[Comparing group educational intervention to individual and self-learning in COPD]. / Comparación de intervención educacional grupal frente a una individual y el autoaprendizaje en EPOC.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is considered a public health issue which affects 10.2% of Spanish population between 40 and 80 years of age. Many patients do not perform well the inhalation technique. Error rates vary between 50-80% depending on the device under study. These values haven been proven to decrease with educational interventions. OBJECTIVE: To ascertain whether a group educational intervention is superior to an individual intervention or to a conventional approach in these patients as regards quality of life measured by means of the total score of the COPD Assessment Test (CAT),of adherence to treatment, exacerbations and hospitalizations. MATERIAL AND METHODS: A multicenter, multidisciplinary cluster-randomized controlled clinical trial with three branches (conventional intervention, individual intervention and group intervention) in a cohort of COPD-patients. Sociodemographic data and risk factors were collected and several questionnaires were completed (CAT, BODEx, Barthel, Lawton y Brody). A descriptive analysis of qualitative and quantitative variables and a multiple linear regression were conducted. OUTCOMES: 149 patients of average age 69.08 (SD 1.26). Significant differences were observed in CAT in the different intervention groups according to the level of severity on BODEx. The rate of patients performing well the inhalation technique was significantly lower at the beginning of the study and the number of exacerbations was lower after the intervention. Last year's exacerbations were linearly related to post-intervention suffering. CONCLUSIONS: Better results are obtained using the traditional and individual interventions. There is a decrease in number of exacerbations, hospitalizations, CAT score and post-intervention inhalation technique.

Cirugía torácica videoasistida uniportal en dos centros universitarios: experiencia inicial / Initial experience in uniportal video-assisted thoracoscopic surgery at two university campuses

Resumen Introducción: Uno de los mayores avances de las últimas décadas en la cirugía de tórax ha sido el desarrollo de la cirugía mínimamente invasiva. Objetivos: Describir la experiencia en videotoracoscopía (VATS) Uniportal de miembros del equipo de Cirugía de Tórax de la Universidad de Chile en 2 campos clínicos, (Clínica Las Condes y Hospital Clínico de la Universidad de Chile). Materiales y Método: Se estudiaron 105 pacientes sometidos a VATS uniportal entre enero de 2016 y enero de 2019. Los datos se analizaron de manera retrospectiva considerando variables demográficas (edad, sexo) y clínicas (diagnóstico, cirugía, estadía hospitalaria, días de pleurostomía, conversión y complicaciones). Resultados: De las 105 cirugías realizadas, 28 (26,6%) correspondieron a cirugías mayores complejas lobectomías y segmentectomías anatómicas. En 4 pacientes se agregó un 2° puerto, uno se convirtió a minitoracotomía y uno a toracotomía (5,7% conversión global). La estadía hospitalaria fue en promedio 3,07 ± 3,1 días y el promedio de mantención de pleurostomía de 2,67 ± 1,61 días. Siete pacientes (6,6%) presentaron complicaciones postoperatorias. Un paciente falleció por progresión de su enfermedad, no hubo mortalidad relacionada a la cirugía. Discusión: Las contraindicaciones de la VATS uniportal son las mismas que en la VATS multipuerto. En manos experimentadas, las complicaciones en cirugía por puerto único son bajas. Impresiona tener menos dolor postoperatorio, menor estadía hospitalaria y reintegración precoz a las actividades diarias comparado con la VATS tradicional. Conclusiones: Se presenta la primera serie de VATS uniportal publicada en Chile. Los resultados obtenidos son comparables a los observados en la literatura. Su implementación y desarrollo requiere de una curva de aprendizaje similar a cualquier nueva técnica quirúrgica.

Objective: To describe the initial results with uniportal Video-Thoracoscopic Surgery (VATS) performed in two campuses by members of the Section of Thoracic Surgery of the University of Chile ("Clínica Las Condes" and University of Chile Clinical Hospital). Materials and Method: Between January 2016 and January 2019, a total of 105 patients underwent uniportal VATS. Clinical data was collected retrospectively from digital records including demographic (age, sex) and clinical variables (diagnosis, surgery, duration of the chest tube, length of stay, conversion rate and postoperative complications). Results: Uniportal VATS was performed on 105 patients during the study period. Twenty-eight cases (26.6%) corresponded to lobectomy or anatomic segmentectomy. In 4 cases a 2nd port was required, 1 patient had to be converted to mini-thoracotomy and 1 to thoracotomy (5.8% global conversion). Overall, the median length of stay was 3.07 ± 3.1 days and the median duration of chest tube drainage was 2.67 ± 1.61 days. Seven patients (6.6%) presented complications. One patient died due to progression of his disease, there were no deaths related to the procedures. Discussion: Uniportal VATS has similar indications than multiportal VATS. On experienced hands, uniportal VATS has a low morbidity rate. Uniportal VATS appears to produce less post-operative pain, with shorter hospital stay and a faster return to normal life compared to standard VATS. Conclusion: We present the first uniportal VATS series in Chile. Results were similar to published series. Implementation and development of uniportal VATS requires a learning curve similar to any new surgical procedure.

Plasmocitoma solitario de costilla como presentación inicial de mieloma múltiple: reporte de un caso / Lone rib plasmacytoma as a presentation of initial multiple myeloma: a case report

Resumen Introducción: El 50% de los tumores de pared torácica son malignos, dentro de los que destaca el plasmocitoma de costilla. Objetivo: Presentar un caso clínico que debutó inicialmente como un plasmocitoma de costilla, y que terminó presentándose como mieloma múltiple. Materiales y Método: Registro clínico de un paciente sometido a resección de tumor de parrilla costal. Resultados: Paciente masculino de 58 años, con un año de dolor costal, asociado a aumento de volumen a nivel de la octava costilla derecha en línea media axilar, indurada. TC de tórax que demuestra imagen sugerente de plasmocitoma de 79 × 44 mm. Se realiza resección quirúrgica, con instalación de malla de prolene en el defecto. Biopsia diferida con compromiso neoplásico por lesión monoclonal de células plasmáticas. Se complementa estudio con biopsia de médula ósea confirmando mieloma múltiple. Se inicia tratamiento con quimioterapia adyuvante. Conclusiones: El plasmocitoma óseo solitario es una entidad de baja frecuencia, que se asocia a la presencia de mieloma múltiple. Es por esto que al momento de la sospecha se hace necesario descartar su presencia, con el fin de mejorar el pronóstico del paciente.

Introduction: Up to 50% of chest wall tumors are malignant; among which rib plasmocytoma stand out. Aim: Showcase a clinical case that debuted as a rib plasmacytoma, and that ended up presenting as Multiple Myeloma. Materials and Method: Records of a patient with resection of chest wall tumor. Results: Male patient of 58 years, with one year of costal pain, associated with an indurated increase in volume at the level of the eighth right rib in the mid-axillary line. Chest CT scan demonstrated a suggestive image of plasmacytoma of 79 × 44 mm. Surgical resection was performed, with prolene mesh installation in the defect. Biopsy showed neoplastic compromise due to monoclonal lesion of plasma cells. Study is complemented with bone marrow biopsy confirming multiple myeloma. The patient was treated with adjuvant chemotherapy. Conclusions: Solitary bone plasmacytoma is a low frequency entity, which is associated with the presence of multiple myeloma. At the moment of suspicion, it is necessary to rule out their presence, in order to improve the patient's prognosis.

Substance abuse and health self-perception in Spanish children and adolescents.

OBJECTIVE: The aim of this study was to analyze substance abuse and health self-perception in children and adolescents from the province of Cádiz (Spain). METHODOLOGY: Participants were 738 students, 50.9 boys and 49.1% girls, from elementary school to high school (1st to 12th grade, mean age 12.2. years), who responded a Spanish adaptation of the Health Behavior in School-aged Children Inventory. RESULTS: No difference was observed in percentage of boys and girls reporting to smoke or drink alcohol. Smoking and drinking habits increased with age, being higher in 11th and 12th grade students. Significant differences were observed among the percentage of smokers and non smokers recognizing to have parents, older brothers or friends who smoke. Rates of drug abuse were generally low, being cannabis the most frequently consumed illicit drug. Most respondents had a perception of excellent or good health, with no significant gender differences. About half of subjects considered that health exclusively depends on self behavior, but an important percentage also gave a relevant role to luck. Stomach-ache was the most frequent physical complaint, followed by headache. Psychological complaints mainly corresponded to nervousness and bad temper. Only a small percentage of subjects declared the use of medicines or tablets without prescription. No significant difference in the percentage of respondent who perceived an excellent or good health was observed among substance users and non users. CONCLUSIONS: Substance abuse and health self-perception in children and adolescents are the result of the interaction of a complex series of individual and social factors. Activities aimed to improve health focusing on partial aspects of adolescents' lifestyle most probably will have limited results, and global programs are required.

Resección de metástasis pulmonares / Resection of lung metastases

Surgical treatment of lung metastases (LM) is a therapy used for several types of metastatic cancers. However, the type of surgery and its outcome is controversial. Aim: To describe a series of patients with LM undergoing surgical treatment, their results and long-term follow up. Material and Methods: We retrospectively reviewed all the medical records of patients with the diagnosis of LM, of whatever origin, operated at our hospital between the years 2002 and 2008. We analyzed their clinical characteristics, treatment, morbidity, mortality and results. Results: During this period 24 patients with LM were operated. The mean age was 52.8 +/- 16.6 years. Most patients had kidney cancer as primary tumour. The usual clinical presentation was multiple bilateral nodules. The surgical approach was in general a video-thoracoscopy (40.9 percent) associated with a wedge resection of the lesions (81.8 percent). In 83.4 percent of cases, there were no post-operative complications. Seventy six percent of the patients relapse, in an average of 16.7 +/- 12 months and 68.7 percent were reoperated for a new resection. The probability of surviving more than 3 and 5 years post metastasectomy was 57 percent and 36 percent respectively. Conclusions: In this series the LM were mostly secondary to renal cancer. The video-thoracoscopy is an emergent and safe technique in the treatment of LM, being the main type of surgical approach in our patients. Despite the high percentage of reoperations, the survival rate is comparable to the rest of the published series.

El tratamiento quirúrgico de las metástasis pulmonares (MP) constituye una terapia usada para varios tipos de cánceres metastásicos. Sin embargo, el tipo de cirugía y sus resultados es controversial, por lo que hemos decidido estudiarla. Objetivo: Describir clínicamente una serie de pacientes con MP sometidos a tratamiento quirúrgico, sus resultados y seguimiento a largo plazo. Material y Método: Se revisaron retrospectivamente las fichas de pacientes con el diagnóstico de MP, de cualquier origen, operados en nuestro hospital entre los años 2002 y 2008. Se analizaron las características clínicas, tratamiento, morbimortalidad y resultados. Resultados: Durante este período se operaron 24 pacientes por MP. El promedio de edad fue 52,8 +/- 16,6 años. La mayoría de los pacientes tenía un cáncer renal como tumor primario. La forma habitual de presentación fueron múltiples nodulos bilaterales. El abordaje quirúrgico más frecuente fue por videotoracoscopía (40,9 por ciento) asociado a una resección en cuña de las lesiones (81,8 por ciento). En el 83,4 por ciento no hubo complicaciones post operatorias. El 76,4 por ciento de los pacientes recidivó, en promedio a los 16,7 +/-12 meses y el 68,7 por ciento fue reintervenido para una nueva resección. La probabilidad de sobrevivir más de 3 y 5 años post me-tastasectomía fue de 57 por ciento y 36 por ciento respectivamente. Conclusiones: En esta serie las MP fueron principalmente secundarias a cáncer renal. La videotoracoscopía es una cirugía emergente y segura en el tratamiento de las MP, siendo la principal forma de abordaje quirúrgico en nuestros pacientes. A pesar del elevado porcentaje de reintervenciones, la sobrevida es comparable al resto de las series publicadas.

Cuerpo extraño pulmonar: resección por videotoracoscopia: caso clínico / Inhaled foreign body: a video-thoracoscopic resection: a case report

We report an 18 years old male who reported a history of 2 years of recurrent episodes of hemoptysis with no other symptoms. A chest X-ray and chest CT sean showed an image suggestive of a metallic foreign body in the posterior segments of the right lower lobe. Since fibro-bronchoscopy failed to extract it, a video-thoracoscopy with wedge resection of the affected lung parenchyma was performed, finding a capsular lesion of inflammatory tissue, which contained a map pin in its interior. The clinical outcome was favorable, with a chest X-ray showing proper lung re-expansion. The patient was discharged 48 hours after surgery.

Se reporta el caso de un paciente hombre de 18 años con un cuerpo extraño pulmonar de presentación tardía, que consultó por un cuadro de 2 años de evolución de episodios de hemoptisis escasa y recurrente, sin otros síntomas asociados. Se realizó estudio con radiografía y TAC de tórax evidenciándose una imagen sugerente de un cuerpo extraño metálico en los segmentos posteriores del lóbulo inferior derecho. Dado que la fibrobroncoscopia resultó frustra se decidió realizar una videotoracoscopia con resección en cuña del parénquima pulmonar afectado, encontrándose una lesión capsular de tejido inflamatorio que en su interior contenía un chinche. La evolución clínica fue favorable, con radiografía de tórax de control con adecuada reexpansión pulmonar y dándose de alta a las 48 hrs postoperatorias.

Empiema pleural: etiología, tratamiento y complicaciones / Therapy of empyema: retrospective review of 77 patients

Background: Empyema can cause significant medical problems, despite the advances in antimicrobial and surgical treatments. Aim: To compare the results of different therapeutic approaches to empyema. Material and Methods: Retrospective review of medical records of 77 patients with empyema (aged 53 +/- 20 years, 48 males) treated in a clinical hospital between 1994 and 2007. Results: In 74 percent of patients the cause of empyema was pneumonia. Thirty two were initially managed with percutaneous pleurostomy. Seven of these required and additional intervention due to residual empyema. Eleven patients were managed with open thoracotomy and 34 with video assisted thoracoscopy. Complications for percutaneous pleurostomy, open thoracotomy and video assisted thoracoscopy were 34, 36 and 12 percent respectively. The figures for mortality were 25, 0 and 0 percent respectively. Patients subjected to video assisted thoracoscopy required less days with a pleural tube than those subjected to percutaneous pleurostomy or open thoracotomy (5,5-14,3 and 12,4 days respectively). Conclusions: Video assisted thoracoscopy had the best therapeutic results for empyema in this series of patients.

Introducción: Definido como la presencia de infección bacteriana en el espacio pleural, determina una importante morbimortalidad a pesar de los avances en el tratamiento antibiótico y las nuevas técnicas quirúrgicas. Objetivos: Comparar resultados de las distintas estrategias terapéuticas para el Empiema Pleural (EP). Material y Métodos: Revisión retrospectiva de fichas clínicas de pacientes con diagnóstico de EP manejados en el Hospital Clínico Universidad de Chile entre enero de 1994 y junio de 2007. Se consideró significación estadística con p < 0,05. Resultados: De 77 pacientes, 48 fueron hombres y 29 mujeres, con edad promedio de 52,6 +/- 19,9 años. La causa más frecuente de EP fue la neumonía (74 por ciento). En 55 pacientes se realizaron exámenes imagenológicos complementarios a la radiografía de tórax. Treinta y dos pacientes se manejaron inicialmente con pleurostomía percutánea (PP). Siete de ellos requirieron una nueva intervención por empiema residual. Once se manejaron con toracotomía abierta (TA) y 34 con Toracoscopia Vídeo asistida (TVA). La tasa de complicaciones y mortalidad fue: 34,37 por ciento y 25 por ciento para PP, 11,7 por ciento y 0 por ciento para TVA y 36,36 por ciento y 0 por ciento para TA, respectivamente (diferencias significativas). El tiempo de hospitalización promedio fue de 22,8 días, y el de tubo pleural de 9,21 días. Se encontró diferencias significativas entre los días con tubo pleural de los pacientes sometidos a TVA (X = 5,56) respecto de los sometidos a PP (X = 14,24) y TA (X = 12,4). No se observan diferencias en tiempo de hospitalización. Conclusiones: La TVA demuestra obtener mejores resultados que la PP y la TA al evaluar mortalidad, complicaciones y días de tubo pleural.

Monitoring the effects of training load changes on stress and recovery in swimmers.

This study was designed to investigate if monitoring of stress and recovery may be useful to detect overreaching in its early stages and may be used to evaluate effects of changes in training load. Nine swimmers were applied the Recovery-Stress Questionnaire for Athletes (RESTQ-Sport) in four different occasions (M1, M2, M3, M4) along a 6-week training period prior to a competition. During the basal training period (M1), recovery scales scored higher than stress scales, being the scales General well-being, Social recovery and Being in shape those reaching higher scores. Following the measure corresponding to the second training period (M2), in which training volume reached a maximum, there were significant increases in two stress scales (Injury and Emotional exhaustion), and decreases in three recovery scales (Success, Physical recovery, and Self-efficacy). Values increased again and did not significantly differ from those corresponding to the first measure during measures M3 and M4, in which there was a decrease in training volume and training time. Only a recovery scale score (Success) increased significantly from period M2 to period M4. When the recovery-stress (total recovery - total stress) state was calculated, it was found that there was a significant decreases in M2, and values progressively increased in measures M3 and M4, with no significant difference from M1. Results obtained indicate that the RESTQ-Sport is able to show significant changes concurrently with training loads. Regular monitoring of stress and recovery by these measures may help to detect overreaching in its early stages.

Enhancement of photorespiration in immobilized Chlamydomonas reinhardtii cells.

Immobilization of Chlamydomonas reinhardtii in alginate increases its photorespiration rate. In the immobilized cells, the photorespiratory enzyme, phosphoglycolate phosphatase, was 75% higher than in freely suspended cells. Thus, the immobilized cells produced glycolate at twice the rate than in freely suspended cells when treated with aminooxyacetate (a transaminase inhibitor). With immobilized cells in a batch reactor, 270 micromol glycolate mg(-1) Chl was produced after 12 h.

Hemangioma esclerosante pulmonar como nódulo pulmonar solitario: comunicación de un caso / Sclerosing hemangioma presenting as a solitary lung nodule: report of one case

Lung sclerosing hemangioma is an uncommon tumor that presents as a solitary asymptomatic nodule and that affects middle age women. It derives from type II pneumocytes. We report a 52 years old female with a solitary lung nodule detected in a chest X ray requested for the diagnosis of an acute respiratory disease. The nodule was excised by video thoracoscopy and the frozen section biopsy was informed as a non small cell undifferentiated carcinoma. Therefore an inferior right lobectomy with lymph node resection was performed. The definitive biopsy was informed as a lung sclerosing hemangioma.

Relationship between perceived physical ability and sport participation motives in young competitive swimmers.

AIM: The purpose of this study was to examine the relationship between participation motives and perceived physical ability in young Spanish swimmers and to investigate whether swimmers with high or low perceived physical competence differ in their intrinsic and/or extrinsic reasons for participation involvement. METHODS: Four hundred and twenty-eight swimmers (204 boys and 224 girls), aged 8-22 years, responded to the Spanish versions of the Participation Motivation Inventory (PMI) and the Perceived Physical Ability Scale (PPA). Swimmers were divided into low (below the 33%), medium (between the 33-66%) and high (above the 66%) perceived ability groups. RESULTS: Multivariate analysis indicated the existence of differences in motives for participation between swimmers with different levels of perceived physical ability. Follow-up univariate analyses yielded significant (p<0.05) effects for 5 motivational factors: health/fitness, fun/friendship, competition/skills, affiliation and status. In all cases swimmers high in perceived physical ability rated significantly higher than those in the other categories. The PPA by gender, age or level of expertise interaction was not significant. CONCLUSIONS: Practitioners must consider the perceived ability of the competitors to better structure the social environment within which their swimmers operate.

Identification of dropout reasons in young competitive swimmers.

AIM: The purpose of this study was to examine reasons for discontinuing sport participation in Spanish competitive swimmers. METHODS: Sixty-two swimming dropouts (40 males and 22 females, ranging in age from 14 to 30 years) were administered the Questionnaire of Reasons for Attrition of Gould et al. RESULTS: The results of the survey indicated that having other things to do was the most important reason for attrition. Other items rated important were related to lack of fun, perception of failure or low skill, while low ratings were given to items related to achievement/status or affiliation. A significant multivariate effect was obtained for gender and for experience at dropout. Analysis of individual items by "t"-test demonstrated that females placed greater emphasis than males on excessive pressure, hard training, dislike of competition, not winning enough and not feeling important enough. Former swimmers with less experience at dropout rated interest in another sport as more important and being too old as less important than swimmers with more experience. CONCLUSION: The results of this study support the importance of negative factors related with aspects of the athletic environment that lead to discontinuing in competitive swimming.

[Study of 1,595 brucellosis cases in the Almeria province (1972-1998) based on epidemiological data from disease reporting]. / Estudio de 1.595 casos de brucelosis en la provincia de Almería (1972-1998) según datos epidemiológicos de declaración de la enfermedad.

OBJECTIVE: To know clinical, diagnostic, and treatment issues of brucellosis in the Almeria province. METHODS: Descriptive, epidemiological study from 1,595 disease report cards in the Almeria province during the 1972-1998 period. Issues concerning complications and treatment were reported in 890 cards (57.8%), symptoms, signs and hemograms in 565 (35.4%), and other diagnostic findings in all cards. The chi2 test was used to compare independent qualitative parameters for a 95% CI. RESULTS: In the early phase the most common symptom was asthenia (95.2%); sweating in the chronic stage (95.8%). The most commonly recorded sign was spleen enlargement (37.5%) and the most commonly reported complication was bone and joint involvement (22.8%). No changes in symptoms occurred over years. The hemogram revealed anemia in 30.3% of cases. Blood culture was positive for 91.2%. Regarding serological diagnosis, rose Bengal was positive for 99.2% of cases; the most common agglutination titer to Brucella or B. mellitensis was 1/640 (13.5%). The most commonly used therapy consisted of the association tetracycline plus streptomycin (42.4%). For 42.6% of cards, patients were transferred to hospital, particularly since 1984. CONCLUSIONS: Generally speaking, clinical data recorded in the reporting card regarding brucellosis disease reveal the clinical features of the disease, after a long surveillance period. Rose Bengal should be used as screening test for the diagnosis of this disease.