Domingo Pérez-Flores

Comparative study of right portal vein ligation versus embolisation for induction of hypertrophy in two-stage hepatectomy for multiple bilateral colorectal liver metastases

AIM In patients with two-stage hepatectomy (TSH) for multiple bilobar liver metastases from colorectal cancer, few clinical series compare functional remnant hypertrophy of the liver volume between right portal vein ligation (PVL) and embolisation (PVE). Our objective is to analyse the effectiveness of portal vein ligation to achieve hypertrophy of the functional remnant volume (FRV) of the liver and to compare the results with portal vein embolisation in a series of patients with multiple bilobar liver metastases from colorectal carcinoma. PATIENTS AND METHODS Between September 2001 and September 2011 we performed a TSH in 41 patients with multiple bilobar colorectal liver metastases. A right PVL was performed in 23 patients with an insufficient FRV (three patients did not complete the second stage due to tumour progression and were excluded). We prospectively compare these results with the increased remnant volume obtained in 18 patients with right PVE. RESULTS The median FRV was higher in the patients with PVE, rising from 501 ml (range 309-703) to 636 ml (range 387-649), than those with PVL, rising from 510 ml (range 203-824) to 595 ml (range 313-1213) (p < 0.05). The median %FRVI was higher in the patients with PVE (median 40%; range 21-65%) than those with PVL (median 30%; range 21-60%) (p < 0.05). CONCLUSIONS PVL and PVE were effective in all cases for obtaining hypertrophy of the FRV before major liver resection. Right PVE obtains better results and should be used where necessary to achieve a further increase in volume.

Elevated Glucocorticoid Levels Are Responsible for Induction of Tyrosine Hydroxylase mRNA Expression, Phosphorylation, and Enzyme Activity in the Nucleus of the Solitary Tract during Morphine Withdrawal

Chronic opiate exposure induces neurochemical adaptations in the noradrenergic system. Enhanced responsiveness of the hypothalamo-pituitary-adrenal axis after morphine withdrawal has been associated with hyperactivity of ascending noradrenergic input from the nucleus of the solitary tract (NTS-A(2)) cell group to the hypothalamic paraventricular nucleus (PVN). This study addressed the role of morphine withdrawal-induced corticosterone (CORT) release in regulation of tyrosine hydroxylase (TH), the rate-limiting enzyme of catecholamine biosynthesis in adrenalectomized (ADX) rats supplemented with low CORT pellet (ADX plus CORT). Present results show that in sham-ADX rats, noradrenergic neurons in the NTS-A(2) became activated during morphine withdrawal, as indicated by increased TH mRNA expression. However, this induction of TH expression is not detected in ADX plus CORT rats that are unable to mount CORT secretory response to morphine withdrawal. Total TH protein levels were elevated in the NTS-A(2) from sham-operated rats during morphine dependence and withdrawal, whereas we did not find any alteration in ADX plus CORT animals. Furthermore, high levels of TH phosphorylated (activated) at Ser31 (but not at Ser40) were found in the A(2) area from sham-morphine withdrawn rats. Consistent with these effects, we observed an increase in the enzyme activity of TH in the PVN. However, induction of morphine withdrawal to ADX plus CORT animals did not alter the phosphorylation (activation) of TH in NTS-A(2) and decreased TH activity in the PVN. These results suggest the existence of a positive reverberating circle in which elevated glucocorticoids during morphine abstinence play a permissive role in morphine withdrawal-induced activation of noradrenergic pathway innervating the PVN.

Suspicion of elder abuse in South Eastern Spain: The extent and risk factors

Elder abuse is recognized internationally as a growing problem. Recent years have seen an increase in the number of authors recommending that the MDs systematically question old people concerning possible abuse. The aim of our study was to ascertain the extent of suspicion of elder abuse and the different types of abuse. We design a cross-sectional survey including 460 patients > or = 65 years at different health centers (South East Spain). A face-to-face interview and a physical examination was carried out. Extent of suspected abuse was 44.6%. Female sex, > or = 75 years, widowhood, living alone or with children, accommodation in house of relatives and income < or = 300 euros/month were the associated sociodemographic variables. The risk factors associated are recent worsening of health, living with a mentally ill person, excessive consumption of alcohol or illegal drugs, arguing frequently with relatives or the dependence on someone to carry out a daily activity. The signs in the physical examination associated are dehydration/malnutrition, pressure ulcers and poor body and/or mouth hygiene. There is a high extent of suspicion of elder abuse and the keyword in this respect is prevention.

Exercise-induced asthma in children : a comparative study of free and treadmill running

BACKGROUND Exercise is one of the most common precipitating factors of acute asthmatic crises in childhood. Although it has been described as more frequent among children, this is probably due to their more abundant physical activity. Nevertheless, it also occurs at other ages. OBJECTIVE The aim of this study is to assess possible differences in postexercise spirometry after treadmill and free running provocation tests. METHODS We compared the results obtained in a treadmill test performed by 30 asthmatic children and 30 healthy children with the results obtained with these same children in a free running test, keeping similar environmental conditions (temperature and humidity), exercise intensity (assessed by heart rate), and airway status at the time of the test. RESULTS Seventy-three percent of the patients had positive treadmill tests and 63.3% had positive free running tests. For the spirometric parameters studied, there were no significant differences in the percent decrease in postexercise performance after either of the provocation tests. For FEV1, which is the most sensitive diagnostic parameter, the sensitivity was 53.3% in treadmill running and 56.7% in free running, with a specificity of 100% in both tests. CONCLUSIONS If environmental conditions, exercise intensity, and airway status are controlled at the time of the test, treadmill and free running can be used indistinctly as asthma-inducing exercises.

Actividad física deportiva en una muestra representativa de la población de la Región de Murcia

Objetivo: Estimar la prevalencia de realizacion de actividad fisica (AF) deportiva intensa en la Region de Murcia segun sexo y edad y analizar su asociacion con los principales determinantes demograficos, socioeconomicos, asi como con otros factores de riesgo cardiovascular. Metodo: Encuesta sobre una muestra representativa de la poblacion de 18 a 65 anos de la Region de Murcia mediante un muestreo aleatorio polietapico con definicion de cuotas muestrales. El numero de personas entrevistadas fue de 3.091. Se recogio, a traves de un cuestionario validado, la frecuencia y duracion de realizacion de AF intensa deportiva durante las 2 semanas previas a la realizacion de la encuesta. Ademas, se obtuvo informacion sobre variables socioeconomicas, habito tabaquico, presion arterial, peso, talla y una analitica de sangre para determinar los lipidos plasmaticos. La AF intensa o vigorosa (≥ 6 equivalentes a la tasa metabolica basal) se midio en kcal/dia y se redujo a h/sem, considerando 3 categorias diferentes: ninguna AF, menos de 2 h/sem, e igual o mas de 2 h/sem. Resultados: Globalmente, el 17,8% (intervalo de confianza [IC] del 95%, 16,6-19,0) de la poblacion adulta de la Region de Murcia realiza AF intensa ≥ 2 h/sem. Por sexos las cifras varian siendo el doble en varones (23,1%; IC del 95%, 21,0-25,2) que en las mujeres (12,5%; IC del 95%, 10,9-14,1). En el analisis mediante regresion logistica la mayor frecuencia de realizacion de AF deportiva intensa se asocio con la edad, el nivel de estudios y la situacion de empleo. En los varones, ademas, con la ocupacion y la residencia en areas urbanas. Conclusiones: En el periodo de estudio, una de cada 5 personas adultas en la Region de Murcia realizo AF deportiva intensa con una frecuencia y duracion compatible con la prevencion de episodios isquemicos coronarios.

Prevalence and control of arterial hypertension in the south-east of Spain: A radical but still insufficient improvement

Stroke mortality rates in Spain are one of the highest in all of Europe. At the same time, the Murcia region (south-east Spain) shows, for both genders, the highest age-adjusted stroke mortality rates in all of Spain. The earliest available hypertension figure estimations for this area go back to 1981, when a high prevalence combined with an almost nonexistent control was detected. One decade later, updated prevalence estimations of hypertension are presented jointly with their degree of control and their association with other risk factors based on the results of a prevalence survey in a random population sample (n = 3,091). Arterial blood pressure was measured following the MONICA protocol, maintaining a tight quality control on between and within-observer variability. As hypertensive was considered as any person with systolic blood pressure (SBP) ≥ 140 mmHg or with diastolic blood pressure (DBP) ≥ 90 mmHg or with antihypertensive pharmacological treatment. Detected prevalence rises to 32.3% (CI 95%: 29.1%–35.5%) among males and to 23.7% (CI 95%: 21.4%– 26%) among females, maintaining its level regarding figures observed back in 1981. However, its control has been increased, especially among hypertensive women [from less than 5% in 1981 to 35% (95% CI: 32%–37.8%) at present]. Hypertension is strongly associated to hipercholesterolemia, overweight, obesity and diabetes (p < 0.01). On the contrary, it shows an opposite association with current smoking, higher educational level and leisure time physical activity (p < 0.01). The highest educational level was associated with better hypertension treatment and control. In summary, while hypertension prevalence is stabilized in our population, its control has improved in a measurable but still insufficient way. These results are in accordance with a decreasing trend in stroke mortality registered in the Murcia Region along the last decade.

Physical sports activity in a representative sample of the population of Región de Murcia, Spain

OBJECTIVE To estimate the prevalence of intense physical activity according to age and sex in the region of Murcia, Spain, and to analyze its association with major demographic and socioeconomic determinants and other cardiovascular risk factors. METHODS Survey of a representative sample of the population aged between 18 and 65 years from Murcia was performed using multistage random sampling with definition of the sample quotas. A total of 3091 individuals were surveyed. The frequency and duration of intense physical sports activity during the two weeks prior to the survey was obtained using a validated questionnaire. Information was also collected on socioeconomic variables, smoking, blood pressure, weight and height and a blood test was performed to determine plasma lipids. Intense or vigorous physical activity (> or = 6 Metabolic Equivalents [MET]) was measured in kcal/day and reduced to hours/week to give three categories: no vigorous physical activity, less than 2 hours/week, and 2 hours/week or more. RESULTS Overall, 17.8% (95% CI: 16.6-19.0) of the adult population of the region of Murcia performed intense physical activity for > or = 2 hours/week. The figures were twice as high in men (23.1%; 95% CI: 21.0-25.2) than in women (12.5%; 95% CI: 10.9-14.1). In the logistic regression analysis, a higher frequency of intense physical activity was associated with age, level of education and employment situation. In men it was also associated with occupation and residence in urban areas. CONCLUSIONS During the study period, one in five adults in the region of Murcia took intense physical sports activity with a frequency and duration that were compatible with the prevention of episodes of coronary ischemia.

Screening for Hazardous Drinking in Migrant Workers in Southeastern Spain

Screening for Hazardous Drinking in Migrant Workers in Southeastern Spain : Maria D. PEREZ‐CARCELES, et al. Department of Health and Social Sciences, Regional Campus of International Excellence “Campus Mare Nostrum”, School of Medicine, University of Murcia, E30100, Spain—

El trasplante hepático aumenta la resecabilidad R0 y la supervivencia de los pacientes con tumor de Klatskin irresecable no diseminado

INTRODUCTION There are no established indications for Liver transplant (LT) in patients with a Klatskin tumour (KT) due to the differences in the published results. OBJECTIVE To report on our patients who have non-disseminated unresectable KT and who were given a LT, and to compare results with those of patients who have had tumour resection and those who have not. PATIENTS AND METHOD We have treated 75 patients diagnosed with KT. The mean age was 62 + or - 11 years (range: 38-88 years) and 50 were males (66%). Twenty patients were inoperable. Of the 55 patients who underwent surgery: tumour resection (TR) was performed in 29 cases; there was no tumour dissemination in 11 unresectable cases and therefore these patients were added to the LT waiting list and the remaining 15 unresectable cases had tumour dissemination and remained on palliative treatment. RESULTS In the LT group there was no postoperative mortality (during the first month) and the survival rate was 95%, 59% and 36% with a disease-free survival of 75%, 40% and 20%; whereas the patients given RT had a survival rate of 80%, 52% and 38% at 1, 3 and 5 years, with a disease-free survival of 65%, 35% and 19%, without any differences compared to the LT group. Patients with unresectable tumour left on palliative therapy had a lower survival than the unresectable who underwent LT (p<0.001). CONCLUSIONS In patients with non-disseminated unresectable KT, LT has a similar survival to that obtained in cases with resectable R0 liver resection. LT improves the survival rate achieved using palliative treatment in patients with non-disseminated unresectable KT.