What kind of non-pharmacological strategy for reducing sedentary behavior in COPD? Data from a scoping review.

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is usually associated with sedentary behavior (SB). Literature reports a harmful impact of SB on the physical, mental, and social health of individuals with COPD. However, Pulmonary Rehabilitation (PR) programs seem to have no clear effect on changing SB. Therefore, our study aimed to identify the strategies used in the literature to reduce SB among individuals with COPD. METHOD: A scoping review was conducted to summarize the current literature regarding the proposed strategies to reduce SB in individuals with COPD. Searches were conducted in PUBMED; SCOPUS and COCHRANE LIBRARY for studies published from 2010 to march 2024. RESULTS: Twenty four articles were retained for our review. Most of the identified strategies in the literature (21/24 articles) are based on behavioral approaches, with various forms: promoting self-efficacy, self-management and self-regulation of one's own behavior (12 articles), goal setting (10 articles), constant feedback (11 articles), therapeutic education (8 articles), motivational strategies (6 articles), re-engagement in meaningful activities (4 articles), promoting light intensity physical activity (LPA) (6 articles) and social support (6 articles). In association with the behavioral strategies, wearable connected technologies have been used in 4 articles, alone or combined with physical exercise programs included or not in a PR program. The home is associated with 83 % of interventions as a place for initial and continuous implementation of behavioral strategies. CONCLUSION: It would seem appropriate to focus on combined strategies to reduce SB in individuals with COPD (improvement of physical abilities and behavioral strategies). Further research is needed to only target the reduction of SB and to evaluate the effects of various interventions.

Colgajo muscular de esternocleidomastoídeo para el manejo de perforación esofágica tardía: reporte de dos casos / Muscle flap of sternocleidomastoid for the management of late esophageal perforation: report of two cases

Resumen Introducción: La perforación esofágica es una complicación poco frecuente en la cirugía de columna cervical por vía anterior, sin embargo, puede tener graves consecuencias cuando hay demoras en diagnóstico y tratamiento. Casos Clínicos: Presentamos dos casos clínicos de pacientes con perforación esofágica secundaria a cirugía de columna cervical por vía anterior. Se usaron para su reparación colgajo muscular de esternocleidomastoideo (ECM). Conclusión: La perforación esofágica secundaria a cirugía de columna cervical es poco frecuente, variable desde el punto de vista clínico, el TC y estudio radiológico contrastado son fundamentales en el diagnóstico de esta patología. El colgajo muscular ECM en estos casos es una herramienta fiable y extremadamente útil debido a sus características anatómicas, fácil disección quirúrgica y baja morbilidad asociada.

Introduction: Esophageal perforation is a rare complication in cervical spine surgery by anterior way, however it can have serious consequences when there are delays in diagnosis and treatment. Cases Report: We present two clinical cases of patients with esophageal perforation secondary to cervical spine surgery by anterior way. Sternocleido-mastoid muscle flaps were used for repair. Conclusion: Esophageal perforation secondary to cervical spine surgery is rare, clinically variable, CT and radiologic study are fundamental in the diagnosis of this pathology. The Sternocleidomastoid muscle flap in these cases is a reliable and extremely useful tool due to its anatomical characteristics, easy surgical dissection and low associated morbidity.

Trauma cervical penetrante / Penetrating neck trauma

Aim: The aim of this study is to report the surgical outcomes in a series of patients undergoing to exploratory cervicotomy by penetrating neck trauma (PNT) in emergency department of Barros Luco-Trudeau Hospital (BLTH), between 2003 and 2013, in terms of postoperative morbidity (POM). Matherial and methods: Retrospective case series of patient undergoing exploratory cervicotomy in emergency department of BLTH, between 2003 and 2013. The outcome variable was development of POM. Other variables were age, sex, etiology and kind of injury, hemodynamic status at admission, surgical time, distribution of injuries by anatomic areas, need for re operation and intra and post operative mortality. Descriptive statistics were used. Results: During the study period, 59 exploratory cervicotomies were performed to patients with PNT, with an average age of 32,5 years old. 89,8 percent of patients were male. The POM was 33,4 percent, being the most frequent the neurological ones. The most frequent etiology was the stab with 83 percent. 66 percent of patients were hemodynamically unstable at admission. Mean operative time was 107 minutes. The most injured area was the area II. Conclusion: The PNT is a little prevalent disease. The outcomes of our study are consistent with those reported in the literature.

Objetivo: El objetivo de este estudio es comunicar los resultados quirúrgicos observados en una serie de pacientes sometidos a cervicotomía exploradora por trauma cervical penetrante (TCP) en el Servicio de Urgencias del Hospital Barros Luco-Trudeau (HBLT), entre los años 2003 y 2013, en términos de morbilidad postoperatoria (MPO). Material y método: Serie de casos retrospectiva de pacientes sometidos a cervicotomía exploradora en el servicio de urgencia del HBLT, entre el año 2003 y 2013. La variable resultado fue desarrollo de MPO. Otras variables fueron: edad, sexo, etiología y tipo de lesión, estado hemodinámico al ingreso, tiempo quirúrgico, distribución de la lesión según zona anatómica, necesidad de re operación y mortalidad intra y post operatoria. Se utilizó estadística descriptiva. Resultados: En el período en estudio, se realizaron 59 cervicotomías a pacientes con TCP, con un promedio de edad de 32,5 años, de los cuales el 89,8 por ciento era de sexo masculino. La MPO fue de 33,4 por ciento, siendo las más frecuentes las de tipo neurológico. La etiología más recurrente fue el arma blanca con 83 por ciento. El 66 por ciento de los pacientes se encontraban hemodinámicamente inestables al momento del ingreso. El tiempo quirúrgico promedio fue de 107 min. La zona más lesionada fue la zona II. Conclusión: El TCP es una entidad poco prevalente. Los resultados obtenidos en nuestra serie son coincidentes con lo reportado en la literatura.

Faster pulmonary oxygen uptake kinetics in children vs adults due to enhancements in oxygen delivery and extraction.

This study aimed to examine if the faster pulmonary oxygen uptake (VO2p) phase 2 in children could be explained by increased O2 availability or extraction at the muscle level. For that purpose, O2 availability and extraction were assessed using deoxyhemoglobin (HHb) estimated by near-infrared spectroscopy during moderate-intensity constant load cycling exercise in children and young adults. Eleven prepubertal boys and 12 men volunteered to participate in the study. They performed one maximal graded exercise to determine the power associated with the gas exchange threshold (GET) and four constant load exercises at 90% of GET. VO2p and HHb were continuously monitored. VO2p , HHb, and estimated capillary blood flow (Qcap) kinetics were modelled after a time delay and characterized by the time to achieve 63% of the amplitude (τ) and by mean response time (MRT: time delay + τ), respectively. Mean values of τ for VO2p (P < 0.001), of MRT for HHb (P < 0.01) and of MRT for Qcap (P < 0.001) were significantly shorter in children. Faster VO2p kinetics have been shown in children; these appear due to both faster O2 extraction and delivery kinetics as indicated by faster HHb and Qcap kinetics, respectively.

Rendimiento de la evaluación clínica en el diagnóstico de fractura de huesos propios nasales / Clinical assessment in the diagnosis of bone fractures in patients with nasal trauma

Introduction: The aim of this study was to evaluate the performance of clinical assessment in the diagnosis of bone fractures in patients with nasal trauma. Methods: Retrospective review of medical records of 220 patients with nasal trauma treated at the Maxillofacial Surgery Department of Hospital Workers in Santiago was performed. Eight clinical criteria were evaluated: epistaxis, ecchymosis, swelling, nasal injury, airway obstruction, nasal deviation, irregular nasal dorsum, and acute septal injury. The gold standard for diagnosis of nasal fracture was the radiological evaluation. The sensitivity, specificity, and positive/negative predictive value (PPV/NPV) were calculated for each separate clinical criteria (8), for all possible combinations of 2 clinical criteria (28) and 3 clinical criteria (56). Results: For any of the 8 criteria, the average sensitivity and negative predictive values for nasal fracture was very low (< 35 percent). However, the specificity and positive predictive values were relatively high (> 90 percent) and increased, respectively, when at least one criterion was present (92 percent and 94 percent respectively), when 2 clinical criteria were present (98 percent and 96 percent, respectively), and when at least 3 clinical criteria were present (100 percent for both). Conclusion: The presentation of the clinical criteria can be a valuable method for diagnosis of nasal fracture, however, when these clinical criteria are absent, the possibility of nasal fracture cannot be excluded, although the possibility is remote.

Introducción: El objetivo del presente trabajo fue conocer el rendimiento de la evaluación clínica en el diagnóstico de fractura de huesos propios en pacientes con trauma nasal. Material y Método: Revisión retrospectiva de fichas clínicas de 220 pacientes con trauma nasal atendidos en el Servicio de Cirugía Maxilofacial del Hospital del Trabajador de Santiago. Ocho criterios clínicos fueron evaluados: epistaxis, equimosis, inflamación, herida nasal, obstrucción de vía aérea, laterorrinia, dorso nasal irregular, y lesión aguda del tabique nasal. El estándar de oro para el diagnóstico de fractura nasal fue el estudio radiológico. La sensibilidad, especificidad, y positivo/valor predictivo negativo (VPP/VPN) se calcularon para cada criterio clínico por separado (8), para todas las combinaciones posibles de 2 criterios clínicos (28) y 3 criterios clínicos (56). Resultados: Para cualquiera de los 8 criterios, el promedio de sensibilidad y valor predictivo negativo para la fractura nasal fue muy baja (< 35 por ciento). Sin embargo, la especificidad y valores predictivos positivos fueron relativamente altas (> 90 por ciento) y aumentó, respectivamente, cuando al menos un criterio estuvo presente (92 por ciento y 94 por ciento, respectivamente), cuando 2 criterios clínicos estaban presentes (98 por ciento y 96 por ciento, respectivamente), y cuando al menos 3 criterios clínicos estaban presentes (100 por ciento para ambos). Conclusiones: La presentación de los criterios clínicos puede ser un método valioso para el diagnóstico de fractura nasal, sin embargo, cuando estos criterios clínicos están ausentes, la posibilidad de la fractura nasal no se puede descartar, aunque la posibilidad es remota.

Hemorragia incoercible por trauma maxilofacial: experiencia del Hospital del Trabajador / Management of intractable bleeding facial trauma

Introduction: The aim of this paper is to show our experience in the management of intractable bleeding facial trauma during the past 10 years to determine its impact on our environment and outline the basic principles of treatment. Methods: A retrospective study of all patients with maxillofacial trauma and uncontrollable bleeding from 1999 to 2009. Inclusion criteria were oro-nasal bleeding secondary to maxi-llofacial trauma requiring emergency treatment by a specialist, without other associated lesions that could be a source of bleeding. We obtained demographic information, mechanism of injury, diagnosis of injury, hemodynamic status, type and timing of tamponade, definitive surgical treatment, results and evolution. Results: 21 patients in the study period, a true incidence of 0.002 percent. 7 patients (33.3 percent) with trauma naso-septal; 5 (23.8 percent) with panfacial fractures, and 7 (33.3 percent) with variable involvement of the upper and middle face. Nine patients (42.9 percent) had isolated facial injuries. Only 5 patients (23.8 percent) had hemodynamic compromise. Thirteen patients (61.9 percent) required posterior nasal packing with or without another procedure to control bleeding. Eight patients (38.1 percent) required early reduction and internal fixation as definitive treatment. Conclusions: Maxillofacial trauma uncontrollable bleeding is uncommon and rarely is the primary cause of hypovolemic shock. It should be suspected in patients with facial injuries from hours bleeding. The packing, suturing of wounds and reduce/OTS are the mainstays of early treatment.

Introducción: El objetivo del presente trabajo es mostrar nuestra experiencia en el manejo de la hemorragia incoercible por trauma facial durante los últimos 10 años, para determinar su incidencia y delinear los principios básicos del tratamiento. Material y Método: Estudio retrospectivo de todos los pacientes con hemorragia incoercible por trauma maxilofacial entre 1999 y 2009. Criterios de inclusión fueron hemorragia oro-nasal secundaria a traumatismo maxilofacial, sin otras lesiones asociadas que pudieran ser fuente de hemorragia, que requirió de tratamiento de urgencia por un especialista. Se obtuvo información demográfica, mecanismo de injuria, diagnóstico del traumatismo, estado hemodinámico, tipo y momento del tratamiento especializado, tratamiento quirúrgico definitivo, resultados y evolución. Resultados: 21 pacientes en el período de estudio, con incidencia real de 0,002 por ciento. Destacan 7 pacientes (33,3 por ciento) con trauma nasoseptal, con o sin heridas faciales; 5 (23,8 por ciento) con fracturas panfaciales; 7 (33,3 por ciento) con compromiso variable del tercio superior y medio de la cara. Nueve pacientes (42,9 por ciento) presentaron lesiones faciales aisladas. 5 pacientes (23,8 por ciento) presentaron compromiso hemodinámico. Trece pacientes (61,9 por ciento) necesitaron un taponamiento nasal posterior, asociado o no a otro procedimiento para el control de la hemorragia. Ocho pacientes (38,1 por ciento) necesitaron reducción y osteosíntesis precoz como tratamiento definitivo. Conclusiones: La hemorragia incoercible por trauma maxilofacial es poco frecuente y rara vez es la causa primaria de shock hipovolémi-co. Se la debe sospechar especialmente en pacientes con lesiones faciales que llevan horas con sangrado, aún de poca cuantía, pero persistente. El taponamiento, sutura de heridas y reducción/OTS precoz son los pilares de su tratamiento.

At identical isowork rates, ageing influences cardiorespiratory adaptations in COPD out-patients.

PURPOSE: To determine the extent to which younger COPD patients improve their cardiorespiratory function during exercise in comparison with older COPD patients, as a result of exercise training. METHODS: Thirty-nine COPD patients underwent an exercise program. They were divided into two groups: a younger group (57.2+/-1.0 years, n=18 patients) and an older group (68.8+/-0.6 years, n=21 patients). Forced expiratory volume in 1s was lower than 55% of the predicted value for all patients. RESULTS: After training, VO2 symptom-limited significantly improved by 10.3% and 8.4% for the younger and older COPD patients, respectively (P<0.05). Peak power significantly improved by 25.2% and 17.8% in the younger and older groups, respectively (P<0.05) with a greater improvement for the younger group (P<0.05). At submaximal exercise, ventilation and heart rate significantly decreased after training in the younger COPD patients (P<0.05) with no significant modification in the older COPD patients. CONCLUSIONS: The results suggest that all patients with COPD benefit from exercise rehabilitation at maximal exercise workload, however, according to their age, submaximal cardiorespiratory adaptations were greater in younger patients.

[Anti-Pseudomonas aerosol therapy in cystic fibrosis: improvement with tobramycin]. / Aérosolthérapie anti-pyocyanique dans la mucoviscidose: apport de la tobramycine.

Aerosol delivery of antibiotics offers the potential to achieve high antibiotic concentrations at the site of infection while reducing the risk of systemic untoward effects because of minimal resorption into the bloodstream. We reviewed knowledge acquired in this field over the two latter decades. While the earliest data were obtained with gentamycin, the most conclusive evidence presently regards aminoglycosides and colistin. Aerosol delivery of tobramycin was recently improved with the development of a new formulation for inhalation. Coupled with an adequate nebulization system, intermittent treatment with tobramycin for inhalation has been evaluated in randomized placebo-controlled studies. These studies have demonstrated a significant improvement of respiratory function.

[Di George's syndrome complicated by graft versus host reaction]. / Syndrome de Di George compliqué d'une réaction du greffon contre l'hôte.

On the occasion of a case of Di George syndrome, complicated by a post-transfusion lethal graft versus host reaction, the authors review its main clinical and biologic criteria. This case also shows that immune deficiencies should be diagnosed early in order to adopt preventive measures before transferring the patient in a specialized unit, where immunorestitution will be discussed.

Study of hepatic binding protein activity in jejuno-ileal by-passed rat hepatocytes.

The kinetic constants of internalization of asialoorosomucoid were determined for normal and jejuno-ileal by-passed rat hepatocytes. In by-passed rats the maximum velocity of asialoorosomucoid internalization is decreased 3-fold, without any modification of apparant constant of internalization. Moreover, the rate constant of internalization was the same in the two groups of rats. These data suggest that the process of asialoorosomucoid internalization is not altered in by-passed hepatocytes and that the decrease of maximal velocity is only due to a decrease of total uptake receptor number.

Endocytosis and binding of asialoorosomucoid by hepatocytes from rats with jejunoileal bypass.

Rats with jejunoileal bypass were used to study the biological activity of the hepatic binding protein. Hepatocytes were prepared 11 weeks after surgical procedure, and presence of asialoorosomucoid in serum has been determined. Compared to control rat hepatocytes, endocytosis of [3H]asialoorosomucoid by bypassed rat hepatocytes was decreased by about 60%. This was due to a decreased number of total and surface receptors. In most sera, an accumulation of asialoorosomucoid was found. A reduction of protein synthesis or turnover could be considered.

[Hepatotoxicity of isaxonine phosphate: 4 cases of severe subacute hepatitis]. / Hépatotoxicité du phosphate d'isaxonine: quatre observations d'hépatites subaiguës sévères.

Isaxonine phosphate is known to induce acute hepatitis which in most cases is reversible after withdrawal of the drug. The authors describe 4 new cases of hepatitis which differ from those previously reported by their evolutive and pathological features. In 3 cases, the outcome was fatal within a delay of 15-40 days despite discontinuation of the drug, and was associated with hepatic encephalopathy and ascites. In the 4 cases plasma concentration of alanine- and aspartate-aminotransferases were initially increased (up to 33 X upper normal range) and decreased to normal values in 2 cases. Plasma bilirubin levels were also elevated at first and continued to increase during the first 15 days of evolution. Pathological examination of the liver showed mild necrosis, sometimes with a piecemeal or a bridging aspect, marked fibrosis infiltrated with mononuclear and neutrophil polymorphonuclear cells and a conspicuous biliary neogenesis. In these particular cases of hepatitis due to isaxonine phosphate, occurrence in women, increased serum immunoglobulin levels, presence of autoantibodies, clinical and pathological aspects resembling those observed in iproniazid hepatitis may be suggestive of an immunological, or even autoimmune, mechanism.

Cancer of the esophagus and associated lesions: detailed pathologic study of 100 esophagectomy specimens.

One hundred surgical specimens from patients with esophageal cancers were studied in detail. The characteristics of the cancers were similar to those described in the literature. Subserial sectioning of the specimens permitted determination of the type, number, and extent of noncancerous mucosal lesions and their exact location in relation to the carcinomas. Ninety-five per cent of the resected esophagi contained at least one focus of intraepithelial neoplasia, for the most part adjacent to the invasive carcinoma; in 14 per cent of the cases, intraepithelial carcinomas were detected at some distance from the invasive carcinomas. The invasive carcinomas involved an average of 20 per cent of the mucosal surface and the intraepithelial neoplasias, 5 per cent. The noncancerous mucosal lesions were analyzed, and their extent was evaluated. Esophagitis, parakeratosis, atrophy, dyskeratosis of the epithelium, and hyperplasia and metaplasia of the mucosal gland ducts were encountered. The exact significance of these lesions in esophageal carcinogenesis is not known. The mucosal abnormalities associated with preoperative irradiation are defined. The results of iodine and toluidine blue testing are presented.

[Dorsal extradural hourglass lipoma in children]. / Lipome extra-dural dorsal en sablier de l'enfant.

The authors would like to recount and discuss the case of a 14 months old child which presented a dumbbell dorsal lipoma, purely extradural with no congenital anomalies. The warning signal was the discovery of paraparesis with the regression of walking ability. The hypothesis of medullary compression by a dumbbell dorsal tumor was quickly dismissed with the discovery of a mediastinal mass on the pulmonary X-Ray. A diagnosis of the pre-operational neuroblastoma was carried out because of detection of dorsal epidural medullary compression revealed by the myelography. The testing was completed with a vertebral computed tomography, which clearly showed the extent of medullar compression, and the mediastinal tumoral development under the paravertebral muscular masses. The child was operated on at 2 fronts, vertebrally and thoraxically for an encapsulated, perfectly separable and non hemorrhaging tumor. The anatomopathological examination confirmed the diagnosis of the lipoma. It is in the resumption of the computed tomographic examination that the tumoral density measures will confirm fatty tissue with numbers of density--50. In light of the literature, we are discussing the appearance of the lipoma, entirely exceptional because of its dorsal location, its extradural and certainly its dumbbell position, with large thoraxic development. It is necessary to stress the importance of the meticulous neurological examination of the child, the diagnostical necessity of the CT scan and the importance of the avoidance of the creation of an instable vertebral lesion at the time of laminotomy. In this case only the early double surgical operation permitted the recovery of the child.

[Malignant histiocytosis of the intestine. An anatomo-clinical case report]. / Histiocytose maligne de i'intestin. Une observation anatomo-clinique.

Clinico-pathological case report of a 11 year-old girl who successively presented persistent abdominal pain, pneumoperitoneum, repeated intestinal hemorrhages, superficial intestinal ulcerations, first localized on the jejunum and later extended to the all gut. After a course of 13 months, the child died from diffuse and repeated hemorrhages. The morphologic studies revealed a diffuse and homogeneous cellular infiltrate made of large round "lymphomatous" cells scattered within the lamina propria and submucosa. Initially this superficial cellular infiltrate was overshadowed by accompanying inflammatory cells and was not recognized as a tumoral process. Later on the dissemination of abnormal cells to the entire ileon, mesenteric lymph nodes, spleen and liver and the cellular appearance confirmed its neoplastic nature and allowed to consider this process as a malignant histiocytosis of the intestine as described by Isaacson and Wright. This case seems to be the first case reported in childhood.

[Angiosarcoma localized in the right cardiac cavities. Apropos of a case]. / Angiosarcome localisé au niveau des cavités cardiaques droites. A propos d'un cas.

The authors report the case of a young 26 years old man admitted for abundant fluid pericarditis which was rapidly recurrent, requiring two perocardial punctures and a surgical drainage. The two dimensional echocardiogram demonstrated a large right atrio-ventricular tumour with infiltration of the right ventricular wall, suggesting its malignant nature. After confirmation by right angiography and in view of the rapid cardiovascular deterioration, it was decided to operate. The surgery was only exploratory; not even palliative surgery was possible for this tumour mass invading the right atrium, the right ventricle and the pericardium. Histology revealed it to be an angiosarcoma.