Simpatectomía dorsal bilateral en el tratamiento de la hiperhidrosis esencial : efectos sobre la función cardiopulmonar /

Introducción: La hiperhidrosis esencial se caracteriza por un exceso de sudoración a nivel de las palmas de las manos, plantas de los pies y las axilas, debido a una hiperestimulación del sistema nervioso simpático que pasa a través del segundo y tercer ganglio torácico simpático (T2-T3). El tratamiento de elección es la simpatectomía dorsal bilateral (SDB) por videotoracoscopia. Es un tratamiento seguro en el que se han descrito cambios en la función pulmonar, relacionados con la denervación simpática, lo que indica una mayor actividad del sistema nervioso autónomo en estos pacientes. El objetivo de nuestro estudio fue evaluar los efectos de la SDB sobre la función cardiopulmonar antes, a los tres meses y a los tres años de la cirugía. Material y métodos: Se estudiaron un grupo de 20 pacientes (2 hombres; 18 mujeres) con una edad media de 29 (rango 17-43) y que presentaban una clínica de hiperhidrosis esencial de más de cinco años de evolución. Se determinaron la espirometría, volúmenes pulmonares estáticos, determinación de óxido nítrico en aire exhalado, prueba de provocación con metacolina y prueba de esfuerzo máxima, antes y a los 3 meses de la cirugía. A los tres años se repitieron las mismas pruebas a excepción de la prueba de esfuerzo y se compararon con las previas a la cirugía. La SDB se realizó por videotoracoscopia y mediante electrocoagulación de los ganglios simpáticos entre T2 y T3. Resultados: Los valores de la espirometría (FVC, FEV1,FEV1/FVC) y volúmenes estáticos (RV, FRC y TLC) no mostraron diferencias estadísticamente significativas, antes y a los tres meses de la cirugía. La única variable que mostró modificaciones fue el MMEF que pasó de 105(26)% a 95(27)%; p 0.05. En 10 pacientes se observó una prueba de provocación bronquial positiva previa y se mantuvo en el mismo valor después de la cirugía, positivándose en dos pacientes más tras la intervención. La única variable que mostró modificaciones durante la prueba de esfuerzo fue la FC máxima que pasó de 172(17) lat/min a 162(15) lat/min; p 0.05. A los 3 años se detectó un incremento estadísticamente significativo del porcentaje de la capacidad vital forzada basal, que pasó de un valor medio (± desviación estándar) del 96 ± 10% al 101 ± 11% (p = 0,008). Respecto a las cifras iniciales del flujo máximo mesoespiratorio, se halló un descenso estadísticamente significativo a los 3 años de la cirugía: de un valor basal de 3,8 ± 0,9 l/s se pasó a 3,5 ± 0,9 l/s (p = 0,01). La prueba de provocación bronquial con metacolina y la concentración de óxido nítrico en aire espirado no experimentaron cambios a los 3 años. Conclusiones: La SDB es el tratamiento de elección de la hiperhidrosis esencial. Es una técnica quirúrgica segura, mínimamente invasiva y con buenos resultados a largo plazo. Las modificaciones en la función pulmonar indican una mínima afectación de la pequeña vía aérea, que persiste a los 3 años de la SDB, presencia de hiperrespuesta bronquial positiva y un ligero bloqueo sobre la frecuencia cardiaca, como consecuencia de la denervación simpática producida por la cirugía, pero sin ninguna significación clínica.Background: Essential hyperhidrosis is characterized by an overactivity of the sympathetic fibres passing through the upper dorsal ganglia T2-T3 and the treatment of choice is video-assisted thoracoscopy sympathectomy. It is a safe treatment but alterations in cardiopulmonary function after treatment have been reported, related to an overactivity of the autonomic nervous system in these patients. Study objective: To evaluate cardiopulmonary function impairment after sympathectomy in patients with essential hyperhidrosis, before, at three months and three years after surgery.. Design and setting: Prospective controlled trial at a Pulmonary Function Unit of an university hospital. Patients: Twenty patients (M: 2; F: 18) with essential hyperhidrosis. At three years, eighteen patients (M: 3; F: 15) of twenty studied previously were revisited. Measurements and results: Pulmonary function tests-including spirometry and thoracic gas volume, bronchial challenge test with methacholine and maximal exercise test-were performed before and three months after T2-T3 sympathectomy. At three years we repeated the same test with an exception, maximal exercise test and we compare the results with initial values. Video-assisted sympathectomy was performed using a one-stage bilateral procedure with electrocoagulation of T2-T3 ganglia. Pulmonary function values (spirometrics and volumes) were not statistically different in the two groups. The maximal mid-expiratory flow (MMEF) was the only variable that shows significant changes from 101%(26) to 92%(27); p 0.05. Ten patients had positive bronchial challenge tests that remained positive three months after surgery and two patients whose challenge tests were negative before surgery became positive after sympathectomy. Significant reductions in maximal heart rate and oxygen and CO2 uptakes were observed during the maximal exercise test. There was a significant statistical increment in initial forced expiratory volume (FVC) at three years, changing from 96 ± 10% to 101 ± 11%(p= 0.008). The maximal mid-expiratory flow (MMEF) shows a significant decrease at three years, changing from 3,8 ± 0,9 L/s to 3,5 ± 0,9 L/s (p= 0.01). There were no changes in bronchial challenge tests and NO determination at three years. Conclusions: Video-assisted thoracoscopic is a safe treatment and the observed modifications in cardiopulmonary function only suggest a minimal small airway alterations in, presence of positive bronchial hyperresponsiveness and mild sympathetic blockade in heart rate that remained at three years after surgery. The clinical importance of these findings is not significant

Asthma outcomes improve with continuous positive airway pressure for obstructive sleep apnea

Continuous positive airway pressure () in asthma patients with concomitant obstructive sleep apnea syndrome () seems to have a favorable impact on asthma, but data are inconsistent due to methodological limitations of previous studies. Prospective, multicenter study. We examined asthma outcomes after 6 months of in 99 adult asthma patients (mean age 57 years) with (respiratory disturbance index ≥20). Asthma control and quality of life were assessed with the Asthma Control Questionnaire () and the Mini Asthma Quality of Life Questionnaire (Mini), respectively. Data were analyzed by intention-to-treat basis. The mean ± score of the decreased from 1.39 ± 0.91 at baseline to 1.0 ± 0.78 at 6 months (P = 0.003), the percentage of patients with uncontrolled asthma from 41.4% to 17.2% (P = 0.006), and the percentage of patients with asthma attacks in the 6 months before and after treatment from 35.4% to 17.2% (P = 0.015). The score of the increased from 5.12 ± 1.38 to 5.63 ± 1.17 (P = 0.009). There were also significant improvements in symptoms of gastroesophageal reflux and rhinitis, bronchial reversibility, and exhaled nitric oxide values (all P < 0.05). No significant changes were observed in drug therapy for asthma or their comorbidities nor in the patients' weight. Asthma control (both actual and future risk), quality of life, and lung function improved after starting continuous positive airway pressure in asthmatics with moderate to severe obstructive sleep apnea syndrome

Asthma outcomes improve with continuous positive airway pressure for obstructive sleep apnea

Continuous positive airway pressure () in asthma patients with concomitant obstructive sleep apnea syndrome () seems to have a favorable impact on asthma, but data are inconsistent due to methodological limitations of previous studies. Prospective, multicenter study. We examined asthma outcomes after 6 months of in 99 adult asthma patients (mean age 57 years) with (respiratory disturbance index ≥20). Asthma control and quality of life were assessed with the Asthma Control Questionnaire () and the Mini Asthma Quality of Life Questionnaire (Mini), respectively. Data were analyzed by intention-to-treat basis. The mean ± score of the decreased from 1.39 ± 0.91 at baseline to 1.0 ± 0.78 at 6 months (P = 0.003), the percentage of patients with uncontrolled asthma from 41.4% to 17.2% (P = 0.006), and the percentage of patients with asthma attacks in the 6 months before and after treatment from 35.4% to 17.2% (P = 0.015). The score of the increased from 5.12 ± 1.38 to 5.63 ± 1.17 (P = 0.009). There were also significant improvements in symptoms of gastroesophageal reflux and rhinitis, bronchial reversibility, and exhaled nitric oxide values (all P < 0.05). No significant changes were observed in drug therapy for asthma or their comorbidities nor in the patients' weight. Asthma control (both actual and future risk), quality of life, and lung function improved after starting continuous positive airway pressure in asthmatics with moderate to severe obstructive sleep apnea syndrome

Simpatectomia dorsal bilateral en el tratamiento de la hiperhidrosis esencial: efectos sobre la función cardiopulmonar

Introducción: La hiperhidrosis esencial se caracteriza por un exceso de sudoración a nivel de las palmas de las manos, plantas de los pies y las axilas, debido a una hiperestimulación del sistema nervioso simpático que pasa a través del segundo y tercer ganglio torácico simpático (T2-T3). El tratamiento de elección es la simpatectomía dorsal bilateral (SDB) por videotoracoscopia. Es un tratamiento seguro en el que se han descrito cambios en la función pulmonar, relacionados con la denervación simpática, lo que indica una mayor actividad del sistema nervioso autónomo en estos pacientes. El objetivo de nuestro estudio fue evaluar los efectos de la SDB sobre la función cardiopulmonar antes, a los tres meses y a los tres años de la cirugía. Material y métodos: Se estudiaron un grupo de 20 pacientes (2 hombres; 18 mujeres) con una edad media de 29 (rango 17-43) y que presentaban una clínica de hiperhidrosis esencial de más de cinco años de evolución. Se determinaron la espirometría, volúmenes pulmonares estáticos, determinación de óxido nítrico en aire exhalado, prueba de provocación con metacolina y prueba de esfuerzo máxima, antes y a los 3 meses de la cirugía. A los tres años se repitieron las mismas pruebas a excepción de la prueba de esfuerzo y se compararon con las previas a la cirugía. La SDB se realizó por videotoracoscopia y mediante electrocoagulación de los ganglios simpáticos entre T2 y T3. Resultados: Los valores de la espirometría (FVC, FEV1,FEV1/FVC) y volúmenes estáticos (RV, FRC y TLC) no mostraron diferencias estadísticamente significativas, antes y a los tres meses de la cirugía. La única variable que mostró modificaciones fue el MMEF que pasó de 105(26)% a 95(27)%; p<0.05. En 10 pacientes se observó una prueba de provocación bronquial positiva previa y se mantuvo en el mismo valor después de la cirugía, positivándose en dos pacientes más tras la intervención. La única variable que mostró modificaciones durante la prueba de esfuerzo fue la FC máxima que pasó de 172(17) lat/min a 162(15) lat/min; p<0.05. A los 3 años se detectó un incremento estadísticamente significativo del porcentaje de la capacidad vital forzada basal, que pasó de un valor medio (± desviación estándar) del 96 ± 10% al 101 ± 11% (p = 0,008). Respecto a las cifras iniciales del flujo máximo mesoespiratorio, se halló un descenso estadísticamente significativo a los 3 años de la cirugía: de un valor basal de 3,8 ± 0,9 l/s se pasó a 3,5 ± 0,9 l/s (p = 0,01). La prueba de provocación bronquial con metacolina y la concentración de óxido nítrico en aire espirado no experimentaron cambios a los 3 años. Conclusiones: La SDB es el tratamiento de elección de la hiperhidrosis esencial. Es una técnica quirúrgica segura, mínimamente invasiva y con buenos resultados a largo plazo. Las modificaciones en la función pulmonar indican una mínima afectación de la pequeña vía aérea, que persiste a los 3 años de la SDB, presencia de hiperrespuesta bronquial positiva y un ligero bloqueo sobre la frecuencia cardiaca, como consecuencia de la denervación simpática producida por la cirugía, pero sin ninguna significación clínica.Background: Essential hyperhidrosis is characterized by an overactivity of the sympathetic fibres passing through the upper dorsal ganglia T2-T3 and the treatment of choice is video-assisted thoracoscopy sympathectomy. It is a safe treatment but alterations in cardiopulmonary function after treatment have been reported, related to an overactivity of the autonomic nervous system in these patients. Study objective: To evaluate cardiopulmonary function impairment after sympathectomy in patients with essential hyperhidrosis, before, at three months and three years after surgery.. Design and setting: Prospective controlled trial at a Pulmonary Function Unit of an university hospital. Patients: Twenty patients (M: 2; F: 18) with essential hyperhidrosis. At three years, eighteen patients (M: 3; F: 15) of twenty studied previously were revisited. Measurements and results: Pulmonary function tests—including spirometry and thoracic gas volume, bronchial challenge test with methacholine and maximal exercise test—were performed before and three months after T2-T3 sympathectomy. At three years we repeated the same test with an exception, maximal exercise test and we compare the results with initial values. Video-assisted sympathectomy was performed using a one-stage bilateral procedure with electrocoagulation of T2-T3 ganglia. Pulmonary function values (spirometrics and volumes) were not statistically different in the two groups. The maximal mid-expiratory flow (MMEF) was the only variable that shows significant changes from 101%(26) to 92%(27); p<0.05. Ten patients had positive bronchial challenge tests that remained positive three months after surgery and two patients whose challenge tests were negative before surgery became positive after sympathectomy. Significant reductions in maximal heart rate and oxygen and CO2 uptakes were observed during the maximal exercise test. There was a significant statistical increment in initial forced expiratory volume (FVC) at three years, changing from 96 ± 10% to 101 ± 11%(p= 0.008). The maximal mid-expiratory flow (MMEF) shows a significant decrease at three years, changing from 3,8 ± 0,9 L/s to 3,5 ± 0,9 L/s (p= 0.01). There were no changes in bronchial challenge tests and NO determination at three years. Conclusions: Video-assisted thoracoscopic is a safe treatment and the observed modifications in cardiopulmonary function only suggest a minimal small airway alterations in, presence of positive bronchial hyperresponsiveness and mild sympathetic blockade in heart rate that remained at three years after surgery. The clinical importance of these findings is not significan

Optimal clinical time for reliable measurement of transcutaneous CO2 with ear probes : counterbalancing overshoot and the vasodilatation effect

Objectives: To determine the optimal clinical reading time for the transcutaneous measurement of oxygen saturation (SpO2) and transcutaneous CO2 (TcPCO2) in awake spontaneously breathing individuals, considering the overshoot phenomenon (transient overestimation of arterial PaCO2). Experimental section: Observational study of 91 (75 men) individuals undergoing forced spirometry, measurement of SpO2 and TcPCO2 with the SenTec monitor every two minutes until minute 20 and arterial blood gas (ABG) analysis. Overshoot severity: (a) mild (0.1-1.9 mm Hg); (b) moderate (2-4.9 mm Hg); (c) severe: (>5 mm Hg). The mean difference was calculated for SpO2 and TcPCO2 and arterial values of PaCO2 and SpO2. The intraclass correlation coefficient (ICC) between monitor readings and blood values was calculated as a measure of agreement. RESULTS: The mean age was 63.1 ± 11.8 years. Spirometric values: FVC: 75.4 ± 6.2%; FEV1: 72.9 ± 23.9%; FEV1/FVC: 70 ± 15.5%. ABG: PaO2: 82.6 ± 13.2; PaCO2: 39.9.1 ± 4.8 mmHg; SaO2: 95.3 ± 4.4%. Overshoot analysis: overshoot was mild in 33 (36.3%) patients, moderate in 20 (22%) and severe in nine (10%); no overshoot was observed in 29 (31%) patients. The lowest mean differences between arterial blood gas and TcPCO2 was -0.57 mmHg at minute 10, although the highest ICC was obtained at minutes 12 and 14 (>0.8). The overshoot lost its influence after minute 12. For SpO2, measurements were were reliable at minute 2. CONCLUSIONS: The optimal clinical reading measurement recommended for the ear lobe TcPCO2 measurement ranges between minute 12 and 14. The SpO2 measurement can be performed at minute 2

Activation of kaolinite based coal waste: chemical and thermal activation and their mineralogy

Trabajo presentado a la 10th International Conference on the Environmental and Technical Implications of Construction with Alternative Materials (WASCON), celebrada en Tampere (Finlandia) del 6 al 8 de junio de 2018

Encuesta sobre la actividad de los laboratorios de función pulmonar. Efectos durante la pandemia por SARS-CoV-2

A raíz de la pandemia de SARS-CoV-2 en marzo del 2020 los laboratorios de función pulmonar (LFP) sufrieron una transformación, con la reducción del número de pruebas o cierre en algunos casos. El objetivo de este trabajo fue conocer la actividad de los LFP en España y la modificación de esta debido a la pandemia. Se realizó una encuesta protocolizada a los miembros de los LFP a través de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Contestaron 39 hospitales del territorio nacional. Las pruebas de función pulmonar que más se realizaban en los LFP fueron: espirometría forzada con prueba broncodilatadora (100%), pletismografía corporal (97,4%), capacidad de transferencia CO (97,4%), fuerza de los músculos respiratorios medidos en boca (97,4%), prueba de la marcha de 6 min (94,7%), medición de fracción exhalada de óxido nítrico (92,3%) y prueba de esfuerzo incremental (71,8%). La pandemia produjo un descenso significativo en el número de pruebas (35,4%) durante el 2020 con posterior recuperación en el 2021, sin llegar a valores prepandemia. Los cambios más importantes fueron: incremento en los tiempos de exploración, el trabajo con equipos de protección individual y la ventilación de los espacios. La realización del frotis nasofaríngeo para estudio de SARS-CoV-2 previo a las pruebas no fue homogénea en los LFP. La mayoría de los hospitales disponen del equipamiento suficiente para la realización de las pruebas de función pulmonar más frecuentes. La pandemia supuso una pérdida de actividad en todos los hospitales

One year of recombinant human growth hormone treatment in adults with Prader-Willi syndrome improves body composition, motor skills and brain functional activity in the cerebellum

We compared body composition, biochemical parameters, motor function, and brain neural activation in 27 adults with Prader-Willi syndrome and growth-hormone deficiency versus age-and sex-matched controls and baseline versus posttreatment values of these parameters after one year of recombinant human growth hormone (rhGH) treatment. To study body composition, we analyzed percentage of fat mass, percentage of lean mass, and muscle-mass surrogate variables from dual X-ray absorptiometry. Biochemical parameters analyzed included IGF-I, glucose metabolism, and myokines (myostatin, irisin, and IL6). To explore muscle function, we used dynamometer-measured handgrip strength, the Timed Up and Go (TUG) test, and the Berg Balance Scale (BBS). To study brain activation, we acquired functional magnetic resonance images during three motor tasks of varying complexity. After one year of treatment, we observed an increase in lean mass and its surrogates, a decrease in fat mass, improvements in TUG test and BBS scores, and increased neural activation in certain cerebellar areas. The treatment did not significantly worsen glucose metabolism, and no side-effects were reported. Our findings support the benefits of rhGH treatment in adults with Prader-Willi syndrome and growth-hormone deficiency on body composition and suggest that it may also improve balance and brain neural activation

Binary cements with high coal waste contents: Properties and behaviour against CO2

It is well known that there are several scientific, technical and environmental advantages of incorporating active additions to the cement, due to its ability to react chemically with the portlandite generated during the hydration reaction of the cement particles, to give more dense and compact matrices. The coal wastes are an alternative source of obtaining future ecological pozzolans, fundamental pillar of the main strategy of the Circular Economy. As a result, an improvement in the blended cement performances was obtained. However, some aspects regarding the durability due to CO2 reaction have not been solved. A wide range of pozzolans (silica fume, fly ash, natural pozzolan, natural metakaolinite) are found in kaolinite-based industrial wastes (paper waste, potable water treatment), which are an excellent alternative for the socio-economic development of a country. The current work presents the scientific-technical advances of coal wastes as supplementary cementing material for the manufacture of low clinker cements and their influence under the action of CO2. The obtained results show that, after thermal activation, the products obtained have a high pozzolanic activity in the range of 550 and 650ºC and the kinetics reaction is similar to other pozzolans of silico-aluminous nature. After exposure to CO2 environment, the behaviour of the pozzolanic material is similar to cement, used as reference, when the percentage of substitution is low; while the 50% blended cements showed a rapid carbonation process.Peer reviewe

Asthma outcomes improve with continuous positive airway pressure for obstructive sleep apnea

Continuous positive airway pressure () in asthma patients with concomitant obstructive sleep apnea syndrome () seems to have a favorable impact on asthma, but data are inconsistent due to methodological limitations of previous studies. Prospective, multicenter study. We examined asthma outcomes after 6 months of in 99 adult asthma patients (mean age 57 years) with (respiratory disturbance index ≥20). Asthma control and quality of life were assessed with the Asthma Control Questionnaire () and the Mini Asthma Quality of Life Questionnaire (Mini), respectively. Data were analyzed by intention-to-treat basis. The mean ± score of the decreased from 1.39 ± 0.91 at baseline to 1.0 ± 0.78 at 6 months (P = 0.003), the percentage of patients with uncontrolled asthma from 41.4% to 17.2% (P = 0.006), and the percentage of patients with asthma attacks in the 6 months before and after treatment from 35.4% to 17.2% (P = 0.015). The score of the increased from 5.12 ± 1.38 to 5.63 ± 1.17 (P = 0.009). There were also significant improvements in symptoms of gastroesophageal reflux and rhinitis, bronchial reversibility, and exhaled nitric oxide values (all P < 0.05). No significant changes were observed in drug therapy for asthma or their comorbidities nor in the patients' weight. Asthma control (both actual and future risk), quality of life, and lung function improved after starting continuous positive airway pressure in asthmatics with moderate to severe obstructive sleep apnea syndrome