Registro del año 2010 de Nutrición Parenteral Domiciliaria en España: Grupo NADYA-SENPE / Home parenteral nutrition registry in Spain for the year 2010: NADYA-SENPE

Objetivos: Comunicar los datos del Registro del Grupo NADYA SENPE de Nutrición Parenteral Domiciliaria NPD en España del año 2010. Material y métodos: Estudio descriptivo de la base de datos del Registro de ámbito nacional de NPD del grupo NADYA-SENPE (1 de enero de 2010 al 31 de diciembre de 2010). Para el cálculo de prevalencias se utilizó los últimos datos publicados por el Instituto Nacional de Estadística. Resultados: Se registraron 148 pacientes procedentes de 23 hospitales, 86 mujeres (58,11%) y 9 niños (6,08%). La edad media de los 139 pacientes adultos fue de 53,06 ± 15,41 años. La duración media de la NPD fue de 316,97 días/paciente. El diagnóstico más frecuente en los niños (menores de 14 años) fue intestino corto traumático con 5 casos (55,55%) y en los adultos la neoplasia en tratamiento paliativo 29 (19,59%). El motivo de la indicación de la NPD fue el síndrome de intestino corto en 74 ocasiones (47%). La vía de acceso más frecuentemente registrada fue el catéter tunelizado en 36 (22,78%) casos seguido del reservorio en 13 (8,23%) y otras vías en 3 ocasiones (1,90%). Se registraron 23 infecciones relacionadas con el catéter (82,14%), lo que representa 0,49/1000 días de NP y todas ellas ocurrieron en los adultos. A lo largo del año finalizaron 24 episodios de NPD, la causa más frecuente fue el paso a la vía oral en 12 episodios (50%). Se registró que los pacientes tenían una actividad normal en 70 episodios de NPD (44,30%) con una total autonomía en 88 de episodios (55,69%). Se identificaron 39 (24,68%) posibles candidatos para trasplante intestinal. Conclusiones: El número de pacientes registrados es discretamente inferior al del año anterior, aunque el número de hospitales participantes es el mismo. La complicación más frecuente sigue siendo la infección relacionada con el catéter aunque ha disminuido su incidencia respecto a años anteriores, presentándose la tasa más baja desde la creación del registro. Las diferencias en la participación en el registro observadas por Comunidades Autónomas lleva a plantear el desarrollo de estrategias de implementación del registro. Se observa un aumento progresivo de la duración de los días de NPD a lo largo de los años que hace pensar en la cronicidad de algunos pacientes, pero nos obliga a estudiar la existencia de un posible factor de confusión, en el caso de que existiera un olvido de cierre de algún episodio por lo que se hace necesario actualizar el registro con sistemas de alertas periódicas que faciliten la revisión de los pacientes incluidos y optimice la validez del registro (AU)

Objectives: To report the Group Registry NADYA SENPE data about home parenteral nutrition (HPN) in Spain in 2010. Material and methods: A descriptive study of the database of the national registry of HPN of NADYA-SENPE (December 10, 2009 to December 10, 2010). For the calculation of prevalence the latest data published by the Institute National Statistics Office (01/01/2009) was used. Results: There were registered 148 patients from 23 hospitals, 86 women (58.11%) and 9 children (6.08%). The average age of the 139 patients older than 14 years was 53.06 ± 15.41 years. The average duration of HPN was 316.97 days/patient. The most common diagnosis in those younger than 14 years was short bowel traumatic with 5 cases (55.55%) and in those older than 14 years, palliative care cancer with 29 cases (19.59%). The reason for the indication for HPN was short bowel syndrome in 74 cases (47%). The access via most frequently recorded was tunneled catheter in 36 cases (22.78%) followed by implanted port-catheters in 13 cases (8.23%) and other pathways in 3 cases (1.90%). There were 23 catheter related infections (82.14%) which represented 0.49 /1,000 days of PN, all of which occurred in cases older than 14 years. During the year 24 episodes of HPN ended, the most frequent cause was the transition to oral nutrition in 12 episodes (50%). It was reported that patients had a normal activity in 70 episodes of HPN (44.30%) with complete autonomy in 88 episodes (55.69%). Some patients 39 (24.68%) were potential candidates for intestinal transplantation. Conclusions: The number of registered patients is slightly lower than the previous year, although the number of participating hospitals is the same. The most frequent complication remains catheter-related infection but its incidence has decreased from previous years, presenting the lowest rate since the creation of the record. Differences in participation in the registry observed in the Autonomous Communities causes the development of implementation strategies. There is a gradual increase in day length of HPN over the years, which suggests the chronic treatments of some patients and obliges to study the existence of a possible confounding factor, in case there is an oversight of closing an episode. Therefore, it is necessary to update the registry with warning systems that facilitate periodic review of the patients and optimize the validity of registration (AU)

[Home Parenteral Nutrition (HPN) registry in Spain for the years 2007, 2008 and 2009 (NADYA-SENPE Group)]. / Registro de la Nutrición Parenteral Domiciliaria (NPD) en España de los años 2007, 2008 y 2009 (Grupo NADYA-SENPE).

OBJECTIVE: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2007, 2008 and 2009. METHODOLOGY: We compiled the data from the on-line registry introduced by the responsible Units for the monitoring of HPN from January 1st 2007 to December 31st 2009. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication. RESULTS: 2007: 133 patients with HPN were registered (61 males and 72 females), belonging to 21 hospitals. Average age for the 119 patients older than 13 years old was 53.7 ± 14.9 years, and 3.6 ± 3.6 y. for the 14 patients under 14 years old. Most frequent pathology was neoplasm (24%), followed by intestinal motility disorders and actinic enteritis (14% both). The reason for HPN provision was short bowel syndrome (43%), malabsorption (27%), and intestinal obstruction (23%). Tunnelled catheters were mostly used (69%), followed by implanted port-catheters (27%). Catheter related infections were the most frequent complications, with a rate of 0.92 episodes/103 HPN days. HPN was provided for more than two years in 50% of the cases. By the end of 2007, 71.4% of the patients remained active; exitus was the most frequent reason to end HPN (57.5%). 26% of the patients were eligible for intestinal transplant. 2008: 143 patients with HPN were registered (62 males and 81 females), belonging to 24 hospitals. Average age for the 133 patients older than 13 years old was 54.7 ± 13.9 years, and 3.7 ± 0.6 y. for the 10 patients under 14 years old. Most frequent pathology was neoplasm (20%), followed by actinic enteritis (14%) and intestinal motility disorders (13% ). The reason for HPN provision was short bowel syndrome (44%), malabsorption (28%), and intestinal obstruction (20%). Tunnelled catheters were mostly used (60%), followed by implanted port-catheters (29%). Catheter related infections were the most frequent complications, with a rate of 0.50 episodes/10³ HPN days. HPN was provided for more than two years in 67% of the cases. By the end of 2008, 71.6% of the patients remained active; exitus was the most frequent reason to end HPN (52.4%). 29% of the patients were eligible for intestinal transplant. 2009: 158 patients with HPN were registered (62 males and 96 females), belonging to 24 hospitals. Average age for the 149 patients older than 13 years old was 55.2 ± 13.0 years. Most frequent pathology was neoplasm (25%), followed by actinic enteritis (12%) and intestinal motility disorders (11%). The reason for HPN provision was short bowel syndrome (42%), malabsorption, and intestinal obstruction (23% both). Tunnelled catheters were mostly used (60%), followed by implanted port-catheters (36%). Catheter related infections were the most frequent complications, with a rate of 0.67 episodes/10³ HPN days. HPN was provided for more than two years in 58% of the cases. By the end of 2009, 79.2% of the patients remained active; full oral nutrition was the most frequent reason to end HPN (48%). 23% of the patients were eligible for intestinal transplant. CONCLUSIONS: We observe an increase in registered patients with respect to previous years, with a very different prevalence among regions. Neoplasia remains as the main pathology since 2003. We observe a decrease in catheter-related infections in the last two years, being the 2008 rate the smallest since the register's beginning.

[Home parenteral nutrition registry in Spain for the year 2010: NADYA-SENPE Group]. / Registro del año 2010 de nutrición parenteral domiciliaria en España: Grupo NADYA-SENPE.

OBJECTIVES: To report the Group Registry NADYASENPE data about home parenteral nutrition (HPN) in Spain in 2010. MATERIAL AND METHODS: A descriptive study of the database of the national registry of HPN of NADYA-SENPE (December 10, 2009 to December 10, 2010). For the calculation of prevalence the latest data published by the Institute National Statistics Office (01/01/2009) was used. RESULTS: There were registered 148 patients from 23 hospitals, 86 women (58.11%) and 9 children (6.08%). The average age of the 139 patients older than 14 years was 53.06 ± 15.41 years. The average duration of HPN was 316.97 days/patient. The most common diagnosis in those younger than 14 years was short bowel traumatic with 5 cases (55.55%) and in those older than 14 years, palliative care cancer with 29 cases (19.59%). The reason for the indication for HPN was short bowel syndrome in 74 cases (47%). The access via most frequently recorded was tunneled catheter in 36 cases (22.78%) followed by implanted port-catheters in 13 cases (8.23%) and other pathways in 3 cases (1.90%). There were 23 catheterrelated infections (82.14%) which represented 0.49 /1,000 days of PN, all of which occurred in cases older than 14 years. During the year 24 episodes of HPN ended, the most frequent cause was the transition to oral nutrition in 12 episodes (50%). It was reported that patients had a normal activity in 70 episodes of HPN (44.30%) with complete autonomy in 88 episodes (55.69%). Some patients 39 (24.68%) were potential candidates for intestinal transplantation. CONCLUSIONS: The number of registered patients is slightly lower than the previous year, although the number of participating hospitals is the same. The most frequent complication remains catheter-related infection but its incidence has decreased from previous years, presenting the lowest rate since the creation of the record. Differences in participation in the registry observed in the Autonomous Communities causes the development of implementation strategies. There is a gradual increase in day length of HPN over the years, which suggests the chronic treatments of some patients and obliges to study the existence of a possible confounding factor, in case there is an oversight of closing an episode. Therefore, it is necessary to update the registry with warning systems that facilitate periodic review of the patients and optimize the validity of registration.

[Spanish home enteral nutrition (HEN) registry of the year 2008 from the NADYA-SENPE group]. / Registro del Grupo NADYA-SENPE de Nutrición Enteral Domiciliaria en España en el año 2008.

AIM: To present the results of the Spanish home enteral nutrition (HEN) registry of the year 2008 from the NADYA-SENPE group. MATERIAL AND METHODS: We recorded the HEN registry data from January 1st to December 31st 2008. RESULTS: The number of patients registered in this period was 6206 (51% male) with up to 6,279 episodes of HEN, from 31 Spanish hospitals. Most of the patients (95%) were older than 14 yr. Mean age was 4.83±3.29 yr in the children group, and 70.75±18.14 yr in the adult group (older than 14 yr). Neurological disorders (39%) and cancer (27%) were the two most prevalent diagnoses. The oral route was the most frequently used (43,4%), followed by nasogastric tube (40,4%), and gastrostomy tube (14,7%). Mean length of treatment was 305,36 days (10 months). The principal reasons for discontinuing treatment were death (43%) and progress to oral diet (40%). Only 33% of the patients had a normal activity level, being limited in different grades in the rest of the patients. Most of the patients required partial (25%) or total help (38%). The enteral formula was provided by the hospital in 65% of the cases and by private pharmacies in 32%. The disposables were provided by the hospital (82,4%) and primary care services (17,2%). CONCLUSIONS: The number and the age of the patients registered have increased comparing to previous years, with little variations in the rest of analyzed variables. The increase in the length of treatment could reflect misreporting of the weaning process in the registry.

[The Spanish Home Enteral Nutrition registry of the year 2009: from the NADYA-SENPE group]. / Registro español de Nutrición Enteral Domiciliaria del año 2009: Grupo NADYA-SENPE.

OBJECTIVE: To describe the Home Enteral Nutrition Characteristics (HEN) recorded by the group NADYA-SENPE during 2009. MATERIAL AND METHOD: collection and analysis of the data voluntary recorded in the HEN registry from the NADYA-SENPE group from January 1st to December 31st. RESULTS: 6.540 HEN patients were registered, 5.11% more than the previous year and 6,649 episodes (3,135 in women, 47,93%) from 32 different hospitals. 6,238 of them (95,38%) were over 14 years. The mean age of the patients under 14 yr was 3,67 ± 2,86 and it was 72,10 ± 16,89 in those over 14 yr group. The base illness registered more frequently was the neurological disorders in 2,732 (41,77%) patients, followed by cancer patients in 1,838; 28,10%. The enteral access route was registered in 1,123 (17,17%) of the episodes, being more frequent the administration by nasogastric tube 562 (50,04%). The mean length of nutritional treatment by episode was 323 days (10,77 months). 606 episodes of HEN ended, being the principal reasons for discontinuing treatment the patient death in 295 (48,68%) occasions. The transition to oral feeding occurred in 219 (36,14%) cases. Patients maintained normal activity in 2162 (32,55%) HEN episodes and 2,468 (37,13%) cases were living "bed-couch". The level of dependence was "total" in 2,598 (39,07%) of the episodes recorded. The nutritional formula was provided by the hospital in 4,183 (62,91%) cases and by the reference pharmacy in 2,262 (el 34,02%). Consumables were provided by the hospital in 3,531 (53,11%) cases. CONCLUSIONS: The number of HEN patients recorded increased from the year 2008, continuing the gradual growth increase since the start of registration. The characteristics of the patients remain in the same profile as in previous years.

[Spanish Registry of Home-based Parenteral Nutrition during 2006 (NADYA-SENPE Group)]. / Registro de la Nutrición Parenteral Domiciliaria (NPD) en España del año 2006 (Grupo NADYA-SENPE).

OBJECTIVE: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the year 2006. METHODOLOGY: We compiled the data from the on-line registry introduced by the responsible Units for the monitoring of HPN from January 1st to December 31st 2006. RESULTS: 103 patients with HPN were registered (47 males and 56 females), belonging to 19 hospitals. Average age for the 91 patients older than 14 years old was 53.3 +/- 14.9 years old, and that for the 12 patients under 14 years old was 2 +/- 0 years old. Most frequent pathology was neoplasm (29%), followed by intestinal motility disorders (13%). The reason for HPN provision was short bowel syndrome (40%), intestinal obstruction (22%), and malabsorption (21%). Tunneled catheters were mostly used (45%), followed by implanted port-catheters (32%). Catheter related infections were the most frequent complications, with a rate of 0.85 episodes / 10(3) days. HPD was provided for more than two years in 50% of the cases. By the end of 2006, 70.9% of the patients remained active; exitus was the most frequent reason to end HPN (53%). Complementary oral or enteral nutrition was provided to 52% of the patients. 48% of the patients had a normal activity level, and a 55% were autonomous. PN formula was supplied by the hospital in 82% of the cases, while this number was 78% for fungible materials. 27% of the patients were eligible for intestinal transplant. CONCLUSIONS: We observe an increase in registered patients with respect to previous years, with a very different prevalence among regions. Neoplasia remains as the main pathology since 2003. We observe a decrease in catheter-related infections with respect to the 2004-2005 period.

[Spanish registry of Home-Based Parenteral Nutrition for the years 2004 and 2005 (NADYA-SENPE Group)]. / Registro de la nutrici6n parenteral domiciliaria en España de los años 2004 y 2005 (Grupo NADYA-SENPE).

OBJECTIVE: To report the results of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group of the years 2004 and 2005. MATERIAL AND METHODS: We summarized the data of the new on-line HPN registry of the NADYA-SENPE group for the period 2004-2005. RESULTS: During the year 2004, 70 HPN-patients (23 males and 47 females) were registered from 14 hospitals. Mean age of adults was 53,7 +/- 14,87 years (m +/- SD) and 6 +/- 2,83 years for those younger than 14 years. The most frequent etiologies of the intestinal failure were neoplasia (24%) and mesenteric ischaemia (19%). Tunnelled catheters were used in 75% of the patients. The catheter-related infections were the most frequent complications, with a rate of 0,98 episodes/10(3) days. In 69% of the cases the nutritional support was maintained for more than 2 years. HPN solutions and disposables were supplied by the hospital pharmacy in 81% and 83%, respectively. Up to 54% of the patients had a normal activity level. The most frequent reasons to end HPN treatment were the transition to oral intake (41%), or exitus (28%). During the year 2005, 79 patients (33 males and 46 females) were registered from 14 hospitals. Mean age of adults was 52,39 +/- 14,21 years and 6,5 +/- 5,21 years for those younger than 14 yrs. The most frequent etiologies of the intestinal failure were neoplasia (22%), and mesenteric ischaemia (15%). Tunnelled catheters were used in 63% of the patients. The catheter-related infections were the most frequent complications, with a rate of 1,14 episodes/10(3) days. In 51% of the cases the nutritional support was maintained for more than 2 years. HPN solutions and disposables were supplied by the hospital pharmacy in 76% and 81%, respectively. Up to 50% of the patients had a normal activity level. The most frequent reasons to end HPN treatment were the transition to oral/enteral feeding (41%) and exitus (31%). CONCLUSIONS: We have observed a mild decrease in the number of HPN patients registered in the period 2004-2005, probably related to the change of the registry. The characteristics of the patients are similar to previous years. We have observed an increase in the septic catheter-related complications in the year 2005.

Registro de la nutrición parenteral domiciliaria en España de los años 2004 y 2005 (Grupo NADYA-SENPE) / Spanish Registry of home-based parenteral nutrition for the years 2004 and 2005 (NADYA-SENPE GROUP)

Objetivo: Comunicar los resultados obtenidos en el registro de Nutrición Parenteral Domiciliaria (NPD) del grupo NADYA-SENPE en los años 2004-2005. Material y métodos: Recopilación de los datos del nuevo registro "on-line" de NPD del grupo NADYA-SENPE en el período 2004-2005. Resultados: Durante el año 2004 se registraron 70 pacientes con NPD (23 hombres y 47 mujeres) pertenecientes a 14 centros hospitalarios. La edad media de los pacientes mayores de 14 años fue de 53,7 ± 14,87 años (m ± DS) y de 6 ± 2,83 años para los menores de 14 años. La enfermedad de base más frecuente fue la neoplasia (24%) seguida de la isquemia mesentérica (19%). Los catéteres más utilizados fueron los tunelizados (75%). Las complicaciones más frecuentes fueron las sépticas relacionadas con el catéter, con una tasa de 0,98 infecciones/ 103 días. El tiempo de soporte nutricional fue superior a dos años en el 69% de los casos. El suministro de las soluciones de NPD y del material fungible fue proporcionado por las farmacias hospitalarias en el 81% y el 83%, respectivamente. El 54% de los pacientes presentaban un nivel de actividad normal. En la mayoría de los pacientes la causa de finalización de la NPD fue la transición a la dieta oral (41%), o el fallecimiento (28%). Durante el año 2005 se registraron 79 pacientes con NPD (33 hombres y 46 mujeres), pertenecientes a 14 centros hospitalarios. La edad media de los mayores de 14 años fue de 52,39 ± 14,21 años y de 6,5 ± 5,21 años para los menores de 14 años. La enfermedad de base más frecuente fue la neoplasia (22%), seguida de la isquemia mesénterica (15%). El 63% de los pacientes utilizaron catéteres tunelizados. Las complicaciones más frecuentes fueron las sépticas relacionadas con el catéter (1,14 infecciones/ 103 días). El tiempo de soporte nutricional fue mayor a dos años en un 51% de los pacientes. El suministro de las soluciones de NPD y del fungible fue en el hospital en el 76% y 81%, respectivamente. El nivel de actividad de los pacientes con NPD fue normal en el 50%. Los motivos más frecuentes de finalización del tratamiento fueron la transición a dieta oral/ enteral (41%) y el fallecimiento (31%). Conclusiones: Hemos observado un ligero descenso en el número de pacientes registrados con NPD durante el período 2004-2005, posiblemente en relación con el cambio del registro. Las características generales de los pacientes son similares a las de años anteriores. Se aprecia un aumento en la tasa de complicaciones sépticas relacionadas con el catéter en el año 2005 (AU)

Objective: To report the results of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group of the years 2004 and 2005. Material y methods: We summarized the data of the new on-line HPN registry of the NADYA-SENPE group for the period 2004-2005. Results: During the year 2004, 70 HPN-patients (23 males and 47 females) were registered from 14 hospitals. Mean age of adults was 53,7 ± 14,87 years (m ± SD) and 6 ± 2,83 years for those younger than 14 years. The most frequent etiologies of the intestinal failure were neoplasia (24%) and mesenteric ischaemia (19%). Tunneled catheters were used in 75% of the patients. The catheter related infections were the most frequent complications, with a rate of 0,98 episodes/103 days. In 69% of the cases the nutritional support was maintained for more than 2 years. HPN solutions and disposables were supplied by the hospital pharmacy in 81% and 83%, respectively. Up to 54% of the patients had a normal activity level. The most frequent reasons to end HPN treatment were the transition to oral intake (41%), or exitus (28%). During the year 2005, 79 patients (33 males and 46 females) were registered from 14 hospitals. Mean age of adults was 52,39 ± 14,21 years and 6,5 ± 5,21 years for those younger than 14 yrs. The most frequent etiologies of the intestinal failure were neoplasia (22%), and mesenteric ischaemia (15%). Tunneled catheters were used in 63% of the patients. The catheter-related infections were the most frequent complications, with a rate of 1,14 episodes/103 days. In 51% of the cases the nutritional support was maintained for more than 2 years. HPN solutions and disposables were supplied by the hospital pharmacy in 76% and 81%, respectively. Up to 50% of the patients had a normal activity level. The most frequent reasons to end HPN treatment were the transition to oral/enteral feeding (41%) and exitus (31%). Conclusions: We have observed a mild decrease in the number of HPN patients registered in the period 2004-2005, probably related to the change of the registry. The characteristics of the patients are similar to previous years. We have observed an increase in the septic catheter related complications in the year 2005 (AU)

[Techniques of bariatric surgery: analysis of 78 cases]. / Técnicas en cirugía bariátrica: experiencia en 78 casos.

OBJECTIVES: Bariatric surgery has demonstrated its efficacy in weight loss and in reducing the comorbidities in the morbid obesity patient. The objectives of this study were to analyze the effectiveness and complication of the Scopinaro and gastric bypass techniques as well as the results from open surgery verses laparoscopy. DESIGN: Retrospective study from 1999-2005. SUBJECT AND METHODS: 78 patients with morbid obesity were operated. 50 patients underwent open surgery and 28 underwent laparoscopy. Gastric bypass was performed in 54 patients, Scopinaro was performed in 20 patients and Vertical Banded Gastroplasty (VBG) was performed in 3 patients. The follow up time was between 6 and 60 months. The results obtained with Scopinaro and gastric bypass were compared as well as the results from open surgery verses laparoscopy. RESULTS: The percentage of patients with a percent of excess weight loss under 50% in two years was of 5% and 13%, and the excess weight loss over 75% was of 55% ad 40% in the gastric bypass and the Scopinaro technique respectively. All the comorbidities improved. The average stay was decreased in the case of laparoscopy. The non-nutritional complications were increased for most cases in open surgery with the emphasis in eventrations, infections of the wound and respiratory complications. The nutritional complications were superior with Scopinaro's technique. CONCLUSIONS: Based on our study, we would recommend the performance of gastric bypass for laparoscopy due to the reduced average stay and less nutritional and surgical complications. The literature results vary and therefore we consider necessary further control and random studies to correctly establish these comparisons.

Técnicas en cirugía bariátrica: experiencia en 78 casos / Techniques of bariatric surgery: analysis of 78 cases

Objetivos: La cirugía bariátrica ha demostrado su eficacia en pérdida de peso y reducción de comorbilidades en el obeso mórbido. Los objetivos de nuestro trabajo fueron: evaluar los resultados con las técnicas de Scopinaro y Bypass gástrico, mediante cirugía abierta y laparoscópica. Material y métodos: 78 pacientes con obesidad mórbida intervenidos desde el año 2000 al 2005. 50 pacientes fueron intervenidos por cirugía abierta y 28 por laparoscopia. Se realizó bypass gástrico en 54 pacientes, la técnica Scopinaro en 20 y gastroplastia vertical anillada en 3. El tiempo de seguimiento fue desde 6 y 60 meses. Se recogieron los resultados obtenidos con las diversas técnicas y vías quirúrgicas. Resultados: El porcentaje de pacientes con pérdida de exceso de peso inferior al 50% a los dos años fue del 5% y del 13%, y superior al 75% fue del 55% y del 40% en el bypass gástrico y el Scopiraro respectivamente. Todas las comorbilidades mejoraron significativamente. La estancia media fue inferior (p < 0,001) en el caso de laparoscopia. Las complicaciones no nutricionales fueron en su mayoría superiores en la cirugía abierta destacando las eventraciones (30%), infección de las herida (32%), y complicaciones respiratorias (16%). Las complicaciones nutricionales fueron superiores en la técnica Scopinaro destacando el déficit de vitamina D (50%), Zinc (25%), magnesio (10%) y albúmina (5%). Conclusiones: En nuestra experiencia, la realización del bypass gástrico por laparoscopia, consigue menor estancia media, menores complicaciones nutricionales y quirúrgicas, sin diferencias significativas con respecto al Scopinaro en cuanto a pérdida de peso y reducción de comorbilidades. Sin embargo, para poder defender esta técnica como de elección se requieren estudios de mayor tamaño, controlados y aleatorizados y a más largo plazo, teniendo siempre en cuenta la experiencia de nuestros cirujanos (AU)

Objetives: Bariatric surgery has demonstrated its efficacy in weight loss and in reducing the comorbidities in the morbid obesity patient. The objectives of this study were to analyze the effectiveness and complication of the Scopinaro and gastric bypass techniques as well as the results from open surgery verses laparoscopy. Design: Retrospective study from 1999-2005. Subject and methods: 78 patients with morbid obesity were operated. 50 patients underwent open surgery and 28 underwent laparoscopy. Gastric bypass was performed in 54 patients, Scopinaro was performed in 20 patients and Vertical Banded Gastroplasty (VBG) was performed in 3 patients. The follow up time was between 6 and 60 months. The results obtained with Scopinaro and gastric bypass were compared as well as the results from open surgery verses laparoscopy. Results: The percentage of patients with a percent of excess weight loss under 50% in two years was of 5% and 13%, and the excess weight loss over 75% was of 55% ad 40% in the gastric bypass and the Scopinaro technique respectively. All the comorbidities improved.The average stay was decreased in the case of laparoscopy.The non-nutritional complications were increased for most cases in open surgery with the emphasis in eventrations, infections of the wound and respiratory complications. The nutritional complications were superior with Scopinaro´s technique. Conclusions: Based on our study, we would recommend the performance of gastric bypass for laparoscopy due to the reduced average stay and less nutritional and surgical complications. The literature results vary and therefore we consider necessary further control and random studies to correctly establish these comparisons (AU)

[Resolution of a neck chylous fistula with oral diet treatment]. / Resolución de una fístula linfática cervical con tratamiento dietético oral.

Chylous fistula after neck dissection is a well-described complication. This pHatology can lead to serious respiratory and nutritional complications. Therapeutical options for chylous fistula remains controversial. On last reviews, there are an agreement on the conservative management. Within of this management, low long-chain triglycerides fat diet is an essential part.

Resolución de una fístula linfática cervical con tratamiento dietético oral / Resolution of a neck chylous fistula with oral diet treatment

La fístula linfática es una complicación con una incidencia considerable en los pacientes sometidos a una disección cervical. Su aparición puede conducir a serios problemas respiratorios y nutricionales. El tratamiento de esta patología ha sido y es en la actualidad debatido entre los diversos especialistas implicados. En las últimas revisiones parece existir consenso en tratar de forma conservadora la mayoría de ellas. Dentro del tratamiento médico conservador, la dieta baja en triglicéridos de cadena larga, es una parte fundamental (AU)

Chylous fistula after neck dissection is a welldescribed complication. This pHatology can lead to serious respiratory and nutritional complications. Therapeutical options for chylous fistula remains controversial. On last reviews, there are an agreement on the conservative management. Within of this management, low long-chain triglycerides fat diet is an essential part (AU)

Hipotiroidismo y gestación: importancia del control periconcepcional / Hypothyroidism and pregnancy. Relevance of periconceptional control

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[Concordance between body self-perception and BMI estimated in a population of volunteers recruited on the IV National Day of Obese People]. / Concordancia entre la autopercepción corporal y el IMC calculado en una población voluntaria captada el IV Día Nacional de la Persona Obesa.

OBJECTIVES: To assess the concordance between corporal self-perception and BMI calculated in a population of volunteers. SECONDARY OBJECTIVES: to know the percentage of overweight, normoweight and obese individuals in this population. SUBJECTS: The study includes 160 volunteers recruited at the Gómez Ulla and Severo Ochoa Hospitals in Madrid during the 4th edition of the "Obesity Day". ACTIONS: A total of 160 interviews were carried out, comprising a first group of 10 questions about how obesity is understood, how they classify themselves by self-perception (obese, overweight or normoweight individuals), the incidence of obesity in the family, living habits and the number of previous failed attempts to lose weight. In the case of a positive response to the last question, the survey is extended to 19 questions, analyzing the reasons, prescriptors, methods used, and weight loss results obtained. RESULTS: The mean Body Mass Index (BMI) of the interviewees was 26.2 +/- 4.97 kg/m2, with 27.45 +/- 5.4 kg/m2 for males and 25.76 +/- 4.7 kg/m2 for women. Overweight men represented 32.5%, with 27.3% overweight women, while obese men accounted for 25.6% and obese women amounted to 20.6%. The differences were not significant between sexes, normoweight, overweight and obesity groups. The concordance between self-perception and BMI using the kappa index was 0,464 for the total sample, 0.229 for males and 0.527 for women, and according to the valuation scale proposed by Landis and Koch, it would correspond to a moderate degree of agreement for the population in general, medium for men and moderate for women. CONCLUSIONS: Overweight and obesity affect a high percentage of the Spanish population (almost 50%). Women show greater concern about being overweight, are more likely to participate in prevention campaigns, and present a corporal perception more in line with their true weight. Preventive campaigns should be implemented to reach the male population better, taking into account that this population presents a greater cardiovascular risk. It is important to place the problem of obesity in the right terms, without any "obesophobia" leading to disorders of the eating behaviour, while indicating the importance of the risk attributable to obesity and excess weight.

[Balance nutrition in the diabetic patient]. / Nutrición equilibrada en el paciente diabético.

Nutrition is an integral part of the monitoring and care of diabetes. Compliance with a nutritional plan is, however, one of the most difficult goals to achieve due to the changes in lifestyle that it implies. In order to integrate nutrition effectively into the follow-up and control of diabetic patients, it is necessary to have a multidisciplinary team of professionals basically comprising a doctor specializing in Endocrinology and Nutrition, a dietician and a trainer in diabetes issues. These team members have to apply an individualized approach for each patient and provide nutritional education to enable patients to be self-sufficient. Test results (blood-glucose levels, HbA1c, lipids, blood pressure and quality of life) must be regularly assessed and, if the desired goals are not achieved, the necessary changes must be indicated for future monitoring and overall management of the condition.

Concordancia entre la autopercepción corporal y el IMC calculado en una población voluntaria captada el IV Día Nacional de la Persona Obesa / Concordance between corporal selfperception and BMI calculated in a population of volunteers recruited on the iv national day for obese people

Objetivos: Valorar la concordancia entre la autopercepción corporal y el IMC calculado en una población voluntaria. Como objetivos secundarios: conocer el porcentaje de sobrepeso, normopeso y obesidad en dicha población.Sujetos: El estudio abarca 160 sujetos voluntarios captados en los hospitales de Gómez Ulla y Severo Ochoa de Madrid durante la 4ª edición de la "Jornada de la persona obesa".Intervenciones: Se realizaron 160 encuestas que constaban de un primer grupo de 10 preguntas acerca de: la forma de entender la obesidad, cómo se clasifican ellos según su autopercepción (obesos, sobrepesos o normopesos), la incidencia de obesidad familiar, los hábitos de vida y el número de intentos previos de pérdida de peso. En el caso de una respuesta positiva a esta última pregunta la encuesta se amplía a 19 preguntas, teniendo en cuenta los motivos, fuentes de prescripción, métodos empleados y resultados obtenidos en la pérdida de peso. Resultados: El índice de masa corporal medio de los encuestados fue de 26,2 ñ 4,97 kg/m2, siendo de 27,45 ñ 5,4 kg/m2 para los varones y 25,76 ñ 4,7 kg/m2 para las mujeres. Hubo un 32,5 por ciento de varones y un 27,3 por ciento de mujeres con sobrepesos, así como un 25,6 por ciento de varones y un 20,6 por ciento de mujeres con obesidad. Las diferencias no fueron significativas entre sexos para normopeso, sobrepeso y obesidad.La concordancia entre autopercepción e IMC mediante el índice kappa fue de: 0,464 para el total de la muestra, 0,229 para varones y 0,527 para mujeres que según la escala de valoración propuesta por Landis y Koch correspondería a un grado de acuerdo moderado para la población en general, mediano para varones y moderado para mujeres.Conclusiones: El sobrepeso y la obesidad afecta a un elevado porcentaje de nuestra población (casi el 50 por ciento). Las mujeres presentan mayor preocupación por la obesidad, son más participativas en las campañas de prevención y representan una percepción corporal más concordante con su peso. Deben realizarse campañas de prevención que logren llegar mejor a la población de sexo masculino, presentando además esta población un riesgo cardiovascular mayor. Es importante situar el problema de la obesidad en su justa medida, sin "obesofobia" que induzca a trastornos de la conducta alimentaria, pero valorando el riesgo atribuible al sobrepeso y obesidad (AU)

Objectives: To assess the concordance between corporal self-perception and BMI calculated in a population of volunteers. Secondary objectives: to know the percentage of overweight, normoweight and obese individuals in this population. Subjects: The study includes 160 volunteers recruited at the Gómez Ulla and Severo Ochoa Hospitals in Madrid during the 4th edition of the “Obesity Day”. Actions: A total of 160 interviews were carried out, comprising a first group of 10 questions about how obesity is understood, how they classify themselves by self perception (obese, overweight or normoweight individuals), the incidence of obesity in the family, living habits and the number of previous failed attempts to lose weight. In the case of a positive response to the last question, the survey is extended to 19 questions, analyzing the reasons, prescriptors, methods used, and weight loss results obtained. Results: The mean Body Mass Index (BMI) of the interviewees was 26,2 ± 4,97 kg/m2, with 27,45 ± 5,4 kg/m2 for males and 25,76 ± 4,7 kg/m2 for women. Overweight men represented 32,5%, with 27,3% overweight women, while obese men accounted for 25,6% and obese women amounted to 20,6%. The differences were not significant between sexes, normoweight, overweight and obesity groups. The concordance between self-perception and BMI using the kappa index was 0,464 for the total sample, 0,229 for males and 0,527 for women, and according to the valuation scale proposed by Landis and Koch, it would correspond to a moderate degree of agreement for the population in general, medium for men and moderate for women. Conclusions: Overweight and obesity affect a high percentage of the Spanish population (almost 50%). Women show greater concern about being overweight, are more likely to participate in prevention campaigns, and present a corporal perception more in line with their true weight. Preventive campaigns should be implemented to reach the male population better, taking into account that this population presents a greater cardiovascular risk. It is important to place the problem of obesity in the right terms, without any “obesophobia” leading to disorders of the eating behaviour, while indicating the importance of the risk attributable to obesity and excess weight (AU)

Nutrición equilibrada en el paciente diabético / Balanced nutrition in diabetic patients

La nutrición es parte integral de la asistencia y del control de la diabetes. Sin embargo, el cumplimiento del plan nutricional es uno de los aspectos más difíciles de conseguir debido a los cambios de estilo de vida que implica. Para integrar de manera eficaz la nutrición en el seguimiento y control de los pacientes diabéticos se precisa de un equipo de profesionales multidisciplinar compuesto fundamentalmente por: médico especialista en Endocrinología y Nutrición, dietista y educador de diabetes. Éstos deberán hacer un enfoque individualizado y proporcionar una enseñanza nutricional al paciente para su autoasistencia. Los resultados (glucemia, HbA1c, lípidos, presión arterial y calidad de vida) deben ser evaluados de forma periódica y si no se alcanzan las metas deseadas se deben indicar cambios en el control y la asistencia global de la enfermedad (AU)

Nutrition is an integral part of the monitoring and care of diabetes. Compliance with a nutritional plan is, however, one of the most difficult goals to achieve due to the changes in lifestyle that it implies. In order to integrate nutrition effectively into the follow-up and control of diabetic patients, it is necessary to have a multidisciplinary team of professionals basically comprising a doctor specializing in Endocrnilogy and Nutrition, a dietician and a trainer in diabetes is-sues. These team members have to apply an individualized approach for each patient and provide nutritional education to enable patients to be self-sufficient. Test results (blood-glucose levels, HbA1c, lipids, blood pressure and quality of life) must be regularly assessed and, if the desired goals are not achieved, the necessary changes must be indicated for future monitoring and overall management of the condition (AU)