Infiltración amigdalar de bupivacaína y adrenalina comparada con sueron fisiolótico en cirugía amigdalar pediátrica / Tonsil infiltration of bupivacaine and adrenaline compared with physiological serum in pediatric tonsil surgerys

INTRODUCCIÓN: La cirugía adenoamigdalar constituye una de las intervenciones quirúrgicas más frecuentes en la edad pediátrica. El dolor posoperatorio, junto con la hemorragia amigdalar, son complicaciones relativamente frecuentes que aumentan la morbilidad. El empleo de infiltración de anestésicos locales en el lecho quirúrgico ha sido ampliamente utilizado para reducir el dolor posoperatorio y las comorbilidades. OBJETIVO: El objetivo de este estudio es demostrar que la infiltración de anestésico local en combinación con adrenalina reduce tanto el dolor posoperatorio como el sangrado posquirúrgico en pacientes pediátricos sometidos a cirugía amigdalar. MATERIALES Y MÉTODOS: Estudio observacional prospectivo, doble ciego y aleatorizado con 90 pacientes entre 6 y 14 años, ASA I y II, divididos en dos grupos: 45 pacientes fueron sometidos a una infiltración periamigdalar con bupivacaína 0,25 % y adrenalina y otros 45 pacientes fueron sometidos a infiltración amigdalar son suero fisiológico. Se evaluó la eficacia analgésica, así como los efectos secundarios presentados durante las primeras 6 horas del posoperatorio inmediato. RESULTADOS Y ANÁLISIS: Durante su estancia en la unidad de recuperación posanestésica (URPA) el 80 % de los pacientes que recibieron infiltración de suero salino necesitaron analgesia suplementaria frente al 13,4 % de los que recibieron infiltración con bupivacaína, siendo esta diferencia estadísticamente significativa (p < 0,05). En nuestro estudio, tres pacientes presentaron sangrado posoperatorio, todos ellos procedentes del grupo que había recibido suero salino. Dentro de los 90 pacientes incluidos, de estos tres solo dos tuvieron que ser reintervenidos para controlar el sangrado. Así, la incidencia de sangrado en este estudio fue del 3,33 %, ligeramente inferior a los hallazgos de otros estudios de la literatura actual. CONCLUSIÓN: La infiltración periamigdalar de bupivacaína con vasoconstrictor es un método seguro y eficaz para el control analgésico posoperatorio en población pediátrica sometida a cirugía amigdalar en comparación con la terapia analgésica convencional. El impacto de esta medida en la reducción del sangrado arroja nuevos estudios para aclarar el papel de los vasoconstrictores en la reducción del sangrado posoperatorio

INTRODUCTION: The adenotonsillar surgery constitutes one of the most frequent surgical interventions in the pediatric age. Postoperative pain (1) together with tonsillar hemorrhage are two relatively frequent complications that increase morbidity. The use of local anesthetic infiltration in the surgical bed has been widely used to reduce postoperative pain and comorbidities. OBJECTIVE: The objective of this study is to demonstrate that infiltration of local anesthetic in combination with adrenaline reduces both postoperative pain and post-surgical bleeding in pediatric patients undergoing tonsillar surgery.Materials and methods: Prospective, double-blind, randomized observational study with 90 patients between 6 and 14 years old, ASA I and II, divided into two groups: 45 patients underwent periamigdalar infiltration with 0.25 % bupivacaine and adrenaline and 45 other patients underwent tonsillar infiltration with physiological saline.The analgesic efficacy was evaluated, as well as the side effects presented during the first 6 hours of the immediate postoperative period. RESULTS: During their stay in the post-anesthesia recovery unit (PACU), 80 % of patients who received saline infiltration needed supplemental analgesia com-pared to 13.4 % of those who received infiltration with bupivacaine, this difference being statistically significant (p < 0.05). In our study, 3 patients presented postoperative bleeding, all of them from the group that had received saline. Within the 90 patients included, of these 3 only 2 had to be reoperated to control bleeding. Thus, the incidence of bleeding in this study was 3.33%, slightly lower than the findings of other studies in the current literature (2,3). CONCLUSION: Periamigdalar infiltration of bupivacaine with vasocontrictor is a safe and effective method for postoperative analgesic control in pediatric popu-lation undergoing tonsillar surgery compared to conventional analgesic therapy. The impact of this measure on the reduction of bleeding yields no significant results, although it is true that there seems to be a lower incidence of bleeding in patients treated with adrenaline. New studies are needed to clarify the role of vasoconstrictors in the reduction of postoperative bleeding

Clinical course of severe colitis: a comparison between Crohn’s Disease and ulcerative colitis.

Few data are available about the clinical course of severe colonic Crohn’s disease (CD). The aim of this study is to describe the clinical course of severe Crohn’s colitis in a patient cohort with isolated colonic or ileocolonic CD, and to compare it with the clinical course of patients with severe ulcerative colitis (UC). Thirty-four patients with severe Crohn’s colitis were prospectively identified in our cohort of 593 consecutive hospitalized patients through evaluation of the Crohn’s Disease Activity Index score and the Harvey-Bradshaw Index. One hundred sixty-nine patients with severe ulcerative colitis were prospectively identified in our cohort of 449 consecutive hospitalized patients through evaluation of the Lichtiger score and the Truelove-Witts score. We evaluated the following data/aspects: response to steroids, response to biologics, colectomy rate in acute, colectomy rate during follow-up, megacolon and cytomegalovirus infection rate. We did not find significant differences in the response to steroids and to biologics, in the percentage of cytomegalovirus infection and of megacolon, while the rate of colectomy in acute turned out to be greater in patients with severe Crohn’s colitis compared to patients with severe UC, and this difference appeared to be the limit of statistical significance (Chi-squared 3.31, p = 0.069, OR 0.39); the difference between the colectomy rates at the end of the follow-up was also not significant. In the whole population, by univariate analysis, according to the linear regression model, a young age at diagnosis is associated with a higher overall colectomy rate (p = 0.024) and a higher elective colectomy rate (p = 0.022), but not with a higher acute colectomy rate, and an elevated ESR is correlated with a higher overall colectomy rate (p = 0.014) and a higher acute colectomy rate (p = 0.032), but not with a higher elective colectomy rate. This correlation was significant on multivariate analysis. The overall rate of colectomy in the cohort of patients with severe Crohn’s colitis was greater than that of the cohort of patients with severe UC, but this figure is not supported by a different clinical response to steroid therapy or rescue therapy with biologics. The clinical course of severe Crohn’s colitis requires to be clarified by prospective studies that include a larger number of patients in this subgroup of disease.

Avaliação dos níveis séricos de hormônios tireoidianos em araras (Ara spp) pelo método de quimioluminescência / Evaluation of serum levels of thyroid hormones in macaws (Ara spp) by chemiluminescence

Este trabalho investigou a eficiência do método de quimioluminescência para obtenção das concentrações séricas de hormônios tireoidianos em 23 exemplares de araras [Ara ararauna (n=12) e Ara chloropterus (n=11)], de ambos os sexos [machos (n=11) e fêmeas (n=12)], mantidas em cativeiro. Os valores de T4 total, T4 livre, T3 livre e TSH variaram, respectivamente, de 0,3 a 2,5µg/dL (média=0,94µg/dL), 0,11 a 0,46ɳg/dL (média=0,28ɳg/dL), 1,46 a 3,59pg/mL (média= 2,42pg/mL) e 0,01 a 0,12µUI/mL (média=0,04µUI/mL). Houve interação entre espécie e sexo (P<0,05) sobre as concentrações de T4 total: os machos possuem maiores valores do que as fêmeas de Ara ararauna, enquanto as fêmeas de Ara chloropterus dispõem de níveis mais altos do que os machos desta espécie. Efeito de sexo não foi observado (P>0,05) para os valores de T4 livre, T3 livre e TSH, mas o efeito de espécie foi constatado (P<0,05) para as concentrações de T3 livre. Neste caso, as concentrações de T3 livre são menores em Ara ararauna do que em Ara chloropterus. Os intervalos de referência obtidos sugerem que é possível mensurar as concentrações séricas de hormônios tireoidianos em araras pelo método de quimioluminescência, devendo-se considerar variações relevantes entre diferentes espécies e sexos.(AU)

This paper investigated the efficiency of chemiluminescence in obtaining serum concentrations of thyroid hormones in twenty-three macaws kept in captivity, from two sexes [male (n=10) and female (n=12)] and two species [Ara ararauna (n=12) and Ara chloropterus (n=11)]. Reference intervals for the hormones sampled were indicated and the effects of species and sex on these values were analyzed. Concentration values of total T4, free T4, free T3 and TSH varied respectively from 0,3 to 2,5µg/dL (average =0,94µg/dL), 0,11 - 0,46ɳg/dL (average = 0,28ɳg/dL), 3,59 - 1,46pg/mL (average =2,42pg/mL), and 0,01 - 0,12µUI/mL (average= 0,04µUI/mL). There was interaction between species and sex (P<0.05) on total T4 concentrations. Males had higher values than females in Ara ararauna, while females had higher values than males in Ara chloropterus. Sex effect was not observed (P>0.05) for concentrations of free T4, free T3 and TSH, but species effect was observed (P<0.05) for free T3 concentrations. In this case, concentrations of free T3 were lower in Ara ararauna than in Ara chloropterus. The results of this study suggest that it is possible to measure serum concentration of thyroid hormones in macaws by means of chemiluminescence method, as long as relevant variations between different species and sexes are taken into account.(AU)

EMG activity of upper limb on spinal cord injury individuals during whole-body vibration.

Whole-body vibration (WBV) has shown positive results increasing electromyographic (EMG) activity and strength in a healthy population when applied to upper and lower limbs. The aim of this study was to verify if WBV increases the EMG signal of the upper limb muscles in patients with spinal cord injury (SCI). For this study, 15 patients with SCI were selected and one single session of WBV was applied to the upper limb. Five sessions of 30 s at 30 Hz were applied and EMG of anterior deltoid and forearm muscles was measured. The results show that EMG activity had a significant increase during WBV session compared with baseline muscle activity. These results support WBV as an efficient tool to increase the upper body EMG in individuals with SCI.

Mouse plasma progesterone levels are affected by different dietary ω6/ω3 ratios.

An imbalance in the dietary polyunsaturated fatty acids (PUFAs) ω6/ω3 ratio, could influence negatively the reproductive performance. The aim of the study was to assess the effects of chronic administration of diets enriched with soybean or sunflower oils with different ω6/ω3 ratios on the reproductive parameters of adult female mice. Mice were fed different diets for 90 days: a commercial diet (CD), a 5 or 10% soy oil-enriched diet (SOD5 and SOD10, respectively), and a 5 or 10% sunflower oil-enriched diet (SFOD5 and SFOD10, respectively). The parameters evaluated were: body weight and food intake, estrous cycle, plasma progesterone concentration, ovulation rate, and oocyte quality. Progesterone concentrations (ng/ml) were significantly higher in the SFOD10: 14.9±2.8 vs CD: 5.4±1.2; SOD5: 5.6±1.1 and SFOD5: 4.6±1.4. Additional parameters evaluated were not affected. However, metestrous and luteal phases were shorter in subjects receiving SOD and longer in those under SFOD diets. In SFOD, there was a trend towards a smaller number of recruited oocytes compared to CD and SOD and a higher percentage of cleaved oocytes were quantified in SOD diets. A 3-month supply of a diet with elevated LA ω6/ALA ω3 ratio to adult female mice affects their reproductive physiology, modifying progesterone production, ovulation rate, and/or oocyte quality. Although some differences in the response to diets have been observed in several mammalian species, the present findings must be taken into consideration when a diet for optimizing reproductive capability is indicated.

[Influence of temperature on food intake in hospitalized patients]. / Influencia de la temperatura en la ingesta de pacientes hospitalizados.

BACKGROUND AND OBJECTIVES: Prevalence of hyponutrition in hospitalized patients is very high and it has been shown to be an important prognostic factor. Most of admitted patients depend on hospital food to cover their nutritional demands being important to assess the factors influencing their intake, which may be modified in order to improve it and prevent the consequences of inadequate feeding. In previous works, it has been shown that one of the worst scored characteristics of dishes was the temperature. The aim of this study was to assess the influence of temperature on patient's satisfaction and amount eaten depending on whether the food was served in isothermal trolleys keeping proper food temperature or not. MATERIAL AND METHODS: We carried out satisfaction surveys to hospitalized patients having regular diets, served with or without isothermal trolleys. The following data were gathered: age, gender, weight, number of visits, mobility, autonomy, amount of orally taken medication, intake of out-of-hospital foods, qualification of food temperature, presentation and smokiness, amount of food eaten, and reasons for not eating all the content of the tray. RESULTS: Of the 363 surveys, 134 (37.96%) were done to patients with isothermal trays and 229 (62.04%) to patients without them. Sixty percent of the patients referred having eaten less than the normal amount within the last week, the most frequent reason being decreased appetite. During lunch and dinner, 69.3% and 67.7%, respectively, ate half or less of the tray content, the main reasons being as follows: lack of appetite (42% at lunch time and 40% at dinner), do not like the food (24.3 and 26.2%) or taste (15.3 and 16.8%). Other less common reasons were the odor, the amount of food, having nausea or vomiting, fatigue, and lack of autonomy. There were no significant differences in the amount eaten by gender, weight, number of visits, amount of medication, and level of physical activity. The food temperature was classified as adequate by 62% of the patients, the presentation by 95%, and smokiness by 85%. When comparing the patients served with or without isothermal trays, there were no differences with regards to baseline characteristics analyzed that might have had an influence on amount eaten. Ninety percent of the patients with isothermal trolley rated the food temperature as good, as compared with 57.2% of the patients with conventional trolley, the difference being statistically significant (P = 0.000). Besides, there were differences in the amount of food eaten between patients with and without isothermal trolley, so that 41% and 27.7% ate all the tray content, respectively, difference being statistically significant (P = 0.007). There were no differences in smokiness or presentation rating. CONCLUSIONS: Most of the patients (60%) had decreased appetite during hospital admission. The percentage of hospitalized patients rating the food temperature as being good is higher among patients served with isothermal trolleys. The amount of food eaten by the patients served with isothermal trolleys is significantly higher that in those without them.

Influencia de la temperatura en la ingesta de pacientes hospitalizados / Influence od temperatura on food intake in hospitalizad patients

Antecedentes y objetivos: La prevalencia de desnutrición en los pacientes hospitalizados es muy elevada y se ha demostrado que constituye un factor pronóstico importante. La mayoría de los pacientes ingresados dependen de la comida hospitalaria para cubrir sus requerimientos nutricionales siendo importante el análisis de los factores que influyen en la ingesta y que se puedan modificar, para conseguir mejorarla y así evitar las consecuencias derivadas de una nutrición inadecuada. En anteriores trabajos se ha demostrado que una de las características de la comida peor valoradas por los pacientes es la temperatura. El objetivo de este trabajo fue evaluar la influencia de la temperatura en la satisfacción y cantidad ingerida en función de que se sirviese o no en carros isotérmicos que mantienen una temperatura adecuada de la comida. Material y métodos: Se realizaron encuestas de satisfacción a pacientes del hospital con y sin carros isotérmicos con dietas basales. Se recogieron los siguientes datos: edad, sexo, peso, número de visitas, movilidad, autonomía, cantidad de medicación por vía oral, ingestión de alimentos traídos de fuera del hospital, calificación de la temperatura, presentación y humedad, cantidad de comida ingerida y motivos por los que no se ingirió todo el contenido del carro isotérmico. Resultados: De las 363 encuestas, 134 de ellas (37,96%) se realizaron en pacientes con bandeja térmica y 229 (62,04%) en pacientes sin ella. El 60% de los pacientes referían haber comido menos de lo normal en la última semana siendo la causa más frecuente la disminución de apetito. En el almuerzo y cena comieron la mitad o menos del contenido de la bandeja el 69,3% y 67,7% respectivamente, siendo las causas más frecuentes las siguientes: la falta de apetito (42% en almuerzo y 40% en cena), no gustarles la comida (24,3 y 26,2%) y el sabor (15,3 y 16,8%). Otras causas menos frecuentes fueron el olor, la cantidad de comida, presentar náuseas o vómitos, cansancio y falta de autonomía. No hubo diferencias significativas en la cantidad de ingesta en función del sexo, peso, número de visitas, cantidad de medicación y grado de actividad. La temperatura de la comida fue clasificada como buena por el 62% de los pacientes, la presentación por el 95% y la humedad por el 85%. Al comparar a los pacientes con y sin carro isotérmico, no hubo diferencias en las características basales analizadas que pudiesen influir en la cantidad ingerida. Calificaron la temperatura como buena un 90% de los pacientes con carro isotérmico y un 57,2% sistema tradicional, siendo esta diferencia estadísticamente significativa (P = 0,000). Además hubo diferencias en la cantidad de comida ingerida entre los pacientes con y sin carro isotérmico, de modo que se lo comieron todo un 41% frente al 27,7% respectivamente siendo esta diferencia estadísticamente significativa (P = 0,007). No hubo diferencias en la calificación de humedad y presentación. Conclusiones: La mayoría de los pacientes (60%) presentan disminución de apetito durante el ingreso. La proporción de ingresados que califican la temperatura como buena es mayor en los pacientes con el sistema de carros isotérmicos. La cantidad ingerida por los pacientes con carros isotérmicos es significativamente mayor que en los pacientes sin ellos (AU)

Background and objectives: Prevalence of hyponutrition in hospitalized patients is very high and it has been shown to be an important prognostic factor. Most of admitted patients depend on hospital food to cover their nutritional demands being important to assess the factors influencing their intake, which may be modified in order to improve it and prevent the consequences of inadequate feeding. In previous works, it has been shown that one of the worst scored characteristics of dishes was the temperature. The aim of this study was to assess the influence of temperature on patient's satisfaction and amount eaten depending on whether the food was served in isothermal trolleys keeping proper food temperature or not. Material and methods: We carried out satisfaction surveys to hospitalized patients having regular diets, served with or without isothermal trolleys. The following data were gathered: age, gender, weight, number of visits, mobility, autonomy, amount of orally taken medication, intake of out-of-hospital foods, qualification of food temperature, presentation and smokiness, amount of food eaten, and reasons for not eating all the content of the tray. Results: Of the 363 surveys, 134 (37.96%) were done to patients with isothermal trays and 229 (62.04%) to patients without them. Sixty percent of the patients referred having eaten less than the normal amount within the last week, the most frequent reason being decreased appetite. During lunch and dinner, 69.3% and 67.7%, respectively, ate half or less of the tray content, the main reasons being as follows: lack of appetite (42% at lunch time and 40% at dinner), do not like the food (24.3 and 26.2%) or taste (15.3 and 16.8%). Other less common reasons were the odor, the amount of food, having nausea or vomiting, fatigue, and lack of autonomy. There were no significant differences in the amount eaten by gender, weight, number of visits, amount of medication, and level of physical activity. The food temperature was classified as adequate by 62% of the patients, the presentation by 95%, and smokiness by 85%. When comparing the patients served with or without isothermal trays, there were no differences with regards to baseline characteristics analyzed that might have had an influence on amount eaten. Ninety percent of the patients with isothermal trolley rated the food temperature as good, as compared with 57.2% of the patients with conventional trolley, the difference being statistically significant (P = 0.000). Besides, there were differences in the amount of food eaten between patients with and without isothermal trolley, so that 41% and 27.7% ate all the tray content, respectively, difference being statistically significant (P = 0.007). There were no differences in smokiness or presentation rating. Conclusions: Most of the patients (60%) had decreased appetite during hospital admission. The percentage of hospitalized patients rating the food temperature as being good is higher among patients served with isothermal trolleys. The amount of food eaten by the patients served with isothermal trolleys is significantly higher that in those without them (AU)

Linfoma de Hodkin en Chile: Experiencia de 15 años del Programa Nacional de Cáncer del Adulto / Hodgkin lymphoma in Chile: Experience of the national adult cancer program

Background: Hodgkin lymphoma is a highly curable disease. Aim: To evaluate the clinical characteristics and the treatment results of Hodgkin lymphoma patients of the National Cancer Program in Chile. Patients and methods: Prospective assessment of 682 patients treated in 18 adult cancer centers. Progression free survival (PFS) and overall survival (OS) were calculated. Median follow up was 127, 95, 87, 72 and 50 months for C-MOPP, radiotherapy (RT), C-MOPP/ABV, NOVP and ABVD, respectively. Results: Median age was 37 years (15-84). Nodular sclerosis and mixed cellularity were equally expressed. Advanced stages (III & IV) were present at diagnosis in 61 percent of cases. Age over 40 was an adverse prognostic factor (p <0.001). The rate of PFS at 5 and 10 years for early stages was 73 percent and 66 percent with RT, 80 percent and 74 percent with C-MOPP+RT, 73 percent and 71 percent with C-MOPP/ABV, 59 percent and 59 percent with NOVP+RT, and 81 percent with ABVD+RT, at 5 years, being significantly lower for NOVP (p =0.02). The rate of OS at 5 and 10 years for advanced stages was 82 percent and 70 percent with RT, 82 percent and 76 percent with C-MOPP+RT, 82 percent and 80 percent with C-MOPP/ABV, 68 percent and 60 percent with NOVP, and 85 percent with ABVD at 5 years, also significantly lower for NOVP (p =0.04). For advanced stages, the rate of PFS at 5 and 10 years was 49 percent and 43 percent with C-MOPP, 69 percent and 62 percent with C-MOPP/ABVD or C-MOPP/ABV, and 71 percent at 5 years with ABVD, significantly lower for C-MOPP (p =0.01). The rate of OS at 5 and 10 years was 52 percent and 46 percent with C-MOPP, 70 percent and 63 percent with C-MOPP/ABVD or C-MOPP/ABV and 76 percent with ABVD at 5 years, significantly lower for C-MOPP (p =0.0002). Conclusions: Age over 40 years was an adverse prognostic factor. C-MOPP/ABVD, C-MOPP/ABV and ABVD had comparable results and reached a high tumor control and overall survival in both early...

Incidence of Crohn's disease and CARD15 mutation in a small township in Sicily.

BACKGROUND: The incidence of Crohn's disease (CD) has been shown to be lower in Southern than in Northern Europe. Data on the frequency of the NOD2/CARD15 mutations for Mediterranean area are very scant. AIM: To determine the incidence of CD from 1979 to 2002 in a township in Sicily together with the allele frequency of NOD2/CARD15 mutations in patients, family members and controls, and to determine the allele frequency of these mutations in sporadic CD from other areas of Sicily in comparison with a control population. METHODS: Casteltermini is a small town close to Agrigento (Sicily) with a population of 9,130 inhabitants. All the diagnoses of inflammatory bowel disease (IBD) made from 1979 to 2002 were obtained through the local health authority. NOD2/CARD15 mutations were studied in 23 out of the 29 patients with CD in Casteltermini, in 60 family members and in 64 controls. NOD2/CARD15 was also studied in 80 sporadic cases of CD disease among Sicilians outside Casteltermini and 118 healthy controls. RESULTS: From 1979 to 2002, 29 patients with CD and 13 patients with ulcerative colitis (UC) were registered. The 6-year mean incidence of CD ranged from 8.0 to 17 new cases for every 100,000 inhabitants, whereas the mean incidence of UC ranged from five new cases to 7.8 for every 100,000 inhabitants. The allele frequencies of NOD2/CARD15 mutations (L1007finsC, G908R, R702W) were 8.7, 4.3 and 8.7%, respectively, in CD cases; 5.0, 4.2 and 3.1% in family members; 1.6, 2.3 and 3.1% in controls. In sporadic Sicilian CD patients outside Casteltermini the allele frequency was 7.5, 8.1, 6.2% whereas in control population it was 3.3, 1.6, 1.6%. CONCLUSIONS: A high incidence of CD compared with UC was observed in this small town in Southern Italy. The frequency of NOD2/CARD15 mutations in CD is similar to other Caucasian population studied so far.

Distrés psíquico en el ámbito hospitalario / Psychic distress in hospital setting

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Herida craneal por arma de fuego / Cranial gunshot wound

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Rentabilidad de la semiología auscultatoria en el diagnóstico de la neumonía adquirida en la comunidad / Reliability of auscultation in the diagnosis of community-acquired pneumonia

Fundamento: Analizar la correlación entre la semiología auscultatoria y las imágenes radiológicas compatibles con condensación neumónica. Métodos: Se seleccionó una muestra de 43 pacientes, que acudieron al servicio de urgencias del Hospital Universitario Marqués de Valdecilla durante un mes, con clínica compatible con neumonía adquirida en la comunidad (NAC). Se registraron factores de comorbilidad y sintomatología asociada. Se realizó auscultación por tres clínicos ciegos respecto al resultado radiológico final, siguiendo los patrones auscultatorios habituales, comparando los hallazgos semiológicos con las imágenes radiológicas encontradas compatibles con condensación. Resultados: La edad media de los pacientes fue de 58±23 años con un rango de edad de 17 a 90. Veintitres casos (53,5%) eran mujeres. Los resultados muestran la poca rentabilidad diagnóstica de la semiología auscultatoria; los roncus son el signo de mejor rentabilidad en cualquiera de las localizaciones anatómicas (con una sensibilidad aproximada del 50%) excepto en segmentos basales de los lóbulos inferiores. La auscultación de estertores crepitantes, en cambio, muestra una pobre rentabilidad (con unas sensibilidades que oscilan entre el el 6 y 21%). Conclusiones: Destaca la baja sensibilidad de la semiologia auscultatoria, así como una alta especificidad que garantiza la ausencia de falsos positivos (AU)

Background: To determine the relationship between auscultation and radiography patterns of pneumonia. Methods: We selected 43 consecutive Emergency Department clinical charts of patients that were presented in the hospital with the suspect of community-acquired pneumonia (CAP). Records were analyzed for: age, sex, symptoms and presence of underlying conditions. Comprehensive lung auscultation was performed sequentially by 3 physicians who were blind to clinical history, laboratory findings, and x-ray results and after that we compared their findings with the chest radiographs of these patients. Results: Patients were analyzed with ages between 17 and 90 years old, with a mean age of 58 years (SD = 22,9). 23 (53.5%) were women and 20 (46.5%) men Bronchial breath sounds were the best diagnostic tool except in segments of the lower lobes of the lung.. Conclusion: The traditional chest auscultation is not sufficiently accurate on its own to confirm or exclude the diagnosis of pneumonia (AU)

Fisioterapia en el Síndrome de X Frágil / Physiotherapy in Fragile X Syndrome

El retraso mental es uno de los grandes problemas médico-sociales con los que se enfrentará la sociedad del siglo XXI. Los avances en el campo de la Genética han permitido reconocer algunas formas de retraso mental, que ahora se pueden diagnosticar con gran fiabilidad. Una de estas formas es el síndrome X Frágil (SXF), descubierto a principios de los 80 y que actualmente es reconocido como la forma más común de retraso mental hereditario que se conoce. De herencia ligada al cromosoma X, este síndrome puede causar déficits intelectuales y cognoscitivos que van desde las sutiles dificultades para el aprendizaje y un cociente intelectual normal, hasta un grave retraso mental y comportamientos autistas. En este momento no hay cura para este síndrome, aunque existen muchos tratamientos disponibles. Este se aplica principalmente por medio de varias formas de terapia, incluyendo educación especial, terapia del habla y del lenguaje, terapia ocupacional y fisioterapia. La intervención médica está basada en el uso de medicación estimulante para tratar la hiperactividad y la escasa capacidad de atención de los niños con SXF. Otras medicaciones pueden ser útiles para problemas de agresividad, ansiedad, depresión u otros. Con el fin de crear y proporcionar un programa educativo, terapéutico o vocacional óptimo, es importante considerar el desarrollo global de cada individuo. Es necesario evaluar las capacidades de aprendizaje, los problemas de comportamiento específicos y las necesidades médicas. Esta recomendación es válida tanto para niños como para los adultos1 (AU)

Severe acute colitis associated with CMV: a prevalence study.

BACKGROUND: Cytomegalovirus has been identified as a pathogen that contributes to flares of colitis when detected in colonic specimens of patients with inflammatory bowel disease. AIM: To determine the overall prevalence and the role of cytomegalovirus infection in a consecutive series of patients with acute severe colitis admitted to our department from 2000 to 2003. METHODS: Among 42 patients (38 with ulcerative colitis and 4 with Crohn's disease) admitted to our hospital for acute severe colitis, we performed proctoscopy and biopsy together with blood sample for cytomegalovirus determination at the time of admission, regardless of their steroid resistance. RESULTS: In the 42 patients, we discovered an overall cytomegalovirus infection prevalence of 21.4% (9/42) in our geographical area. In seven patients (16.6%), cytomegalovirus was detected through biopsy. The presence of cytomegalovirus in biopsies was not always predictive of steroid resistance. Three patients with cytomegalovirus in biopsies responded to conventional treatment without needing any antiviral treatment, which suggests that the virus plays only an incidental role. CONCLUSIONS: Cytomegalovirus is frequently associated with colitis but it is not always pathogenic. Studies on the genotyping of the virus might explain the diversity of its biological behaviour.

Tromboembolia pulmonar. Otro riesgo de los viajes / Lung tromboembolism. Another risk of travelling

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Colorectal cancer and high grade dysplasia complicating ulcerative colitis in Italy. A retrospective co-operative IG-IBD study.

BACKGROUND: Ulcerative colitis is a well-known risk factor for colorectal cancer. AIM: To take a census of the cases of colorectal cancer in ulcerative colitis patients observed in Italy and to evaluate the clinical presentation of neoplastic complication. PATIENTS AND METHODS: Experts from 28 Italian centres specialised in the management of inflammatory bowel disease or malignancies participated to the study. They were invited to send clinical data of patients with ulcerative colitis complicated by colorectal cancer or high-grade dysplasia consecutively observed between 1985 and 2000. One hundred and twelve patients (92 with cancer and 20 with high-grade dysplasia) were collected. Fourteen of them had undergone colectomy and ileo-rectal anastomosis for ulcerative colitis. Data of surgical patients were analysed separately. RESULTS: The mean age at diagnosis of ulcerative colitis and colorectal cancer patients was 39.3 and 53.2 years, respectively, and the mean duration between diagnosis of ulcerative colitis and cancer was 13.9 years (range 0-53). Inflammation was proximal to the splenic flexure in 71 cases (76.3%). One hundred and three colorectal cancers were registered (93 patients with single lesion and five patients with two synchronous cancers), with 76.7% of cancers being located in the left colon. As to the surgical patients, the mean age at diagnosis of ulcerative colitis and cancer was 28.9 and 47.0 years, respectively, and the mean diagnostic interval for ulcerative colitis and cancer was 18.1 years. Only 51 out of 112 patients were in follow-up. An early diagnosis of neoplasia (high grade dysplasia, stage A or B sec. Dukes) occurred in 72.5% of patients who were subjected to endoscopic surveillance and in 48.0% of patients who did not undergo endoscopic surveillance (p=0.02). CONCLUSIONS: These data show an earlier diagnosis of cancer in patients who had undergone endoscopic surveillance. The poor compliance to the follow-up program, however, reduces its effectiveness. Moreover, total colectomy allows an easier follow-up, with only the rectum being controlled. Colectomy with ileo-rectal anastomosis or proctocolectomy with ileo-anal anastomosis, could represent a valid alternative in patients at high risk of cancer who refuse endoscopic surveillance.

Síndrome de Rett: actualización del proceso de rehabilitación / Rett syndrome. Updating of rehabilitation process

Los recientes hallazgos genéticos en el síndrome de Rett obligan a una actualización de los recursos terapéuticos actuales y de la metodología empleada en su rehabilitación. Se establecen explícitamente los objetivos generales y específicos en el marco de una rehabilitación integral y los medios para alcanzarlos. Estas niñas presentan un abigarrado cuadro en el que destacan los problemas ortopédicos (escoliosis, luxación adquirida de cadera, pie equino, fracturas óseas), alteraciones del tono muscular, problemas cognitivos y del lenguaje. Además se revisa el afrontamiento terapéutico de los graves problemas neurológicos y del comportamiento, como la ataxia, apraxia, movimientos estereotipados, problemas foniátricos y respiratorios, ataques de llanto, problemas de autonomía personal, problemas senso-perceptivos, alteraciones cognitivas, y problemas del comportamiento. Se establece la utilidad clínica de diferentes terapias: "técnica de energía muscular", "reptación refleja y volteo reflejo de la terapia Vojta", "concepto Bobath", estimulación del equilibrio y transferencia de peso, patrones progresivos y de repetición, férulas, estimulación eléctrica transcutánea, comunicación aumentativa y alternativa, musicoterapia, etc. El objetivo global es establecer un programa individualizado de enseñanza y terapéutico que, manteniendo en permanente contacto y supervisión a los pacientes y su familia con los servicios especializados asistenciales de rehabilitación, mejore la calidad de vida de estas niñas y de sus familias (AU)

[Acute hepatic failure in a teaching hospital: a review of 20 cases in the past seven years]. / Fallo hepático agudo en un hospital universitario: revisión de 20 casos en los últimos siete años.

Acute liver failure (ALF) is a medical emergency which entails a multisistemic affectation almost always. Twenty cases of ALF have been reviewed in a teaching hospital with active liver transplantation programme. A high percentage of patients with alcohol abuse was observed although these patients did not have previously known hepatic damage. Although microbiological, toxicological and anatomopatological studies were performed in all cases, an important difficulty for establishing the etiologic agent was observed. We observed a worse prognosis in those patients older than 40, those with grade IV encephalophaty and those that did not undergo a liver transplantation. Most patients needed UCI attention and more than half died.