113 events of the Lorca seismic series has been relocated by using Double difference algorithm and data from both temporary and permanent seismic networks. Relocations yield shallow hypocentral ...distribution of aftershocks with a ~5 km long, NE-SW trending, placed SW of the mainshock, suggesting a SW propagating rupture along the Alhama de Murcia fault. Similar oblique reverse faulting mechanism has been obtained for three largest events. Source parameters of these three earthquakes have been estimated. Horizontal ground motion was estimated at 11 city points whose local structure was known by SPAC experiments. A set of ground motion parameters (PGA, PGV, AI, CAV, SI, SA and SV) here calculated, have higher values at these points respect to the ones at LOR station. All parameter values are also above the expected values for Euro -Mediterranean earthquakes with local intensity VIII (EMS). Nevertheless, SD values are unusually short and less than the reference ones. Higher values of the response spectra of acceleration and velocity are given for periods of less than 0.7 s, with maximum spectral acceleration at 0.15 s and velocity at 0.5 s. The elastic input energy spectrum is well connected to the shake destructiveness in each place. Equivalent velocity > 60 cm/s is found in almost all sites and > 100 cm/s (for periods 0.3 to 0.6 s) in someone. Factors such as proximity, and focal mechanism and ground response characteristics explain the high ground motion parameter values obtained in Lorca sites and show the great influence of the source and site conditions on the characteristics of strong ground motion in the vicinity of the rupture.
Objective. To evaluate the association between professional seniority and self-interest (PSI) attitudes in the resolution of vascular ethical dilemmas (VED).
Design. Cross-sectional.
Subjects. ...Vascular surgeons (residents included) from the 28 vascular teaching departments of Spain.
Measurements. Multidisciplinary team-designed questionnaire of 5 VED. Each VED had 3 different answers (attitudes): 2 favouring legitimate ethical attitudes (LEA) and 1 favouring PSI. The questionnaire was self-administered and all participants stated their degree of agreement with each answer on a continuous Likert scale. PSI was evaluated by: (1) adding the magnitudes of the 5 answers favouring PSI (absPSI); and (2) by comparing in each case the magnitude of the PSI answer with that of the 2 LEA (relPSI).
Statistics. Linear regression adjusted by confounding factors.
Results. Two hundred and fifty-three vascular surgeons from the 26 participating teaching vascular departments of public hospitals completed the questionnaire (87.5% surgeons/department). Surgeon characteristics were: (1) median age 37 years; (2) 187 (74%) male; (3) 59 (23%) brought up with a health professional relative; (4) 94 (38%) had additional private practice; (5) 133 (65%) professed religious beliefs; and (6) 1–10 years of experience in 116 (47%), 11–20 years in 58 (24%), 21–30 years in 57 (23%), and >30 years in 15 (6%). The multivariate analysis disclosed that for every 10-years rise in professional seniority there was a 3.2% increase in absPSI (
p=0.007, adjusted by variables 3 and 4), and a 3.4% increase in relPSI (
p=0.002, adjusted by variable 5).
Conclusions. Professional seniority is associated with a slight increase in pro-PSI attitudes in cases of vascular ethical dilemma. Both vascular surgeons and health institutions should promote the reversal of this worrying tendency.
We have analyzed overall survival (OS-REL), progression-free survival (PFS-REL) and the clinical variables influencing the long-term outcome for patients with Hodgkin′s lymphoma (HL) who relapse ...after an autologous stem cell transplantation (ASCT). From 639 patients autografted for HL 383 males (60%) and 256 (40%) females, median age of 30 (1–66) years reported to the GEL/TAMO Cooperative Group between January/1984 and January/2003, 175 patients (27%) relapsed at a median time of 10 (4 – 125) months median (range) after ASCT. They were 97 males (56%) and 78 (44%) females with a median age of 28 (10 – 66) median (range) years at transplantation. Sixty-three patients were autografted in complete remission, 73 in sensitive relapse and 31 in resistant relapse. One hundred and sixty three patients (94%) received different chemotherapy (CT) protocols as conditioning regimen and 12 patients (6%), CT plus total body irradiation. At relapse, 94 patients (53%) presented with advanced stages (III-IV), 49 patients (28%) with B symptoms and 19 (11%) with bulky disease. Relapse was extranodal in 45% of the patient population. Ten percent of the patients had a poor performance status (ECOG ≥2) and 37 patients (22%) had a hemoglobin (Hb) level < 100 g/l at relapse. Thirty four patients (20%) received no further therapy, 107 (60%) received different CT +/− radiotherapy and the remaining 34 patients (20%) were treated with a second stem cell transplantation (13 patients, an ASCT and 21 an allogeneic transplantation). OS-REL and PFS-REL were of 35% ± 4% and 23% ± 4% at 3 years, respectively. Advanced clinical stage (III-IV) at relapse relative risk (RR) 4.4, 95% confidence interval (CI) (1.7 – 10.8), p = 0.002 and an interval between ASCT and relapse < 12 months RR 2.4, 95%CI (1.1 – 5.0), p = 0.03 were independent adverse prognostic factors for PFS-REL. Advanced clinical stage at relapse RR 4.4, 95%CI (1.4 – 14.4), p = 0.012, extranodal disease RR 2.4, 95%CI (1.3 – 15.4), p = 0.02 and a Hb level < 100 g/l at relapse RR 3.4, 95%CI (2.0 – 10.4), p = 0.03 were significant adverse prognostic factors for OS-REL. Although the long-term outcome of HL patients who relapse after ASCT is poor, results are better in patients with late relapses and localized disease. Moreover, a minority of the patients can become long-term progression-free survivors after relapse. The identification and construction of prognostic sub-groups according to the number of risk factors may be useful to develop risk-adapted therapeutic strategies.
We have analyzed the incidence and risk factors for developing a secondary malignancy (SM) in patients with Hodgkin's lymphoma (HL) treated with an autologous stem cell transplantation (ASCT). From ...639 patients autografted for HL 383 males and 256 females with a median age of 30 (1–66) years and a median follow-up after ASCT of 53 (3–202) months reported to the GEL/TAMO Spanish Cooperative Group between January/1984 and January/2003, 37 patients (6% of the series) developed a SM at a median time of 35 months after ASCT 24 patients (65%) a myelodisplastic syndrome (MDS)/acute myelogenous leukemia (AML), 3 patients (8%) a non Hodgkin's lymphoma (NHL) and 10 patients (29%) a solid tumor (ST). There were 24 males and 13 females with a median age of 39 (13–60) years 23 patients (61%), <40 years at ASCT. Twenty-three patients (62%) presented with advanced disease at diagnosis, 14 patients (38%) had B symptoms, seven (19%) bone marrow (BM) involvement and 13 (35%), bulky mediastinal disease. Eighteen patients (49%) had previously received nitrogen mustard containing therapies, eight patients (22%) had been splenectomized before ASCT and 18 (49%) had received complementary radiotherapy. Twenty patients (70%) had received more than two lines of chemotherapy (CT) before ASCT. Fourteen patients (38%) were in complete remission (CR) at ASCT, 16 patients (43%) were in chemosensitive relapse and seven in resistant relapse. In 25 patients (68%), peripheral blood was used as the source of hematopoietic stem cells and in the remaining 12 patients, BM. Only three patients received total body irradiation as part of the conditioning regimen. Time between diagnosis and ASCT was >24 months in 23 patients (62%). Twenty-three patients (62%) were in CR when they developed the SM and the remaining 14 (38%), had active disease. Median time to develop a myeloid malignancy was of 12 (4 – 34) months, to develop a lymphoid malignancy (T cell NHL, 2 patients; B cell NHL, 1 patient) was of 23 (12 – 31) months and to develop a ST (2 squamous cell carcinomas of the lung, 2 rabdomisarcomas, 2 adenocarcinomas of the rectum, 1 basocelular carcinoma, 2 in situ bladder carcinoma and one oropharyngeal carcinoma) of 60 (34 – 91) months, respectively (p = 0.0001). Twenty eight patients have died: 18 patients (64%) due to the SM and 10 (36%) due to HL progression. Multivariate analysis identified age at ASCT > 40 years and the time between diagnosis and ASCT > 24 months as the only two bad prognostic factors for developing a SM relative risk (RR) 2.48, 95% confidence interval (CI) (1.20–5.10), p = 0.01 and 2.17, 95%CI (1.06–4.46), p = 0.034, respectively. The risk of developing a SM is a real long time side effect after an autologous procedure in HL patients. Advanced age at ASCT and a long time interval between diagnosis and ASCT, a probable surrogate marker of the amount of CT given to the patient before the ASCT have been, in our experience, the only two risk factors for developing this complication.
The peripheral face palsy (PFP) is the commonest acute cranial neuropathy. The PFP has a showy clinical pattern which contrasts with a favorable course. Our objective was to determine the sensitivity ...and specificity for the nervous excitability test (NET) with transcutaneous electrical nerve stimulation (TENS) and the time required to obtain face symmetry.
An analytical cross-sectional study was made in 22 patients with PFP. The goal was the time (days) to obtain face symmetry. The sensitivity and specificity was carried out.
A sensitivity and specificity of the NET was of 100 %. The correlation corrected by sex and age between both variables was 0.89. The average in days of recovery was smaller in those with a positive NET (p < 0.05) test.
The test of nervous excitability for PFP with TENS is safe and simple to use in primary care and urgencies services.
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