Abordajes en cirugía tiroidea

Thyroidectomy is the most frequent procedure in endocrine surgery. The conventional approach through a collar incision, as described by Kocher in XIX^th century, has become the “gold standard”. It is continuously evolving in spite of, many years ago, it showed to be safe and efficient with quality standards difficult to beat.Endoscopic and robotic surgery have developed “new approaches” to thyroid in order to improve the cosmetic results, looking even for invisible scars.We have done a thoughtful review of most of them trying to understand their benefits and drawbacks.Currently none of these “new approaches” have been shown to be better than conventional open thyroidectomy beyond offering a better cosmetic result. Besides, only a small percentage of patients can benefit of them. However, most of these approaches will remain if they treat the diseased thyroid and also improve the quality of life of our patients.     

Mulibrey nanism: Three additional patients and a review of 39 patients

We report on 3 patients with Mulibrey nanism (MN), or Perheentupa syndrome: the first 2 sibs from Argentina and a new patient from Spain. All 3 patients had growth failure, short stature, abnormal pigmentary retinal changes, and a J-shaped sella turcica. These findings are considered major criteria of MN. Two had pericardial constriction, which is a frequent and lifethreatening abnormality in this syndrome. MN is a rare autosomal recessive condition. Reviewing the 39 patients described so far, we have classified the anomalies into the very frequent (present in more than 66%), frequent (in at least 25%), and not frequent. Identifying the anomalies specific to MN should help its early diagnosis and treatment. © 1995 Wiley-Liss, Inc.     

Epidemiology of neurosensorial deafness in the Foral Community of Navarra

Congenital deafness is a relatively frequent disorder that shows a heterogeneous aetiology. Knowledge and the control of some risk factors have decreased the incidence of acquired deafness and increased the relative importance of genetic cause. In an attempt to investigate the clinical relevance of congenital deafness and the mechanisms of prevention in our population, a clinical and genetic study of cases with neurosensorial deafness born in Navarra between 1975 and 1990 was carried out. A total of eighty-one cases were identified, giving an incidence of 0.8 per thousand. Thirty per cent of the cases showed deafness associated with defects. Cause of deafness was identified in seventy per cent of the cases with whom a detailed clinical and genetic study could be performed (n=50). Genetic factors were responsible for the disorder in more than half of these cases. The most frequent hereditary factor was of the autosomic recessive type. This was associated with a more severe form of hearing loss.     

Evaluation of the Program for the Prevention and Control of Tuberculosis during the period January 1993 - June 1996

In 1992 a Technical Commission was formed in Navarra with the participation of different specialists who drew up the Program of Vigilance and Control of Tuberculosis. We present the results of the evaluation of this program for the period from January 1993 to June 1996. In the 3.5 years of the study, 419 cases of tuberculosis were found, 317 belonging to respiratory forms and 102 to extra-respiratory forms. The annual rate of incidence of total tuberculosis, 22.8 cases per 100,000 inhabitants observed in Navarra, is the lowest of those registered at the level of the Autonomous Communities according to the TIR study of the SEPAR (acronym for Spanish Society of Pneumology and Thoracic Surgery) in 1996, and the second lowest, after Castilla-La Mancha, according to the multicentric study of the National Centre of Epidemiology. In Navarra the highest rates of incidence are produced in those over 65 years of age, following the pattern observed in the more developed countries. 13.9% of the patients with respiratory tuberculosis showed co-infection by HIV, and besides more than 90% of these were users of intravenous drugs. The percentage of immigrants, prisoners and the destitute observed in the Navarra series is lower than that found in areas such as Madrid, Barcelona or Zaragoza. 91% of the cases of respiratory tuberculosis showed bacteriological confirmation and 98% of the cases were diagnosed and treated in specialised care. Outstanding were the high follow-up of the cases until discharge and the high percentage of cures achieved, some 85.4%.     

Decreased serum ubiquinone-10 concentrations in phenylketonuria.

BACKGROUND: Ubiquinone-10 is a lipid with important metabolic functions that may be decreased in phenylketonuria (PKU) because patients with PKU consume diets restricted in natural proteins. OBJECTIVE: We studied serum ubiquinone-10 concentrations in PKU patients. DESIGN: This was a retrospective, transversal study in which we compared serum ubiquinone-10, plasma cholesterol, plasma tyrosine, and plasma phenylalanine concentrations in 43 PKU patients with concentrations in a reference population (n = 102). Serum ubiquinone-10 concentrations were analyzed by HPLC with ultraviolet detection. Plasma tyrosine and phenylalanine were measured by ion-exchange chromatography. RESULTS: Serum ubiquinone-10 concentrations in PKU patients were significantly lower than in the reference population (P < 0.01 for patients aged 1 mo to <8 y and P < 0.00005 for patients aged 8-33 y). Moreover, 5 of 18 PKU patients (28%) in the younger age group and 10 of 23 (43%) in the older age group had serum ubiquinone-10 concentrations below the reference interval. CONCLUSIONS: Serum ubiquinone-10 deficiency appears to be related to the restricted diet of PKU patients. Because serum ubiquinone-10 plays a major antioxidant role in the protection of circulating lipoproteins, the correction of ubiquinone-10 concentrations should be considered in PKU patients. Further investigation seems advisable to elucidate whether the deficiency in serum ubiquinone-10 status is clinically significant.     

An interdisciplinary national program developed at Baylor to make science exciting for all K-5 students.

The achievement gap in science begins in elementary school, where many students lose interest in science-related studies, particularly students from traditionally underrepresented groups. The "My Health My World" Project (hereafter, "the Project"), developed at Baylor College of Medicine with the assistance of federal funds, is a national effort to address this problem. The Project's goals are to make science appealing and relevant for elementary school students (i.e., kindergarten through grade five), including those from underrepresented minorities (URMs), and easy to teach for teachers and parents. It is achieving this goal by the development of interdisciplinary instructional materials that use environmental health issues as a unifying theme. The Project provides its materials (including take-home materials for parents) and training for teachers at seven dissemination centers across the country, established in 1997. Workshops are also held to train facilitators, chosen from among local science education leaders, who in turn hold workshops to train other teachers. Each center receives a mini-grant to cover costs related to the training it provides, and all coordinate their training to offer comparable experiences for all participants. Field tests in 1995, 1996, and 1997 involving culturally, racially, and ethnically diverse students and teachers in two sites indicate that the participating teachers found that the Project's materials promote science learning and enthusiasm for science and are easy to use and engaging for teachers. Ratings for workshops in 1998 were also high for all characteristics evaluated. All signs after the Project's first full year of dissemination activities (1998) indicate that it will continue to reach more teachers and students across the nation and will eventually help more students from all backgrounds achieve in science-related studies.     

CT evaluation of gastric wall pathology

The purpose of this study is to show the CT features of common and infrequent pathological lesions of the gastric wall. Although CT features are not often specific, familiarity with the most frequent pathological gastric findings on CT can assist in differential diagnosis.     

Subjective versus statistical model assessment of mortality risk in open heart surgical procedures

BACKGROUND: The aim of this study was to compare the predictive accuracy for open heart surgical mortality between a statistical model based on collection of clinical data and surgeons' subjective risk assessment. METHODS: Predictive discrimination of both risk assessments (surgeons' and model) was compared through the area under the receiver operating characteristic curve. Logistic regression analysis was used to assess the relation between surgeons' and model predictions to actual outcomes. Calibration of the subjective estimates was evaluated with a chi2 test. RESULTS: Overall, the area under the receiver operating characteristic curve was 0.76 for the statistical model and 0.70 for the subjective assessment. Logistic regression analysis showed that the statistical model remained significant after accounting for the subjective assessment. Calibration of subjective mortality predictions was poor. CONCLUSIONS: Surgeons' risk assessment tends to cluster in the middle ranges of risk. Subjective assessment seems accurate in identifying the two extremes of risk but is inaccurate for intermediate risk levels. A multivariate statistical model improves the accuracy of subjective predictions.