glucose metabolism after one year. Thus, its determination in this group of patients could be used to identify those subjects requiring a more exhaustive study in order to establish an early diagnosis., (Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.)

Objectives: To determine whether there is a linear association of age and aspirin, betablockers, angiotensin-converting enzyme inhibitors and statins; the extent to which elderly patients receive these treatments; and whether age is independently associated with these treatments., Design: A prospective cohort study., Setting: Coronary Unit of two hospitals in the Region of Murcia (Spain)., Patients: Consecutive patients admitted with the diagnosis of acute myocardial infarction between January 1998 and January 2008., Interventions: None., Main Outcomes: Those related to the administration of aspirin, betablockers, angiotensin-converting enzyme inhibitors and statins during stay in the Coronary Care Unit., Results: Regarding the remaining patients, octogenarians received a similar proportion of angiotensin-converting enzyme inhibitors (70.8% vs. 69.3%, p=0.41) and less often aspirin (90.4% vs. 94.6%, p<0.001), betablockers (44.4% vs. 69.4%, p<0,001) and statins (47.6% vs. 64.7%, p<0.001). We were only able to demonstrate an abrupt and significant decrease in the use of statins after 80 years of age. Patient age was independently associated with the use of betablockers (OR 0.59; 95%CI 0.47 - 0.73) and statins (OR 0.78; 95%CI 0.65 - 0.95). The lesser administration of these drugs was also associated with early mortality (OR 0.17, 95%CI 0.09 to 0.33 and OR 0.14; 95%CI 0.08 to 0.23, respectively)., Conclusions: Octogenarians less often receive aspirin, betablockers and statins, though old age was not an independent factor associated with lesser aspirin use., (Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.)

The management of extracolonic gastrointestinal polyps is controversial in patients with familial adenomatous polyposis (FAP). The treatment of adenomatous polyps with severe dysplasia in the stomach through wide gastric resections can hamper subsequent surveillance of the development of new polyps in the duodenal-jejunal area. We report the exceptional case of a 45-year-old man with FAP who developed two synchronic adenomatous polyps, with severe dysplasia. The first was located in the gastric antrum and the second in the proximal jejunum. Given the preoperative diagnosis of gastric neoplasm with invasion of the gastric wall (T(2)N(0)), subtotal Roux-en-Y gastrectomy and resection of the proximal jejunal segment were performed., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Objective: To describe clinical characteristics of patients with central precocious puberty (CPP) and pineal cyst, whose causal relationship remains unknown., Method: An observational, multicentre, and retrospective study of patients with CPP and pineal cyst was carried out., Results: We recorded four girls, aged between 2-7 years, diagnosed with CPP, without other medical problems, with the finding of an asymptomatic pineal cyst bigger than 5 x 5 mm in Magnetic Resonance Imaging (MRI). All of them were treated with GnRH agonists with regression of pubertal symptoms. Three of the patients had no changes on pineal cyst follow up with successive imaging. In the other, the pineal cyst disappeared after four years., Comments: We review the epidemiological data and clinical evolution of pineal cysts and the possible mechanisms involved in central precocious puberty., (Copyright 2009 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Objectives: Study the use of non-invasive ventilation (NIV) in patients with acute respiratory failure in intensive care units (ICUs) in Spain., Methods: A questionnaire was sent to 254 ICUs, after which, they were invited to participate in a multicenter, retrospective study, providing detailed information on ventilated patients., Results: Answers were received from 123 hospitals. Of these, 119 used NIV, although its use varied greatly. NIV is the treatment of choice in 89% of the units for chronic obstructive pulmonary disease (COPD), in 79% for acute pulmonary edema (APE), in 53% for postextubation failure, in 53% for pneumonia 53%, and in 17% for acute respiratory distress syndrome (ARDS). It was used occasionally in COPD in 11% of the units, and in 21% of the units for APE. Eighteen hospitals provided additional information on 432 ventilated patients, 232 (54%) of whom received NIV as first line therapy. Presence of pneumonia or acute respiratory distress syndrome (ARDS) was an independent predictive factor of NIV failure (ORa=5.71; CI 95%, 1.83-17.8; p=0.003). Admission in a unit with experience in NIV in >50 patients/year (ORa=0.22; CI 95%, 0.07-0.63; p=0.005) and a higher PaO2/FiO2 ratio after one hour of ventilation (ORa=0.98 per point; CI 95%, 0.97-0.99; p<0.001) were protector factors., Conclusions: In Spain, NIV is widely used but it may continue to be underused in COPD and APE. The diagnosis of pneumonia or ARDS was an independent predictive risk factor. Admission in an ICU with NIV in more than 50 patients/year also have higher PaO2/FiO2 ratio after one hour of ventilation were predictive factors of success.

Introduction and Objectives: In patients with acute myocardial infarction, a number of variables in the initial ECG are useful prognostic indicators. The presence of ST-segment elevation, however, usually indicates the need for reperfusion therapy. The aims of this study were to investigate sex differences in the ECGs of patients with ST-elevation myocardial infarction (STEMI) and to look for a possible association between sex and marked ST-segment elevation., Methods: A prospective observational longitudinal study of consecutive patients (n=1422) who were admitted early for a first STEMI to one of two coronary units was carried out. Initial ECG parameters were analyzed for sex differences. Multivariate analysis was performed to identify variables associated with marked ST-segment elevation (i.e., total ST-segment elevation >11 mm, according to the upper tertile of the frequency distribution)., Results: In women (n=336), Q-wave myocardial infarction was observed more often in the initial ECG (19% versus 15.6%; P< .03), the total ST-segment elevation was lower (10+/-6.6 mm versus 11.1+/-7.9 mm; P< .004), and marked ST-segment elevation was less common (26.4% versus 35.5%; P< .005). There was an independent inverse association between female sex and marked ST-segment elevation (odds ratio=0.70; 95% confidence interval, 0.52-0.96; P< .02)., Conclusions: In patients with STEMI, female sex was associated with a lower total ST-segment elevation and there was an independent inverse association with marked ST-segment elevation.

Introduction: San Antonio, Somacarrera (1977) and Rousaud-Inmark (1984) studies established the first data of incidence and prevalence about urolithiasis in Spain. Other regional or national epidemiologic details were given for several authors from 1977 to 2002., Material and Method: Sixteen papers with original data about incidence or prevalence have been selected, 5 of them are about incidence, 8 about prevalence and 3 include both. Ten papers are based on poblational research (San Antonio, Martin, Pedrajas, Rousaud-Inmark, Torres, Ripa, Romero, Grases, Alapont, Aíbar), 5 on subjective estimations (Solé-Balcells, Cifuentes, Puigvert, Serrallach, Conte) and one include both (Somacarrera). Seven papers are nationwide and 9 are about local areas. A map with different location studies is presented and a data register show incidence and prevalence medians., Results: The Spanish median urolithiasis incidence is 0.73%, corresponding to 325,079 new cases per year; and the prevalence is 5.06%, corresponding to 2,233,214 cases., Discussion: Methodologically the best epidemiologic studies about lithiasis are based on general population survey. The commonest slant is extract data from retrospective clinical registers. Most studies have significant methodological difficulties, but they reflected interest about epidemiology of stone disease in Spain. There is a concordance between Spanish results and international published data.

Purpose: To present a case of recurrent neobladder rupture treated in a conservative fashion. To review the articles on conservative management of cases like this one published from 1985., Results: Nineteen articles have been published since 1985 on spontaneous neobladder rupture, 4 of which describe the possibility of a successful conservative management, provided that the patients are carefully selected., Conclusions: Faced to abdominal pain in patients with neobladder, it is essential to suspect spontaneous perforation and, if possible, to confirm such suspicions by means of cystography or CT. An exploratory laparotomy may be necessary in many instances, sometimes due to lack of a diagnosis and sometimes because the patient's status rules out any other procedure, but in selected and precisely diagnosed cases a conservative management can be resolvent.

Introduction and Objectives: To identify the independent prognostic factors of prostate cancer and to develop a table for predicting the probabilities of not-localised prostate cancer occurrence, thus permitting to restrict the radical prostatectomy indication to those patients who have greater probabilities of being cured by the procedure., Methods: 1293 patients with clinically localised prostate cancer, with histories of neither hormone therapy nor prostate radiation therapy, in whom radical prostatectomy was performed during the period 1990-2003, were retrospectively evaluated. In order to analyse the prognostic factors, logistic regression was carried out by studying all the potential confusion and interaction factors, and by introducing the independent variables in a forward fashion with the following criteria: BCON(0.0001) LCON(0.00001) ITER(50) POUT(0.1). The prognostic variables were categorised, and the prediction table of the not-localised prostate cancer probability was developed from them., Results: Clinical stage, prostatic specific antigen and Gleason's "grade" were identified as prognostic factors, taking into account that the higher they are, the higher the probability of not-localised prostate cancer occurrence. Logistic regression enabled us to develop a table to predict the probability of not-localised prostate cancer in which, taking a 50% probability as the cutoff point, a 26.13% sensitivity and a 94.65% specificity are obtained. The pathological examination of the prostate and the lymphadenectomy showed that, globally, 70% of the tumours were localised., Conclusions: Application of tables to predicting the probability of having not-localised prostate cancer offers the possibility of improving the prognostic accuracy of the so-called "risk groups", and enables to issue a therapeutic indication better adjusted to the actual status of the disease.

Objective: To present a new case of a primary lymphoepithelioma-like carcinoma of the urinary bladder., Material and Methods: We describe the clinical, diagnosis, treatment and development of this kind of tumor. Review of the literature., Conclusions: It is an unusual type of bladder cancer that requires a carefully analyse from the pathologist and a confirmation by means of immunohistochemistry techniques. The focal form is associated with poor prognosis. Radical cystectomy is the gold standard. This kind of tumor has sensibility to chemo and radiotherapy, who can be used as adjuvant therapy.

Objective: Ventricular septal defect is the most frequently diagnosed congenital heart defect. The prognosis is usually good. The aim of this study was to describe this idea to general pediatricians., Material and Methods: We review the follow-up of 81 patients with ventricular septal defect. Defects that spontaneously closed in the first 12 months of life and those that formed part of a malformative syndrome or a complex congenital heart defect were excluded., Results: Localization was perimembranous, including all defects affecting mainly the septal membrane independent of whether the surrounding tissues were involved, in 66.7 %, muscular in 29.6 % and mixed in 3.7 %. Perimembranous position was more frequent among large and medium-sized defects. Large and perimembranous defects were characterized by holosystolic murmur; in small, muscular defects, murmur was cut off in mid-systole. In 45.8 % of large defects, weight development was delayed, but there was no appreciable effect on height. Generally we observed a tendency to partial closure and to improvement. Surgical closure was required in 9.8 %., Conclusions: Because of the trend to partial or complete spontaneous closure, the prognosis of ventricular septal defect is generally good.

Objective: Indication of temporary pacemakers in patients during acute myocardial infarction was widely studied in the pre-thrombolytic era without having determined whether the generalization of fibrinolysis might have changed the overall incidence and significance of temporary pacemakers. Our aim was to determine the incidence and the prognostic significance of insertion of temporary pacemakers in patients with acute myocardial infarction., Patients and Methods: In a study involving 1,239 patients consecutively admitted to hospital with acute myocardial infarction we studied clinical characteristics and prognosis depending on temporary pacemaker insertion or not. We performed an univariate analysis on in-hospital mortality and those selected variables were introduced in to a logistic regression analysis., Results: A temporary pacemaker was indicated in 55 patients (4.4%), prophylactically in 22% and therapeutically in 78%. Temporary pacemakers were inserted in 55% of the patients with advanced AV block and in the 10% of the patients with bundle-branch block. Pacemaker insertion was associated with higher number of affected leads in the ECG, and higher CK peak, regardless of the association with thrombolysis. The following complications were more often observed in patients with temporary pacemakers: atrial fibrillation, heart failure, right bundle-branch block, advanced atrioventricular block and in-hospital mortality (45.4 vs 10.2%; p < 0.001). Need for a temporary pacemaker was less frequent in patients treated with thrombolytics compared with those not treated (3.0 vs 6.1%; p < 0.02). Pacemaker insertion had an independent value for predicting in-hospital mortality (OR = 5.51; 95% CI, 2.71-11.19)., Conclusion: The insertion of a temporary pacemaker in acute myocardial infarction is less frequent nowadays than on the pre-thrombolytic era. Pacemaker insertion is associated with higher indices of infarct extension and in-hospital mortality, having independent prognostic value on the in-hospital mortality.

Background: Advanced atrioventricular block (AB) during acute myocardial infarction (AMI), characterizes a high-risk subgroup of patients. Our aim was to determine the prognostic significance of AB and its possible peculiarities in relation to infarction localization and/or the thrombolytic therapy., Patients and Methods: The prospective study involved 1,239 patients with AMI. We studied clinical characteristics, as well as indexes of infarct size, short and long-term complications., Results: AB was present in 85 (6.8%) patients and was more often associated with: previous treatment with diuretics, diabetes, inferior localisation, higher number of ECG leads with elevated ST segment, and higher peak of CK. The AB was associated with a higher mortality: in-hospital (27% vs 10.6%; p < 0.01)) and after one-year (31.7% vs 19.4%; p < 0.05). Patients with AB had a different in-hospital mortality depending on anterior or inferior infarct localization (66% vs 18.5%; p < 0.001, respectively). In patients receiving thrombolytic treatment (n = 681), the duration of AB was shorter and in-hospital mortality was lower (13.7% vs 47%, p < 0.11) than that occurred in patients without this treatment (n = 558). AB had independent value for predicting in-hospital mortality (OR: 3.56; 95% CI: 1.84-6.90) and one-year mortality (OR: 2.77; 95% CI: 1.52-5.04)., Conclusions: AB is associated with larger infarcts and higher incidence of complications. The prognosis is especially poor when it is presented associated with anterior infarction and/or in patients without thrombolytic treatment. AB is a variable with independent prognostic value on the mortality.

Objectives: The study of incidence and prognostic significance of supraventricular tachyarrhythmias in patients with acute myocardial infarction., Patients and Methods: Prospective study on 1,239 patients consecutively admitted because of a diagnosis of acute myocardial infarction. Clinical characteristics, indexes of myocardial infarction and complications were analysed., Results: Supraventricular tachyarrhythmias were observed in 116 (9.3%) cases: atrial fibrillation in 96 (7.7%); atrial tachycardia in 15 (1.2%); and atrial flutter in the remaining five cases (0.4%). Patients with supraventricular tachyarrhythmias were older, and presented higher heart rate, lower blood pressure, a higher number of affected leads in ECG, and higher Killip class. A higher creatine kinase peak and a lower left ventricular ejection fraction were associated with the presence of supraventricular tachyarrhythmias. Predictors of supraventricular tachyarrhythmias were: age, systolic blood pressure, number of affected leads in ECG, and congestive heart failure at admission. The following complications were found more frequently in patients with supraventricular tachyarrhythmias: bundle-branch block, complete A-V block, ventricular tachycardia, ventricular fibrillation; heart failure; stroke; and mortality, in-hospital 18.1% vs 11.1% (p < 0.05) and one-year, 38.7% vs 18.4% (p < 0.001). The logistic regression model showed that supraventricular tachyarrhythmias had no independent prognostic value on mortality., Conclusions: The appearance of supraventricular tachyarrhythmias during the acute phase of myocardial infarction is a relatively frequent finding, often associated with older age and larger infarctions. Supraventricular tachyarrhythmias are accompanied by higher short and long-term mortalities, although there is no independent prognostic significance.

To assess the current incidence and meaning of left bundle-branch block associated with acute myocardial infarction we studied 1,239 patients consecutively admitted in three hospitals. Left bundle branch block was present in 42 cases (3.3%). Compared to the patients without left bundle-branch block, those with left bundle-branch block were older (70 +/- 8.8 versus 63.9 +/- 11.4 years; p < 0.001), and had a more prevalent history of diabetes, angina, myocardial infarction and heart failure. Left bundle-branch block was associated more frequently with female gender and poor left ventricular ejection fraction. Patients with left bundle branch block were admitted with a longer interval from the onset of the symptoms (7.8 +/- 6.3 versus 5.4 +/- 6.7 hours; p < 0.01) and received in a lesser rate thrombolytics agents (21% versus 56%; p < 0.001), than those without left bundle-branch block. Complications significatively associated with left bundle-branch block were: complete AV block; heart failure and one-year mortality (40.4% versus 19.5%, p < 0.01). Female gender, age and heart failure were independent predictors of mortality whereas left bundle-branch block was not. In conclusion, current incidence of left bundle-branch block in acute myocardial infarction is lower than that referred in the pre-thrombolytic era. Left bundle-branch block is accompanied by a low rate of thrombolysis, whereas a higher mortality rate of these patients seems to depend on their clinical characteristics.

Dermatophytes are a group of closely related fungi that have the capacity to invade keratinized tissue (skin, hair, and nails) of humans and animals to produce an infection, dermatophytosis, commonly referred to as ringworm. Dermatophytoses are common of world wide: in the United States, Microsporum audouinii and Microsporum canis, once the major agents of tinea capitis, have been superseded by Trichophyton tonsurans. Since the 1950s, T. tonsuranshas advanced from Mexico and the Caribbean and is now the prevalent cause of tinea capitisin North America. M. canisis the prevalent agent of tinea capitis in many regions of the world, including Spain, at this moment. This could be related to close association of humans with their pets. M. canis is more prevalent in urban areas and Trichophyton mentagrophytes in rural ones. The superficial dermatophyte infections of the skin do not represent a single disease, their clinical appearance is dependent largely on the region of the body affected. There are more antifungal preparations available today than at any other time in medical history. Oral antifungals are indicated or required to treat hyperkeratotic areas such as nails, palms, soles and tinea capitis, patients with disabling or extensive disease, patients intolerant to or who have failed topical therapy, tose with chronic infection, those with granulomatous lesions and patients immunosuppressed by disease or by therapy. A successfull eradication of the fungi is now possible with relatively short treatment regimens.

Background: Analysis of clinical characteristics of acute renal failure (ARF) after allogeneic bone marrow transplantation (BMT)., Patients and Methods: Analysis of 92 patients who developed ARF of 260 patients following BMT., Results: ARF incidence was 35.4%. Sixty three percent of ARF occurred before day 20 after BMT. Duration of ARF was less of 10 days in 72.8%. ARF was non oliguric in the 80.4% of cases. Most common ARF etiologies were: multifactorial (37%), nephrotoxicity (NPH) (33.7%) and veno-occlusive disease of the liver (VOD) (14.1%). ARF secondary to VOD was the most severe: and the longest, where the secondary to NPH was less lever and shorter. Hemodialysis (HD) was necessary in 22.8% of ARF. Mortality in ARF group was 45.6%, higher in HD group (80.9%) than in non-HD group (35.2%) (p < 0.0002)., Conclusions: ARF is a frequent complication following BMT. It occurs early, has short duration, is non oliguric, mainly hemodynamic and carries a whose prognosis.

Introduction and Objectives: Complete atrioventricular block (CAVB) during inferior acute myocardial infarction (AMI), characterizes a high-risk subgroup of patients. This study was designed to determine the incidence and meaning of CAVB associated with inferior AMI and their peculiarities in relation to thrombolytic therapy., Methods: Prospective and multicenter, involving 605 patients consecutively admitted with inferior AMI. We studied clinical characteristics and complications occurring during hospitalization and one-year follow-up were monitored., Results: CAVB was found in 57 (9.4%) patients and was more frequently associated with: right ventricular involvement (35% vs 10%; p < 0.001), higher indexes of infaret size: ST elevated ECG leads (4.67 +/- 1.67 vs 4.1 +/- 1.4; p < 0.01) and peak of creatinkinase (2,219 +/- 1,543 vs 1,589 +/- 1,203; p < 0.01). Patients with CAVB had a higher incidence of cardiogenic shock (14% vs 5%; p < 0.05) and in-hospital mortality (21% vs 8.7%). CAVB had an independent value for predicting in-hospital mortality (odds ratio 2.7, 95% confidence interval, 1.3-5.5). CAVB appeared more frequently in the first hour of evolution (91% vs 41%; p < 0.01); its duration was shorter than 6 hours in a higher ratio (80% vs 5%; p < 0.01), and in- hospital mortality was lower (8.5 vs 40.9%; p < 0.05), in patients receiving thrombolytic treatment compared with patients without this treatment., Conclusions: CAVB is a relatively frequent complication of inferior AMI and is often associated with larger infarcts, high incidence of complications and mortality. Earlier appearance, shorter duration and fewer in-hospital mortalities seem to characterize those CAVBs occurring in patients treated with thrombolytics.

Background: A single-center experience review about accessibility to bone marrow transplantation (BMT) as postremission therapy for acute myeloid leukemia (AML) is analyzed., Patients and Methods: From January 1988 to December 1994, 86 patients were diagnosed from de novo AML in our institution. A BMT was the treatment of choice for all patients younger than 55 years. An allogenic BMT (Allo-BMT) was offered for all patients younger than 35 years with a compatible sibling donor or those older patients, 35-55 years, with bad prognosis features. An autologus BMT (ABMT) was offered to those patients older than 35 years or those younger than 35 without an histocompatible donor., Results: 52 out of 86 diagnosed patients were younger than 50 years (60%). 29 of them were candidates to Allo-BMT (24 patients younger than 35 years and 5 patients older than 35 with refractory disease) and the rest 23 to ABMT. 22 out of the 24 candidates to Allo-BMT entered complete remission (CR) and 12 of them had an HLA-identical donor. The Allo-BMT was performed in CR1 in 7 patients in CR2 in three patients and with refractory disease in two cases. An ABMT was finally planned in 30 patients, 18 patients older than 35 who entered CR and the rest 12 patients younger than 35 years in CR without a sibling donor. Only 11 out of this 30 patients underwent an ABMT in first CR. Reasons for this low number were: early relapse (B), toxicity (6), refuse (2), lost of follow-up (2) and suicide (1). Five out of this early relapse patients underwent an ABMT in CR2. Disease-free survival (DFS) at three years was 23 +/- 10% for the 52 patients included in the study. DFS obtained with Allo-BMT and AMBT were 39 +/- 16% and 63 +/- 22% respectively., Conclusions: In spite of the new postremission treatment modalities available for AML the rate of longer survivals are still low. When data from BMT is analyzed we must be awared because only a small fraction of patients assigned to BMT will finally access to this treatment.