[Bilateral ureterohydronephrosis secondary to massive vesical hernia]. / Uropatía obstructiva bilateral secundaria a hernia vesical masiva.

Bladder hernia is not a rare pathological condition, with a frequency between 0,3 and 3%. Massive bladder hernia is less frequent an very rarely ureterohydronephrosis with this pathology. We will present a case a renal failure secondary to inguinoscrotal bladder hernia with bilateral obstructive uropathy and an analyzed the clinical presentation, the diagnosis and the treatment for those hernias.

A rare case of a secondary pituitary abscess arising in a craniopharyngioma with atypical presentation and clinical course / Un caso raro de absceso hipofisario secundario derivado de un craneofaringioma con presentación y evolución clínica atípicas

Pituitary abscesses are very uncommon. They are divided into primary, arising within a healthy gland, and secondary, observed with an underlying pre-existing lesion. Here we present the eighth case reported of a secondary abscess within a craniopharyngioma. A 59-year-old-woman presented with a 3-week history of headache, and fever. Physical examination was unremarkable. An Magnetic Resonance Imaging (MRI) showed a pituitary lesion suggestive of a chronic inflammatory process. She was diagnosed with lymphocytic meningitis with hypophysitis and she was treated with corticosteroids. Two months later she presented with headache and fever again. Control MRI showed enlargement of the pituitary lesion. Therefore, a transsphenoidal biopsy was performed. During the procedure, purulent material was released. Histological study demonstrated a craniopharyngioma and meningeal inflammation. Empiric antibiotics were started. Three months post-operatively, a follow-up MRI showed a suspect minimal residual mass. Secondary pituitary abscesses are rare. The key to successful management is a high index of suspicion. Transsphenoidal surgical evacuation plus antibiotics is the mainstay of treatment. Although most symptoms resolve, endocrinopathies improve only rarely (AU)

Los abscesos hipofisarios son infrecuentes. Se pueden dividir en primarios o secundarios, si se producen sobre una lesión previa. Presentamos el octavo caso de un absceso asentado sobre un craneofaringioma. Una mujer de 59 años consultó por fiebre y cefalea de tres semanas de evolución. La exploración física era anodina. Una resonancia magnética (RMN) evidenció una lesión hipofisaria sugestiva de un proceso inflamatorio crónico. Finalmente, se diagnosticó de una meningitis linfocítica e hipofisitis y se trató con corticoides. Dos meses después reconsultó por los mismos síntomas. En la RMN se evidenció crecimiento de la lesión, por lo que se biopsia endoscópicamente. Durante el procedimiento salió pus. En el examen histológico se evidenció un craneofaringioma y una inflamación meníngea. Se iniciaron antibióticos empíricamente. En el seguimiento a tres meses, la RMN evidenciaba un dudoso resto. Los abscesos hipofisarios secundarios son raros y hay que tener un alto índice de sospecha para diagnosticarlos. El tratamiento se basa en antibioterapia y evacuación transesfenoidal. Aunque los síntomas se suelen resolver, las endocrinopatías no (AU)

Application of strengths, weaknesses, opportunities and threats analysis in the development of a health technology assessment program.

There has been recent interest in developing a health technology assessment (HTA) function in Estonia. A group of individuals knowledgeable about HTA in Canada, Germany, Romania and Spain, along with representatives of the University of Tartu, Estonia, was convened by the Institute of Health Economics in Edmonton, Canada, to consider options for such a function. In a one-day workshop strengths, weaknesses, opportunities and threats (SWOT) analyses of HTA were conducted, first at a 'global' level, and then of the Estonian situation. The 'global' SWOT analysis yielded a large number of items that pertain to institutionalized HTA in a generic sense, i.e. not based on any individual HTA agency. The 'Estonian' SWOT yielded a subset of items, which pertain to development of HTA in that country. Ten actionable steps were then developed on the basis of this subset, which could be used to initiate the creation of an HTA body in Estonia.

[Uroflowmetric nomogram in the adult population of Canary Islands]. / Nomograma uroflujométrico en la población adulta canaria.

In order to know the uroflowmetric values of our healthy population, a uroflowmetry was made to 214 healthy subjects of both sexes. 75% of our group of volunteers collected mictional volumes under 300 ml. with no differences either by age or sex. The corresponding nomograms, in the form of percentile, for peak and mean flow in both sexes, were created. We found a progressive increase of peak and mean flow values with regard to mictional volume. Time to peak flow is shorter in women than in men. Volume at peak flow represents under 50% of total mictional volume. No significant differences in the uroflowmetric data of our healthy population and those from Anglo-Saxon authors was found.

[Socio-economic costs of road traffic accidents in the Canary Islands, Spain, in 1997]. / Los costes socioeconómicos de los accidentes de tráfico en las Islas Canarias en 1997.

OBJECTIVE: To evaluate the economic impact in terms of direct and indirect costs road traffic accidents in Canarias Islands (Spain) in 1997. METHOD: The cost-of-illness method was used. Direct and indirect costs were estimated using prevalence cost, i.e., the costs produced in 1997. Direct costs were divided into health services costs, insurance administration costs and the costs of material damage to the vehicles. Indirect costs were obtained through transformation of physical units into monetary units using the approach of human capital theory. RESULTS: The total cost of road traffic accidents was 39,887.16 million pesetas, equivalent to 24,470 for each inhabitant of the Canary Islands and representing 1.3% of the GNP in this region. The total direct cost was 32,559.67 million pesetas, constituting 82% of the total, which was distributed according to the different concepts analyzed: health service costs: 2,407.40 million pesetas; insurance administration costs, 13,415.89 million pesetas and the costs of material damages to the vehicles: 16,736.38 million pesetas. The total indirect costs was 7,327.49 million pesetas, accounting for 18% of the total costs, which was distributed in premature mortality (6,884.88 million pesetas) and absenteeism from work (442.61 million pesetas). CONCLUSIONS: Although this study adopts a conservative approach by omitting costs associated with pain and suffering, permanent disability, and those of at-home care provided by the family, the hight socio-economic cost of road traffic accidents clearly indicates the need for the different administrations of the Canary Islands to collaborate in implementing preventive measures.

[Chorea and systemic lupus erythematosus]. / Corea y lupus eritematoso sistémico.

The appearance of chorea due to systemic lupus erythematosus is extremely rare. A greater frequency of circulating anticoagulant, false positive luetic serology and antiphospholipid antibodies has been recently detected in these patients. For this reason, it has been postulated that these could be involved in the genesis of the chorea through a thrombotic mechanism or autoimmune encephalitis. We describe a case or chorea in a female patient with systemic lupus erythematosus.

[In vitro study of the stability of reduced intraerythrocyte glutathione against a group of drugs frequently used during the neonatal period]. / Estudio "in vitro" de la estabilidad del glutation reducido intraeritrocitario, frente a un grupo de fármacos de utilización frecuente en el período neonatal.

Authors have studied in 32 samples of cord blood (normal newborns and normal births) the stability of glutathione reduced form (GSH) in human erythrocytes opposite to ten drugs (gentamicin, cephazolin, amikacin, carbenicillin, amoxicillin, benzodiacepine, metil-prednisolone, phenilbarbituric acid, fosfomycin, trimethroprim-sulphamethoxazole) using it at similar concentration to the highest haemotic levels that are obtained in the newborn with therapeutic doses. They showed that these drugs have not an effect on stability of GSH. For this reason is very unprobable that these drugs are cause of haemolitic crisis in the newborn. In the another hand, they suggest the use co-trimoxazole in the newborn always, in correct doses.

Los costes socioeconómicos de los accidentes de tráfico en las Islas Canarias en 1997 / Socio-economic coasts of road traffic accidents in the Canary Islands, Spain, in 1997

Objetivo: Evaluar el impacto económico, en términos de costes directos e indirectos de los accidentes de tráfico en Canarias durante el año 1997.Métodos: El enfoque que se ha utilizado es el método del coste de la enfermedad. Los costes directos e indirectos se han estimado utilizando los costes de la prevalencia, es decir, los costes que se producen durante el año 1997. Los costes directos se han desglosado en costes derivados de la asistencia sanitaria, los costes administrativos y los costes de los daños materiales a los vehículos. Los costes indirectos se obtienen a partir de unidades físicas mediante su transformación en unidades monetarias utilizando el enfoque de la teoría del capital humano. Resultados: El coste total atribuible a los accidentes de tráfico es de 39.887,16 millones de pesetas, o el equivalente a24.470 pesetas por cada habitante en Canarias, lo que supone el 1,3% del PIB canario. El coste directo total es de32.559,67 millones de pesetas, constituyendo el 82% del total, que se distribuye según los diferentes conceptos considerados: coste de la asistencia sanitaria, 2.407,40 millones de pesetas; costes administrativos, 13.415,89 millones de pesetas, y costes de los daños materiales de los vehículos,16.736,38 millones de pesetas. El coste indirecto total es de (..) (AU)

Objective: To evaluate the economic impact in terms of direct and indirect costs road traffic accidents in Canarias Islands(Spain) in 1997.Method: The cost-of-illness method was used. Direct and indirect costs were estimated using prevalence cost, i.e., the costs produced in 1997. Direct costs were divided into health services costs, insurance administration costs and the costs of material damage to the vehicles. Indirect costs were obtained through transformation of physical units into monetary units using the approach of human capital theory. Results: The total cost of road traffic accidents was 39,887.16million pesetas, equivalent to 24,470 for each inhabitant of the Canary Islands and representing 1.3% of the GNP in this region. The total direct cost was 32,559.67 million pesetas, constituting82% of the total, which was distributed according to the different concepts analyzed: health service costs: 2,407.40million pesetas; insurance administration costs, 13,415.89 million pesetas and the costs of material damages to the vehicles:16,736.38 million pesetas. The total indirect costs was (..) (AU)