Physiological consequences of prolonged periods of flow limitation in patients with sleep apnea hypopnea syndrome

Flow limitation during sleep occurs when the rise in esophageal pressure is not accompanied by a flow increase which results in a non-rounded inspiratory flow shape. Short periods of flow limitation ending in an arousal or in a fall in SaO2 (hypopnea or upper airway resistance syndrome) are detrimental but the role of prolonged periods of flow limitation (PPFL) has not yet been clarified. This is important not only for diagnosis but also for nasal continuous positive airway pressure (CPAP) titration, especially for the automatic devices that need to be setup. The aim of this study was to analyze the effects of PPFL. We compared the behavior of the mean end-expiratory systemic blood pressure (SBP), end-tidal CO2, esophageal pressure and the pattern of breathing during a period of normal breathing at optimal (CPAP) and during PPFL at suboptimal CPAP in 14 patients with sleep apnea/hypopnea syndrome during a full polysomnography CPAP titration. The mean values of the parameters studied, at optimal and suboptimal CPAP were (1) SBP 92+/-13 vs. 91+/-15 mmHg (P: ns). At suboptimal CPAP, swings of blood pressure were associated with changes in pleural pressure; (2) SaO2 97.5+/-1.2 vs. 96.5+/-1.6 (P: 0.03), (3) end-tidal CO2 43.5+/-4 vs. 49.5+/-4 (P:0.001); (4) oesophageal pressure, 10.5+/-4 vs. 37.6+/-15 cmH2O (P:0.001) and (5) pattern of breathing: minute ventilation 6.6+/-1.4 vs. 6.1+/-1.2L/min (P: ns) and inspiratory time 1.24+/-0.3 vs. 1.66+/-0.4s (P:0.001). It can be concluded that PPFL induces significant physiological changes. Nevertheless, given the scant literature, clinical studies are warranted to elucidate the clinical role of these physiological changes.     

Systemic amyloidosis in inflammatory bowel disease: Retrospective study on its prevalence,clinical presentation,and outcome

BackgroundSystemic amyloidosis is a rare but life-threatening complication of inflammatory bowel disease (IBD), most cases being reported among Crohn's disease (CD) patients. The only two available retrospective studies showed a prevalence ranging from 0.9% to 3% among CD patients.AimsTo evaluate the prevalence of secondary systemic amyloidosis in a large IBD cohort of a referral centre, and to describe its clinical characteristics and outcome.MethodsPatients diagnosed with amyloidosis were identified among 1006 IBD patients included in the IBD database of our centre, and their medical records were carefully reviewed.ResultsAmong a total of 1006 IBD patients, 5 cases of amyloidosis were identified, all of them with CD, resulting in a prevalence of 0.5% for IBD and 1% for CD. Two patients died after developing renal failure. Two patients were treated with anti-TNF agents, showing a clinical improvement of their amyloidosis.ConclusionsSecondary amyloidosis occurs mainly in long-lasting, complicated, Crohn's disease and seems to be as prevalent among IBD patients as previously reported.     

Simultaneous excision of two cerebral abscesses with the capsule

Case report A boy of 8 suffering from hemoglobinopathy M had two encapsulated cerebral abscesses confirmed on CT—one in the right temporal lobe, the second in the left frontal lobe—measuring 48 and 58 mm in diameter respectively. The disease began with fever, daily vomiting, and permanent somnolency, and was defined as encephalitis of viral etiology.Treatment Conservative treatment proved ineffective and the patients state grew worse. He underwent simultaneous excision of the two cerebral abscesses with a capsule. Continuous drainage of the operational cavities was performed.Outcome The patient has been observed for 3 months.     

Espirometría como método de cribado y de intervención antitabaco en fumadores de alto riesgo en atención primaria

ObjectiveTo show the effectiveness of screening in the detection of new cases of COPD in smokers of high-risk, and to describe the characteristics associated with COPD, as well as determine the predisposition to quit.DesignA cross-sectional and multicentre study.LocationBasic Primary Care Centres representing different rural and urban areas of Lleida.ParticipantsA total of 497 active smokers without COPD from 40 to 70 years selected from the database Primary Care Database (e-CAP).InterventionSpirometry was performed on all patients. The spirometry results were reported and brief counselling was given on quitting smoking and the readiness to stop smoking was determined.VariablesAge, gender, height, weight, smoking, respiratory symptoms and physical activity.ResultsThe majority of patients (65.4%) were men, age 51± 7.6 years. They smoked an average of 32 packs/year; 40.4% performed moderate activity and 27.4% referred to some respiratory symptoms. Of the 25% who had an obstructive or mixed pattern, 75.8% of the cases had a moderate level of severity. A decision to quit was made by 38.8%.In the multivariate analysis, gender, age 50 to 59 years and a smoking index > 40 were associated with COPD. Moderate or intense physical activity decreased the risk of COPD.ConclusionsTo perform spirometry in high-risk smokers, to show the spirometry results and give brief anti-smoking counselling, enables not previously diagnosed cases of COPD to be detected. It also helps to determine the readiness to stop smoking and to establish individualised treatment and follow-up plans.     

Cetuximab as treatment for head and neck cancer patients with a previous liver transplant: report of two cases

Cetuximab is a monoclonal antibody against epidermal growth factor receptor useful in the treatment of patients with Head and Neck Squamous Cell Carcinoma combined with radiotherapy or chemotherapy. Its pharmacokinetics are not influenced by hepatic status and there are no specific warnings concerning its indication in patients with impaired hepatic function. Patients with a previous liver transplant are at risk for hepatic toxicity and use immunosupressants to avoid rejection that can interact with other drugs. We present two cases of patients with a previous liver transplant in which cetuximab was administered to treat head and neck cancer.     

Cocaine use in Europe - a multi-centre study: patterns of use in different groups

AIM: The study investigates patterns of cocaine powder and crack cocaine use of different groups in nine European cities. DESIGN, SETTING, PARTICIPANTS: Multi-centre cross-sectional study conducted in Barcelona, Budapest, Dublin, Hamburg, London, Paris, Rome, Vienna, and Zurich. Data were collected by structured face-to-face interviews. The sample comprises 1,855 cocaine users out of three subgroups: 632 cocaine users in addiction treatment, mainly maintenance treatment; 615 socially marginalized cocaine users not in treatment, and 608 socially integrated cocaine users not in treatment. MEASUREMENTS: Use of cocaine powder, crack cocaine and other substances in the last 30 days, routes of administration, and lifetime use of cocaine powder and crack cocaine. Findings: The marginalized group showed the highest intensity of cocaine use, the highest intensity of heroin use and of multiple substance use. 95% of the integrated group snorted cocaine powder, while in the two other groups, injecting was quite prevalent, but with huge differences between the cities. 96% of all participants had used at least one other substance in addition to cocaine in the last 30 days. CONCLUSIONS: The use of cocaine powder and crack cocaine varies widely between different groups and between cities. Nonetheless, multiple substance use is the predominating pattern of cocaine use, and the different routes of administration have to be taken into account.