Pituitary surgery in elderly patients: a safe and effective procedure.

PURPOSE: The incidence of pituitary adenoma (PA) increases with age. Transsphenoidal surgery (TSS) in elderly patients is often considered to have greater risk compared to the younger population. The aim of this study is to compare surgical results, evolution and postoperative complications between elderly and young patients undergoing TSS. METHODS: Retrospective review of patients undergoing TSS between 2011 and 2018 in our institution. Patients were divided into two cohorts: elderly (≥65 years) and non-elderly (<65 years). Characteristics and outcomes of both groups were compared at diagnosis, before surgery and for an average of 5.9 years of postoperative follow-up. RESULTS: One hundred and twenty-five patients were included, 53 patients were ≥65 years (42%). The elderly patients were more likely to have non-functioning PA (NFPA) (90.5% vs. 45.8%, p: <0.01), a higher proportion of macroadenomas (92.4% vs. 77.8%, p = 0.029) and greater extrasellar extension (88.7% vs. 68.1%, p = 0.007). The elderly group also had more compressive symptoms (54.7% vs. 34.7%, p = 0.035) and hypopituitarism (66% vs. 47.2%, p = 0.029). Overall, surgical and endocrinological outcomes between the two groups were similar. Inpatient mortality in the elderly group was 1.8%. Regarding long-term outcomes, elderly patients had more postoperative hypopituitarism (67.9% vs. 45.8%, p = 0.03) with no differences in permanent diabetes insipidus, less residual tumours (24.5% vs. 40.3%, p = 0.019) and a higher rate of remission after surgery (71.7% vs. 52.8%, p = 0.034). When only NFPA cases were compared, the only significant difference was a higher frequency of macroadenomas in the elderly group. CONCLUSIONS: Our results support the safety and efficacy of TSS in elderly patients with PA. Age should not be considered an exclusion criterion for TSS given that successful results can be achieved if an experienced pituitary team is available.

Early versus conventional nutritional intervention in head and neck cancer patients before radiotherapy: benefits of a fast-track circuit.

BACKGROUND/OBJECTIVES: Radiotherapy (RT) is a component of therapy for head and neck cancer (HNC) with a negative nutritional impact. Our aim was to compare an early versus a conventional nutritional intervention. SUBJECTS AND METHODS: Retrospective study of HNC patients undergoing RT. Evolution before and after the establishment of a fast-track circuit was evaluated. A conventional group (CG) made up of patients submitted to the nutrition unit during RT after nutritional deterioration, was compared to an early group (EG) represented by patients included in a fast-track circuit, starting nutritional follow-up before the beginning of RT. Only patients with preserved oral intake were involved. Demographic, nutritional and clinical variables were analyzed. Data of hospitalizations and deaths were collected up to three months after RT. RESULTS: 135 subjects constituted the EG and 39 the CG. At baseline, the prevalence of malnutrition was lower in the EG (31.9% vs 69.5%, p = 0.0001), as was the need for nutritional supplements (40% vs 79.5%, p = 0.0001) or nasogastric tube (0% vs 12.8%, p = 0.0001) in comparison to the CG. Three months after RT, there were less patients with oral nutritional support in the EG (79.1% vs 96.9%, p = 0.018), and the number of emergency visits (0.75 vs 1.1 episodes per patient, p = 0.021) and hospitalizations was also lower in this group (29% vs 59%, p = 0.044). CONCLUSIONS: The fast-track approach made early intervention possible. Therefore, patients maintained a better nutritional status, needed less nutritional support and their evolution improved, with a significant decrease in hospitalizations.

Atopic dermatitis incidence and risk factors in young adults in Castellon (Spain): A prospective cohort study.

INTRODUCTION: There are few atopic dermatitis (AD) incidence cohort studies in young adults, the etiology of this disease remains obscure, and AD risk factors in adults are not well understood. The objective of this study was to estimate AD ten-year incidence and prevalence in a cohort of adolescent aged 14-16 at inception in Castellon province in Valencia Region, Spain and describe related risk factors. MATERIAL AND METHODS: From 2002 to 2012, a population-based prospective cohort study was carried out. Questionnaires from the International Study of Asthma and Allergies in Childhood (ISAAC) were used with an additional questionnaire for related factors completed by participants and their parents, respectively, in 2002. In 2012 the same questionnaires were completed by the participants' through a telephone interview, and incidence and prevalence of AD were estimated. Directed acyclic graphs, Poisson regression and inverse probability weighted regression adjustment were used. RESULTS: The participation rate was 79.5% (1435/1805) with AD lifetime prevalence of 34.9% and AD incidence of 13.5 per 1000 person years. Females presented higher prevalence and incidence than males. After adjustment significant risk factors were being female, history of asthma or allergic rhinitis, family history of AD, history of respiratory infections, history of bronchitis, history of pneumonia, history of sinusitis, and birthplace outside Castellon province. The highest AD population attributable risks were female, 30.3%, and history of respiratory infections 15.3%. Differences with AD childhood risk factors were found. CONCLUSIONS: AD incidence in our cohort was high and several risks factors were related to AD.

Incidence of asthma in young adults from Castellon, Spain: A prospective cohort study

Background: The objective was to estimate the incidence of asthma in young adults from 13-15 years old to 23-25 years old, and associated factors. Methods: In 2012, a population-based prospective cohort study was carried out in Castellon from the cohort who had participated in the International Study of Asthma and Allergy in Childhood in 1994 and 2002. A telephone survey was undertaken using the same questionnaires. A new case of asthma was defined as a participant free of the disease in 2002 who suffered asthma, was diagnosed with asthma, or took medications against asthma based on self-report from 2002 to 2012. Results: The mean age of participants was 24.9 ± 0.6 with a follow-up of 79.1%. Asthma cumulative incidence was 3.4%: 44 new cases occurred among 1280 participants. The incidence was higher in females than males with relative risk (RR) =2.02 (95% confidence interval [CI] 1.1-3.8). A significant decrease of asthma incidence density was observed (8.2 cases to 3.5 cases per 1000 person/year). Factors associated with the incidence of asthma were allergic rhinitis (RR = 4.05; 95% CI 1.7-9.6), bronchitis (RR = 2.13; 95% CI 1.0-4.5), mother's age at time of birth (RR=0.87; 95% CI 0.8-0.9) and a pet other than a dog or cat (RR = 0.42; 95% CI 0.2-0.9). For gender, some variations in the risk factors were observed. Conclusions: A significant decrease in the incidence of asthma was observed. Several risk and protective factors were found (AU)

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Incidence of asthma in young adults from Castellon, Spain: A prospective cohort study.

BACKGROUND: The objective was to estimate the incidence of asthma in young adults from 13-15 years old to 23-25 years old, and associated factors. METHODS: In 2012, a population-based prospective cohort study was carried out in Castellon from the cohort who had participated in the International Study of Asthma and Allergy in Childhood in 1994 and 2002. A telephone survey was undertaken using the same questionnaires. A new case of asthma was defined as a participant free of the disease in 2002 who suffered asthma, was diagnosed with asthma, or took medications against asthma based on self-report from 2002 to 2012. RESULTS: The mean age of participants was 24.9±0.6 with a follow-up of 79.1%. Asthma cumulative incidence was 3.4%: 44 new cases occurred among 1280 participants. The incidence was higher in females than males with relative risk (RR)=2.02 (95% confidence interval [CI] 1.1-3.8). A significant decrease of asthma incidence density was observed (8.2 cases to 3.5 cases per 1000 person/year). Factors associated with the incidence of asthma were allergic rhinitis (RR=4.05; 95% CI 1.7-9.6), bronchitis (RR=2.13; 95% CI 1.0-4.5), mother's age at time of birth (RR=0.87; 95% CI 0.8-0.9) and a pet other than a dog or cat (RR=0.42; 95% CI 0.2-0.9). For gender, some variations in the risk factors were observed. CONCLUSIONS: A significant decrease in the incidence of asthma was observed. Several risk and protective factors were found.

Recombinant activated factor VII use in the emergency department.

Recombinant activated factor VII (rFVIIa) has recently gained wide attention as a potent prohaemostatic agent for patients with excessive or life-threatening blood loss. Originally licensed for the treatment of patients with bleeding haemophilia with antibodies to factor VIII or IX, rFVIIa is now being used on an off-label basis to thwart blood loss in a variety of other clinical situations. Despite concerns over the drug's cost, risk profile and the lack of large-scale clinical trials validating its use, more and more patients are being treated with rFVIIa in the emergency department. With few clinical trials available to guide its administration, emergency physicians must weigh the existing evidence when considering whether to use rFVIIa for their patients with bleeding. This paper reviews the current literature regarding rFVIIa as it pertains to the practice of emergency medicine.

Inhibition of direct haemolytic plaques by antistaphylococcal sera.

An in vitro study was carried out to determine the IgM response to staphylococcal antigens (Staphylococcus aureus, serotype 3, ATCC 12600), at different stages of the growth curve. This was in order to observe the number of inhibited haemolytic plaques when immunosera obtained from blood-letting in rabbits previously immunized with antigenic components were used.

ELISA IgG as screening test for the research of true prevalence of human hydatidosis in Badajoz, Spain.

IgG antibodies against E. granulosus were investigated in order to determine the true prevalence of human echinococcosis in Badajoz, Spain. The seroepidemiological survey was carried out on 1540 subjects not suspected of suffering from hydatidosis, in order to add this morbidity rate to that already declared. Because of its high sensitivity and specificity, a standardized immunoenzymatic technique, ELISA was used, and the results subsequently compared using a classical technique for seroepidemiological surveys, namely indirect hemagglutination test (IHA). According to ELISA, 2.2% of the tested subjects were positive. This indicates a higher morbidity in our province than that declared. This test was found to be ideal for seroepidemiological surveys since it is reproducible, easily and rapidly conducted and safe. It requires economical reagents, a large number of samples can be processed simultaneously and it offers a totally objective reading.