[Maximal static respiratory pressures. The importance of the study of normal reference values]. / Presiones respiratorias estáticas máximas. Importancia del estudio de los valores de referencia normales.

In order to determine the validity for our population of the theoretical reference values available in the literature today, we studied respiratory muscle force by calculating maximum expiratory pressure PEmax and maximum inspiratory pressure (PImax) in 100 healthy subjects in Asturias (50 women) between 17 and 80 years-old (mean 40.4 +/- 19.3 years). We used the same methods and apparatus as Black and Hyatt and compared the results with theoretical values given by them as references corresponding to our subjects, according to age and sex. Values were significantly lower (p < 0.001) in our population for both parameters and for both men and women. In men PEmax was 69.7% and PImax was 88.5% of the theoretical values, in women PEmax was 60.9% and PImax was 82.9%. These figures indicate that the theoretical values given by Black and Hyatt are not valid for the population we studied and that normal reference values appropriate for each population, laboratory and apparatus must be obtained if valid conclusions are to be reached.

[Alcoholic liver cirrhosis, portal hypertension, and behavior of different lymphocyte populations]. / Cirrosis hepática alcohólica, hipertensión portal y comportamiento de las diversas poblaciones de linfocitos.

There is no clear explanation for the known fact that peripheral levels of T lymphocytes are decreased in alcoholic hepatic cirrhosis. Cellular immune deficiency in cirrhosis has been attributed to this phenomenon. In order to confirm this observation and clarify its cause, the different lymphocyte populations of the peripheral blood of 52 patients with alcoholic hepatic cirrhosis and of 30 control subjects were studied. Absolute lymphocyte counts were decreased in cirrhotic patients (p less than 0.05) due to a marked reduction of T lymphocytes (p less than 0.001). Furthermore, T lymphocytes and, to a lesser degree, B lymphocytes, but not the remaining lymphocyte populations (referred to as "other lymphocytes" in this study), were decreased in relation to the existence of portal hypertension. Thus, a significant reduction of T and B lymphocytes (p less than 0.001) exists in cirrhotics with portal hypertension with respect to those without portal hypertension. The sequestering action of the hypertrophic spleen in patients with portal hypertension could be responsible for this phenomenon.

[The current treatment of nonvaricose upper digestive hemorrhage. The moderator's introduction]. / Tratamiento actual de la hemorragia digestiva alta no varicosa. Introducción del moderador.

Incidence of peptic ulcer is about 2-3/1000 and its prevalence 17/1000. Hospitalizations for ulcer are stable at 30-40/100,000 inhabitants. About 70% of patients hospitalized for peptic ulcer complications are over 60 years of age and 80% of deaths occur in individuals aged more than 65. The main association for ulcer and bleeding is the intake of NSAIDS. This symposium analyzes various diagnostic and therapeutic aspects of peptic ulcer bleeding.

[Incidence of epidermoid cancer of the esophagus in Asturias (1975-85)]. / Incidencia del cáncer epidermoide de esófago en Asturias (1975-85).

We present the incidence the esophageal squamous cell carcinoma in Asturias, based on the review of the clinical histories of eleven years (1975-85). Of 356 total cases, 92.4% were male patients and the remaining 7.6% females; the relation M:F was 12.2:1. Mean age at the time of diagnosis was 59.4 +/- 9.6 for males and 70 +/- for females. Total annual incidence was 2.8 +/- 0.8 cases/10(5) + population/year. Maximal annual incidence was registered in 1981: 1.1 cases/10(5) population/year. Asturias has eight health districts; those with highest incidence were mining areas: Mieres, Cangas de Narcea and Riaño. Compared to that of some developing countries, the incidence of esophageal cancer in Asturias is low, similar to that in European countries (except France) and white population of the USA; there is an aggregation of cases in males living in mining areas.

[Influence of liver cirrhosis with and without ascites on ventilatory mechanics]. / Influencia de la cirrosis hepática con y sin ascitis sobre la mecánica ventilatoria.

BACKGROUND: The thoracic cavity plays an important role in the mechanical ventilatory function, and the alteration of some of its structures, such as those which occur in decompensated cirrhosis of the liver, for example the presence of ascites and muscle atrophy, directly influence its normal function. METHODS: In the present study we have evaluated the ventilatory function and respiratory muscular tension by means of the calculation of volumes, flows and resistances of the airways, and also the maximum inspiratory and expiratory pressures (Pimax, Pemax). PATIENTS: One hundred patients with liver cirrhosis and ascites without associated respiratory illness, mean age 57 +/- 15 years (range 32-80), were studied. We evaluated the respiratory function before and after the disappearance of the ascites. RESULTS: A restrictive pattern was evident, and various parameters were altered. The most affected being that of the reserve expiratory volume. No associated bronchial obstruction was observed. Respiratory muscular tension was decreased in both the Pimax and the Pemax. With the disappearance of the ascites we found an improvement in the affected parameters, but this did not reach normality. CONCLUSION: In liver cirrhosis associated with ascites, the most common respiratory pattern, is a decrease in ventilatory function of a restrictive type, and also a decrease in the respiratory muscular tension. These alterations improve after the resolution of the ascites.

Epidemiological study of the prevalence of Helicobacter pylori infection in the general population in Asturias, Spain.

BACKGROUND: Helicobacter pylori is a worldwide infection, and it is estimated that approximately 50% of the general population is affected. However, its distribution varies considerably between developed and developing countries. AIMS: in the present study we report the results of an epidemiological investigation of the prevalence of H. pylori infection in the general population in Asturias (Northern Spain), in order to describe the current state of this infection in our region, and obtain figures for comparison with the results obtained in different communities of Spain and other countries. EXPERIMENTAL DESIGN: a descriptive transversal, epidemiological study, based on the serological determination of the IgG antibodies against H. pylori was carried out in the general population of a randomly selected sample of subjects without previous gastroduodenal antecedents. PARTICIPANTS: we analyzed 480 serum samples obtained from the general population of Asturias. These were divided into decades according to the age pyramid and tested for the presence of antibodies against H. pylori with a commercially available latex agglutination technique (Pyloriset). RESULTS: the global prevalence of H. pylori infection in our study was 226/480 (49.2%), and was slightly higher in women (50.6%) compared to men (47.6%). No significant differences were found between sexes (p = 0.51). In the first decade mean prevalence was 13.6%. In the second this figure was 25.4%, and it increased steadily to a maximum in the sixth decade of 76.4%. Thereafter, the prevalence decreased to 66.6% in persons over 80 years of age. CONCLUSIONS: we found a high prevalence approximately 50% of H. pylori infection in the general population of Asturias, as in other epidemiological studies in Spain and other European countries. The distribution according to age shows a clear tendency to increase, from childhood to adolescence and adult life (50-60 years), when prevalence is highest (76%). From this decade onwards it begins to decrease, showing a clear cohort effect with a pattern intermediate between that of developed and developing countries.

[Study of arterial blood gases in liver cirrhosis with and without ascites]. / Estudio de la gasometría arterial en cirrosis hepática con y sin ascitis.

OBJECTIVE: The study of the disturbances of arterial gases and the changes in the arterial pH which are present in patients with liver cirrhosis and ascites and their modification after the disappearance of ascites by treatment. EXPERIMENTAL DESIGN: Open study,with protocol and prospective, to evaluate the changes in measurement of the arterial gases and acid-base, parameters in matching groups of patients. PATIENTS: We include 24 patients, 15 males and 9 females, without preliminary or cardio-respiratory pathology age range between 37 and 77 years, average of 56.8 years, all of them diagnosed of liver cirrhosis of different etiologies and with important ascites. All of them finished the study. RESULTS: In patients with liver cirrhosis and ascites a fall in the PaO2 and in the PaCO2 was demonstrated the pH in the upper limit of the normality compatible with hypoxemia and respiratory alkalosis. After the disappearance of the ascites, a significant improvement in the PaO2 (p < 0.05), without any changes in the PaCO2 and pH values was apparent. CONCLUSIONS: In patients with liver cirrhosis, with or without ascites, hyperventilation is present, that can be multifactorial in origin, but which really has an unknown cause. We have found no relationship with the circulating levels of progesterone.

[Prognosis of patients with irritable intestine syndrome. A prospective study with 1 year follow-up]. / Pronóstico de los pacientes con síndrome del intestino irritable. Estudio prospectivo con seguimiento de un año.

An analysis was made of the prognosis over a one-year follow-up period of a consecutive series of 86 out patients with irritable bowel syndrome (SII) who were treated randomly with an antispasmodic (otilonium) or a tranquilizer (clobazam), and the existence of factors, mainly psychological, that could worsen it was determined with the Zung anxiety test and the Hamilton depression scale. We confirmed that irritable intestine syndrome is a chronic disease, with a mean course of 13 +/- 12.5 years at the time of consultation. A large proportion of patients had permanent problems (58.1%) and did not experience important changes in the intensity of symptoms throughout evolution (68.6%). Although most improved initially with the treatment instated (76.7%), the improvement was rarely complete (11.8%). A year after beginning treatment, 61.6% were the same or worse than before the index consultation. In the group of patients with a good course, the proportion of those that correctly followed medical treatment and of those who had experienced more or less lengthy asymptomatic periods before consultation was significantly larger. In the group of patients with poor evolution, the scores on the Zung anxiety test and Hamilton depression scale were significantly higher than in those who evolved favorably. Neither consultation of a specialist nor the treatment used in this study seem to have contributed to an evident improvement in the prognosis.

[An epidemiologic study on the prevalence of alcohol consumption in a rural area of Asturias (council of Somiedo)]. / Estudio epidemiológico sobre la prevalencia del consumo de alcohol en una zona rural asturiana (concejo de Somiedo).

AIMS: To determine the prevalence of alcoholism in a rural area of Asturias and the usefulness of others clinical and analytical parameters for a rapid detection of its related pathology. MATERIAL AND METHODS: We conducted a cross-sectional descriptive study on a sample of 198 persons, divided into two groups (Group I: Heavy-drinkers and Group II: Moderate and nondrinkers), according with alcohol daily intake. The limit for the classification was the consumption of 80 or more grams of ethanol/day in men, and 60 g/day or more in women. Data about physical findings and blood biochemistry were collected and compared into the two groups. RESULTS: The prevalence of alcoholism in group I, was of 16.5% and the mean age of 54.3 +/- 11.4 years with increased proportion of males over females with a ratio of 7.25/1. The main analytical parameters useful as indicators of heavy alcohol consumption were an increase of AST, ALT, GGT, Total Cholesterol, Uric acid and gammaglobulin levels. We found a significative relation between legal problems and alcohol consumption (p < 0.005) as well as an increased prevalence of chronic obstructive lung diseases (p < 0.005). Digestive diseases as a whole, were most frequently associated with heavy alcohol consumption. CONCLUSION: This paper confirms the finding of a increased alcohol consumption in this mainly agricultural area of Asturias (Spain) in 16.5% and also confirms the usefulness of the use of simple clinical and analytical parameters for its detection in order to permit an earlier diagnostic and better use of preventive measures.

[Immunity and malnutrition in alcoholic liver diseases]. / Inmunidad y malnutrición en hepatopatías alcohólicas.

Assessment of immunity was performed in 150 patients with alcoholic liver disease (15 steatosis, 30 hepatitis and 105 cirrhosis: 34 in grade A, 34 in grade B and 37 in grade C, according to Child-Pugh classification). This assessment was based on the total lymphocyte count and a delayed hypersensitivity skin multiple test. Likewise, nutritional status of patients was studied using anthropometric and biochemical parameters (triceps skinfold thickness, arm muscle circumference and serum albumin). The association between alcoholic liver disease, malnutrition and immunity was analyzed. The results show that lymphopenia and disorders in cell-mediate immunity were more common in those patients with cirrhosis, increasing the number of anergic patients while the degree of hepatocellular insufficiency worsens (8.8% in grade A, 11.8% in grade B and 32.4% in grade C). Although there where significantly more alterations of delayed cutaneous hypersensitivity in cirrhotics with malnutrition (hypoergy: 55.2% and anergy: 37.9%) than in those well nourished (hypoergy: 23.7% and anergy: 10.5%, p < 0.01), lymphopenia didn't show differences between these groups. We think that immunity mus'nt be considered a parameter in nutritional assessment.

[An epidemiologic study of the prevalence of alcohol consumption in the Council of Tineo (Asturias)]. / Estudio epidemiológico de la prevalencia del consumo de alcohol en el Concejo de Tineo (Asturias).

AIMS: To know the incidence and prevalence of alcohol consumption in the studied area and also the somatometric alterations and laboratory findings found. PATIENTS AND METHODS: One prospective study was performed in one-way, transversal in a sample of 216 people. With a protocol we collect the data of alcohol habits and also physical examination and biochemical findings. We divided the sample into two groups: Group I "heavy drinkers" (men with ethanol intake greater than 100 g/day, and women more than 50 g/day), and Group II composed by abstemics and slight drinkers. RESULTS: We found and excessive intake of alcohol in the 15.75%, the whole sample (11.6% males and 4.17% females). Mean age was of 41.7% +/- 12.1 y.o. Un group I we found slight jaundice in 32.3% spinders in 64.7%, hepatomegaly in 58.8%, palmar erythema in 29.4% gynecomastia in 29.4% and Dupuytren in 11.8% (p < 0.001). Of the symptoms we found matutinal cough in 52.9%, epigastric burning in 64.7%, nausea and vomiting in 41.2% and hands tremors in 29.4% (p < 0.001). Biochemical parameters elevated were found in TGC TGO/TGP, GGT and amylase. CONCLUSIONS: In this study we confirm the excessive alcohol consumption in this rural area of Tineo in Asturias. We also found an important increase of alcohol intake in last year in women. The utility of analytical and exploratory findings is also proved for the early diagnosis of this illness in the ambulatory study of these patients.

[Acute ++indomethacin-induced hepatitis in a female patient with asymptomatic primary biliary cirrhosis]. / Hepatitis aguda por indometacina en una enferma con cirrosis biliar primaria asintomática.

We present an infrequent case of acute hepatitis by indomethacin, in a patient with a primary biliary cirrhosis, previously not diagnosed and asymptomatic, in who during in the follow-up, with a persistent analytical pattern of disociated cholestasis, a liver biopsy was indicated, with the final diagnosis of chronic non-suppurative destructive cholangitis.

[An epidemiological study of alcohol consumption habits in La Foz de Morcín (Asturias)]. / Estudio epidemiológico sobre los hábitos del consumo de alcohol en La Foz de Morcín (Asturias).

OBJECTIVE: To determine the prevalence of alcoholism in a rural area of Asturias and the correlation between this disease and several disorders, symptoms and clinical signs, as well as personal and social factors. DESIGN: We conducted a cross-sectional descriptive study on a sample of 200 persons divided into two groups according to alcohol consumption, stating as limit for the classification of a person as hard-drinker, the consumption of 80 or more grams of ethanol/day in the case of men and 50 gr/day in the case of women, during at least 10 years. Through a specially designed survey and the data on physical explorations and blood biochemistry, the results in both groups were compared. RESULTS: The prevalence of alcoholism in the area under study was 19.5%, with domination of males (12/1) and a mean age of 47.4 +/- 12.8 years, this being globally greater than the national average. The most sensitive analytical parameters a indicators of hard alcohol consumption were Hct, Hb, TGO, TGP, FA, bilirubin and gamma-GT. The main physical signs observed among the hard-drinkers were: malar telangiectasias, parathyroid hypertrophy, conjunctival jaundice and hepatomegaly. There were no significant differences between both groups with respect to mean age, marital status or labour activity. A greater prevalence of depressive-type psychiatric problems were observed in the group of hard-drinkers. In this group, there was also a greater proportion of traumatic antecedents, judicial-type problems and accidents, as well as a greater work absenteeism. CONCLUSIONS: All these findings support the already known idea of the severity of the problem caused by excessive consumption of alcohol, both at the individual, public health and socio-economical level; as well as the usefulness of several hematological and hepatic biochemical parameters for its detection. The high prevalence of excessive alcohol consumption in this rural area of Asturias, its population being characterized by a great proportion of miners, has also been demonstrated.