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Background Iatrogenic bile duct injury (IBDI) is a challenging surgical complication. IBDI management can be guided by artificial intelligence models. Our study identified the factors associated with successful initial repair of IBDI and predicted the success of definitive repair based on patient risk levels. Methods This is a retrospective multi-institution cohort of patients with IBDI after cholecystectomy conducted between 1990 and 2020. We implemented a decision tree analysis to determine the factors that contribute to successful initial repair and developed a risk-scoring model based on the Comprehensive Complication Index. Results We analyzed 748 patients across 22 hospitals. Our decision tree model was 82.8% accurate in predicting the success of the initial repair. Non-type E (p p p Discussion Machine learning algorithms for IBDI are a novel tool may help to improve the decision-making process and guide management of these patients.

BACKGROUND: The management of a vascular injury during cholecystectomy is still very complicated, especially in centers not specialized in complex hepatobiliary surgery.; METHODS: This was a multi-institutional retrospective study in patients with vascular injuries during cholecystectomy from 18 centers in 4 countries. The aim of the study was to analyze the management of vascular injuries focusing on referral, time to perform the repair, and different treatments options outcomes.; RESULTS: A total of 104 patients were included. Twenty-nine patients underwent vascular repair (27.9%), 13 (12.5%) liver resection, and 1 liver transplant as a first treatment. Eighty-four (80.4%) vascular and biliary injuries occurred in nonspecialized centers and 45 (53.6%) were immediately transferred. Intraoperative diagnosed injuries were rare in referred patients (18% vs 84%, P= .001). The patients managed at the hospital where the injury occurred had a higher number of reoperations (64% vs 20%, P ? .001). The need for vascular reconstruction was associated with higher mortality (P= .04). Two of the 4 patients transplanted died.; CONCLUSION: Vascular lesions during cholecystectomy are a potentially life-threatening complication. Management of referral to specialized centers to perform multiple complex multidisciplinary procedures should be mandatory. Late vascular repair has not shown to be associated with worse results. Copyright © 2022 Elsevier Inc. All rights reserved.

Paragangliomas are infrequent neuroendocrine tumours whose only criterion for malignancy is presence of metastases; thus, all paragangliomas show malignant potential. Actually, different risk factors have been analyzed to predict metastases but they remain unclear. To analyze clinical, histological, and genetic factors to predict the occurrence of metastasis. A multicentre retrospective observational analysis was performed between January 1990 and July 2019. Patients diagnosed with paraganglioma were selected. Clinical, histological, and genetic features were analyzed for the prediction of malignancy. A total of 83 patients diagnosed with paraganglioma were included, of which nine (10.8%) had malignant paraganglioma. Tumour size was greater in malignant tumours than in benign (6 cm vs. 4 cm, respectively; p = 0.027). The most frequent location of malignancy was the thorax-abdomen-pelvis area observed in six cases (p = 0.024). No differences were observed in histological differentiation, age, symptoms, and catecholaminergic production. The most frequent genetic mutation was SDHD followed by SDHB but no differences were observed between benign and malignant tumours. In the univariate analysis for predictive factors for malignancy, location, tumour size, and histological differentiation showed statistical significance (p = 0.025, p = 0.014, and p = 0.046, respectively); however, they were not confirmed as predictive factors for malignancy in the multivariate analysis. In this study, no risk factors for malignancy have been established; therefore, we recommend follow-up of all patients diagnosed with paraganglioma.

There could be important failures in clinical data and plan records that potentially influence the surgical care process.To complete a quality of care improvement cycle on the surgical care process in the General Surgery ward rounds. Structured quality criteria were measured, in order to identify major deficiencies, to implement improvement measures and to reassess the quality of surgical care process. Furthermore, we'll value the viability the implementation of a structured registration system and nutritional assessment method.Comparative quality study (n = 60) before-after the setting of several improvement measures derived from the analysis of the surgical care process. Evaluated criteria were the information received by the patient, adequate recording of the clinical course and plan of care established by the surgeon in the Electronic Health Record, recording of patient's weight and size and nutritional assessment. Informative sessions, subjective, objective, assessment, plan notes on the electronic clinical record and a nutritional assessment test were implemented.There was a significant improvement in all measured criteria (information, data records and nutritional assessment).Simple organizational measures allow a significant improvement in the information process, clinical records and malnutrition risk detection in a surgical ward.Podrían existir carencias en el registro de datos relevantes del proceso asistencial de hospitalización quirúrgica.Completar un ciclo de mejora de la calidad del proceso asistencial quirúrgico en una planta de cirugía. Mediremos unos criterios de calidad estructurados, identificando las principales deficiencias, implementando medidas de mejora y reevaluando la calidad del proceso asistencial quirúrgico. Además, se valora la viabilidad de la implantación de un sistema nemotécnico de registro de actividad y de un método de evaluación nutricional.Estudio comparativo (n = 60) antes-después del establecimiento de medidas de mejora basadas en el análisis del proceso asistencial quirúrgico. Los criterios evaluados fueron la información recibida por el paciente, el registro de la evolución clínica y el plan de cuidado establecido por el cirujano en la historia clínica, el registro de peso y talla, y la valoración nutricional. Se realizaron sesiones informativas e implementación electrónica de la nota SOAP (subjetive, objetive, assessment, plan) y de un test de valoración nutricional.Hubo mejoría significativa en todos los criterios medidos (información, registro y evaluación nutricional).Algunas medidas sencillas permiten una mejoría importante en la información, la evaluación nutricional y el registro del proceso asistencial en una planta de cirugía.

Background There could be important failures in clinical data and plan records that potentially influence the surgical care process. Objective To complete a quality of care improvement cycle on the surgical care process in the General Surgery ward rounds. Structured quality criteria were measured, in order to identify major deficiencies, to implement improvement measures and to reassess the quality of surgical care process. Furthermore, we'll value the viability the implementation of a structured registration system and nutritional assessment method. Method Comparative quality study (n = 60) before-after the setting of several improvement measures derived from the analysis of the surgical care process. Evaluated criteria were the information received by the patient, adequate recording of the clinical course and plan of care established by the surgeon in the Electronic Health Record, recording of patient's weight and size and nutritional assessment. Informative sessions, subjective, objective, assessment, plan notes on the electronic clinical record and a nutritional assessment test were implemented. Results There was a significant improvement in all measured criteria (information, data records and nutritional assessment). Conclusion Simple organizational measures allow a significant improvement in the information process, clinical records and malnutrition risk detection in a surgical ward.

Resumen Antecedentes y objetivo El cancer tiroideo puede manifestarse clinicamente por la presencia de un nodulo cervical, o constituir un hallazgo casual en el estudio histologico de la glandula extirpada con diagnostico, a priori, benigno. El objetivo del presente estudio fue estudiar las diferencias clinicas, de manejo quirurgico y curso evolutivo entre los tumores tiroideos incidentales y los tumores detectados clinicamente. Material y metodos Estudio retrospectivo de pacientes intervenidos por enfermedad tiroidea, ya fuese benigna o maligna, en el periodo comprendido entre enero de 2000 y marzo de 2014. De 1.415 pacientes que se sometieron a algun tipo de cirugia tiroidea se identificaron un total de 264 neoplasias, de las cuales 170 fueron incidentales. Se realizo comparacion entre carcinomas incidentales versus no incidentales. Ademas, entre los incidentales se compararon los casos cuya indicacion quirurgica fue enfermedad de Graves frente a bocio multinodular. Resultados Los carcinomas incidentales presentaron estadios mas precoces y requirieron cirugia menos agresiva. No se observaron diferencias en las complicaciones quirurgicas entre ambos grupos, aunque tanto la mortalidad como las tasas de recidiva fueron notablemente mayores en el grupo de no incidentales (4,4% vs 0% y 13,2% vs 4,8% respectivamente). Los carcinomas desarrollados sobre enfermedad de Graves no mostraron diferencias respecto al resto de los tumores incidentales, respecto a complicaciones, mortalidad o recidiva tras la cirugia. Conclusiones El cancer tiroideo en estadios iniciales presenta mayor supervivencia y mejor respuesta al tratamiento quirurgico.

Background and objective Thyroid cancer may be clinically evident as a tumor mass in the neck or as a histopathological incidental finding after thyroid surgery for an apparent benign condition. Our objective was to assess the differences in clinical signs, surgical management, and course between incidental and clinically diagnosed thyroid tumors. Methods A retrospective study was conducted on patients operated on for benign or malignant thyroid disease from January 2000 to March 2014. Among the 1415 patients who underwent any thyroid surgery, 264 neoplasms were found, of which 170 were incidental. A comparison was made of incidental versus non-incidental carcinomas. Among incidental carcinomas, cases whose indication for surgery was Graves’ disease were compared to those with multinodular goiter. Results Incidental carcinomas were in earlier stages and required less aggressive surgery. There were no differences in surgical complications between incidental and clinical tumors, but mortality and relapses were markedly higher in non-incidental cancers (4.4% vs 0% and 13.2% vs 4.8% respectively). Carcinomas developing on Graves’ disease showed no differences from all other incidental tumors in terms of complications, mortality, or relapse after surgery. Conclusions Early stage thyroid cancer has better survival and prognosis after surgical treatment.

In this study, the endophytic capacity of B. bassiana was determined for two barley (Hordeum vulgare) varieties, Josefa and Esmeralda, inoculated with a seedling immersion at three different concentrations (1 × 106, 1 × 107 and 1 × 108 conidia/mL). Seedling length and chlorophyll content were found to be not affected when inoculated with the entomopathogenic fungus, in both barley varieties. However, the colonisation percentage was found to be significantly lower with the inoculum concentration 1 × 106 conidia/mL for both barley varieties (P

In this study, the endophytic capacity of B. bassiana was determined for two barley (Hordeum vulgare) varieties, Josefa and Esmeralda, inoculated with a seedling immersion at three different concentrations (1 × 10(6), 1 × 10(7) and 1 × 10(8) conidia/mL). Seedling length and chlorophyll content were found to be not affected when inoculated with the entomopathogenic fungus, in both barley varieties. However, the colonisation percentage was found to be significantly lower with the inoculum concentration 1 × 10(6) conidia/mL for both barley varieties (P

Clinical pathways are care plans applicable to patient care procedures that present variations in practice and a predictable clinical course. They are designed not as a substitute for clinical judgment, but rather as a means to improve the effectiveness and efficiency of the procedures. This clinical pathway is the result of a collaborative work of the Sections of Endocrine Surgery and Quality Management of the Spanish Association of Surgeons. It attempts to provide a framework for standardizing the performance of thyroidectomy, the most frequently performed operation in endocrine surgery. Along with the usual documents of clinical pathways (temporary matrix, variance tracking and information sheets, assessment indicators and a satisfaction questionnaire) it includes a review of the scientific evidence around different aspects of pre, intra and postoperative management. Among others, antibiotic and antithrombotic prophylaxis, preoperative preparation in hyperthyroidism, intraoperative neuromonitoring and systems for obtaining hemostasis are included, along with management of postoperative hypocalcemia.

Clinical pathways are care plans applicable to patient care procedures that present variations in practice and a predictable clinical course. They are designed not as a substitute for clinical judgment, but rather as a means to improve the effectiveness and efficiency of the procedures. This clinical pathway is the result of a collaborative work of the Sections of Endocrine Surgery and Quality Management of the Spanish Association of Surgeons. It attempts to provide a framework for standardizing the performance of thyroidectomy, the most frequently performed operation in endocrine surgery. Along with the usual documents of clinical pathways (temporary matrix, variance tracking and information sheets, assessment indicators and a satisfaction questionnaire) it includes a review of the scientific evidence around different aspects of pre, intra and postoperative management. Among others, antibiotic and antithrombotic prophylaxis, preoperative preparation in hyperthyroidism, intraoperative neuromonitoring and systems for obtaining hemostasis are included, along with management of postoperative hypocalcemia.

Resumen Objetivos La hemorragia digestiva alta (HDA) es una potencial complicacion tras la cirugia bariatrica, con una incidencia entre el 2 y el 4%. El objetivo de este estudio es presentar nuestra incidencia de HDA tras cirugia bariatrica, su forma de presentacion y su manejo mediante un algoritmo terapeutico. Pacientes y metodo Estudio observacional prospectivo de una serie de 300 cirugias bariatricas por laparoscopia de manera consecutiva, desde enero del 2004 hasta diciembre del 2012. Se recogen datos demograficos, forma de presentacion, diagnostico y tratamiento de la HDA. En 280 pacientes se practico bypass gastrico segun la tecnica de Wittgrove modificada, con anastomosis circular en 265 y anastomosis longitudinal en 15. En 20 pacientes se practico gastrectomia vertical. Resultados Aparecieron 27 casos (9%) de HDA tratados con: cirugia en un caso por inestabilidad hemodinamica; con gastroscopia diagnostica-terapeutica en 13 casos (en 2 casos, 2 veces); en 10 de ellos, aparecio de forma precoz (1-6 dias) cuyo origen fue la linea de sutura de la anastomosis gastroyeyunal (GY) y en 3 de forma tardia, a los 15-20 dias, siendo su origen una ulcera en la boca anastomotica. En el resto (13 pacientes), el manejo fue de forma conservadora. Conclusiones Aunque el manejo conservador de la HDA resuelve la mayoria de los casos, la clinica y la forma de presentacion deben alertarnos, por lo que, en casos graves de sangrado, se requerira de una endoscopia urgente. Es importante un equipo multidisciplinar y una comunicacion estrecha entre cirujanos y endoscopistas para el manejo de esta seria complicacion.

Gastrointestinal bleeding (GB) is a potential complication after bariatric surgery and its frequency is around 2-4% according to the literature. The aim of this study is to present our experience with GB after bariatric surgery, its presentation and possible treatment options by means of an algorithm.From January 2004 to December 2012, we performed 300 consecutive laparoscopic bariatric surgeries. A total of 280 patients underwent a laparoscopic Roux en Y gastric bypass with creation of a gastrojejunal anastomosis using a circular stapler type CEAA No 21 in 265 patients and with a linear stapler in 15 patients. Demographics, clinical presentation, diagnostic evaluation and treatment were reviewed. A total of 20 patients underwent a sleeve gastrectomy.Twenty-seven cases (9%) developed GB. Diagnosis and therapeutic endoscopy was required in 13 patients. The onset of bleeding occurred between the 1(st)-6(th) postop days in 10 patients, and the origin was at the gastrojejunostomy staple-lines, and 3 patients had bleeding from an anastomotic ulcer 15-20 days after surgery. All other patients were managed non-operatively.Conservative management of gastrointestinal bleeding is effective in most cases, but endoscopy with therapeutic intent should be considered in patients with severe or recurrent bleeding. Multidisciplinary postoperative follow- up is very important for early detention and treatment of this complication.

Keywords: internal customer, methodology, model, quality service, service measurementAbstract. The measure of service to external clients was one of the principal foci in studies of service in the eighties, while the measure of service to internal clients went unattended although multiple studies have highlighted its visible effect on the satisfaction of final clients (external). This study seeks to pay attention to that reality and propose 1) a model for conceptualizing the phenomenon of internal service and 2) a methodology for evaluating the quality of service to internal clients which can be used in any kind of organization, independent of its product (goods or services), size, or industry. The development of the methodology rests on a review of the literature, in research into the current practices of various companies, on the experience of researchers who have developed similar systems in various organizations, and on the use of the Research-Action model (apply the model and correct it based on experience). The result is a simple and practical methodology which allows specialists to choose the internal services they mean to evaluate (and eventually improve), identify the clients, develop and apply instruments and mechanisms for evaluating the level of service, and finally to deploy actions for improvement. It offers recommendations for application and key questions that can help the user apply it effectively at every step. It also describes a pilot implementation to clarify and demonstrate its effectiveness.Palabras clave: calidad en el servicio, cliente interno, medición del servicio, metodología, modeloResumen. La medición del servicio al cliente externo ha sido uno de los principales enfoques de los estudios sobre servicios desde los años ochenta, mientras que la medición del servicio al cliente interno ha sido desatendida a pesar de que múltiples investigaciones han destacado su visible efecto en la satisfacción del cliente externo final. El presente desarrollo busca atender esa necesidad y propone 1) un modelo para conceptualizar el fenómeno del servicio interno y 2) una metodología para evaluar la calidad del servicio al cliente interno, que puede ser usada en cualquier tipo de organización independientemente de su producto o servicio, tamaño o giro. El desarrollo de la metodología se fundamentó en la revisión de la literatura, en la investigación de prácticas actuales de diversas compañías, en la experiencia de los autores al desarrollar sistemas similares en varias organizaciones y en el uso del enfoque Investigación – Acción. El resultado es una metodología simple y práctica que permite a los especialistas seleccionar los servicios internos que desean evaluar y mejorar, identificar a los clientes, desarrollar y aplicar instrumentos y mecanismos para evaluar el nivel del servicio y finalmente, desplegar acciones de mejora. En cada paso se ofrecen recomendaciones de aplicación y preguntas clave que pueden ayudar al usuario a aplicarla más efectivamente. Adicionalmente se describe una implementación piloto como ilustración y como prueba de su efectividad.

Resumen La adquisicion y jerarquizacion de la evidencia, asi como la posterior formulacion de recomendaciones, constituyen la base del desarrollo de las guias de practica clinica. Sistemas de graduacion de la calidad de la evidencia y de la fuerza de las recomendaciones han existido muchos y actualmente se va imponiendo el modelo Grading of Recommendations, Assessment, Development and Evaluation (GRADE). En el sistema GRADE la calidad de la evidencia se clasifica, inicialmente, en alta o baja, segun provenga de estudios experimentales u observacionales; posteriormente, segun una serie de consideraciones, la evidencia queda en alta, moderada, baja y muy baja. La fuerza de las recomendaciones se apoya no solo en la calidad de la evidencia, sino en una serie de factores como son el balance entre riesgos y beneficios, los valores y preferencias de pacientes y profesionales, y el consumo de recursos o costes.

The acquisition and classification of scientific evidence, and subsequent formulation of recommendations constitute the basis for the development of clinical practice guidelines. There are several systems for the classification of evidence and strength of recommendations; the most commonly used nowadays is the Grading of Recommendations, Assessment, Development and Evaluation system (GRADE). The GRADE system initially classifies the evidence into high or low, coming from experimental or observational studies; subsequently and following a series of considerations, the evidence is classified into high, moderate, low or very low. The strength of recommendations is based not only on the quality of the evidence, but also on a series of factors such as the risk/benefit balance, values and preferences of the patients and professionals, and the use of resources or costs.

OBJECTIVE: To determine and report the rate and pattern of HIV testing among pregnant women receiving ambulatory prenatal care, and the total number of positive cases in pregnant women in Managua, Nicaragua. METHODS: A retrospective epidemiological review was conducted to assess HIV testing rates among pregnant women in Managua attending district-level health centers in 2010 and 2011, with a focus on a single district (District 6.1). RESULTS: A total of 39.4% of pregnant women receiving prenatal care at Managua health centers in 2010 received an HIV test, and this number increased to 49.8% in 2011 (P < 0.001; phi statistic, 0.10). In 2010, 27 pregnant women in Managua were found to be HIV positive, corresponding to 0.17% of those who were tested. In 2011, 31 tested positive (0.12% of those who were tested). Comparisons between 2010 and 2011 at the District 6.1 level reflect an increase in women who received HIV tests from 24.2% in 2010 to 49.3% in 2011 (P < 0.001; phi statistic, 0.26). In District 6.1, two pregnant women were identified as HIV positive in 2010 and three in 2011, corresponding to 0.32% and 0.13% of pregnant women tested, respectively. CONCLUSIONS: Despite significant improvements in HIV testing rates from 2010 to 2011, the numbers tested remain below the goal recommended by the Pan American Health Organization (PAHO) in order to achieve virtual elimination of mother-to-child transmission by 2015 (> 95%). Patterns of testing demonstrated increased rates coinciding with a health fair in District 6.1, but effects were short-lived. Therefore, new approaches are necessary to bolster prenatal HIV screening efforts within Managua and District 6.1 in Nicaragua.OBJETIVO: Determinar y notificar la tasa de realización de pruebas de detección del VIH, los patrones obtenidos y el número de casos positivos en las mujeres embarazadas que recibieron asistencia prenatal ambulatoria, en Managua, Nicaragua. MÉTODOS: Se llevó a cabo un examen epidemiológico retrospectivo para evaluar las tasas de realización de pruebas de detección del VIH en mujeres embarazadas que acudieron a centros de salud de distrito en Managua en el 2010 y el 2011, centrándose en un solo distrito (distrito 6.1). RESULTADOS: El 39,4% de las mujeres embarazadas que recibieron asistencia prenatal en los centros de salud de Managua en el 2010 se sometieron a pruebas de detección del VIH, y esta cifra aumentó a 49,8% en 2011 (P 95%) por la Organización Panamericana de la Salud (OPS) para lograr la eliminación virtual de la transmisión maternoinfantil para el 2015. Los patrones de realización de pruebas evidenciaron que las tasas aumentaron en coincidencia con una feria de salud en el distrito 6.1, aunque los efectos duraron poco. Por consiguiente, es necesario utilizar nuevas estrategias para reforzar las pruebas de detección sistemática del VIH prenatales en Managua y en el distrito 6.1.

To determine and report the rate and pattern of HIV testing among pregnant women receiving ambulatory prenatal care, and the total number of positive cases in pregnant women in Managua, Nicaragua.A retrospective epidemiological review was conducted to assess HIV testing rates among pregnant women in Managua attending district-level health centers in 2010 and 2011, with a focus on a single district (District 6.1).A total of 39.4% of pregnant women receiving prenatal care at Managua health centers in 2010 received an HIV test, and this number increased to 49.8% in 2011 (P0.001; phi statistic, 0.10). In 2010, 27 pregnant women in Managua were found to be HIV positive, corresponding to 0.17% of those who were tested. In 2011, 31 tested positive (0.12% of those who were tested). Comparisons between 2010 and 2011 at the District 6.1 level reflect an increase in women who received HIV tests from 24.2% in 2010 to 49.3% in 2011 (P0.001; phi statistic, 0.26). In District 6.1, two pregnant women were identified as HIV positive in 2010 and three in 2011, corresponding to 0.32% and 0.13% of pregnant women tested, respectively.Despite significant improvements in HIV testing rates from 2010 to 2011, the numbers tested remain below the goal recommended by the Pan American Health Organization (PAHO) in order to achieve virtual elimination of mother-to-child transmission by 2015 (95%). Patterns of testing demonstrated increased rates coinciding with a health fair in District 6.1, but effects were short-lived. Therefore, new approaches are necessary to bolster prenatal HIV screening efforts within Managua and District 6.1 in Nicaragua.

Two series of heterocyclic tin compounds of general formula [(S{C6H3(CH2)nS}2O)SnR1R2] with different central ring sizes were prepared. The ten-membered series includes the compounds with n = 1 and R1 = R2 = Ph (5); R1 = Cl, R2 = Ph (6); R1 = Cl, R2 = n-Bu (7); R1 = R2 = Cl (8); the eight-membered series includes the compounds with n = 0 and R1 = R2 = Ph (10); R1 = Cl, R2 = n-Bu (11) and R1 = R2 = Cl (12). The compounds 5, 7, 8, 10, and 11 were investigated by single-crystal X-ray diffraction. The chloro compounds 7, 8, and 11 displayed a bipyramidal geometry at the tin atom with different degrees of distortion ranging from 57% to 62%. The diphenyl compounds 5 and 10 displayed a tetrahedral geometry at Sn. The conformation of the central ring in the ten-membered series is similar and is described as boat; the other series displayed two different conformations described as boat–chair and boat–boat. The possible conformers in the gas state of compounds 5, 7, 8, 10, 11, and 12 were investigated by MMFF, LSDA, BLYP, B3LYP, and M06 functionals using the DGDZVP and TZVP basis sets. The structural data of the total optimization agreed with the experimental results. The topological analysis indicated that bond critical points are present along the O⋯Sn direction in the compounds 7, 8, 11, and 12.

Fundamentals and objectives: Frozen section (FS) constitutes a diagnostic procedure in patients following hemithyroidectomy. It is used to diagnose malignant lesions and to avoid reoperations. Our objective is to confirm this test as useless to rule out cancer. Patients and methods: Retrospective and comparative trial between two series of patients following hemithyroidectomy. G I: 179 patients operated in 1995–2002. In this period we performed systematic FS. Sensitivity (S), specificity (E) and predictive values (PPV, NPV) are analyzed. G II: 126 patients were operated between 2003–2008. Selective FS was performed (23 patients). Both groups are compared: hospital stay, number of FS, percentage of cancer, definitive biopsy and reoperations. Results: Data analyzed in the first period: S: 48%, E: 100%, PPV: 100%, NPV: 90%, positive likelihood ratio 410, negative likelihood ratio 0.52. When both periods are compared no significant differences between reoperations are found. Conclusion: FS during hemithyroidectomy does not reduce reoperations for cancer.

Mountain gazelles (Gazella gazella) rank among the most critically endangered mammals on the Arabian Peninsula. Past conservation efforts have been plagued by confusion about the phylogenetic relationship among various 'phenotypically discernable' populations, and even the question of species boundaries was far from being certain. This lack of knowledge has had a direct impact on conservation measures, especially ex situ breeding programmes, hampering the assignment of captive stocks to potential conservation units. Here, we provide a phylogenetic framework, based on the analysis of mtDNA sequences (360 bp cytochrome b and 213 bp Control Region) of 126 individuals collected from the wild throughout the Arabian Peninsula and from captive stocks. Our analyses revealed two reciprocally monophyletic genetic lineages within the presumed species Gazella gazella: one 'northern clade' on the Golan Heights (Israel/Syrian border) and one genetically diverse larger clade from the rest of the Arabian Peninsula including the Arava Valley (Negev, Israel). Applying the Strict Phylogenetic Species Concept (sensu Mishler & Theriot, 2000) allows assigning species status to these two major clades.

Resumen Introduccion Las lesiones de viscera hueca y mesentericas en pacientes politraumatizados estan en aumento. Su diagnostico representa un reto para el radiologo y el clinico experimentado, ya que su retraso aumenta la morbimortalidad. El desarrollo de la tomografia computarizada (TC) helicoidal lo ha mejorado, aunque los resultados publicados son contradictorios. El objetivo de este trabajo es valorar la utilidad de la TC en el diagnostico de estas lesiones en el traumatismo abdominal cerrado (TabC). Material y metodos Entre enero de 2000 y octubre de 2007, 79 pacientes con TabC (60 varones y 19 mujeres) se incluyeron en este estudio. Se les realizo laparotomia exploradora tras la realizacion de TC abdominal, lo que permitio comparar los hallazgos de las pruebas de imagen preoperatorias con los de la laparotomia. Resultados Para la deteccion de lesiones de viscera hueca y mesentericas se obtuvo para la TC sensibilidad del 84,2%, especificidad del 75,6%, valor predictivo positivo del 76,2%, valor predictivo negativo del 83,8%, coeficiente de probabilidad positivo de 3,45 y coeficiente de probabilidad negativo de 0,21. La precision fue del 79,7%. Conclusion La TC helicoidal abdominal es una prueba util para la deteccion de lesiones de viscera hueca y mesentericas en pacientes con TabC.

The objective of this study was to analyze the variables related to inappropriate admissions and hospital stays and their financial repercussions. This was a descriptive retrospective study in which the Appropriateness Evaluation Protocol (AEP) was applied to a representative sample of 725 hospital admissions and 1350 hospital stays. The cost of inappropriate stays was calculated by cost accounting. The study found that 7.4% of admissions and 24.6% of stays were inappropriate. Inappropriate admissions were significantly related to medical specialties and younger patient age. Inappropriate stays were related to these factors, plus patients being outside their corresponding areas, nonurgent admissions, and low occupancy rate. The cost of the inappropriate admissions and stays was 147 044 euros. Extrapolated to the hospital as a whole this would represent 2125638 euros per year. Steps must be taken to reduce inappropriate admissions and stays to lower health care costs and to reserve hospital resources for patients who genuinely need them.

Treatment of RnGeCl4−n with {S(C6H3SH)2O} (1) afforded the stable phenoxathiin-4,6-dithiolate compounds [{S(C6H3S)2O}GeR2] [n = 2; R = Et (2), Ph (3)] and [{S(C6H3S)2O}GeRCl] [n = 1; R = Et (4), Ph (5)]. Treatment of GeCl4 with 1 in benzene afforded the dichloro compound [{S(C6H3S)2O}GeCl2] (8) at 7 °C. Bromo compounds [{S(C6H3S)2O}GeRBr] [R = Et (6), Ph (7)] and [{S(C6H3S)2O}GeBr2] (9) were synthesized by halogen exchange from the appropriate chloro derivative using KBr/HBr. X-ray structure determinations of diorganyl dithiolate compounds 2 and 3 revealed that germanium atom is contained in a boat–chair-shaped eight-membered central ring and displays a tetrahedral geometry. In contrast, compounds 4–6 display a boat–boat-shaped central ring with a significant intramolecular transannular O···Ge interaction. The geometry of the pentacoordinate Ge atom in these last complexes may be described as distorted trigonal bipyramidal with a 62–65% distortion displacement.

Treatment of Ph2PbCl2 with O(C6H4SH)2 (1a), S(C6H4SH)2 (2a) and S(C6H3SH)2O (3a) afforded the stable organolead compounds [{O(C6H4S)2}PbPh2] (1b), [{S(C6H4S)2}PbPh2] (2b) and [{S(C6H3S)2O}PbPh2] (3b). X-ray structure determinations of dithiolate-diphenyl lead compounds 1b–3b revealed that the trichalcogenated ligands are tridentate in 1b and 2b, and bidentate in 3b. The lead atom acts as an acceptor atom exhibiting weak intramolecular transannular interactions with the donor D atom, with tetrahedral distortions of 48% for 1b, 51% for 2b and 45% for 3b. The local geometry at the lead atom is described as monocapped tetrahedral. The crystal packing of title compounds is stabilized by several non-bonded interactions.

Resumen Fundamento y objetivo la hipocalcemia, transitoria o permanente, es una de las principales complicaciones que pueden presentar los pacientes a quienes se realiza tiroidectomia total. Las determinaciones seriadas de calcio o el tratamiento sustitutivo de todos los pacientes son los metodos mas utilizados en la prevencion de este cuadro. El objetivo de nuestro trabajo ha sido validar la tecnica de determinacion de hormona paratirina (PTH) intacta como metodo para predecir los casos de hipocalcemia. Pacientes y metodo se trata de un estudio prospectivo de 46 pacientes a quienes se practico tiroidectomia total. Se determino el valor serico de PTH en el momento de la induccion anestesica, asi como a los 10 min de la exeresis del tiroides y a las 24 h. Igualmente se midio el calcio ionico en sangre a las 24 y 48 h de la cirugia. Se determino el valor predictivo, tanto de los valores postoperatorios de PTH como de su gradiente de descenso respecto al valor preoperatorio, para la deteccion de hipocalcemia. Se considero hipocalcemia un valor serico de calcio ionico inferior a 4 mg/dl ( Resultados de los 46 pacientes, 13 (28,3%) presentaron hipocalcemia. No se observo relacion significativa entre los valores postoperatorios de PTH considerados de forma aislada y los casos de hipocalcemia. Sin embargo, cuando se considero el gradiente entre el valor preoperatorio de PTH y las determinaciones postoperatorias, se observo que el porcentaje de descenso de la PTH si predecia la hipocalcemia. La exactitud global del test fue mayor cuando el punto de corte se fijo entre el 85 y el 90% de descenso respecto al valor preoperatorio. Conclusiones el gradiente de descenso de PTH en el postoperatorio inmediato de pacientes a quienes se practica tiroidectomia total es un test valido para predecir los casos de hipocalcemia.

Background The frequency of bowel and mesenteric injuries is increasing. They are difficult to diagnose and delays in their diagnosis leads to a significantly increased morbidity and mortality. The aim of this study is to evaluate the usefulness of the computed tomography (CT) in the detection of blunt bowel and mesenteric injuries. Method Between January 2000 and October 2007, 79 patients with blunt abdominal trauma (60 men and 19 women) were included in our study. They underwent laparotomy after performing the abdominal CT. The CT findings were compared with the findings at laparotomy in order to determine the accuracy of the CT in the detection of bowel and mesenteric injuries. Results For the detection of bowel and mesenteric injuries we obtained for the CT: sensitivity = 84.2%, specificity = 75.6%, positive predictive value = 76.2%, negative predictive value = 83.8%, positive probability value = 3.45, and negative probability value = 0.21. Accuracy: 79.7%. Conclusion The abdominal CT is suitable for detecting bowel and mesenteric injuries following blunt abdominal trauma.

El neumomediastino espontaneo se define como la presencia de aire o gas en el mediastino de forma primaria. Presentamos todos los casos de neumomediastino espontaneo hallados en nuestro hospital entre enero de 1996 y diciembre de 2004. Para ello, elaboramos un protocolo de recogida de datos que incluyo: antecedentes personales, desencadenantes, semiologia, radiologia, tratamiento, estancia y complicaciones. En este periodo diagnosticamos 36 casos --25 varones (69,4%) y 11 mujeres (27,5%)--, con una edad media de 36,8 anos (rango: 11-90) y estancia media de 8,56 dias (rango: 1-53). El cuadro clinico mas habitual fue el dolor toracico, aislado (27%) o asociado a disnea (19,4%). En 14 pacientes (38,8%) hubo factor desencadenante. No hubo morbimortalidad asociada al proceso. Por todo ello, se concluye que el neumomediastino espontaneo es una entidad infrecuente, con gran variabilidad clinica, cuyo diagnostico correcto exige un alto indice de sospecha, y la radiografia de torax es la prueba idonea para ello.

Resumen Introduccion La escala POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) es un sistema de clasificacion de pacientes que se utiliza para predecir la mortalidad y la morbilidad ajustada a riesgo en gran variedad de procesos quirurgicos. El objetivo de este trabajo es valorar su utilidad en los pacientes quirurgicos de un servicio de cirugia general. Pacientes y metodos La escala se ha aplicado, de forma prospectiva, a los pacientes intervenidos por laparotomia programada y urgente en nuestro departamento de cirugia general (hospital nivel II) durante un periodo de 8 meses. Se han incluido 105 casos de los que 81 fueron operados de forma programada y los 24 restantes, de forma urgente. Posteriormente, se han comparado, utilizando el test exacto de Fisher, los resultados predichos por la escala con los observados en la realidad. Resultados La puntuacion fisiologica media fue de 23,4 puntos (rango: 12-40 puntos), y la quirurgica de 11,3 puntos (rango: 6-24 puntos). Fallecieron 3 pacientes y 47 presentaron morbilidad. Al comparar los resultados observados con los predichos por el sistema POSSUM, en cuanto a mortalidad, no se hallaron diferencias significativas en el analisis por grupos de riesgo, excepto en el grupo de riesgo Conclusion El sistema POSSUM es una herramienta util para los analisis de morbimortalidad en nuestros pacientes quirurgicos.