Aseguramiento en la indicación quirúrgica. Réplica a: causas de conversión en la cirugía laparoscópica de la enfermedad por reflujo gastroesofágico: análisis de nuestra experiencia (1) / No disponible

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La enfermedad celiaca en el adulto / Celiac disease in the adult

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Grupos de riesgo y procesos asociados con la enfermedad celíaca / No disponible

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Infliximab en la enfermedad de Crohn / Infliximab in crohn's disease

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[Study of pre and postsurgical ventilatory function in idiopathic thoracic scoliosis using the Harrington method]. / Estudio de la función ventilatoria pre y postcirugía de la escoliosis torácica idiopática por el método de Harrington.

OBJECTIVE: To study the evolution and ventilatory function measured by spirometry after surgery with the Harrington method for idiopathic thoracic scoliosis. PATIENTS AND METHODS: A prospective study with evaluation of changes in scoliosis angle following the Cobb method, as well as ventilatory parameters after surgery, measured after a mean time of 19.2 +/- 11.8 (range: 9-60) months post-surgery. Twenty patients were studied, 6 men and 14 women, with no previous respiratory conditions, with ages ranging from 12 and 35 years, and a mean of 16.3 +/- 4.6 years, and all of them with the diagnosis of idiopathic thoracic scoliosis and with pre-surgery angle of 59.9 degrees +/- 13.5 degrees. RESULTS: No statistically significant changes were observed in any of the ventilatory parameters considering both the absolute value and percentage of the theoretical value, although there was indeed a significant improvement in the scoliosis angle. CONCLUSIONS: In our study no ventilatory function improvement was observed after scoliosis surgery, although we cannot say that the results were the same if the previous thoracic deformity were more remarkable and caused greater changes in ventilatory parameters.

Epidemiological study of the prevalence of Helicobacter pylori infection in the general population in Asturias, Spain.

BACKGROUND: Helicobacter pylori is a worldwide infection, and it is estimated that approximately 50% of the general population is affected. However, its distribution varies considerably between developed and developing countries. AIMS: in the present study we report the results of an epidemiological investigation of the prevalence of H. pylori infection in the general population in Asturias (Northern Spain), in order to describe the current state of this infection in our region, and obtain figures for comparison with the results obtained in different communities of Spain and other countries. EXPERIMENTAL DESIGN: a descriptive transversal, epidemiological study, based on the serological determination of the IgG antibodies against H. pylori was carried out in the general population of a randomly selected sample of subjects without previous gastroduodenal antecedents. PARTICIPANTS: we analyzed 480 serum samples obtained from the general population of Asturias. These were divided into decades according to the age pyramid and tested for the presence of antibodies against H. pylori with a commercially available latex agglutination technique (Pyloriset). RESULTS: the global prevalence of H. pylori infection in our study was 226/480 (49.2%), and was slightly higher in women (50.6%) compared to men (47.6%). No significant differences were found between sexes (p = 0.51). In the first decade mean prevalence was 13.6%. In the second this figure was 25.4%, and it increased steadily to a maximum in the sixth decade of 76.4%. Thereafter, the prevalence decreased to 66.6% in persons over 80 years of age. CONCLUSIONS: we found a high prevalence approximately 50% of H. pylori infection in the general population of Asturias, as in other epidemiological studies in Spain and other European countries. The distribution according to age shows a clear tendency to increase, from childhood to adolescence and adult life (50-60 years), when prevalence is highest (76%). From this decade onwards it begins to decrease, showing a clear cohort effect with a pattern intermediate between that of developed and developing countries.

[Study of arterial blood gases in liver cirrhosis with and without ascites]. / Estudio de la gasometría arterial en cirrosis hepática con y sin ascitis.

OBJECTIVE: The study of the disturbances of arterial gases and the changes in the arterial pH which are present in patients with liver cirrhosis and ascites and their modification after the disappearance of ascites by treatment. EXPERIMENTAL DESIGN: Open study,with protocol and prospective, to evaluate the changes in measurement of the arterial gases and acid-base, parameters in matching groups of patients. PATIENTS: We include 24 patients, 15 males and 9 females, without preliminary or cardio-respiratory pathology age range between 37 and 77 years, average of 56.8 years, all of them diagnosed of liver cirrhosis of different etiologies and with important ascites. All of them finished the study. RESULTS: In patients with liver cirrhosis and ascites a fall in the PaO2 and in the PaCO2 was demonstrated the pH in the upper limit of the normality compatible with hypoxemia and respiratory alkalosis. After the disappearance of the ascites, a significant improvement in the PaO2 (p < 0.05), without any changes in the PaCO2 and pH values was apparent. CONCLUSIONS: In patients with liver cirrhosis, with or without ascites, hyperventilation is present, that can be multifactorial in origin, but which really has an unknown cause. We have found no relationship with the circulating levels of progesterone.

[Influence of liver cirrhosis with and without ascites on ventilatory mechanics]. / Influencia de la cirrosis hepática con y sin ascitis sobre la mecánica ventilatoria.

BACKGROUND: The thoracic cavity plays an important role in the mechanical ventilatory function, and the alteration of some of its structures, such as those which occur in decompensated cirrhosis of the liver, for example the presence of ascites and muscle atrophy, directly influence its normal function. METHODS: In the present study we have evaluated the ventilatory function and respiratory muscular tension by means of the calculation of volumes, flows and resistances of the airways, and also the maximum inspiratory and expiratory pressures (Pimax, Pemax). PATIENTS: One hundred patients with liver cirrhosis and ascites without associated respiratory illness, mean age 57 +/- 15 years (range 32-80), were studied. We evaluated the respiratory function before and after the disappearance of the ascites. RESULTS: A restrictive pattern was evident, and various parameters were altered. The most affected being that of the reserve expiratory volume. No associated bronchial obstruction was observed. Respiratory muscular tension was decreased in both the Pimax and the Pemax. With the disappearance of the ascites we found an improvement in the affected parameters, but this did not reach normality. CONCLUSION: In liver cirrhosis associated with ascites, the most common respiratory pattern, is a decrease in ventilatory function of a restrictive type, and also a decrease in the respiratory muscular tension. These alterations improve after the resolution of the ascites.

[Maximal static respiratory pressures. The importance of the study of normal reference values]. / Presiones respiratorias estáticas máximas. Importancia del estudio de los valores de referencia normales.

In order to determine the validity for our population of the theoretical reference values available in the literature today, we studied respiratory muscle force by calculating maximum expiratory pressure PEmax and maximum inspiratory pressure (PImax) in 100 healthy subjects in Asturias (50 women) between 17 and 80 years-old (mean 40.4 +/- 19.3 years). We used the same methods and apparatus as Black and Hyatt and compared the results with theoretical values given by them as references corresponding to our subjects, according to age and sex. Values were significantly lower (p < 0.001) in our population for both parameters and for both men and women. In men PEmax was 69.7% and PImax was 88.5% of the theoretical values, in women PEmax was 60.9% and PImax was 82.9%. These figures indicate that the theoretical values given by Black and Hyatt are not valid for the population we studied and that normal reference values appropriate for each population, laboratory and apparatus must be obtained if valid conclusions are to be reached.

[An epidemiologic study on the prevalence of alcohol consumption in a rural area of Asturias (council of Somiedo)]. / Estudio epidemiológico sobre la prevalencia del consumo de alcohol en una zona rural asturiana (concejo de Somiedo).

AIMS: To determine the prevalence of alcoholism in a rural area of Asturias and the usefulness of others clinical and analytical parameters for a rapid detection of its related pathology. MATERIAL AND METHODS: We conducted a cross-sectional descriptive study on a sample of 198 persons, divided into two groups (Group I: Heavy-drinkers and Group II: Moderate and nondrinkers), according with alcohol daily intake. The limit for the classification was the consumption of 80 or more grams of ethanol/day in men, and 60 g/day or more in women. Data about physical findings and blood biochemistry were collected and compared into the two groups. RESULTS: The prevalence of alcoholism in group I, was of 16.5% and the mean age of 54.3 +/- 11.4 years with increased proportion of males over females with a ratio of 7.25/1. The main analytical parameters useful as indicators of heavy alcohol consumption were an increase of AST, ALT, GGT, Total Cholesterol, Uric acid and gammaglobulin levels. We found a significative relation between legal problems and alcohol consumption (p < 0.005) as well as an increased prevalence of chronic obstructive lung diseases (p < 0.005). Digestive diseases as a whole, were most frequently associated with heavy alcohol consumption. CONCLUSION: This paper confirms the finding of a increased alcohol consumption in this mainly agricultural area of Asturias (Spain) in 16.5% and also confirms the usefulness of the use of simple clinical and analytical parameters for its detection in order to permit an earlier diagnostic and better use of preventive measures.

[An epidemiologic study of the prevalence of alcohol consumption in the Council of Tineo (Asturias)]. / Estudio epidemiológico de la prevalencia del consumo de alcohol en el Concejo de Tineo (Asturias).

AIMS: To know the incidence and prevalence of alcohol consumption in the studied area and also the somatometric alterations and laboratory findings found. PATIENTS AND METHODS: One prospective study was performed in one-way, transversal in a sample of 216 people. With a protocol we collect the data of alcohol habits and also physical examination and biochemical findings. We divided the sample into two groups: Group I "heavy drinkers" (men with ethanol intake greater than 100 g/day, and women more than 50 g/day), and Group II composed by abstemics and slight drinkers. RESULTS: We found and excessive intake of alcohol in the 15.75%, the whole sample (11.6% males and 4.17% females). Mean age was of 41.7% +/- 12.1 y.o. Un group I we found slight jaundice in 32.3% spinders in 64.7%, hepatomegaly in 58.8%, palmar erythema in 29.4% gynecomastia in 29.4% and Dupuytren in 11.8% (p < 0.001). Of the symptoms we found matutinal cough in 52.9%, epigastric burning in 64.7%, nausea and vomiting in 41.2% and hands tremors in 29.4% (p < 0.001). Biochemical parameters elevated were found in TGC TGO/TGP, GGT and amylase. CONCLUSIONS: In this study we confirm the excessive alcohol consumption in this rural area of Tineo in Asturias. We also found an important increase of alcohol intake in last year in women. The utility of analytical and exploratory findings is also proved for the early diagnosis of this illness in the ambulatory study of these patients.