Open preperitoneal vs. open anterior repair for the treatment of emergency femoral hernia: a bicentric retrospective study.

PURPOSE: The aim of this study is to compare the postoperative results, in terms of complications and recurrence, between the anterior and open preperitoneal approaches in emergency femoral hernia. METHODS: This bi-centric retrospective cohort study included patients who underwent emergency femoral hernia repair between January 2010 and December 2018. Postoperative complications and recurrence were analyzed comparing anterior and open preperitoneal approaches. The predictors of complications, mortality and recurrence were investigated using multivariate logistic regression. RESULTS: A total of 204 patients met the inclusion criteria. Open anterior approach was performed in 128 (62.7%) patients and open preperitoneal was performed in 76 (37.3%). Open preperitoneal approach was associated with lower rates of recurrence (P = 0.033) and associated midline laparotomies (P = 0.006). Multivariable analysis identified patients with chronic nephropathy (OR, 3.801; 95%CI, 1.034-13.974; P = 0.044), preoperative bowel obstruction (OR, 2.376; 95%CI, 1.118-5.047; P = 0.024) and required midline laparotomy (OR, 12.467; 95%CI, 11.392-102.372; P = 0.030) as risk factors for complications and ASA ≥ III (OR, 7.820; 95%CI, 1.279-47.804; P = 0.026), COPD (OR, 5.064; 95%CI, 1.188-21.585; P = 0.028), necrotic contents (OR, 36.968; 95%CI, 4.640-294.543; P = 0.001), and required midline laparotomy (OR, 11.047; 95%CI, 1.943-62.809; P = 0.007). as risk factors for 90-day mortality. Male gender (OR, 4.718; 95%CI, 1.668-13.347; P = 0.003) and anterior approach (OR, 5.292; 95%CI, 1.114-25.149; P = 0.036) were risk factors for recurrence. CONCLUSION: Open preperitoneal approach may be superior to anterior approach in the emergency setting because it can avoid the morbidity of associated midline laparotomies, with a lower long-term recurrence rate.

Alteraciones cognitivas y conductuales tras adenoamigdalectomía en el síndrome de apnea del sueño / Neurocognitive and behavioral disturbances after adenotonsillectomy in obstructive sleep apnea syndrome

INTRODUCCIÓN: La adenoamigdalectomía es un tratamiento eficaz en la apnea obstructiva del sueño. Su capacidad para resolver los problemas cognitivos y conductuales derivados no es tan clara. OBJETIVO: Analizar la evolución de dichas alteraciones a un año de la cirugía. MÉTODO: Se estudian alteraciones de conducta y cognitivas de 45 niños con apnea obstructiva del sueño y 30 controles sanos, entre 3 y 13 años. Ambos grupos son analizados mediante test psicológicos, en el momento basal y pasado un año. RESULTADOS: En el preoperatorio, todas las variables cognitivas y conductuales estaban más afectadas en el grupo de estudio que en el control: atención, en el 46,7% de casos del grupo de estudio y el 20% en el grupo control (p = 0,016); ansiedad, en el 60,9 y el 40,9% (no significativo); memoria, en el 55,6% y el 36,7% (p = 0,019); estructuración espacial, en el 64,4% y el 36,7% (p = 0,017); hiperactividad, en el 42,9% y el 12,5% (p = 0,016), y déficit de atención, en el 46,4% y el 8,3% (p = 0,003). A un año persiste mayor afectación en el grupo de estudio en todas las variables, aunque se mantienen diferencias significativas solo en estructuración espacial (31,3% versus 3,3%; p = 0,017) y déficit de atención (40,5% versus 16,7%; p = 0,031). Los porcentajes de pacientes que mejoran a un año no son significativamente diferentes en ambos grupos. CONCLUSIÓN: Las alteraciones de conducta y cognitivas de los niños con apnea del sueño se resuelven de forma parcial. Las mejoras obtenidas en las variables analizadas no difieren significativamente de la evolución normal del individuo y son independientes de la resolución de sus trastornos respiratorios

INTRODUCTION: Adenotonsillectomy is an effective treatment for sleep-disordered breathing in children, but its ability to resolve neurocognitive issues, is not clear. OBJECTIVE: To analyze the outcomes of cognitive and behavioral disorders after one year of adenotonsillectomy. METHOD: We studied the behavioral and cognitive abnormalities in 45 children with obstructive sleep apnea and 30 healthy controls, aged 3 to 13 years. Psychological tests were performed inboth groups at baseline and at 12 months. RESULTS: Preoperatively, all cognitive and behavioral disturbances were higher in the study group than in the control group: attention in 46.7% of cases in the study group versus 20%in the control group (P=0.016), anxiety 60.9% versus 40.9% (not significant); memory 55.6% versus 36.7% (P=.019), spatial structuring 64.4% versus 36.7% (P=0.017), hyperactivity 42.9% versus 12.5% (P=.016), and attention deficit 46.4% versus 8.3% (P=0.003). After one year we observed more disturbances in all variables in the study group. However, significant differences remained only in spatial structure (31.3% versus 3.3%, P=.017), and attention deficit (40.5% versus 16.7%, P=0.031). The percentages of patients that improved in one year were not significantly different between both groups. CONCLUSION: Behavioral and cognitive disturbances in children with sleep apnea were partially esolved following adenotonsillectomy. Improvements in the cognitive and behavioral variables did not differ significantly from those the normal evolution of the individual, and were independent of the resolution of respiratory disorders

[Neurocognitive and behavioral disturbances after adenotonsillectomy in obstructive sleep apnea syndrome]. / Alteraciones cognitivas y conductuales tras adenoamigdalectomía en el síndrome de apnea del sueño.

INTRODUCTION: Adenotonsillectomy is an effective treatment for sleep-disordered breathing in children, but its ability to resolve neurocognitive issues, is not clear. OBJECTIVE: To analyze the outcomes of cognitive and behavioral disorders after one year of adenotonsillectomy. METHOD: We studied the behavioral and cognitive abnormalities in 45 children with obstructive sleep apnea and 30 healthy controls, aged 3 to 13 years. Psychological tests were performed in both groups at baseline and at 12 months. RESULTS: Preoperatively, all cognitive and behavioral disturbances were higher in the study group than in the control group: attention in 46.7% of cases in the study group versus 20% in the control group (P=.016), anxiety 60.9% versus 40.9% (not significant); memory 55.6% versus 36.7% (P=.019), spatial structuring 64.4% versus 36.7% (P=.017), hyperactivity 42.9% versus 12.5% (P=.016), and attention deficit 46.4% versus 8.3% (P=.003). After one year we observed more disturbances in all variables in the study group. However, significant differences remained only in spatial structure (31.3% versus 3.3%, P=.017), and attention deficit (40.5% versus 16.7%, P=.031). The percentages of patients that improved in one year were not significantly different between both groups. CONCLUSION: Behavioral and cognitive disturbances in children with sleep apnea were partially resolved following adenotonsillectomy. Improvements in the cognitive and behavioral variables did not differ significantly from those the normal evolution of the individual, and were independent of the resolution of respiratory disorders.

Eficacia de la terapia herbal con melisa y valeriana en la deshabituación de benzodiacepinas en pacientes con insomnio primario / Efficacy of herbal therapy with melissa and valerian to treat benzodiazepine dependence in patients with primary insomnia

Introducción. La utilización de benzodiacepinas en pacientes con insomnio es una práctica habitual, y no es infrecuente una cierta inercia terapéutica que puede prolongar su consumo durante meses e incluso años. Aunque sus beneficios a corto plazo son evidentes, su uso prolongado conlleva a menudo un cierto grado de neuroadaptación, por ello disminuir los síntomas de abstinencia durante la retirada es importante para conseguir un mayor éxito en el abandono del fármaco. El uso de la terapia herbal puede ayudar a conseguir dichos objetivos. El objetivo del presente estudio es valorar la eficacia de la combinación valeriana y melisa en la mejoría de dichos síntomas y sobre los parámetros de sueño. Sujetos y métodos Estudio experimental randomizado con existencia de grupo control y sin enmascaramiento, realizado en la Clínica de Sueño Estivill sobre una muestra de 50 pacientes con insomnio primario, en tratamiento con 1 mg de lorazepam entre 6 meses y 2 años anteriores a su entrada en el estudio, que fueron asignados paritariamente a un grupo intervención (GI), que recibió una combinación de 120mg de extracto valeriana y 80 mg de extracto de melisa y a un grupo control (GC) realizándose visitas de seguimiento en consulta y autoregistros semanales para valorar parámetros relacionados con la calidad del sueño y descanso, así como la evolución de la sintomatología asociada más frecuentemente al abandono del fármaco. Resultados. Tras un seguimiento de 90 días, el grupo sometido a terapia herbal presentó una menor proporción de sujetos que manifestaron ansiedad ( GI 59%; GC 77%), irritabilidad ( GI 54%; GC 84%), inquietud (GI 52%; GC 62%) y trastornos del ánimo (GI 43%; GC 64%), así como un menor predominio de formas moderadas o severas en su presentación. Del mismo modo, el grupo tratado experimentó una disminución en el tiempo necesario para conciliar el sueño y de la vigilia intrasueño, así como un mayor tiempo de descanso medio tras la retirada, comparado con el grupo control. Aunque en el grupo tratado existió una mayor proporción de pacientes que manifestaron una mayor calidad en el sueño, y del descanso obtenido, las diferencias observadas no obtuvieron significación estadística. Conclusiones. A pesar de las limitaciones del estudio, los presentes resultados sugieren que la terapia herbal proporciona una mejoría subjetiva de la calidad de ciertos parámetros de sueño y de la presentación y severidad de los síntomas asociados a la retirada de benzodiacepinas en pacientes con insomnio primario, pudiendo constituir una alternativa eficaz en su abordaje (AU)

Introduction. The use of benzodiazepines in patients with insomnia is common practice, and it is not unusual to detect a degree of therapeutic inertia that can prolong the consumption of these agents for months or even years. Although they have clear short-term benefits, prolonged use often leads to a degree of neuroadaptation; it is therefore important to reduce the symptoms of abstinence during withdrawal in order to achieve greater success in the discontinuation of treatment. The use of herbal therapy can help to achieve these aims. The objective of the present study was to evaluate the efficacy of a combination of Valerian and Melissa on the reduction of symptoms of withdrawal and the effect of this combination on sleep parameters. Subjects and methods This was a randomised, controlled, unblinded experimental study performed in the Estevill Sleep Clinic on a sample of 50 patients with primary insomnia and on treatment with 1 mg of lorazepam for between 6 months and 2 years prior to recruitment. Patients were assigned in a 1-to-1 ratio to the intervention group (IG), which received a combination of 120 mg of extract of Valerian and 80 mg of extract of Melissa, or to the control group (CG). Outpatient follow-up visits and weekly patient diaries were used to evaluate the parameters related with the quality of sleep and rest and the severity of symptoms most commonly associated with drug withdrawal. Results. After a follow-up of 90 days, fewer subjects in the group receiving herbal therapy reported anxiety (IG, 59%; CG, 77%), irritability (IG, 54%; CG, 84%), restlessness (IG, 52%; CG, 62%), or mood disorders (IG, 43%; CG, 64%), and a smaller proportion of this group suffered moderate or severe forms of these symptoms. In addition, the IG presented a shorter time to onset of sleep and fewer episodes of waking compared with the CG, as well as a greater mean duration of sleep after withdrawal. Although a larger proportion of patients in the IG reported a better quality of sleep and of derived rest, the differences observed did not reach statistical significance. Conclusions. Despite the limitations of the study, the results suggest that herbal therapy gives rise to a subjective improvement in the quality of certain sleep parameters and a reduction in the onset and severity of symptoms associated with benzodiazepine withdrawal in patients with primary insomnia. This treatment could constitute an effective option in the management of benzodiazepine withdrawal (AU)

Tratamiento farmacológico del insomnio: ventajas e inconvenientes. Cómo sustituir la medicación hipnótica / Pharmacological treatment of insomnia: advantages and disadvantages. Replacing hypnotics

La prevalencia estimada indica que alrededor de un tercio de la población adulta manifiesta síntomas de insomnio, de los que en un 9-12% manifiestan consecuencias diurnas. De éstos, sólo el 10% son tratados de forma adecuada. El insomnio es la mayoría de las veces un síntoma. Descubrir la etiología será fundamental para aplicar un correcto tratamiento. Existe una alta comorbilidad entre el insomnio y otras patologías médicas. Además de las causas médicas, los factores sociales, del entorno, psicológicos, conductuales y cronobiológicos también pueden causar insomnio. Pero realmente, una de las causas más frecuentes de insomnio crónico es el llamado insomnio psicofisiológico. Consiste en la presencia de ansiedad diurna somatizada con la asociación de unos hábitos de sueño erróneos. El tratamiento del insomnio debe estar dirigido hacia la eliminación de la causa que produce el trastorno, y provocar una mejoría sintomática. El insomnio transitorio y de corta duración, puede ser tratado con fármacos hipnóticos. En el insomnio crónico siempre tendrá que tratarse la causa que lo produce y los fármacos hipnóticos se utilizarán como complemento. El insomnio crónico está asociado a un aumento del riesgo de depresión y un uso (o incluso abuso) crónico de hipnóticos (AU)

Estimates indicate that around one third of the adult population has insomnia symptoms, of which 9%-12% has diurnal consequences. Of these, only 10% receive adequate treatment. Insomnia is usually only a symptom. Discovering its etiology is fundamental in order to apply correct treatment .There is a high comorbidity between medical insomnia and other pathologies. In addition to medical causes, social, environmental, psychological, behavioral and chronobiological factors also can also cause insomnia. One of the frequent causes of chronic insomnia is psychophysical insomnia. It consists of the presence of externalized diurnal anxiety along with counterproductive sleep habits. The treatment of insomnia ust be directed towards the elimination of the causes that produce the problem, and to alleviate the symptoms. Transitory, shot term insomnia can be dealt with using hypnotics. In chronic insomnia, the root causes that produce it need to be treated and hypnotics us ed as a complement. Chronic insomnia is associated with an increased risk of depression and a chronic use (or even abuse) of hypnotics (AU)

[Gastroesophageal reflux and obstructive sleep apnea syndrome]. / Reflujo gastroesofágico proximal y sindrome de la apnea obstructiva del sueño. Datos preliminares de un estudio prospectivo.

INTRODUCTION: Patients with mild or moderate Sleep Apnea Syndrome (SAS) need wider therapeutic scope options according to their disease severity. AIM: To consider including proton pump inhibitors (PPI) to the therapeutical alternatives of these patients. MATERIAL AND METHODS: A prospective study was designed, among patients with SAS. Nocturnal polysomnography and double channel pHmetry were performed simultaneously. RESULTS: From the 18 patients included in this preliminary phase, in three (16.7%) nocturnal proximal ph monitoring was positive. These 3 patients were treated with PPI during at least 3 months with a very satisfactory outcome in two of them. CONCLUSIONS: Treatment with PPI may be a useful therapeutical alternative in patients with mild to moderate SAS.

Reflujo gastroesofágico proximal y síndrome de la apnea obstructiva del sueño. Datos preliminares de un estudio prospectivo / Gastroesophageal reflux and obstructive sleep apnea syndrome

Introducción: Los pacientes con síndrome de apnea del sueño (SAOS) leve o moderado precisan una ampliación de la oferta terapéutica acorde con la intensidad de su enfermedad. Objetivo: Valorar la posibilidad de incluir los inhibidores de la bomba de protones (IBP) al arsenal terapéutico de estos pacientes. Material y métodos: Se diseña un estudio prospectivo entre pacientes con cuadro clínico de SAOS registrando de forma simultánea polisomnografía (PSG) nocturna y pHmetría de 24 horas de dos canales. Resultados: En esta primera fase del estudio se han recogido un total de 18casos, de los que en tres (16,7%) la pHmetría proximal durante la noche resultó positiva. Estos tres pacientes fueron tratados con IBP durante un mínimo de 3 meses siendo el resultado satisfactorio en dos. Conclusión: El tratamiento con IBP puede ser una alternativa terapéutica útil en algunos pacientes con SAOS de intensidad leve o moderada (AU)

Introduction: Patients with mild or moderate Sleep Apnea Syndrome (SAS) need wider therapeutic scope options according to their disease severity. Aim: To consider including proton pump inhibitors (PPI) to the therapeutical alternatives of these patients. Material and methods: A prospective study was designed, among patients with SAS. Nocturnal polysomnography and double channel pHmetry were performed simultaneously. Results: From the 18 patients included in this preliminary phase, in three (16.7%) nocturnal proximal ph monitoring was positive. These 3 patients were treated with PPI during at least 3 months with a very satisfactory outcome in two of them. Conclusions: Treatment with PPI may be a useful therapeutical alternative in patients with mild to moderate SAS (AU)

[The use of olanzapine in sleep disorders. An open trial with nine patients]. / Uso de olanzapina en los trastornos del sueño. Estudio abierto con nueve pacientes.

INTRODUCTION: The impossibility of treating patients with sleep disorders adequately means that, as specialists, we have to look for new pharmacological treatments and for this reason we examined the information in the paper by Salin Pascual (1999) about the increase in deep sleep when olanzapine is used as an antipsychotic drug. CASE REPORTS: We decided to use this medication in six females and three males who were suffering from different sleep disorders that conditioned their chronic insomnia. The dosages of olanzapine used ranged from 2.5 and 10 mg in a single dose. The clinical history and progress were used to elaborate the results and conclusions. The result was positive in eight of the nine patients, five who were administered the medication as monotherapy and three as polytherapy. CONCLUSION: The population studied is insufficient to prove the effectiveness of the drug, but the fact that in eight of our patients the treatment clearly improved their symptoms leads us to think that this line of research must be continued.

Uso de la olanzapina en los trastornos del sueño. Estudio abierto con nueve pacientes / The use of olanzapine in sleep disorders. An open trialwWith nine patients

Introducción. La imposibilidad de tratar adecuadamente a los pacientes que presentan trastornos del sueño hace que los especialistas intentemos nuevas terapias farmacológicas, de acuerdo con la información del artículo de Salin-Pascual (1999) sobre el incremento del sueño profundo cuando se usaba la olanzapina como antipsicótico. Casos clínicos. Decidimos usar esta medicación en seis mujeres y tres varones, afectados de distintos problemas del sueño que condicionaban su insomnio crónico. Se utilizaron dosis de olanzapina que oscilaban entre los 2,5 y los 10 mg en dosis única. La anamnesis y la evolución clínica han sido nuestros criterios para elaborar los resultados y las conclusiones. El resultado fue positivo en ocho de los nueve pacientes, en cinco de ellos como monoterapia y en tres como politerapia. Conclusión. La población estudiada es insuficiente para establecer una probada eficacia del fármaco, pero el hecho de que en ocho de nuestros pacientes el tratamiento aportara una mejoría clara de la sintomatología, nos hace pensar que debe seguirse en esta línea de investigación (AU)

Introduction. The impossibility of treating patients with sleep disorders adequately means that, as specialists, we have to look for new pharmacological treatments and for this reason we examined the information in the paper by SalinPascual (1999) about the increase in deep sleep when olanzapine is used as an antipsychotic drug. Case reports. We decided to use this medication in six females and three males who were suffering from different sleep disorders that conditioned their chronic insomnia. The dosages of olanzapine used ranged from 2.5 and 10 mg in a single dose. The clinical history and progress were used to elaborate the results and conclusions. The result was positive in eight of the nine patients, five who were administered the medication as monotherapy and three as polytherapy. Conclusion. The population studied is insufficient to prove the effectiveness of the drug, but the fact that in eight of our patients the treatment clearly improved their symptoms leads us to think that this line of research must be continued (AU)

[Adverse effects of continuous positive airway pressure therapy and its relation to the nose]. / Efectos adversos derivados del tratamiento con nCPAP y su relación con la nariz.

The main problem in the treatment of obstructive sleep apnea syndrome (OSAS) with nasal continuous airway pressure (nCPAP) is the lack of compliance. One of the most important reasons for no compliance is the adverse effects of this treatment. We analyse, prospectively, 182 patients treated with nCPAP in order to show the relationship between previous nasal problems and adverse effects of nCPAP. Sixty percent of the population developed one o more side effects. Of this group, 69% showed nasal septum deviation at first examination in front of 31% that did not showed this problem (p = 0.001). In the group of patients with nasal side effects we observed an increase of compliance in 80% of patients treated medically and in 89% of those treated by a septoplasty. We demonstrate that the adverse effects of nCPAP are related to previous nasal problems and, also, that treatment of those problems can achieve an increase in compliance to nCPAP therapy.

Efectos adversos derivados del tratamiento con nCPAP y su relación con la nariz / Adverse effects of continuous positive airway pressure therapy and its relation with the nose

El principal inconveniente del tratamiento del síndrome de la apnea obstructiva del sueño (SAOS) con presión positiva nasal continua (nCPAP) es el incumplimiento, muchas veces debido a los efectos adversos del mismo. Mediante un análisis prospectivo de los pacientes tratados con nCPAP, se pretende demostrar la relación de las alteraciones nasales preexistentes con los efectos adversos de la utilización de nCPAP. Se han recogido 182 casos tratados con nCPAP y el 60 por ciento explicaron uno o más efectos adversos. De éstos, el 69 por ciento tenían dismorfia septal y 31 por ciento no (p=0,001). En los casos con efectos adversos de cariz nasal se observó un 80 por ciento de aumento de la tolerancia al nCPAP en los tratados médicamente y un 89 por ciento en los sometidos a septoplastia. Este trabajo pone en evidencia que los efectos adversos del tratamiento con nCPAP se relacionan de forma significativa con las alteraciones nasales preexistentes y que el tratamiento de éstas colabora a incrementar la tolerancia a nCPAP (AU)

The main problem in the treatment of obstructive sleep apnea syndrome (OSAS) with nasal continuous airway pressure (nCPAP) is the lack of compliance. One of the most important reasons for no compliance is the adverse effects of this treatment. We analyse, prospectively, 182 patients treated with nCPAP in order to show the relationship between previous nasal problems and adverse effects of nCPAP. Sixty percent of the population developed one o more side effects. Of this group, 69% showed nasal septum deviation at first examination in front of 31% that did not showed this problem (p = 0.001). In the group of patients with nasal side effects we observed an increase of compliance in 80% of patients treated medically and in 89% of those treated by a septoplasty. We demonstrate that the adverse effects of nCPAP are related to previous nasal problems and, also, that treatment of those problems can achieve an increase in compliance to nCPAP therapy (AU)

Un paciente con insomnio

En este artículo se hace una revisión de las consideraciones básicas para el abordaje del insomnio. En primer lugar, se hace una descripción del problema clasificándolo en función de distintos criterios (gravedad, duración, forma de presentación, etc.) y unos comentarios sobre datos epidemiológicos. Seguidamente se exponen las diferentes etiologías del insomnio así como los requerimientos para realizar un buen diagnóstico diferencial. Por último, se exponen las distintas alternativas terapéuticas posibles en el insomnio en sus diferentes presentaciones (AU)

Advanced and unsuspected secondary abdominal pregnancy misdiagnosed before laparotomy.

A case of advanced secondary abdominal pregnancy is presented. It happened in a multiparous patient, a heroin addict and with a previous secondary amenorrhea. In spite of having been controlled through the whole pregnancy, the ectopic pregnancy was not diagnosed until a laparotomy was performed, several days after fetal death. After full extraction of the fetus and placenta, followed by left adnexectomy, the postoperatory evolution was normal. Hormonal and echographic studies and fetal monitorings are provided, and the diagnosis and treatment are discussed.

Spirometric reference values from a Mediterranean population.

Maximal expiratory flow-volume (MEFV) curves were measured in 1044 healthy nonsmoking volunteers living in the Barcelona area, as part of a larger interhospital project to obtain reference values of pulmonary function tests. Forced vital capacity (FVC), one-second forced expiratory volume (FEV1), FEV1/FVC, %, forced maximal mid-expiratory flow (FEF25-75%), peak expiratory flow rate (PEF) and maximal expiratory flow at 50 and 75% of FVC (MEF50% and MEF25% respectively) were obtained and expressed at BTPS conditions. Techniques and equipments followed both the recommendations of the American Thoracic Society (ATS) and of the European Community for Coal and Steel (ECCS). Prediction equations for age 20 through 70 were calculated for both sexes from a final sample composed of 870 adult subjects, 443 males and 427 females. Simple linear equations using height, age and body weight predicted all spirometric variables as well as more complex equations except MEF25%. Logarithmic equations were proposed for MEF25% to correct for the heteroscedasticity shown in a simple linear model. To our knowledge, this study provides reliable spirometric equations from a large urban Mediterranean sample which were lacking so far in the literature.

Asbestosis in the industries of the Barcelona area.

This presentation is the result of the survey of eight industries with asbestosis risk in the Barcelona area (two of fibro-cement, three of auto brakes, two of textiles, and one of insulation materials). Of 1,472 workers, 271 or 18.5% have asbestosis. Pleural involvement in asbestosis is twice as common as that of the lung, 15.7% versus 8.5%. Pulmonary asbestosis without pleural participation is seen in only 2.6% of cases. Pleural plaques, calcified and not calcified, are detected in only a few cases. There is a definite correlation between the incidence of asbestosis and the exposure time: from 1% in the group of workers with less than five years of exposure up to 64.58% for those with 30 or more years of exposure. Clinical symptoms (cough, and/or expectoration, and/or dyspnea) were present in 68% of the studied population. Pulmonary crepitations are the most significant physical sign detected, observed in one quarter to one third of the patients. Pulmonary function tests in asbestos workers revealed restrictive and mixed type syndromes in 17% of the cases and obstructive syndrome in 36%. The percentages for those workers without asbestosis are 9% and 16%, respectively. It seems, therefore, that a bronchial factor plays a role in asbestosis. The bronchial pathology would be manifested clinically by the appearance or the exaggeration of the chronic bronchitis symptoms, and physiologically by the presence of the obstructive syndrome. There is no doubt that smoking enhances the incidence of asbestosis, aggravates the respiratory symptoms in those affected, and is a cause of further deterioration of pulmonary function.

The problems of asbestosis in Spain.

About 50 cases of asbestosis have been descirbed in Spain from 1948 through 1974. Since 1975 the Instituto Territorial de Barcelona, Servicio Social de Higiene y Seguridad del Trabajo, has initiated a survey of all the industries with an asbestosis risk in the Barcelona area. Nearly 300 cases of asbestosis have been detected to date. Given the poor hygienic conditions of most of the industries, with an asbestosis risk, and the considerably large number of exposed people, it can easily be predicted that a rapid increase of the incidence of the disease in the years to come will occur. Most of the observed cases in Barcelona were from two fibrocement industries. Of a total of 1003 workers examined, 247 (about 25%) had asbestosis.

Modern concepts about drowning.

Drowning remains one of the three leading causes of accidental death in the world, yet few textbooks deal with its evaluation and treatment. Because of overemphasis placed upon distinguishing between fresh- and sea-water drowning, the importance of immediate attention to simple and effective resuscitative procedures has been bypassed. We have outlined a continuum of evaluation and treatment in four stages: (1) emergency care at the scene and during transportation, (2) hospital admission resuscitation, (3) intensive care, and (4) return to normal. Four representative cases are presented in order to review pathophysiological concepts in this serious problem.