We report 67-year-old woman with a sinus node dysfunction and diffuse conduction system disease, with a history of recurrent paroxysmal atrial fibrillation. She was admitted to the Hospital due to palpitations, dizziness, and vertigo, attributing the symptoms to the rhythm disorder described, for which the implantation of a pacemaker was indicated. With a history of tracheal cancer treated with radio and chemotherapy, and chronic steroid therapy for rheumatoid arthritis, she had an important limitation in vascular access for a conventional pacemaker, so, added to a high risk of infection, a decision was made to implant a leadless pacemaker. We discuss the electrocardiographic and clinical manifestations of sinus node disease, its relationship with oncological treatment and the indication for a permanent pacemaker, highlighting the characteristics of this new modality of artificial cardiac stimulation, for a special type of patients.

We report a 20-year-old male athlete who while running, presented a sudden death due to ventricular fibrillation. He was successfully rescued by cardiopulmonary resuscitation maneuvers and an automatic external defibrillator. Without evidence of structural heart disease, Brugada syndrome was diagnosed as the cause, after which a subcutaneous implantable cardioverter defibrillator was indicated. We discuss the subject of sudden cardiac death in athletes and its unusual relationship with exercise in this channelopathy.

RESUMO: O controle de plantas daninhas é um aspecto crucial em muitos sistemas de agricultura de conservação, uma vez que os custos e a economia de tempo de evitar o plantio direto estão intimamente ligados ao uso de herbicidas eficazes e ecologicamente corretos. Isso levou ao uso difundido de glifosato em fazendas administradas sob agricultura de conservação, por ser um herbicida de amplo espectro, facilmente degradável e de baixo custo. O recente debate sobre a segurança do glifosato e sobre o uso excessivo de herbicidas químicos na produção de alimentos causou uma crescente preocupação dos agricultores sobre os possíveis efeitos econômicos de uma proibição virtual do glifosato. O objetivo deste trabalho é estimar os custos associados a uma eventual proibição do glifosato nas áreas de agricultura de conservação espanhola. Os custos de diferentes estratégias alternativas de controle de plantas daninhas foram calculados para herbáceas e árvores: i) substituição do glifosato no controle químico; ii) cultivo mínimo; iii) plantio convencional e iv) coberturas vegetais naturais ou plantadas. Os resultados mostram que a proibição do glifosato aumentaria os custos do controle químico em 40% para as culturas herbáceas e em 57% para as culturas de árvores. No entanto, a lavoura convencional seria uma opção mais barata para herbáceas, já que os custos aumentam em 10% com relação às técnicas atuais. Nossas estimativas sugerem que a proibição do glifosato teria um impacto negativo na lucratividade econômica de fazendas administradas sob a agricultura de conservação e também em outras vantagens não econômicas decorrentes de técnicas de agricultura de conservação.

ABSTRACT: Weed control is a crucial aspect in many conservation agriculture systems given that costs and time savings from avoiding tillage are closely linked to the use of effective and environmental friendly herbicides. This has led to the widespread use of glyphosate in farms, as it is a broad-spectrum, easily degradable, low- cost herbicide. The recent debate on the safety of glyphosate and on the excessive use of chemical herbicides in food production has caused concern on farmers about the possible economic effects of a virtual ban on glyphosate. The aim of this paper is to estimate the costs associated with an eventual prohibition of glyphosate in Spanish conservation agriculture areas. The costs of different alternative weed control strategies for herbaceous and tree crops were calculated: i) substitution of glyphosate in chemical control; ii) minimum tillage; iii) conventional tillage; and iv) natural or planted vegetal groundcovers. The results show that banning glyphosate would increase the costs of chemical control by 40% for herbaceous and by 57% for tree crops. However, conventional tillage would be a cheaper option for herbaceous because costs increase by 10% compared to current techniques. Our estimations suggest that the ban on glyphosate would have a negative impact on the economic profitability of farms and also on other non-economic advantages derived from conservation farming techniques.

RESUMO: Uma desvantagem importante na adoção de técnicas de cultivo mínimo (MT) e plantio direto (NT) é o deslocamento de plantas daninhas frequentemente observado, promovendo espécies adaptadas e, com isso, um controle de plantas daninhas mais precário. Essas mudanças só podem ser detectadas com experimentos de longo prazo, e os resultados podem diferir, dependendo das características do solo e da flora local. Os objetivos deste trabalho foram avaliar o efeito da lavoura reduzida sobre a distribuição de sementes de plantas daninhas no perfil do solo e identificar possíveis consequências na diversidade de plantas daninhas em um experimento de longa duração mantido durante 24 anos em Sevilha (Espanha) com três sistemas de plantio: NT, MT e preparo convencional (CT), incluindo arado de aiveca em um Vertissolo. Com esse propósito, amostras de solo com 0-8 e 8-16 cm de profundidade foram coletadas no inverno de 2005 e na primavera de 2006, e as plântulas de plantas daninhas emergentes foram registradas. O índice de diversidade de Shannon (H) e a uniformidade (J’) foram calculados para comunidades de banco de sementes e plantas daninhas acima do solo. A densidade total de sementes de plantas daninhas foi maior para NT e menor para CT. Algumas espécies de sementes grandes, como Chrozophora tinctorea L., apresentaram maior densidade de sementes no CT. NT aumentou a densidade relativa de sementes de Amaranthus blitoides S. Watson no banco de sementes e a presença de plantas emergidas de Malva parviflora L., Anagallis arvensis L. e Picris echioides L. Com relação aos resultados gerais, a TM levou a um banco de sementes menos diversificado na profundidade de 0 a 8 cm do solo do que a CT. As frequentes fraturas profundas na argila expansível do solo provocam um preparo natural, originando provavelmente menos diferenças dos parâmetros analisados do que em outros tipos de solo.

ABSTRACT: An important drawback in adopting minimum tillage (MT) and no-tillage (NT) techniques is the frequently observed weed shift promoting adapted species and achieving poorer weed control. These changes can be detected best with long-term experiments, and results might differ depending on soil characteristics and the local flora. The objectives of this work were to evaluate the effect of reduced tillage on weed seed distribution in the soil profile and to identify possible consequences on weed diversity on a long-term experiment maintained during 24 years in Seville (Spain) with three tillage systems: NT, MT and conventional tillage (CT) including moldboard plow on a vertisol. For this purpose, soil seedbanks at 0-8 cm and 8-16 cm depths were enumerated in autumn 2005 and in-field emerged plants in autumn 2005 and winter 2006. Shannon diversity index (H) and evenness (J’) were calculated for seedbank and aboveground weed communities. Total weed seed density was highest for NT and lowest for CT. Some big-seeded species, such as Chrozophora tinctorea L., showed highest seed density in CT. NT increased the relative density of Amaranthus blitoides S. Watson seeds in the seedbank and the abundance of emerged plants of Malva parviflora L., Anagallis arvensis L. and Picris echioides L. Overall, MT led to a less diverse seedbank in the 0-8 cm depth of soil than CT. The frequent drought-induced deep fractures in the expandable clay soil caused natural tillage, which probably resulted in fewer differences in weed seed and seedling densities among tillage treatments compared to what might be expected in other soil types.

Treatment of locally advanced prostate cancer remains controversial. Treatment options include radical prostatectomy (PR), radiotherapy (RT) and hormonotherapy (HT). A Medline database search with key words "prostate cancer", "locally advanced", "high risk" and "treatment" in articles published during the last 15 years was done. Fifty one out of 329 papers were selected and reviewed. Selection criteria were a minimum of scientific evidence level of IIa, except for some specific level IV reference. Numerous randomized studies show that patients may benefit of a combined therapy with RT and HT. RP has shown its usefulness in selected cases of locally advanced prostate cancer. Results of long follow-up series are similar to those obtained with RT and HT. Furthermore, the possibility of clinical over staging is an argument in favour of RP. We perform an updated revision of every possible choice available in the treatment of these tumours.

El tratamiento del cáncer de próstata localmente avanzado continúa siendo controvertido. Las opciones terapéuticas comprenden desde la prostatectomía radical (PR), a la radioterapia (RT) y la hormonoterapia (HT). Se ha efectuado una revisión en la base de datos Medline de los trabajos publicados en los últimos 15 años, con las palabras clave en inglés: "cáncer de próstata", "localmente avanzado", "alto riesgo" y "tratamiento". Cincuenta y uno de 329 artículos fueron seleccionados y revisados. El criterio de selección incluía un mínimo nivel de evidencia científica IIa, destacando alguna referencia puntual con evidencia IV. Como demuestran múltiples estudios aleatorios, estos pacientes se pueden beneficiar de una terapia combinada con RT y HT. La PR en enfermedad localmente avanzada ha demostrado su utilidad en algunos casos seleccionados. Los resultados a largo plazo de algunas series son equiparables a los obtenidos con RT y HT. Además, la posibilidad de sobreestadiaje clínico también es un argumento a favor de la PR. Se realiza una revisión actualizada de todas las posibles opciones disponibles en el tratamiento de estos tumores.

We presented you a patient who suffered a left brachial plexus avulsión with hard neuropatic pain in the posttraumatic acute phase (visual analogue scale 8). High-dose remifentanil infusión was uneffective in controlling pain, which was further ameliorated by ropivacaine infused through a cervical (C5-6) epidural catheter. At discharge pain remained controlled (visual analogue scale 2) with specific treatment against neuropathic pain (gabapentin, amytriptiline, clonacepam, and tramadol).

Presentamos el caso de una paciente que sufrió accidente de tráfico con avulsión del plexo braquial izquierdo, y que presentaba dolor muy intenso (escala visual analógica 8) de características neuropáticas en la fase aguda postraumática. Dosis altas de remifentanilo fueron inefectivas para control del cuadro álgico, el cual se trato con éxito con una infusión de ropivacaína a través de catéter epidural cervical (C5-6). El dolor es controlado en fase crónica (escala visual analógica 2) con agentes específicos contra dolor neuropático (gabapentina, amitriptilina, clonacepam y tramadol).

Background: The sistematic use of mammography and ultrasound have increased the diagnosis of non-palpable breast lesions and the indications of biopsies. Aim: To evaluate ten years of surgical biopsies of nonpalpable suspicious breast lesions. Material and Method: We present our experience in 315 excisional biopsies from occult breast lesions with preoperative localization. We used mammography in 83.8% and ultrasound in 10.5% of our cases in order to place a metallic wire. Ultrasound guided us to localize the occult lesions in 5.7% of the cases, placing a mark over the breast skin. Results: We obtained 21.2% of malignant tumors, 17.5% of atypical hyperplasic and 60.3% of benign pathology. We could not obtain an adequate specimen in 1% of the cases (three patients). Discussion: The incidence of 21.2% of malignant pathology is consistent with data published in the general literature (20 to 30%). If atypical hyperplasic specimens were added, the positive results would be increased to 38.7%. More than half of the lesions are benign. Improvement in sensibility and specificity of the diagnostic methods are essential to avoid unnecessary surgeries

El uso sistemático de la mamografía y ultrasonido ha incrementado el diagnóstico de lesiones mamarias no palpables y con ello, la indicación de biopsia. Material y Método: Presentamos nuestra experiencia en 315 biopsias excisionales de lesiones mamarias ocultas con localización preoperatoria. Utilizamos la mamografía en el 83,8% y el ultrasonido en el 10,5% de los casos para posicionar una guía metálica; en el 5,7% se realizó marcación sobre la piel, guiada por ultrasonido. Resultados: Obtuvimos 21,2% de tumores malignos, 17,5% de hiperplasia atípica y 60,3% de patología benigna. No obtuvimos una muestra adecuada en el 1% de los casos (3 pacientes). Discusión: La incidencia de 21,2% de patología maligna es consistente con los hallazgos de la literatura general (entre 20 y 30%). Si incluimos la hiperplasia atípica, como patología premaligna, los resultados positivos alcanzan el 38,7%. Más de la mitad de las lesiones son de etiología benigna. Es necesario mejorar tanto la sensibilidad como la especificidad de los métodos diagnósticos, para evitar cirugías innecesarias

Primary non-Hodgkin lymphoma of the breast is a rare entity. They represent less than 0.5% of all breast cancer malignancies. No features at clinical presentation distinguish patients with lymphoma from those with carcinoma of the breast. There are both mammographic and sonographic difficulties to establish the preoperative diagnosis. Contemporary frozen sections can be mistaken with breast carcinoma. In this article we present a case of a primary non-Hodgkin lymphoma of the breast in a 57 years old women

El linfoma no Hodgkin primario de la mama es una patología poco frecuente, constituye menos del 0,5% de todos los tumores mamarios malignos. Debido a que carecen de características propias, tanto clínicas, mamográficas y ultrasonográficas, resulta muy difícil establecer el diagnóstico preoperatorio, confundiéndose con el carcinoma mamario, incluso en el análisis histológico contemporáneo. Presentamos el caso de un linfoma no Hodgkin primario de la mama en una paciente de 57 años