[Prevalence of childhood obesity in the Murcia Region; an assessment of different references for body mass index]. / Prevalencia de obesidad infantil en la Región de Murcia, valorando distintas referencias para el índice de masa corporal.

INTRODUCTION: Childhood obesity is a problem of high magnitude with serious repercussions on health, which justifies estimating its prevalence at local level to identify conditioning factors and to take preventive actions. The main objective of the present work is to estimate the prevalence of overweight and obesity in the children in the general population of the Murcia Region, using the body mass index (BMI) and applying the International Obesity Task Force (IOTF) criteria, and to compare these results with the ones obtained from other frequently used references in Spain. MATERIAL AND METHODS: The BMI of 178,894 children aged from 2 to 14 years was determined. The prevalence of overweight and obesity was compared to the IOTF, to the studies of the World Health Organization, as well as those of the Orbergozo Foundation (FO), and the Cross-sectional Spanish Growth Study (ETEC) references. The agreement between the different results was evaluated using the kappa index. RESULTS: The evaluation using the IOTF cut-off points gave an overweight prevalence of 20.6% (95% CI: 20.4-20.8), an obesity prevalence of 11.4% (95% CI: 11.2-11.5) and an overweight plus obesity prevalence of 32% (95% CI: 31.8-32.2), with this last one being higher in girls (33.2%) than in boys (30.9%). The highest agreement is between IOTF and FO-2011 (kappa=.795) and between FO-2011 and ETEC (kappa=.794). CONCLUSION: A high prevalence of overweight and obesity in children in the Region of Murcia was found. The ETEC and the FO-2011 study showed the highest agreement with the results obtained using the IOTF criteria.

Comparative study of right portal vein ligation versus embolisation for induction of hypertrophy in two-stage hepatectomy for multiple bilateral colorectal liver metastases.

AIM: In patients with two-stage hepatectomy (TSH) for multiple bilobar liver metastases from colorectal cancer, few clinical series compare functional remnant hypertrophy of the liver volume between right portal vein ligation (PVL) and embolisation (PVE). Our objective is to analyse the effectiveness of portal vein ligation to achieve hypertrophy of the functional remnant volume (FRV) of the liver and to compare the results with portal vein embolisation in a series of patients with multiple bilobar liver metastases from colorectal carcinoma. PATIENTS AND METHODS: Between September 2001 and September 2011 we performed a TSH in 41 patients with multiple bilobar colorectal liver metastases. A right PVL was performed in 23 patients with an insufficient FRV (three patients did not complete the second stage due to tumour progression and were excluded). We prospectively compare these results with the increased remnant volume obtained in 18 patients with right PVE. RESULTS: The median FRV was higher in the patients with PVE, rising from 501 ml (range 309-703) to 636 ml (range 387-649), than those with PVL, rising from 510 ml (range 203-824) to 595 ml (range 313-1213) (p < 0.05). The median %FRVI was higher in the patients with PVE (median 40%; range 21-65%) than those with PVL (median 30%; range 21-60%) (p < 0.05). CONCLUSIONS: PVL and PVE were effective in all cases for obtaining hypertrophy of the FRV before major liver resection. Right PVE obtains better results and should be used where necessary to achieve a further increase in volume.

Prognostic value of histological and immunohistochemical characteristics for predicting the recurrence of medullary thyroid carcinoma.

INTRODUCTION: In medullary thyroid carcinoma, there is currently no consensus about the prognostic value of histological and immunohistochemical parameters. This study was designed to analyze the value of various histological and immunohistochemical characteristics for predicting the recurrence of medullary carcinoma. METHODS: A total of 55 cases of medullary thyroid carcinoma have been reviewed. These were operated on consecutively between 1971 and 2004 after histological confirmation. The data referring to clinical characteristics and evolution were taken from the patient's clinical history. The macroscopic, microscopic, and immunohistochemical characteristics of the tumors were taken from the pathological anatomy report. RESULTS: In 14 (27%) cases, there was recurrence of the disease. The disease-free interval at 1 year was 88 +/- 5%; at 5 years 73 +/- 7%; at 10 years 73 +/- 7%; at 15 years 61 +/- 10%; and at 20 years or more 61 +/- 10%. Of the histological parameters, only vascular invasion (0.0098) was related to a higher relapse rate. No epidemiological variable or immunohistochemical marker was associated with relapse. However, it was found that staging (P = 0.0102), as well as tumor size (P = 0.0211) and lymph node affectation (P = 0.0012), are factors significantly related to relapse of the disease. According to Cox's regression model, the only variable with a statistically significant effect was vascular invasion (P = 0.0056; odds ratio = 5.2308). CONCLUSIONS: The overall recurrence rate was 27%, and the main independent prognostic factor of recurrence was tumoral vascular invasion at diagnosis. Staging, tumor size, and lymph node metastasis are prognostic factors of recurrence, although they are not significant in the multivariate analysis.

Suspicion of elder abuse in South Eastern Spain: the extent and risk factors.

Elder abuse is recognized internationally as a growing problem. Recent years have seen an increase in the number of authors recommending that the MDs systematically question old people concerning possible abuse. The aim of our study was to ascertain the extent of suspicion of elder abuse and the different types of abuse. We design a cross-sectional survey including 460 patients > or = 65 years at different health centers (South East Spain). A face-to-face interview and a physical examination was carried out. Extent of suspected abuse was 44.6%. Female sex, > or = 75 years, widowhood, living alone or with children, accommodation in house of relatives and income < or = 300 euros/month were the associated sociodemographic variables. The risk factors associated are recent worsening of health, living with a mentally ill person, excessive consumption of alcohol or illegal drugs, arguing frequently with relatives or the dependence on someone to carry out a daily activity. The signs in the physical examination associated are dehydration/malnutrition, pressure ulcers and poor body and/or mouth hygiene. There is a high extent of suspicion of elder abuse and the keyword in this respect is prevention.

Validity of self reported diagnoses of cancer in a major Spanish prospective cohort study.

INTRODUCTION: This study aims to assess the validity of self reported diagnoses of cancer by persons recruited for the Spanish EPIC (European prospective investigation into cancer and nutrition) cohort study and to identify variables associated with correctly reporting a diagnosis of cancer. METHODS: 41 440 members of EPIC were asked at the time of recruitment whether they had been diagnosed with cancer and the year of diagnosis and site. The process of validating self reported diagnoses of cancer included comparison of the cohort database with the data from the population based cancer registries. Cancer diagnostic validity tests were calculated. The association between a correct report and certain sociodemographic, tumour related, or health related variables were analysed by logistic regression. RESULTS: The overall sensitivity of self reported diagnoses of cancer is low (57.5%; 95% CI: 51.9 to 63.0), the highest values being shown by persons with a higher level of education or with a family history of cancer and the lowest values by smokers. Breast and thyroid cancers are those with the highest diagnostic validity and uterus, bladder, and colon-rectum those with the lowest. In both sexes the variables showing a significant association with a correct report of cancer are: higher education level, number of previous pathologies, invasive tumour, and, in women, a history of gynaecological surgery. CONCLUSIONS: The overall sensitivity of self reported diagnoses of cancer is comparatively low and it is not recommended in epidemiological studies for identifying tumours. However, self reported diagnoses might be highly valid for certain tumour sites, malignant behaviour, and average to high levels of education.

Primary care confidentiality for Spanish adolescents: fact or fiction?

BACKGROUND: By providing healthcare to adolescents, a major opportunity is created to help them cope with the challenges in their lives, develop healthy behaviour and become responsible healthcare consumers. Confidentiality is a major issue in adolescent healthcare, and its perceived absence may be the main barrier to an adolescent seeking medical care. Little is known, however, about confidentiality for adolescents in primary care practices in Spain. OBJECTIVE: To ascertain the attitudes of Spanish family doctors towards the right of adolescents to confidentiality in different healthcare situations and in the prescription of treatment. METHOD: A descriptive postal questionnaire was self-administered by family doctors. RESULTS: Parents of patients under 18 years are always informed by 18.5% of family doctors, whereas parents of those under 16 years are informed by 38.8% of doctors. The patients are warned of this likelihood by 79.3% of doctors. The proportion of doctors supporting confidentiality for adolescents increases with the age and maturity of the patients, whereas workload and previous training has a negative effect. CONCLUSIONS: Spanish laws on adolescent healthcare are not reflected by the paternalistic attitude that Spanish primary care doctors have towards their adolescent patients. Doctors need to be provided with up-to-date and clinically relevant explanations on contemporary legal positions. In primary care, more attention should be paid to adolescents' rights to information, privacy and confidentiality. Doctors should be more aware of the need to encourage communication between teenagers and their parents, while also safeguarding their patients' rights to confidential care.

Symmetrical fetal growth retardation after gestational cocaine exposure in the rat.

Cocaine use during pregnancy results in an increase in different maternal and perinatal complications. The fetal effects of cocaine could be mainly related to the disturbances in the brain development, microcephaly being the most common brain abnormality. The aim of this study was to analyze maternal outcome and fetal somatic effects of cocaine and to evaluate the hypothesis that maternal cocaine exposure would specifically impair fetal global brain development. Fifty-four timed-pregnant female Sprague-Dawley rats were daily injected with 15 or 40 mg/kg per day from gestational day (GD) 1 or 8 and sacrificed at gestational day 20. By analyzing different maternal and fetal outcomes, it could be suggested that the cocaine exposure in pregnant rats decreased maternal weight gain without significant maternal mortality, did not affect the mean number of fetuses by litter, although notably increased stillbirths, reduced fetal birth weight, and reduced the fetal central nervous system weight. Present results are globally in agreement with the literature and underline a possible selective effect of cocaine on the fetal CNS resulting in symmetrical intrauterine fetal growth retardation in contrast to the asymmetrical retardation of undernutrition.

[Longitudinal study of the growth of preterm newborn infants]. / Estudio longitudinal de crecimiento de recién nacidos pretérmino.

BACKGROUND: The growth and nutrition of premature infants should be accurately assessed. To do this, reference values of normality, obtained from population to be studied, are required. OBJECTIVES: To study the postnatal growth of premature infants in our environment and to compare their growth with intrauterine growth (Lubchenco et al). PATIENTS: A total of 103 premature infants born at 28-36 weeks of gestation in the Virgen de la Arrixaca University Children's Hospital in Murcia (Spain) from April 1994 to June 1995 were studied. Children who received medical care during the first 24 hours of life and who had no prenatal condition that could affect their growth were selected. Those who suffered from serious disease were excluded. The study was carried out from birth to a postconceptional age of 48-52 weeks. The 2-step regression model was used to calculate the percentile graphs. RESULTS: Percentile growth graphs were drawn up for the following variables: weight, length, arm circumference, head circumference, subscapular fold, and tricipital fold. In premature infants, postnatal growth in weight and length was uniform, progressive, and practically linear and did not show the flattening that is characteristic of intrauterine growth. Other corporal segments such as the head and arm circumference showed a certain slowing down at a postconceptional age of 42 or 43 weeks, and the folds showed a moderate dispersion of values as the study progressed. CONCLUSIONS: Intrauterine growth charts do not accurately assess postnatal growth in premature infants.

[Physical sports activity in a representative sample of the population of Región de Murcia, Spain]. / Actividad física deportiva en una muestra representativa de la población de la Región de Murcia.

OBJECTIVE: To estimate the prevalence of intense physical activity according to age and sex in the region of Murcia, Spain, and to analyze its association with major demographic and socioeconomic determinants and other cardiovascular risk factors. METHODS: Survey of a representative sample of the population aged between 18 and 65 years from Murcia was performed using multistage random sampling with definition of the sample quotas. A total of 3091 individuals were surveyed. The frequency and duration of intense physical sports activity during the two weeks prior to the survey was obtained using a validated questionnaire. Information was also collected on socioeconomic variables, smoking, blood pressure, weight and height and a blood test was performed to determine plasma lipids. Intense or vigorous physical activity (> or = 6 Metabolic Equivalents [MET]) was measured in kcal/day and reduced to hours/week to give three categories: no vigorous physical activity, less than 2 hours/week, and 2 hours/week or more. RESULTS: Overall, 17.8% (95% CI: 16.6-19.0) of the adult population of the region of Murcia performed intense physical activity for > or = 2 hours/week. The figures were twice as high in men (23.1%; 95% CI: 21.0-25.2) than in women (12.5%; 95% CI: 10.9-14.1). In the logistic regression analysis, a higher frequency of intense physical activity was associated with age, level of education and employment situation. In men it was also associated with occupation and residence in urban areas. CONCLUSIONS: During the study period, one in five adults in the region of Murcia took intense physical sports activity with a frequency and duration that were compatible with the prevention of episodes of coronary ischemia.

Role of appendectomy in training for laparoscopic surgery.

BACKGROUND: This study aimed to evaluate a program of training in laparoscopic surgery based on clinical practice in the emergency room, in which laparoscopic appendectomy is the first technique that residents perform as surgeons. METHODS: A prospective nonrandomized study was conducted involving all the laparoscopies performed in emergencies with a diagnosis of acute abdomen, appendicular in origin, during the period between June 1991 and December 1997. RESULTS: There were no statistically significant differences between residents and assistants in terms of conversion rates (22/242 vs 15/158), mean hospital stay for each type of surgeon (5.2 days for residents and 5.1 days for assistants), and complications (12.8% for residents and 13.7% for assistants). Operating time, was significantly longer (p < 0.05) for residents (52.2 min) than for assistants (48 min). CONCLUSIONS: Apprenticeship in laparoscopic appendectomy can be accomplished with gradual clinical training and without the need for resort to animal experimentation laboratories.

[Invasive pneumococcal disease in children in the region of Murcia (Spain)]. / Enfermedad neumocócica invasiva en niños de la Región de Murcia.

OBJECTIVE: Because of the availability of a conjugate pneumococcal vaccine, the incidence and characteristics of invasive pneumococcal disease in children in the region of Murcia should be determined. This would provide information that could be useful for properly establishing the indications for vaccination. METHODS: A retrospective search was conducted for cases of invasive Streptococcus pneumoniae in children aged less 15 years old treated in hospitals in Murcia from 1991-2000. The data sources were the databases of the microbiology services, the Minimum Data Set, the Pediatric Admissions Register and the EDO Register. RESULTS: The incidence rate for the period 1996-2000 was 18.25 per 105 children per year for children aged under 1 year in the case of invasive disease (10.6 for meningitis), 13.6 for those under 2 years for invasive disease (6 for meningitis), 8.9 for those under 5 years (1.35 for meningitis) and 3.7 for those under 15 years (1.3 for meningitis). Twenty-eight percent of the patients presented risk factors. Complications occurred in 35.2% and sequelae occurred in 5%. The mortality rate was 11.8%. The prevalent serogroups were 19, 6, 18, 5, 14 and 23. CONCLUSIONS: The high percentage of patients with risk factors for invasive pneumococcal disease suggests the need to implement vaccination programs aimed at risk groups. Although the incidence of invasive pneumococcal disease in the region of Murcia differs from that in other areas, the incidence of meningitis is similar to that reported by other studies. Because of the severity of the disease, cost-effectiveness studies to evaluate the possible incorporation of the vaccine in the vaccination calendar are justified.

Extremely high prevalence of overweight and obesity in Murcia, a Mediterranean region in south-east Spain.

OBJECTIVE: To estimate the prevalence of obesity in the Murcia Region according to age and sex, and to analyse how obesity is related to demographic and socio-economic determinants and to other cardiovascular risk factors of interest to the community. DESIGN: Survey on a representative population sample using multi-stage random sampling with definition of the sample quotas. SUBJECTS: A total of 3091 persons aged 18-65 y residing in the Murcia Region. MEASUREMENTS: : The following data were collected: socio-economic data; tobacco smoking; recent physical activity; blood pressure; weight; height; and blood analysis to determine plasma lipids. Obesity was defined by body mass index (BMI)> or =30. Intense or vigorous physical activity (VPA> or =6 equivalents to baseline metabolic rate or METs) was measured in kilocalories per day and reduced to hours per week. RESULTS: In all, 20.5% of the adult population of the Murcia Region is obese, and 40.9% is overweight. In the logistic regression analysis, obesity in men is associated with age and level of education. In women it is associated with age, level of education, living in a non-urban area and being a housewife. When adjusted for socio-economic variables and for other cardiovascular risk factors the effect of age and level of education disappears in men and it is directly associated with hypertension and hypertriglyceridaemia and inversely related to more than 2 h VPA per week. Obesity in women is associated positively with age, hypertension, hypertriglyceridaemia and little VPA, and inversely with level of education. CONCLUSIONS: In the Murcia Region 61.4% of the adult population presents with some form of excess weight. The prevalence of obesity (BMI> or =30) is greater in women (23.7%; CI 95% 19.7-27.7) than in men (17.3%; CI 95% 15.3-19.3). The widespread nature of this factor makes it a mass problem that requires generalised interventions to prevent it.

Value of 99mTc-MIBI scintimammography in women with impalpable breast lesions seen on mammography.

OBJECTIVE: To find out if 99mTc-methoxyisobutylisonitrile scintimammography (MIBI) is useful in the evaluation of impalpable breast lesions in women referred for biopsy after mammography screening. DESIGN: Observational and prospective study. SETTING: Radiological screening campaign in Spain. PATIENTS: 36 patients referred between September 1997 and June 1998 (37 biopsies) with impalpable breast lesions referred consecutively from a screening campaign. Ages ranged from 50 to 64 years. INTERVENTIONS: Mammography, ultrasound, MIBI, and wire-guided biopsy. MAIN OUTCOME MEASURES AND RESULTS: Mean values for sensitivity, specificity, positive predictive value, and negative predictive value for scintimammography were 78.9, 72.2, 75, and 76.5 respectively (p = 0.002). The logistic regression analysis showed that 99mTc-MIBI scintimammography result predicted (p = 0.003) the risk of breast cancer in this group of patients (odds ratio: 9.75), particularly infiltrating ductal carcinoma. CONCLUSIONS: MIBI scintimammography in patients referred for biopsy after mammography screening does not so much rule out cancer as confirm the diagnosis. Its practical benefit would be not so much avoiding biopsy for these patients as aiding in planning the radicality of their excision.

Intravenous administration of propacetamol reduces morphine consumption after spinal fusion surgery.

We sought to determine the analgesic efficacy, opioid-sparing effects, and tolerability of propacetamol, an injectable prodrug of acetaminophen, in combination with morphine administered by patient-controlled analgesia (PCA) after spinal fusion surgery. Forty-two patients undergoing spinal stabilization surgery were randomized into two groups, which were given either an IV placebo or an IV injection of 2 g propacetamol every 6 h for 3 days after surgery. The postoperative opioid analgesic requirement was assessed with a PCA device used to self-administer morphine. Pain relief was evaluated by a visual analog pain scale and by verbal rating scores of pain relief at 8-h intervals for up to 72 h after surgery. The cumulative dose of morphine at 72 h was smaller in the Propacetamol group than in the Placebo group (60.3 +/- 20.5 vs 112.2 +/- 39.1 mg; P < 0.001). The pain scores were significantly lower in the Propacetamol group measured at two intervals of the study, although visual analog scale pain intensity scores were smaller than 3 in both groups. Most patients in the Placebo group obtained a greater degree of sedation on postoperative Day 3 (P < 0.05). This study demonstrates the usefulness of propacetamol as an adjunct to PCA morphine in the treatment of postoperative pain after spinal fusion.

Extrathyroid spread in papillary carcinoma of the thyroid: clinicopathological and prognostic study.

INTRODUCTION: The extrathyroid spread (ETS) is one of the risk factors that influence mortality and recurrence in patients with papillary carcinoma of the thyroid (PCT). The aim of this study is to analyze the clinical and histologic features and follow-up of a series of patients with ETS undergoing surgery for PCT and to identify patients with a greater risk of presenting with ETS. MATERIAL AND METHODS: Retrospective study of a series of 200 patients undergoing surgery for PCT, of whom 47 (23.5%) presented with ETS. The clinical and histologic features and follow-up of the patients with ETS were compared with those without ETS using the Pearson chi(2) test. We used a logistics regression model to perform a multivariant analysis for ETS. The survival and disease-free interval rates were calculated using the Kaplan-Meier method. RESULTS: ETS is most associated with patients over 50 years of age, with tumors over 4 cm that are not encapsulated, with lymph node metastasis, and with certain PCT histologic subtypes after the multivariant analysis. The overall rate of recurrence and mortality in patients with ETS was much higher than in patients without ETS. CONCLUSIONS: PCT patients with ETS have a greater risk of tumor-related recurrence and mortality than patients without ETS. There are patients with certain clinical and histologic features who have a greater risk of presenting with ETS.

Antibiotic prophylaxis in incisional hernia repair using a prosthesis.

Antibiotic prophylaxis in clean surgery with implantation of prosthetic material is widely accepted, although there are no studies on its use in abdominal incisional hernia repair. The objective was to evaluate antibiotic chemoprophylaxis in incisional herniorrhaphy with the implantation of prosthetic material. A prospective non-randomized study (1990-1998) was conducted to analyse 216 patients undergoing surgery for abdominal incisional hernia who required a prosthesis (polypropylene) in the reconstruction and who met the criteria for clean surgery. Risk factors were observed in 31.5%, the most frequent being diabetes and obesity. The incisional hernia was located mostly in the abdominal midline and in 64.4% measured over 10 cm. Antibiotic prophylaxis was administered in 140 patients (64.8%) via the systemic route, the antibiotics being first- or second-generation cephalosporins or amoxicillin-clavulanic acid. Surgical wound infection occurred in 39 patients (18.1%), 19 who had received antibiotic prophylaxis (13.6%) and 20 who had not (26.3%). In multivariate analysis using logistic regression, the variables with statistical significance for local septic infection were antibiotic prophylaxis and number of risk factors. We can conclude therefore that antibiotic chemoprophylaxis is useful in abdominal incisional herniorrhaphy surgery with implantation of prosthetic material for reducing local septic complications.

[Cardiovascular response to tracheal intubation in patients with intracranial tumor. Comparative study between urapidil and lidocaine]. / Respuesta cardiovascular a la intubación traqueal en pacientes con tumor intracraneal. Estudio comparativo entre el urapidilo y la lidocaína.

OBJECTIVES: To compare the effects of urapidil and lidocaine on cardiovascular response to laryngoscopy and tracheal intubation in patients with brain tumors. PATIENTS AND METHODS: Prospective, randomized double-blind study of 40 ASA II-III patients undergoing elective surgery for supratentorial tumor resection. The patients were assigned to two groups of 20 to receive an intravenous bolus of 1.5 mg/kg of lidocaine or 0.4 mg/kg urapidil before laryngoscopy and intubation. Anesthetic induction was performed with 0.03 mg/kg midazolam, 3 micrograms/kg of fentanyl, 5 mg/kg of thiopental and 0.2 mg/kg of vecuronium. Anesthesia was maintained with N2O/O2 (60%/40%) and isoflurane (0.5% expired). The following variables were recorded: mean blood pressure, heart rate and arterial oxygen saturation (SpO2) at baseline and 1, 2 and 3 min after induction and at 1, 2, 3, 4, 5 and 10 min after laryngoscopy and tracheal intubation. RESULTS: The two groups were comparable with respect to age, sex, weight, height and baseline hemodynamics. No statistically significant differences in hemodynamic variables were found between the two groups. Mean blood pressure in the postintubation period stayed near baseline and heart rate increased significantly after laryngoscopy and tracheal intubation in both groups. SpO2 decreased 7 min after administration of urapidil and stayed lower throughout the study period and was statistically different from SpO2 in the lidocaine group. All changes described were within clinically normal ranges. CONCLUSIONS: In patients undergoing neurosurgery to remove a supratentorial tumor, both lidocaine and urapidil reduce the pressor response to laryngoscopy and tracheal intubation at the doses given in this study. However, neither was able to prevent the increase in heart rate.

Seroconversion and duration of immunity after vaccination against group C meningococcal infection in young children.

An increase in the incidence of group C meningococcal disease was observed in the Murcia Region (Spain) during 1996-1997. In September 1997, a massive vaccination campaign was implemented among the population aged 18 months to 19 years. The aim of this study was to assess the seroconversion rate of children aged 18-59 months and the persistence of immune response 1 year after vaccination. A total of 296 children were included. Blood samples were obtained before vaccination and 1 month and 1 year after vaccination. Three point seven percent of the children had bactericidal antibody titres of >/=1:8 before vaccination. One month after vaccination seroconversion was 63.7%, with a growing trend related to age at vaccination (p<0.0001). The increase in antibody titres was shown to be quantitatively greater above the age of 36 months (p<0.0001). One year after vaccination only 4.3% of the children who initially seroconverted still had bactericidal activity. Seroconversion in children under 5 increases with age but antibodies decline rapidly in the year following vaccination.

[The behavior of FEV1 and PEFR in the free running test for the detection of exercise-induced asthma in childhood]. / Comportamiento del FEV1 y del PEFR en la prueba de carrera libre para la detección del asma inducida por ejercicio en la infancia.

OBJECTIVE: Our aim was to study the behavior and validity of PEFR and FEV1 in the free-running exercise test in order to diagnose exercise-induced asthma during childhood. PATIENTS AND METHODS: We studied 30 asthmatic children and 30 healthy children as controls. A provocation test was performed by means of free-running exercise in an indoor sports center. Environmental temperature and humidity were equal in both groups. Forced breathing spirometry and the "Mini-Wright peak flow meter" test were recorded before and two, five, fifteen and twenty minutes after the exercise challenge. The spirometric values representing two standard deviations below the mean for each variable studied in the control group were considered as reference values (FEV1 > or = 83.5% and PEFR > or = 81.5%). RESULTS: There was a decrease in FEV1 in 17 asthmatic children (56.7%) and a decrease in PEFR occurred in 14 children (46.7%). No statistically significant differences were found in either test. Specificity was 100% for FEV1 and 96.7% for PEFR. The greatest decrease in both spirometric parameters occurred at five minutes. CONCLUSIONS: According to our results, in a free-running provocation test if we maintain previously controlled environmental conditions and exercise intensity "forced breathing spirometry" and "Mini-Wright peak flow" can be used interchangeably in order to diagnose exercise-induced asthma.

Cardiovascular disturbances caused by extradural negative pressure drainage systems after intracranial surgery.

Extradural drainage systems connected to a vacuum device for preventing postoperative haematoma formation are often used in neurosurgical practice. Cardiovascular complications, including bradycardia or low arterial pressure caused by intracranial hypotension, have been described associated with their use. We have investigated the relationship between the negative pressure applied to extradural drainage systems and intracranial pressure (ICP), and analysed the effects of negative pressure of the drains on systolic (SAP), diastolic (DAP) and mean (MAP) arterial pressures and on heart rate (HR). We studied prospectively 15 patients undergoing neurosurgery for supratentorial tumours or aneurysms. Transient decreases in ICP (P < 0.001) and HR (P < 0.001), with no clinical effects, were observed after connecting the vacuum device to the drain. There were no significant changes in SAP, DAP or MAP.