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Objective: Methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) may complicate the treatment of diabetic foot infections (DFIs). The aim of this study was to determine the risk factors for these pathogens in DFIs., Methods: This was a prospective observational study of 167 consecutive adult patients with DFIs. The diagnosis and severity of DFIs were based on the Infectious Disease Society of America (IDSA) classification system. Multivariate analyses were performed in order to identify risk factors for MRSA and ESBL-E infections., Results: S. aureus was the most isolated pathogen (n=82, 37.9 %) followed by Escherichia coli (n= 40, 18.5%). MRSA accounted for 57.3% of all S. aureus and 70% of Klebsiella pneumoniae and 25% of E. coli were ESBL producers, respectively. Deep ulcer [OR 8,563; 95% CI (1,068-4,727)], previous use of fluoroquinolones [OR 2,78; 95% CI (1,156-6,685)] and peripheral vasculopathy [OR 2,47; 95% CI (1.068-4.727)] were the independent predictors for MRSA infections; and osteomyelitis [OR 6,351; 95% CI (1,609-25,068)] and previous use of cephalosporins [OR 5,824; 95% CI (1,517-22,361)] for ESBL-E infections., Conclusions: MRSA and ESBL-E have adquired a great clinical relevance in DFIs. The availability of their risk factors is very convenient to choose the empirical treatment in severe forms., (©The Author 2020. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)

Background: The rates of breastfeeding worldwide are slowly improving since 1996. Europe is still trailing behind the global breastfeeding incidence and prevalence rates. Thus, breastfeeding promotion, protection, prolongation and support have become an important challenge as breastfeeding sharply decreases in the first six months of life., Objectives: The aim of this project is to determine, assess and identify the real impact of breastfeeding support networks in Murcia (Spain)., Methods: After searching unsuccessfully for a validated questionnaire, a specific one was developed and validated for measuring the impact of formal and informal support networks through five dimensions: satisfaction, consultation, experience, problems and support. The questionnaire was provided to 500 mothers with experience in breastfeeding, who brought their children to baby paediatricians between 2 June and 27 November 2014. Upon completion of the survey and fieldwork, a detailed statistical analysis was conducted., Results: The degree of satisfaction perceived by the users of the services of support breastfeeding networks is remarkable. In addition, mothers who clarified their doubts and discussed their problems with health professionals and/or breastfeeding support networks were more likely to breastfeed for a longer duration compared to those who did not (p=0.005). Furthermore, mothers who sought support in breastfeeding are more likely to breastfeed for more than 6 months (p<0.0005)., Conclusion: Based on this information, we conclude that breastfeeding support networks have a positive influence in the duration of a women's decision to breastfeed., (Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: overweight and obesity have been increasing, and university students are an important target for prevention programs. Previous studies have reported differences in the diagnosis between different anthropometric methods, so some students can be misclassified depending on the method used., Objective: to evaluate the efficacy of different anthropometric methods to detect those university students in a probable status of overweight, including a comparison with a new proposed method, the normalized weight-adjusted index (NWAI)., Methods: different anthropometric methods (waist circumference, waist-hip ratio, waist-height ratio, body mass index, conicity index, bioimpedance and Brozek, Siri and Heath-Carter equations) were calculated for 505 university students. By k-means cluster analysis, students with higher values according to variables involved in overweight were identified. Parameters of accuracy were calculated by operating characteristic curves., Results: NWAI showed significant correlations with the most used methods. Prevalence of students with body fat excess varied from 5.9% to 48.4% for women and from 8.5% to 49.0% for men depending of the method employed, being demonstrated a great variability between the different methodologies. Body mass index for women and waist circumference for men resulted to be the most accurate methods to detect a probable situation of excess of body fat or cardiovascular risk associated. NWAI resulted also a good alternative for overweight classification., Conclusions: differences between anthropometric methods for overweight and cardiovascular disease risk classification were confirmed. Classical cut-off point may misdiagnose overweight or health risk in Spanish university students depending of the method employed.

Background Acoustic radiation force impulse (ARFI) is a non-invasive alternative to a liver biopsy for the evaluation of liver fibrosis (LF). Purpose To investigate the potential usefulness of acoustic radiation force impulse ARFI for detecting LF in overweight and obese children Material and Methods A cross-sectional study was conducted in 148 schoolchildren. A diagnosis of non-alcoholic fatty liver disease (NAFLD) and LF was based on ultrasound (US) and ARFI shear wave velocity (SWV). Results The laboratory parameters were normal in all the children. NAFLD was observed in 50 children (33.8%). The median SWV was 1.18 ± 0.28 m/s. Differences between ARFI categories and hepatic steatosis grades were observed (χ2 = 43.38, P = 0.0005). No fibrosis or insignificant fibrosis (SWV ≤ 1.60 m/s) was detected in 137 children (92.5%), and significant fibrosis (SWV > 1.60 m/s) in 11 children (7.5%), nine of whom had normal US or mild steatosis. Conclusion The present study is the first to evaluate the utility of the ARFI technique for detecting LF in overweight and obese children. The results of the study suggest that children with normal laboratory parameters such as normal liver ultrasound or mild steatosis may present with significant LF.

Objective: The aim of the study was to analyze the impact of steroid treatment in patients with community acquired pneumonia (CAP), both in length of stay and economical cost of admission at a clinical university hospital., Methods: Prospective study of admitted patients with the diagnosis of CAP, both in Internal Medicine and Infectious diseases department. The study was conducted from January to march 2015; patients receiving steroids from diagnosis to end of antibiotic treatment were classified as group I; otherwise, they were considered in group II. Administration of steroids was done according to the criteria of the responsible. Cost was stablished according to CAP Diagnostic Related Group (DRG)., Results: Prevalence of patients younger than 65 year-old was higher in group I (p<0.05). In bivariate analyses, mean admission time was lower in group I (5.37 vs 8.88 days) (p<0.0005) and also economical cost (2,361 euros vs 3,907 euros) (p<0.0005). In multivariate analysis, factors independently associated to higher cost (>3,520 euros) were COPD (OR=2.602; 95% CI 1.074-6.305) and group II (patients with no steroids) (OR=6.2; p=0,007)., Conclusions: No administration of steroids in patients with CAP was associated, together with COPD, with higher economical cost (evaluated by DRG/length of stay).

Objective: Outpatient parenteral antimicrobial therapy (OPAT) programs are a good assistance option in a wide variety of infectious diseases. Our aim was to design and implement an OPAT program in the area of influence of a second-level hospital, with no Home Hospitalization Service available, being necessary close collaboration between hospitalization and Primary Care teams, describe our cohort, analyse the antimicrobial treatment indicated and evaluate the prognostic and risk factors associated with readmission and mortality., Methods: Prospective study cohorts of patients admitted to the OPAT programme, from 1 January 2012 to 31 May 2015., Results: During the period of study a total of 98 episodes were recorded. The average age of the cohort was 66 years. The most frequent comorbidity was immunosuppression (33.67 %), with an overall average of Charlson index of 5.21 ± 3.09. The most common source of infection was respiratory (33.67 %). Microbiological isolation was achieved in fifty-eight patients (59.18 %) being Escherichia coli the most frequently isolated (25%). The average number of days of antibiotics administration at home was 10.42 ± 6.02 (SD), being carbapenems (43.48%) the more administered. Eighty-six patients (87.75%) completed the treatment successfully. Thirty-two patients (32.65%) were readmitted within 30 days after being discharged and seven patients (7.14%) died. A statistically significant association was only found in the readmission with variables: elderly patients (p=0.03), being carriers of Porth-a-Cath (p=0.04) and treatment termination related with infection (p<0.05)., Conclusions: This is the first programme of OPAT administration not dependent on Home Hospitalization Service in Spain, which could allow to optimize the hospital and primary care resources available. Nevertheless this pilot study results are poor in terms of optimization of antibiotics choice, transition to oral administration, de-escalation and duration.

Background and Objectives: Postoperative seroma after axillary lymphadenectomy leads to an increased use of resources and an impaired quality of life of patients. This randomized clinical trial was designed to assess the value of a hemostatic and sealing agent for decreasing seroma occurrence after axillary lymphadenectomy., Methods: A prospective, randomized, blind study was conducted on 91 axillary lymphadenectomies distributed into a control group (n = 47) and a test group in which a collagen sponge coated with human coagulation factors was used (n = 44). Primary end-points were number of days before removal of axillary drainage, axillary drainage output, and occurrence of seroma, wound infection, haematoma, or wound dehiscence, within 8 weeks of surgery. Bivariate and multivariate analyses on seroma occurrence were performed., Results: Seroma occurred in 29 patients (31.86%). A significant direct relationship (P = 0.002) was only noted between use of the hemostatic and sealing agent and nonoccurrence of seroma. In the multivariate study, the only variable found to be significantly related to seroma occurrence was use of the above agent (P = 0.046; odds ratio: 3.365 [95%CI: 1.024-11.060])., Conclusions: Use of a collagen sponge coated with human coagulation factors following axillary lymphadenectomy was associated to a lower incidence of postoperative seroma. J. Surg. Oncol. 2016;114:423-427. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Objectives: To describe the differences in obstetrical results and women's childbirth satisfaction across 2 different models of maternity care (biomedical model and humanised birth)., Setting: 2 university hospitals in south-eastern Spain from April to October 2013., Design: A correlational descriptive study., Participants: A convenience sample of 406 women participated in the study, 204 of the biomedical model and 202 of the humanised model., Results: The differences in obstetrical results were (biomedical model/humanised model): onset of labour (spontaneous 66/137, augmentation 70/1, p=0.0005), pain relief (epidural 172/132, no pain relief 9/40, p=0.0005), mode of delivery (normal vaginal 140/165, instrumental 48/23, p=0.004), length of labour (0-4 hours 69/93, >4 hours 133/108, p=0.011), condition of perineum (intact perineum or tear 94/178, episiotomy 100/24, p=0.0005). The total questionnaire score (100) gave a mean (M) of 78.33 and SD of 8.46 in the biomedical model of care and an M of 82.01 and SD of 7.97 in the humanised model of care (p=0.0005). In the analysis of the results per items, statistical differences were found in 8 of the 9 subscales. The highest scores were reached in the humanised model of maternity care., Conclusions: The humanised model of maternity care offers better obstetrical outcomes and women's satisfaction scores during the labour, birth and immediate postnatal period than does the biomedical model., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objective: The aim of this study was to determine the possible relationship between the Sp1 polymorphism of gene COL1A1 and bone metabolism disorder in individuals with epilepsy., Methods: To this end, we carried out an observational cross-sectional study on 64 patients in monotherapy with an antiepileptic drug. The patients were classified on the basis of the presence of the 's' allele of the COL1A1 Sp1 polymorphism., Results: In the patients with SS, the standardized bone mineral density (sBMD) in the left femoral neck was 1024.9±206.1 mg/cm, whereas in the patients with Ss or ss, the density was significantly lower, 917±141.4 mg/cm (P=0.027), as was the femoral t-score (0.72±1.67 vs. -0.29±1.15, P=0.01). The values in the lumbar spine were equally greater in those with SS: 1219.1±236.3 versus 1090.5±142.7 mg/cm for the sBMD (P=0.018) and 0.67±1.98 versus -0.34±1.16 for the lumbar t-score (P=0.023). The bone biomarkers showed no significant differences nor did the 25-OH vitamin D and parathormone values. In the patient group treated with valproic acid (VPA), the densitometric values were significantly lower in the Ss or ss patients compared with SS homozygotes: 887.1±142.6 versus 1120.6±198.2 mg/cm for femoral sBMD (P=0.02), 990±98.1 versus 1417±251.2 mg/cm for lumbar sBMD (P=0.001). Of the patients who were carriers of the 's' allele and who were treated with VPA, 86% achieved osteopenia values., Conclusion: In our study, the presence of the 's' allele of the COL1A1 Sp1 polymorphism in individuals with epilepsy was related to lower bone BMD (lumbar and femoral). This relationship seemed to be further apparent in the patients undergoing treatment with VPA.

Gross Motor Function Classification System has discriminative purposes but does not assess short-term therapy goals. Locomotion Stages (LS) classify postural body functions and independent activity components. Assessing the relation between Gross Motor Function Classification System level and Locomotion Stages will make us understand if clinical assessment can explain and predict motor environmental performance in cerebral palsy. A total of 462 children were assessed with both scales. High reliability and strong negative correlation (-0.908) for Gross Motor Function Classification System and Locomotion Stages at any age was found. Sensitivity was 83%, and specificity and positive predictive value were 100% within the same age range. Regression analysis showed detailed probabilities for the realization of the Gross Motor Function Classification System depending on the Locomotion Stages and the age group. Postural body function measure with Locomotion Stages is reliable, sensitive, and specific for gross motor function and able to predict environmental performance., (© The Author(s) 2015.)

Objective: to understand the episiotomy rate and its relationship with various clinical variables., Method: a descriptive, cross-sectional, analytic study of 12,093 births in a tertiary hospital., Variables: Parity, gestational age, start of labor, use of epidural analgesia, oxytocin usage, position during fetal explusion, weight of neonate, and completion of birth. The analysis was performed with SPSS 19.0., Results: the global percentage of episiotomies was 50%. The clinical variables that presented a significant association were primiparity (RR=2.98), gestational age >41 weeks (RR=1.2), augmented or induced labor (RR=1.33), epidural analgesia use (RR=1,95), oxytocin use (RR=1.58), lithotomy position during fetal expulsion (RR=6.4), and instrumentation (RR=1.84). Furthermore, maternal age ≥35 years (RR=0.85) and neonatal weight <2500 g (RR=0.8) were associated with a lower incidence of episiotomy., Conclusions: episiotomy is dependent on obstetric interventions performed during labor. If we wish to reduce the episiotomy rate, it will be necessary to bear in mind these risk factors when establishing policies for reducing this procedure.

Objectives: To analyse factors associated to "failure" in patients under antibiotic (AB) treatment at a third level hospital., Patients and Methods: All patients receiving an AB treatment along April 2012 were prospectively observed and factors associated to failure were analyzed. Failure was defined as clinical or microbiological failure, relapse or death. Statistically significance was established as p<0.05., Results: 602 of 1,265 admitted patients during the study month included an AB in their medical prescriptions, being 178 considered as prophylactic AB prescriptions, 342 empirical treatments and 82 directed treatments as empiric treatments. Ceftriaxone and levofloxacin were the most used AB; choice of empirical and directed treatments were in line with protocols in 71% (242 of 342 cases) and 67% (55 of 82), respectively. Of all the patients receiving antibiotics for therapy (n=424), 402 had infection criteria (in 22 cases antibiotic treatment was deemed unnecessary since the patient showed no infectious process). Of these, 292 (72%) showed a good evolution, while the others were considered as failed therapies, either because of microbiological persistence in 49 (12.8%), relapse in 31 (7.71%) and death in en 30 (7.46%). Factors associated to "failure" were Charlson score ≥3 (OR 3.35; 95%CI 1.602-7.009); empirical and/or directed treatment not in keeping with the protocol (OR 5.68; 95%CI 2.898-11.217); and infection by ESBL and/or ciprofloxacin resistant E. coli (OR 4.43; 95%CI 1.492-13.184)., Conclusions: A high rate of AB prescriptions in admitted patients correspond to empirical infection treatment, being ceftriaxone and levofloxacin the most used AB. Inadequate empirical and/or directed treatment is associated to clinical or microbiological failure and death.

Objectives: get to know, analyze and describe the current situation of the Delivery and Birth Plans in our context, comparing the delivery and birth process between women who presented a Delivery and Birth Plan and those who did not., Method: quantitative and cross-sectional, observational, descriptive and comparative cohort study, carried out over two years. All women who gave birth during the study period were selected, including 9303 women in the study., Results: 132 Delivery and Birth Plans were presented during the first year of study and 108 during the second. Among the variables analyzed, a significant difference was found in "skin to skin contact", "choice of dilation and delivery posture", "use of enema", "intake of foods or fluids", "eutocic deliveries", "late clamping of the umbilical cord" and "perineal shaving"., Conclusions: the Delivery and Birth Plans positively influence the delivery process and its outcome. Health policies are needed to increase the number of Delivery and Birth Plans in our hospitals.

Background: the hypothesis of this study is that there are not enough validated questionnaires that measure the impact of networks to support breastfeeding for the Spanish speaking population., Objective: For this reason, we ask as a general objective of this study, to develop and validate (in terms of content and construct) a quantitative instrument of measure., Method: We evaluated the content validity, subjecting the survey to a breastfeeding expert's opinion in the Region of Murcia. The pilot test was conducted between the months of March and April 2014. Surveys were carried out directly by users who attended the breast-feeding support group "Lactando". For construction validity, a factor analysis was conducted, which determined the different dimensions that the survey could measure. A description of each of the items on the statistics was conducted. Through principal component analysis, the total variance explained was obtained, determining the factors that define the elements., Results: Through factor analysis, the questionnaire has a high internal consistency for its five components (satisfaction, consultations, experience, problems and support), obtaining values from 0.942 to 0.632. And a high percentage of total variance explained (11,157% - 5,093%)., Conclusion: This study has served to create a relevant and valid in terms of content and construction, instrument, capable of measuring the impact of networks of support for breastfeeding through 5 dimensions., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Background: Galactography is the technique of choice for investigating pathological nipple discharge. However, there is no standardized interpretation system for this procedure., Purpose: To evaluate radiological and histological correlation using a Galactogram Imaging Classification System (GICS)., Material and Methods: We retrospectively studied all galactograms obtained in 62 women with pathological nipple discharge who subsequently had biopsy at our institution between 1999 and 2007. The GICS proposes five categories for galactographic findings: GICS 1: negative; GICS 2: benign; GICS 3: probably benign; GICS 4: suspect for malignancy; GICS 5: highly suspect for malignancy., Results: The galactographic findings were classified as follows: GICS 2: 25.8% (16/62); GICS 3: 30.6% (19/62); GICS 4: 25.8% (16/62); and GICS 5: 17.7% (11/62). A good correlation was observed between histological diagnosis and GICS categories (P < 0.05). All the cases diagnosed with carcinoma (n = 11) were classified in GICS category 5., Conclusion: The present study shows a good correlation between GICS categories and histological diagnosis.

Purpose: To compare examination adequacy and patient discomfort during retrograde urethrography (RUG) performed by using the conventional balloon method versus those of RUG and voiding cystourethrography (VCUG) performed with the clamp method of using drip infusion for the administration of contrast material., Materials and Methods: This prospective study was approved by the institutional review board; written informed consent was obtained from all patients. Eighty men (mean age, 64.3 years +/- 16 [standard deviation]; range, 18-85 years) suspected of having urethral stenosis were randomly distributed into two groups for urethrography: a control group (n = 36) and a clamp group (n = 44). In 11 of the 36 patients in the control group, the conventional balloon method could not be used, so these patients were transferred to the clamp group. Drip infusion was used to administer contrast material for RUG, and, except in cases where a suprapubic catheter was used (n = 8), for VCUG. The pain levels reported by patients were recorded by using a verbal descriptor scale (VDS) and a visual analogue scale (VAS)., Results: In the control group, RUG was successfully performed in 69% of patients (25 of 36), and mean pain levels recorded on inflation of the balloon were distressing according to the VDS and 4.8 +/- 1.4 (range, 2.3-7.5) according to the VAS. In the clamp group, RUG was successfully performed in all cases; in 69% of patients in this group (38 of 55), the pain level recorded at external compression was no pain according to the VDS and 0 according to the VAS, while mean values in the remaining 31% of patients (17 of 55) were mild pain on the VDS and 0.6 +/- 0.3 (range, 0.3-1.2) on the VAS. Bladder filling for VCUG was achieved with drip infusion in 96% of patients (69 of 72) in an average time of 11 minutes., Conclusion: The conventional balloon method of performing RUG is painful and, in some cases, not effective. The clamp method is a simple, well-tolerated procedure that allowed diagnostic evaluation in all cases. Drip infusion enables RUG and VCUG to be performed without the need for syringes or bladder catheters, thus increasing patient comfort., ((c) RSNA, 2009.)

Background: The aim of this paper is to determine the possible association between five different profiles of immunohistochemical expression related to clinical, histopathological and immunohistochemical known prognostic value variables for breast cancer., Material and Method: A total of 194 breast carcinoma tumour samples were studied. In this study five groups or immunohistochemical profiles were defined, based on expression of hormone receptors (oestrogen or progesterone) and/or Her2/neu (luminal-type A, luminal-type B, mixed profile, Her2/neu profile and triple-negative-type profile) and we studied whether there are differences between them with regard to clinical, histopathological and immunohistochemical variables that have a known prognostic significance., Results: In the series we found 134 (69%) cases corresponding to a luminal immunophenotype, of which 98 (50.5%) were from the luminal A group and 36 (18.6%) from luminal B. Twenty-nine cases (15.9%) were triple-negative, 18 (9.3%) mixed and 13 (6.7%) Her2/neu type. It is worth noting the relationship between the triple-negative and Her2/neu immunophenotypes and the more poorly differentiated histological forms (62% and 60%, respectively) and between the luminal A group and well-differentiated tumours (p = 0.008). Expression of ki67 was high in the triple-negative group (73.9%) and low in the luminal A group (26.3%; p = 0.001). The expression of p53 was also greater for the Her2/neu (55.5%) and triple-negative (60.8%) groups (p = 0.0005) than for the others., Conclusions: The subgroups without hormone receptor expression, with Her2/neu overexpression or without (triple-negative group), have characteristics associated with variables of a poorer prognosis. The lack of progesterone receptor expression also seems to be associated with these.

Aim: The aim of this study was to evaluate the efficacy of different frequencies of a stretching exercise program on lower extremity range of motion (ROM) in prepubertal schoolchildren., Methods: A total of 62 children were divided into 3 groups (experimental groups: A, B; control group: C). Experimental group A performed hamstring stretches for 5 min during the Physical Education classes over a full school term (9 months), 2 sessions per week (31 weeks, 62 sessions of Physical Education). Experimental group B performed hamstring stretches for 5 min during the Physical Education classes and during a specific extracurricular physical activity, over a full school term (9 months), 4 sessions per week (31 weeks, 62 sessions of Physical Education and 62 sessions of after-school physical activities). Control group followed the standard class program of Physical Education classes. Hamstring flexibility was measured using the straight leg raise test before and after the program., Results: No significant differences were revealed in ROM before and after the Physical Education classes for the control group. However, significant improvements in ROM were shown in the two experimental groups (P<0.001). Four days per week produced a greater rate of gains in ROM (16.9 degrees) than 2 days per week (9.3 degrees). For all groups, the initial and the final ROM between the right and left sides were similar., Conclusion: This study indicates that a full school term (9 months) incorporating static stretching as part of the Physical Education classes and the extracurricular physical activities significantly increases the ROM of the hamstrings in prepubertal schoolchildren. The study also suggests that the increase of the frequency of stretching is effective for increasing ROM.

Objectives: The sentinel node is defined as the node with the highest probability of being involved in the case of lymphatic spread from a tumor. Accurate identification and biopsy of this node can avoid unnecessary lymphadenectomies. The aim of this study was to determine if there are differences in the number of isolated sentinel lymph nodes in breast cancer according to whether a mixed technique (vital dye plus isotopic tracer) or radiotracer alone is used and if there are differences in the detection of more than one lymphatic basin and in the number of lymphatic nodes depending on the site of tracer injection., Patients and Method: A total of 173 sentinel lymph node biopsies in 173 women with breast cancer were studied taking into account the technique (mixed [n = 109] or radiotracer alone [n = 64]) and the location of tracer injection (periareolar [n = 81], intra and/or peritumoral [n = 92]). The number of lymphatic basins and the number of sentinel nodes were compared among the distinct groups resulting from the combination of the 2 parameters., Results: Simultaneous drainage to both the axilla and internal mammary chain was more frequent with the intra-periareolar technique. The number of identified nodes was significantly higher when mixed techniques were compared, and was higher with periareolar injection than with the intra-peritumoral route., Conclusions: In breast cancer sentinel lymph node biopsy, the number of identified nodes is not influenced by the use of a mixed technique or radiotracer alone. However, the number of identified nodes is higher with the periareolar route than with the intra-peritumoral route. Intra-peritumoral injection of the tracer shows a higher frequency of internal mammary chain drainage than periareolar injection, although this difference was not statistically significant.

Melanoma is one of the most frequently metastasizing malignant neoplasias. This study examines an experimental model of pulmonary metastasis and the B16F10 cell subline, highly metastatic in the lung. Antimetastatic effects of the flavonoids tangeretin, rutin, and diosmin were analyzed, and at the same time an analysis of the metastatic activity of ethanol was performed, considered to be necessary because it is used as a vehicle for administering the flavonoids. Lentini's model, which complements the macroscopic evaluation of nodule numbers by using a stereoscopic microscope and image analysis at the microscopic level, was used. The greatest reduction in the number of metastatic nodules (52%) was obtained with diosmin; similarly, the percentages of implantation, growth index, and invasion index (79.40, 67.44, and 45.23%, respectively), were all compared with those of the ethanol group, considered to be an effective control group. Rutin- and tangeretin-treated groups also showed reductions of the same index compared with the ethanol group. It would seem that structural factors would better explain these results and the antimetastatic activity of each flavonoid and the respective metabolites.

Introduction: The anatomical location of cutaneous melanoma has been suggested to be an independent prognostic factor. The aim of the present study was to determine whether the location of the primary tumor influences sentinel node detection in cutaneous melanoma., Patients and Method: Two hundred twelve patients with primary cutaneous melanoma (96 of the limbs, 89 of the trunk and 27 of the head or neck) who underwent sentinel lymph node biopsy were studied. Adequate lymphoscintigraphic and surgical localization was evaluated and epidemiological and histopathological variables, the number of lymph nodes draining the site of the primary lesion, sentinel nodes per drainage basin, and tumor-positive nodes were compared., Results: Localization was less successful for tumors of the head and neck (88.8%), both with lymphoscintigraphy (P<.001) and surgery (P<.0005), especially for lymph nodes adjacent to salivary glands (P<.0005). Melanomas of the trunk showed a greater number of nodes per lesion and wider variability in drainage pathways (P<.0005), although there were no differences in the number of sentinel nodes per drainage basin (P=.455)., Conclusions: Sentinel node detection with less successful in cutaneous melanomas located in the head and neck. Location of the sentinel node adjacent to a salivary gland is a factor that influences its detection. Cutaneous melanomas of the trunk showed a higher number of draining nodes per lesion than those located in the limbs or head and neck.

Introduction: Melanoma is one of the neoplasias that most frequently metastasize, especially in the lung, where represents a challenge in oncology since current treatment is ineffective, and mortality is high., Material and Methods: Swiss mice (n = 52) were inoculated with 0.5 x 106 B16F10 cell lines and, later, given an oral administration of grape-seed extract, red wine or ethanol. Metastatic nodules on the lung surface were counted and, after processing for microscopy, five sections were selected for image analysis and the invasion index was calculated., Results: Macroscopic analysis showed that grape-seed extract and red wine reduced the number of metastatic nodules by 26.07 and 20.81%, respectively, compared with a control group treated with ethanol. Microscopically, the reduction in the invasion index was 31.65 for grape-seed extract and 17.57% for red wine., Conclusion: Ethanol administration significantly increased pulmonary metastasis while grape-seed extract and red wine led to their reduction.

Introduction: In multinodular goiter there is no consensus on which is the most adequate surgical technique, since although the techniques with partial resection show lower risk of complications they are associated with a higher risk of recurrences. The objective of this study is to define the risk factors for recurrence of multinodular goiters after surgery in a series with a mean postoperative follow-up higher than 12 years., Patients and Method: 231 multinodular goiters with partial thyroid surgery are analyzed. The recurrence is assessed through clinical exploration, and is confirmed with echography. The variables analyzed are age, sex, family history of thyroid pathology, residence in goitrogenic areas, asymptomatic hyperthyroidism, compression syndromes, intrathoracic extension of goiter, surgeon experience with endocrine surgery, weight of the thyroid, and surgical technique, chi2 test, Student's t test and a logistic regression test are applied., Results: After a mean postoperative follow-up of 152 +/- 71 months 67 goiters (29%) showed recurrence with a mean time for recurrence of 85 +/- 67 months. Risk factors detected in the multivariate study were youngest age, surgeon's lack of experience in endocrine surgery, and the surgical technique. Forty-six patients (69%) were operated because of recurrence, most of them by surgeons experienced in endocrine surgery. Thyroidectomy was completed in all cases, and two definitive postoperative complications occurred., Conclusions: The index of clinical recurrences is high and increases with the progression; primary risk factors are age, surgeon's experience, and surgical technique. The implication is that partial resection techniques should be carried out by surgeons with experience and there should be avoided in young patients.

Aim: To determine the influence of the information on donation generated from primary health-care on the attitude towards organ donation., Design: Descriptive transversal study., Setting: 45 municipalities of Murcia Region, Spain., Participants: The population in this study was randomly selected and stratified according to age, sex, and geographic localization among people over > or =15 years of age (n=1887). INTERVENTIONS AND MEASURES: The attitude was evaluated according to a questionnaire psychosocial aspects of donation. There is valued the information transmitted on donation to the population from primary care (group A) or other informative sources (group B), and if this information was to favour or in opposition to the same one., Statistics: chi2 test, t Student, and logistic regression analysis., Results: Of 1887 surveys, 129 cases (group A) (7%) had received information from primary care. In this group, the 89% is in favour of the donation. In 120 cases the received information was favourable, presenting an attitude in favour of the donation of 93%, whereas in all 9 remaining cases the information was in against, decreasing the attitude to favour up to 44% (P<.05). In the group B (n=1758) the attitude in favour of the donation was of 65% (P<.05, with regard to the group A). The 62% (n=1083) received favourable information, improving in them the favourable attitude towards the donation up to 74%. The rest (38%; n=675) had received also unfavourable information, decreasing his attitude to favour up to 51% (P<.05)., Conclusions: Little information about organ donation is transmitted from primary care, but when it is realized a very positive impact has if it is favourable and very negative if it is unfavourable.

Introduction: P. aeruginosa causes serious infections with high mortality., Objectives: Identify the prognostic factors associated with higher mortality in P. aeruginosa bacteremias (PAB)., Methods: 211 consecutive cases of PAB were analyzed prospectively between 1992-1998. Blood cultures, isolation, and antimicrobial sensitivity were carried out according to microbiology standard methodology. The variables analyzed as prognostic factors were: sex, age, source of infection, background, main disease, initial clinical severity, foci, presence of complications, leukocyte count, type of antibiotic treatment and adaptation. Bivariate and multivariate statistical analyses were carried out by the method of logistic regression., Results: Global mortality was 27.96%; factors associated with higher mortality in the bivariate study were main disease rapidly and eventually fatal, diabetes, a situation of critical initial clinical severity, lung focus, complications, neutropenia and inadequate antibiotic treatment. The logistic regression study, the critical initial clinical severity, and the presence of complications were the variables associated with worse prognosis. We did not find significant differences in the evolution among the patients who received monotherapy and those on combinations of antimicrobial drugs against pseudomonas., Conclusion: Higher mortality of PAB is statistically associated to the situation of critical initial clinical severity and to the presence of complications; therefore, an early diagnosis and adequate treatment to improve the morbidity and mortality are recommended.

Introduction: The cytokinesis-blocked (CB) micronucleus test (MN) on irradiated human lymphocytes is normally used to evaluate chromosomal and genotoxic damage produced by various physical and chemical agents., Objective: Determine any possible genotoxic effect induced by the different types of ionizing radiation employed in medical diagnostic radiology and nuclear medicine., Material and Methods: The frequency of the MN appearance was determined in CB lymphocyte cultures of a total of 4 different groups of patients: (1) in 35 supposedly healthy volunteers to establish the MN spontaneous frequency in the medium; (2) in 9 volunteers to measure the in vitro dose-response curves in order to calculate the MN frequency following X-ray irradiation and gamma radiation; (3) in 25 patients in whom a specific diagnostic and/or therapeutic procedure employing diagnostic radiology techniques involving X-ray exposure was applied, and (4) in 26 patients in whom the diagnostic procedure in question involved nuclear medicine techniques (scintiscan)., Results: A lineal relationship was observed between the MN frequency and the dose of ionizing radiation administered in vitro, both in X-rays and gamma radiation. A significant increase in the MN is observed after radiation is given to patients during medical diagnostic radiology examinations when compared with the control values obtained from the same patients prior to being subjected to the radiological procedure (p < 0.01). No significant MN increase is observed following exposure to radiation involved in diagnostic examinations in patients studied in Nuclear Medicine., Conclusion: Ionizing radiation employed in complex medical diagnostic radiology examinations produces a significant increase in the MN appearance frequency and as such indicates both radiation induced chromosomal and genotoxic damage. However, the ionizing radiation used in diagnostic nuclear medicine examinations does not induce any significant increase in MN appearance frequency.

Background and Objective: The hypoparathyroidism is one of the most important complications in the patients submitted to thyroid surgery. The aim is to analyze across a multivariate statistical analysis the risks factors for the development of transient and permanent hypoparathyroidism following the multinodular goiter (MG) surgery., Patients and Method: Between 1970 and 1999, 672 thyroidectomies by MG were reviewed. It was considered transient hypoparathyroidism when the calcemia was minor of 7.5 mg/dl or when being minors of 8.5 mg/dl the patient was presenting symptomatology for the hipocalcemia. The hypoparathyroidsm was considered permanent when the calcemia was minor of 8.5 mg/dl to the year of the surgery., Results: The hypoparathyroidism appeared in 75 patients (11.2%), 20 with symptomatology (3%), persisting like permanent 6 cases (0.9%). The risk factors for the development of this were the hyperthyroidism (p = 0.0370), and the surgical technique (p < 0.00001) (unilateral versus bilateral surgery), persisting in the multivariate analysis both variables. With respect to the permanent hypoparathyroidism, the risk factor was the toxic MG (p = 0.0109), persisting as independent risk factor in the multivariate analysis (RR = 2.3)., Conclusions: The principal risk factor of permanent hypoparathyroidism in the MG surgery is the presence of hyperthyroidism.

Objective: Postmenopausal women have higher risk of cardiovascular events compared with premenopausal. The aim of this clinical study was to evaluate the effect of hormone replacement therapy (HRT) on the atherogenic profile in apparently healthy postmenopausal women., Method: The subjects were 76 healthy postmenopausal women, aged 45 to 59 years, and 15 premenopausal women with regular cycles, aged 40 to 45 years. 63 postmenopausal women completed the study. None of the participating women had a history of hypertension, diabetes mellitus or medications known to affect the cardiovascular system. Twenty seven postmenopausal women received daily 50 micrograms of transdermal estradiol and 100 milligrams of oral progesterone. Thirty six dit not receive HRT. Checkups were preformed at baseline and after six months of treatment, except the group of premenopausal women (only at baseline). Examinations consisted in measurement of body weight, length, waist/hip ratio and plasma levels of biochemical parameters., Results: Estradiol levels were higher among premenopausal women than among treated and non-treated postmenopausal women (83 +/- 78.47 versus 10 +/- 3.99; 12 +/- 4.56 mg/l, p < 0.0001). Levels of serum cholesterol (198 +/- 30.2 versus 236 +/- 33.7; 228 +/- 32.8 mg/dl; p < 0.002), LDL-cholesterol (120 +/- 25 versus 151 +/- 34.2; 144 +/- 31.5 mg/dl, p < 0.02), uric acid (3.98 +/- 0.5 versus 4.6 +/- 1; 4.8 +/- 1 mg/dl, p < 0.004) and homocysteine (9.8 +/- 3.3 versus 13 +/- 3.1; 11 +/- 1.7 mmol/l, p < 0.02) were higher among postmenopausal women than among premenopausal women. The treated women showed higher levels of serum estradiol (49 +/- 34.43 versus 10 +/- 3.99, p < 0.0001) and CRP (0.11 +/- 0.06 vs. 0.24 +/- 0.12 mg/l, p < 0.05), lower waist/hip ratio (0.82 +/- 0.06 versus 0.83 +/- 0.05, p < 0.03), glucose (78 +/- 15.4 versus 85 +/- 14.3 mg/dl, p < 0.03), cholesterol (215 +/- 33.2 versus 236 +/- 33.7 mg/dl, p < 0.03), triglycerides (90 +/- 30.1 versus 106 +/- 47 mg/dl, p < 0.003) and calcium (9.4 +/- 0.4 versus 9.5 +/- 0.4 mg/dl, p < 0.0005) than postmenopausal women without hormone replacement., Conclusion: That HRT may have a favourable effect on atherogenic profile in apparently healthy postmenopausal women.

Objective: To evaluate P 53 and c-erb-2 overexpression as a prognostic factor for progression and survival in patients with renal pelvis and ureter tumors., Methods: Retrospective review of the medical records and pathology/immunohistochemical reports of 61 patients who underwent surgery for upper urinary tract urothelial tumors. Immunohistochemical studies were performed using the STREPTAVIDIN-BIOTIN-PEROXIDASE techniques with a LASAB kit (DAKO). Pearson's Chi square for 2 x 2 contingency tables and residues analysis were used for non continuous variables, with a confidence level of p < 0.05. COX multivariate analysis and survival curves were used for multiple variables association., Results: A higher P 53 overexpression was related with tumour dependent death (p < 0.001). These patients have their long term survival compromised. C-erb-2 overexpression is not statistically related to either proliferation or cancer specific death in upper urinary tract urothelial tumors., Conclusions: In our series P53 overexpression has prognostic value in upper urinary tract urothelial tumors, but c-erb-2 did has not prognostic value.

Objective: To analyze the influence of personal and histopathological factors as prognostic variables in the evolution of upper urothelial tumors submitted to radical surgery., Methods: Multifactorial retrospective study of a series of 61 patients submitted to radical surgery for upper urinary tract transitional cell tumors. Patient habits and histopathological factors are analyzed. The statistical significance of the different factors was analyzed using the Pearson chi-square test for the qualitative variables, with analysis of the residuals and Kaplan-Meier survival curves and statistical validation with the Mantel Cox test. The level of significance was p < 0.05., Results: A statistically significant correlation was found for tumor-related death and pathological stage, positive lymphadenectomy and positive lymphadenopathy on the CT (p < 0.05). The presence or absence of a history of smoking was not available for all patients and was therefore not evaluable. The most frequent reason for consultation was hematuria (39%). Tumor growth was mostly of the papillary type (79%), localization was mostly in the renal pelvis (30%) and the most frequent procedure was nephroureterectomy without endoscopic detachment (60%)., Conclusions: The pathological stage and a positive lymphadenectomy or the presence of positive lymphadenopathies on the CT were found to be prognostic factors in urothelial tumors of the upper urinary tract.