Showing papers by "Hospital General Universitario Gregorio Marañón published in 1996"
TL;DR: Quality of life in elderly patients improved as much as in younger patients, thereby fully justifying the use of EPO for the elderly, and final hematocrit was positively related to global SIP improvement.
116 citations
93 citations
TL;DR: Although all Doppler echocardiographic indexes of aortic stenosis are affected by flow, valve resistance is more stable than valve area under dobutamine-induced hemodynamic changes.
86 citations
TL;DR: The accuracy of US in depicting cholangiocarcinoma was attributable to the skill of the radiologists who performed the study and evaluated the findings and to the high frequency of tumor at the hilar level, where the liver and gallbladder allowed a clear acoustic window that facilitated detection of tumors.
Abstract: PURPOSE: To assess the accuracy of ultrasonography (US) in the demonstration of extrahepatic biliary tree cholangiocarcinoma and to analyze US features of the different morphologic types of this tumor. MATERIALS AND METHODS: US findings were reviewed retrospectively in 49 patients with pathologically proved cholangiocarcinoma. Findings from percutaneous transhepatic cholangiography (n = 47) and endoscopic retrograde cholangiopancreatography (ERCP) (n = 2) were compared with those from US. RESULTS: US demonstrated the tumor in 47 (96%) of the 49 patients; a mass was demonstrated in 44 patients, and a focal or diffuse thickening of the bile duct wall was seen in three patients. CONCLUSION: The accuracy of US in depicting cholangiocarcinoma was attributable to the skill of the radiologists who performed the study and evaluated the findings and to the high frequency of tumor at the hilar level, where the liver and gallbladder allowed a clear acoustic window that facilitated detection of tumors.
69 citations
TL;DR: It is indicated that infants who carried viruses with more cytopathic biologic phenotype and who had higher viral RNA coy numbers in blood were more likely to have lower CD4+ T cell counts and morelikely to have AIDS.
Abstract: We have investigated the relationship among the HIV-1 biologic phenotype, replicative capacity of virus isolates, HIV-RNA copy number in plasma, p24 antigenemia, CD4+ T lymphocyte counts in peripheral blood, and the clinical status in a cohort of 13 HIV-infected children younger than 12 mo of age, born of HIV-1 seropositive mothers. Six out of 13 HIV-1 isolates from these patients were classified as rapid/high and seven as slow/low. We have found a significantly positive correlation between the replication rate of HIV isolates and their capacity to induce syncytia in vitro. Most of the serial HIV-1 isolates obtained from infants with AIDS had the rapid/high phenotype and induced syncytia, whereas only two out of 23 HIV-1 isolates obtained from infants without AIDS showed these properties. In sequential analysis of HIV-1 isolates from infants with AIDS, the presence of viral isolates with rapid/high and SI phenotype was associated with higher levels of HIV-1 RNA in plasma, CD4+ T cell depletion, and clinical progression. By contrast, infants whose viruses exhibited nonsyncytium-inducing phenotype throughout the follow-up showed lower levels of HIV RNA, stable CD4+ T cell counts, and mild symptomatic HIV infection. Our findings indicate that infants who carried viruses with more cytopathic biologic phenotype and who had higher viral RNA coy numbers in blood were more likely to have lower CD4+ T cell counts and more likely to have AIDS.
66 citations
TL;DR: The in vivo development of resistance to teicoplanin among CoNS strains limits the therapy of infections by these microorganisms, and there is a need for surveillance of nosocomial isolates of CoNS to determine resistance to glycopeptides.
Abstract: Over a period of 5 years we have recovered 32 clinical isolates of coagulase-negative staphylococci (CoNS) exhibiting either decreased levels of susceptibility or true resistance to teicoplanin (MICs, 16 to 128 micrograms/ml); these isolates make up 0.55% of the total CoNS isolated by us. Twenty-nine of the strains were also methicillin resistant, and all were susceptible to vancomycin. Fourteen of the strains were Staphylococcus epidermidis, fourteen were Staphylococcus haemolyticus, and four were Staphylococcus hominis. In one case, a strain of S. haemolyticus was isolated with a vancomycin-resistant, teicoplanin-resistant Enterococcus faecalis strain. All strains were nosocomially acquired and were isolated from 17 different wards. Teicoplanin resistance occurred as a sporadic phenomenon, and none of the isolates were epidemiologically related. The isolates were from 30 patients, 13 of whom presented with true infections (43%). Five (38%) of the 13 patients with true infections had been previously treated with vancomycin. None of the infected patients were previously treated with teicoplanin. The in vivo development of resistance to teicoplanin among CoNS strains limits the therapy of infections by these microorganisms. There is a need for surveillance of nosocomial isolates of CoNS to determine resistance to glycopeptides.
64 citations
TL;DR: The present case is a 2-year-old boy, the son of an HIV-positive mother, who responded well to oral erythromycin and topical metronidazole, and the pathogenic role of Demodex mites is discussed as well as the possible mechanisms for an exaggerated reaction.
Abstract: A second case of rosacea-like demodicosis in an HIV-positive child was seen at our center. No such cases have previously been published. The present case is a 2-year-old boy, the son of an HIV-positive mother, who responded well to oral erythromycin and topical metronidazole. The frequency of rosacea-like eruptions in HIV-negative children is very low. However, the incidence of these eruptions in HIV-positive children may have been underestimated. The pathogenic role of Demodex mites is discussed as well as the possible mechanisms for an exaggerated reaction.
46 citations
TL;DR: It is suggested that patients with multiple myeloma, human immunodeficiency virus infection, solid organ tumors, and chronic liver disease with bacteremic pneumococcal infections should be offered antipneumococcal vaccine and other potentially preventive measures, despite doubts about their efficacy.
Abstract: Background: Recurrent pneumococcal infections are known to occur occasionally in patients with profound immune defects. We performed a case-control analysis of recurrent pneumococcal bacteremias. Patients and Methods: The 547 episodes ofStreptococcus pneumoniaebacteremia detected from January 1, 1985, to December 31, 1994, were reviewed. We selected all cases with more than 1 episode separated by 30 days or more ("cases") and compared each of them with 2 controls (patients with single episodes of pneumococcal bacteremia). Results: Fifteen patients (2.8%) had 31 episodes of pneumococcal bacteremia. Except for multiple myeloma (P Conclusions: Our data suggest that recurrence is more than anecdotal in patients with bacteremic infections caused byS pneumoniae(2.8%). We believe that recurrence is a warning sign of immunodeficiency. Patients with multiple myeloma, human immunodeficiency virus infection, solid organ tumors, and chronic liver disease with bacteremic pneumococcal infections should be offered antipneumococcal vaccine and other potentially preventive measures, despite doubts about their efficacy. This is justified by the high mortality rate associated with recurrent episodes (47%). Arch Intern Med. 1996;156:1429-1434
43 citations
TL;DR: Mild forms of Poland's syndrome are more frequent than severe forms, and may go undiagnosed, and Hypoplasia of one breast or a horizontal anterior axillary fold may be the sole clinical manifestation of this syndrome.
Abstract: Purpose:Poland's syndrome is a congenital and unilateral aplasia of the pectoralis major muscle (PMM), with other anomalies of the ipsilateral upper extremity. We present 6 cases in which the only ...
42 citations
TL;DR: The higher concentration required for atrial flutter, exceeding that usually seen in humans, may help to explain the rarity of atrialFlutter in clinical alcohol intoxication.
Abstract: Alcohol abuse has long been suspected clinically to cause paroxysmal atrial tachyarrhythmias. However, such a relationship has never been conclusively proven, partly due to the lack of experimental evidence. Although atrial fibrillation (AF) is the most common atrial arrhythmia attributed to acute alcoholic ingestion, atrial flutter has occasionally been noted. We analyzed the possible role of alcohol in initiation and/or maintenance of a variety of atrial tachyarrhythmias in a closed-chest porcine model. Nine pigs underwent nine endocardial right atrial stimulation protocols (RASP) at baseline and 17 RASPs after increasing doses of ethanol (first infusion 1,230 mg/kg, second infusion 870 mg/kg) by means of one multipolar catheter advanced under heavy sedation from the femoral vein. Each RASP included 1, 2, and 3 extrastimuli, and rapid pacing at 5 times diastolic threshold. Venous ethanol concentrations were measured (HPGC method) every 10 minutes and at the time of arrhythmia induction. Atrial tachyarrhythmias were induced in 4 of 9 baseline RASPs, and lasted for a mean of 21 seconds, and in 16 of 17 RASPs after alcohol lasting for a mean of 357 seconds. Only fibrillation was observed at the baseline RASP. The atrial tachyarrhythmias induced after alcohol were AF in 11 RASPs and atrial flutter in 5 RASPs (in 5 animals). The mean venous ethanol concentration at the time of the longest arrhythmia induced for each RASP were 200 +/- 89 mg/dL for RASP inducing fibrillation and 292 +/- 40 mg/dL for RASP inducing flutter (P 1 minute in duration) more often than fibrillation (4 of 5 flutter vs 2 of 11 fibrillation P 10 minutes and was terminated by overdrive atrial pacing. We concluded: (1) in this closed-chest porcine model, an ethanol infusion facilitates a variety of atrial arrhythmias related to the ethanol concentration; (2) flutter tended to be sustained, and its termination by overdrive pacing suggests the possibility of an alcohol induced reentrant mechanism; and (3) the higher concentration required for atrial flutter, exceeding that usually seen in humans, may help to explain the rarity of atrial flutter in clinical alcohol intoxication.
42 citations
TL;DR: To the authors' knowledge, only six cases of EED in HIV‐positive patients have been reported to dale and a brief review of these seven cases is described.
Abstract: Summary
Erythema elevatum diutinum (EED) is a rare chronic disease of unknown origin, part of the spectrum of cutaneous leucocytoclastic vasculitis, A case of EED in a 32-year-old HIV-infected male patient, with no previous opportunistic infections and a CD4+ cell count of less than 200/mm3 is reported. Therapy with oral dapsone (100 mg/day for 15 days) resulted in clinical cure with no relapse after 6 months of follow-up. To our knowledge, only six cases of EED in HIV-positive patients have been reported to dale. A brief review of these seven cases is described.
TL;DR: In this article, a structured, time-limited group focused on the development of social skills in boys who have a brain tumor was described, and a parallel group for parents focused on relevant issues that arose in the boys∗ group and on the parents' general concerns about their child's social integration.
Abstract: Children with brain tumors often experience organically based illness- and treatment-related sequelae that interfere with the development of complex social skills necessary for confident, mutually satisfying interactions with peers. This article describes a structured, time-limited group focused on the development of social skills in boys who have a brain tumor. Social support and medical education were additional components. A parallel group for parents focused on relevant issues that arose in the boys∗ group and on the parents' general concerns about their child's social integration. The uniqueness of this program stemmed from the combination of development of social skills, specificity and homogeneity of the target population, highly structured group interventions, and parallel parent group. The program's efficacy in developing specific social skills was reported by both the boys and their parents. The authors recommend offering similar group interventions to other medically ill children and t...
TL;DR: Although cytarabine is well tolerated by patients with AIDS and PML, only modest short-term clinical improvement in the conditions of patients treated with the drug has been observed, with no significant impact on survival.
Abstract: To evaluate the efficacy and safety of intravenous cytarabine in the treatment of AIDS-associated progressive multifocal leukoencephalopathy (PML), we reviewed the charts of all human immunodeficiency virus-infected patients with PML who were seen during a 28-month period at our institution. Patients with biopsy-proven PML were offered therapy with intravenous cytarabine (2 mg/[kg.d] for 5 days every 4 weeks). The diagnosis of PML was histologically confirmed for 13 patients. The median CD4 cell count was 91 x 10(6)/L. A median of three courses of cytarabine was administered to eight patients. Two patients developed mild drug-related toxicities. Clinical and/or radiological signs of improvement were observed for three patients treated with cytarabine; no signs of improvement were noted for the untreated patients. Median survival time after the diagnosis of PML was 102 days (range, 46-220 days) for patients who received cytarabine and 60 days (range, 28-72 days) for untreated patients matched for Karnofsky scores (P = .06, logrank test). Although cytarabine is well tolerated by patients with AIDS and PML, only modest short-term clinical improvement in the conditions of patients treated with the drug has been observed, with no significant impact on survival.
TL;DR: Treatment with amphotericin B at an accumulative dose of 5.5 grams led to significant recovery, and there was no recurrence of disease over a follow-up period of six months.
Abstract: The case of a 30-year-old, female, HIV-positive, intravenous drug user who suffered from isolated cerebral mucormycosis is reported. Treatment with amphotericin B at an accumulative dose of 5.5 grams led to significant recovery, and there was no recurrence of disease over a follow-up period of six months. Patients with isolated cerebral mucormycosis in whom surgery would be a high-risk or impossible procedure could be managed medically with prolonged courses of intravenous amphotericin B.
TL;DR: According to the univariate analysis, access to mammography is most strongly associated with number of gynaecologist visits, residence in the autonomous community of Navarre, and physician referral for mammography, while the multivariate analysis showed a significant association with place of residence and with women's attitudes about testing.
TL;DR: In vitro susceptibility tests revealed that each infection was caused by fluconazole-resistant Candida albicans isolates, and strain delineation showed that meningitis and oral thrush were caused by two genetically different isolates.
Abstract: We describe a patient with AIDS who simultaneously developed Candida meningitis with three positive cerebrospinal fluid cultures and oral candidiasis. This patient also had a history or recurrent episodes of oral candidiasis treated with fluconazole. The patient did not respond to this therapy but was cured with amphotericin B and flucytosine. In vitro susceptibility tests revealed that each infection was caused by fluconazole-resistant Candida albicans isolates. Strain delineation by karyotyping, NotI restriction pattern analysis, hybridization with the specific probe 27A, and PCR fingerprinting with the phage M13 core sequence clearly demonstrated that meningitis and oral thrush were caused by two genetically different isolates.
TL;DR: In this paper, the authors evaluated the efficiency of the first experience in pediatric basic and advanced life support courses in Spain and found that only 12% of practitioners answered at least 80% of the questions in the initial theory test correctly, compared with 77% in the final test.
TL;DR: The trapezius osseomyocutaneous flap is the only pedicled flap that is able to transfer vascularized bone for mandibular reconstruction as well as skin for intra-extra oral reconstruction.
Abstract: The trapezius osseomyocutaneous flap is the only pedicled flap that is able to transfer vascularized bone for mandibular reconstruction as well as skin for intra-extra oral reconstruction. The trapezius muscle also helps to fill the defect created by the neck dissection and covers the vessels of the neck. This flap has been used in our maxillofacial surgery service during the past 14 years. In spite of having incorporated microvascular flaps in our reconstructive techniques it continues to be one of the flaps we use in selected patients for bone and soft tissue compound defects of the oral cavity. We describe in this article our experience using this flap with dental implants in order to achieve a functional reconstruction. We also discuss when we use this flap for mandibular reconstruction and when a free vascularized flap is used.
TL;DR: A case study of a patient who presented with abdominal pain and a palpable mesogastric mass is discussed, and it is demonstrated that the palpable mass was jejunojejunal intussusception of the small intestine.
Abstract: A case study of a patient who presented with abdominal pain and a palpable mesogastric mass is discussed. Ultrasound and computed tomography (CT) demonstrated that the palpable mass was jejunojejunal intussusception of the small intestine. The lead point of the intussusception was a lipoma that appeared in the CT scan as a small intramural mass with an attenuation coefficient of fat.
TL;DR: Results suggest that ampicillin resistance in the clinical isolates of E. faecalis described could be associated with alterations in different PBPs, and apparently increased amount of PBP 5 and decreased penicillin binding of PBPs 1 and 6.
Abstract: We analyzed the penicillin-binding protein (PBP) profiles of two clinical isolates of Enterococcus faecalis for which ampicillin MICs were 32 and 64 micrograms/ml. Six PBPs were detected in both isolates, demonstrating an apparently increased amount of PBP 5 and decreased penicillin binding of PBPs 1 and 6. These results suggest that ampicillin resistance in the clinical isolates of E. faecalis described could be associated with alterations in different PBPs.
TL;DR: A case of pneumocephalus after spinal anesthesia in which no air was injected at any time is presented.
Abstract: Pneumocephalus is relatively frequent in neurosurgery' and neuroradiology (pneumoencephalography, 2 pneumomyelography 3 ). It can also be caused by trauma 4 or infection. 5,6 It is known to occur, albeit rarely, with epidural blocks, particularly when the loss of resistance to air technique 7-9 is used. Conversely, the occurrence of pneumocephalus after spinal anesthesia is extraordinarily rare. Only one case has been described, in which a small quantity of air was injected to clear the spinal needle. 10 We present a case of pneumocephalus after spinal anesthesia in which no air was injected at any time.
TL;DR: One patient was treated with PTA and the other was managed with balloon dilation and subsequent implantation of a vascular stent.
Journal Article•
TL;DR: C. difficile can be a relevant cause of nosocomial diarrhoea in the authors' setting, particularly in HIV-positive patients, but also in other patients, and its early diagnosis and appropriate therapy can contribute to decrease arelevant cause of morbidity in inpatients.
Abstract: Clostridium difficile is considered the most common cause of nosocomial acquired diarrhoea, with frequencies differing widely from one institution to another. So far, it is a scarcely reported condition in Spain. In the present study 129 episodes of Clostridium difficile associated diarrhoea (CDAD) occurred in 120 patients in a 2,000-bed hospital in 1994 is reported. All cases were diagnosed by demonstrating cytotoxicity on cellular lines (MRC-5) from feces or from the strain isolated from a culture medium (CCFA). The overall incidence was 2.4 episodes every 1,000 admissions. Twenty-eight out of the 120 patients (23%) were HIV-positive patients, that is, an incidence of 30 episodes every 1,000 admissions. No significant differences were observed regarding the presentation and clinical course between HIV-positive and HIV-negative patients, with the exception of the antimicrobial agents used previously. Forty-two percent of patients had undergone surgery and 97% had received antimicrobials in the 8 weeks before the CDAD episode, with an average of 3.3 antibiotics per patient. Out of the 129 episodes, 72.8% were treated correctly. A total of 11.7% of patients responded exclusively to the discontinuation of the antimicrobials that were being administered. Eighty-three patients were treated with specific antibiotics, 59 with oral vancomycin, and 24 with metronidazole. Seventy-six patients (91.5%) responded to the initial therapy, 5 relapsed (6%), and 2 (2.5%) failed. The associated mortality rate was 0.7%. C. difficile can be a relevant cause of nosocomial diarrhoea in our setting, particularly in HIV-positive patients, but also in other patients. Its early diagnosis and appropriate therapy can contribute to decrease a relevant cause of morbidity in inpatients.
TL;DR: This design avoids any possible problems caused by membrane breakage, thereby minimizing the risk of gas embolic events and stagnation regions, and by using active valves, it is possible to ensure better flow control and minimize pressure gradients inside and outside the pump.
Abstract: We propose a new vacuum-driven blood pump having a tubular shape with active valves. This design avoids any possible problems caused by membrane breakage, thereby minimizing the risk of gas embolic events and stagnation regions. By using active valves, it is possible to ensure better flow control and minimize pressure gradients inside and outside the pump. The low cost of the pump's disposable parts enables it to be used for such applications as a ventricular assist device, a pulsatile pump device in extracorporeal circulation, a pump in hemodialysis and apheresis circuits, and a pump in extracorporeal membrane oxygenator systems.
TL;DR: Although definitively safe with this schedule of administration, Mitonafide is not active in NSCLC, and no neurologic side effects were observed.
Abstract: Background: The new intercalative agent Mitonafide was shown in early clinical trials to be toxic to the central nervous system when administered as a short intravenous infusion, but not when given as a 120-hour continuous infusion. Thus, clinical development in different tumor types was pursued using only this administration schedule,
Patients and methods: Forty-nine patients with previously untreated non-small cell lung cancer(NSGLC) and at least one measurable site received Mitonafide as a 120-hour continuous (5 days) infusion every 3 weeks. The starting dose was 170 mg/m2/day × 5 in the first 26 patients and 200 mg/m2/day × 5 in the remainder. Patients were evaluated for toxicity after each course and for response every two courses and remained on treatment until excessive toxicity or disease progression were observed. A special test, the “Mini-mental state”, was used to assess patients' cognitive functions.
Results: Of the 49 patients entered, 42 were evaluable for response and toxicity. Toxicity consisted mainly of myelosuppression and no neurologic side effects were observed. Only one patient presented a partial response.
Conclusions: Although definitively safe with this schedule of administration, Mitonafide is not active in NSCLC.
01 Apr 1996
TL;DR: This paper reports on a rare association between Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis and questions the validity of excluding the diagnosis of DISH in patients with radiological features of sacroiliac ankylosis.
Abstract: UNLABELLED To the best of our knowledge, 10 cases of Ankylosing Spondylitis (AS) and Diffuse Idiopathic Skeletal Hyperostosis (DISH) coexisting in the same patient have been reported. A new case was found in a female patient at Los Angeles Medical Center in 1993, which we report in this paper. We also review the literature (Medline 1970-1994) and analyze the features of the reported cases. In order to study the incidence of this association in our population we have reviewed 106 cases of AS for radiological features of DISH. We found only one case. CONCLUSION this is a rare association with an incidence of 0.94% in our patients with AS. From the known cases, patients showing this association present clinically mild AS in which radiologic findings are the basis for the diagnosis. Finally we question the validity of excluding the diagnosis of DISH in patients with radiological features of sacroiliac ankylosis.
TL;DR: The cytogenetic study of a neuroendocrine tumor of Merkel cells which appeared in a patient following a heart transplant and an abnormal karyotype was observed in a metastatic lymph node includes two markers derived from the long arm of chromosome 1, while maintaining two normal chromosomes 1.
TL;DR: La oximetria nocturna puede constituir un metodo util para el cribado del SAOS, en orden a poder disminuir las PSG realizadas a pacientes sin the enfermedad.
Abstract: La escasa disponibilidad, la complejidad y el alto coste de la polisomnografia convencional (PSG) hacen que sea problematica su utilizacion en todos los pacientes con sospecha clinica de sindrome de apnea obstructiva del sueno (SAOS). Este hecho ha provocado la aparicion de diversos procedimientos de deteccion en un intento de seleccionar a los enfermos candidatos a realizar PSG. Estudiamos la utilidad del analisis visual de la oximetria nocturna en 96 sujetos con sospecha clinica de SAOS. El diagnostico de SAOS se confirmo por PSG en 67 de ellos (69,8%). La oximetria fue positiva en 70 casos y negativa en los 26 restantes. Comparando ambas tecnicas, 61 pacientes tenian positiva la oximetria y la PSG, mientras que nueve presentaron oximetria positiva con PSG negativa. El analisis de estos resultados muestra que la oximetria nocturna tiene una sensibilidad del 91% y una especificidad del 69% para la deteccion del SAOS, con un valor predictivo positivo del 87% y negativo del 77%. Como conclusion, creemos que la oximetria nocturna puede constituir un metodo util para el cribado del SAOS, en orden a poder disminuir las PSG realizadas a pacientes sin la enfermedad.
TL;DR: The most common sources of adenocarcinoma cells in a cervical/vaginal smear are the endocervix and endometrium, but, as in this case, the tumor may well be metastatic disease, originating in the ovary or even in extragenital sites, such as gastrointestinal tract, breast and lung.
Abstract: BACKGROUND: Malignancies in cervical polyps are rare. In the literature, malignant transformation to adenocarcinoma and squamous cell carcinoma has been described, but metastasis from ovarian tumors has not been reported before. CASE: An asymptomatic female had a serous surface papillary carcinoma of the ovary, metastatic to a cervical polyp and first noticed on a routine vaginal/cervical/endocervical smear. CONCLUSION: The most common sources of adenocarcinoma cells in a cervical/vaginal smear are the endocervix and endometrium, but, as in our case, the tumor may well be metastatic disease, originating in the ovary or even in extra genital sites, such as gastrointestinal tract, breast and lung. The possibility of dual primaries, involving, for instance, both ovary and endocervix, should be considered.
TL;DR: The practice of Radiotherapy as it is defined today lasted to be generalized, and for decades radiological medicine combined the practice of diagnostic and therapeutic use of this technology.
Abstract: Cancer started to forge as a visible disease in the first third of this century (1). This means that it began to be considered as a conceivable illness by society, and above all, a concern for doctors. They were the social agents to persuade public and states of cancer curability. The lay reality was colonized by medical discourse, and individuals were assigned to be the assistants of doctors in the ideal frame of an industrial healthy society (2). This new medical mentality about cancer was a result of the professional commitment with social change, the improvement of surgery, and the perception of radioactive remedies as innovative therapeutical hopes. The process was linked to medical profession dynamics directed at the autonomization of radiotherapy as a new medical discipline. In western societies the concern about cancer and the rise of radiotherapy as a medical speciality was a process with common steps in its devolopment (3). In Spain, the therapeutic use of x-rays and radium was incorporated with a similar celerity to other countries. In the 30s the presence of radiological devices and instruments was significant in private practice medicine. According to the Spanish Medical Catalog (Anuario Medico de Espafia), from 1927 to 1931 the number of radiologists tripled (from 223 to 571) (4). This extraordinary increase did not mean a specialized type of radiological practice. Several medical specialists (surgeons, gynecologists, dermatologists) used radiological apparatus, particularly radium, due to its simple manipulation in clinics as an auxiliary therapy or, above all, as diagnostic methods. The practice of Radiotherapy as it is defined today lasted to be generalized, and for decades radiological medicine combined the practice of diagnostic and therapeutic use of this technology. In 1936, with the beginning of the Spanish Civil War, there was no regulation of the radiology practice, although in 1935 (Primer Congreso Promedico Espafiol) it was decided to name a Commission to study the legal implications and present a regulatory proposal to the health authorities. It was not until the 1930s when the health authorities of the Spanish government had a project to fight against cancer. Until then, some benefit cancer institutions, including individuals of the medical and social elite together with members of the government, were helped occasionally with financial support. These initiatives defined their objectives with the criteria of the doctors involved and in general were directed more toward the adquisition of radioactive material and its instrumentation requirements, more than to solve public education on the incurable problem. In 1909, the ComitC Central Contra el Cancer [Central Committee Against Cancer] and the Asociacion National Contra el CXncer were founded. Also the main proposals of campaigning were discussed, but following foreign experiences, difficult to carry on. The unique achievements for this period were the national enquiries (1902 and 1909) to know clinical cancer incidence, etiology, medical services available, and doctors knowledge about the disease. But the reply obtained was insignificant: 2O.ooO enquiries and 298 replies (1902) (5). The decline of international initiatives due to the war had a negative effect on Spanish institutions. In fact, except for the creation of a modest laboratory for cancer research at the Instituto Rubio (Madrid, 1909) and the discussion about radiumtherapy in the cancer campaign, nothing more was done In 1914 the Sociedad Benefica Radium-Barcelona arose, as a nonprofit institution. to provide radium to pri-