Single-incision versus four-port laparoscopic cholecystectomy in an ambulatory surgery setting: A prospective randomised double-blind controlled trial.

BACKGROUND: Single-incision laparoscopic cholecystectomy (SILC) can be done as a day-case procedure and may have advantages over conventional laparoscopic cholecystectomy (LC). We present the results of our study looking at post-operative pain and post-operative recovery time. METHODS: This was a single-institution randomised double-blind controlled trial. Seventy-three patients with symptomatic cholelithiasis were randomized to SILC (n = 37) or LC (n = 36). The primary endpoint was to compare post-operative pain. We also compared surgical time, procedural difficulty, adverse events, additional ports used and conversion rate, success of day surgery process, return to work, aesthetic satisfaction, quality of life and 4-year incisional hernia rate. RESULTS: In the SILC group, post-operative analgesic requirements were lower on day 7, there was an earlier return to work and cosmetic satisfaction was significantly higher. The SILC procedure presented a higher technical difficulty. Operative time, surgical complications, post-operative pain, success of the day-case process, return to normal activity, quality of life scores and incisional hernia rates were similar for both the procedures. CONCLUSIONS: SILC has advantages over LC in terms of late post-operative analgesic requirements and aesthetic results; however, it is technically harder to perform. There was no benefit in terms of day surgery outcomes.

High incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis. A case-control study.

OBJECTIVES: To estimate the incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis (RA) and analyze risk factors for fracture. METHODS: Incidence of clinical fragility fractures in 330 postmenopausal women with RA was compared to that of a control population of 660 age-matched postmenopausal Spanish women. Clinical fractures during the previous five years were recorded. We analyzed associations with risk factors for fracture in both populations and with disease-related variables in RA patients. RESULTS: Median age of RA patients was 64 years; median RA duration was eight years. Sixty-nine percent were in remission or on low activity. Eighty-five percent had received glucocorticoids (GCs); 85 %, methotrexate; and 40 %, ≥1 biologic DMARD. Fifty-four patients and 47 controls had ≥1 major osteoporotic fracture (MOF). Incidence of MOFs was 3.55 per 100 patient-year in patients and 0.72 in controls (HR: 2.6). Risk factors for MOFs in RA patients were age, previous fracture, parental hip fracture, years since menopause, BMD, erosions, disease activity and disability, and cumulative dose of GCs. Previous fracture in RA patients was a strong risk for MOFs (HR: 10.37). CONCLUSION: Of every 100 postmenopausal Spanish women with RA, 3-4 have a MOF per year. This is more than double that of the general population. A previous fracture poses a high risk for a new fracture. Other classic risk factors for fracture, RA disease activity and disability, and the cumulative dose of GCs are associated with fracture development.

Epidemiology of osteoporotic fractures in Andalusia, Spain, from 2000-2010. / Epidemiología de las fracturas osteoporóticas en Andalucía en el período 2000-2010.

BACKGROUND AND OBJECTIVE: The aim of this study was to examine the epidemiological data on osteoporotic fractures in Andalusia in the period 2000-2010. In view of the lack of epidemiological studies of fractures in Andalusia, we set out to ascertain the number and incidence rates of osteoporotic fractures and their distribution by gender and age, location, comorbidity, seasonality and secular trend. METHODS: Cohort study observed over a period of 11 years analysing the data provided by the Minimum Basic Data Set register for the period 2000-2010. RESULTS: There were a total of 96,458 osteoporotic fractures, with a crude incidence rate of 374.18 fractures per 100,000 population. Fractures increased in this period by 27% (p<.01, IC 95%, 0.71; 0.73). We found a trend change in female/male ratio, from 3.4 to 3.2, and in the reduction in fractures in the last two years, especially in the past year, with a decrease of 11.2% in hip fractures (p<.001, IC 95%, 0.88; 0.895). CONCLUSIONS: In this period, there has been an increase in fractures as a consequence of the ageing of the population, but also a change in trend, with fractures decreasing in some age groups. The incidence rate of fractures varies between different countries and regions of Spain, and between different provinces of Andalusia.

[Effect of tumour necrosis factor α blockade on bone metabolism in chronic inflammatory joint diseases]. / Efecto del bloqueo del factor de necrosis tumoral α sobre el metabolismo óseo en las enfermedades inflamatorias articulares crónicas.

BACKGROUND AND OBJECTIVE: To evaluate the effect of anti-TNF treatments on bone mineral density (BMD), bone remodelling markers (BRM) and receptor activator of nuclear factor κB ligand (RANKL) and osteoprotegerin (OPG) in patients with chronic inflammatory joint diseases. METHODS: A longitudinal prospective study was performed under clinical practice conditions on 31 patients diagnosed of rheumatoid arthritis, psoriatic arthropathy and ankylosing spondylitis who had received treatment with anti-TNF alpha drugs for one year. BMD, OPG and RANKL soluble form (sRANKL) were studied at the onset and end of the study. During the study (0, 3, 6, 9 and 12 month), disease activity (SDAI, BASDAI and CRP), functional capacity (HAQ, BASFI), BRM and vitamin D were studied. RESULTS: BMD was not modified after one year of treatment. The patients who took corticosteroids had a mean bone mass loss of 3% in the lumbar spine (±1.6, P=.02). In regards to the BRM, did not experience significant changes over the course of the study. Disease activity, both SDAI (P=.002) and BASDAI (P=.002), decreased. OPG was maintained without changes during the year of treatment while both the sRANKL (0.28±0.22, P=.013) and sRANKL/OPG ratio significantly decreased (0.04±0.03, P=.031). CONCLUSION: The patients being treated with anti-TNF did not present with a significant loss of DMO during the study (one year), at the same time experiencing an improvement in disease activity. This protection has been clearer in the responding patients.

[Consensus document: nutritional and metabolic importance of cow's milk]. / Documento de consenso: importancia nutricional y metabólica de la leche.

Cow's milk is a staple food for human consumption at all stages of life. Industrial processing has allowed widespread access to its consumption by the population, which has helped to significantly improve their health. From its composition point of view, milk is a complete and balanced food that provides high nutrient content in relation to its calorie content, so its consumption should be considered necessary from childhood to elderly. The benefits of cow's milk are not limited to its nutritional value, but extend beyond and are a factor of prevention in certain non communicable pathologies as cardiovascular disease, some cancers, high blood pressure or bone or dental pathology. It can also help in the fight against childhood overweight and obesity. In recent years we have seen a worrying decline in milk consumption among the Spanish population, at least in part influenced by misconceptions about its consumption and of other dairy products. This consensus document aims to review the current state of the topic regarding the effects of milk consumption on health, while making a call to the institutions and scientific societies to develop programs and information campaigns about the benefits of milk and dairy products consumption.

La leche de vaca es un alimento básico en la alimentación humana en todas las etapas de la vida. Su procesamiento industrial ha permitido el acceso generalizado a su consumo por parte de la población, lo que ha contribuido a mejorar notablemente su nivel de salud. Desde el punto de vista de su composición, la leche es un alimento completo y equilibrado, que proporciona un elevado contenido de nutrientes en relación con su contenido calórico, por lo que su consumo debe considerarse necesario desde la infancia a la tercera edad. Los beneficios de la leche de vaca no se limitan exclusivamente a su valor nutricional, sino que se extienden más allá y constituyen un factor de prevención en determinadas patologías afluentes como son la enfermedad cardiovascular, algunos tipos de cáncer, la hipertensión arterial o en patología ósea o dental. Puede contribuir también en la lucha frente al sobrepeso y la obesidad infantil. En los últimos años hemos asistido a un descenso preocupante en el consumo de leche entre la población española, condicionado al menos en parte por ideas equivocadas sobre su consumo y el de otros derivados lácteos. Este documento de consenso pretende revisar el estado actual de la cuestión en relación con los efectos del consumo de leche sobre la salud, al tiempo que hace una llamada a las instituciones y a las sociedades científicas para elaborar programas y campañas divulgativas sobre los beneficios del consumo de leche y derivados lácteos.