[Reliability of bioelectric impedance analysis as a method of nutritional monitoring in cirrhosis with ascites]

Bioelectric impedance analysis (BIA) was carried out in 55 cirrhotic patients (32 with and 23 without ascites) and 20 healthy controls with the aim of evaluating its usefulness in cirrhosis. Furthermore, in 13 of the ascitic patients BIA was performed immediately before and 24 hours after paracentesis. No differences were observed among the three groups in either resistance or the values of total body water (TBW), lean body mass (LBM) and fatty body mass (FBM) estimated by BIA. On the other hand, reactance and the phase angle were lower in cirrhotic patients. Likewise, the percentage of body cell mass (BCM) was lower in ascitic patients than in the non ascitic patients and the controls (37.7 +/- 1.2 vs 42.3 +/- 1.2 vs 45.5 +/- 1.6%; p = 0.0003). Mid-arm muscle circumference was correlated with TBW and LBM in all the groups and with only BCM in the controls and those without ascites. In general, the precision of the regression lines was lower in the ascitic patients than in the non ascitic patients and controls. TBW decreased following paracentesis (28.3 +/- 1.7 vs 30.3 +/- 2.0 kg; p = 0.008) but this decrease did not correspond with the volume of ascitic fluid obtained in any case. The mean BCM did not change with paracentesis although individual differences ranged between -8.0 and +11.2% (CI 95%). It is concluded that BIA is not a reliable method for nutrition evaluation in cirrhotic patients with ascites in clinical practice and that the anthropometric parameters are still preferable in these cases.

Treatment of patients with cirrhosis and refractory ascites using LeVeen shunt with titanium tip: comparison with therapeutic paracentesis

It has recently been suggested that insertion of a titanium tip at the venous end of the LeVeen shunt drastically reduces the rate of shunt obstruction. To assess whether the LeVeen shunt with titanium tip improves the results obtained with therapeutic paracentesis, 81 patients with cirrhosis and refractory ascites were randomly assigned to therapy with paracentesis plus intravenous albumin (42 patients) or LeVeen shunt with titanium tip (39 patients). If patients were readmitted for ascites during follow-up, those in the first group were treated with paracentesis, and those in the LeVeen shunt group by the insertion of a new valve or a new shunt if obstruction was demonstrated. During first hospitalization, both treatments were equally effective in removing ascites. Complications were similar in both groups except for a higher rate of severe bacterial infection in the LeVeen shunt group. The mean duration of hospitalization was shorter in the paracentesis group than in the shunt group. During follow-up, the total number of readmissions and the number of readmissions for ascites were higher in the paracentesis group than in the shunt group (252 vs. 99, P < .001; and 193 vs. 43, P < .001, respectively). The total time in hospital, however, was similar (38 +/- 38 vs. 39 +/- 43 days, P = NS). Three patients had obstruction of the shunt during first hospitalization and 14 patients had a total of 22 obstructions during follow-up. Long-term survival was similar in both groups. The insertion of a titanium tip at the venous end of the LeVeen shunt does not prevent obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

A longitudinal study of depression in an urban Spanish pubertal population

Depression characteristics were investigated in 507 adolescents using a two-stage longitudinal study design. The three-year longitudinal study started when the girls and boys were 11 and 12 years, respectively. In the initial (screening) phase the Children's Depression Inventory (CDI) was used to select subjects for phase-II of the study in which the Children's Depression Rating Scale-Revised (CDRS-R) interview was used. The caseness definition of Major Depression (MD) and Dysthymia (D) was based on the DSM-III-R criteria. Pubertal development was assessed by Tanner's staging. Estimated prevalence of Major Depression in the female sample for each increasing year of age was 2.2%, 2.7% and 4.1%. In the male sample the prevalence for the three years was 0.9%, 0.3% and 0.6%. There was no relation to age. The estimated mean prevalence of Dysthymia was 1.4% in girls and 0.8% in boys. No association between pubertal development and depression was found. Longitudinal data support the notion of chronic depression in early adolescence.

Prevalence of childhood depression: results of the first study in Spain

Prevalence of depressive disorders was studied in 6432 children aged 8-11 years, selected by exhaustive random sampling in four Spanish cities and two rural areas. The number of non-participants was 38 (0.6%). Selection was by a two-stage procedure. At stage I, the Children's Depression Inventory was used to identify a sample for more intensive interviewing. At stage II, children were individually evaluated using a semi-structured interview, the Children's Depression Rating Scale-Revised (CDRS-R). CDRS-R and DSM-III diagnostic criteria were used to define caseness. 1.8% of children met the criteria for major depression, with a further 6.4% being diagnosed as having dysthymic disorder.

Rupture and migration of the venous segment of LeVeen shunt: an unreported complication

The LeVeen peritoneovenous shunt has been used for nearly 20 yr in the treatment of refractory ascites due to liver cirrhosis. However, the technique encompasses a high incidence of serious complications. We report the case of a 59-yr-old man presenting with right pulmonary artery embolization caused by ruptured venous segment of a LeVeen shunt. After localizing it arteriographically, we were able to satisfactorily remove the segment by tying it up with a catheter introduced through the femoral vein.

Scores on the State-Trait Anxiety Inventory for children in a longitudinal study of pubertal Spanish youth

Changes in scores on the State-Trait Anxiety Inventory for Children for a sample of 534 pubertal adolescents were longitudinally studied over a period of 4 years. Biological development and other variables were investigated. For the 310 boys, A-trait scores decreased significantly with age. The 224 girls showed significantly higher scores than boys in all years of the study. No significant relationship was found between anxiety and pubertal maturity. The year-to-year persistence in symptomatology of anxiety ranged between 55.6% and 66.1% for girls and between 48.5% and 53.1% for boys. Girls showed bi- and tri-annual persistence between 31% and 50%, and boys between 13% and 27%. Neuroticism scores formed the best predictor of A-trait scores. Symptomatology of anxiety is not transient during early adolescence, so personality may provide a risk indicator in the development of anxiety.