Role Of Intravenous Iron Over Nonsurgical Transfusions In Major Burns.

Anemia is a frequent condition in burn patients due to a mixture of blood loss and chronic inflammation. Transfusions increase the probability of serious infections and reduce overall survival, especially when unrelated to perioperative blood loss. Once the surgical phase in burn patients is completed, the role of parenteral iron administration in the reduction of subsequent transfusions is not well established. Burn patients subjected to at least two surgeries and presenting progressive anemia after concluding the surgical phase, without major symptoms, were selected (n=12). Those patients with confirmed iron deficiency were treated with intravenous (i.v.) ferric carboxymaltose (n=8). Subsequently, these patients were compared with a group of 18 control patients selected from our historical database (n=1375), matching controls by age (±5 years), sex, and TBSA burn (±6%). The objective was to verify if i.v. iron administration reduced the need for blood transfusions after the surgical phase. The analysis concluded that none of the cases treated required transfusions compared to 44% of the controls. There were no side effects related to the i.v. iron infusion. This result suggests that i.v. iron supplementation with ferric carboxymaltose could be an alternative in anemic patients without major symptoms once the surgical phase is completed. Iron deficiency should be assessed and i.v. supplementation must be administered if required in burn patients showing progressive anemia.

L'anémie, à la fois par pertes sanguines et inflammation, est fréquente chez les brûlés. Les transfusions, en particulier lorsque l'anémie n'est pas liée à la chirurgie, sont corrélées à la survenue d'infections sévères et à la mortalité. Une fois la phase chirurgicale terminée, le rôle de la thérapie martiale intraveineuse sur l'épargne transfusionnelle est mal connu. Nous avons évalué 12 patients brûlés, ayant été opérés au moins 2 fois et ne devant plus l'être, qui développaient une anémie progressive bien tolérée. Les 8 patients ayant une carence martiale ont reçu du carboxymaltose ferrique intraveineux. Ils ont été comparés avec 18 patients témoins, sélectionnés dans notre base de données de 1 375 dossiers, appariés sur l'âge +/- 5 ans, le sexe et la surface brûlée +/- 6%, l'objectif étant de vérifier si le traitement permettait effectivement de réduire les transfusions. Effectivement, aucun des patients traités n'a été transfusé, contre 44% des témoins. Aucun effet secondaire n'a été observé après administration de fer. Ceci suggère que des patients brûlés, chirurgie terminée, anémiques pauci- symptomatiques par carence martiale devraient recevoir un traitement martial IV.

[Epidemiology and long-term outcome of sepsis in elderly patients]. / Epidemiología y pronóstico tardío de la sepsis en ancianos.

OBJECTIVES: A study was made of the epidemiological data of sepsis requiring admission to the ICU in patients over 65 years of age, with an evaluation of independent predictors of survival at 2 years. DESIGN: A prospective cohort study was made. PATIENTS: Patients meeting criteria for sepsis upon admission to the ICU. SETTING: A 40-bed ICU in a tertiary hospital. RESULTS: The study group included 237 elderly patients (≥ 65 years of age) and 281 controls (<65 years of age) (n=518). At least one chronic comorbid condition was present in 70% of the elderly patients as compared to only 56.1% of patients under age 65 (P<.01). There were several epidemiological differences between the groups: the prevalence of chronic diseases (diabetes, chronic obstructive pulmonary disease, and chronic heart failure), presentation as septic shock (52.3% vs 42%; P<.05), and the abdomen as the source of sepsis (52% vs 36%; P<.01) were all more frequent in elderly patients. Nine percent of the global patients discharged from hospital died in the 2-year follow-up period, but this rate reached 20% among the elderly. Independent predictors of 2-year mortality in the elderly were: chronic heart failure (adjusted hazard ratio [aHR] 2.24, 95% confidence interval [CI 95%] 1.28-3.94; P<.01), acute renal failure (aHR 3.64, 95%CI 2.10-6.23; P<.01), acute respiratory failure (aHR 3.67, 95%CI 2.31-5.86; P<.01), and inappropriate empirical antimicrobial therapy (aHR 2.19, 95%CI 1.32-3.62; P<.01). CONCLUSIONS: Sepsis showed different demographic characteristics and clinical presentations in the elderly. In the aging cohort, after adjusting for potential confounders, inadequate empirical antimicrobial therapy was associated to a 2-fold decrease in survival at two years.

[Oxygen extraction as a predictor of mortality in patients on high frequency ventilation]. / Extracción de oxígeno como predictor de mortalidad en pacientes con ventilación de alta frecuencia.

INTRODUCTION: The high frequency oscillatory ventilation (HFOV) may reduce cardiac output. The haemodynamics were analysed and predictors of mortality identified. PATIENTS AND METHODS: A total of 48 children with respiratory failure undergoing HFOV between January 2003 and December 2010 were included. The study design was prospective, observational, and descriptive. Inclusion criteria were based on the existence of hypoxemia. The variables studied were: arterial and central venous pressure, arterial pH, venous saturation and oxygen extraction ratio, with determinations performed prior to HFOV, during, and before turning to conventional ventilation. Prognostic factors were identified by bivariate analysis and a predictive model of mortality was developed. RESULTS: The mean age was 21 [4 to 72] months. On admission, PRISM scales and Murray were 33 and 2.8, PaO(2)/FiO(2) of 61 and oxygenation index of 35. After HFOV an increase in pH (P<.001), mean arterial pressure (P<.001) and venous saturation, and decreased venous pressure and O(2) extraction (P<.001), was obtained. The prognostic factors of mortality at 24 hours after starting HFOV were: FiO(2), PaO(2)/FiO(2), oxygenation index, shunt, pH, central venous pressure and mean arterial pressure, venous saturation, and O(2) extraction. The model developed at 12 hours, consisting of EtO(2) and SvcO(2) was able to predict death with a probability of 92.3%. CONCLUSIONS: HFOV improves haemodynamics. The model at 12 hours is the best predictor of death.

[Filter content after carotid angioplasty and stenting: relation to ischemic lesions in diffusion-weighted imaging]. / Contenido en filtros tras angioplastia y colocación de stent carotídeo: relación con lesiones isquémicas en la resonancia magnética de difusión.

OBJECTIVES: To evaluate the relation between the material retrieved from distal filters after carotid angioplasty and stenting and the development of ischemic brain lesions in diffusion-weighted imaging (DWI). To determine the influence of demographic, clinical, and procedural variables in the pathogenesis of emboli and in ischemia after carotid angioplasty and stenting. MATERIAL AND METHODS: We submitted the contents of the filters of 76 patients (60 men; mean age, 68.39 years; range, 46-82) who had undergone angioplasty and stenting for severe stenosis of the internal carotid artery for histologic analysis evaluating volume (< 1 λ = 0.001 ml = 1 µl; 1-10 λ; and > 10 λ) and the composition of the particles. All patients underwent DWI before and 24 hours after the procedure; we recorded whether lesions appeared and their number, size, and distribution. We correlated the findings with demographic, clinical, and procedural variables. RESULTS: Symptoms were present before the procedure in 58 (76.3%) patients. Particles were present in 49 (64.5%) of the filters; most particles (77.5%) were 1 λ with a predominance of fibrin-platelet aggregates, cell remnants, and cholesterol crystals. DWI after the procedure detected lesions in 12 (15.8%) patients. We found no statistically significant correlation between filter contents and lesion detection after the procedure or between filter contents and other variables. CONCLUSIONS: Ischemia after carotid angioplasty and stenting does not depend solely on the embolic load and its nature. We consider that the lower prevalence of postprocedural lesions in our series compared to others suggests that appropriate patient selection and experience minimize the negative influence of some variables like age in their development.

[Evaluation of telephone assessment in stroke and TIA recurrence]. / Evaluación de la revisión telefónica en la recurrencia de ictus y AIT.

INTRODUCTION: Stroke recurrence is an important issue in stroke registries, but direct patient contact months after stroke is not always feasible. Telephone assessment is often used to evaluate long term stroke outcome, treatments and recurrences. Our aim is to evaluate telephone interview in a stroke registry. MATERIAL AND METHODS: Three hundred and eighty patients with a stroke or TIA were prospectively registered, evaluating baseline characteristics and type of event. At 6 months, 248 patients were reviewed by structured telephone interview and 132 were reviewed by direct contact. We analysed stroke outcome and disability, treatments and stroke or TIA recurrences. RESULTS: There were no differences in baseline characteristics and type or severity of the index event. At 6 months, treatments were similar between both groups and 10.5% (40 patients) had a recurrent event. There were no differences in recurrent ischaemic strokes (6.1% in direct contact vs 4.4% telephone, P=.49), but we detected a higher number of TIA in direct examination compared to phone interview (9.1% vs 4.0%, P=.04). CONCLUSIONS: Telephone assessment of stroke patients is reliable and facilitates stroke registries in detecting long-term treatments and stroke recurrences. However, it is probable that new transient events or TIA are under-estimated.

Dyslipidemia as a long-term marker for survival in pulmonary embolism.

OBJECTIVES: To analyse survival rate after 24 months in consecutive patients with a diagnosis of PE as well as associated factors. METHODS: Prospective cohort study during a follow-up period of two years in a series of consecutive patients with PE. RESULTS: During the follow-up period, 34 out of 148 patients died (23%). Factors independently associated with reduced survival rate were: creatinine levels > 2 (OR, 8.8; 95% CI, 1.1 - 70.87), previous neoplasm (OR, 8.8; 95% CI, 3.69 - 20.98), dementia (OR, 6.85; 95% CI, 2.1 - 22.33) and dyslipidemia (OR, 5.07; 95% CI, 1.92 - 13.44). Forty four percent of the patients with dyslipidemia died vs. 20.8% of patients without this condition. CONCLUSIONS: In our study dyslipidemia shows as a long-term negative prognostic marker for survival in patients with EP.

[Improving the outcomes in spontaneous subarachnoid haemorrhage: the EHSA project]. / Mejora de los resultados en la hemorragia subaracnoidea espontánea: proyecto EHSA.

AIM: To investigate our clinical practices with the aim of identifying opportunities to improve the medico-surgical management of spontaneous subarachnoid haemorrhages (SAH). PATIENTS AND METHODS A prospective, longitudinal cohort study was conducted of the cases of SAH attended consecutively in the critical care and emergency services in 29 public hospitals in Andalusia over a period of 20 months, between the years 2000 and 2002. SAH were considered to be acute haemorrhagic cerebrovascular accidents diagnosed as such by imaging. Results at 12 months and care management (medical and surgical therapy, diagnostic techniques, care times and specific neurological complications) were analysed and the latter was then compared with the clinical practices that scientific evidence has proved to be the most useful. Deaths due to rebleeding in patients with no arteriographic study or without exclusion of the aneurysm were catalogued as potentially avoidable deaths. RESULTS: A total of 506 SAH were included. During the follow-up 5% of the sample were lost. In all 155 patients died. The non-modifiable independent risk variables for mortality were: age, being male, history of arterial hypertension, coma on arrival at the hospital and hydrocephalus. The independent risk variables for death that can be influenced were: absence of urgent analgesic, no arteriographic diagnosis, appearance of ischaemic neurological impairment and rebleeding. Twenty per cent of the overall mortality could be considered potentially avoidable. CONCLUSIONS: Although fatality is mostly dependent on variables that cannot be influenced (sex, age, history, clinical severity and hydrocephalus), 20% of deaths are associated to modifiable factors.

Skull fracture, with or without clinical signs, in mTBI is an independent risk marker for neurosurgically relevant intracranial lesion: a cohort study.

PRIMARY OBJECTIVE: To explore the possibility of identifying skull fracture, with or without clinical signs, as a predictor of positive CT scans in mild traumatic brain injury (mTBI). RESEARCH DESIGN: Prospective cohort study, matched 1:1 for five potential confounding variables (age, sex, symptoms, mechanism of injury and extracranial trauma severity). METHODS AND PROCEDURES: The study was performed on patients with mTBI (Glasgow Coma Scale 15-14), with or without radiologically demonstrated skull fracture. The cohort with skull fracture included 155 patients selected from a sample of 5097 mTBI patients treated during 1998 at the Critical Care and Emergency Department of the Trauma Centre. The cohort without skull fracture was prospectively recruited from patients with mTBI treated in the same department from 2002-2005. MAIN OUTCOMES AND RESULTS: The percentage of patients with intracranial lesion (IL) was significantly higher in mTBI patients with skull fracture than in those without. The risk of requiring neurosurgery was 5-fold higher when skull fracture was present. Of mTBI patients with skull fracture and IL, 63.2% showed no clinical signs of bone injury. CONCLUSIONS: Skull fracture, with or without clinical signs, in mTBI patients is associated with an increased risk of neurosurgically-relevant intracranial lesion.

[Diverging trends in prostate cancer mortality in the autonomous community of Andalucia (1975-2004)]. / Tendencias divergentes en la mortalidad por cáncer de próstata en la comunidad autónoma de Andalucía (1975-2004).

OBJECTIVE: To describe the evolution of prostate cancer mortality in Andalucia during the period 1975-2004 at the provincial level. SUBJECTS AND METHOD: Mortality data for prostate cancer and population denominator data was supplied by the Statistical Institute of Andalucia. Age group-specific and standardised overall and truncated (50-79 years old) rates were calculated by the direct method (European standard population). RESULTS: In 2004 there were 813 deaths in Andalucia from prostate cancer. Prostate cancer accounts for around 8% of male deaths from cancer. Joinpoint analysis shows three diverging trends (fall in Cadiz, Huelva and Malaga, rise in Granada and stabilization in the other provinces) in age-standardized mortality rates. CONCLUSION: In Granada, an increment in mortality from prostate cancer is observed in opposition to the trend in the other provinces.

[High-frequency oscillatory ventilation. A single-center study]. / Nuestra experiencia con la ventilación de alta frecuencia oscilatoria.

INTRODUCTION: High-frequency oscillatory ventilation is a safe and effective means of delivering mechanical ventilatory support. OBJECTIVE: To evaluate the safety and effectiveness of high-frequency oscillatory ventilation in pediatric patients with acute respiratory failure. PATIENTS AND METHOD: From August 2003 to July 2005, we performed a prospective observational study of 11 children older than 1 month who underwent high-frequency oscillatory ventilation. Pediatric risk of mortality scores (PRISM), Murray lung-injury scores and air leak scores were recorded at baseline before ventilation. The following variables were studied: ventilatory settings (FiO2 and mean airway pressure), gasometric (PaO2, SaO2, PaCO2, pHa, PaO2/FiO2 ratio) and hemodynamic parameters (Partm, PVC), and the oxygenation index. RESULTS: The overall survival rate was 82 %. Significant increases were found in PaO2 (p < 0.05), SaO2 (p < 0.05) and the PaO2/FiO2 ratio (p < 0.05), while mean airway pressure (p < 0.001), oxygenation index (p < 0.001), and FiO2 (p < 0.001) significantly decreased over time. CONCLUSIONS: High-frequency oscillatory ventilation significantly improved oxygenation in children with acute hypoxemic respiratory failure.

[Renal oncocytoma. Review of our 22 patients]. / Oncocitoma renal. Revisión de nuestra serie de 22 pacientes.

UNLABELLED: Renal oncocytoma (OR) is a benign tumor. It may represent up to 3-7% of solid kidney masses, and shows specifics cellular and evolutive characteristics. Metacronicity, multifocality and bilateralism has been reported. MATERIALS AND METHODS: Between 1986 and 2005, 478 kidney tumors have been surgically treated at our institution. We report the frequency and characteristics of OR in our patients, compared with renal cell carcinomas (RCC). We try to find out the rate of multifocality, bilateralism and other tumor association, and the number of neoplasms originally diagnosed as OR before surgery. Mean and median follow up: 36.86 and 13 months (1-193). Specific survival rate 100%. RESULTS: We found 24 OR in 10 men and 12 women with a mean age of 59 years (34-84). 12 in the left kidney and 12 in the right one, one patient presenting oncocytomatosis. Tumor mean size was 4.64 cm (1-12.5 cm). Tumors were discovered incidentally in 17 cases. Presentation symptoms in the rest of patients were gross hematuria. CONCLUSIONS: The rate of OR found in our sample population of renal tumors undergoing surgery matches other series already published. Two synchronic OR, but not metacronous, bilateral or metastatic tumors were found. All cases presented a benign evolution.

[Related factors with the failed surgery of herniated lumbar disc]. / Factores relacionados con la cirugía fallida de hernia discal lumbar

INTRODUCTION: The surgery for herniated disc is the most common operation at the level of the lumbar spine. The failed surgery rates range between 10% and 40%, conforming what is known as Failed Back Surgery Syndrome (FBSS). Return to work after surgery occurs in 70-85% of the cases. There are a few studies analysing the quality of life after the operation. The aims of this study are to know the incidence of the herniated disc lumbar failed surgery in our area, identify those factors influencing its development, and study behavioural parameters as the return to work and the quality of life at a middle term after surgery, also its relation with the success or failure surgery. MATERIAL AND METHODS: A descriptive transversal study of 117 patients operated for herniated lumbar disc during the first six months of the year 2003 is reported. In order to evaluate the incidence of failed surgery and the related factors, the clinical records were retrospectively analyzed. Ninety one patients were interviewed by phone using the Health Questionnaire SF-36, in order to analyze the non clinical factors related to FBSS, such as labour reincorporation, satisfaction with surgery, realization of rehabilitation treatment and quality of life after surgery. For the statistical analysis of the results, we used the program SPSS 11.01. RESULTS: In a sample in which the proportion between both sexes was 1/1, and the middle age was over 45 years [35-54], in which the most frequent clinical symptom was right sciatica, lasting more than 6 months, correlated to disc herniation at L5-S1 level, 37.9% of the patients presented FBSS. Although there were a few patients with reoperation in our study, the incidence of FBSS in these patients was higher (52.9%) than in patients who suffered this surgery for first time (32%). The predictive clinical factors of an unfavourable result in patients operated on for first time were bilateral sciatica, the presence of stenosis associated to herniated disc and comorbidity factors. On the other hand the sociolabor factors identified were a low culture level and those working as drivers, building and service sectors. Return to work occurred in the 64% of the active workers before surgery. Only around 10% of patients were dissatisfied with surgical result and there was a significant relationship between this and the physical function, pain, vitality and emotional status in the SF-36 with the FBSS. CONCLUSIONS: One out of three patients operated of herniated lumbar disc in our area presented failed disc surgery and the return to work occurred in 2 out of three patients active before the operation. The failed surgery patient suffers from pain, that interferes and limits the labour and home activities. Furthermore, the patient presents frequent sensation of fatigue and exhaustion and also emotional problems that contribute to interfere with work and activities of the daily life.

[Analysis of renal neoplasms in adult patients under 40]. / Análisis de las neoplasias renales en adultos menores de 40 años.

OBJECTIVES: To analyze within our sample population the number of patients under 40 receiving surgery as a result of renal neoplasm; to describe the characteristics of these patients and compare them with those of adult patients over 40. PATIENTS AND METHODS: We have revised the clinical history of the 379 patients with renal neoplasm who have undergone surgery in our Service from January 1986 through June 2003. Patients were divided into two groups. Group I, formed by 36 subjects (9.5%) < or = 40. Group II includes 343 patients (90.5%) over 40. Data were included in a database created using the software programme Access and were subsequently analysed using the statistical package SPSS. A descriptive analysis was performed and life expectancy was calculated for both groups using the Kaplan-Meier survival curve. RESULTS: 7.3% of the total number of renal cell carcinomas included in our series occurs in patients of or under 40. No significant differences have been observed as regards the distribution per sexes, laterality, size, incidental occurrence, clinical symptoms, anatomopathology, staging or surgical technique employed. However, we have observed differences as regards cancer-specific survival rate after 5 years, being 94.74% in the case of group I and 68.64% in group II (log-rank 0.0338). CONCLUSIONS: The number of patients < or = 40 undergoing surgery as a result of renal cell carcinoma in the sample under study matches other series already published. No statistically significant difference has been observed as regards staging among patients under and over 40. Differences do exist as regards cancer-specific survival rate. In the case of our patients, irrespective of the age group to which they were ascribed, it is more common to diagnose a renal neoplasm incidentally than through the clinical manifestations.

[CA 19.9 and HDL-cholesterol behaviour in a sporadic colorectal carcinoma sample]. / Compartimiento del CA 19.9 y de fracción HDL-colesterol en una muestra de pacientes con carcinoma colorrectal esporádico.

BACKGROUND AND OBJECTIVE: We have carried out a comparative prediction analysis in sporadic colorectal carcinoma of plasmatic lipids and currently tumor markers used in this neoplasia (carcinoembrionary antigen - CEA, CA 19.9 and sialic acid -SA). PATIENTS AND METHODS: Transversal hospital-based case-control study. Sample was composed by 53 sporadic colorectal neoplasia patients just before surgery and 40 non matched controls. A 90 per cent of cases were at Dukes A and B stages. A multivariable model was fitted with non-conditional logistic regression. Confidence intervals were calculated at 95 per cent of confidence. Model sensibility and specificity were performed at 50 per cent cutting point. We also explored possible interactions. RESULTS: All three tumor markers (CEA, CA 19.9 and SA) were elevated in cases (p<0.01). Multivariable model included: Total cholesterol (TC) (OR= 0.69; CI: 0.50-0.96) high density lipoprotein fraction (HDL) (OR = 0.30; CI: 0.11-0.83) very low density lipoprotein fraction (VLDL) (OR = 2.21; CI = 1.07-4.55) years of age (OR = 1.11; CI = 0.98-1.26) CA 19.9 (OR = 1.20; CI = 1.02-1.42) and alkaline phosphatase (OR = 1.09; CI = 1.01 - 1.19). No interactions were found out. Model sensibility reached 96.23% and a specificity of 92.50%. CONCLUSIONS: HDL showed a similar diagnostic strength than CA 19.9 in this sporadic colorectal carcinoma sample but with an inverse OR. This multivariable model is going to be validated.

[Transcranial Doppler velocimeter in pregnant and later normotensive puerperal women]. / Velocimetría Doppler transcraneal en gestantes y posteriormente puérperas normotensas.

INTRODUCTION: The physiological changes that take place in blood flow in the brain during pregnancy and the puerperium are still only poorly understood. The harmlessness of transcranial Doppler (TCD) makes it a suitable method of study. AIMS: The purpose of this study was to determine the TCD velocimeter reading at the end of pregnancy and in the early puerperium of healthy expectant mothers. SUBJECTS AND METHODS: TCD was used to perform a bilateral study of the anterior (ACA), middle (MCA) and posterior cerebral arteries (PCA). Arterial blood pressure and haematocrit were also measured. Mean velocity (MV), the pulsatility index (PI), mean arterial blood pressure and haematocrit were employed as variables in the statistical analysis. Results from 44 normotensive pregnant women in the latter stages of gestation (week 33 to term) were compared with those of a control group made up of 58 women of a similar age, who were normotensive and not pregnant. The study was repeated in the group of pregnant women during the early puerperium (the first five days after labour) and the two different results were compared. RESULTS: Age and MAP were similar in the gestating and non-gestating groups. Haematocrit was significantly lower in the former (p < 0.001) and MV were significantly lower in the pregnant women in all the arteries (p < 0.001), whereas the PI were also significantly lower in four of the six territories that were studied (p < 0.005). During the puerperium, a significant rise in MV was observed in all the arteries (p < 0.001) and the PI increased in three of them (p < 0.05). In this phase, the mean arterial pressure rose (p < 0.05), although haematocrit levels dropped (p < 0.001). CONCLUSIONS: The low MV and PI seen at the end of pregnancy are compatible with cerebral vasodilatation. MV increase during the early puerperium and is probably linked to a relative hyperperfusion.

[The effectiveness of a correlation diagram of the echographic and haemodynamic patterns in the brain]. / Rendimiento de un diagrama de correlacion entre patrones ecograficos y hemodinamicos cerebrales.

INTRODUCTION: Transcranial Doppler (TCD) constitutes a valuable method for managing acute/critical neurological patients and it would therefore be interesting to reduce, as far as possible, the complexity involved in interpreting its findings. AIMS: The Objective of this study was to design and validate a correlation diagram of the echographic patterns and acute haemodynamic situations in the brain that makes it easier to teach and optimises the effectiveness of TCD as a diagnostic aid. MATERIALS AND METHODS: A diagram that represents the average speed and pulsatility index on a system of coordinates. Five fundamental echographic patterns were identified and the most frequent acute cerebral haemodynamic situations are detailed for each of them. The value of the diagram was tested in resident doctors with varying degrees of knowledge of TCD. In the first phase with no diagram (evaluation A), the interpretation of the TCD and diagnosis of the haemodynamic situation in the brain were evaluated in nine clinical cases. In the second phase, with a diagram (evaluation B), they were asked to draw up new reports on the same cases. We compared the number of times they were right in the two evaluations. RESULTS: A total of 216 echographic reports were obtained. The mean number of correct answers in evaluation A was 2, interquartile range (0.25 3.75). In evaluation B the number of correct answers rose to 4 (3.25 6.75) (p= 0.005). Using the diagram increased the diagnostic capacity of all the residents, but especially so in those with less training. CONCLUSIONS: Use of the diagram makes it easier for people who are not experts to learn to interpret TCD findings in acute/critical neurological situations.

[Lung cancer mortality in Andalucia, 1975-2000]. / Mortalidad por cáncer de pulmón en Andalucia (1975-2000).

OBJECTIVE: To describe trends in lung cancer mortality in Andalucia, Spain, during the period from 1975 through 2000. SUBJECTS AND METHOD: Records of lung cancer deaths for the period from 1975 through 2000 were obtained from the Statistical Institute of Andalucia. The following indicators were calculated: crude rates, age-adjusted rates, truncated rates, and cumulative rates. RESULTS: Mortality rates for men dropped in all subject groups aged over 50 years during the period from 1994 through 2000. In women mortality rates were much lower, although we observed an increase in the 35-39 and 45-49 age groups, which is reflected in the 6.1% rise in the truncated rates (35-64 years) during the period from 1994 through 2000. In older women mortality rates fluctuated more within the different age groups, although on the whole the truncated rate for all those over 65 years old fell by 9.7% in the period between 1995 and 2000. CONCLUSION: Lung cancer mortality rates among men in Andalusia began to decrease after 1994. In contrast, mortality increased among young women, although their rates are still very low.

[Anomalies in brain haemodynamics in pre-eclamptic expectant mothers]. / Anomalías hemodinámicas cerebrales en gestantes con preeclampsia.

INTRODUCTION: Transcranial Doppler (TCD) is being used more and more frequently in the study of brain haemodynamics in pre-eclampsia/eclampsia. It has received less attention in the puerperium of these patients. AIMS: The aim of our study was to compare pre-eclamptic (PE) and normotensive (NT) patients at the end of gestation, using a Doppler velocimeter, and also to compare the results from PE women in two consecutive periods of time: at the end of gestation and in early puerperium (EP). PATIENTS AND METHODS: TCD was performed with bilateral evaluation of the anterior, middle and posterior cerebral arteries (ACA, MCA and PCA, respectively). Average speed (AS) and the pulsatility index (PI) were used as Doppler parameters. Arterial blood pressure (BP) and haematocrit were also measured. The AS, PI, average BP (ABP) and haematocrit were used as variables in the statistical analysis. At the end of gestation (33 weeks to full term) we compared the average values of these variables in PE (n=38) against those of NT (n=44). We also compared the results obtained for PE (n=30) in two consecutive periods: at the end of gestation and EP (the first five days following childbirth). RESULTS: At the end of gestation, AS were significantly higher in the PE than in the NT in all the arteries that were examined. The ABP was higher in the first group but there was no significant correlation between ABP and AS. PI were lower in the first group, with statistical signification in four of the six arteries. The AS rose significantly in the EP of the PE women, in spite of the existence of a drop in the ABP. Conversely, the PI remained unaltered. CONCLUSIONS: A pattern of high AS and low PI was found in PE women at the end of gestation and may be due to a primary failure of the brain's capacity to regulate itself. Anomalies in the TCD increased in the EP, despite a drop in the ABP, and this could account for the predominance of the neurological symptoms that are reported in the later forms of the syndrome.