[Appendectomy with a single trocar through the umbilicus: results of our series and a cost approximation]. / Apendicectomía con trocar único a través del ombligo: resultados de nuestra serie y aproximación a su coste.

UNLABELLED: In our department we perform the appendectomy through a single periumbilical incision. A double channel laparoscope aids to locate and exteriorize the appendix. OBJECTIVE: We studied this practice to determine if this technique makes it possible to make use of the advantages of laparoscopic surgery and of open surgery, decreasing costs without increasing the rate of complications. MATERIALS AND METHODS: Clinical prospective paper. The study group was made up of transumbilical appendectomies (TA) for acute, uncomplicated appendicitis carried out in 2004 and 2005. The control group consisted of a group of open appendectomies (OA) performed for acute, uncomplicated appendicitis in our department in 2002 and 2003 (from a previous study). RESULTS: Both study groups were comparable. We performed a total of 162 TA due to uncomplicated appendicitis. The mean hospital stay was 2.84 days (versus 4.83 days with OA) (significant difference). Infectious complications presented in 4.29% (versus 1.75% in the OA group) (this difference was not significant). Postoperative pain and need for analgesia were less in the TA group than in the OA (difference did not reach significance). CONCLUSIONS: Described technique is easily performed. The savings resulting from the transumbilical technique represent some 90,561.97 euros / year compared with the cost that laparoscopic appendectomy would incur, and some 42,232.37 euros/ year versus traditional, open surgery. Postoperative complications didn't increase significantly if compared with open appendectomy.

[Cormobidity of sensorineural hearing loss and other autoimmune diseases. Usefulness of laboratory tests]. / Estudio de comorbilidad de la hipoacusia neurosensorial y otras enfermedades de patogenia autoinmune. Utilidad de las pruebas de laboratorio.

OBJECTIVES: To value if the sensorineural hearing loss (SHL) in several autoimmune diseases (AD) is also secondary to immunomediation. PATIENTS AND METHODS: In 342 cases with SHL and any AD and 301 normoacoustic controls with AD a non-specific immunologic battery of tests and a Western-blot (WB) for anticochlear autoantibodies were developed, and cases with SHL were treated with deflazacort. RESULTS: Alterations in non-specific battery were similar between cases and controls. But a 12,5% of cases with SHL and a 1,6% of normoacoustic showed a positive WB (p<0,001). Steroid therapy improved hearing in 14,3% of cases. In them, sensitivity and specificity of non-specific battery were 78,4% and 75,5%, respectively, to predict response to therapy. These were 98,9% and 81,6% for WB. CONCLUSIONS: The SHL in cases with AD can be considered immunomediated in a discrete average, but the diagnostic efficiency of WB to predict an improvement after steroid therapy is high.

Estudio de comorbilidad de la hipoacusia neurosensorial y otras enfermedades de patogenia autoinmune. Utilidad de las pruebas de laboratorio / Comorbidity of sensorineural hearing loss and other autoimmune diseases. Usefulness of laboratory tests

Objetivos: Valorar si la hipoacusia neurosensorial (HNS) detectada en diversas enfermedades autoinmunes (EA) es también secundaria a inmunomediación. Pacientes y Métodos: En 342 casos con HNS y alguna EA y 301 controles normoacúsicos con EA se efectuó una batería de pruebas inmunológicas inespecíficas y un Western-blot (WB) para autoanticuerpos anticocleares, tratándose la HNS con deflazacort. Resultados: Las alteraciones en la batería inespecífica entre casos y controles fueron similares, pero el 12,5% de los casos con HNS y el 1,6% de los normoacúsicos presentaban WB positivo (p<0,001). La corticoterapia fue eficaz en el 14,3%. Entre casos, la batería inespecífica evidenció especificidad y sensibilidad del 78,4% y 75,5%, respectivamente, en predecir respuesta al tratamiento y el WB de 98,9% y 81,6%. Conclusiones: La HNS en algunos casos de EA parece ser inmunomediada en un porcentaje discreto de ellos, pero la eficacia diagnóstica del WB en predecir la mejoría tras corticoterapia resulta alta

Objetives: To value if the sensorineural hearing loss (SHL) in several autoimmune diseases (AD) is also secondary to immunomediation. Patients and methods: In 342 cases with SHL and any AD and 301 normoacoustic controls with AD a non-specific immunologic battery of tests and a Western-blot (WB) for anticochlear autoantibodies were developed, and cases with SHL were treated with deflazacort. Results: Alterations in non-specific battery were similar similar between cases and controls. But a 12,5% of cases with SHL and a 1,6% of normoacoustic showed a positive WB (p<0,001). Steroid therapy improved hearing in 14,3% of cases. In them, sensitivity and specificity of non-specific battery were 78,4% and 75,5%, respectively, to predict response to therapy. These were 98,9% and 81,6% for WB. Conclusions: The SHL in cases with AD can be considered immunomediated in a discrete average, but the diagnostic efficiency of WB to predict an improvement after steroid therapy is high

Antibodies to carbonic anhydrase and IgG4 levels in idiopathic chronic pancreatitis: relevance for diagnosis of autoimmune pancreatitis.

BACKGROUND: Increased serum antibodies against carbonic anhydrase II (CA-II Ab) or IgG4 levels have been reported in cases of autoimmune chronic pancreatitis (ACP). AIM: To assess the relevance of serum CA-II Ab and IgG4 levels for the diagnosis of ACP in idiopathic CP (ICP) versus alcoholic CP and Sjogren's syndrome (SS). SUBJECTS: This was a multicentre study involving 227 subjects divided into four groups: ICP (n = 54), normal controls (n = 54, paired by age and sex with ICP patients), alcoholic CP (n = 86), and SS (n = 33). METHODS: CA-II Ab was measured by ELISA and confirmed by western blotting. A score of easy clinical use with major clinical, morphological, and biochemical parameters for the diagnosis of ACP was applied. RESULTS: The percentage of patients with increased serum CA-II Ab was higher in the ICP group (28%) than in controls (1.9%) and in patients with alcoholic CP (10.5%), but lower than in patients with SS (64%). The proportion with elevated IgG4 levels was higher in the ICP group (15%) compared with controls (1.9%) and SS (0%) but not significantly different from alcoholic CP (8%). Most ICP patients (7/8) with high IgG4 levels exhibited increased CA-II Ab and a compatible ACP score. A definitive diagnosis of ACP by histological analysis was associated with other autoimmune disorders, an increase in both serum IgG4 and CA-II Ab levels, and IgG4 positive plasma cells. CONCLUSIONS: The increase in serum IgG4 levels was strongly associated with elevated CA-II Ab levels, manifestations compatible with ACP, and lymphoplasmacytic infiltration when surgical specimens were available.

Treadmill chamber for studies of respiratory gas exchange in the rat during exercise.

A treadmill for studying gas exchange in small mammals during exercise is presented. The system consists of a motor-driven running mat enclosed in a gastight chamber that receives a measured flow of air from a compressed air cylinder. The gas flow and temperature, pressure and instantaneous gas composition of the chamber (oxygen, carbon dioxide and water) are measured continuously and the data are computed to include the effects on chamber atmosphere of the rat activity, either running or at rest. The system is completed with a shock delivery grid that stimulates the rat to run. The calculations are based on the changes in the composition of the gas in the chamber (constantly stirred by a small electric fan) induced by the rat instead of relying on the alterations induced in the outflowing gas. The consumption of oxygen, and production of carbon dioxide and water by the rat are computed in real time, giving a very fast response to physiological change induced by exercise. The chamber is custom-made from an aluminium block and a plexiglass lid; all other components are available commercially. The system, as described, allows for a detailed analysis of respiratory gas (and water) exchange by rats under varying exercise conditions, there is practically no time lag between changes in respiratory gases and the detection of these changes, and the buffering effect of the chamber size is practically eliminated because of the calculation approach used.