[Inflammatory pseudotumor of paranasal sinuses]. / Pseudotumor inflamatorio de fosas nasales.

Inflammatory pseudotumor is a rare benign lesion of unknown etiology which was first described in the lung. In head and neck the areas most commonly involved are the orbit and paranasal sinuses, but they have been also described in the larynx, pterygomaxilar space, tonsils, ears, gingiva and other periodontal tissues. We present a case of a 64 years old male who presented a three months history of right nasal obstruction. Physical examination showed a big nasal tumor arising from the nostril. CT scan shows nasal fossa mass with a normal paranasal sinuses. Histology made the diagnosis of an inflammatory pseudotumor. The lesion was surgically removed trough a midface degloving approach. The patient has no signs of recurrence two years after surgery. Data about diagnosis, treatment and outcome of inflammatory pseudotumors is revised also in this paper.

[External lateral osteotomy in rhinoplasty for the correction of nasal dorsal deviations]. / Osteotomías laterales externas en rinoplastia para la corrección de las desviaciones de dorso óseo.

We present a revision of 45 patients with nasal deviation operated on between 1993 and 2001. Septorhinoplasties were done in all cases using the external lateral nasal osteotomies technique. 67% of our patients were male and 33% were female with a mean age of 25. In all cases a septoplasty was performed. To correct nasal deviation, medial osteotomies through an intercartilaginous approach and external lateral nasal osteotomies were done. We did a postoperative follow-up of 35 patients. In terms of patient satisfaction, 78% of them felt that their nasal appearance had improved after surgery, and 22% felt that they had a great improvement. One case had to be reoperated on because of a traumatic nasal fracture after surgery. We believe this technique offers important advantages, such as: an excellent control of the fracture line, fewer incidences of open roof and lateral step, without causing visible scars.

[Cartilaginous grafts in rhinoplasty]. / Injertos cartilaginosos en rinoplastia.

We present a revision of 38 cases operated on for augmentation rhinoplasty from 1992 to 2001, using a cartilaginous graft. 83% of our patients were men and 17% were female. The mean age was 31 years old. In 33 rhinoplasties, the graft was placed in the nasal dorsum; in 4 cases it was placed at the nasal tip and in one case reconstruction of the dorsum and the tip was performed. The most frequently used graft was septal cartilage, in 28 cases. Conchae cartilages were used in 3 cases, lower lateral cartilage in 5 cases, rib cartilage in one, and in another case, septal and lower lateral cartilage were used in the same patient. We stabilized the graft fixing it to the skin with a suture which is removed after a week. We did a postoperative follow-up on 25 of the patients. In terms of patient satisfaction, 12% of them felt that their nasal appearance had improved, 76% felt that there had been a great improvement, and 12% did not notice any change. Only one patient had to be reoperated on because of an overprojection of the graft in the nasal dorsum. We conclude that the use of autologous cartilaginous grafts offers important advantages in rhinoplasty; they are easy to be obtained, easy to mould and with a low index of resorption.

Readiness to change questionnaire: reliability study of its Spanish version.

The present study explored the reliability and validity of a Spanish version of the Readiness to Change Questionnaire (RCQ) (12-item short form) as it might be used for opportunistic intervention. The test has three scales to allocate patients to a stage of change: pre-contemplation (P), contemplation (C) or action (A). The RCQ was translated and back-translated prior to pilot administration to 15 patients. From two settings (a general hospital ward and a primary health care centre), 201 patients were identified as excessive drinkers on the Alcohol Use Disorders Identification Test. Patients known to be alcohol-dependent and attending for alcohol-related reasons were excluded. Patients completed the RCQ. Test-retest reliability after 2 days was assessed in 35 patients. A components analysis was performed. Patients were classified on RCQ scores to a stage of change. Two experts separately interviewed the patients and made an allocation to stage of change, blind to the RCQ score. Test-retest reliability was good (P: r = 0.81; C: r = 0.87; A: r = 0.86). Within the three scales, RCQ items showed fair consistency in terms of Cronbach's alpha (P: 0.58, C: 0.75, A: 0.80). Component analysis showed that together the scales accounted for 57. 4% of the variance. The experts agreed between themselves on patients' stage of change (weighted kappa 0.92) but much less with the stage of change according to RCQ (expert A, kappa = 0.44; expert B, kappa = 0.52). Omitting patients with low consumption did not improve internal reliability, and omitting those with low educational level who might have filled in the questionnaire wrongly did not improve internal reliability or agreement between RCQ and the experts. We conclude that the Spanish RCQ did not function efficiently in a population of opportunistically identified excessive drinkers.

[Peripheral arteriopathy in type 2 diabetes mellitus]. / Arteriopatía periférica en la diabetes mellitus tipo 2.

OBJECTIVES: To find the prevalence of peripheral arteriopathy (PA) in type 2 diabetics registered at a Health Centre, to detect their main risk factors and examine the usefulness of the portable Doppler in Primary Care consultations. DESIGN: A crossover descriptive study. SETTING: Urban Health Centre. PATIENTS: All the type 2 diabetics registered. MEASUREMENTS AND RESULTS: Anamnesis, physical examination, analysis and base ECG were performed. A portable Doppler determined systolic blood pressure in the lower extremities (foot and posterior tibial arteries) and brachial arteries in order to calculate the ankle/arm index (AAI). PA well recorded in the clinical history and AAI < or = 0.90 were considered criteria of PA. Diabetics with AAI > or = 1.25 were analysed separately. 289 patients with an average age of 65.3 (+/- 10.8 SD) were studied. 45.7% were men and 67% had Diabetes Mellitus for less than 10 years. 37.4% followed a dietary treatment and 21.1% were treated with insulin. Multivariate analysis showed that risk factors were: tobacco dependency, age, Hypertension and the type of treatment for the DM. CONCLUSIONS: The prevalence of PA found (21.4%) was very much higher than what had been previously diagnosed (6.9%). Identified risk factors were tobacco dependency, age, Hypertension and the type of DM treatment. A portable Doppler is easy to handle and allows peripheral arteriopathy to be diagnosed at an early stage.

[Smoking initiation in students: cross-sectional and longitudinal study of predictive factors]. / El inicio del consumo de tabaco en escolares: estudio transversal y longitudinal de los factores predictivos.

BACKGROUND: This study examines the evolution of tobacco use among schoolchildren in sixth and seventh grades in Barcelona (11-13 years) and identifies smoking risk factors through cross-sectional and follow-up analysis. POBLATION AND METHODS: The cohort consists of 1,003 students attending 13 schools who served as control units for a study assessing the effects of a school-based addictive substances prevention program. Participants answered the same questionnaire in 1990 and 1991. Risk factors for the experimentation and for regular smoking are studied through cross-sectional and prospective studies. RESULT: In a year, smokers increase from 9.7% to 18.9% and regular smokers rise from 1.1% to 5.5%. The initial cross-sectional analysis finds stronger associations than the follow-up one. Some variables loose their significance in the longitudinal analysis. Among non-smokers, the strongest predictors to emerge are intention to smoke, the belief that smoking is fun, peers, siblings and mother consumption, and being male; however girls appear to consolidate the consumption more than boys among the cohort of triers. CONCLUSIONS: Tobacco use prevalences are consistent with other studies developed in our city. Social environment emerges as an important predictor; friends, siblings and mothers tobacco use and gender are the main risk factors.

Acoustic stimulation in hypoxic-ischemic encephalopathy: heart rate analysis.

Two groups of 30 term newborns (normal and anoxic) were analyzed to study the influence of anoxia in the heart rate. The experiment consisted in a polygraphic EEG register before, during and after an acoustic stimulus. In basal conditions of active sleep, the heart rate in the asphyctic newborn was higher than in the normal group. The acoustic stimulation caused a transitional tachycardia. The variability of the heart rate was smaller in the asphyctic group. The basal heart rate varied in relation to the grade of Hypoxic-Ischemic Encephalopathy (HIE) and there was also a difference in the capacity of response to acoustic stimulation between the moderate HIE group and the normal group.

[Difficulties in carrying out preventive activities in primary care]. / Dificultades en la realización de las actividades preventivas en atención primaria.

OBJECTIVE: To find the difficulties perceived by Primary Care health professionals in integrating preventive activities into their daily practice. DESIGN: A descriptive study using a survey. SETTING: Barcelonès Nord and Maresme health region. PARTICIPANTS: Health professionals from primary care teams. RESULTS: The overall coverage of the survey was 47.7%. Pressure from patients or lack of time obtained the highest score (6.2), followed by the absence of a procedure or programme (4.5), absence of economic incentives (4.4) and the lack of material resources (4.2). The lowest scores corresponded to training (3.4) and motivation (2.9). CONCLUSIONS: Primary Care occupies a strategic position for carrying out preventive activities and health promotion. But in practice health professionals encounter various obstacles. Lack of time and forgetting preventive activities are basic factors. The registration sheets or other specific devices to act as reminders, together with procedures or programmes involving the joint participation of all the team members, can help resolve these problems. There is a clear need to concentrate on those problems which the professionals directly involved are most concerned with.

[Alcohol consumption by primary care physicians]. / Consumo de alcohol entre los médicos de atención primaria.

OBJECTIVE: To find the consumption of alcoholic drinks by Primary Care doctors. DESIGN: A descriptive study using an anonymous questionnaire. SETTING: Health base areas located in the Baix Llobregat and in Barcelona city. MEASUREMENTS AND MAIN RESULTS: Total coverage was 68.7%. In the group which replied, daily consumption along with week-end consumption predominated. Men consumed alcohol more often and in greater quantity than women. The prevalence of excessive drinkers according to the PAPPS criteria was 5.9%. 29% of the doctors exceeded the level of alcohol consumption considered acceptable by their own criteria, no gender differences being appreciated. Similarly, 33% of them accepted consumption above that recommended by the experts. CONCLUSIONS: The consumption of alcoholic drinks found among Primary Care doctors was low in comparison with other studies of medical groups or the general population. The Primary Care doctor occupies a privileged position in the prevention of excessive consumption of alcoholic drinks, which implies that their own alcohol consumption and training could have an impact on carrying out preventive activities in this field.

[Tobacco and adolescents: influence of the personal environment]. / Tabaco y adolescentes: influencia del entorno personal.

BACKGROUND: The initiation of the smoking habit is related both with personal and environmental characteristics. Several authors have described the association of the smoking habit of parents, older siblings, and friends with the use of tobacco by teens. METHODS: This study is based on a cross-sectional survey to 6th and 7th grade students in Barcelona (Spain). RESULTS: This study confirms there is a growing proportion of smokers among teens when their parents, siblings and friend smoke. Children whose parents have quit smoking behave as the sons of parents who have never smoked, and smoke much less than the children of current smokers. When parents do not smoke, having siblings and friends who smoke increases the frequency of smoking from 0.2 to 3.4%, a 17-fold increase. CONCLUSIONS: Current smoking and future smoking intention are related with the number of smokers in the teen environment. These results support preventive programs in schools that include activities to resist external pressures to smoke. It also suggests that helping young adult smokers quit contributes not only to their own health, but also prevents the initiation of smoking among teens in their environment.

[Results of a school addictive substances abuse prevention program: the Barcelona PASE pilot project]. / Resultados de un programa escolar de prevención del abuso de sustancias adictivas: proyecto piloto PASE de Barcelona.

A pilot project for the prevention of substance abuse in schools (PASE) has been developed in 1988-90 in sixth and seventh grades (12-14 years-old) in 11 primary schools in the city of Barcelona (Spain). Data on consumption smoking, alcohol and drugs were obtained before the implementation of the project, shortly afterwards, and in the next school year. These results are presented, comparing the evolution of attitudes, beliefs and behavior of these school children with a control group composed of students from reference schools. The results suggest a modest but significant effect of the program, which seems to decrease over time for smoking, suggesting the need for booster interventions to maintain its effects.

[The consumption of alcoholic drinks in adolescence]. / Consumo de bebidas alcohólicas en la adolescencia.

OBJECTIVE: To identify the factors involved in the use and abuse of alcoholic drinks among a group of adolescents attending school. DESIGN: A descriptive, crossover study. SITE. 23 schools in the city of Barcelona. PARTICIPANTS: Students doing the sixth and seventh grades of EGB (in general, between 11 and 13 years old). MAIN MEASUREMENTS AND RESULTS: An in-school questionnaire, which gathered data from 2,033 students (92.2% coverage), was carried out. The students' replies were used to construct one index of probable alcohol abuse (IPAA) and another of the penetration of alcohol in the environment (IPAE). 51.9% had consumed some alcoholic drink, with 9.5 as the average age for the first drink. 1.3% drank alcohol every day. 1.8% said they had been drunk two or more times during the previous six months. 3.1% had bought alcohol for their own use. 8% of the students had at least one point on the IPAA. The seventh-grade students scored higher on the IPAE. The alcohol abuse indicators increased if the parents consumed alcohol, but more so if their peers were also consumers (older siblings or friends). There is a link between alcohol and tobacco consumption. CONCLUSIONS: The data showed how the increased penetration of alcohol into schoolchildren's environment resulted in abusive consumption being more likely. The importance of preventing the abuse of alcoholic drinks among adolescents was confirmed.

[Yield of laboratory tests in the detection of excessive drinkers in the work place]. / Rendimiento de las pruebas de laboratorio en la detección de bebedores excesivos en el medio laboral.

BACKGROUND: The identification of personnel consuming excess quantities of alcoholic beverages in the work place is necessary due to the economic, health, and laboral problems caused by alcohol. The objectivity of laboratory tests provides great credibility and these tests have replaced other methods as the anamnesis. METHODS: A transversal study was carried out of the employees of a Barcelona enterprise. During the periodic medical check ups the consumption of alcoholic beverages and laboratory blood tests were obtained from the employees seven days previously. RESULTS: All the laboratory tests presented a weak positive correlation with the consumption of alcohol. The calculation of diagnostic efficacy for weekly consumption equal to or grater than 280 g of pure alcohol in a male shows that the greatest sensitivity corresponds to mean corpuscle volume (33%) followed by gammaglutamyltranspeptidase (GGT) (16%) with high specificity being observed in both (85% and 93%, respectively). The results are better in employee consuming more than or equal to 420 g of alcohol weekly. CONCLUSIONS: The diagnostic efficacy of laboratory tests in identifying subjects with elevated consumption of alcohol in the work place has low clinical performance and the use of anamnesis on the consumption of alcoholic beverages should first be evaluated.

[Evaluation of a project of primary prevention of smoking: the Barcelona PASE project]. / Evaluación de un proyecto de prevención primaria del tabaquismo: el proyecto piloto PASE de Barcelona.

The results of the short-term evaluation of a program to prevent the use of tobacco and other substances among schoolchildren of sixth and seventh grade are presented. Schoolchildren who participated in the project show significant differences when compared to a reference group through a matched analysis in the regular use of tobacco and having bought tobacco, but not in the experimentation nor in the intention to smoke. The results suggest the program is useful to prevent the onset of smoking, although longer term evaluation data are needed. The results and their implications for a comprehensive smoking prevention approach in schools are discussed.