[Comparing group educational intervention to individual and self-learning in COPD]. / Comparación de intervención educacional grupal frente a una individual y el autoaprendizaje en EPOC.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is considered a public health issue which affects 10.2% of Spanish population between 40 and 80 years of age. Many patients do not perform well the inhalation technique. Error rates vary between 50-80% depending on the device under study. These values haven been proven to decrease with educational interventions. OBJECTIVE: To ascertain whether a group educational intervention is superior to an individual intervention or to a conventional approach in these patients as regards quality of life measured by means of the total score of the COPD Assessment Test (CAT),of adherence to treatment, exacerbations and hospitalizations. MATERIAL AND METHODS: A multicenter, multidisciplinary cluster-randomized controlled clinical trial with three branches (conventional intervention, individual intervention and group intervention) in a cohort of COPD-patients. Sociodemographic data and risk factors were collected and several questionnaires were completed (CAT, BODEx, Barthel, Lawton y Brody). A descriptive analysis of qualitative and quantitative variables and a multiple linear regression were conducted. OUTCOMES: 149 patients of average age 69.08 (SD 1.26). Significant differences were observed in CAT in the different intervention groups according to the level of severity on BODEx. The rate of patients performing well the inhalation technique was significantly lower at the beginning of the study and the number of exacerbations was lower after the intervention. Last year's exacerbations were linearly related to post-intervention suffering. CONCLUSIONS: Better results are obtained using the traditional and individual interventions. There is a decrease in number of exacerbations, hospitalizations, CAT score and post-intervention inhalation technique.

Cirugía torácica videoasistida uniportal en dos centros universitarios: experiencia inicial / Initial experience in uniportal video-assisted thoracoscopic surgery at two university campuses

Resumen Introducción: Uno de los mayores avances de las últimas décadas en la cirugía de tórax ha sido el desarrollo de la cirugía mínimamente invasiva. Objetivos: Describir la experiencia en videotoracoscopía (VATS) Uniportal de miembros del equipo de Cirugía de Tórax de la Universidad de Chile en 2 campos clínicos, (Clínica Las Condes y Hospital Clínico de la Universidad de Chile). Materiales y Método: Se estudiaron 105 pacientes sometidos a VATS uniportal entre enero de 2016 y enero de 2019. Los datos se analizaron de manera retrospectiva considerando variables demográficas (edad, sexo) y clínicas (diagnóstico, cirugía, estadía hospitalaria, días de pleurostomía, conversión y complicaciones). Resultados: De las 105 cirugías realizadas, 28 (26,6%) correspondieron a cirugías mayores complejas lobectomías y segmentectomías anatómicas. En 4 pacientes se agregó un 2° puerto, uno se convirtió a minitoracotomía y uno a toracotomía (5,7% conversión global). La estadía hospitalaria fue en promedio 3,07 ± 3,1 días y el promedio de mantención de pleurostomía de 2,67 ± 1,61 días. Siete pacientes (6,6%) presentaron complicaciones postoperatorias. Un paciente falleció por progresión de su enfermedad, no hubo mortalidad relacionada a la cirugía. Discusión: Las contraindicaciones de la VATS uniportal son las mismas que en la VATS multipuerto. En manos experimentadas, las complicaciones en cirugía por puerto único son bajas. Impresiona tener menos dolor postoperatorio, menor estadía hospitalaria y reintegración precoz a las actividades diarias comparado con la VATS tradicional. Conclusiones: Se presenta la primera serie de VATS uniportal publicada en Chile. Los resultados obtenidos son comparables a los observados en la literatura. Su implementación y desarrollo requiere de una curva de aprendizaje similar a cualquier nueva técnica quirúrgica.

Objective: To describe the initial results with uniportal Video-Thoracoscopic Surgery (VATS) performed in two campuses by members of the Section of Thoracic Surgery of the University of Chile ("Clínica Las Condes" and University of Chile Clinical Hospital). Materials and Method: Between January 2016 and January 2019, a total of 105 patients underwent uniportal VATS. Clinical data was collected retrospectively from digital records including demographic (age, sex) and clinical variables (diagnosis, surgery, duration of the chest tube, length of stay, conversion rate and postoperative complications). Results: Uniportal VATS was performed on 105 patients during the study period. Twenty-eight cases (26.6%) corresponded to lobectomy or anatomic segmentectomy. In 4 cases a 2nd port was required, 1 patient had to be converted to mini-thoracotomy and 1 to thoracotomy (5.8% global conversion). Overall, the median length of stay was 3.07 ± 3.1 days and the median duration of chest tube drainage was 2.67 ± 1.61 days. Seven patients (6.6%) presented complications. One patient died due to progression of his disease, there were no deaths related to the procedures. Discussion: Uniportal VATS has similar indications than multiportal VATS. On experienced hands, uniportal VATS has a low morbidity rate. Uniportal VATS appears to produce less post-operative pain, with shorter hospital stay and a faster return to normal life compared to standard VATS. Conclusion: We present the first uniportal VATS series in Chile. Results were similar to published series. Implementation and development of uniportal VATS requires a learning curve similar to any new surgical procedure.

Plasmocitoma solitario de costilla como presentación inicial de mieloma múltiple: reporte de un caso / Lone rib plasmacytoma as a presentation of initial multiple myeloma: a case report

Resumen Introducción: El 50% de los tumores de pared torácica son malignos, dentro de los que destaca el plasmocitoma de costilla. Objetivo: Presentar un caso clínico que debutó inicialmente como un plasmocitoma de costilla, y que terminó presentándose como mieloma múltiple. Materiales y Método: Registro clínico de un paciente sometido a resección de tumor de parrilla costal. Resultados: Paciente masculino de 58 años, con un año de dolor costal, asociado a aumento de volumen a nivel de la octava costilla derecha en línea media axilar, indurada. TC de tórax que demuestra imagen sugerente de plasmocitoma de 79 × 44 mm. Se realiza resección quirúrgica, con instalación de malla de prolene en el defecto. Biopsia diferida con compromiso neoplásico por lesión monoclonal de células plasmáticas. Se complementa estudio con biopsia de médula ósea confirmando mieloma múltiple. Se inicia tratamiento con quimioterapia adyuvante. Conclusiones: El plasmocitoma óseo solitario es una entidad de baja frecuencia, que se asocia a la presencia de mieloma múltiple. Es por esto que al momento de la sospecha se hace necesario descartar su presencia, con el fin de mejorar el pronóstico del paciente.

Introduction: Up to 50% of chest wall tumors are malignant; among which rib plasmocytoma stand out. Aim: Showcase a clinical case that debuted as a rib plasmacytoma, and that ended up presenting as Multiple Myeloma. Materials and Method: Records of a patient with resection of chest wall tumor. Results: Male patient of 58 years, with one year of costal pain, associated with an indurated increase in volume at the level of the eighth right rib in the mid-axillary line. Chest CT scan demonstrated a suggestive image of plasmacytoma of 79 × 44 mm. Surgical resection was performed, with prolene mesh installation in the defect. Biopsy showed neoplastic compromise due to monoclonal lesion of plasma cells. Study is complemented with bone marrow biopsy confirming multiple myeloma. The patient was treated with adjuvant chemotherapy. Conclusions: Solitary bone plasmacytoma is a low frequency entity, which is associated with the presence of multiple myeloma. At the moment of suspicion, it is necessary to rule out their presence, in order to improve the patient's prognosis.

Resilience and recovery-stress in competitive athletes / Resiliencia y recuperación-estrés en deportistas de competición / Resiliência e recuperação-estresse em atletas de competição

Resilience is an important construct in sport because athletes must constantly withstand a wide range of stressors to attain optimal performance. The aim of this study was to analyse how the resilient profile influences the recovery-stress levels of competitive athletes. Participants were 235 subjects (126 males and 109 females, M age = 20.7 years, SD = 4.3) who practiced different sports. They were evaluated on two occasions coinciding with the beginning of the last competitive mesocycle and after the most important competition of the season. Recovery-stress and resilience levels were studied by using the Spanish adaptations of the Recovery-Stress Questionnaire for Athletes (RESTQ-Sport) and the Resilience Scale. Resilience related positively to recovery factors and negatively to stress factors of the RESTQ-Sport. No significant difference was observed in resilience scores between evaluations performed during the last mesocycle or competition, but values for the different RESTQ-Sport stress factors increased during the second evaluation. Athletes with high resilience attained higher scores in recovery factors and lower scores in stress factors. Our results suggest that a higher level of resilience influences positively recovery-stress processes (AU)

La resiliencia es un constructo importante en el deporte ya que los atletas deben enfrentarse de manera continua a un amplio rango de factores estresantes para alcanzar un rendimiento óptimo. El propósito de este estudio fue analizar cómo influye el perfil resiliente en los niveles de recuperación-estrés del deportista de competición. La muestra estuvo formada por 235 deportistas (126 hombres y 109 mujeres) con edades entre los 15 y los 35 años (M edad = 20.7, SD = 4.3) de diferentes modalidades deportivas que fueron evaluados en dos ocasiones, al principio del último mesociclo competitivo e inmediatamente después de la competición más importante de la temporada. Se registraron los niveles de recuperación estrés y de resiliencia por medio de las versiones españolas del Cuestionario de Recuperación-Estrés (RESTQ-Sport) y de la Escala de Resiliencia. No se pusieron de manifiesto diferencias en la resiliencia entre las evaluaciones realizadas antes del último mesociclo o al final de la competición, pero las puntuaciones en los factores de estrés del RESTQ-Sport se incrementaron significativamente en la segunda evaluación. Los valores de resiliencia correlacionaron positivamente con los alcanzados en los factores de recuperación y negativamente con los correspondientes a los factores de estrés del RESTQ-Sport. Los sujetos con una resiliencia elevada eran quienes mostraban puntuaciones más altas en los factores de recuperación y más reducidas en los factores de estrés. A la vista de nuestros resultados, unos mayores niveles de resiliencia parecen influir de manera positiva sobre los procesos de recuperación-estrés (AU)

Resiliência é um constructo que é importante no esporte porque atletas devem enfrentar em uma base contínua para uma grande variedade de estressores para atingir o desempenho ideal. O objetivo deste estudo foi analisar como o perfil resiliente influencia os níveis de estresse-recuperação dos atletas competitivos. Os participantes foram 235 individuos (126 homens e 109 mulheres), com idades entre 15 e 35 anos (idade M = 20,7 anos, SD = 4.3) que praticavam esportes diferentes. Eles foram avaliados em duas ocasiões, coincidindo com o início do último mesocycle competitiva e após a competição mais importante da temporada. Níveis de recuperação-estresse e resiliência foram estudos pelas versões espanholas do Questionário de Recuperação-Estress para Atletas (RESTQ-Sport) e o Escala de Resiliência. Nenhuma diferença significativa foi observada no golo de resiliência entre avaliações realizadas durante a última mesocycle ou concorrência, mas os valores para os diferentes factores de estresse do RESTQ-Sport aumentaram durante a segunda avaliação. Resiliência foi associada positivamente a fatores de recuperação e negativamente ao factores de estresse do RESTQ-Sport. Atletas com alta resiliência atingiram escores mais altos nos fatores de recuperação e menor pontuação nos fatores de estresse. Nossos resultados parecem mostrar que níveis mais altos de resiliência parecen influenziar positivamente os processos de recuperação-estresse (AU)

Actividad física y salud percibida en pacientes con enfermedad coronaria / Physical activity and perceived health in patients with coronary artery disease / Actividade física e saúde percebida em pacientes com doença coronaria

La enfermedad coronaria es una de las principales causas de morbilidad y mortalidad en el mundo y se asocia con importantes consecuencias emocionales y sociales. La actividad física parece ralentizar el inicio y la progresión de las enfermedades cardiovasculares pero también presenta beneficios sobre la salud psicosocial. El presente estudio tiene como objetivo el análisis de la relación entre la práctica de actividad física y la calidad de vida, el bienestar psicológico y la depresión en pacientes con enfermedad coronaria. La muestra estaba compuesta por 275 personas, con edades entre 54 a 98 años. Se aplicó un Cuestionario Sociodemográfico, el Cuestionario de Salud SF-36, la Escala de Depresión Geriátrica (GDS), la Escala de Bienestar Psicológico (EBP) y el Cuestionario de Actividad Física de Yale (YPAS). Los resultados obtenidos pusieron de manifiesto que la práctica de actividad física se asociaba en pacientes con enfermedad coronaria a una mejora en las distintas escalas del Cuestionario de Salud SF-36 y en la Escala de Depresión Geriátrica, confirmando su importancia para el mantenimiento de la calidad de vida relacionada con la salud en estos pacientes (AU)

Coronary artery disease is one of the main causes of morbidity and mortality in the world and associates with important emotional and social consequences. Physical activity seems to slow down the start and the progression of the cardiovascular illnesses but also presents benfits on psychosocial health. The present study is amied to analyze the relationship between the practice of physical activity and quality of life, psychological wellbeing and depression in patients with coronary illness. The sample was composed by 275 subjects, aged between 54 to 98 years. They were applied a Sociodemograpahic Questionnaire, the Questionnaire of Health SF-36,the Scale of Geriatric Depression (GDS), the Scale of Psychological Welbeing (EBP) and the Yale Physical Activity Scale (YPAS). Results obtained indicated that the practice of physical activity associated in patients with coronary illness to an improvement in the distinct scales of the Questionnaire of Health SF-36 and in the Scale of Geriatric Depression, confirming his importance for the maintenance of health-related quality of life in these patients (AU)

A doença coronaria é uma das principais causas de morbilidad e mortalidade no mundo e associa-se com importantes consequências emocionais e sociais. A actividade física parece reduzir o início e a progressão das doenças cardiovasculares mas também apresenta benefícios sobre a saúde psicosocial. O presente estudo tem como objectivo a análise da relação entre a prática de actividade física e a qualidade de vida, o bem-estar psicológico e a depressão numa mostra de pacientes com doença coronaria. A mostra estava composta por 275 pessoas, com idades entre 54 a 98 anos. Aplicou-se um Cuestionario Sociodemográfico, o Cuestionario de Saúde SF-36, a Escala de Depressão Geriátrica (GDS), a Escala de Bem-estar Psicológico (EBP) e o Cuestionario de Actividade Física de Yale (YPAS). Os resultados obtidos puseram de manifesto que a prática de actividade física se associava em pacientes com doença coronaria a uma melhora nas difrentes escalas do Cuestionario de Saúde SF-36 e na Escala de Depressão Geriátrica, confirmando sua importância para a manutenção da qualidade de vida relacionada com a saúde nestes pacientes (AU)

Substance abuse and health self-perception in Spanish children and adolescents.

OBJECTIVE: The aim of this study was to analyze substance abuse and health self-perception in children and adolescents from the province of Cádiz (Spain). METHODOLOGY: Participants were 738 students, 50.9 boys and 49.1% girls, from elementary school to high school (1st to 12th grade, mean age 12.2. years), who responded a Spanish adaptation of the Health Behavior in School-aged Children Inventory. RESULTS: No difference was observed in percentage of boys and girls reporting to smoke or drink alcohol. Smoking and drinking habits increased with age, being higher in 11th and 12th grade students. Significant differences were observed among the percentage of smokers and non smokers recognizing to have parents, older brothers or friends who smoke. Rates of drug abuse were generally low, being cannabis the most frequently consumed illicit drug. Most respondents had a perception of excellent or good health, with no significant gender differences. About half of subjects considered that health exclusively depends on self behavior, but an important percentage also gave a relevant role to luck. Stomach-ache was the most frequent physical complaint, followed by headache. Psychological complaints mainly corresponded to nervousness and bad temper. Only a small percentage of subjects declared the use of medicines or tablets without prescription. No significant difference in the percentage of respondent who perceived an excellent or good health was observed among substance users and non users. CONCLUSIONS: Substance abuse and health self-perception in children and adolescents are the result of the interaction of a complex series of individual and social factors. Activities aimed to improve health focusing on partial aspects of adolescents' lifestyle most probably will have limited results, and global programs are required.

Substance abuse and health self-perception in Spanish children and adolescents / Abuso de sustancias y percepción de la salud en niños y adolescentes españoles

Objective: The aim of this study was to analyze substance abuse and health self-perception in children and adolescents from the province of Cádiz (Spain). Methodology: Participants were 738 students, 50.9 boys and 49.1% girls, from elementary school to high school (1st to 12th grade, mean age 12.2. years), who responded a Spanish adaptation of the Health Behavior in School-aged Children Inventory. Results: No difference was observed in percentage of boys and girls reporting to smoke or drink alcohol. Smoking and drinking habits increased with age, being higher in 11th and 12th grade students. Significant differences were observed among the percentage of smokers and non smokers recognizing to have parents, older brothers or friends who smoke. Rates of drug abuse were generally low, being cannabis the most frequently consumed illicit drug. Most respondents had a perception of excellent or good health, with no significant gender differences. About half of subjects considered that health exclusively depends on self behavior, but an important percentage also gave a relevant role to luck. Stomach-ache was the most frequent physical complaint, followed by headache. Psychological complaints mainly corresponded to nervousness and bad temper. Only a small percentage of subjects declared the use of medicines or tablets without prescription. No significant difference in the percentage of respondent who perceived an excellent or good health was observed among substance users and non users. Conclusions: Substance abuse and health self-perception in children and adolescents are the result of the interaction of a complex series of individual and social factors. Activities aimed to improve health focusing on partial aspects of adolescents' lifestyle most probably will have limited results, and global programs are required (AU)

Objetivo: El objetivo del estudio ha sido analizar el uso de sustancias tóxicas y la autopercepción del estado de salud en niños y adolescentes de la provincia de Cádiz. Metodología: Participaron 738 alumnos, 50.9% de chicos y 49.1% de chicas, que cursaban educación primaria y secundaria (desde 1o educación primaria a 2o de bachillerato, edad media 12,2 años), a los que se aplicó la versión española del Inventario de Conductas de Salud en Escolares. Resultados: No se observaron diferencias en el porcentaje de chicos y chicas que fumaban o bebían alcohol. Los hábitos de consumo de tabaco y alcohol se incrementaban con la edad, alcanzando sus máximos valores en los alumnos de bachillerato. Se encontraron diferencias significativas en el porcentaje de fumadores y no fumadores que reconocían el tener padres, hermanos mayores o amigos que fumaban. El consumo de drogas ilegales era generalmente reducido, predominando la utilización del cannabis. La mayoría de los sujetos tenían una percepción de su salud como excelente o buena. En torno a la mitad de los encuestados consideraban que la salud depende exclusivamente del propio comportamiento, aunque una parte importante también le otorgaba un papel relevante a la suerte. El dolor de estómago era el síntoma físico más frecuente, seguido del dolor de cabeza. Entre los síntomas psicológicos predominaban el nerviosismo y el estar irritado o enfadado. Solo un pequeño porcentaje declaraba consumir medicamentos o píldoras no prescritos. No se observaron diferencias significativas en el porcentaje de los que reconocían una salud excelente o buena entre los usuarios y no usuarios de sustancias tóxicas. Conclusiones: El abuso de sustancias tóxicas y la auto-percepción del estado de salud en niños y adolescentes es el resultado de la interacción de una compleja serie de factores individuales y sociales. Las actividades diseñadas para la mejora de la salud centradas en aspectos parciales del estilo de vida tendrán probablemente resultados limitados, requiriéndose el desarrollo de programas globales (AU)

Resección de metástasis pulmonares / Resection of lung metastases

Surgical treatment of lung metastases (LM) is a therapy used for several types of metastatic cancers. However, the type of surgery and its outcome is controversial. Aim: To describe a series of patients with LM undergoing surgical treatment, their results and long-term follow up. Material and Methods: We retrospectively reviewed all the medical records of patients with the diagnosis of LM, of whatever origin, operated at our hospital between the years 2002 and 2008. We analyzed their clinical characteristics, treatment, morbidity, mortality and results. Results: During this period 24 patients with LM were operated. The mean age was 52.8 +/- 16.6 years. Most patients had kidney cancer as primary tumour. The usual clinical presentation was multiple bilateral nodules. The surgical approach was in general a video-thoracoscopy (40.9 percent) associated with a wedge resection of the lesions (81.8 percent). In 83.4 percent of cases, there were no post-operative complications. Seventy six percent of the patients relapse, in an average of 16.7 +/- 12 months and 68.7 percent were reoperated for a new resection. The probability of surviving more than 3 and 5 years post metastasectomy was 57 percent and 36 percent respectively. Conclusions: In this series the LM were mostly secondary to renal cancer. The video-thoracoscopy is an emergent and safe technique in the treatment of LM, being the main type of surgical approach in our patients. Despite the high percentage of reoperations, the survival rate is comparable to the rest of the published series.

El tratamiento quirúrgico de las metástasis pulmonares (MP) constituye una terapia usada para varios tipos de cánceres metastásicos. Sin embargo, el tipo de cirugía y sus resultados es controversial, por lo que hemos decidido estudiarla. Objetivo: Describir clínicamente una serie de pacientes con MP sometidos a tratamiento quirúrgico, sus resultados y seguimiento a largo plazo. Material y Método: Se revisaron retrospectivamente las fichas de pacientes con el diagnóstico de MP, de cualquier origen, operados en nuestro hospital entre los años 2002 y 2008. Se analizaron las características clínicas, tratamiento, morbimortalidad y resultados. Resultados: Durante este período se operaron 24 pacientes por MP. El promedio de edad fue 52,8 +/- 16,6 años. La mayoría de los pacientes tenía un cáncer renal como tumor primario. La forma habitual de presentación fueron múltiples nodulos bilaterales. El abordaje quirúrgico más frecuente fue por videotoracoscopía (40,9 por ciento) asociado a una resección en cuña de las lesiones (81,8 por ciento). En el 83,4 por ciento no hubo complicaciones post operatorias. El 76,4 por ciento de los pacientes recidivó, en promedio a los 16,7 +/-12 meses y el 68,7 por ciento fue reintervenido para una nueva resección. La probabilidad de sobrevivir más de 3 y 5 años post me-tastasectomía fue de 57 por ciento y 36 por ciento respectivamente. Conclusiones: En esta serie las MP fueron principalmente secundarias a cáncer renal. La videotoracoscopía es una cirugía emergente y segura en el tratamiento de las MP, siendo la principal forma de abordaje quirúrgico en nuestros pacientes. A pesar del elevado porcentaje de reintervenciones, la sobrevida es comparable al resto de las series publicadas.

Cuerpo extraño pulmonar: resección por videotoracoscopia: caso clínico / Inhaled foreign body: a video-thoracoscopic resection: a case report

We report an 18 years old male who reported a history of 2 years of recurrent episodes of hemoptysis with no other symptoms. A chest X-ray and chest CT sean showed an image suggestive of a metallic foreign body in the posterior segments of the right lower lobe. Since fibro-bronchoscopy failed to extract it, a video-thoracoscopy with wedge resection of the affected lung parenchyma was performed, finding a capsular lesion of inflammatory tissue, which contained a map pin in its interior. The clinical outcome was favorable, with a chest X-ray showing proper lung re-expansion. The patient was discharged 48 hours after surgery.

Se reporta el caso de un paciente hombre de 18 años con un cuerpo extraño pulmonar de presentación tardía, que consultó por un cuadro de 2 años de evolución de episodios de hemoptisis escasa y recurrente, sin otros síntomas asociados. Se realizó estudio con radiografía y TAC de tórax evidenciándose una imagen sugerente de un cuerpo extraño metálico en los segmentos posteriores del lóbulo inferior derecho. Dado que la fibrobroncoscopia resultó frustra se decidió realizar una videotoracoscopia con resección en cuña del parénquima pulmonar afectado, encontrándose una lesión capsular de tejido inflamatorio que en su interior contenía un chinche. La evolución clínica fue favorable, con radiografía de tórax de control con adecuada reexpansión pulmonar y dándose de alta a las 48 hrs postoperatorias.

Empiema pleural: etiología, tratamiento y complicaciones / Therapy of empyema: retrospective review of 77 patients

Background: Empyema can cause significant medical problems, despite the advances in antimicrobial and surgical treatments. Aim: To compare the results of different therapeutic approaches to empyema. Material and Methods: Retrospective review of medical records of 77 patients with empyema (aged 53 +/- 20 years, 48 males) treated in a clinical hospital between 1994 and 2007. Results: In 74 percent of patients the cause of empyema was pneumonia. Thirty two were initially managed with percutaneous pleurostomy. Seven of these required and additional intervention due to residual empyema. Eleven patients were managed with open thoracotomy and 34 with video assisted thoracoscopy. Complications for percutaneous pleurostomy, open thoracotomy and video assisted thoracoscopy were 34, 36 and 12 percent respectively. The figures for mortality were 25, 0 and 0 percent respectively. Patients subjected to video assisted thoracoscopy required less days with a pleural tube than those subjected to percutaneous pleurostomy or open thoracotomy (5,5-14,3 and 12,4 days respectively). Conclusions: Video assisted thoracoscopy had the best therapeutic results for empyema in this series of patients.

Introducción: Definido como la presencia de infección bacteriana en el espacio pleural, determina una importante morbimortalidad a pesar de los avances en el tratamiento antibiótico y las nuevas técnicas quirúrgicas. Objetivos: Comparar resultados de las distintas estrategias terapéuticas para el Empiema Pleural (EP). Material y Métodos: Revisión retrospectiva de fichas clínicas de pacientes con diagnóstico de EP manejados en el Hospital Clínico Universidad de Chile entre enero de 1994 y junio de 2007. Se consideró significación estadística con p < 0,05. Resultados: De 77 pacientes, 48 fueron hombres y 29 mujeres, con edad promedio de 52,6 +/- 19,9 años. La causa más frecuente de EP fue la neumonía (74 por ciento). En 55 pacientes se realizaron exámenes imagenológicos complementarios a la radiografía de tórax. Treinta y dos pacientes se manejaron inicialmente con pleurostomía percutánea (PP). Siete de ellos requirieron una nueva intervención por empiema residual. Once se manejaron con toracotomía abierta (TA) y 34 con Toracoscopia Vídeo asistida (TVA). La tasa de complicaciones y mortalidad fue: 34,37 por ciento y 25 por ciento para PP, 11,7 por ciento y 0 por ciento para TVA y 36,36 por ciento y 0 por ciento para TA, respectivamente (diferencias significativas). El tiempo de hospitalización promedio fue de 22,8 días, y el de tubo pleural de 9,21 días. Se encontró diferencias significativas entre los días con tubo pleural de los pacientes sometidos a TVA (X = 5,56) respecto de los sometidos a PP (X = 14,24) y TA (X = 12,4). No se observan diferencias en tiempo de hospitalización. Conclusiones: La TVA demuestra obtener mejores resultados que la PP y la TA al evaluar mortalidad, complicaciones y días de tubo pleural.

Monitoring the effects of training load changes on stress and recovery in swimmers.

This study was designed to investigate if monitoring of stress and recovery may be useful to detect overreaching in its early stages and may be used to evaluate effects of changes in training load. Nine swimmers were applied the Recovery-Stress Questionnaire for Athletes (RESTQ-Sport) in four different occasions (M1, M2, M3, M4) along a 6-week training period prior to a competition. During the basal training period (M1), recovery scales scored higher than stress scales, being the scales General well-being, Social recovery and Being in shape those reaching higher scores. Following the measure corresponding to the second training period (M2), in which training volume reached a maximum, there were significant increases in two stress scales (Injury and Emotional exhaustion), and decreases in three recovery scales (Success, Physical recovery, and Self-efficacy). Values increased again and did not significantly differ from those corresponding to the first measure during measures M3 and M4, in which there was a decrease in training volume and training time. Only a recovery scale score (Success) increased significantly from period M2 to period M4. When the recovery-stress (total recovery - total stress) state was calculated, it was found that there was a significant decreases in M2, and values progressively increased in measures M3 and M4, with no significant difference from M1. Results obtained indicate that the RESTQ-Sport is able to show significant changes concurrently with training loads. Regular monitoring of stress and recovery by these measures may help to detect overreaching in its early stages.

Monitoring the effects of training load changes on stress and recovery in swimmers

This study was designed to investigate if monitoring of stress and recovery maybe useful to detect overreaching in its early stages and may be used to evaluate effectsof changes in training load. Nine swimmers were applied the Recovery-Stress Questionnairefor Athletes (RESTQ-Sport) in four different occasions (M1, M2, M3, M4)along a 6-week training period prior to a competition. During the basal training period(M1), recovery scales scored higher than stress scales, being the scales Generalwell-being, Social recovery and Being in shape those reaching higher scores. Followingthe measure corresponding to the second training period (M2), in which trainingvolume reached a maximum, there were significant increases in two stress scales(Injury and Emotional exhaustion), and decreases in three recovery scales (Success,Physical recovery, and Self-efficacy). Values increased again and did not significantlydiffer from those corresponding to the first measure during measures M3 and M4, inwhich there was a decrease in training volume and training time. Only a recoveryscale score (Success) increased significantly from period M2 to period M4. When therecovery-stress (total recovery – total stress) state was calculated, it was found thatthere was a significant decreases in M2, and values progressively increased in measuresM3 and M4, with no significant difference from M1. Results obtained indicatethat the RESTQ-Sport is able to show significant changes concurrently with trainingloads. Regular monitoring of stress and recovery by these measures may help todetect overreaching in its early stages (AU)

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Rehospitalización de los traumatismos craneoencefálicos tras el alta de una Unidad de Neurorrehabilitación / Traumatic brain injuries rehospitalization after medical dischargefrom the neurorehabilitation unit

Objetivo. Conocer en nuestro medio la incidencia y causas de rehospitalización del traumatismo craneoencefálico (TCE) tras ser dado de alta hospitalaria de una Unidad de Neurorrehabilitación (UNR), identificando factores relacionados con los reingresos y la necesidad de acudir a los servicios de Urgencias tras dicha alta. Pacientes y método. Estudio de cohortes con 209 pacientes dados de alta hospitalaria de una UNR (enero 2000-diciembre 2002) con diagnóstico de TCE, realizando un seguimiento de 2 años. A través de historias clínicas se han obtenido datos demográficos del paciente, gravedad del TCE, lesiones asociadas, imágenes patológicas en tomografía axial computarizada, complicaciones hospitalarias, escalas de valoración, reingresos, necesidad de acudir a Urgencias y seguimiento especializado. Resultados. La incidencia de rehospitalización el primer año fue de un 15,8 %, la mitad programadas, fundamentalmente por malfunción valvular, craneoplastia y retirada de material quirúrgico. En el segundo año los reingresos, en su mayoría programados, descendieron al 5,2 %, preferentemente para la liberación quirúrgica de rigideces articulares. Aunque distintas variables mostraron correlación con los reingresos del TCE, sólo se obtuvo significación estadística con el hematoma subdural. Uno de cada 3 pacientes acudió a Urgencias, al menos una vez, durante los dos años siguientes al alta hospitalaria. Conclusiones. Los motivos principales por los que reingresa un paciente con TCE tras el alta hospitalaria de una UNR son neurológicos, ortopédicos y de cirugía reconstructiva, en la misma línea que las complicaciones por las que se tratan en Urgencias. Se observa un notable descenso de rehospitalización entre el primer y segundo año del alta hospitalaria

Objectives. Study the incidence and the reasons of rehospitalization for traumatic brain injury (TBI) after the subject was discharged from the Neurorehabilitation Unit (NRU), identifying those factors related to the rehospitalization and the need of these patients to attend to the emergency department after this discharge. Patients and method. Study of cohort of 209 patients with TBI diagnostic, discharged from the NRU (January 2000-December 2002) with a two year follow-up. We obtained demographic features, severity of the TBI, related injuries, pathological images in a CT, hospital complications, evaluation scales, hospitalization readmissions, need to go to the emergency department and a specialized follow-up from the clinical records. Results. The incidence of rehospitalization in the first year was 15.8 %, half of which were planned, valvular malfunctions, cranioplasty and withdrawal of the surgical equipment were the main reasons. During the second year, readmissions decreased to 5.2 %, most of them planned for the surgical release of the joint stiffness. Although some variables showed correlation with the TBI rehospitalization, only the subdural hematoma was statistically significant. One out of three patients went to the emergency department at least once during the two years following hospital discharge. Conclusions. The main reasons of TBI rehospitalization after hospital discharge are neurological, orthopedic and reconstructive surgery, similar to the complications by which they are treated in the emergency department. There is an important descent of rehospitalization between first and second year after hospital discharge

Enhancement of photorespiration in immobilized Chlamydomonas reinhardtii cells.

Immobilization of Chlamydomonas reinhardtii in alginate increases its photorespiration rate. In the immobilized cells, the photorespiratory enzyme, phosphoglycolate phosphatase, was 75% higher than in freely suspended cells. Thus, the immobilized cells produced glycolate at twice the rate than in freely suspended cells when treated with aminooxyacetate (a transaminase inhibitor). With immobilized cells in a batch reactor, 270 micromol glycolate mg(-1) Chl was produced after 12 h.

Hemangioma esclerosante pulmonar como nódulo pulmonar solitario: comunicación de un caso / Sclerosing hemangioma presenting as a solitary lung nodule: report of one case

Lung sclerosing hemangioma is an uncommon tumor that presents as a solitary asymptomatic nodule and that affects middle age women. It derives from type II pneumocytes. We report a 52 years old female with a solitary lung nodule detected in a chest X ray requested for the diagnosis of an acute respiratory disease. The nodule was excised by video thoracoscopy and the frozen section biopsy was informed as a non small cell undifferentiated carcinoma. Therefore an inferior right lobectomy with lymph node resection was performed. The definitive biopsy was informed as a lung sclerosing hemangioma.

Relationship between perceived physical ability and sport participation motives in young competitive swimmers.

AIM: The purpose of this study was to examine the relationship between participation motives and perceived physical ability in young Spanish swimmers and to investigate whether swimmers with high or low perceived physical competence differ in their intrinsic and/or extrinsic reasons for participation involvement. METHODS: Four hundred and twenty-eight swimmers (204 boys and 224 girls), aged 8-22 years, responded to the Spanish versions of the Participation Motivation Inventory (PMI) and the Perceived Physical Ability Scale (PPA). Swimmers were divided into low (below the 33%), medium (between the 33-66%) and high (above the 66%) perceived ability groups. RESULTS: Multivariate analysis indicated the existence of differences in motives for participation between swimmers with different levels of perceived physical ability. Follow-up univariate analyses yielded significant (p<0.05) effects for 5 motivational factors: health/fitness, fun/friendship, competition/skills, affiliation and status. In all cases swimmers high in perceived physical ability rated significantly higher than those in the other categories. The PPA by gender, age or level of expertise interaction was not significant. CONCLUSIONS: Practitioners must consider the perceived ability of the competitors to better structure the social environment within which their swimmers operate.

Identification of dropout reasons in young competitive swimmers.

AIM: The purpose of this study was to examine reasons for discontinuing sport participation in Spanish competitive swimmers. METHODS: Sixty-two swimming dropouts (40 males and 22 females, ranging in age from 14 to 30 years) were administered the Questionnaire of Reasons for Attrition of Gould et al. RESULTS: The results of the survey indicated that having other things to do was the most important reason for attrition. Other items rated important were related to lack of fun, perception of failure or low skill, while low ratings were given to items related to achievement/status or affiliation. A significant multivariate effect was obtained for gender and for experience at dropout. Analysis of individual items by "t"-test demonstrated that females placed greater emphasis than males on excessive pressure, hard training, dislike of competition, not winning enough and not feeling important enough. Former swimmers with less experience at dropout rated interest in another sport as more important and being too old as less important than swimmers with more experience. CONCLUSION: The results of this study support the importance of negative factors related with aspects of the athletic environment that lead to discontinuing in competitive swimming.

Estudio de 1.595 casos de brucelosis en la provincia de Almería (1972-1998) según datos epidemiológicos de declaración de la enfermedad / Study of 1,595 brucellosis cases in the Almeria province (1972-1998) based on epidemiological data from disease reporting

Objetivo. Conocer aspectos clínicos, diagnósticos y de tratamiento de la brucelosis en la provincia de Almería. Métodos. Se ha realizado un estudio epidemiológico descriptivo, a partir de las 1.595 fichas de declaración individualizada de enfermedad en la provincia de Almería, en el período 1972-1998. Los apartados de complicaciones y tratamiento aparecen en 890 fichas (57,79 por ciento), los síntomas, signos y hemograma en 565 (35,42 por ciento) y otros datos diagnósticos en la totalidad de las fichas estudiadas. Se realiza la prueba estadística de Chi Cuadrado para comparación de variables cualitativas independientes para un nivel de confianza del 95 por ciento. Resultados. En la fase inicial el síntoma más frecuente fue la astenia (95,2 por ciento); en la fase de estado la sudación (95,8 por ciento). El signo más registrado es la esplenomegalia (37,5 por ciento) y la complicación más descrita la osteoarticular (22,8 por ciento). No se han encontrado modificaciones en la sintomatología a lo largo de los años. El hemograma revela que un 30,3 por ciento de casos presentaban anemia. El hemocultivo ha sido positivo en el 91,2 por ciento. Respecto al diagnóstico serológico, la Rosa de Bengala presenta un 99,2 por ciento de positividad; el hallazgo de las aglutinaciones a Brucella o B. melitensis más frecuente es 1/640 (13,47 por ciento). El tratamiento más utilizado ha sido asociación de tetraciclina y estreptomicina (42,5 por ciento). En un 42,6 por ciento consta que se derivaron los pacientes al hospital, sobre todo a partir del año 1984. Conclusiones. En general, los datos clínicos registrados en las fichas de declaración obligatoria de la brucelosis permiten conocer las características clínicas de esta enfermedad, tras la observación de un largo período de tiempo. La prueba Rosa de Bengala debería ser utilizada como prueba de cribado en el diagnóstico de la enfermedad (AU)

[Study of 1,595 brucellosis cases in the Almeria province (1972-1998) based on epidemiological data from disease reporting]. / Estudio de 1.595 casos de brucelosis en la provincia de Almería (1972-1998) según datos epidemiológicos de declaración de la enfermedad.

OBJECTIVE: To know clinical, diagnostic, and treatment issues of brucellosis in the Almeria province. METHODS: Descriptive, epidemiological study from 1,595 disease report cards in the Almeria province during the 1972-1998 period. Issues concerning complications and treatment were reported in 890 cards (57.8%), symptoms, signs and hemograms in 565 (35.4%), and other diagnostic findings in all cards. The chi2 test was used to compare independent qualitative parameters for a 95% CI. RESULTS: In the early phase the most common symptom was asthenia (95.2%); sweating in the chronic stage (95.8%). The most commonly recorded sign was spleen enlargement (37.5%) and the most commonly reported complication was bone and joint involvement (22.8%). No changes in symptoms occurred over years. The hemogram revealed anemia in 30.3% of cases. Blood culture was positive for 91.2%. Regarding serological diagnosis, rose Bengal was positive for 99.2% of cases; the most common agglutination titer to Brucella or B. mellitensis was 1/640 (13.5%). The most commonly used therapy consisted of the association tetracycline plus streptomycin (42.4%). For 42.6% of cards, patients were transferred to hospital, particularly since 1984. CONCLUSIONS: Generally speaking, clinical data recorded in the reporting card regarding brucellosis disease reveal the clinical features of the disease, after a long surveillance period. Rose Bengal should be used as screening test for the diagnosis of this disease.