Comparison of oxygen cost of breathing between pressure-support ventilation and airway pressure release ventilation.

We compared the oxygen cost of breathing between pressure-support ventilation (PSV) and airway pressure release ventilation (APRV). This prospective, randomized, crossover study was conducted in a mixed ICU of a university hospital. Twenty clinically stable and spontaneously breathing patients after long-term mechanical ventilation were included. The patients were randomized to start on either PSV or APRV mode and measurements were obtained after an adaptation period of 30 minutes with a PaCO2 between 35-45 mmHg and PaO2 above 60 mmHg. Patients were then switched to the other mode and the same measurements were repeated. Indirect calorimetry was performed during each ventilatory mode for a period of 30 minutes. Oxygen consumption, energy expenditure, CO2 production, and respiratory quotient were measured. The parameters did not differ significantly between the two ventilatory modes, regardless of the patient's randomization. There were no statistically significant differences with regard to respiratory rate, minute volume, and blood gas analysis. All patients tolerated both ventilatory modes without signs of discomfort. PSV and APRV produced similar results in terms of oxygen cost of breathing and other metabolic variables.

The evaluation of diagnostic accordance between plain radiography and bone scintigraphy for the assessment of sternum and rib fractures in the early period of blunt trauma.

OBJECTIVE: To evaluate the diagnostic accordance between scintigraphy and radiography in the early period following blunt thoracic trauma. DESIGN: Double-blind, prospective clinical study. METHODS: Thirty-four adult patients with blunt thoracic trauma were examined by plain radiography and scintigraphy within 24 hours of trauma. RESULTS: Radiography displayed pathologies in 25 (73.5%), while scintigraphy suggested pathologies in 24 (70.5%) patients. Rib fractures were identified radiographically in 16 (47%) and scintigraphically in 17 (50%) patients. Lateral radiograph of the sternum showed fracture in 10 (52.6%), while scintigraphy suggested fracture in 14 (73.6%) patients with suspected sternal trauma. CONCLUSION: Scintigraphy gave better results in the evaluation of sternal fractures during the early period of thorax trauma. Conventional plain radiography is thought to be the initial imaging modality, because it saves time and shows hemothorax or pneumothorax besides the osseous abnormality.

Surgery in Spain.

The Iberian Peninsula-the southwestern point of Europe, between the Mediterranean Sea and the Atlantic Ocean-was visited and settled in ancient times by a variety of peoples. Phoenicians, Carthaginians, Celts, Greeks, Romans, Visigoths, and Arabs all left their mark on the peninsula, and their cultures blended together to found, among other things, a rich tradition in medicine and surgery. During the Renaissance, the fluid exchange of technical skills and knowledge with the rest of Europe and the emergence of universities ensured the development of a high level of medical expertise. Today, surgery in Spain is at the forefront of innovations in the field.

Breast cancer screening in Navarra: interpretation of a high detection rate at the first screening round and a low rate at the second round.

Our objective was to evaluate the on-going European pilot project for breast cancer screening in Navarra, Spain, and to predict the effects and costs of the programme in the long run. Observed results in Navarra, consisting of more than 100,000 screens, were compared with expected results. A microsimulation screening analysis model was used that included demographical, epidemiological and screening characteristics of Navarra. Alternative assumptions on epidemiological and screening characteristics were also addressed. The observed detection rate (5.9 per 1,000 screened women) in the first round was 18% higher than expected; the observed rate in the subsequent round (2.9) was 17% lower than expected. Longer pre-clinical durations, lower sensitivity or the existence of a high-risk group in Navarra could not satisfactorily explain the first and second round results together. Nevertheless, the programme will have an important health benefit for the women involved, due to an important trend in incidence in recent years and the relatively unfavourable clinical stage distribution in Navarra. The proportion T2+ cancers that will be prevented after 10 years of screening amounts to 36%. The annual mortality reduction in steady state is expected to range between 17% (if the observed rates in the second round indicate real screening performance) to 23% (if the first round indicates real performance). Our results demonstrate that a high detection rate in the first round is insufficient to evaluate the quality of a programme. Interval cancer rates, results of the subsequent round and size distributions are also crucial indicators of the quality of the screening programme and should be analysed in their specific context.

A comparative study of smoking, drinking and dietary habits in population samples in France, Italy, Spain and Switzerland. II. Tobacco smoking.

This paper describes the smoking habits of six populations in France, Switzerland, Italy and Spain. A total of 2,965 men and 2,369 women have been interviewed. The proportion of ever smoking men is almost the same (75 to 80%) everywhere but in Geneva and Calvados a higher proportion of smokers quitted the habit (over 30%). In females, on the contrary, the prevalences of ever smokers is higher in Torino (42%) and Geneva (36%) than in Spain (25%) and Calvados (19%). Young females, however, tend to smoke more and intercountry differences tend to disappear. In both sexes successive generations begin to smoke earlier. Exclusive use of black tobacco is still very high in Calvados (90%) and Navarra (80%) whilst it tends to disappear in Italy (30%). Plain cigarettes decrease everywhere, especially in Spain and Varese, but they are still smoked by the majority of men in Calvados. The results suggest that the tobacco epidemic is still increasing in those areas where it began more recently.