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L’objecte d’aquest treball és l’elaboració i implementació d'un Pla de Riscos Laborals (PRL) per a una empresa del sector industrial de la fabricació de mobles, basat en la norma ISO 45001 (Internacional Organization for Standardization, 2018), en compliment del que disposa en el Real Decreto 39/1997 de 17 de gener i en les recomanacions de les normes NTP del "Instituto Nacional de Seguridad y Salud en el Trabajo (INSST)" a fi de minimitzar els riscos laborals que aquest tipus d’activitat industrial genera. El treball s’ha realitzat amb una empresa fictícia, ja que lamentablement, les empreses, no d’aquest sector en concret, sinó en general, tenen moltes reticències en el fet que es pugui elaborar qualsevol mena d’estudi sobre riscos laborals, incloent-hi facilitar informació i molt menys que puguis tu mateix fer algun tipus d’autoria per determinar-ne l'eficàcia i les possibles mancances. Aquesta actitud no és solament imputable a les direccions de les empreses, sinó que és compartida en la majoria de les ocasions pels representants dels treballadors - sindicats -. Estranya aquesta situació quan un treball d’aquesta mena podria ser entregat a l’empresa de forma totalment gratuïta i representar sinó més no, una informació útil. Afirmar que el treball tindrà una confidencialitat absoluta no produeix cap mena d’efecte. Tot plegat fa que personalment encara hi tingui una motivació més gran.

Background Positional plagiocephaly frequently affects healthy babies. It is hypothesized that manual therapy tailored to pediatrics is more effective in improving plagiocephalic cranial asymmetry than just repositioning and sensory and motor stimulation. Methods Thirty-four neurologically healthy subjects aged less than 28 weeks old with a difference of at least 5 mm between cranial diagonal diameters were randomly distributed into 2 groups. For 10 weeks, the pediatric integrative manual therapy (PIMT) group received manual therapy plus a caregiver education program, while the controls received the same education program exclusively. Cranial shape was evaluated using anthropometry; cranial index (CI) and cranial vault asymmetry index (CVAI) were calculated. Parental perception of change was assessed using a visual analogue scale (− 10 cm to + 10 cm). Results CVAI presented a greater decrease in PIMT group: 3.72 ± 1.40% compared with 0.34 ± 1.72% in the control group (p = 0.000). CI did not present significant differences between groups. Manual therapy led to a more positive parental perception of cranial changes (manual therapy: 6.66 ± 2.07 cm; control: 4.25 ± 2.31 cm; p = 0.004). Conclusion Manual therapy plus a caregiver education program improved CVAI and led to parental satisfaction more effectively than solely a caregiver education program. Trial registration Trial registration number: NCT03659032; registration date: September 1, 2018. Retrospectively registered.

Background: Positional plagiocephaly (PP) is a cranial deformation frequent amongst children and consisting in a flattened and asymmetrical head shape. PP is associated with excessive time in supine and with congenital muscular torticollis (CMT). Few studies have evaluated the efficiency of a manual therapy approach in PP. The purpose of this parallel randomized controlled trial is to compare the effectiveness of adding a manual therapy approach to a caregiver education program focusing on active rotation range of motion (AROM) and neuromotor development in a PP pediatric sample. Methods: 34 children with PP and less than 28 week old were randomly distributed into two groups. AROM and neuromotor development with Alberta Infant Motor Scale (AIMS) were measured. The evaluation was performed by an examiner, blinded to the randomization of the subjects. A pediatric integrative manual therapy (PIMT) group received 10-sessions involving manual therapy and a caregiver education program. The control group received the caregiver education program exclusively. To compare intervention effectiveness across the groups, improvement indexes of AROM and AIMS were calculated using the difference of the final measurement values minus the baseline measurement values. If the distribution was normal, the improvement indexes were compared using the Student t-test for independent samples; if not, the Mann-Whitney U test was used. The effect size of the interventions was calculated using Cohen's d. Results: All randomized subject were analysed. After the intervention, the PIMT group showed a significantly higher increase in rotation (29.68 ± 18.41º) than the control group (6.13 ± 17.69º) (p< 0.05). Both groups improved the neuromotor development but no statistical significant differences were found. No harm was reported during the study.Conclusion: The PIMT intervention program was more effective in increasing AROM than using only a caregiver education program.

Background Positional plagiocephaly (PP) is a cranial deformation frequent amongst children and consisting in a flattened and asymmetrical head shape. PP is associated with excessive time in supine and with congenital muscular torticollis (CMT). Few studies have evaluated the efficiency of a manual therapy approach in PP. The purpose of this parallel randomized controlled trial is to compare the effectiveness of adding a manual therapy approach to a caregiver education program focusing on active rotation range of motion (AROM) and neuromotor development in a PP pediatric sample. Methods Thirty-four children with PP and less than 28 week-old were randomly distributed into two groups. AROM and neuromotor development with Alberta Infant Motor Scale (AIMS) were measured. The evaluation was performed by an examiner, blinded to the randomization of the subjects. A pediatric integrative manual therapy (PIMT) group received 10-sessions involving manual therapy and a caregiver education program. Manual therapy was addressed to the upper cervical spine to mobilize the occiput, atlas and axis. The caregiver educational program consisted in exercises to reduce the positional preference and to stimulate motor development. The control group received the caregiver education program exclusively. To compare intervention effectiveness across the groups, improvement indexes of AROM and AIMS were calculated using the difference of the final measurement values minus the baseline measurement values. If the distribution was normal, the improvement indexes were compared using the Student t-test for independent samples; if not, the Mann-Whitney U test was used. The effect size of the interventions was calculated using Cohen’s d. Results All randomized subjects were analysed. After the intervention, the PIMT group showed a significantly higher increase in rotation (29.68 ± 18.41°) than the control group (6.13 ± 17.69°) (p = 0.001). Both groups improved the neuromotor development but no statistically significant differences were found. No harm was reported during the study. Conclusion The PIMT intervention program was more effective in increasing AROM than using only a caregiver education program. The study has been retrospectively registered at clinicaltrials.gov, with identification number NCT03659032. Registration date: September 1, 2018.

(1) Background: anthropometric measurements with calipers are used to objectify cranial asymmetry in positional plagiocephaly but there is controversy regarding the reliability of different methodologies. Purpose: to analyze the interrater and intrarater reliability of direct anthropometric measurements with caliper on defined craniofacial references in infants with positional plagiocephaly. (2) Methods: 62 subjects (&lt, 28 weeks), with a difference of at least 5 mm between cranial diagonal diameters. Maximal cranial circumference, length and width and diagonal cranial diameters were measured. Intrarater (2 measurements) and interrater (2 raters) reliability was analyzed. (3) Results: intra- and interrater reliability of the maximal cranial length and width and right cranial diagonal was excellent: intraclass correlation coefficient (ICC) &gt, 0.9. Intrarater and interrater reliability for the left cranial diagonal was excellent: ICC &gt, 0.9 and difference in agreement in the Bland-Altman plot 0.0 mm, respectively. Intrarater and interrater reliability for the maximal cranial circumference was good: differences in agreement in Bland-Altman plots: intra: &minus, 0.03 cm, inter: &minus, 0.12 cm. (4) Conclusions: anthropometric measurements in a sample of infants with moderate positional plagiocephaly have shown excellent intra- and interrater reliability for maximal cranial length, maximal cranial width, and right and left cranial diagonals, and good intra- and interrater reliability in maximal cranial circumference measurement.

La plagiocefalia deformacional (PD) se refiere a una condición en la que la cabeza del bebé y posiblemente su cara están deformadas como resultado de fuerzas moldeables externas prenatales o postnatales en un cráneo maleable y en crecimiento. La PD afecta frecuentemente a bebés sanos y la prevalencia está entre el 20-30% según el país y los meses de vida. El tratamiento conservador suele incluir reposicionamiento, fisioterapia y terapia con casco. El objetivo general de este estudio fue comparar la eficacia de la Terapia Manual Pediátrica aplicada junto a un protocolo de fisioterapia educacional frente a la aplicación aislada del protocolo de fisioterapia educacional para el tratamiento de la plagiocefalia deformacional en: a. La mejora de la simetría craneal y la amplitud de la movilidad cervical.b. La normalización de los índices craneales de los bebés con plagiocefalia. c. La normalización del neurodesarrollo.d. El cambio percibido por los padres sobre el estado del niño. 34 sujetos menores de 6 meses, neurológicamente sanos y con indicios de plagiocefalia no sinostósica fueron divididos aleatoriamente en dos grupos. A un grupo se le aplicó un protocolo de Terapia Manual Pediátrica (TMP) más fisioterapia educacional. La fisioterapia educacional incluyó estimulación del desarrollo, consejos posicionales y tiempo en posición prona. Al grupo control se le aplicó únicamente fisioterapia educacional. Ambos durante 10 semanas. Al inicio y al final se evaluaron los cambios en la forma el cráneo con antropometría craneal, a partir de la cual se calculó el Cranial Index (CI) y el Cranial Vault Asymmetry Index (CVAI). Se midió igualmente el rango de movimiento cervical activo de rotación y se pasó la escala de motricidad Alberta Infant Motor Scale. Al finalizar la intervención se evaluó la percepción de los padres respecto a los cambios en la forma de la cabeza, en el movimiento cervical y en el bienestar global del bebé con una escala visual analógica (-10cm a +10cm). El grupo TMP pasó de una diferencia de diámetros de 8,20 a 4mm mientras que el grupo control pasó de 7 a 7,66mm (p0,05). El CVAI pasó de 6,58 a 2,93% en el grupo TMP frente al cambio de 5,36 a 6,03% en el grupo control (p0,05). El grupo TMP también mejoró el rango de movilidad cervical de forma significativa. El tratamiento con TMP mostró favorecer significativamente la percepción positiva por parte de los padres respecto a los cambios en la forma de la cabeza (TMP: 6,65cm; control: 4,28cm; p=0,04). También fue significativamente mayor la percepción del rango de movimiento cervical y del bienestar global.. Conclusión: En nuestro estudio el tratamiento con Terapia Manual Pediátrica específica para las disfunciones neuro-músculo-esqueléticas de la plagiocefalia deformacional posterior añadido a fisioterapia educacional ha mostrado ser más efectivo que la aplicación única de fisioterapia educacional en la mejora del índice de asimetría de la bóveda craneal, en la mejora de la movilidad cervical activa en rotación a la derecha y en la total, en los aumentos de la circunferencia máxima craneal y la longitud craneal, en la disminución de la diferencia de diámetros diagonales, y finalmente, en la percepción de los padres respecto a los cambios en la forma de la cabeza, en el movimiento cervical y en el cambio global.

Resumen El angiosarcoma primario de mama es una neoplasia agresiva muy infrecuente. Su diagnostico es dificil por aparecer en mujeres jovenes y porque la clinica y los hallazgos radiologicos son inespecificos, pudiendo simular entidades inflamatorias o infecciosas. Se ha relacionado con el embarazo, aunque no se ha demostrado hormonodependencia. Presentamos un caso de angiosarcoma mamario bilateral sincronico en el periodo de lactancia. A pesar de ser infrecuente debe incluirse en el diagnostico diferencial de una lesion palpable de rapido crecimiento en mujeres jovenes.

Urinary system birth defects represent the abnormality most often detected in prenatal studies, accounting for 30% to 50% of all structural anomalies present at birth. The most common disorders are urinary tract dilation, developmental variants, cystic kidney diseases, kidney tumors, and bladder defects. These anomalies can present in isolation or in association with various syndromes. They are normally evaluated with sonography, and the use of magnetic resonance imaging (MRI) is considered only in inconclusive cases. In this article, we show the potential of fetal MRI as a technique to complement sonography in the study of fetal urinary system anomalies. We show the additional information that MRI can provide in each entity, especially in the evaluation of kidney function through diffusion-weighted sequences.

Urinary system birth defects represent the abnormality most often detected in prenatal studies, accounting for 30% to 50% of all structural anomalies present at birth. The most common disorders are urinary tract dilation, developmental variants, cystic kidney diseases, kidney tumors, and bladder defects. These anomalies can present in isolation or in association with various syndromes. They are normally evaluated with sonography, and the use of magnetic resonance imaging (MRI) is considered only in inconclusive cases. In this article, we show the potential of fetal MRI as a technique to complement sonography in the study of fetal urinary system anomalies. We show the additional information that MRI can provide in each entity, especially in the evaluation of kidney function through diffusion-weighted sequences.

Resumen Objetivo Revisar nuestra experiencia en la biopsia selectiva del ganglio centinela (BGC) en pacientes con cancer de mama operable tratadas con quimioterapia neoadyuvante (QTN). Material y metodos Estudio prospectivo, enero de 2008/diciembre de 2014, 235 BGC en pacientes con cancer de mama infiltrante T1-3/N0-1, tratadas con epirrubicina/ciclofosfamida, docetaxel y trastuzumab en Her2/neu positivas. El estatus axilar se establecio por exploracion fisica, ecografia axilar y puncion de ganglios sospechosos. El dia antes de la cirugia se inyectaron periareolarmente 74-111 MBq de 99mTc-nanocoloide de albumina. Al finalizar el tratamiento se realizo BGC y linfadenectomia axilar. El GC se analizo por cortes de congelacion, hematoxilina-eosina, inmunohistoquimica o one-step nucleic acid amplification. Se determinaron tasa de identificacion (Id.GC) y falsos negativos (FN). Resultados Grupo I BGC pre-QTN pacientes cN0 de inicio: n = 73, Id.GC 97,2% (IC 95% 90,5-99,2). Grupo II 2.a BGC pos-QTN pacientes pN1(gc) de inicio: n = 31, Id.GC 61,3% (IC 95% 43,8-76,3), FN 18,2% (IC 95% 5,1-47,7). Grupo III BGC pos-QTN pacientes cN0 de inicio: n = 54, Id.GC 96,3% (IC 95% 87,5-99,0), FN 9,5% (IC 95% 2,7-28,9). Grupo IV BGC pos-QTN pacientes cN1 de inicio, ycN0 posneoadyuvancia: n = 77, Id.GC 83,1% (IC 95% 73,2-89,8), FN 8,3% (IC 95% 2,9-21,8). Conclusiones La identificacion de la BGC pre-QTN es excelente. En pacientes pN1(gc) al diagnostico, una 2.a BGC pos-QTN no es valida para su aplicacion clinica. La BGC pos-QTN puede realizarse con fiabilidad en pacientes cN0 y cN1 de inicio, con axila clinicamente negativa al finalizar la neoadyuvancia (ycN0), y linfadenectomia axilar si el resultado del GC es positivo o no se identifica en la cirugia, en el ambito de un equipo multidisciplinar con experiencia.

Opsoclonus-myoclonus syndrome is a rare neurological disorder. In children, the etiology varies, although it is a paraneoplastic manifestation (mainly of neuroblastoma) in 40% to 80% of cases. Whole-body MRI promises to be a powerful tool in the search for a possible primary tumor in this condition for which the diagnostic algorithm is yet to be established. We present the case of a two-year-old boy with signs of opsoclonus-myoclonus syndrome in whom a retroperitoneal neuroblastoma was detected by whole-body MRI.

Objectives To prospectively evaluate the accuracy of real-time ultrasound combined with supine-MRI using volume navigation technique (RtMR-US) in diagnosis and biopsy of incidental breast lesions (ILSM) and axillary lymph nodes (LNSM) suspicious of malignancy on contrast enhanced magnetic resonance imaging (CE-MRI). Materials and methods Five hundred and seventy-seven women were examined using breast CE-MRI. Those with incidental breast lesions not identified after second-look ultrasound (US) were recruited for RtMR-US. Biopsy was performed in ILSM. Breast lesions were categorized with BI-RADS system and Fisher’ exact test. Axillary lymph nodes morphology was described. To assess efficacy of RtMR-US, diagnostic accuracy, sensitivity, specificity, detection rate and Kappa index of conventional-US and RtMR-US were calculated. Results Forty-three lesions were detected on CE-MRI before navigation. Eighteen were carcinomas and 25 ILSM. Of these, 21 underwent a RtMR-US. Detection rate on RtMR-US (90.7%) was higher than on conventional-US (43%) ( p k = 0.138). Twenty ILSM and 2 LNSM were biopsied. Sixty-five percent were benign (100% of BI-RADS3 and 56% of BI-RADS4-5). Diagnostic performance of RtMR-US identifying malignant nodules for overall lesions and for the subgroup of ILSM was respectively: sensitivity 96.3% and 100%, specificity 18.8% and 30.7%, positive predictive value 66.7% and 43.7%, negative predictive value 75% and 100%. In addition RtMR-US enabled biopsy of 2 metastatic lymph nodes. Conclusions Real time-US with supine-MRI using a volume navigation technique increases the detection of ILSM. RtMR-US may be used to detect occult breast carcinomas and to assess cancer extension, preventing unnecessary MRI-guided biopsies and sentinel lymph node biopsies. Incidental lesions BI-RADS 3 non-detected on conventional-US are probably benign.

Resumen Objetivo Valorar la validez diagnostica de una segunda biopsia del ganglio centinela (GC) en pacientes con cancer de mama operable y axila negativa al diagnostico, con GC metastasico, tratadas con quimioterapia neoadyuvante (QTN). Pacientes y metodos Estudio prospectivo realizado en 52 mujeres con cancer de mama infiltrante (2 bilateral); estadio II-A (cT2N0M0): 50, II-B (cT3N0M0): 4. El estatus axilar se establecio por exploracion fisica, ecografia y puncion ecoguiada de los ganglios sospechosos. Pauta QTN: epirrubicina/ciclofosfamida × 4, y docetaxel × 4. El dia antes de la cirugia se inyecto periareolarmente 74-111 MBq de nanocoloide de albumina. El GC se analizo por amplificacion de acido nucleico de un solo paso. Se realizo linfadenectomia axilar en las pacientes con GC positivo al diagnostico. Resultados El GC axilar pre-QTN se identifico en el 96,3% de los casos; GC extirpados 1,8 ± 0,8 (rango 1-4). En el 55,8% el resultado del GC fue positivo. Actualmente, 44 pacientes (2 bilateral) han completado el tratamiento. Se ha realizado una segunda biopsia del GC posneoadyuvancia en 22 pacientes: 20 con GC pre-QTN positivo, 2 sin migracion axilar preneoadyuvancia. Solo se identifico el GC en el 54,5% de las pacientes; GC resecados 1,5 ± 0,8 (rango 1-3). En 9 de las 10 mujeres sin migracion la linfadenectomia axilar fue negativa. En 7 pacientes el GC fue un verdadero positivo, y en 4 de ellas los GC eran los unicos afectados de la axila. En 2 casos el resultado fue falso negativo (22,2%). Conclusiones Los resultados de una segunda biopsia del GC post-QTN no son adecuados para su aplicacion en la practica clinica.

Resumen Objetivo Valorar la utilidad de la biopsia selectiva del ganglio centinela (BGC) despues de la quimioterapia neoadyuvante (QTN) en pacientes con cancer de mama operable y axila positiva al diagnostico. Material y metodos Estudio prospectivo entre enero de 2008 y diciembre de 2012 en 52 pacientes, con una edad media de 50,7 anos y con cancer de mama infiltrante T1-3, N1, M0 (uno bilateral, 7 multifocales), tratadas con epirrubicina/ciclofosfamida, docetaxel y trastuzumab en HER-2/neu positivas. El estatus axilar se establecio por la exploracion fisica, la ecografia axilar y la puncion ecoguiada de ganglios sospechosos. El dia antes de la cirugia se inyecto periareolarmente 74-111 MBq de 99mTc-nanocoloide de albumina. En todas se realizo una cirugia mamaria, una BGC y una linfadenectomia axilar. El GC se analizo por cortes de congelacion, hematoxilina-eosina, inmunohistoquimica u OSNA. Resultados Tamano medio del tumor: 3,5 cm. Tipo histologico: 81,1% carcinoma ductal infiltrante. Respuesta completa al tumor primario: clinica 43,4%, patologica 41,5%. Ninguna de las pacientes presento adenopatias axilares palpables despues del tratamiento. Respuesta completa patologica axilar: 42,2%. El porcentaje de identificacion del GC fue de 84,9%. En 6 de las 8 pacientes sin migracion del nanocoloide la axila resulto positiva en el estudio anatomopatologico. En el 95,5% de los casos el GC determino correctamente el estatus axilar. La tasa de falsos negativos fue de 8,3%. En el 68,2% de los casos el GC fue el unico afectado de la axila. El numero medio de GC identificados fue de 1,9 y el de ganglios axilares extirpados fue de 13,2. Conclusion La BGC post-QTN es una tecnica segura y factible en pacientes con cancer de mama operable T1-3, N1 y axila clinicamente negativa despues del tratamiento.

Aim To evaluate the utility of the sentinel lymph node biopsy (SLNB) in patients with operable breast cancer and positive axillary nodes at initial diagnosis treated with neoadjuvant chemotherapy (NAC). Material and methods A prospective study was performed from January 2008 to December 2012 on 52 women, mean age 50.7 years, with infiltrating breast carcinoma T1-3, N1, M0 (1 bilateral, 7 multifocal) treated with epirubicin/cyclophosphamide, docetaxel and trastuzumab in HER-2/neu-positive patients. Axillary evaluation included physical examination, axillary ultrasound, with ultrasound-guided core needle biopsy of any suspicious lymph node. The day before surgery, 74–111 MBq of 99m Tc-albumin nanocolloid was injected periareolarly. All patients underwent breast surgery, with SLNB and complete axillary lymph node dissection (ALND). The SLNs were examined by frozen sections, hematoxylin–eosin staining, immunohistochemical analysis or one-step nucleic acid amplification assay (OSNA). Results Mean tumor size: 3.5 cm. Histologic type: 81.1% invasive ductal carcinoma. Complete response of primary tumor was clinical 43.4%, pathological 41.5%. All patients were clinically node-negative after NAC. Pathological complete response of axillary node was 42.2%. SLN identification rate was 84.9%. Axilla was positive in the pathology study in 6 of 8 patients without migration. SLN accurately represented the axillary status in 95.5%. False negative rate was 8.3%. SLN was the only positive node in 68.2% of patients. Mean number of SLN removed was 1.9 and of nodes resected from the ALND 13.2. Conclusion SLN biopsy after NAC is a feasible and accurate tool in patients with operable breast cancer T1-3, N1 and clinically node-negative after therapy.

Resumen Objetivo Validar la biopsia selectiva del ganglio centinela (BGC) en pacientes con cancer de mama tratadas con quimioterapia neoadyuvante. Materiales y metodos Estudio prospectivo de enero de 2008 a enero de 2011, 88 pacientes con una edad media de 49,4 anos, con cancer de mama infiltrante T1-3, N0-1, M0, tratadas con epirrubicina/ciclofosfamida, docetaxel y trastuzumab en Her2/neu positivas. El estatus axilar se establecio por exploracion fisica, ecografia axilar y puncion ecoguiada de ganglios sospechosos. El dia antes de la cirugia se inyectaron periareolarmente 74-111 MBq de 99m Tc-nanocoloide de albumina. En todas se realizo cirugia mamaria, BGC y linfadenectomia axilar. El ganglio centinela (GC) se analizo por cortes de congelacion, hematoxilina-eosina, inmunohistoquimica u OSNA. Resultados El tamano medio del tumor fue de 3,5 cm. Segun el tipo histologico, 69 se clasificaron como ductal infiltrante, 16 como lobulillar infiltrante y 3 como de otro tipo. Treinta y siete pacientes tenian axila clinica/ecografica positiva al diagnostico. La respuesta clinica del tumor primario fue: 38 completa, 45 parcial, 5 no respuesta. En todas las pacientes la axila fue clinica/ecografica negativa despues del tratamiento. En 25 casos hubo respuesta patologica completa en el tumor primario. El porcentaje de identificacion del GC fue del 92,0%, 6 de las 7 pacientes sin migracion eran axila clinica/ecografica positiva al diagnostico. En el 96,3% de los casos el GC determino correctamente el estatus axilar. La tasa de falsos negativos fue del 8,3%. En el 69,4% de los casos el GC era el unico afectado de la axila. El numero medio de GC identificados fue 1,7 y el de ganglios axilares extirpados fue 13,2. Conclusion La BGC es una tecnica factible en pacientes con cancer de mama tratadas con quimioterapia neoadyuvante, pudiendo evitar linfadenectomias innecesarias.

Aim To evaluate the accuracy of sentinel lymph node biopsy (SLNB) in operable breast cancer patients treated with neoadjuvant chemotherapy (NAC). Material and methods Between January 2008 and 2011, 88 women, mean age 49.4 years, with infiltrating breast carcinoma, were studied prospectively. Patients were T1–3, N0–1, M0. Prior to surgery, the patients received chemotherapy (epirubicin/cyclophosphamide, docetaxel), and trastuzumab in Her2/neu-positive patients. Axillary status was established by physical examination, ultrasound-guided core needle biopsy of any suspicious lymph node. The day before surgery, 74–111 MBq of 99m Tc-albumin nanocolloid was injected periareolarly. All patients underwent breast surgery, with SLNB, followed by complete axillary lymph node dissection (ALND). Sentinel lymph node (SLN) was examined by frozen sections, hematoxylin–eosin staining and immunohistochemical analysis or One Step Nucleic Acid Amplification (OSNA). Results Mean tumor size: 3.5 cm, histologic type: 69 invasive ductal, 16 invasive lobular and 3 others. Thirty-seven patients had clinical/ultrasound node-positive at presentation. Clinical response of primary tumor to NAC: complete in 38, partial in 45, and stable disease in 5 patients. A pathological complete response was achieved in 25. All patients were clinically node-negative after NAC. SLN identification rate was 92.0%. Six of 7 patients in whom SLN was not found had clinical/ultrasound positive axilla before NAC. SLN accurately determined the axillary status in 96.5%. False negative rate was 8.3%. In 69.4% of patients, SLN was the only positive node. The mean number of SLN removed was 1.7 and nodes resected from the ALND were 13.2. Conclusion SLN biopsy after NAC can predict the axillary status with a high accuracy in patients with breast cancer, avoiding unnecessary ALND.

Urinary system birth defects represent the abnormality most often detected in prenatal studies, accounting for 30% to 50% of all structural anomalies present at birth. The most common disorders are urinary tract dilation, developmental variants, cystic kidney diseases, kidney tumors, and bladder defects. These anomalies can present in isolation or in association with various syndromes. They are normally evaluated with sonography, and the use of magnetic resonance imaging (MRI) is considered only in inconclusive cases. In this article, we show the potential of fetal MRI as a technique to complement sonography in the study of fetal urinary system anomalies. We show the additional information that MRI can provide in each entity, especially in the evaluation of kidney function through diffusion-weighted sequences.

Objetivos Material y método Resultados Conclusiones Bibliografía, Objetivos: - Objetivo principal: Evaluación prospectiva de la utilidad y de la precisión diagnóstica de la ecografía en tiempo realfusionada con imágenes de resonancia magnética obtenidas en supino, usando la técnica de navegación volumétrica...

To evaluate the utility of the sentinel lymph node biopsy (SLNB) in patients with operable breast cancer and positive axillary nodes at initial diagnosis treated with neoadjuvant chemotherapy (NAC).A prospective study was performed from January 2008 to December 2012 in 52 women, mean age 50.7 years, with infiltrating breast carcinoma T1-3, N1, M0 (1 bilateral, 7 multifocal) treated with epirubicin/cyclophosphamide, docetaxel and trastuzumab in Her2/neu-positive patients. Axillary evaluation included physical examination, axillary ultrasound, and ultrasound-guided core needle biopsy of any suspicious lymph node. The day before surgery, 74-111 MBq of (99m)Tc-albumin nanocolloid was injected periareolarly. All patients underwent breast surgery, with SLNB and complete axillary lymph node dissection (ALND). The SLNs were examined by frozen sections, hematoxylin-eosin staining, immunohistochemical analysis or one-step nucleic acid amplification assay (OSNA).Mean tumor size: 3.5 cm. Histologic type: 81.1% invasive ductal carcinoma. Complete response of primary tumor was clinical 43.4%, pathological 41.5%. All patients were clinically node-negative after NAC. Pathological complete response of axillary node was 42.2%. SLN identification rate was 84.9%. Axilla was positive in the pathology study in 6 of 8 patients without nanocolloid migration. SLN accurately represented the axillary status in 95.5%. False negative rate was 8.3%. SLN was the only positive node in 68.2% of patients. Mean number of SLN removed was 1.9 and of nodes resected from the ALND 13.2.SLN biopsy after NAC is a feasible and accurate tool in patients with operable breast cancer T1-3, N1 and clinically node-negative after therapy.

Opsoclonus-myoclonus syndrome is a rare neurological disorder. In children, the etiology varies, although it is a paraneoplastic manifestation (mainly of neuroblastoma) in 40% to 80% of cases. Whole-body MRI promises to be a powerful tool in the search for a possible primary tumor in this condition for which the diagnostic algorithm is yet to be established. We present the case of a two-year-old boy with signs of opsoclonus-myoclonus syndrome in whom a retroperitoneal neuroblastoma was detected by whole-body MRI.

To evaluate the accuracy of sentinel lymph node biopsy (SLNB) in operable breast cancer patients treated with neoadjuvant chemotherapy (NAC).Between January 2008-2011, 88 women, mean age 49.4 years, with infiltrating breast carcinoma, were studied prospectively. Patients were T1-3, N0-1, M0. Prior to surgery, the patients received chemotherapy (epirubicin/cyclophosphamide, docetaxel), and trastuzumab in Her2/neu-positive patients. Axillary status was established by physical examination, ultrasound-guided core needle biopsy of any suspicious lymph node. The day before surgery, 74-111 MBq of (99m)Tc-albumin nanocolloid was injected periareolarly. All patients underwent breast surgery, with SLNB, followed by complete axillary lymph node dissection (ALND). Sentinel lymph node (SLN) were examined by frozen sections, hematoxylin-eosin staining and immunohistochemical analysis or One Step Nucleic Acid Amplification (OSNA).Mean tumor size: 3.5 cm. Histologic type: 69 invasive ductal, 16 invasive lobular and 3 others. Thirty seven patients had clinical/ultrasound node-positive at presentation. Clinical response of primary tumor to NAC: complete in 38, partial in 45, and stable disease in 5 patients. A pathological complete response was achieved in 25. All patients were clinically node-negative after NAC. SLN identification rate was 92.0%. Six of 7 patients in whom SLN was not found had clinical/ultrasound positive axilla before NAC. SLN accurately determined the axillary status in 96.5%. False negative rate was 8.3%. In 69.4% of patients, SLN was the only positive node. The mean number of SLN removed was 1.7 and nodes resected from the ALND were 13.2.SLN biopsy after NAC can predict the axillary status with a high accuracy in patients with breast cancer, avoiding unnecessary ALND.

INTRODUCCIÓN.- Nuestro objetivo ha sido valorar el conocimiento que tiene el paciente del tratamiento prescrito por primera vez, en función de la información recibida en la consulta médica. MATERIAL Y MÉTODOS.- Estudio observacional transversal, realizado en 10 oficinas de farmacia de las provincias de Albacete y Jaén del 1 de abril al 31 de mayo del 2009 entre pacientes o cuidadores que acudieron con un inicio de tratamiento. A dichos sujetos se les realizó una encuesta para cada uno de los medicamentos prescritos y los datos se analizaron con SPSS. RESULTADOS.- Tuvieron validez un total de 318 encuestas y, de éstas, sólo un 44% de los casos demostraron tener un total conocimiento del tratamiento. La intervención del farmacéutico fue requerida principalmente para aclarar posología (35,4%) y duración del tratamiento (33,9%). El grado de conocimiento aumentó cuando la información era escrita, apreciándose un aumento significativo si se acompañaba de oral, y cuando se la proporcionaba el especialista. Disminuyó a mayor edad del paciente y menor nivel de estudios. DISCUSIÓN.- El moderado conocimiento del tratamiento podría ser debido a la presión ejercida por la masificación de las consultas, que provocaría que el médico general no pueda atender al paciente el tiempo suficiente. Además, el paciente acude al especialista para ser tratado de patologías más graves y lo hace con menor frecuencia, lo que podría suponer que ponga mayor interés en conocer el tratamiento. El menor conocimiento de los ancianos se explicaría porque se trata de pacientes habitualmente polimedicados y con problemas cognitivos., INTRODUCTION.- Our aim has been to evaluate the knowledge that a patient has regarding a treatment newly prescribed, according to the information given in the medical consultation. METHODOLOGY.- Cross-sectional study, carried out in 10 community pharmacies of Albacete and Jaén, from 1st of April to 31st of May 2009. Data was obtained from a survey completed by the patients or their carers for each one of the new treatments started. Information obtained was analyzed with SPSS. RESULTS.- 318 valid surveys, only 44% of these cases proved a total knowledge of the treatment. Pharmacist intervention was mainly needed to clarify the dosage (35,4%) and the duration of the treatment (33,9%). The degree of knowledge increased when the information was given by a consultant and also when was written information. Moreover it was seen a significant increase of knowledge when written information was accompanied by verbal. In the other hand, it decreased in elderly patients and in them with lower level of education. DISCUSION.- The moderate knowledge of the treatment could be due to the limited time GP have for each patient. Also, patients normally attend to the consultant for more serious illness and less often, probably paying more attention to the information about the treatment prescribed. The lower level of knowledge in the elderly could be explained for the high number of medicines they take and the cognitive problems.

INTRODUCCIÓN.- Nuestro objetivo ha sido determinar el perfil del tratamiento con levotiroxina, incidiendo en las posibles interacciones que se pueden producir en pacientes polimedicados. METODOLOGÍA.- Estudio observacional transversal a partir de los datos obtenidos en 10 farmacias comunitarias de Albacete y provincia, durante los meses de enero a marzo de 2008. Se incluyeron un total de 184 pacientes (33 varones y 151 mujeres) que acudieron a la oficina de farmacia con una prescripción de levotiroxina. Se diseñó una hoja registro que contenía diversos datos acerca del paciente y del tratamiento. RESULTADOS.- El perfil más frecuente del paciente fue el siguiente: mujer de más de 60 años que hace más de un año que comenzó el tratamiento con levotiroxina y la posología más habitual la siguiente: 50-100 mcg/día tomados en ayunas antes del desayuno. Un 58,7% de los encuestados tomaban levotiroxina y algún otro fármaco y de éstos más de la mitad lo hacían en la misma toma, detectando una posible interacción en prácticamente un tercio de los mismos, siendo la principal consecuencia el aumento de los niveles de levotiroxina. DISCUSIÓN.- La elevada probabilidad de interacción obliga a que se recomiende analizar los tratamientos concomitantes con levotiroxina, especialmente en pacientes ancianos habitualmente polimedicados. Llama la atención que el farmacéutico tuvo que intervenir en prácticamente la mitad de las dispensaciones, principalmente para indicar que el medicamento se debe tomar en ayunas y a la hora indicada, hecho que refuerza que se trata de un profesional clave en la adherencia al tratamiento., INTRODUCTION.- Our aim has been to determine the treatment profile with levothyroxine, focusing on the possible interactions that can occur in polymedicated patients. METHODOLOGY.- Cross-sectional study, with data obtained from 10 community pharmacies of Albacete and its county from January to March 2008. 184 patients (33 men and 151 women) were included in the study. These patients obtained the levothyroxine from one of the 10 pharmacies collaborating in the study. Data log sheet contained a variety of information about the patient and the treatment. RESULTS.- The most frequent profile of the patients was: women over sixty years age, who had been taking levothyroxine for over a year, with the most common dosage being 50-100 mcg/day before breakfast. A 58,7% of the patients were taking levothyroxine and another drug. More than half of these patients, were taking levothyroxine at the same time of other medicines. We detected a possible interaction in one third of the cases, resulting in an increase of levothyroxine blood levels. DISCUSION.- Due to the high probability of drug interactions, concomitant treatments with levothyroxine need to be analyzed, specially in elderly patients very often polymedicated. It was surprising the fact that the pharmacist had to intervene in practically half of the cases, mainly to indicate that levothyroxine has to be taking on an empty stomach. This reinforces the important role that pharmacists play to ensure adherence to the treatment.

INTRODUCCIÓN.- El objetivo ha sido reflejar el grado de satisfacción del paciente con la información recibida cuando se le prescribe un medicamento por primera vez, en función del tipo de información y del grado de capacitación del que se la proporciona. MATERIAL Y MÉTODOS.- Estudio observacional transversal, realizado en 10 oficinas de farmacia de las provincias de Albacete y Jaén del 1 de abril al 31 de mayo del 2009 entre pacientes o cuidadores que acudieron con un inicio de tratamiento. A dichos sujetos se les realizó una encuesta de satisfacción para cada uno de los medicamentos prescritos y los datos se analizaron con SPSS. RESULTADOS.- Se recogieron un total de 318 encuestas válidas. En el 76,7% de los casos, los pacientes manifestaron estar satisfechos con la información recibida. Cuando la información que se da al paciente es únicamente escrita a mano, el grado de satisfacción es superior al manifestado cuando se da oral o escrita informatizada, destacando el aumento significativo de este grado de satisfacción cuando la información escrita se acompaña de la oral. La satisfacción es mayor en el caso de tratamientos puntuales frente a crónicos y cuando la información la da el médico especialista, aunque la diferencia no es estadísticamente significativa. DISCUSIÓN.- Cuando la información es únicamente escrita informatizada, casi en la mitad de los casos los encuestados no están satisfechos y sólo un tercio comprende todo el tratamiento, cobrando especial relevancia este tema si consideramos que la prescripción informatizada es la que prevalece en nuestro medio., INTRODUCTION.- The objective has been to reflect the degree of satisfaction shown by the patient with the information received when starting a new treatment. It was based on the type of information and the level of training of the person who provides the information. METHODOLOGY.- Cross-sectional study, carried out in 10 community pharmacies of Albacete and Jaén from the 1st of April to the 31st of May 2009. Patients or their carers completed a survey about satisfaction for each one of the new medicines prescribed. Data obtained was analyzed with SPSS. RESULTS.- 318 valid surveys were collected. In 76,7 % of the cases, patients stated to be satisfied with the information received. The level of satisfaction was higher when information was given handwritten to the patient in comparison with verbal or computerized written. Moreover a significant increase of satisfaction was seen when written information was accompanied by verbal one. Satisfaction was greater in acute treatments than in chronic treatments and also when information was given by a consultant. However this difference was found not to be statiscally significant. DISCUSION.- When only computerized written information is supplied, nearly half of the patients are not satisfied and only one third of them understand everything about the new treatment. These findings are very significant for us due to the high number of computerized prescriptions we have to deal with in our pharmacies.

Interdisciplinary research made by neuropsychologist, neurologists and radiologists is making possible descriptions of the anatomic bases of memory. The hippocampus is one of the main structures related to memory processing. The aim of the present study was to study the relationship between verbal and visual memory, and the volumetry and relaxometry of the.36 patients with temporal lobe epilepsy and mesial temporal sclerosis (MTS). Fist, a neuropsychological assessment of was made the verbal and visual memory. Second, hippocampal structure were studied by magnetic resonance image (hippocampal volumetry and relaxometry).Reactive gliosis measured by T2 relaxation time predicted poorer visual memory in patients with right or left MTS. These results indicate that structural damage in right hippocampus implies worse performance in visual memory. Moreover, MTS was found to have negative effects on contralateral memory (poorer verbal memory in right MTS, and poorer visual memory in left MTS). These results could be due to memory compensation. Thus, the memory function associated with the sclerotic hippocampus is adopted by the contralateral structure. Therefore, the more damage there is to the latter, the poorer is the memory functioning.

Temporal lobectomy (TL) is an effective treatment for drug refractory temporal lobe epilepsy. The main neuropsychological consequences of the intervention are changes in episodic and semantic memory. Aim. To study the consequences of right temporal lobectomy (RTL) and left temporal lobectomy (LTL) on episodic and semantic mnemonic functioning.27 patients who had undergone TL in the Hospital Universitario Virgen de las Nieves in Granada were submitted to pre and post surgical evaluation by means of a battery of neuropsychological tests that included episodic and semantic memory tests for both verbal and visual material.ANOVA analysis was employed to analyse the pre and post surgical changes for the whole group of patients, and Student s t and Wilcoxon s non parametric test were used for each group of RTL and LTL. No deterioration was found in ipsilateral memory after the intervention, that is to say, in the verbal memory of the patients submitted to LTL and in the visual memory of RTL patients. With regard to contralateral memory, that is, the visual memory of patients submitted to LTL and the verbal memory of RTL patients, the ANOVA analyses of the whole group revealed a statistically significant improvement. The analyses performed for the whole group (LTL and RTL), however, did not reveal any statistically significant changes.