[The sequelae of osteoporotic femoral fracture in Barcelona]. / Secuelas de la fractura osteoporótica de fémur en Barcelona.

BACKGROUND: The aim of the present was to study the long term sequelae of osteoporotic fracture of the femur in a general hospital of 300 beds in Barcelona, analyzing 1) mortality; 2) degree of functional capacity; 3) care requirements; 4) familial repercussion, and 5) psychic repercussion. METHODS: Structured telephone interviews were carried out between 1990-1991 with the patients attended for osteoporotic fracture of the femur in our center from 1988-1989. Of a total of 145 patients, 12 died within 1 month. Among the remaining patients the interview was performed with 100 patients--25 of whom were males of 78 +/- 8 years of age and 75 females of 82 +/- 10 years of age. The degree of functional capacity was evaluated by the index of independence in daily activities (DA). RESULTS: Mortality within one month was 8.3%; at one year 30% and at 2 years 38%. Factors associated with the highest mortality were: age of over 80 years (p less than 0.004), deterioration of post fracture functional capacity (p less than 0.0004) and pre-fracture dementia (p less than 0.01). Important deterioration in post fracture functional capacity was seen in 45% of the cases. Seventeen percent of the patients required transfer to a center for chronic care and 34% resided in a center for chronic care prior to the fracture. Familial repercussion was observed in 43% of the cases and post fracture psychologic repercussion was seen in 28%. CONCLUSIONS: Osteoporotic fracture of the femur presents the following sequelae: mortality, intense deterioration of functional capacity and important health care requirements in addition to considerable familial and psychological repercussion.

[Indications, performance and complications of bronchofibroscopy in the aged]. / Indicaciones, rendimiento y complicaciones de la broncofibroscopia en el anciano.

Bronchofibroscopy is a widely used exploration for the diagnosis of several pulmonary processes. However, its use in aged patients, these being considered a high risk group, is still a controversial issue. The aim of this study was to analyze the indications, diagnostic performance and complications of the bronchofibroscopy in the elderly and to determine if there are any differences with respect to the adult population. A retrospective case control study was conducted, taking as cases those patients with 70 or more years of age, and as controls, those patients with less than 70 years. The study period was 1 year, with 54 bronchofibroscopies performed in 49 patients from the study group and 149 in 145 patients from the control group. The indications were similar in both groups, except for the study of opportunistic infections, these being more frequent among the control group. Diagnostic performance and complications did not show any differences between both groups. Indications, performance and complications of bronchofibroscopy in aged patients are similar to those in the adult population. Hence, the age in itself should not be a limiting factor for the indication of this exploration.

[Evaluation of the use of digoxin in a primary care emergency service]. / Evaluación del uso de la digoxina en asistencia primaria en un servicio de urgencias.

Digoxin is a widely used drug. Previous studies suggest a high prevalence of inadequate use, subtherapeutic levels and high toxicity rates. The aim of the present study was to evaluation the use of digoxin in our area. 50 consecutive patients who attended our emergency service and who were receiving digoxin on a chronic basis were prospectively evaluated. There were 37 females and males, with age 78.1 +/- 8.6 years. We found that digoxin was not indicated in 12% of cases. Only 48% had digoxin plasma levels within the therapeutic range. When plasma levels were considered in association with clinical and electrocardiographic findings, 12% of patients were undertreated and 6% had digitalis toxicity. There was no relation between the digoxin plasma level and the dosage schedule, the ECG findings, the renal function, the use of other drugs or the anthropometric data. Emphasis is made on the need to individualize digoxin therapy and to measure plasma levels in particular cases.

Primary cerebral abscess due to nocardia presenting as 'ghost tumor'. Clinical and pathological study.

We report a case of a primary cerebral abscess due to Nocardia asteroides in a nonimmunocompromised patient with a particular clinical course. The first symptom (right subacute brachial palsy) and the lesion in a computed tomographic (CT) scan (left parietofrontal edema suggestive of brain tumor) disappeared after corticosteroid treatment and the patient was discharged with total recovery. After 2 months she complained of headache and visual disturbance. A new CT scan showed an annular lesion in the left occipital lobe. A cerebral biopsy was diagnosed of nocardia infection. The patient died 2 weeks after this biopsy. A postmortem study showed an occipital brain abscess but not structural abnormalities were seen in the left parietofrontal area. We believe that the first episode could be a local inflammatory response to cerebral implantation of nocardia which disappeared clinically in the CT scan and in the postmortem study after corticosteroid treatment. Then the nocardia could have displaced by the hematological route to the second and definitive cerebral lesion.

Correlation between densitometric and hystomorphometric values in isolated vertebrae of Sprague-Dawley rats.

The study of bone mass in experimental animals usually requires invasive techniques. Dual energy X-ray absorptiometry (DEXA) may be an alternative as a non-invasive method (1). Bone mineral density (BMD) and bone mineral content (BMC) of 62 vertebrae of Sprague Dawley rats (SDr) measured by DEXA densitometry were compared with histomorphometric bone volume measurements, and a statistically significant correlation was found (r = 0.79 and 0.75, respectively, p < 0.001). In conclusion, DEXA is an accurate and feasible technique for the study of trabecular bone mass in SDr.