Gaceta Medica de Bilbao最新文献

Introduction

The study of lymph nodes is the most important prognostic factor in colorectal cancer without metastasis. The sentinel lymph node technique identifies the lymph node that best predicts the patient's lymph node status and allows the performance of techniques of intensive study that improve staging. The aim of this study was to evaluate the efficacy of the sentinel lymph node technique in the staging of colon cancer.

Methods

We performed a prospective study of 45 patients preoperatively diagnosed with colon cancer in stages 0, i and ii. We carried out the sentinel lymph node technique ex vivo and with methylene blue. The sentinel lymph node was studied through multiple sections and immunohistochemical techniques in addition to hematoxylin and eosin staining. We performed a comparison with a control group of 45 patients who were studied through a single section and hematoxylin and eosin staining.

Results

We identified the sentinel lymph node in 98% of the patients, with a false-negative rate of 0. Overstaging was found to occur in 4.8 to 23.8% of the patients. In patients in whom less than 12 lymph nodes were studied, overstaging was between 10.5 and 36.8%.

Conclusions

Study of sentinel lymph nodes carried out ex vivo and with methylene blue predicts the lymph node status of patients with colon cancer. This technique overstages patients to stage iii, who will receive chemotherapy, which could improve their prognosis. The benefit of this technique is greater in patients, in whom less than 12 lymph nodes are studied.

Glucosamine sulphate and chondroitin sulphate have been approved by the Spanish Medications and Health Products Agency for the symptomatic treatment of osteoarthritis arthritis. Their efficacy and safety have been demonstrated in multiple clinical studies and via meta-analyses. Recently, based on a meta-analysis published in the British Medical Journal (2010), the therapeutic advantage of glucosamine and chondroitin sulphate versus other older drugs has been seriously questioned. The publication was criticized from key opinion leaders in the field and the journal published a rectification criticizing some aspects of the paper, particularly its conclusions on a possible veto on funding and prescription of these drugs, which were not directly related to the results. The methodology employed was also widely criticized and therefore the entire paper should be interpreted with reserve. Despite subsequent support for the use of these drugs, the impact of that first publication on their funding and use remains considerable.

The present study analyzes, from a pharmacological point of view, the causes that may have contributed to a false and imprudent accusation. The aim is to define the correct place of glucosamine sulphate and chondroitin sulphate in the treatment of osteoarthritis arthritis, a chronic disease whose prevalence is increasing and which, by 2020, could become the fourth most important cause of disability worldwide.

Introduction

Nowadays, the approach to gynecological malignancies is surgical and pelvic lymphadenectomy is needed for staging. To do this, laparoscopy is becoming the gold standard. However, in our environment, this modality is still restricted to large university hospitals.

Material and methods

We performed a retrospective review of 26 pelvic lymphadenectomies performed at the Centro de Ginecología y Medicina Fetal in Bilbao, Basque Country, Spain, to investigate its surgical results and applicability.

Results

The mean surgical time was 90 min (70-135 min) and the mean number of nodes excised was 10.1 (2-17), with only one case of positive pelvic node. The mean time till discharge from the hospital was 2.17 days (2-3). The conversion rate to laparotomy was 0%, if patients who required laparotomy for other reasons during the oncologic intervention were excluded. There were no major complications and the rate of minor complications was low (11.53%).

Conclusions

Laparoscopic pelvic lymphadenectomy is a safe and feasible procedure and is currently the gold standard for pelvic node excision in gynecologic malignancies.

The prevalence of cannabis use is high in Spain. Although cannabis has a known antiemetic effect, there have been reports of cyclic and recurrent vomiting due to its use, called cannabinoid hyperemesis. The symptoms can be temporarily relieved by baths or hot showers but only disappear with cessation of cannabis use. Cannabinoid hyperemesis should be suspected in cannabis users when the results of diagnostic tests for other disorders are normal.

Objectives

To compare Spanish regional laws on the training and use of automated external defibrillators (AED) in the out-of-hospital setting and to analyze the current situation and regional variation in the development of these regulations.

Methodology

We reviewed the regulations published in Official Bulletins until January 2012, extracting data for the conditions required to use an AED, training methodologies, the duration of initial and continuous training, the legal validity of certificates, and the entities accredited to impart AED training.

Results

Sixteen autonomous regions have developed regulatory standards on AED. Except for the Basque Country, the remaining regions allow medical staff to use AED devices, sometimes including nurses and other emergency staff. For all other persons, training programs are established, with varying duration.

Conclusions

Legislation on the training and utilization of AED devices has been developed independently in each region, leading to heterogeneous models.

We review some features of food allergy and discuss the problems caused by cross-reactivity between proteins from distinct foods, as well as common questions and their possible answers.