Upper airway obstruction in patients with endothoracic goiter enlargement: no relationship between flow-volume loops and radiological tests.

BACKGROUND: In about 16-85% of subjects with goiter, upper airway obstruction (UAO) is observed. This percentage is higher in patients affected by goiter with endothoracic enlargement. UAO is an indication for surgery. Visual analysis of flow-volume loops (FVL) are the best indicators for UAO, although various studies using clinical and radiological parameters have observed no correlation. OBJECTIVE: To evaluate the presence of UAO in patients with endothoracic goiter enlargement and the relationship between the FVL with the observed symptoms and the measurements obtained by computed tomography (CT). SUBJECTS: Subjects with endothoracic goiter enlargement participated in the study. DESIGN: i) Symptom questionnaire (dysphagia, dyspnea, cough, oppression, dysphonia, and worsened symptoms when prone); ii) analysis: TSH and free thyroxine; iii) cervical ultrasound; iv) cervical-thoracic CT (measurements of area and diameter in the area of maximum stenosis and at 2 cm from the carina); v) chest radiography and vi) forced spirometry: visual analysis of FVL morphology and the maximum forced expiratory volume in 1 s (FEV(1)), forced expiratory flow at 50% vital capacity/forced inspiratory flow at 50% vital capacity and FEV(1)/peak expiratory flow parameters. RESULTS: Fifty subjects participated in the study: 11 men/39 women, median age 73.8 years (43.76-88.43). UAO was diagnosed in 13 cases (26%, confidence interval: 14.6-40.3%) and 27 subjects (54%) presented symptoms suggesting goiter compression. No clinical or radiological variables showed the presence of UAO. CONCLUSIONS: The frequency of UAO in subjects affected by goiter with endothoracic enlargement was lower than that described for goiter patients, and there were no clinical or radiological indicators to establish its presence.

[Evaluation of the diagnosis and treatment of children with attention deficit hyperactivity disorder in Spain using the Achievable Benchmarks of Care (ABC) technique]. / Evaluación del diagnóstico y tratamiento de los niños con trastorno por déficit de atención/hiperactividad en España mediante la técnica Achievable Benchmarks of Care (ABC).

INTRODUCTION AND AIMS: Attention deficit hyperactivity disorder (ADHD) is currently of great interest to the public and the diagnostic process, evaluation of the follow-up and therapeutic strategies in these patients are the subject of a fierce debate. In this study we assess compliance with the ADHD diagnostic and therapeutic guidelines in Spain, in relation to the American Academy of Pediatrics (AAP) guidelines, and it is measured using the Achievable Benchmarks of Care (ABC) technique. SUBJECTS AND METHODS: The study involved 215 specialists, 138 child and youth psychiatrists, and 77 neuropaediatricians. Questions were selected to elicit responses on compliance with the AAP diagnostic (1 to 5) and therapeutic (1 to 5) guidelines. The ABC technique, developed at the University of Alabama, Birmingham, USA, was applied for the analysis. RESULTS: The degree of compliance with the diagnostic guidelines was: guideline 2, 63.1% (ABC 100%), guidelines 3 and 4, 65.8% (ABC 100%) and guideline 5, 87% (ABC 100%); and in the treatment guidelines: guideline 2, 87.1% (ABC 100%) and guideline 3, 71.2% (ABC 100%). CONCLUSIONS: Compliance with the AAP guidelines for treating patients with ADHD is higher than observance of the diagnostic guidelines. In 10% of the best centres (ABC) compliance reaches 100% of all the guidelines, a high degree of adherence to the US guidelines, although compliance with them is not mandatory in our clinical area.

Evaluación del diagnóstico y tratamiento de los niños con trastorno por déficit de atención/hiperactividad en España mediante la técnica Achievable Benchmarks of Care (ABC) / Evaluation of the diadnosis and treatment of children with attention deficit hyperactivity disorder in Spain using the achievable benchmark of care (ABD) technique

Introducción y objetivos. Observamos un gran interés público hacia el trastorno por déficit de atención/hiperactividad (TDAH) con un intenso debate sobre el proceso diagnóstico, la evaluación del seguimiento y las estrategias terapéuticasen estos pacientes. En este estudio valoramos el cumplimiento de las recomendaciones diagnósticas y terapéuticas en el TDAH en España, en relación con las recomendaciones de la Academia Americana de Pediatría (AAP), y lo cuantificamos mediante la técnica Achievable Benchmarks of Care (ABC). Sujetos y métodos. Participaron en el estudio 215 especialistas, 138 psiquiatras infantojuveniles y 77 neuropediatras. Las preguntas fueron seleccionadas para responder al cumplimiento de las recomendaciones para el diagnóstico (1 a 5) y tratamiento (1 a 5) de la AAP. Se aplicó para el análisis la técnica ABC, de la Universidad de Alabama, Birmingham, EE. UU. Resultados. El grado de cumplimiento de las recomendaciones diagnósticas fue: recomendación 2, 63,1% (ABC 100%), recomendaciones 3 y 4, 65,8% (ABC 100%), y recomendación 5, 87% (ABC 100%); y en las recomendaciones de tratamiento: recomendación 2, 87,1% (ABC 100%), y recomendación 3, 71,2% (ABC 100%). Conclusiones. El seguimiento de las recomendaciones de la AAP para el tratamiento de los pacientescon TDAH es mayor que el seguimiento de las recomendaciones diagnósticas. En el 10% de los mejores centros (ABC) se alcanza un cumplimiento de un 100% de todas las recomendaciones, un elevado grado de adherencia a las recomendaciones estadounidenses, aun no siendo de obligado cumplimiento en nuestro ámbito clínico

Introduction and aims. Attention deficit hyperactivity disorder (ADHD) is currently of great interest to the public and the diagnostic process, evaluation of the follow-up and therapeutic strategies in these patients are the subject of a fierce debate. In this study we assess compliance with the ADHD diagnostic and therapeutic guidelines in Spain, in relation to theAmerican Academy of Pediatrics (AAP) guidelines, and it is measured using the Achievable Benchmarks of Care (ABC)technique. Subjects and methods. The study involved 215 specialists, 138 child and youth psychiatrists, and 77 neuropaediatricians. Questions were selected to elicit responses on compliance with the AAP diagnostic (1 to 5) and therapeutic (1 to 5) guidelines. The ABC technique, developed at the University of Alabama, Birmingham, USA, was applied for the analysis. Results. The degree of compliance with the diagnostic guidelines was: guideline 2, 63.1% (ABC 100%), guidelines 3 and 4, 65.8% (ABC 100%) and guideline 5, 87% (ABC 100%); and in the treatment guidelines: guideline 2, 87.1% (ABC 100%) and guideline 3, 71.2% (ABC 100%). Conclusions. Compliance with the AAP guidelines for treating patients with ADHD is higher than observance of the diagnostic guidelines. In 10% of the best centres (ABC) compliance reaches 100% of all the guidelines, a high degree of adherence to the US guidelines, although compliance with them is not mandatory in our clinical area