Vigilancia compartida: enfermedad meningocócica vs gripe / Shared surveillance: meningococcal disease vs influenza

Objetivo: Analizar la asociación entre el comportamiento de la enfermedad meningocócica y la gripe utilizando datos poblacionales de España, para el periodo de 1964 a 1997.Métodos: Estudio ecológico de la incidencia de enfermedad meningocócica y gripe en España para los años 1964 a 1997, ambos inclusive. Se han utilizado los datos semanales de ambas enfermedades procedentes del Sistema de Enfermedades de Declaración Obligatoria (EDO). La componente determinista de las series de enfermedad meningocócica y gripe se estudió mediante el análisis espectral basado en la Transformada Rápida de Fourier y la parte no determinista mediante la modelización ARIMA. Se utilizó la técnica de Box-Jenkins para el preblanqueo de las series, estableciéndose posteriormente funciones de correlación cruzada entre los residuales para detectar la existencia de correlaciones significativas entre las series de enfermedad meningocócica y gripe. Resultados: En el periodo de 1964 a 1997, la semana que, en término medio, ha presentado el mayor número de casos de la temporada ha sido la semana 7 para la enfermedad meningocócica y la 6 para la gripe. El análisis espectral de las series de gripe y enfermedad meningocócica muestra una clara periodicidad anual para ambas series, así como una periodicidad próxima a los 11 años para la enfermedad meningocócica y para periodos superiores a 10 años para la gripe. Si se establecen funciones de correlación cruzada una vez preblanqueadas las series se obtienen correlaciones positivas en los retrasos 0, 1, 2 y 3. La modelización multivariada de enfermedad meningocócica introduciendo la gripe como variable exógena corrobora lo anteriormente expuesto teniendo significación estadística la relación establecida entre ambas en la misma semana y desfasada 3 semanas. Conclusiones: Mediante una metodología no empleada con anterioridad para abordar este tema y utilizando datos poblacionales del conjunto de un país a lo largo de un periodo de tiempo prolongado (que incluye varias ondas epidémicas) se ha corroborado la existencia de una asociación entre enfermedad meningocócica y gripe. Se plantea la necesidad de vigilar ambos procesos de forma interrelacionada (AU)

Recurrent hemoptysis following a systemic-to-pulmonary anastomosis in a child with a complex congenital cardiomyopathy.

A 14-year-old boy with a history of congenital cardiopathy is presented. At age 4, a left systemic-to-pulmonary fistula was performed, using a tubular prosthesis to anastomose the left subclavian artery to the left pulmonary artery. Following this procedure, he developed recurrent episodes of hemoptysis, cough, and left upper lobe consolidation. Treatment resulted in clinical but no radiologic resolution. At age 6, a new right systemic-to-pulmonary anastomosis was needed, as the left one was no longer functioning. After placement of the second shunt, the hemoptysis disappeared. At age 14, flexible bronchoscopy revealed a foreign body granuloma at the left secondary carina. Rigid bronchoscopy and laser photoresection showed it to be the left vascular prosthesis, placed 10 years before. Surgery failed to remove it.

Anestesia epidural para cesárea en una paciente con síndrome de Marfán / Epidural anesthesia for cesarean section of a patient with Marfan syndrome

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[Shared surveillance: meningococcal disease vs influenza]. / Vigilancia compartida: enfermedad meningocócica vs gripe.

OBJECTIVE: To analyse the association between the behavior of meningococcal disease and influenza, using for this purpose population statistics for Spain for the period of 1964 to 1997. METHODS: Ecological study of the incidence of meningococcal disease and influenza in Spain from 1964 to 1997, inclusive. The study used weekly statistical data for these diseases supplied by the Compulsory Disease Reporting System (Enfermedades de Declaración Obligatoria, EDO). The deterministic component of the meningococcal disease and influenza series was studied by means of spectral analysis based on the Fast Fourier Transformation, and the non-deterministic component was studied using the ARIMA model. The Box-Jenkins method was used for pre-bleaching the series, and a cross-correlation was subsequently established between the residuals in order to detect the presence of any significant correlations between the meningococcal disease and influenza series. RESULTS: During the period from 1964 to 1997, the week that showed, on average, the greatest number of cases for the season was week 7 in the case of meningococcal disease and week 6 in the case of influenza. Spectral analysis of the meningococcal disease and influenza series clearly demonstrated the annual periodicity of both series, and periodicity of nearly 11 years for meningococcal disease and slightly over 10 years for influenza. When cross-correlation is established after prebleaching the series, positive correlations are obtained in the results of lags 0, 1, 2, and 3. Introducing influenza as an exogenous variable in the multivariate model of meningococcal disease corroborates these results. There was a statistically significant relationship between the two processes during the same week and with a three-week lapse. CONCLUSIONS: By means of a methodology not previously applied to this subject, and by the use of prolonged time-span, country-comprehensive population statistics (which includes several epidemics waves), an association was shown to exist between meningococcal disease and influenza. This suggests the need for the surveillance of the two processes in an interrelated manner.

Efficacy and safety of photodynamic therapy versus Nd-YAG laser resection in NSCLC with airway obstruction.

A prospective controlled randomized trial was performed in order to assess the effectiveness and safety of photodynamic therapy versus laser resection in 31 patients with partial or complete tracheobronchial obstruction due to inoperable non-small cell lung cancer. Fourteen patients received dihaematoporphyrin ether and argon dye laser photoradiation, and 17 patients received Nd-YAG laser resection. Endoluminal obstruction of >75% was found in 77.4% of the patients. Among the symptoms, cough was more severe in the Nd-YAG group (p=0.02). Patients in both groups experienced symptomatic relief after treatment (p=0.003). Patients in the photodynamic therapy (PDT) group showed a significantly longer time until treatment failure (p=0.03) and longer median survival (p=0.007). Bronchitis and photosensitization (both in the PDT group) were the most common adverse effects. There was one death, probably related to treatment, in the PDT group. Photodynamic therapy and neodymium-yttrium aluminium garnet laser resection showed similar effectiveness and safety in the palliation of symptoms. The more prolonged survival in the photodynamic therapy group may have been due to differences in tumour stage between the groups. The degree of obstruction improved after treatment in both groups. In conclusion, photodynamic therapy is a valid method of palliation in partially or totally obstructing non-small cell lung carcinoma.

[Effects of environmental factors on the number of emergency admissions to the Hospital Complex Juan Canalejo in La Coruña: creation of a prediction model]. / Influencia de los factores ambientales en el número de ingresos por urgencias en el complejo hospitalario "Juan Canalejo" de A Coruña: elaboración de un modelo de predicción.

BACKGROUND: This study is aimed at establishing the possible associations between the number of admissions through the emergency room at the "Juan Canalejol" Hospital in Corunna in 1994-1994 due to organic, circulatory and respiratory reasons and the weather variables introduced as being exogenous for the purpose of preparing a prediction model. METHODS: The Box-Jenkins methodology is used for obtaining univariate ARIMA models of the time-based series taken into consideration. Cross-Correlation Functions (CCF's) are established among the series of residuals which afford the possibility of establishing weights and lags among the variables for a subsequent modeling by means of multivariate ARIMA models which include environmental variables. RESULTS: The emergency admissions for organic reasons significantly increase 0-2 days following a rise in temperature. The admissions due to respiratory ailments are associated with drops in temperature with 10-14 lags, whilst the admissions for circulatory reasons increase significantly due to long-lasting spells of hot weather (10 lags). For people over age 65, significant increases in emergency admissions for circulatory reasons are also recorded with cold snaps. The multivariate ARIMA models that take into account the effect of environmental variables provided the best adjustment for all of the admissions variables. CONCLUSIONS: The number of emergency room admissions at the "Juan Canalejo" Medical Center Complex in Corunna due to organic, respiratory and circulatory causes shows a seasonal behavior pattern. The admissions for respiratory reasons are associated with a drop in temperature, whilst the admissions for circulatory reasons are affected fundamentally by hot weather, although also by cold weather as regards people over age 65. The multivariate ARIMA models including climate-related variables provide a system for predicting admissions in terms of said variables that can be useful from the standpoint of hospital management.

[Association of air pollution caused by sulphur dioxide and total number of particles in suspension and daily mortality in the city of Madrid (1986-1992)]. / Asociación entre la contaminación atmosférica por dióxido de azufre y partículas totales en suspensión y la mortalidad diaria en la ciudad de Madrid (1986-1992).

OBJECTIVE: The aim of the study is to quantify the relationship between sulphur dioxide (SO2), total suspended particulate (TSP) and daily mortality in Madrid. METHODS: Data were plotted to exhibit the functional relationship between SO2, TSO and mortality. Box-Jenkins prewhitening method was used to detect lags and weights from the transfer function. Multivariate ARIMA models were built to control for confounding variables (air temperature and influenza epidemics). RESULTS: Graphic analysis suggested a logarithmic relationship between SO2 and mortality, and lineal relationship with TSP. No evidence of a threshold was found for each pollutant. Cross-correlation functions showed a statistically significant relationship between daily mortality caused by organic, cardiovascular and respiratory diseases and air pollution. The first lag was statistically significant for TSP and the third lag for SO2. Multivariate models gave a coefficient beta = 0.039 for TSP and beta = 1.04 for SO2 indicating a 6.6% increase in mortality for each 100 micrograms/m3 increase in TSP and a 2.2% for SO2. CONCLUSIONS: The result suggest a causal relationship between daily mortality and air pollution in Madrid.

Air pollution and mortality in Madrid, Spain: a time-series analysis.

OBJECTIVE: To assess the relationship, if any, between air pollutant (sulfur dioxide and total suspended particulate) levels and mortality in the city of Madrid during the period 1986-1992, controlling for weather, season, and influenza epidemics. METHODS: Daily death counts were obtained from the Regional Mortality Registry. Pollution data were supplied by the Municipal Monitoring Network. Time-series analysis methodology was used to assess the link between non-accidental as well as circulatory- and respiratory-disease mortality, on the one hand, and mean daily concentrations of SO2 and total suspended particulate (TSP), on the other. Multivariate autoregressive integrated moving-average (ARIMA) models were used to adjust for season, temperature, relative humidity, and influenza. A sensitivity analysis was run to assess the robustness of the estimators. RESULTS: Graphical analysis revealed a linear relationship between mortality and TSP. The relationship was logarithmic in the case of SO2. TSP lagged 1 day and SO2 lagged 3 days with an independent effect on mortality. This relationship was produced without the detection of a minimal threshold in emission values. CONCLUSIONS: These results support the hypothesis of an association between pollution levels and mortality between 1986-1992 in Madrid. Additional measures designed to reduce pollution levels without compromising thermal comfort should be implemented.

[The 1st case in Spain of detection of occult squamous carcinoma using LIFE system]. / Primer caso en España de detección de un carcinoma escamoso oculto mediante la utilización del sistema LIFE.

LIFE system (lung imaging fluorescence endoscope) is a new system of detection for early lung cancer using a He-Cd laser through a conventional fiberoptic bronchoscope. This system is able to capture and processing the autofluorescence from the bronchial mucosa and to show it in a video screen in real time. In the screen the normal tissue appears in green colour and the neoplastic tissue in brown colour. The first studies performed with LIFE system show the same specificity of the conventional bronchoscopy but the sensibility is 50% higher. In this paper we present the first case of detection of a occult squamous cell carcinoma with sputum and bronchial aspiration cytology positive for carcinoma but chest X ray, CT scanner and bronchoscopy negative for lung cancer. The LIFE system was able to detect carcinoma in the carina.

[The effect of atmospheric variables on mortality due to respiratory and cardiovascular diseases in those over 65 in the Community of Madrid]. / Influencia de variables atmosféricas sobre la mortalidad por enfermedades respiratorias y cardiovasculares en los mayores de 65 años de la Comunidad de Madrid.

OBJECTIVE: To investigate the influence of environmental variables on daily mortality, due to respiratory and cardiovascular diseases, in the C.M. from 1986 to 1991. METHODOLOGY: The environmental and mortality variables are correlated between cold and heat effects, checking the possible coincidence of models between temperature and mortality by Box-Jenkins models. The filtered mortality is correlated to the daily average temperatures, for 0-15 lags. RESULTS: The minimum daily mortality is produced in an average temperature of 23.9 degrees. There exists a correlation (p < 0.001) between cold temperature and all the mortality causes in the 15 analysed lags. A correlation (p < 0.01) to vascular diseases appears with hot temperature and, among them, with cerebrovascular accidents (ACVA) in women for 0-3 lags. CONCLUSIONS: Cold temperatures increase the mortality for all the analysed lags and causes. The heat produces immediate effects on the mortality by ACVA in women.

[Daily mortality in the Madrid community during 1986-1991 for the group between 45 and 64 year of age: its relationship to air temperature]. / Mortalidad diaria en la Comunidad de Madrid durante el período 1986-1991 para el grupo de edad de 45 a 64 años: su relación con la temperatura del aire.

BACKGROUND: There are many types of work which relate mortality with different environmental factors. These focus on the general population or in the over-65 age-group, but are relatively few in those with reference to the 45-64 age group in which mortality has a large economic and social impact. The object of the present article is to analyse the existant association between daily mortality, from both diverse specific causes, as well as the air temperature in this group in Madrid. Madrid's extreme climatic characteristics make this work of special interest. METHODS: The ARIMA model was used according to the Box-Jenkins methodology for the infiltration of the daily series of mortality regarding temperature. Amongst the residuals, interrelated functions were established which establish an association between series eliminating communal seasonal factors as well as determining the length of disequilibrium between thermal extremes and excesses in mortality. RESULTS: There is a V-shaped relationship between total daily mortality and temperature. The minimum mortality rate is established at a maximum daily temperature of 33 degrees C. Excess mortality is 0.8% for each degree below 33 degrees C, while that for each degree above is 3.0%. The functions of interrelated correlation indicate that this association is clear in males regarding general mortality as well as for circulatory diseases. In the case of high temperature the effect is immediate, while in lower temperatures we have to add a delay of 10-13 days. CONCLUSION: There is a significant statistical association between mortality and temperature extremes in people of this age group. Lost life expectancy indicates the extent of the problem and the need to implement preventative measures.

[Modeling of daily mortality in the Autonomous Community of Madrid (1986-1991)]. / Modelización de la mortalidad diaria en la Comunidad Autónoma de Madrid (1986-1991).

OBJECTIVE: To describe, estimate and model trends and seasonal variations in daily mortality in the Comunidad of Madrid, Spain. METHODS: Overall mortality rate, as well as gender, age and cause-specific mortality rates between january 1, 1986 and december 31, 1991 were analyzed. A cyclic pattern was detected using fast Fourier transform. Mortality was modelled using ARIMA stochastic models and Poisson regression models. RESULTS: Spectral analysis detected two statistically significant periodic components (winter-summer). Winter peak was related mainly to an excess in cardiovascular diseases in women aged 65 and over, as well as with cardiovascular, respiratory and digestive diseases in men aged 45 and over. The summer peak was related with women, aged 65 and over with cerebrovascular diseases as the cause of death. CONCLUSIONS: The two cycles detected support the hypothesis of an association between mortality and environmental factors.

Silicone stents in the management of benign tracheobronchial stenoses. Tolerance and early results in 63 patients.

STUDY OBJECTIVE: To assess tolerance and early results of Dumon silicone stents inserted in patients with nonneoplastic airway obstruction. DESIGN: Tracheobronchial stenting for palliative or curative restoration of airway narrowing has been evaluated in a retrospective study. SETTING: Tertiary-referral teaching hospital. PATIENTS: Between May 1991 and September 1994, 64 patients with a mean age of 52 years had endobronchial silicone stent insertion for benign tracheal stenosis (82% secondary to intubation or tracheostomy injury). Lesions were pure fibrous stenosis in 25 patients and fibroinflammatory stenosis in 38. Prostheses were used for temporary stenting of the airway during 18 months in 48 patients in whom cure was expected and as a procedure for palliation in the remaining 15 patients. INTERVENTIONS: In all cases, the Dumon tracheobronchial stent was implanted with the rigid bronchoscope under general anesthesia. RESULTS: Five patients died (four from unrelated causes); one was due to hypersecretion and airway obstruction at the time of an emergency tracheostomy 20 days after stent insertion. Complications included migration of prostheses in 11 (17.5%) patients, granuloma formation in 4 (6.3%) patients, and airway obstruction due to heavy secretion in 4 (6.3%). In 48 patients who received silicone stents with curative expectations, removal of the device was accomplished in 21 patients. Therapy proved successful in 17 patients with a mean follow-up of 259+/- 173 days and stenosis recurred in 4. In 16 patients, stents still remain for a mean period of 364+/-119 days. In the series of 15 patients in whom silicon stents were implanted for palliation, prostheses were placed permanently in 11 with a mean follow-up of 486+/-260 days. In the remaining four patients with tracheostomy, silicone stents were used after inability to expand the upper limb of the T-tube (two patients) or placed above the tracheostomy stoma to maintain laryngotracheal patency and preserve phonation when a T-tube was poorly tolerated (two patients). CONCLUSIONS: Silicone tracheobronchial stents are effective in the maintenance of airway patency and are associated with good tolerance and infrequent complications that are rarely life-threatening.

Video endoscopy for laser photoresection in tracheobronchial pathology: some considerations after 9 years experience with 2105 treatments.

Between 1984 and 1993 we performed 2105 laser treatments in 1210 patients: 52% of treatments were done for malignant pathology, 45% for benign tracheal stenoses and 3% were in a miscellaneous group. The procedure was carried out with a rigid bronchoscope under general anaesthesia. In patients with malignant tumors, it is a good palliative treatment-safe, well tolerated and with immediate results; it can be repeated as many times as needed with and is well accepted by the patient. In patients without tumors, this method avoids emergency tracheotomies. The long term results are now under evaluation.

Nd:YAG laser photoresection of low-grade malignant tumors of the tracheobronchial tree.

Nineteen patients with low-grade malignant tumors of the tracheobronchial tree received Nd:YAG laser treatment. They were referred for palliation of symptomatic airway obstruction due to carcinoid (14 cases) or adenocystic carcinoma (five cases). In all patients, laser treatment was followed by symptomatic relief. Fifteen patients have done well and remain in good condition between six months and four years after laser photoresection. Two of the five patients with adenocystic carcinoma died because of hemoptysis at one and 49 months after laser therapy. In the group of 14 patients with carcinoids, two episodes of bleeding (more than 250 ml) occurred that were controlled by tamponade with the tube and coagulation by the laser beam itself. Two patients with carcinoid died of unrelated causes (stroke and gastric carcinoma).

[Treatment of obstructive tracheobronchial disease with the Yag-Nd laser: 400 procedures in a 4-year experience]. / Tratamiento con láser Yag-Nd en patología traqueobronquial obstructiva: 400 administraciones en 4 años de experiencia.

Overall, 400 procedures with the Yag-Nd laser were carried out in 252 patients with tracheobronchial disease susceptible to photoresection during a 4-year period. Most procedures were carried out under general anesthesia and with a rigid bronchoscope. 149 tumors were treated. Of these, 118 were malignant, 16 had low malignancy and 15 were benign. These patients received overall 203 procedures. 92 patients with 113 tracheal stenoses underwent overall 185 procedures. Finally, a miscellaneous group of 11 patients with several conditions underwent 12 procedures. Immediate results were classified as excellent, good or poor, depending on the achieved tracheal or bronchial diameter. No significant complications were found. After a 4-year experience, the authors believe that laser photoresection is currently the most effective and safe procedure to relieve obstruction in the stenoses caused by malignant proliferative tracheal or bronchial diseases not amenable to surgery. It is also the ideal substitute for surgery in benign tumors and in some cases of non-tumoral tracheal stenosis.