Tomás Ratia

Influencia de la presión atmosférica sobre la incidencia de neumotórax espontáneo

BACKGROUND This study analyses the relationship between the incidence of idiopathic spontaneous pneumothorax (ISP) and atmospheric pressure (AP). METHODS A total of 288 cases of ISP were included, 229 men and 59 women. The AP of the day of diagnosis, of the 3 prior days and the monthly average was registered. The association between the incidence of ISP and AP was analyzed by calculating standardized incidence ratio (SIR) and Poisson regression. RESULTS The AP on the day of admission (mean±standard deviation) (1,017.9±7 hectopascals [hPa]) was higher than the monthly average AP (1,016.9±4.1 hPa) (P=.005). There was a monthly distribution pattern of ISP with the highest incidence in the months of January, February and September and the lowest in April. When AP was less than 1,014 hPa, there were fewer cases registered than what would statistically have been expected (58/72 cases). In contrast, when the pressure was higher than 1,019 hPa, the registered cases were more than expected (109/82 cases) (SIR=1.25; 95% CI: 1.04 to 1.51). The risk of ISP increased 1.15 times (95% CI: 1.05 to 1.25, P=.001) for each hPa of AP, regardless of sex, age and monthly average AP. A dose-response relationship was observed, with progressive increases in risk (IRR=1.06 when the AP was 1,014-1016 hPa; 1.17 hPa when the AP was 1,016-1,019 hPa and 1.69 when AP was superior to 1,019 hPa) (P for trend=.089). CONCLUSION The AP is a risk factor for the onset of idiopathic spontaneous pneumothorax.

Differences in p53 and PCNA expression in rectal adenocarcinomas due to preoperative adjuvant radiotherapy.

Preoperative Adjuvant Radiotherapy (PAR) is a very important step in current therapeutic schemes for rectal adenocarcinoma (1). This therapy increases the resectability rate and reduces the incidence of locoregional recurrence (2). It is often possible to observe a clear decrease in the tumor mass, more significant in the ectophytic part. In 10-30% of cases no tumor can be detected in the surgically excised specimen (3). However, the relationship between the histopathologic features of the irradiated and possibly modified tumor, and the postoperative course has been scarcely studied. Also, the implications of these changes for the postoperative indication of adjuvant chemotherapy have not been analyzed. We have recently compared the immunohistochemical expression of p53 protein, Proliferative Cell Nuclear Antigen (PCNA) protein and ploidy status in primary tumor tissue from 30 patients with rectal adenocarcinomas undergoing PAR and from 37 patients operated on without preoperative radiotherapy (nonPAR group). We have also evaluated the predictive value of those histologic factors after radiotherapy. All patients were operated on between January 1994 and September 1996. Irradiated tumors showed transmural infiltration in the preoperative evaluation, and the neoplasms were located below the sacral promontory. Pathologic examination of the excised specimen showed 8 (26.7%) patients to be in AstlerColler stage Bl, 14 (46.6%) in B2 and 8 (26.7%) in C2. The non-PAR group included tumors with similar characteristics, but PAR was not administered due to advanced age or serious concomitant illness. Six (16.2%) patients were in stage Bl, 15 (40.6%) in B2 and 16 (43.2%) in C2. The median postoperative follow-up was 21 months. During this time 22 (32.8%) patients developed tumor recurrences, 10 (33%) in the PAR group (3 locoregional recurrences and 8 metastases;

Relationship Between Parathormone Concentration During Surgery and the Post-Operative Outcome of Primary Hyperparathyroidism

Abstract Introduction The relationship between the intra-operative concentration of parathyroid hormone (IOPTH) and the long-term outcome of patients intervened due to primary hyperparathyroidism (PHPT). Patients and methods A prospective observational study was performed with 120 patients. Three determinations were made of PTH in blood: baseline, when the diseases gland was located, and 10minutes after its extirpation. The calcium, PTH and vitamin D (25-OH-D3) levels were measured during follow up. Results A decrease in IOPTH>50% was observed in 96 (80%) patients, and the postextirpation value returned to the normal range (Group I), in 18 (15%) a decrease of >50% but the final value remained higher than normal (Group II) and in 6 (5%) the decrease was .001). Conclusion The risk of persistent PHPT is higher when the IOPTH decreases more than 50% but still remains high.

Pouch excision for recurrent serrated adenomas following restorative proctocolectomy for juvenile polyposis

PURPOSE: The study contained herein was undertaken to report the case of a patient with juvenile polyposis in whom multiple and rapid recurrence of mixed polyps, with progressive predominance of the adenomatous component, developed in a diverted ileoanal pouch. METHODS: The case of this patient with juvenile polyposis was reviewed. Despite regular surveillance and polypectomies, extensive and multiple recurrences of serrated polyps developed. RESULTS: Because the pouch was never cleared of polyps, a compromise to remove the pouch was decided on. Such a case has not been reported previously. CONCLUSION: Mixed juvenile polyposis may affect any level of the gastrointestinal tract. The ileal pouch and any rectal remnant may incidentally need surgical excision.

Relación entre concentración intraoperatoria de parathormona y evolución postoperatoria del hiperparatiroidismo primario

INTRODUCTION The relationship between the intra-operative concentration of parathyroid hormone (IOPTH) and the long-term outcome of patients intervened due to primary hyperparathyroidism (PHPT). PATIENTS AND METHODS A prospective observational study was performed with 120 patients. Three determinations were made of PTH in blood: baseline, when the diseases gland was located, and 10 minutes after its extirpation. The calcium, PTH and vitamin D (25-OH-D3) levels were measured during follow up. RESULTS A decrease in IOPTH > 50% was observed in 96 (80%) patients, and the post-extirpation value returned to the normal range (Group I), in 18 (15%) a decrease of > 50% but the final value remained higher than normal (Group II) and in 6 (5%) the decrease was<50% (Group III). Persistent PHPT was detected during follow up in 6 patients (5%): one in Group I (1%), 3 (16.7%) in II and 2 (33.3%) in group III (P<.001). The risk of persistent PHPT was higher in Group II (odds ratio: 19; 95% CI: 1.85-194) and in Group III (odds ratio: 47; 95% CI: 3.53-639). There were no cases of recurrent PHPT. A normal calcium with an increased PTH was detected in 20 patients of Group I (20.8%), 11 (61.1%) in II and 3 (50%) in III (P<.001). These patients had a lower concentration of post-operative vitamin D (17 ng/ml, range: 24; compared to 28 ng/ml, range: 21) (P=.008) and higher frequency of hypovitaminosis D (70.6% compared to 26.2%) (P>.001). CONCLUSION The risk of persistent PHPT is higher when the IOPTH decreases more than 50% but still remains high.