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Background: This study compared the efficacy of topical anaesthesia with levobupivacaine 0.75% vs lidocaine 2% during cataract surgery by phacoemulsification.Methods: A prospective, randomized, double-blind study comparing two agents for topical anaesthesia in cataract surgery. Two hundred and forty-six consecutive patients undergoing corneal phacoemulsification were enrolled into two groups to receive either topical levobupivacaine 0.75% (n=126) or lidocaine 2% (n=120). The main outcome variables of the study were intraoperative and postoperative pain, requirement for additional anaesthesia, patient comfort and cooperation, surgeon satisfaction, and corneal epithelial toxicity induced by topical drugs.Results: evobupivacaine 0.75% provided significantly better analgesia than lidocaine 2% during cataract surgery (P<0.001) at the end of surgery (P<0.002), and up to 30 min after surgery (P<0.001). There were no statistically significant differences between the two groups 5 h after surgery. Epithelial toxicity was similar in both groups, and patient comfort and surgeon assessment of patient cooperation were better in the levobupivacaine group.Conclusions: Topical anaesthesia with levobupivacaine 0.75% was more effective than lidocaine 2% in preventing pain and improving patient and surgeon comfort during cataract surgery, with similar toxicity. [ABSTRACT FROM AUTHOR]

Due to limited studies, we systematically reviewed evidence on the impact of physical exercise on intraocular pressure (IOP) in glaucoma patients, adhering to PRISMA guidelines. Using MEDLINE/Web of Science, PubMed, and Scopus, we selected English, Portuguese, or Spanish studies excluding case reports and yoga-based interventions. From 1001 records, 15 studies were independently evaluated. Evaluated through the MMAT scoring system, two quantitative randomised controlled studies scored 100% while 13 non-randomised studies averaged 84.62%. Our findings indicated that both aerobic and resistance training led to an immediate IOP reduction post-exercise. However, these findings were largely from single-session experiments. In contrast, the effects of longer-term exercise programmes on IOP varied. Although our review underscores the potential utility of exercise in IOP management, the evidence remains inconclusive due to variations in study design, participant demographics, and exercise parameters. This lack of consistency in the research highlights the necessity for larger, standardised, and longer-term studies to robustly corroborate these preliminary findings., (© 2024. The Author(s).)

Body dissatisfaction is commonly associated with rhythmic gymnastics (RG) practice, but limited research exists on the prevalence of this issue among recreational level practitioners. This study examines body image dissatisfaction among young girls practicing RG recreationally. A total of 88 girls between six and eleven years of age, who participate in RG as an extracurricular activity, were measured and completed the Stunkard pictogram. To create a control group, 88 girls who did not practice RG were also recruited and matched to the gymnasts by age. Results revealed that the mean body mass index values in both groups were within the normal weight range. The mean score for body dissatisfaction was similar between the two groups, with slightly positive values (RG = 0.94; CG = 1.06). The Mann-Whitney U test showed that there was no significant difference in the ratings of actual body size, ideal body size, and body dissatisfaction between the RG and control groups. These findings suggest that practicing RG at a young age is not associated with body dissatisfaction among girls.

There is evidence that elite soccer players live longer than general population, but there is no information on soccer coaches and referees. We aimed to analyze the longevity of both professionals, comparing them with soccer players and with general population. In this retrospective cohort study, a total of 328 male Spanish soccer coaches, 287 referees, and 1230 soccer players, all born before 1950, were divided in two cohorts, matched 2:1 with coaches and referees. We compared the survival of the cohorts with the Kaplan-Meier estimator and significance with the log-rank test. We calculated hazard ratios of death for coaches and referees compared with male Spanish general population of the same period. Differences in survival among cohorts were found, but they did not reach statistical significance. The estimated median survival time was 80.1 years (95% CI 77.7-82.4) for referees, 78 years (95% CI 76.6-79.3) for coaches, 78.8 years (95% CI 77.6-80) for referees matched with players, and 76.6 years (95% CI 75.3-77.9) for coaches matched with players. Both coaches and referees had lower mortality than general population, but this advantage disappeared after 80 years of age. We found no differences in longevity among Spanish elite soccer referees, coaches and players born before 1950. Both coaches and referees had lower mortality than general population, but this advantage disappeared after 80 years of age.

Introduction: Limited research has explored the influence of quality of life (QoL) and disease severity on physical activity (PA) in Parkinson's disease (PD) patients, and the sources of PA prescription and advice for this population. This study aims to expand scientific knowledge on these topics., Patients and Methods: Two-hundred eleven PD patients were personally interviewed to collect data on PA levels using the International Physical Activity Questionnaire-Short Form and QoL using the Parkinson's Disease Questionnaire-8. An ad hoc questionnaire gathered information on disease severity (Hoehn and Yahr stages), PA behaviors, and PA recommendations., Results: Weak but significant associations were found between PA levels, disease severity (r: -0.218; p = 0.004), and QoL (r: -0.244; p = 0.001). Most participants (85%) received PA counselling, predominantly from neurologists, either at diagnosis (52%) or shortly after (28%). Before PD onset, ~86% engaged in PA, decreasing to 66% post-diagnosis. Approximately 78% reported changes in PA, including reduced frequency (18.4%) and duration (32.8%), with walking as the primary activity., Conclusions: Disease severity and QoL significantly affect PA levels in PD patients. Diagnosis is associated with decreased PA frequency and duration, and walking is the preferred activity. Neurologists primarily provide PA advice.

Background and Objective: To revise and critically summarize the available scientific evidence regarding the effect of exercise on sleep quality in patients with chronic kidney disease (CKD)., Methods: A systematic review of randomized controlled trials (RCTs) and comparative studies was conducted, searching MEDLINE/PubMed, SPORTDiscus, and Scopus using keywords "Exercise", "Physical Activity", "Chronic Kidney Disease," and "Sleep". The methodological quality of included studies was assessed using the PEDRo and MINORS scales., Results: A total of 8 RCTs and 3 comparative studies were included, showing a low (n = 1), fair (n = 7), and good (n = 3) methodological quality. Most of the studies included patients undergoing hemodialysis (HD) (n = 8). Self-reported sleep quality (n = 9), sleepiness (n = 2), and objective sleep status (n = 2) were the main outcomes analyzed. The most frequent exercise interventions included aerobic training (n = 7), resistance training (n = 2), or a combination of both (n = 4). Generally, exercise induced positive effects on the reported outcomes. Data synthesis indicated that participants who exercised obtained significant improvements on their self-reported sleep quality in comparison with those included in the control groups, with a mean difference in the Pittsburgh Sleep Quality Index of - 5.27 points (95% CI - 7.76, - 2.77; p < 0.001)., Conclusion: Preliminary scientific evidence indicates that patients with CKD, especially those undergoing HD, report improvements in self-reported sleep quality after taking part in aerobic exercise programs, while combined training interventions yielded diverse findings. The effects of exercise on sleepiness and objective sleep status were backed by few studies with mixed results., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

This review aimed to systematically evaluate and meta-analyze the available data on the effects of Brain Gym (BG) on cognitive function in older people. Six electronic databases were searched systematically using: "Brain Gym" AND "elderly, "Brain Gym" AND "older people". The PEDro and MINORS scales were used to evaluate methodological quality. For the meta-analysis, inverse variance or generic inverse variance was used and heterogeneity was assessed with the Chi2 test and I2 test. Ten research studies with a high to low quality. Significant changes intra- and inter-group were observed for neurocognitive outcomes in the BG groups. Findings from the metaanalysis indicated changes in the BG groups, on cognitive function by means of the Mini-Mental State Examination, were not greater than those reported in the control/comparison groups. BG will not lead to improvements in cognitive function in people with and without cognitive impairment, supported by low to high evidence., Competing Interests: Declaration of Competing Interest The authors report that this study has been conducted without funding and that they have no competing interests to declare., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction and Hypothesis: Studies on the prevalence of urinary incontinence (UI) among CrossFit practitioners are on the rise. This systematic review with meta-analysis was aimed at determining the prevalence of UI among CrossFit practitioners., Methods: A systematic review of the literature was performed by searching MEDLINE/PubMed, Scopus, and SPORTDiscus through January 2021. The search strategy included the keywords CrossFit, urine incontinence, exercise, high impact and pelvic floor dysfunction. The inclusion criterion was any study with a sample of CrossFit practitioners and results separated from the other fitness modalities analysed. The subjects were women with no restriction of age, parity, experience or frequency of training. Quality assessment of the studies included was conducted using the Oxford Centre of Evidence-Based Medicine scale and the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies., Results: Thirteen studies (6 comparative and 7 non-comparative) were included for the systematic review, all using a cross-sectional design. The level of evidence was 4, with their quality ranging from poor (n = 10) to fair (n = 3). A total of 4,823 women aged 18 to 71 were included, 91.0% participated in CrossFit, and 1,637 presented UI, which indicates a prevalence of 44.5%. Also, 55.3% and 40.7% presented mild or moderate UI respectively. Stress UI was the most common type reported (81.2%)., Conclusions: The factors that increased the likelihood of UI were age, body mass index and parity. Exercises based on jumps were commonly associated with urine leakage. CrossFit practitioners presented higher UI than control groups., (© 2022. The International Urogynecological Association.)

Introduction: We aimed to identify the utility, reliability, and validity of an adapted version of the OMNI self-perceived exertion (PE) rating scale in preschoolers., Population and Methods: Firstly, 50 (mean age ± standard deviation [SD] = 5.3 ± 0.5 years, 40% girls) performed a cardiorespiratory fitness (CRF) test twice, with a one-week interval between assessments, and rated their PE either individually or in groups. Secondly, 69 children (mean age ± SD = 4.5 ± 0.5 years, 49% girls) performed two CRF tests, separated by a one-week interval, twice and rated their self-PE. Thirdly, the heart rate (HR) of 147 children (mean age ± SD = 5.0 ± 0.6 years, 47% girls) were compared against self-rated PE after finishing the CRF test., Results: Self-assessed PE differed when the scale was administered individually (e.g., 82% rated PE with 10) or in groups (42% rated PE with 10). The scale showed poor test-retest reliability (ICC:0.314-0.031). No significant associations were found between the HR and PE ratings., Conclusions: An adapted version of the OMNI scale was found not suitable for assessing self-PE in preschoolers.

Background: Studies suggest that physical exercise lead to improvements in the psychosocial dimension, associated comorbidities as well as to a higher quality of life (QoL) in people with epilepsy. However, there is a need to provide evidence-based guidelines for its prescription. Therefore, this review aimed to systematically evaluate and meta-analyze the available data on the potential effects of physical exercise training programs in people with epilepsy., Methods: Four electronic databases (MEDLINE/PubMed, PEDro, SPORTDiscuss and Scopus) were searched systematically from their inception until April 2022 for randomized controlled trials (RCTs), comparative studies and non-controlled studies that provided information regarding the effects of physical exercise training programs on people with epilepsy. The studies' methodological quality assessment was performed using the PEDro, the MINORS and the Quality Assessment Tool for Before-After Studies with No Control Group scales. For the meta-analysis, inverse variance or generic inverse variance was use to report mean difference or standardized mean difference for continuous data and their 95% confidence intervals (CI). Heterogeneity was assessed with the Chi-squared test and I 2 test., Results: After removing duplicated studies, 82 results were retrieved by the literature search and 14 were eligible for full text search. Finally, 14 studies with a methodological quality ranging from good to low quality met the inclusion criteria. Totally, 331 people with epilepsy were evaluated. Significant changes between preand post-intervention results in the exercise intervention groups were observed for QoL, fitness level, psycho-affective and neurocognitive outcomes. Findings from the meta-analysis indicated that moderate exercise led to a non-significant decrease (p = 0.08, Chi-squared test) in seizure frequency (SMD 0.33 95% CI 0.04; 0.70), while a significant effect of exercise was observed on QoL with a mean improvement of 4.72 percentage points (95% CI 0.58; 8.86, p = 0.03)., Conclusion: Improvements on QoL, fitness level, psycho-affective and neurocognitive outcomes can be achieved through exercise training in people with epilepsy. Altogether, the findings suggest that people with epilepsy can benefit from exercising., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: Self-perception questionnaires are considered a useful alternative to assess the level of physical fitness (PF) of a specific population. However, very few questionnaires of this type have been validated in the Spanish population. The aim of this study was to identify the reliability and validity of the Perceived Physical Fitness Scale (PPFS) in Spanish students., Methods: After a back-translation process, the PPFS questionnaire was administered twice to 722 students (primary school, n=207; secondary school, n=515) to determine its reliability. To identify its convergent validity, the International Fitness Scale (IFIS) was administered, as well as a set of PF field-based tests from the Eurofit battery. The questionnaire internal consistency, reliability and convergent validity of the questionnaire were assessed by means of the Cronbach's alpha, intraclass correlation coefficient and Pearson corelation coefficient., Results: The internal consistency of the PPFS was accurate among Primary (α=0.702) and good among Secondary (α=0.888) students., Reliability was poor among Primary (ICC=0.490; 95% CI [0.298-0.665]) and good among Secondary (ICC=0.797; 95% CI [0.760-0.829]) students. The PPFS showed significant associations with PF levels assessed by means of the Eurofit (Primary; r=0.421; p<0.001 / Secondary; r=0.533; p<0.001) and with the IFIS scale (Primary; r=0.356; p<0.001 / Secondary r=0.792; p<0.001)., Conclusions: The Spanish adapted version of the PPFS questionnaire shows good reliability and acceptable convergent validity when used as a tool to assess PF among secondary school students. Its poor reliability, together with the weak association demonstrated against the IFIS scale among primary school students discourages the PPFS use at this educational level., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: This study aimed to determine the prevalence, severity and type of urinary incontinence (UI) in female and male CrossFit® practitioners., Study Design: The study design is an online cross-sectional survey distributed to CrossFit® practitioners across all Spanish regions. The questionnaire included categorical questions related to CrossFit® practice, multiple-choice questions to determine the exercises performed during reported UI symptoms, and The International Consultation on Incontinence Questionnaire Short-Form questionnaire items., Results: Five hundred seventy-one practitioners (34.0 ± 8.37 years, Body Mass Index 24.20 ± 3.34 kg/m 2 ) met inclusion criteria and completed the survey. There were and 316 females and 255 males. Around 45 % of women and 6 % of men reported having UI (p < 0.001). The severity of UI mainly was slight (30.3 % women, 3.5 % men) and moderate (11.7 % women, 2.3 % men) (p < 0.001). Stress and urgent UI were the most prevalent types among women (36 %) and men (5 %) (p < 0.001)., Conclusions: This study found that UI is relatively common among female CrossFit® practitioners, especially in repetitive jumps. The practitioners' profile (amateur/competitor) does not affect the prevalence or severity of UI. Male athletes can also experience urine leakage while performing CrossFit®, although its prevalence is much lower when compared to female practitioners., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: The feasibility and reliability of the Functional Movement Screen (FMS) battery for predicting injury risk have been widely studied in athletic, military, public service and healthy populations. However, scant research has been carried out in people with disabilities. This study aimed at identifying the feasibility and reliability of the FMS battery when administered to adults with intellectual disability (ID)., Methods: Adults from a residential and day care centre over 18 years of age, diagnosed with ID and able to follow simple instructions, were included in the study. All participants with behavioural or health problems that prevented the completion of the FMS battery were excluded. All exercises were video recorded to assure proper scoring. Three assessors (one trained and two novices) scored each of the FMS subtests performed separately from the videos. Feasibility was based on completion rates. Reliability of the composite test scores was analysed using intraclass correlation coefficients (ICCs)., Results: A total of 30 people with ID (mean age: 35.5 ± 7.12 years; 33.3% women) completed all assessments. The battery showed to be feasible, although difficulties when performing two of the subtests were observed among those with moderate and severe ID. Mean total scores from the three assessors ranged from 7.83 to 8.90. An inverse trend was observed indicating that the higher the ID level, the lower the total FMS score. Test-retest reliability was good for the trained assessor (ICC = 0.89) and mostly moderate for both novice assessors (ICC range: 0.60 to 0.76). Moderate to good inter-rater reliability was observed (ICC range: 0.65 to 0.80)., Conclusion: The FMS battery is a reliable tool that can be performed by people with ID, albeit with certain difficulties, especially in those with moderate to severe impairment. The battery does not seem to be useful for identifying people with ID at risk of suffering a sport injury. Adequately powered, well-designed studies are required to determine if the FMS battery is appropriate for identifying changes in functional performance in this population., (© 2022 The Authors. Journal of Intellectual Disability Research published by MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.)

Scientific evidence regarding whether intellectually gifted children show similar physical activity habits and physical fitness levels in comparison to typically developed children, is inconclusive. This is in part due to the scant research that has directly compared both groups of people. In this study, physical activity prevalence, self-perceived and objectively assessed physical fitness levels, and body image were assessed in a sample of 74 intellectually gifted children (mean age 11.6 ± 1.2 years). Seventy-four non-gifted children matched by age and sex were selected as a comparison cohort. Results indicated that both groups showed similar self-perceived and objectively assessed fitness levels. Physical activity habits were also similar, although significant differences were observed indicating that intellectually gifted girls were less active in comparison with non-gifted girls. Both cohorts perceived their body image accurately, although intellectually gifted children were much more satisfied with their physical appearance.

Background: Students spend a high number of hours being seated while at school. In order to find the correct adjustment between school furniture and the anthropometric characteristics, specific knowledge and tools are necessary., Objective: The objective of the study is to evaluate the accuracy and reliability of the measurers with different instruments, as well as contrast the differences between the values that were obtained by the different examiners., Methods: Measurements were taken independently by one expert examiner and two inexperienced teachers from the school. They used a measuring tape, a segmometer and an anthropometer for the anthropometric measurements. The statistical tests conducted: Kolmogorov-Smirnov test, Intraclass Correlation Coefficient, Bland and Altman method, Standard Error of Measurement, Technical Error of Measurement and relative TEM with a level of significance of ρ ≤ 0.05., Results: A total of 108 students (8.87±1.67 years; 40.7% girls) participated in the study. The non-expert measurers had good accuracy and reliability, but they far exceeded the error percentages of the expert, obtaining the worst results in the shoulder measurement. The instrument with the lowest affinity between the inexperienced measurers was the anthropometer., Conclusions: In order to assign furniture in the schools, the experts should continue using the anthropometer. The inexperienced measurers can use more accessible instruments in the school environment such as a measuring tape and segmometer.

We analyzed whether male Spanish elite soccer players live longer than the general population. Secondly, we compared their mortality with a cohort of soccer players who continued working as soccer elite coaches after retirement. Using age and calendar-date adjusted life tables, we analyzed the mortality hazard ratio of 1333 Spanish male players born before 1950, and who played in elite leagues from 1939, compared with the Spanish population. Using Cox proportional hazards model we compared their mortality with a cohort of 413 players who continued as coaches. Players showed significantly lower mortality than the general population, but this advantage decreased with advanced age, disappearing after 80 years. Coaches showed a similar pattern. Comparing players versus coaches, date of birth and years as professional were associated with survival, but debut age and player position were not. Unadjusted median survival time was 79.81 years (IQR 72.37-85.19) for players and 81.8 years (IQR 74.55-86.73) for coaches. Kaplan-Meier estimator adjusted for covariables showed no difference between cohorts (p=0.254). In conclusion, former Spanish male players showed lower mortality than the general population, but this effect disappeared after 80 years of age. Continuing their career as coaches after retirement from playing did not confer major benefits., Competing Interests: The authors declare that they have no conflict of interest, (Thieme. All rights reserved.)

Objective: Stressful situations may have a negative effect on population's mental health, including impaired sleep quality. Thus, we analysed the effect on sleep during the confinement due to the COVID-19 outbreak, in a Galicia population sample, measuring subjective sleep satisfaction, and insomnia intensity and incidence., Methods: Through an adapted questionnaire from the Cuestionario Oviedo de Sueño, distributed telematically and printed, using a convenience sampling in Galicia, we compared sleep situation, before and during the first two weeks of confinement for COVID-19. We compared the results of the questionnaire before and during confinement with the Wilcoxon signed-rank test and McNemar's test., Results: In 451 analysed subjects, there was about half point decrease in sleep satisfaction (in a 1 to 7 scale), three points increase in insomnia score (9 to 45 scale) and an increase from 23.1 to 36.3% in the insomnia incidence (p<0.001 for all the comparisons). There existed less affectation in the insomnia incidence in elderly above 65 years (from 21.7 to 26.1%, p=1) and in subjects that telecommuted (unchanged 28.1% incidence, p=1). In a post-hoc analysis of a health workers subgroup, sleep affectation was similar to that of others workers., Conclusions: Confinement situation in COVID-19 outbreak context in our environment has caused important alterations in the population's sleep quality, increasing the symptoms and incidence of insomnia.

Purpose: This research was aimed at evaluating the effects of a five-month detraining period on the functional fitness level of a group of non-institutionalized and active older adults after taking part in a multi-component training program. A secondary aim was to determine how usual physical activity (PA) levels vary due to cessation of the program., Methods: We tested sixty-five older people (mean age: 77.1 ± 6.2; 83% women) during the final week of an 8-month multi-component training program and during the first week after its resumption (five months later). We used the senior fitness test and the Minnesota Questionnaire to assess their functional fitness and their PA levels respectively., Results: We observed a significant worsening of lower-limb strength (p = 0.008), shoulder range of motion (p = 0.004), and dynamic balance (p < 0.001) once the detraining period was completed. There was a slight downward trend in the remaining functional fitness dimensions, and there were significant differences when comparing the amount of PA estimated at pre-detraining and post-detraining (5155 ± 2258 vs 3937 ± 2087 MET-min·wk -1 ; p < 0.001). Older adults classified as very active showed a non-significant trend to smaller decreases in functional fitness once the detraining period was over, in comparison with those considered active., Conclusions: Active older people who regularly participated in a multicomponent training program showed a significant reduction in their strength, range of motion, and dynamic balance levels after a five-month detraining period. Self-reported PA decreased significantly during this time frame. Effective strategies are needed to increase PA levels in older people when systematic training programs are temporarily interrupted., Competing Interests: Declaration of Competing Interest All authors declare to have no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: In our country the Spanish short version of the Minnesota Leisure Time Physical Activity Questionnaire (VREM) and the International Physical Activity Questionnaire in elderly people (IPAQ-E) are considered useful tools for estimating the amount of physical activity (PA) performed by the geriatric population. However, few studies have been carried out on their psychometric properties. Therefore, this research aims to provide information on their convergent validity by analysing the degree of association that both questionnaires show with physical fitness level., Material and Methods: A total of 105 people (mean age: 76.77 (SD=6.01) years; 84.8% women), answered both questionnaires and performed the Senior Fitness Test (SFT), in order to assess their physical fitness level., Results: Significant correlations were found between the SFT and the VREM items related to energy expenditure derived from walking (r=0.227) or from performing sports activities or dancing (r=0.235), and the estimated total energy expenditure (r=0.314). The IPAQ-E did not establish significant associations with any of the variables analysed. Although a certain a priori correlation was observed between the VREM and the IPAQ-E (r=0.447, p<0.001) and the mean difference between both parameters was nil (p=0.553), it was considered that the questionnaires showed a lack of agreement due to the great width found in the range of differences., Conclusions: The use of the VREM questionnaire is recommended for estimating the amount of PA performed by the geriatric population, as it shows a certain degree of association, albeit weak, with the level of physical fitness.

Background: Propofol and sevoflurane act on the GABA(A) receptor, modulating the function of this receptor in an additive manner. The pharmacodynamic interaction of both drugs considering their effect on EEG activity analysed by the bispectral index (BIS) was identified as additive, but this has not been studied in a clinical setting. The objective of this study was to analyse the pharmacodynamic interaction of propofol and sevoflurane on BIS using a surface response model in patients undergoing general anaesthesia with i.v. induction and inhalation maintenance., Methods: We performed a prospective study in 24 patients undergoing general anaesthesia with propofol induction and sevoflurane maintenance. Anaesthetic depth was measured with a BIS VISTA Bilateral monitor. Propofol biophase concentration was determined using a three-compartment pharmacokinetic model, and sevoflurane end-tidal concentration was measured continuously. The response surface model described by Minto and colleagues was used to analyse the interaction. Statistical analysis was performed with Excel 2002 and SPSS v11.0., Results: The mean value of U(50)(theta) was 0.956 (sd 0.029) in the overall estimated data, and remained within the predefined range for all ratios of the drugs, fulfilling the criterion of additivity. The median of the weighted residuals between the actual BIS value and the BIS value predicted by the model was -5.926%., Conclusions: Under the study conditions, it was confirmed that sevoflurane and propofol have an additive effect on BIS, with no evidence suggesting the existence of a synergistic effect for the concentrations of both drugs typically used in clinical practice.

Aortopulmonary fistulas secondary to thoracic aneurysms are difficult to diagnose and few cases are reported in the literature. We describe the case of a patient first admitted to another hospital with a diagnosis of right upper lobe pneumonia. After the patient had been a week in hospital without improving, a computed tomography scan of the chest revealed a saccular aneurysm of the aortic arch measuring 9 cm at its widest diameter. Hemodynamics and respiratory signs deteriorated a few hours after transfer to our hospital. Physical examination revealed a systolic murmur and poor peripheral perfusion. The patient was intubated and inotropic support was provided. Upon insertion of a Swan-Ganz catheter, given suspicion of septic shock, progressive elevation of mixed venous oxygen saturation was observed. Measurement of venous oxygen saturation was 74% in the right atrium and 93% in the pulmonary artery. Left-right shunt was diagnosed and an emergency aortography revealed the aortopulmonary fistula. Emergency surgery was performed with the patient in deep hypothermia and cardiocirculatory arrest. There were no adverse events, and postoperative recovery and clinical course were good.

Wolff-Parkinson-White syndrome is important for the anesthesiologist because the sudden development of tachyarrhythmias may result in deleterious hemodynamic changes. We describe an episode of reciprocating tachycardia triggered by the insertion of the guide wire during central venous cannulation in a patient with this syndrome.

Although the Spanish Civil War (1936-1939) has been the focus of many papers in many countries, there are few references concerning medicine during this war, and many of the related events and medical progress are not well known. Some of these events came to influence civilian and military medicine. Among these were advances in blood transfusion, in which the Canadian surgeon, Norman Bethune, played an important role, particularly in advocating transfusion of blood to soldiers at the front rather than at medical centres behind the lines. While much of Bethune's work, especially in Canada and China, is well known, 1-3 certain aspects of Bethune's work and his stay in Spain are worth reviewing.