Comparison of chromium and cobalt serum levels between a modular neck stem and its monoblock counterpart in primary total hip arthroplasty.

BACKGROUND: The addition of junctions in modular stems implies a greater susceptibility to corrosion. PURPOSE: The aim of this study is to compare serum chromium and cobalt levels after using a bimodular stem and its monoblock counterpart in primary total hip arthroplasty. Postoperative clinical scores were also compared. PATIENTS AND METHODS: A prospective cohort study between 2012 and 2015 was designed. One arm of the cohort included patients with the cementless modular neck stem H-Max M® and the other with the cementless monoblock stem counterpart H-Max S®. RESULTS: No statistically significant difference was found in chromium value between groups (p = 0.621) at two years postoperative. Cobalt value was higher in the modular group (p = < 0.001). No statistically significant difference was found in clinical postoperative scores except for the Harris Hip Score, with better results at six months in modular group (p = 0.007). CONCLUSIONS: Higher serum cobalt level in the modular group has limited the use of modular stems in our daily practice. Advantages of modular stem were not found. LEVEL OF EVIDENCE: II.

Preventive Analgesia with Pregabalin in Neuropathic Pain from "Failed Back Surgery Syndrome": Assessment of Sleep Quality and Disability.

OBJECTIVE: Pregabalin group (PGB) is an antiepileptic used to treat neuropathic pain. We evaluated analgesic efficacy and safety for postoperative/chronic pain, disability, and sleep quality in patients who underwent spine surgery administered with PGB, or not, during the presurgical and postsurgical periods. DESIGN: Retrospective cohort study of 60 patients (two groups with 30 patients) with full information on 50 (29 with PGB and 21 without PGB). Ten patients were dismissed as information was lacking. The PGB group (P) (29 patients) received 75 mg/12 hours before surgery, 150 mg 10 hours after surgery, and 150 mg/12 hours 3 days after surgery. The control group (C; 21 patients) took no PGB. METHODS: Neuropathic pain was assessed before surgery, and 2 and 6 months later using visual analog scales (VAS), DN4, disability (Oswestry), and sleep quality. No serious adverse events occurred with PGB. RESULTS: The median VAS pain score at rest was lower in the PGB group at 2 months postsurgery (1 vs 2, P = 0.032), as was the median DN4 score (0 vs 3, P = 0.032) and the median Oswestry disability index (ODI: 12 vs 18, P = 0.001). At 6 months postsurgery, pain scores were also lower in the PGB group for VAS (0 vs 4, P = 0.001), DN4 score (0 vs 4, P = 0.001) and the ODI (10 vs 24, P = 0.001). Improvement in the functionality and sleep quality of the PGB group was noteworthy (P = 0.018). CONCLUSIONS: PGB has analgesic/antihyperalgesic effects on postoperative neuropathic pain after surgery for lumbar disc hernia. Our findings show that this benefit increases with time.

Squamous Cell Carcinoma: Clinical and Pathological Features and Associated Risk Factors in an Observational Study of 118 Patients.

BACKGROUND AND OBJECTIVE: In the latest edition of its cancer staging manual, the American Joint Committee on Cancer (AJCC) revised the criteria for staging squamous cell carcinoma (SCC) by introducing high-risk tumor features to define tumor stage (T) and help to identify tumors with a higher risk of metastasis. The aim of this study was to investigate the characteristics associated with SCC meeting the high-risk criteria defined by the AJCC for T2 lesions. PATIENTS AND METHOD: We performed a case-case observational study in which patients with SCC were included over a period of 18 months. We collected clinical, anthropometric, and tumor data, and analyzed these using PASW Statistics (SPSS) version 18. RESULTS: One-hundred eighteen patients, the majority of whom were men, were included. Mean age was 77 years. Over 70% of the tumors were located in the head region and a majority of tumors measured 2 cm or less. The prevalence of SCC T2 was 61.9%. The risk factors significantly associated with SCC T2 were an age of over 85 years (odds ratio [OR], 4.48), location in the head and neck region (OR, 3.38), presence of solar elastosis in the peritumoral tissue (OR, 2.08), a higher tumor growth rate (>1.5 mm·wk(-1); OR, 5.73), and higher cumulative exposure to smoking (>20 pack-years, OR, 3.63). CONCLUSIONS: Advanced age, location in the head and neck region, presence of solar elastosis, high tumor growth rate, and high cumulative smoking exposure were all significantly associated with the presence of SCC T2.

Vitamin D and cutaneous lupus erythematosus: effect of vitamin D replacement on disease severity.

BACKGROUND: The main vitamin D source is exposure to ultraviolet radiation, which aggravates cutaneous lupus erythematosus (CLE). OBJECTIVES: The aims of this study were to identify variables associated with lower serum 25-hydroxyvitamin D [25(OH)D] levels in CLE patients and assess the effect of vitamin D restoration on disease severity. METHODS: Vitamin D status in 60 CLE patients and 117 apparently healthy subjects was compared. We recommended oral vitamin D3 to 27 CLE patients. After one year of treatment, changes in disease severity were assessed and compared to 25 untreated CLE patients. Disease severity was measured by the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI), number of exacerbations, duration of active lesions and patient assessment. RESULTS: Presence of CLE raised the odds of having vitamin D deficiency (OR 3.47, 95% CI 1.79-6.69). Increasing age and disease duration were associated with higher odds of having vitamin D deficiency. After a one-year follow-up, disease activity improved in the treatment group (CLASI A 2.7 ± 2.9 vs. 0.9 ± 1.4) (p = 0.003), as confirmed by the patient assessment (p = 0.01). CONCLUSIONS: Vitamin D inadequacy is more prevalent in CLE participants than in healthy controls. Treating vitamin D insufficiency is associated with improved disease severity according to physician and patient assessments.

Detection of human papillomavirus in nonmelanoma skin cancer lesions and healthy perilesional skin in kidney transplant recipients and immunocompetent patients.

BACKGROUND: The influence of human papillomavirus (HPV) on the development of nonmelanoma skin cancer (NMSC) is a topic of debate. HPV types from the beta genus (HPV-ß) have been most frequently associated with the development of skin cancer. OBJECTIVES: To analyze the prevalence and range of HPV types in NMSC lesions and healthy perilesional skin in immunodepressed and immunocompetent patients and to evaluate the influence of various clinical factors on the prevalence of HPV in skin cancer. METHODS: Nested polymerase chain reaction and sequencing were used to detect HPV in 120 NMSC samples obtained by biopsy from 30 kidney transplant recipients and 30 immunocompetent patients. In all cases, a sample was taken from the tumor site and the surrounding healthy skin. Potential confounders were assessed and the data analyzed by multivariate logistic regression. RESULTS: HPV DNA was detected in 44 (73.3%) of the 60 samples from immunodepressed patients and in 32 (53.3%) of the 60 samples from immunocompetent patients (adjusted odds ratio, 3.4; 95% CI, 1.2-9.6). In both groups of patients, HPV was more common in healthy perilesional skin than in lesional skin. HPV-ß was the most common type isolated. CONCLUSION: We found a wide range of HPV types (mostly HPV-ß) in the skin of kidney transplant recipients and immunocompetent patients with skin cancer.

The role of new immunosuppressive drugs in nonmelanoma skin cancer in renal transplant recipients.

INTRODUCTION: Nonmelanoma skin cancer (NMSC) is the most common malignancy in patients who have received a solid organ transplant. Multiple factors are involved in the onset of posttransplant NMSC. OBJECTIVES: To analyze the relationship between new immunosuppressive drugs and the onset of NMSC in renal transplant recipients. METHOD: This was a combined retrospective and prospective observational study in which we studied 289 patients who received a kidney transplant between January 1996 and December 2010 at Hospital Universitario Doctor Peset in Valencia, Spain. RESULTS: Seventy-three patients (25.2%) developed 162 NMSCs over a median follow-up of 72 months. There were no statistically significant differences in the onset of NMSC on comparing different induction therapy strategies involving monoclonal and polyclonal antibodies. NMSCs occurred less frequently in patients treated with mammalian target of rapamycin (mTOR) inhibitors than in those treated with other immunosuppressive regimens, although the differences were not statistically significant. Three of 5 patients with recurrent NMSC who were switched from calcineurin inhibitors to mTOR inhibitors developed additional NMSCs despite the change. CONCLUSIONS: Induction therapy with monoclonal and polyclonal antibodies in renal transplant recipients is not associated with an increased risk of NMSC. While mTOR inhibitors are associated with a lower risk of posttransplant NMSC, it remains to be determined whether a switch to these drugs is useful in the management of patients who develop multiple NMSCs.

Evolution of chromium and cobalt serum levels after the use of a modular neck stem in primary total hip arthroplasty. / Evolución de los niveles séricos de cromo y cobalto tras el empleo de un vástago con cuello modular en la artroplastia total de cadera primaria.

INTRODUCTION AND OBJECTIVES: Modular neck primary stems were introduced with the theoretical advantage of restoring the hip anatomy more precisely. However, the presence of a second junction has been associated with increased corrosion and release of metal debris. The objective of our study is to quantify of chromium and cobalt serum values, and to analyze their temporal evolution during five years. MATERIAL AND METHODS: We present a prospective series of 61 patients who underwent primary total hip arthroplasty by implantation of the HMAX-M® stem (Limacorporate, San Daniele, Italy). Serum chromium and cobalt determinations were performed at six months, two years and five years. RESULTS: Our series shows a progressive elevation in chromium levels with a significant difference between chromium values at six months (0.35±0.18) and five years (0.52±0.36), P=.01. Regarding cobalt, a statistically significant elevation is observed between six months and two years and a subsequent stabilization of values between two and five years, with a cobalt mean at six months (1.17±0.8) significantly lower than at two (2.63±1.76) and five years (2.84±2.1), P=.001. CONCLUSION: Elevated serum cobalt levels have been observed in patients who underwent modular neck stem implantation. The results obtained in this study have limited the use of stems with a modular neck in our clinical practice.

[Translated article] Evolution of chromium and cobalt serum levels after the use of a modular neck stem in primary total hip arthroplasty.

INTRODUCTION AND OBJECTIVES: Modular neck primary stems were introduced with the theoretical advantage of restoring the hip anatomy more precisely. However, the presence of a second junction has been associated with increased corrosion and release of metal debris. The objective of our study is to quantify of chromium and cobalt serum values, and to analyse their temporal evolution during five years. MATERIAL AND METHODS: We present a prospective series of 61 patients who underwent primary total hip arthroplasty by implantation of the H MAX-M® stem (Limacorporate, San Daniele, Italy). Serum chromium and cobalt determinations were performed at six months, two years and five years. RESULTS: Our series shows a progressive elevation in chromium levels with a significant difference between chromium values at six months (0.35±0.18) and five years (0.52±0.36), p=.01. Regarding cobalt, a statistically significant elevation is observed between six months and two years and a subsequent stabilisation of values between two and five years, with a cobalt mean at six months (1.17±0.8) significantly lower than at two (2.63±1.76) and five years (2.84±2.1), p=.001. CONCLUSION: Elevated serum cobalt levels have been observed in patients who underwent modular neck stem implantation. The results obtained in this study have limited the use of stems with a modular neck in our clinical practice.

Arterial hypertension and smoking in pregnant women in the Valencian Community: maternal and neonatal outcomes.

OBJECTIVE: Hypertension and smoking during pregnancy have been linked to various adverse maternal and fetal outcomes. The objective of this work is to study how the smoking influences the development of hypertension, its effects on the pregnant woman, and on the newborn. MATERIALS AND METHODS: An observational study in two phases was carried out: the descriptive first phase allows characterization of the sample and the analytical second phase is a case-control nested in a retrospective cohort corresponding to pregnancy. RESULTS: A total of 712 women were included in the study. Of the 672 (94.4%) non-hypertensive women, 533 (79.3%) were non-smoking and 139 (20.7%) smoking. For the 40 (5.6%) hypertensive women, 30 (75.0%) were non-smoking and 10 (25.0%) smoking. The prevalence of hypertension was of 5.6%. Women who quit smoking before pregnancy saw a reduced risk of hypertension. For women who smoke during pregnancy, those of younger ages, with a normal body mass index, who are primiparous, employed and with a low-medium level of education have higher risk of hypertension. The risk of hypertension according to the level of physical activity during leisure time follows a "U" shape, with those who perform light physical activity at the lowest risk of hypertension. Hypertensive women have a higher risk of small for gestational age newborns. Smoking does not pose an additional risk for adverse outcomes once hypertension is diagnosed. CONCLUSIONS: Future studies should aim to determine the role of smoking habit in the appearance of hypertension in pregnancy in order to establish adequate intervention guidelines that may aid in reducing the prevalence of hypertension.

Pediculosis capitis risk factors in schoolchildren: hair thickness and hair length.

The human head lice is a cosmopolitan ectoparasite that causes pediculosis. The main way of spreading lice is through direct head-to-head contact. It is popular knowledge that some individuals are more susceptible to contracting head lice than others. Reports of individuals who have never been affected by the disease are common, even living in the same environment and under the same conditions as people who regularly have lice infestations. Previous research has been carried out on the risk of this infection associated with different human factors like gender or age. However, studies on the influence of the individual hair characteristics are scarce. The objective of the study was to analyze the pediculosis risk using geographical location, gender, age and individual hair characteristics as variables. Pediculosis was diagnosed through the detection of living lice in the hair. This cross-sectional school-based epidemiological study was conducted in 310 schoolchildren aged 1 to 13 years of schools in 4 municipalities situated in the State of Paraná, Brazil. The prevalence of head louse infection in primary school students was 49.35 %. The Odds Ratio of presence of pediculosis (OR) was estimated using multivariate logistic regression analysis. The results obtained indicate that hair length and thickness increase the risk of infection. Furthermore, the inclusion of hair color, hair shape, kind of hair-scale as covariates increases the risk of pediculosis, indicating that these variables partly explain this susceptibility and that pediculosis is independent of gender. A smaller hair diameter may favor insect fixation to the hair in the nymphal phases. These results may explain why girls are a greater risk as they let their hair grow for cultural reasons, i.e., being of female gender is an agglutinating variable. The conclusions drawn may explain the discrepancies obtained in previous analyses.

Embryonic Development of Pediculus humanus capitis: Morphological Update and Proposal of New External Markers for the Differentiation Between Early, Medium, and Late Eggs.

BACKGROUND AND OBJECTIVES: The head louse Pediculus humanus capitis is a cosmopolitan ectoparasite that causes pediculosis. In the study of human lice, little research focuses on embryonic development. Currently, external markers of embryonic development represent a new approach in the evaluation of ovicidal drugs. The objective of this work was to update the morphology of embryonic development and propose novel external markers to differentiate between early, medium, or late P. h. capitis eggs. METHODS: Using stereoscopic light microscopy, we describe the morphological characteristics of P. h. capitis eggs with a special focus on embryonic development. RESULTS: The morphological analysis of the eggs revealed the presence of an operculum with ten aeropyles, although no micropyles were observed. For the first time, the presence of defective eggs that were non-viable due to the apparent absence of yolk granules was documented. The early eggs presented yolk granules and developing germ bands, while the medium eggs presented an embryonic rudiment and the outlines of the eyes and limbs. In late eggs, the head with eyes and antennae, the thorax with three pairs of legs, and the abdomen with six pairs of spiracles were observed as formed structures. At the end of this stage, the embryos acquired the morphology of the nymph I stage. CONCLUSION: We propose novel biomarkers (e.g., the presence of spiracles and antennae, the proportion of the egg occupied by the embryo) to facilitate the differentiation between the developmental stages. The updated morphological characteristics of P. h. capitis eggs facilitate the standardization of toxicological tests in the quest for ovicidal drugs.

[Sedentary lifestyle in pregnancy: Effects on the mother and the newborn]. / Sedentarismo en el embarazo: efectos sobre la madre y el recién nacido.

OBJECTIVE: Identify the state of sedentary lifestyle during pregnancy and the factors associated with this behavior, the possible factors of your health situation and that of the newborn. MATERIAL AND METHODS: This two-phase, cross-sectional observational study was developed at the La Fe University and Polytechnic Hospital and 228 pregnant women participated. Maternal sociodemographic characteristics were obtained using structured questionnaire and health information from the electronic medical records, as well as perinatal results of the newborn. To assess sedentary lifestyle, exercise in free time and exercise during working hours were assessed, categorizing them based on intensity (sedentary lifestyle, light activity, moderate and intense activity). RESULTS: In total, the prevalence of physical inactivity was 31.14%. The profile of this group has a lower level of education and unemployment (P<.05), presenting a higher prevalence of problems during childbirth, which required a caesarean section, as well as problems after birth in the newborn (P<.05). CONCLUSIONS: Physical inactivity is highly prevalent among pregnant women. Due to the benefits (or non-harm) attributed to exercise during pregnancy. Further efforts should be taken to overcome the barriers to promote activities among pregnant women who are younger, less well educated, and unemployed and those with multiple children and a lower income are less likely to engage in an adequate amount of physical activity, aware of the importance of doing it, resolving doubts and allaying fears that may arise from a poor understanding of the mechanism of its benefit.

Fish intake in pregnant women and its impact on maternal-fetal health status.

OBJECTIVE: The objective was to evaluate the consumption of fish in pregnant women and its association with maternal and infant outcomes. MATERIAL AND METHODS: In this observational study carried out at the La Fe University and Polytechnic Hospital in Valencia, 300 pregnant women participated. The participants were divided into 2 groups according to their fish consumption during pregnancy for comparison. The χ2 test or ANOVA test were applied for comparisons for qualitative and quantitative variables respectively. RESULTS: It was observed that 49% of women consumed adequate amounts of fish during pregnancy (2 or 3 weekly servings). Significant differences were observed for iron supplementation (higher in women with inadequate fish consumption), threatened pregnancy loss (higher in women with inadequate fish consumption), infant size (better in women with adequate fish consumption), and arterial O2 pressure (better in women with adequate fish consumption). In regard to the other components of the dietary pattern, no differences were observed but the adequacy of intake for grains and white meat was very poor (less than 5.0%). CONCLUSIONS: Half of the women met the recommendations for fish intake during pregnancy and presented an overall healthier eating pattern but without statistical significance.

[Retrospective study of patients diagnosed with Sweet syndrome in the health area of a tertiary hospital in the autonomous community of Valencia]. / Estudio retrospectivo de pacientes diagnosticados de síndrome de Sweet en el área de un hospital terciario de la Comunidad Valenciana.

Sweet syndrome is the most characteristic of the neutrophilic dermatoses. We performed a retrospective study of patients with Sweet syndrome seen in our department between 2001 and 2009, inclusive; the aims were to define the patient profile and to evaluate the clinical and epidemiological differences between subgroups. There were 24 patients (13 women and 11 men). The age distribution was similar in both sexes and showed 2 peaks, one in the fourth decade and the other in the eighth decade. The etiology was predominantly infectious or inflammatory, followed by the idiopathic form. There were 4 cases of paraneoplastic disease, 2 of which involved solid-organ tumors. One case was associated with the administration of infliximab. Symptoms persisted longer in cases that were idiopathic or that developed in the context of neoplastic disease.

[Translated article] Comparison of leg length discrepancy correction after the use of a modular neck stem and its monoblock homologue in total primary hip arthroplasty.

INTRODUCTION AND OBJECTIVE: Dual modularity stems seek to more precisely restore anatomy by allowing intraoperative adjustments thanks to modular necks. Our aim is to compare the radiographic length correction with the H MAX-M® Stem versus its monoblock counterpart H MAX-S®. MATERIAL AND METHODS: A prospective cohort study was carried out through consecutive sampling on patients who underwent primary total hip arthroplasty with coxarthrosis diagnosis between 2011 and 2015. One arm of the cohort included patients who were operated with a modular stem and the other with a monobloc stem. Length was measured on the anteroposterior pelvic-bearing radiograph at 6 months. The mean of the measurements obtained for each arm of the cohort were compared with each other. RESULTS: No statistically significant differences were observed in the correction of asymmetry between both groups, determined as the difference in length between the operated hip and the contralateral hip (p=.106). Nor were differences observed in postoperative length values (p=.053). It should be noted that for both the modular stem and the monobloc stem, the majority group is the one with restored length (84.1% and 80.4%, respectively; p=.001). CONCLUSION: Despite the theoretical advantage of modularity and that having interchangeable parts could be of great interest, in our study, we have not been able to demonstrate a superiority of modular designs compared to monoblock for control of postoperative leg length discrepancy.

Comparison of leg length discrepancy correction after the use of a modular neck stem and its monoblock homologue in total primary hip arthroplasty. / Comparación de la corrección de la discrepancia de longitud de miembros tras el empleo de un vástago con cuello modular y su homólogo monobloque en la artroplastia total de cadera primaria.

INTRODUCTION AND OBJECTIVE: Dual modularity stems seek to more precisely restore anatomy by allowing intraoperative adjustments thanks to modular necks. Our aim is to compare the radiographic length correction with the H MAX-M® Stem versus its monoblock counterpart H MAX-S®. MATERIAL AND METHODS: A prospective cohort study was carried out through consecutive sampling on patients who underwent primary total hip arthroplasty with coxarthrosis diagnosis between 2011 and 2015. One arm of the cohort included patients who were operated with a modular stem and the other with a monobloc stem. Length was measured on the anteroposterior pelvic-bearing radiograph at six months. The mean of the measurements obtained for each arm of the cohort were compared with each other. RESULTS: No statistically significant differences were observed in the correction of asymmetry between both groups, determined as the difference in length between the operated hip and the contralateral hip (P=.106). Nor were differences observed in postoperative length values (P=.053). It should be noted that for both the modular stem and the monobloc stem, the majority group is the one with restored length (84.1% and 80.4%, respectively; P=.001). CONCLUSION: Despite the theoretical advantage of modularity and that having interchangeable parts could be of great interest, in our study, we have not been able to demonstrate a superiority of modular designs compared to monoblock for control of postoperative leg length discrepancy.

[Adherence to influenza vaccination campaign 2020/21 in the pandemic SARS-CoV-2. Context analysis in management changes: A pilot study]. / Adherencia a la campaña de vacunación de la gripe 2020/21 en el contexto de la pandemia de SARS-CoV-2. Análisis de los cambios en la gestión: un estudio piloto.

INTRODUCTION: Vaccination campaigns against influenza virus achieve coverages under recommended and desired values. In current context of SARS-CoV-2 pandemic it becomes more relevant. Our objective is to evaluate the impact on vaccination coverage of a set of implementation strategies carried out. MATERIAL AND METHODS: Vaccine implementation strategies were introduced in our basic health zone as active caption of patients and schedule extension. Then the vaccination coverage achieved in the current campaign was evaluated and compared with previous in the 8th week and at the end of the campaign. Besides, a transversal study through a survey was carried out to measure the impact of the applied strategies. RESULTS: In the 8th week of the campaign significant differences were detected in the increase of vaccination coverage compared with previous years. These results were confirmed at the end of the campaign, getting a significant difference (<.05) of vaccination coverage in all the studied centers, these data support the effectivity of the applied strategies. CONCLUSIONS: The vaccine implementation strategies applied have shown effectivity, achieving an increase of until 74% in the total administered doses compared to previous campaigns and even a 15% of vaccination coverage increased in the group of patients older than 64 years; even in a pandemic context and the increasing of anti-vaccine movements.

Comparison of the correction of the femoral offset after the use of a stem with modular neck and its monoblock homologue in total primary hip arthroplasty. / Comparación de la corrección del offset femoral tras el empleo de un vástago monobloque y un vástago con cuello modular en la artroplastia total de cadera primaria.

INTRODUCTION AND OBJECTIVE: Dual modularity stems were introduced with the theoretical advantage of restoring hip anatomy more precisely through femoral offset and limb length adjustment. Interchangeable necks allow for intraoperative angulation, anteversion and length changes. Our objective is to study whether a better femoral offset correction is achieved with the H MAX-M® prosthesis (Limacorporate, San Daniele, Italy) compared to its monoblock counterpart. MATERIAL AND METHODS: A prospective cohort study was conducted by means of consecutive sampling on adult patients undergoing total hip arthroplasty with the diagnosis of coxarthrosis between January 2011 and December 2015. This cohort has two arms, one arm included patients who underwent modular neck arthroplasty and the other included patients who underwent monoblock total hip arthroplasty. Radiographic offset measurement of the operated hip and the contralateral hip was performed, and the difference between both values was calculated. The mean of the measurements obtained for each arm of the cohort were compared with each other. RESULTS: No statistically significant differences were observed in the difference in offset between the operated hip and the contralateral hip (P=.323). No statistically significant differences were observed in the correction of the femoral offset, determined as the difference between the operated hip and the contralateral hip (P=.323). Nor were differences observed in the postoperative offset values (P=.097). It should be noted that for both designs, the majority group is the one with restored offset (P=.001).

Occupational exposure to pesticides and bile tract carcinoma in men: results from a European multicenter case-control study.

OBJECTIVES: To estimate the associations between occupational exposure to pesticides and extrahepatic biliary tract carcinoma in men, a population-based case-control study was carried out. METHODS: Cases (n = 104), aged 35-70, diagnosed in 1995-1997, were sampled by active reporting systems from hospitals. Controls (n = 1,401) were a random sample of the general male population. Information on occupation and confounding factors was obtained by questionnaires. Exposures were quantified with respect to time, application methods, and use of personal protective equipment. Intensity was evaluated by using a published algorithm which weighted the exposure assigned according to the use of personal protective equipment and mode of application. Logistic regression analyses were conducted adjusted for gallstones, age, and country. RESULTS: Being ever exposed to pesticides resulted in an odds ratio (OR) of 1.0 [95%-confidence interval (CI) 0.6-1.6]. A modestly elevated risk was found for backpack mounted sprayers OR = 1.4 [95% CI 0.7-2.6] and vine farmers OR = 2.5 [95% CI 0.9-7.2]. Using time periods and exposure frequency as intensity measure, no elevated risks were found. The only exception was year of maximum exposure which yielded an OR of 1.6 [95% CI 0.7-3.5]. However, no clear trend was observed in this analysis. CONCLUSIONS: This study does not rule out that pesticide exposure represents an occupational risk factor for extrahepatic biliary tract carcinoma, but no indication of a strong association was observed. Some modes of exposure were weakly, albeit not significantly associated with carcinoma risk. The observed estimates of effects may be influenced by a lack of precise exposure assessment. Different chemical compositions of pesticides were utilized during a long time span of pesticide exposure, and it should be considered that the exposure is assessed with substantial uncertainty that could non-differential and bias results toward the null.

Bispectral index changes in carotid surgery.

BACKGROUND: Intraoperative monitoring of cerebral ischemia with shunting during carotid endarterectomy (CEA) remains controversial. Our objective was to evaluate the sensitivity and specificity of BIS changes during carotid clamping in relation to shunted patients in awake CEA. METHODS: Eighty CEAs under cervical block were included. There were two patient groups: with clinical signs of cerebral ischemia (shunted patients) and without signs of cerebral ischemia (nonshunted patients). Data were based on bispectral index (BIS) values and neurological monitoring at different surgery time points, with special attention paid during carotid clamping. BIS values were compared between shunted and nonshunted patients. Sensitivity and specificity, along with positive and negative predictive values of a percentage BIS value decrease during carotid clamping from baseline BIS values, were calculated in both patient groups. RESULTS: Shunting was performed in 11 patients with cerebral ischemia at carotid clamping. Mean BIS values were 82.82+/-11.98 in shunted patients and 92.31+/-5.42 in nonshunted patients at carotid clamping (p<0.001). Relative decreased BIS values in relation to basal BIS values were 13.57% in shunted patients and 3.68% in nonshunted patients (p<0.05). The percentage decrease in BIS was 14%, sensitivity was 81.8% (95% CI 49.9-96.8), and specificity was 89.7% (95% CI 79.3-95.4). CONCLUSION: BIS monitoring during carotid clamping is an easy, noninvasive method which correlates with cerebral ischemia in patients undergoing CEA. A decrease>or=14% from the basal BIS value presents a high negative predictive value, and ischemia is unlikely without a decrease. Nonetheless, a decrease may not always indicate cerebral ischemia with a low positive predictive value.