Influence of atmospheric pressure on the incidence of spontaneous pneumothorax.

BACKGROUND: This study analyses the relationship between the incidence of idiopathic spontaneous pneumothorax (ISP) and atmospheric pressure (AP). METHODS: A total of 288 cases of ISP were included, 229 men and 59 women. The AP of the day of diagnosis, of the 3 prior days and the monthly average was registered. The association between the incidence of ISP and AP was analyzed by calculating standardized incidence ratio (SIR) and Poisson regression. RESULTS: The AP on the day of admission (mean±standard deviation) (1,017.9±7 hectopascals [hPa]) was higher than the monthly average AP (1,016.9±4.1 hPa) (P=.005). There was a monthly distribution pattern of ISP with the highest incidence in the months of January, February and September and the lowest in April. When AP was less than 1,014 hPa, there were fewer cases registered than what would statistically have been expected (58/72 cases). In contrast, when the pressure was higher than 1,019 hPa, the registered cases were more than expected (109/82 cases) (SIR=1.25; 95% CI: 1.04 to 1.51). The risk of ISP increased 1.15 times (95% CI: 1.05 to 1.25, P=.001) for each hPa of AP, regardless of sex, age and monthly average AP. A dose-response relationship was observed, with progressive increases in risk (IRR=1.06 when the AP was 1,014-1016 hPa; 1.17 hPa when the AP was 1,016-1,019 hPa and 1.69 when AP was superior to 1,019 hPa) (P for trend=.089). CONCLUSION: The AP is a risk factor for the onset of idiopathic spontaneous pneumothorax.

[Effect of vitamin D deficiency on hypocalcaemia after total thyroidectomy due to benign goitre]. / Efecto de la deficiencia de vitamina D sobre la hipocalcemia tras tiroidectomía total por bocio benigno.

INTRODUCTION: The purpose of this study was to analyse the relationship between preoperative serum levels of vitamin D and postoperative hypocalcaemia after total thyroidectomy. MATERIAL AND METHODS: A prospective observational study was conducted on 113 patients treated by total thyroidectomy due to benign disease. Preoperative vitamin D serum levels and postoperative albumin-corrected calcium and parathormone (PTH) levels were determined. Sensitivity, specificity, positive predictive value and negative predictive value of vitamin D and PTH levels, respectively, in the diagnosis of postoperative hypocalcaemia were calculated. RESULTS: Hypocalcaemia was diagnosed in 44 (38.9%) patients. Vitamin D levels were significantly higher in the group of patients with normal postoperative calcium (median: 25.4pg/mL; range: 4-60), compared to those who developed hypocalcaemia (median: 16.4pg/mL; range: 6.3-46.9) (P=.001). Postoperative hypocalcaemia was more frequent in patients with vitamin D < 30ng/mL (39/78) (50%), than among those with normal levels (5/35) (14.2%) (P=.001). Sensitivity, specificity, positive predictive value and negative predictive value were 88% and 68%, 43% and 82%, 50% and 71%, and 85% and 80% for vitamin D and PTH, respectively. Vitamin D and PTH showed independent prognostic values on the risk of hypocalcaemia. The OR associated with vitamin D < 30ng/mL was 4.25 (95% CI: 1.31-13.78) (P=.016), and the OR of PTH<13pg/mL was 15.4 (95% CI: 4.83-49.1) (P<.001). CONCLUSION: Vitamin D deficiency is a risk factor of hypocalcaemia after total thyroidectomy for benign goitre. The vitamin D level provides independent prognostic information, which is complementary to that given by PTH.

Influencia de la presión atmosférica sobre la incidencia de neumotórax espontáneo / Influence of atmospheric pressure on the incidence of spontaneous pneumothorax

INTRODUCCIÓN: Se analiza la relación entre incidencia de neumotórax espontáneo idiopático (NEI) y presión atmosférica (PA). MÉTODOS: Se incluyen 288 casos de NEI, 229 hombres y 59 mujeres. Se recogió PA el día del diagnóstico, PA en los 3 días previos y PA media mensual. Se analizó la asociación entre incidencia de NEI y PA mediante cálculo de razón de incidencia estandarizada (RIE) y regresión de Poisson. RESULTADOS: La PA el día del ingreso (media ± desviación típica) (1.017,9 ± 7 hectopascales [hPa]), fue más elevada que la PA media mensual (1.016,9 ± 4,1 hPa; p = 0,005). Hubo un patrón de distribución mensual del NEI, con mayor incidencia los meses de enero, febrero y septiembre y menor en abril. Cuando la PA fue inferior a 1.014 hPa se registraron menos casos de los que estadísticamente hubiera sido esperable encontrar (58/72 casos); sin embargo, cuando la PA fue superior a 1.019 hPa se registraron más casos de los esperados (109/82 casos) (RIE = 1,25; IC95%: 1,04-1,51). El riesgo de NEI aumentó 1,15 veces (IC 95%: 1,05-1,25; p = 0,001) por cada hPa de PA, independientemente del género, la edad y la PA media mensual. Se observó relación dosis-respuesta, con aumentos progresivos del riesgo (IRR = 1,06 cuando la PA fue 1.014-1.016 hPa; 1,17 cuando la PA fue 1.016-1.019 hPa y 1,69 cuando la PA fue superior a 1.019 hPa) (p de tendencia = 0,089). CONCLUSIONES: La PA es factor de riesgo para la aparición de neumotórax espontáneo idiopático

BACKGROUND: This study analyses the relationship between the incidence of idiopathic spontaneous pneumothorax (ISP) and atmospheric pressure (AP). METHODS: A total of 288 cases of ISP were included, 229 men and 59 women. The AP of the day of diagnosis, of the 3 prior days and the monthly average was registered. The association between the incidence of ISP and AP was analyzed by calculating standardized incidence ratio (SIR) and Poisson regression. RESULTS: The AP on the day of admission (mean ± standard deviation) (1,017.9 ± 7 hectopascals [hPa]) was higher than the monthly average AP (1,016.9 ± 4.1 hPa) (P=.005). There was a monthly distribution pattern of ISP with the highest incidence in the months of January, February and September and the lowest in April. When AP was less than 1,014 hPa, there were fewer cases registered than what would statistically have been expected (58/72 cases). In contrast, when the pressure was higher than 1,019 hPa, the registered cases were more than expected (109/82 cases) (SIR = 1.25; 95% CI: 1.04 to 1.51). The risk of ISP increased 1.15 times (95% CI: 1.05 to 1.25, P = .001) for each hPa of AP, regardless of sex, age and monthly average AP. A dose-response relationship was observed, with progressive increases in risk (IRR = 1.06 when the AP was 1,014-1016 hPa; 1.17 hPa when the AP was 1,016-1,019 hPa and 1.69 when AP was superior to 1,019 hPa) (P for trend = .089). CONCLUSION: The AP is a risk factor for the onset of idiopathic spontaneous pneumothorax

Es segura la hernioplastia sin sutura como opción para tratar las hernias de pared abdominal ? Estudio prospectivo con un adhesivo tisular sintético (n-hexil-alfa-cianoacrilato) / Effect of vitamin D deficiency on hypocalcaemia after total thyroidectomy due to benign goitre

Introducción El uso de adhesivos tisulares puede ser una alternativa a la sutura en la fijación de la malla, pero su experiencia clínica es muy limitada. Material y métodos Estudio prospectivo y descriptivo en un grupo de 35 pacientes con hernias inguinales operados mediante hernioplastia sin sutura (20 vía abierta y 15 vía endoscópica); la prótesis se fijó con adhesivo sintético (n-hexil-α-cianoacrilato). Este grupo se ha comparado con uno control operado mediante hernioplastia utilizando suturas. Todos los pacientes seguían protocolo de cirugía mayor ambulatoria. Se han registrado variables peri- y postoperatorias. El seguimiento se realizó a la semana, al mes, a los 6 meses y al año. Resultados No ha existido morbilidad asociada con el uso del adhesivo tisular. Durante una mediana de 15 meses no se han detectado complicaciones ni recurrencias. En la hernioplastia abierta el uso del adhesivo disminuye de forma significativa el tiempo quirúrgico (30min versus 62min, p=0,001), el dolor postoperatorio (de 2,4 a 4,5 a la semana, p < 0,001) y el consumo de analgésico (de 7 a 14 días, p < 0,001). En el abordaje laparoscópico se demuestran diferencias significativas a favor del adhesivo en el dolor (p=0,001 a las 24h) y consumo de analgésicos (p <0,001). El análisis económico demuestra un ahorro anual de 117.461,2 euros (sobre 460 hernias).Conclusión El uso de un adhesivo tisular sintético (n-hexil-α-cianocrilato) es seguro como medio de fijación en las hernioplastias no complejas en pacientes sin comorbilidad, con buenos resultados postoperatorios (AU)

Introduction: The purpose of this study was to analyse the relationship between preoperative serum levels of vitamin D and postoperative hypocalcaemia after total thyroidectomy. Material and methods: A prospective observational study was conducted on 113 patients treated by total thyroidectomy due to benign disease. Preoperative vitamin D serum levels and postoperative albumin-corrected calcium and parathormone (PTH) levels were determined. Sensitivity, specificity, positive predictive value and negative predictive value ofvitamin D and PTH levels, respectively, in the diagnosis of postoperative hypocalcaemia were calculated. Results: Hypocalcaemia was diagnosed in 44 (38.9%) patients. Vitamin D levels were signifi-cantly higher in the group of patients with normal postoperative calcium (median: 25.4 pg/mL; range: 4-60), compared to those who developed hypocalcaemia (median: 16.4 pg/mL; range: 6.3-46.9) (P = .001). Postoperative hypocalcaemia was more frequent in patients with vitamin D < 30 ng/mL (39/78) (50%), than among those with normal levels (5/35) (14.2%)(P = .001). Sensitivity, specificity, positive predictive value and negative predictive value were 88% and 68%, 43% and 82%, 50% and 71%, and 85% and 80% for vitamin D and PTH, respectively. Vitamin D and PTH showed independent prognostic values on the risk of hypocalcaemia. The OR associated with vitamin D < 30 ng/mL was 4.25 (95% CI: 1.31-13.78)(P = .016), and the OR of PTH < 13 pg/mL was 15.4 (95% CI: 4.83-49.1) (P < .001).Conclusion: Vitamin D deficiency is a risk factor of hypocalcaemia after total thyroidectomy for benign goitre. The vitamin D level provides independent prognostic information, which his complementary to that given by PTH (AU)