Predictores de hipocalcemia postquirúrgica tras tiroidectomía total / Predictors of post-surgical hypocalcaemia following total thyroidectomy

Introducción y objetivo: Dado el número creciente de cirugía de tiroides, la incidencia de hipoparatiroidismo postquirúrgico está en aumento. La frecuencia de la hipocalcemia por hipoparatiroidismo tras tiroidectomía total es muy variable según la literatura (0,3-68%). El objetivo principal del presente estudio es analizar los factores bioquímicos, quirúrgicos y demográficos relacionados con un mayor riesgo de hipocalcemia.Metodología: Se trata de un estudio retrospectivo, sobre un total de 297 pacientes intervenidos de tiroidectomía total en un periodo de 8 años en un hospital terciario. Se analizan datos demográficos, clínicos y bioquímicos, tanto preoperatorios, intraoperatorios como postoperatorios y su relación con la hipocalcemia postquirúrgica.Resultados: La tasa de hipocalcemia total fue de 40,2%, siendo transitoria en el 26,1%.Fueron variables estadísticamente significativas la edad (p=0,04), la enfermedad de Graves (p=0,04), el carcinoma confirmado por anatomía patológica (p=0,04), la tiroidectomía en dos tiempos (p=0,00), el número de paratiroides trasplantadas (p=0,00) y la PTH pre y post –operatorias (p=0,03 y p=0,00) y el gradiente de PTH (p=0,00).Conclusiones: Este estudio demuestra que hay una serie de factores de riesgo intrínsecos al paciente y al acto quirúrgico capaces de predecir el riesgo de hipocalcemia tras la tiroidectomía total. Posiblemente, la optimización de la técnica quirúrgica podría evitar la aparición de hipocalcemia tras la tiroidectomía total en algunos casos, mientras que en otros, la identificación de dichos factores en el postoperatorio podría permitir la detección temprana y el tratamiento eficaz de estos pacientes. En el presente estudio, la edad, la enfermedad de Graves y el autotrasplante de paratiroides se asociaron con hipocalcemia postquirúrgica; mientras que el carcinoma de tiroides y la tiroidectomía en dos tiempos fueron factores protectores. (AU)

Two decades of monitoring in marine debris ingestion in loggerhead sea turtle, Caretta caretta, from the western Mediterranean.

Anthropogenic marine debris is one of the major worldwide threats to marine ecosystems. The EU Marine Strategy Framework Directive (MSFD) has established a protocol for data collection on marine debris from the gut contents of the loggerhead sea turtle (Caretta caretta), and for determining assessment values of plastics for Good Environmental Status (GES). GES values are calculated as percent turtles having more than average plastic weight per turtle. In the present study, we quantify marine debris ingestion in 155 loggerhead sea turtles collected in the period 1995-2016 in waters of western Mediterranean (North-east Spain). The study aims (1) to update and standardize debris ingestion data available from this area, (2) to analyse this issue over two decades using Zero-altered (hurdle) models and (3) to provide new data to compare the only GES value available (off Italian waters). The composition of marine debris (occurrence and amounts of different categories) was similar to that found in other studies for the western Mediterranean and their amounts seem not to be an important threat to turtle survival in the region. Model results suggest that, in the study area, (a) period of stranding or capture, (b) turtle size and (c) latitude are significant predictors of anthropogenic debris ingestion (occurrence and amount) in turtles. The GES value for late juvenile turtles (CCL>40 cm) has decreased in the last ten years in the study area, and this is very similar to that obtained in Italian waters. We also provide a GES value for early juvenile turtles (CCL≤40 cm) for the first time. Recommendations arising from this study include ensuring use of (1) the standardized protocol proposed by the MSFD for assessing marine debris ingestion by loggerhead sea turtles and (2) the ecology of the turtles (neritic vs oceanic), rather than their size, to obtain GES values.

Parasitic outbreak of the copepod Balaenophilus manatorum in neonate loggerhead sea turtles (Caretta caretta) from a head-starting program.

BACKGROUND: Diseases associated to external parasitosis are scarcely reported in sea turtles. During the last decades several organism have been documented as a part of normal epibiont community connected to sea turtles. The copepod Balaenophilus manatorum has been cited as a part of epibiont fauna with some concern about its parasitic capacity. This study serves three purposes, i.e. (i) it sheds light on the type of life style that B. manatorum has developed with its hosts, particularly turtles; (ii) it makes a cautionary note of the potential health risks associated with B. manatorum in sea turtles under captivity conditions and in the wild, and (iii) it provides data on effective treatments against B. manatorum. RESULTS: We report for the first time a massive infestation of the copepod B. manatorum and subsequent acute mortality in a group of loggerhead sea turtle hatchlings. Four-month-old turtles from a head-starting program started exhibiting excitatory and fin rubbing behavior preceding an acute onset of lethargy, skin ulceration and death in some animals. All the individuals (n = 57) were affected by severe copepod load and presented different degrees of external macroscopic skin lesions. The ventral area of front flippers, axillar and pericloacal skin were mostly affected, and were the main parasite distribution regions. Copepods were also detected on plastron and carapace sutures. The gut contents of B. manatorum reacted positively for cytokeratin, indicating consumption of turtle skin. Severe ulcerative necrotic dermatitis and large amount of bacteria presence were the major histopathological findings. CONCLUSIONS: Individual fresh water immersion for 10 min and lufenuron administration (0.1 ppm) to the water system every 2 weeks proved effective for removing turtle parasites and to control re-infestation, respectively. The results from our study clearly indicated that B. manatorum individuals consume turtle skin. The pathological effects of this agent and the potential implications in sea turtle conservation and management are discussed.

Estudio EPOCA sobre el impacto de los problemas de conducta en niños menores de 12 años y sus familias / Impact of behavioral problems in children under 12 and their families: the EPOCA study

Introducción: El objetivo del estudio EPOCA fue conocer el impacto de los problemas de conducta en el estado de salud y la calidad de vida (CV) de la población pediátrica, así como el tipo de recomendaciones no farmacológicas que realiza el pediatra en este tipo de consultas. Métodos: Estudio multicéntrico y observacional de niños de entre 6 y 12 años de edad, sin patología neurológica y/o psiquiátrica conocida, que acudieron a la consulta del pediatra y refirieron problemas de conducta. Se compararon los datos basales de la muestra con los de población infantil de la Encuesta Nacional de Salud de España (ENSE 2011), los resultados basales frente a los obtenidos al cabo de 3 meses, y también las diferencias a los 3 meses según las medidas recomendadas por el pediatra, en un grupo al que se le recomendó un suplemento alimentario a base de ácidos grasos (AG) omega-3 y otro grupo sin esta recomendación. Resultados: Las puntuaciones basales mostraron que el 67,8% de los participantes presentaban «probables» problemas de salud mental, además de una puntuación menor en la calidad de vida (CV) respecto a la muestra de la ENSE. La CV de los padres también se vio afectada en función de la presencia o no de problemas de conducta en sus hijos. Entre las medidas recomendadas por el pediatra, la complementación con AG omega-3 durante 3 meses se asoció a un porcentaje de mejora significativamente mayor en las puntuaciones de salud mental (el 35,1 vs. 25,5%; p= 0,019), de problemas de conducta (el 40,9 vs. 29,3%; p= 0,017) y de hiperactividad (el 35,9 vs. 24,1%; p= 0,017). La misma tendencia se observó en los resultados sobre «prestar atención» y «sentirse lleno de energía» » (p <0,05; 79,7 ± 103,6 vs. 65,2 ± 98,3, y 20,1 ± 80 vs. 13,3 ± 94,5, respectivamente). Conclusiones: En general, los niños con problemas de conducta presentan un peor estado de salud y una peor CV que los de la población general. La CV de los padres también se ve notablemente afectada por los problemas de conducta de sus hijos. La suplementación de la dieta con AG omega-3 parece tener efectos positivos en distintos factores relacionados con el estado de salud de los niños que refieren problemas de conducta. Las medidas no farmacológicas recomendadas por el pediatra, incluido el uso de un suplemento a base de omega-3, muestran un efecto positivo y sumatorio en la mejoría de tales problemas (AU)

Introduction: The EPOCA study aimed to assess the impact of behavioural problems on health and quality of life (QoL) of pediatric population and to know the non-pharmacological recommendations of pediatrician in such cases. Methods: Observational multicentre study of children aged 6-12 years (without neurological and/or psychiatric diagnosis) whom parents reported behavioral problems during a standard medical visit. Baseline data of EPOCA's participants was compared with those reported for pediatric population of the 2011 Spanish National Health Survey (SNHS). Other analyzes included comparisons of different outcomes at 3-months according to pediatrician recommendations between a group of patients who received dietary supplementation with omega-3 polyunsaturated fatty acids (PUFA) and another group without this recommendation. Results: Baseline scores showed that 67.8% of children were considered with «probable» mental health problems, while a lower score on QoL regarding sample of SNHS was also observed. Parents' QoL also was affected depending on the presence or not of behavioural problems in their progeny. Among the recommendations of pediatricians, supplementation with omega-3 for 3 months was associated with significantly improvements on mental health (35.1 vs. 25.5%; p= 0.019), on behavioral problems (40.9 vs. 29.3%; p= 0.017) and on hyperactivity (35.9 vs. 24.1%; p= 0.017). The same trend was observed on 'paying attention' and 'feel full of energy' (p <0.05; 79.7 ± 103.6 vs. 65.2 ± 98.3, and 20.1 ± 80 vs. 13.3 ± 94.5, respectively). Conclusions: Globally, children with behavioural problems have shown worse scores of health and QoL compared with children of the general population. Parents' QoL was also significantly affected by the behavioral problems of their children. Overall, paediatricians' recommendations, including dietary supplementation with omega-3 PUFA, seems to have positive effects on different factors associated with health in children with behavioral problems (AU)

[Contribution of a portable hand-held miniature gamma camera in surgical treatment of primary hyperparathyroidism]. / Aportación de una minigammacámara portátil en el tratamiento quirúrgico del hiperparatiroidismo primario.

Primary hyperparathyroidism diagnosis and radioguided surgery by (99m)Tc-MIBI scintigraphy have become more generalized during recent years. The recent creation of a new portable hand-held miniature gamma camera opens new perspectives for this technique. We present a preliminary study of three patients with primary hyperparathyroidism in whom intraoperative scintigraphy with portable hand-held miniature gamma camera has been shown to be useful.

Aportación de una minigammacámara portátil en el tratamiento quirúrgico del hiperparatiroidismo primario / Contribution of a portable hand-held miniature gamma camera in surgical treatment of primary hyperparathyroidism

En los últimos años se ha generalizado el uso de la gammagrafía paratiroidea con 99mTc-MIBI para el diagnóstico preoperatorio e intraoperatorio del hiperparatiroidismo primario. La aparición de un nuevo modelo de minigammacámara portátil (MGP) abre nuevas perspectivas en el campo de la detección intraoperatoria. Presentamos un estudio preliminar de tres pacientes con hiperparatiroidismo primario en el que se demuestra la utilidad del empleo de la MGP

Primary hyperparathyroidism diagnosis and radioguided surgery by 99mTc-MIBI scintigraphy have become more generalized during recent years. The recent creation of a new portable hand-held miniature gamma camera opens new perspectives for this technique. We present a preliminary study of three patients with primary hyperparathyroidism in whom intraoperative scintigraphy with portable hand-held miniature gamma camera has been shown to be useful (AU)

[Hypopharyngeal cancer: analysis of the evolution and surgical results]. / Cáncer de hipofaringe. Análisis de la evolución y resultados del tratamiento quirúrgico.

OBJECTIVE: Hypopharyngeal carcinoma is an aggressive malignancy that usually presents at a late stage, thereby resulting in an overall poor prognosis for these patients. The aim of this study is to determine the evolution and postoperative results of patients treated in our department for hypopharyngeal cancer. METHODS: We retrospectively reviewed 60 patients who had undergone surgery followed by radiation therapy between 1980-1999. Most of them were advanced stage (III-IV) and 75% patients showed regional metastases at presentation. RESULTS: The 5-year survival rate was 38.4%. The overall incidence of distant metastases and second neoplasms was 12.5% and 10.4%. CONCLUSIONS: Hypopharyngeal cancer remains one of the most lethal ones in head and neck cancer. The poor survival rate is related primary to advanced stage disease and particularly to lymph node metastases.

Cáncer de hipofaringe. Análisis de la evolución y resultados del tratamiento quirúrgico / Hypopharyngeal cancer: analysis of the evolution and surgical results

Objetivo: El cáncer de hipofaringe es un cáncer muy agresivo que generalmente se diagnostica en estadios muy avanzados, siendo su pronóstico desalentador y la tasa de supervivencia muy baja. El objetivo de este estudio es presentar la evolución y los resultados postoperatorios de pacientes tratados en nuestro servicio por cáncer de hipofaringe. Material y Método: Realizamos un estudio retrospectivo sobre 60 pacientes intervenidos quirúrgicamente entre los años 1980-1999. En su mayoría se trataba de estadios avanzados (III-IV) y el 75 por ciento presentaban adenopatías palpables en el momento del diagnóstico. Resultados: La supervivencia a los 5 años fue de 38,4 por ciento. Encontramos una incidencia de metástasis a distancia y segundos tumores de un 12,5 por ciento y un 10,4 por ciento respectivamente. Conclusiones: El carcinoma de hipofaringe continúa siendo el cáncer de cabeza y cuello de peor pronóstico. La tasa de supervivencia parece estar relacionada primeramente con el estadio tumoral de presentación y particularmente con el estatus de los ganglios linfáticos cervicales (AU)

OBJECTIVE: Hypopharyngeal carcinoma is an aggressive malignancy that usually presents at a late stage, thereby resulting in an overall poor prognosis for these patients. The aim of this study is to determine the evolution and postoperative results of patients treated in our department for hypopharyngeal cancer. METHODS: We retrospectively reviewed 60 patients who had undergone surgery followed by radiation therapy between 1980-1999. Most of them were advanced stage (III-IV) and 75% patients showed regional metastases at presentation. RESULTS: The 5-year survival rate was 38.4%. The overall incidence of distant metastases and second neoplasms was 12.5% and 10.4%. CONCLUSIONS: Hypopharyngeal cancer remains one of the most lethal ones in head and neck cancer. The poor survival rate is related primary to advanced stage disease and particularly to lymph node metastases (AU)

Effect of mineral salts addition on the behaviour of an ethanol biofilter.

Ethanol biofiltration was studied in a 0.1651 packed bed reactor filled with sugar cane bagasse complemented with mineral medium and inoculated with Candida utilis. The main objective was to improve the elimination capacity of the system by adding salts to the solid medium. The biofilter was operated for one month, varying both the inlet ethanol concentration (7.6-16.5 g m(-3) and the airflow rate (1.61-2.50 x 10(-3) m3 h(-1)). Removal efficiency (RE) of 100% was attained at ethanol loads ranging from 74.2 to 250 g h(-1) m(-3). When the RE decreased, acetaldehyde and ethyl acetate appeared in the outlet stream; adding mineral salts restored a 100% RE. Both ammonium sulfate and ammonia were assimilated by the yeast (conversion yield of nitrogen from the N-source to biomass of 75%), but only ammonia restored the pH of the medium to a value adequate for efficient biofiltration (7.7). Fifty seven percent of the carbon from ethanol was converted into CO2, and 8.7% into biomass. Final yeast population was 7 x 10(9) cells g(-1) dry matter, corresponding to 56 mg protein g(-1) dry matter, which offers potential to also use the protein enriched bagasse as feed.

[Why does a mastoidectomy cavity become suppurative? Our experience and revision of the literature]. / Por qué supura una cavidad de mastoidectomía? Nuestra experiencia y revisión de la literatura.

The main goal for performing surgery for chronic otitis media is to eliminate the disease and improve hearing whenever possible. Persistent drainage of a mastoid cavity means failure of surgery and of achieving the goal. In this study, we present our department's attitude for suppurative mastoid cavities as well as the reasons that do not allow adequate control of them.

El uso de modelos aviares en el estudio de la arterioesclerosis humana / Use of avian models for human atherosclerosis researchetrospective study of chronic copper poisoning in sheep

Las aves se han utilizado desde los comienzos de la experimentación animal aplicada al estudio de la arteriosclerosis humana. Este trabajo presenta los cuatro modelos aviares empleados en la gran mayoría de dichos estudios (pollo, paloma, codorniz japonesa y pavo); resume ventajas e inconvenientes de su utilización y analiza su contribución a la comprensión de diversos aspectos de la enfermedad. La experimentación con modelos aviares ha aportado valiosos conocimientos acerca del papel que desempeñan factores genéticos, virus, estrógenos o la hipertensión en la susceptibilidad a la arteriosclerosis y se han utilizado además en el estudio de los mecanismos celulares y bioquímicos implicados en su patogenia. (AU)

¿Por qué supura una cavidad de mastoidectomía? Nuestra experiencia y revisión de la literatura / Why does a mastoidectomy cavity suppurate? Our experience and revision of the literature

El objetivo principal de la cirugía de la otitis media crónica es eliminar la enfermedad y mejorar la audición siempre que sea posible. La supuración persistente de una cavidad de mastoidectomía supone un fracaso de la cirugía e impide que estos objetivos se alcancen. En el siguiente trabajo, presentamos la actitud de nuestro servicio ante las cavidades de mastoidectomía supurante y así mismo exponemos cuáles son las causas que impiden el adecuado control de la misma (AU)

The main goal for performing surgery for chronic otitis media is to eliminate the disease and improve hearing whenever possible. Persistent drainage of a mastoid cavity means failure of surgery and of achieving the goal. In this study, we present our department's attitude for suppurative mastoid cavities as well as the reasons that do not allow adequate control of them (AU)

Biofiltration of volatile ethanol using sugar cane bagasse inoculated with Candida utilis.

Candida utilis (C. utilis) growing on sugar cane bagasse complemented with a mineral salt solution was studied for gaseous ethanol removal in a biofilter. Ethanol loads from 93.7 to 511.9 g/h m(3) were used, by varying both inlet ethanol concentration (9.72 to 52.4 g/m(3)) and air flow rate (1.59 x 10(-3) to 2.86 x 10(-3) m(3)/h). At a loading rate of 93.7 g/h m(3), a steady-state was maintained for 300 h. Ethanol removal was complete, and 76.3% of the carbon consumed was found in carbon dioxide. At an higher aeration rate (ethanol load=153.8 g/h m(3)), the biofilter displayed an average removal efficiency (RE) of 70%, and an elimination capacity (EC) of 107.7 g/h m(3). Only 64.4% of the carbon consumed was used for CO(2) production. Acetaldehyde and ethyl acetate in the outlet gas attained 7.86 and 20.4% in terms of carbon balance, respectively. In both cases, the transient phase was less than one day. At a high inlet ethanol concentration (52.4 g/m(3)), no steady-state was observed and the process stopped during the third day. In the three cases, final biomass was poor, ranging from 10.5 to 14.8 mg/g dm. Final pH 4.0-4.6, indicated that acidifying non-volatile metabolites, such as acetate, accumulated in the reactor.

Influencia del grado de reducción de la fractura en el ambiente mecánico del callo durante el proceso de reparación ósea mediante fijación externa / Influence of fracture reduction on the mechanical environment of callus formation during bone repair using external fixation

Objetivo: Se evalúa la influencia que, sobre el ambiente mecánico del callo, ejercen distintos grados de reducción no anatómica de fracturas tratadas mediante fijación externa unilateral. Diseño experimental: Se desarrolla un modelo de elementos finitos del conjunto fijador externo-tibia fracturada, validado con ensayos mecánicos de compresión, flexión en los planos frontal y sagital, y torsión. El modelo considera, además, la evolución del callo desde un estado inicial hasta su consolidación, mediante la variación de sus propiedades elásticas. Del modelo desarrollado se obtienen valores de fuerzas, momentos y tensiones en el foco de fractura, considerando diversos grados de reducción no anatómica según las configuraciones siguientes: ángulo entre fragmentos (planos sagital y frontal), desalineación entre ejes de fragmentos (planos sagital y frontal) y separación longitudinal. Resultados: Los momentos presentes en el callo aumentan al disminuir el grado de reducción, especialmente en los casos de angulación y desalineación, con valores máximos de 60 Nm (+600 por ciento). La tensión de von Mises también aumenta con menores grados de reducción, produciéndose incrementos del 180 por ciento (hasta 80 MPa) respecto a los valores obtenidos en fracturas con reducción anatómica. Conclusiones: Una reducción de fractura no adecuada incrementa los momentos flectores en el callo, así como su estado tensional en general, que se hace más crítico cuanto menor es el grado de reducción alcanzado, fundamentalmente en el caso de angulación y desalineación entre fragmentos. Ciertos grados de reducción no anatómica representan, por tanto, un mayor riesgo de retardo en la consolidación o incluso ausencia de la misma (AU)

Surgical voice restoration after total laryngectomy: long-term results.

Tracheoesophageal puncture (TEP) with a voice prosthesis has been the preferred treatment for speech rehabilitation of total laryngectomies at the Dr. Peset Hospital since 1984. This study reviews 350 consecutive patients over a 15-year period. There were 334 patients with primary and 16 with secondary TEP. Long-term tracheoesophageal speech was achieved in approximately 70% of our patients. Problems related to or affecting TEP for voice restoration were studied. The different types of problems identified occurred in proportions ranging from 0.6% to 18%. Most of them were easily managed, but problems such as salivary leakage and dislodging of the prosthesis led to tracheoesophageal tract closure in 30% of the patients.

Stress and rest myocardial SPET quantification with 201Tl and 99Tcm-tetrofosmin: a comparison.

99Tcm-tetrofosmin is a new myocardial perfusion agent that has excellent physical and pharmacokinetic characteristics for performing tomographic myocardial perfusion studies. The aim of this study was to compare the behaviour of 99Tcm-tetrofosmin and 201Tl in the assessment of ischaemia and viability in patients with previous myocardial infarction. Twenty consecutive patients who had suffered infarction and been referred for assessment of ischaemia and myocardial viability were enrolled into the study. Each patient underwent two stress tests performed no more than 10 days apart, one with a 201Tl exercise-reinjection-redistribution method and one with a 99Tcm-tetrofosmin short protocol (exercise-rest). The results were quantified using polar maps to represent images for stress, rest and reversibility. The post-stress images showed there was a slight tendency to overestimate defect size with 99Tcm-tetrofosmin in the lateral region (P < 0.006). We found no significant differences between the two tracers when comparing reversibility. The same defect size at rest were obtained when the maps for 201Tl with uptake of 50% were compared with those for 99Tcm-tetrofosmin with uptake of 45%. Agreement between the two agents for assessment of viability was 93%. We conclude that the quantitative assessment of myocardial ischaemia and uptake of 99Tcm-tetrofosmin at rest are comparable to those obtained with 201Tl in patients who have suffered myocardial infarction.

[Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis)]. / Enfermedad de Kikuchi-Fujimoto (linfadenitis necrotizante histiocitaria.

Kikuchi-Fujimoto's disease (histiocytic necrotizing lymphadenitis) is a benign, self-limited disease of unknown cause that often presents with persistently enlarged cervical lymph nodes that are unresponsive to antibiotic therapy. The disease should be considered in the differential diagnosis of cervical lymphadenopaty: viral infection, tuberculosis, hyperplastic lymphadenopathy, and metastatic disease. It can be confused histologically with malignant lymphoma.