Reference values of thyroid volume in a healthy, non-iodine-deficient Spanish population.

Our aim was to assess reference values of thyroid volume by ultrasonography in healthy adult subjects. We conducted an epidemiological cross-sectional study where 880 subjects were randomly selected from the town census of L'Hospitalet de Llobregat after being invited to participate in our study directly by mail and phone call. We made a clinical history of each subject and determined serum thyrotropin, antiperoxidase antibodies, urinary iodine excretion and thyroid volume by ultrasonography. Subjects with thyroid disease were excluded. We finally studied 268 representative subjects. The reference thyroid volume was median 7.31 ml, mean 8.22 ml (Confidence Interval: 7.75 - 8.69 ml). In men: median 9.19 ml, mean 9.87 ml (CI: 9.09 - 10.65 ml); in women: median 6.19 ml, mean 6.57 ml (CI: 6.22 - 9.92 ml) (p < 0.0001). We grouped the subjects into decades, and found that thyroid volume was different (p = 0.0034) in males because the younger group had lower volume. We did not find any differences among age groups in women. The mean of the urinary iodine excretion was 154.23 microg/l. We have determined reference values of thyroid volume measured by ultrasonography in our iodine non-deficient population and prepared tables that distribute thyroid volume by sex and age.

Thyroid volume as measured by ultrasonography in patients With type 1 diabetes mellitus without thyroid dysfunction.

The aim of this cross-sectional study was to assess and compare thyroid volume and its derminants in a cohort of type 1 diabetes mellitus (DM1) and compare the results to a healthy control group. We studied 65 DM1 patients treated with an intensive insulin regimen and 65 matched controls. In all participants we evaluated weight, height, BMI, waist-hip ratio, body surface area and body composition variables determined by using a bioelectrical impedance analyser. Thyroid size was estimated by ultrasonography. We determined basal TSH, anti-thyroid antibodies and urinary iodine excretion. Body weight, height, BMI and body surface area were similar in DM1 patients and in controls. Fat-free mass was higher in both male and female DM1 patients than in controls (64.4 +/- 6.9 vs. 60.4 +/- 8.2 kg, p=0.03 and 48.3 +/- 5.7 vs. 45.4 +/- 6, p=0.04, respectively), and fat mass was lower in male DM1 patients than in controls (9.7 +/- 7 vs. 14.2 +/- 8.1 kg, p=0.01). Thyroid volume was greater in both male and female DM1 patients than in controls (11.12 +/- 2.87 vs. 9.63 +/- 2.27 ml, p=0.0001 and 9.5 +/- 2.3 vs. 7.7 +/- 2 ml, p=0.002, respectively). Urinary iodine excretion was similar in the two groups. In both DM1 patients and controls, thyroid volume correlated with weight, height, BMI, waist-hip ratio, body surface area, fat-free mass and the multivariate linear regression analysis with thyroid volume as the dependent variable showed that fat-free mass in either group was the only significant determinant of thyroid volume. We conclude that DM1 patients had larger thyroid volume compared with healthy controls with similar anthropometry; body composition is different in DM1 patients and that the anthropometric and body composition variables, especially fat-free mass and body surface area, predict thyroid volume either in DM1 patients or in healthy controls.

Ultrasonographic thyroid volume as a reliable prognostic index of radioiodine-131 treatment outcome in Graves' disease hyperthyroidism.

OBJECTIVE: We studied the relationship between thyroid volume, thyroid function and immunological markers of Graves' disease (GD) to determine prognostic factors of treatment response to low-dose radioiodine-131 (131I). MATERIAL AND METHODS: A prospective study of 40 patients with GD hyperthyroidism treated with 131I (141 +/- 85MBq) and 10 GD patients who went spontaneously into remission (controls). Free T4, total T3 and basal TSH levels, TSH-receptor antibodies (TRAb) and anti-thyroid peroxidase antibodies (TPOAb) were studied. Thyroid volume was determined by ultrasonography. Logistic regression models were used to predict the probability of final thyroid status. Receiver-operating characteristics (ROC) curves and Hosmer Lemeshow tests were used to evaluate the final statistical models. RESULTS: Of 40 patients treated with 131I, 16 became euthyroid, 12 hyperthyroid and 12 hypothyroid at 12 months. Median thyroid volume was reduced from 24.8 ml before to 8.5 ml at 12 months (p<0.001). In 10 control patients, the median reduction was from 16.6 ml to 11.3 ml (p=0.029). Thyroid volume reduction was lower in the hyperthyroid than in the euthyroid group, but higher in the hypothyroid group. Thyroid volume at baseline and at 3 months predicted hyperthyroidism outcome with a cut-off of 45 ml and 24.4 ml, respectively (odds ratio 1.074, p=0.003, ROC curve 0.78 and odds ratio 1.182, p=0.012, ROC curve 0.86 respectively). Thyroid volume at 6 months differentiated the hyperthyroid group with a cut-off of 17 ml. Thyroid volume at 3 and 6 months with a cut-off of 8.5 ml and 9.3 ml respectively, predicts permanent hypothyroidism outcome (odds ratio 0.768 and 0.685, p=0.012 and p=0.008, ROC curve 0.89 and 0.88, respectively). Changes in thyroid echogenicity and TRAb and TPOAb levels did not show any predictive value in the follow-up after 131I therapeutic outcome. CONCLUSION: The study shows that the ultrasonographic thyroid volume at 3 and 6 months after low-dose 131I treatment for GD hyperthyroidism could be a reliable prognostic factor of thyroid function outcome in the first year after treatment, and also reveals that the changes in the thyroid echogenicity and in the immunological markers of GD have no prognostic value.

Factors promoting colonization by legionellae in residential water distribution systems: an environmental case-control survey.

As part of a case-control study of community-acquired Legionnaires' disease, several factors related to residential water distribution systems and public drinking water systems were studied in the homes of 124 patients with community-acquired Legionnaire's disease and in the homes of 354 controls. The presence of water reservoirs and hot water tanks was studied in residential systems. Factors such as deficient chlorine levels, pipe repairs and other work, water flow interruptions, the use of alternative water sources, inadequate cleaning operations in public water reservoirs, and the position of the home within the public network (and whether this location constituted an endpoint) were studied in public water supply systems. Levels of legionellae in domestic water samples were also measured. Although the use of water reservoirs and hot water tanks promotes colonization by legionellae in residential systems, none of the variables studied seems to increase the incidence of community-acquired Legionnaires' disease.

Tonometry after laser in situ keratomileusis treatment.

PURPOSE: To assess the reliability of intraocular pressure measurements by Goldmann applanation tonometry versus pneumotonometry after laser in situ keratomileusis for myopia. PATIENTS AND METHODS: In this prospective study, corneal Goldmann applanation tonometry and pneumotonometry measurements were made in 118 eyes of 60 patients before and 1 and 3 months after undergoing laser in situ keratomileusis for myopia. Manifest refraction, ultrasonic corneal thickness measurements, and keratometry readings were also obtained. RESULTS: Preoperative intraocular pressure showed a good correlation between Goldmann applanation tonometry and pneumotonometry values (Pearson r = 0.71; P < 0.001). although Goldmann applanation tonometry readings were slightly higher at low intraocular pressure values and slightly lower at high intraocular pressure values. After a mean stromal ablation depth of 77.1 microm, mean intraocular pressure by Goldmann applanation tonometry decreased significantly (P < 0.001) from a preoperative value of 14.8 +/- 11.9 mm Hg to 11.9 +/- 2.1 mm Hg and 11.7 +/- 1.7 mm Hg after 1 and 3 months, respectively. Mean pre- and post-laser in situ keratomileusis measurements by pneumotonometry were similar (P = 0.8). Differences of postoperative intraocular pressure measurements by Goldmann applanation tonometry and pneumotonometry were statistically significant. After 3 months, there was a poor correlation between Goldmann applanation tonometry and pneumotonometry intraocular pressure values (Pearson r = 0.58). Postoperative intraocular pressure decrease in applanation tonometry correlated with changes in keratometry, spherical equivalent, and central corneal thickness. Regression analysis showed a decrease of 2.9 mm Hg per 70 microm reduction in central corneal thickness. CONCLUSIONS: Contact pneumotonometry measures the IOP reliably after laser in situ keratomileusis for myopia, whereas Goldmann applanation tonometry underestimates the intraocular pressure. This may be important in the treatment of any future glaucoma.

La cesárea en cataluña: estudio de algunos factores de riesgo / Cesarean section in Catalunya (Spain): a study of risk factors

Objetivo: El incremento del porcentaje de partos por cesárea observado en Cataluña nos ha inducido a estudiar algunos de los factores asociados a este tipo de parto.Métodos: Las variables estudiadas fueron el peso, la edad gestacional y la edad materna en el momento del nacimiento, así como el día de la semana y el tipo de hospital donde tuvo lugar el parto, a las que se aplicó el modelo de regresión logística no condicional.La muestra analizada estuvo constituida por 167.720 nacimientos, correspondientes a los años 1993, 1994 y 1995.Resultados: El porcentaje de cesáreas se incrementó del 22,9 al 23,6 por 100 en el período estudiado, observándose el mayor porcentaje (41,2 por 100) cuando se presenta un peso bajo al nacer o el parto es prematuro (39,3 por 100). La edad materna superior a 39 años es el tercer factor en importancia, con un 34,8 por 100 de cesáreas. En todos los casos los hospitales de titularidad privada presentan un porcentaje ligeramente superior de cesáreas.Conclusiones: Los factores de riesgo que afectan a la elevada tasa de cesáreas observada en Cataluña son el bajo peso, el sobrepeso, la prematuridad, la edad materna avanzada y que el parto tenga lugar en un día laborable y en un hospital privado. (AU)

Proxy-perceived prior health status and hospital outcome among the critically ill: is there any relationship?

OBJECTIVES: To measure the health status of critically ill patients prior to hospital admission and to study the relationship between prior health status (PHS) and hospital mortality. DESIGN: 523 patients admitted to the intensive care department from October 1994 to June 1995 were included consecutively in the study. Health status 3 months prior to admission was assessed retrospectively by proxies using the EuroQol 5D (EQ-5D) and the Karnofsky Performance Status Scale (KF). Patients were classified into four admission categories: trauma injury, scheduled surgery, unscheduled surgery and other medical conditions. SETTING: Department of Intensive Medicine, University Hospital of Bellvitge, Barcelona, Spain. PATIENTS: 84 trauma injury patients, 239 scheduled surgery patients, 57 unscheduled surgery patients and 143 patients with other medical conditions. INTERVENTIONS: The descriptive system and visual analogue scale (VAS) of the EQ-5D and the K.F. MEASUREMENTS AND MAIN RESULTS: Using proxy responses we found that trauma injury patients had the best PHS and scheduled surgery patients the worst. There were statistically significant differences in mean VAS scores and all EQ-5D dimensions, except self-care, when trauma injury patients or scheduled surgery patients were compared with the other admission categories. No significant differences were found on these variables between unscheduled surgery patients and medical patients. We found no statistically significant differences in PHS health status between patients who died and those who survived, either within each admission category or in the sample as a whole. CONCLUSIONS: The PHS of critically ill patients varied according to admission category. Given the instruments used and population studied, there was no association between PHS and hospital outcome.

[Identification and validation of prognostic factors in differentiated thyroid carcinoma]. / Identificación y validación de factores pronósticos del cáncer diferenciado de tiroides.

BACKGROUND: The aims of this study are to identify prognostic factors of differentiated thyroid carcinoma and to validate the application of prognostic classifications obtained by others studies to another population. PATIENTS AND METHODS: The survival of 208 patients with differentiated thyroid carcinoma (129 papillary and 79 follicular carcinoma) was calculated by the Kaplan-Meier method. The mean follow-up was 7.5 years (1-17.7). Cox-proportional hazard model was used for variables influencing on survival (Mantel-Cox method). In addition, the EORTC, AGES, AJC, AMES and DeGroot classifications were tested. RESULTS: The independent prognostic factors identified were patient age > 60 years, tumor size > 6 cm and the presence of distant metastases. The absence of poor prognostic factors defined the low risk group (153 patients, survival 97% at 17.7 years of follow-up). The application of the other prognostic classifications differentiated several risk groups not in accordance with those obtained in the initial population. CONCLUSIONS: In this series of patients with thyroid carcinoma the main prognostic factors were age, tumor size and the presence of distant metastases. However, there are pitfalls in applying the prognostic classifications of published studies to another population.

[The influence of clinical presentation and metabolic control of insulin dependent diabetes in the evolution of residual insulin secretion. A prospective study at five years]. / Influencia de la presentación clínica y del control metabólico de la diabetes insulinodependiente en la evolución de la secreción residual de insulina. Estudio prospectivo a cinco años.

BACKGROUND: To study the influence of clinical, metabolic and immunological parameters during the first years of the evolution of insulin-dependent diabetes mellitus (IDDM) on the long-term residual insulin secretion (IS). PATIENTS AND METHODS: 186 IDDM subjects diagnosed from 1986 to 1993 were included; 135 subjects have completed a two year follow-up, and 57 have completed a five year follow-up. The influence of individual characteristics at diagnosis (age, sex, clinical presentation, islet-cell antibodies) and during the first two years of follow-up (IS, metabolic control) on IS at five years was evaluated by multiple linear regression. Differences between groups were evaluated by non-parametric tests. RESULTS: 18 patients had a significant insulin secretion at five years (post-glucagon C-peptide > or = 0.15 nmol/l). They showed minor significant differences in sex (77.7 vs 48.7% of males, p = 0.03), duration of symptoms (12.9 vs 7.2 weeks, p = 0.01), ketoacidosis at diagnosis (23.3 vs 46.1%, p = 0.07) and ICA positivity at diagnosis (41.1 vs 69.4%, p = 0.05). They also had a better metabolic control (8.8 vs 10.8% of HbA1, p < 0.001) with lss insulin (0.48 vs 0.71 Ul/kg, p < 0.001) during the first two years of evolution. Initial IS was similar, but differences became significant at 6 months. In the multivariate analysis, only metabolic control during the second year of evolution (p = 0.008), ketoacidosis at diagnosis (p = 0.026) and sex (p = 0.026) had an independent influence on IS at five years. A more intensified therapeutic approach introduced in 1990 induced a better metabolic control and higher IS during the first years of follow-up. CONCLUSION: The absence of ketoacidosis at diagnosis and a good metabolic control during the first two years can have a positive influence in the long-term preservation of IS in IDDM patients.

[Health information of intercontinental Spanish travelers]. / Información sanitaria de viajeros intercontinentales españoles.

To investigate the level of health information and degree of protection of Spanish travelers to tropical and temperate zones, 910 individuals were interviewed in the Prat del Llobregat airport before their departure. Very low levels of protection were detected, regarding both compulsory and optional vaccines as well as antimalarial protection. It was found out that the information sources that had been consulted were not the optimal ones and that they had delivered remarkably inaccurate advice. Only 44% had received some type of vaccination. Important geographic errors were recorded regarding vaccination against yellow fever. Few travelers received optional vaccines, although these provide protection against highly prevalent diseases in tropical areas. Errors in antimalarial chemoprophylaxis were related both to drug dosage and their adequacy to the corresponding areas. Travelers prematurely interrupted prophylaxis in a progressive fashion depending on the number of elapsed weeks. Only 33% of the 39% who started prophylaxis before leaving completed it correctly. Travelers from health care professions had a higher rate of early abandonment of antimalarial prophylaxis and a worse immune protection against yellow fever, with a 5% signification level (p less than 0.05) when compared with the rest of travelers. Suggestions to improve this situations are made, such as an adequate education of health professionals and the general population, the reshaping of official vaccination centers and the introduction of adequate antimalarial drugs in the Spanish pharmacopeia.

[Imported myiasis: analysis of 5 cases]. / Miasis importada: análisis de 5 casos.

Five cases of furuncular myiasis imported by Spanish travelers from tropical countries are reported. After reviewing the cycle of the infecting organism and the characteristics of the human disease, a table with the clinical and epidemiological data of our patients is presented. The relevance of an adequate clinical and geographical anamnesis in these patients is discussed. Finally, the effectiveness of a simple, nonaggressive treatment is reported, which permits the patient to verify by himself the disappearance of the parasite.