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JR Valdizán-Usón,1 A Cánovas-Martínez,2 MT De Lucas-Taracena,3 F Díaz-Atienza,4 LS Eddy-Ives,5 A Fernández-Jaén,6 M Fernández-Pérez,7 M García-Giral,8 P García-Magán,9 M Garraus-Oneca,10 MA Idiazábal-Alecha,11 M López-Benito,12 G Lorenzo-Sanz,13 J Martínez-Antón,14 MA Martínez-Granero,15 F Montañés-Rada,16 F Mulas-Delgado,17 G Ochando-Perales,18 E Ortega-García,19 A Pelaz-Antolín,20 JA Ramos-Quiroga,21 FC Ruiz-Sanz,22 J Vaquerizo-Madrid,23 A Yusta-Izquierdo241Unidad Trastornos Neurofuncionales, Clínica Montpellier, Zaragoza, 2Hospital Dr Peset, Valencia, 3Hospital 12 de Octubre, Madrid, 4Hospital Virgen de las Nieves, Granada, 5Centre Mèdic Sant Ramon, Santa Coloma de Gramenet, Barcelona, 6Hospital Universitario Quirón, Madrid, 7Centro de Salud La Felguera, Langreo, Asturias, 8Hospital Clínic, Barcelona, 9Unidad Salud Mental, Talavera de la Reina, 10Clínica Universitaria de Navarra, Pamplona, 11Hospital Ntra. Sra. del Pilar, Barcelona, 12Centro Salud Contrueces, Gijón, 13Hospital Ramón y Cajal, Madrid, 14Complejo Hospitalario Carlos Haya, Málaga, 15Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, 16Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, 17Hospital Universitario La Fe, Valencia, 18Hospital Universitario La Fe, Valencia, 19Complejo Asistencial Universitario de León, 20Centro Salud Mental, Alcalá de Henares, 21Hospital Universitari Vall d'Hebron. CIBERSAM. Department of Psychiatry and Legal Medicine. Universitat Autònoma de Barcelona, 22Hospital General Rio Carrión, Palencia, 23Hospital Materno-Infantil, Badajoz, 24Hospital Universitario, Guadalajara, SpainBackground: The purpose of this multicenter Spanish study was to evaluate the response to immediate-release methylphenidate by children and adults diagnosed with attention-deficit/hyperactivity disorder (ADHD), as well as to obtain information on current therapy patterns and safety characteristics.Methods: This multicenter, observational, retrospective, noninterventional study included 730 patients aged 4–65 years with a diagnosis of ADHD. Information was obtained based on a review of medical records for the years 2002–2006 in sequential order.Results: The ADHD predominantly inattentive subtype affected 29.7% of patients, ADHD predominantly hyperactive-impulsive was found in 5.2%, and the combined subtype in 65.1%. Overall, a significant lower Clinical Global Impression (CGI) score and mean number of DSM-IV TR (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision) symptoms by subtype were found after one year of treatment with immediate-release methylphenidate; CGI decreased from 4.51 to 1.69, symptoms of inattention from 7.90 to 4.34, symptoms of hyperactivity from 6.73 to 3.39, and combined subtype symptoms from 14.62 to 7.7. Satisfaction with immediate-release methylphenidate after one year was evaluated as “very satisfied” or “satisfied” by 86.90% of the sample; 25.75% of all patients reported at least one adverse effect. At the end of the study, 41.47% of all the patients treated with immediate-release methylphenidate were still receiving it, with a mean time of 3.80 years on therapy.Conclusion: Good efficacy and safety results were found for immediate-release methylphenidate in patients with ADHD.Keywords: attention deficit hyperactivity disorder, ADHD, pharmacologic treatment, methylphenidate, satisfaction

Background: Physicians play a fundamental role in the care of patients at the end of life that includes knowing how to accompany patients, alleviate their suffering and inform them about their situation. However, in reality, doctors are part of this society that is reticent to face death and lack the proper education to manage it in their clinical practice. The objective of this study was to explore the residents' concepts of death and related aspects, their reactions and actions in situations pertaining to death in their practice, and their perceptions about existing and necessary training conditions., Methods: A qualitative approach was used to examine these points in depth based on interviews conducted with seven oncology residents., Results: Participants do not have a clear concept of death and, although it is seen as a common phenomenon, they consider it an enemy to beat. The situations to which respondents react more frequently with frustration and sadness after the death of patients were when they felt emotionally involved, if they identify with the patient, in cases of pediatric patients and with patients who refuse treatment. To deal with death, participants raise barriers and attempt to become insensitive. Although residents in this study recognize the importance of training to learn how to better deal with death, it seems they are not fully invested in reaching more of it., Conclusions: Participants face death in a daily basis without the necessary training, which appears to impact them more than they are willing to accept. They do not achieve their goals managing situations regarding death as well as they assume they do. Despite recognizing the need of more training and support for better coping with death, they prefer to continue to learn from their experience., Trial Registration: Not applicable.

Objective: To compare the grade of histologic agreement between stereotaxic core needle aspiration biopsy (SCNAB) with multiple passes, and surgical excision., Methods: A total of 180 patients with 182 nonpalpable breast lesions underwent SCNAB with multiple passes in an upright add-on stereotaxic device using a manual 1.8-mm needle (15 G). In this group, 125 patients underwent subsequent surgical excision., Results: A SCNAB result indicative of malignancy (invasive or noninvasive carcinoma) was obtained in 68 (87%) of the 78 breast carcinomas (14 noninvasive and 64 invasive) and definitive surgical therapy with a one-stage procedure was performed. Complete or partial agreement between core biopsy and surgery was observed in 19 (86%) of 22 invasive or noninvasive carcinomas discovered by microcalcifications, 40 (97.5%) of 41 invasive carcinomas discovered by a mass, and 9 (60%) of 15 invasive or noninvasive carcinomas discovered by architectural distortion. Six (33%) of the 18 patients whose core biopsies showed noninvasive carcinoma had an invasive or microinvasive component at subsequent surgery. Atypical hyperplasia or benign core biopsy was observed in 6 (8%) and 4 (5%) breast carcinomas respectively., Conclusion: SCNAB with multiple passes is a reliable method for identifying nonpalpable lesions in patients with noninvasive or invasive carcinomas discovered by respectively microcalcifications or mass.

Purpose: To evaluate a new procedure for locating intraductal breast lesions detected by galactography, using the technique of intraductal placement of a Kopans spring-hookwire guide., Material and Methods: A catheter (0.7 mm) with a Kopans hookwire guide inside it was placed in 34 patients in whom an intraductal growth had been detected by galactography. The catheter was introduced through the discharging duct, with one hand holding the catheter and the other hand gently pushing the Kopans guide until it was anchored in the duct. The correct position of the guide was confirmed with new galactograms., Results: A precise excision of the lesion was satisfactorily executed in 29 of 34 patients (85%) who underwent this procedure. In 5 patients the method was unsuccessful because the Kopans guide was dislodged., Conclusion: This method is effective in removing intraductal lesions because it ensures a precise ductal excision and enables the pathologist to find the lesion more easily.

Objectives: To analyze the sensitivity and specificity of high resolution ultrasound in testicular tumors., Methods: The study comprised 18 histologically confirmed testicular tumors. Patient ages ranged from 19 to 79 years (mean 41). The ultrasound and the anatomopathological findings were compared., Results: 12 of 18 were primary testicular tumors: 5 classical seminomas, 1 spermatocytic seminoma, 1 anaplastic seminoma, 3 embryonary carcinoma, 1 mixed teratoma and 1 immature teratoma. Ultrasound detected all tumors, accounting for a sensitivity of 100%. All tumors were hypoechoic. Substantial differences were observed between the classical seminomas and the other tumor types: the echo structure was homogeneous in 60% of the classical seminomas vs 50% for the other tumor types; 80% of the former and none of the other tumor types had well- or partially well-defined tumor margins; and finally, cystic or hyperechoic areas were not observed in the classical seminomas but in 30% of the other tumors., Conclusion: High resolution ultrasound should be performed if testicular tumor is suspected. This technique will confirm or discard this condition and, furthermore, if the ultrasound findings show a solid, hypoechoic lesion, regardless of the degree of definition of the tumor margins, with no cystic or hyperechoic areas, a presumptive diagnosis of classical seminoma can be made.