Validation study of the dynamic parameters of pulse wave in pulmonary resection surgery. / Estudio de validación de los parámetros dinámicos de onda de pulso en cirugía de resección pulmonar.

INTRODUCTION: In lung resection surgery, restrictive fluid therapy is recommended due to the risk of acute lung injury. In contrast, this recommendation increases the risk of hypoperfusion. Guided fluid therapy allows individualization of fluid intake. The use of dynamic volume response parameters is not validated during one-lung ventilation. The main objective is the validation of dynamic parameters, stroke volume variation (SVV) and pulse pressure variation (PPV), during lung resection surgery as fluid response predictors, after the administration of 250ml crystalloid volume loads, if IC<2.5ml/min/m2 and if SVV≥8% and/or PPV≥10%. MATERIAL AND METHODS: Pilot, prospective, observational and single centre study. Twenty-five patients monitored with the PiCCO system were included during open lung resection surgery with the patient in a lateral position, one lung ventilation with tidal volume (TV): 6ml/kg and open chest. Hemodynamic variables were collected before and after volume loading. The results were classified into two groups: volume responders (increase IC≥10% and/or VSI≥10% after volume loading) and non-responders (no increase or increase IC<10% and/or VSI<10% after volume loading). We assess the diagnostic efficacy of SVV and PPV by analyzing the AUC (area under curve) in the ROC curves. RESULTS: In the analysis of ROC curves, SVV and PPV did not reach a discriminative value (AUCSVV: 0.47; AUCPPV: 0.50), despite the decrease in the threshold value of SVV and PPV to initiate an overload of volume during one-lung ventilation, in lateral position and open chest. CONCLUSIONS: The results obtained show that the values of the dynamic parameters of volume response (SVV≥8% and PPV≥10%) do not discriminate against responders patients and non-responders during open lung resection surgery.

Review of difficult airway management in thoracic surgery. / Revisión del manejo de la vía aérea díficil en cirugía torácica.

The management of difficult airway (DA) in thoracic surgery is more difficult due to the need for lung separation or isolation and frequent presence of associated upper and lower airway problems. We performed an article review analysing 818 papers published with clinical evidence indexed in Pubmed that allowed us to develop an algorithm. The best airway management in predicted DA is tracheal intubation and independent bronchial blockers guided by fibroscopy maintaining spontaneous ventilation. For unpredicted DA, the use of videolaryngoscopes is recommended initially, and adequate neuromuscular relaxation (rocuronium/sugammadex), among other maneuvers. In both cases, double lumen tubes should be reserved for when lung separation is absolutely indicated. Finally, extubation should be a time of maximum care and be performed according to the safety measures of the Difficult Arway Society.

[Present situation of the otorhinolaryngology departments in the Spanish Hospitals. Heterogeneity in handling voice disorders]. / Estado actual de los Servicios ORL españoles. Heterogeneidad en el manejo de los problemas de voz.

The study of voice disorders present some specific difficulties such as the aetiological variability of this kind of disorders or the heterogeneity and the poor data we have about the effectiveness of certain treatments used. Research has performed different types of questionnaires in this area to obtain data about the treatments used in clinical practice. These studies have shown lack or scarce of evaluation and control methods in the rehabilitation programs that the specialists commonly use. In this report, a screening questionnaire was sent to the Otorhinolaryngology Departments of the Spanish Hospitals to obtain information about evaluation and treatment resources in voice pathologies. The results show great variability in clinical voice disorders in Spain. However we can observe a full agreement in the need to systematize this evaluation and the collaboration of the speech-therapists in the treatment of the voice disorders.

Potentiometric determination of hydrogen peroxide with permanganate in presence of fluoride, with iron as a catalyst: Application to the titanium-fluoride-peroxide mixed complex.

A potentiometric permanganate titration has been developed for the determination of hydrogen peroxide in the presence of fluoride, as well as of the peroxide content in the titanium-fluoride-peroxide mixed complex. It is based on the stabilization of manganese(III) with an excess of fluoride in a moderately acidic medium (pH close to 3) and on the use of iron(III) as catalyst. Errors are less than 0.5%.

Enzymatic flow-injection determination of l-phenylalanine using the stopped-flow and merging-zones techniques.

A flow injection enzymatic method for the spectrophotometric determination of l-phenylalanine has been developed. l-phenylalanine is deaminated in the presence of l-amino acid oxidase and the keto acid formed is made to react with borate to give a coloured enol-borate complex that can be detected at 282 nm. Catalase is added to the catalyzed reaction to prevent the keto acid being destroyed by the hydrogen peroxide generated. Kinetic determinations are performed by measuring the change in absorbance between 2 and 4 min. The proposed procedure, involving both merging-zones and stopped-flow techniques, can be applied to the quantitation of l-phenylalanine between 10 and 260 mg l(-1). Detection limit and R.S.D. are 1.1 mg l(-1) and 3.0%, respectively.

Voice therapy used to test a basic protocol for multidimensional assessment of dysphonia.

The aim of this study was the elaboration of a basic voice protocol to discover which combination of tests and measures (multidimensional evaluation) provide decisive and essential data for the diagnosis of voice pathology and its prognosis. Voices of 21 patients with dysphonia and 21 subjects in a control group were evaluated and compared. Vocal function was assessed using a multiparametric set of videolaryngostroboscopic, perceptual, acoustic, spectrographic, aerodynamic, and subjective basic measurements (Multidimensional "Teatinos" Protocol). The dysphonic group received voice therapy for two sessions/week during 3 months. The results of the study were the following-(1) alterations in vocal function were reflected in the indicators: maximum phonation time (MPT) /a/, maximum exhalation time (MET) /s/, MPT during connect speech (MPTS), jitter, shimmer, harmonic-to-noise ratio, vocal well being (WB), self-voice assessment (SELF), vocal hygiene (HYGIENE), anxiety (ANX) and perceptual, laryngoscopic, and spectrographic explorations; (2) the indicators which are most sensitive to voice therapy are the following: MPT /a/, MET /s/, MPTS, jitter, WB, SELF, HYGIENE, ANX and perceptual, laryngoscopic, and spectrographic explorations; and (3) these positive effects were maintained or increased 4 months after termination of the treatment. Multidimensional "Teatinos" Protocol makes it possible to detect significant differences in mean values of subjective, qualitative, and objective voice assessments between dysphonic patients and control group at pre- and posttreatment stages. Therefore, multidimensional voice evaluation is a useful tool in the diagnostics of dysphonia in clinical and speech-language-therapy contexts.

Sequential and simultaneous determination of bromate and chlorite (DBPs) by flow techniques: kinetic differentiation.

3-3'-Dimethoxybenzidine (o-dianisidine, ODA) is oxidised by Br(2), among other oxidants, generating a compound that absorbs at 450 nm, while the non-oxidised reagent absorbs in the UV region. This reaction has been used previously as the basis of a continuous-flow method for the determination of bromate in ozonised water, with a detection limit lower than the maximum permitted for drinking water (10 microg L(-1)). The only interference observed in the method was that due to the chlorite ion (ClO(2)(-)), which generated the same ODA bromation product. Thus, in systems in which O(3) is employed as a disinfectant and disinfection is later enhanced with ClO(-) and ClO(2), there exists the possibility of finding BrO(3)(-) and ClO(2)(-), oxoanions generated as subproducts. The kinetic behaviour of the reaction between bromate and chlorite with bromine in acidic medium is different, allowing the proposal of a continuous-flow method for the simultaneous or sequential determination of both subproducts in water purification systems. None of the other subproducts interfered in the reaction. Kinetic differentiation was achieved by combining the temperature of the reaction and the length of the coils, after which it was possible to determine both analytes sequentially within a concentration range of 6-160 microg L(-1).

Online monitoring of bromate in ozonized water without a previous separation process.

The use of ozonation for the purification of drinking water can lead to the formation of bromate. The US Environmental Protection Agency and the European Directive for human drinking water has lowered the regulatory level for bromate down to 10 microg l(-1), such that methods must be developed for monitoring the formation of bromate, particularly in on-site situations. In the present work we report a fluorometric method for the determination of bromate based on the reaction with carbostyril-124, a compound that shows fluorescence mainly at pH values above 4 and, when bromated, generates a non-fluorescent product. The reaction can thus be used as an indirect method for determination of the ion. The proposed method, which uses the flow injection (FI) technique, allows online application and kinetic control of the variables affecting the process, together with shorter reaction times, and it provides maximum sensitivity and selectivity. Under optimum conditions, it is possible to determine the analyte within the 4-200 microg l(-1) range, with a limit of detection of 0.9 microg l(-1) and a relative standard deviation (n=12, [BrO3-]=5 and 30 microg l(-1)) of 3.2% and 2.6% respectively. The determination rate was ten samples per hour.

[Pilot study of the validity, reliability and normative data for PRO-NEURO scale in adult-elderly people without cognitive impairments]. / Estudio piloto de la validez, fiabilidad y valores de referencia normativos de la escala PRO-NEURO en adultos mayores sin alteraciones cognitivas.

INTRODUCTION: We present preliminary data on validity, reliability and normative values of a short neuropsychological protocol in Spanish called PRO-NEURO including different cognitive functions: orientation, attention and memory, mental calculation, verbal comprehension, writing, naming, reasoning, verbal fluency, praxias, and gnosias. The purpose is to more suitably balance the time of application and the extension of the cognitive areas to be evaluated. MATERIAL AND METHODS: Different Spanish versions of classical measurements (used as control) and PRO-NEURO were applied of a sample of 273 (137 men and 136 women) volunteers, cognitive healthy (<>) adult and elderly people over 55. Normative data were obtained for three age groups (55-65, 66-75 and >75 years) and two educational levels: low (to 6 years of school) and medium/high (more than 7 years of school). RESULTS: The validity of PRO-NEURO according to Morillama's method is 93% interrater agreement, test-retest reliability is r=0.74 and internal consistency reliability (Cronbach's alpha) is 0.79. The age-group of younger- elderly subjects (55-65) and those with higher educational level score significantly better and they spend less time in PRO-NEURO performance. Conversely, no-significant differences by sex are observed. Descriptive data of PRO-NEURO for this normative sample are shown. CONCLUSIONS: The PRO-NEURO scale can be useful as screening protocol and help for short and reliable assessment of some important cognitive functions in clinical practice.

Online monitoring of aluminium in drinking water with fluorimetric detection.

We report a procedure for the online monitoring of aluminium in drinking water by flow injection analysis. The reaction used is the formation of a complex with morin. Under the working conditions, this can be accomplished in an ethanol-rich hydroalcoholic medium, which modifies the fluorescent characteristics of the complex, allowing the determination of aluminium concentrations higher than 3.1 microgl(-1), with a linear application range between 2 and 250 microgl(-1), an R.S.D. of 2.3% (n=10, 120 microgl(-1)) and a sampling frequency of 90 h(-1). The method can thus be considered one of the most sensitive and fastest for the continuous determination of aluminium. In the presence of anionic surfactants, the sensitivity of the determination is increased. In this form, aluminium is detected at concentrations higher than 2.8 microgl(-1), with a linear application range of 2-50 microgl(-1). The procedure was applied to the analysis of aluminium in drinking, river, and underground water. Under the proposed working conditions, only Fe(III), fluoride and phosphates interfere. The interference of Fe(III) can be avoided with hydroxylamine and that of phosphates and polyphosphates by acid digestion of the samples.

Chromosomal imbalance in the offspring of translocation carriers involving 7p. Further contribution with three cases to the partial trisomy 7p phenotype.

Five families with balanced translocations involving 7p are reported. Three girls from two of these families presented several congenital malformations and partial trisomy 7p. A comparison is made of their phenotype with other reported cases.

Estudio piloto de la validez, fiabilidad y valores de referencia normativos de la escala PRO-NEURO en adultos mayores sin alteraciones cognitivas / Pilot study of the validity, reliability and normative data for PRO-NEURO scale in adult-elderly people without cognitive impairments

Introducción. Se presentan datos preliminares de la validez,fiabilidad y valores normativos del protocolo de evaluaciónneuropsicológica (PRO-NEURO), que incluye las siguientesfunciones cognitivas: orientación, atención ymemoria, cálculo mental, comprensión verbal, escritura, denominación,razonamiento, fluidez verbal, praxias y gnosiascon el propósito de equilibrar el tiempo de aplicación y laextensión de las áreas evaluadas.Material y métodos. Se aplicaron el Mini-Mental StateExamination (MMSE), la Escala de Depresión Geriátrica deYesavage, el Test de Acentuación de Palabras, los subtests deFiguras Incompletas y Vocabulario del Wechsler Adult IntelligenceScale (WAIS) y la escala PRO-NEURO a una muestrade 273 voluntarios (137 hombres y 136 mujeres) cognitivamentesanos mayores de 55 años. Los datos normativos seobtuvieron para tres grupos de edad (55-65, 66-75 y>75 años) y dos niveles educativos: bajo (hasta 6 años de escolarización)y medio/alto (más de 7 años de escolarización).Resultados. La validez de PRO-NEURO según la pruebaMorillama de acuerdo interjueces es del 93 %, la fiabilidadtest-retest es de r=0,74 y la consistencia interna (alfa deCronbach) es de 0,79. El grupo de menor edad (55-65) y losde nivel educativo más alto puntúan significativamente mejory tardan menos en realizar PRO-NEURO. No aparecen diferenciasdependiendo del sexo. Se presentan los datos descriptivosde PRO-NEURO en esta muestra normativa.Conclusiones. PRO-NEURO puede ser una herramientaútil para una primera evaluación de algunas de las más importantesfunciones cognitivas en la práctica clínica (AU)

Introduction. We present preliminary data on validity,reliability and normative values of a short neuropsychologicalprotocol in Spanish called PRO-NEURO includingdifferent cognitive functions: orientation,attention and memory, mental calculation, verbal comprehension,writing, naming, reasoning, verbal fluency,praxias, and gnosias. The purpose is to more suitably balancethe time of application and the extension of thecognitive areas to be evaluated.Material and methods. Different Spanish versions ofclassical measurements (used as control) and PRO-NEUROwere applied of a sample of 273 (137 men and 136women) volunteers, cognitive healthy («normal subjects»)adult and elderly people over 55. Normative data were obtainedfor three age groups (55-65, 66-75 and >75 years)and two educational levels: low (to 6 years of school)and medium/high (more than 7 years of school).Results. The validity of PRO-NEURO according toMorillama’s method is 93% interrater agreement, test-retestreliability is r=0.74 and internal consistency reliability(Cronbach’s alpha) is 0.79. The age-group of younger-elderly subjects (55-65) and those with highereducational level score significantly better and theyspend less time in PRO-NEURO performance. Conversely,no-significant differences by sex are observed. Descriptivedata of PRO-NEURO for this normative sample areshown.Conclusions. The PRO-NEURO scale can be useful asscreening protocol and help for short and reliable assessmentof some important cognitive functions in clinicalpractice (AU)

Evaluación funcional y tratamiento logopédico de pacientes con disfonía: resultados de una intervención interdisciplinar de la voz en el ámbito hospitalario / Functional Assessment and speech-therapy treatment of diphonic patients: Interdisciplinary voice intervention results in a hospital enviroment

Este trabajo presenta los primeros resultados empíricos obtenidos al utilizar un protocolo interdisciplinar ("Teatinos") en la evaluación funcional de pacientes con trastornos de la voz. El objetivo es propiciar una mejor detección de las variables de pronóstico, recuperación y prevención de las disfonías. Los resultados del estudio, llevado a cabo en 8 pacientes con nódulos bilaterales y disfonía, muestran los efectos de los distintos parámetros e índices multidimensionales valorados en la fase pre-tratamiento. Todos los pacientes manifestaron tras la rehabilitación funcional (fase post-tratamiento) una mejoría subjetiva en el bienestar vocal, en el grado de satisfacción con su voz, además de una disminución de la ronquera y un aumento de la extensión vocal. Asimismo, se observa una desaparición o reducción de los nódulos vocales, un menor grado perceptual de la disfonía, una mejora de los parámetros acústicos y una recuperación significativa de los índices aerodinámicos. Por ejemplo, los resultados muestran una mejora de un 22,5 por ciento en el Tiempo Máximo de Fonación (TMF) al comparar la fase pre vs. resultados en la evaluación de la efectividad del tratamiento logopédico son tratados en la discusión (AU)

Evaluación de marcadores psicolingüísticos en el diagnóstico de niños con trastorno específico del lenguaje / Evaluation of the psycholinguistic characteristics in specific language impairment diagnosis

Este trabajo presenta los resultados obtenidos al estudiar 41 niños con trastorno específico del lenguaje (TEL) mediante 27 tareas y procedimientos basados en herramientas clásicas en la evaluación de la patología del lenguaje. El objetivo consistió en determinar los principales indicadores psicolingüísticos que caracterizan a los TEL. Para el análisis estadístico de las diferencias intersujeto se utilizó un grupo control de niños de primaria (5-12 años), emparejados con los TEL según edad y nivel escolar. Los TEL resultaron significativamente peores en 25 de los tests evaluados. En general, estos datos confirman lo hallado en otros trabajos en diferentes idiomas. Por otra parte, un análisis discriminante muestra que con sólo dos tests (repetición de secuencias de sonidos y definiciones) se explica el 54 por ciento de la varianza de los grupos estudiados. En nuestra opinión, los resultados presentados ayudan a esclarecer en gran medida la estructura psicolingüística subyacente a los TEL y aporta ideas sobre su evaluación en screening (AU)