[European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. Spanish adaptation of the CEIPC 2008]. / Guía Europea de Prevención Cardiovascular en la Práctica Clínica. Adaptación Española del Comité Español Interdisciplinario para la Prevención Cardiovascular (CEIPC) 2008.

We present the Spanish adaptation made by the CEIPC of the European Guidelines on Cardiovascular Disease Prevention (CVD) in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD through the management of its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care medical doctors in promoting a healthy life style, based on increasing physical activity, change dietary habits, and non smoking. The therapeutic goal is to achieve a Blood Pressure < 140/90 mmHg, but among patients with diabetes, chronic kidney disease, or definite CVD, the objective is <130/80 mmHg. Serum cholesterol should be < 200 mg/dl and cLDL<130 mg/dl, although among patients with CVD or diabetes, the objective is <100 mg/dl (80 mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, to reach body mass index (BMI) guided and waist circumference objectives. In diabetic type 2 patients, the objective is glycated haemoglobin <7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to transfer the recommendations established into the daily clinical practice.

[European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. CEIPC 2008 Spanish adaptation]. / Guía Europea de Prevención Cardiovascular en la Práctica Clínica. Adaptación española del CEIPC 2008.

The present CEIPC Spanish adaptation of the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD by means of dealing with its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care doctors in promoting a healthy life style, based on increasing physical activity, changing dietary habits, and not smoking. The therapeutic goal is to achieve a Blood Pressure < 140/90 mmHg, but in patients with diabetes, chronic kidney disease, or definite CVD, the objective is < 130/80 mmHg. Serum cholesterol should be < 200 mg/dl and cLDL < 130 mg/dl, although in patients with CVD or diabetes, the objective is < 100 mg/dl (80 mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, with the objective guided by body mass index and waist circumference. In diabetic type 2 patients, the objective is glycated haemoglobin < 7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to put the recommendations into practice.

Treatment of postoperative pain for burn patients with intravenous analgesia in continuous perfusion using elastomeric infusors.

INTRODUCTION: Postoperative pain after surgery with patients suffering from burns tends to be moderate or severe, and its treatment requires a combination of high-strength analgesics (opioids) with others having different action mechanisms according to the concept of multimodal analgesia. AIMS: In this article we propose the use of continuous intravenous analgesia with morphine using elastomeric infusors at fixed dose for the treatment of this kind of pain. An evaluation is made of its analgesic efficacy, side effects and level of satisfaction. MATERIAL AND METHODS: A study was made of 17 burn patients operated on in our unit who received continuous intravenous analgesia during the postoperative period, with morphine at 1mg/h, using elastomeric infusors for a period of 24h. Its analgesic efficacy was analysed using the visual analogical scale (VAS) at different moments; side effects and the level of acceptance by the patient was also evaluated. RESULTS: The results confirm a good analgesic effect after 2h from starting perfusion (VAS < 3). The side effects reveal a similar or lesser incidence to the use of morphine in bolus or using the PCA system, and in no cases did they require treatment to be halted. The level of acceptance of the procedure by patients was good. CONCLUSION: This method reveals a high level of analgesic efficacy in the postoperative period with burn patients in this study. However, it is important to note the lower results obtained in the first hours of perfusion, and proposing a heavy initial dose of analgesics when starting perfusion. This is presented as an efficient analgesic method that is easy to apply, has a low cost, and the possibility of extending its indications to ambulatory treatment.

Mortality attributable to cardiovascular risk factors in Spain.

OBJECTIVE: To present the current burden of mortality attributable to some of the main cardiovascular risk factors in adults in Spain. METHODS: Mortality attributable to risk factors was calculated by combining their prevalence, the relative risks for death, and the number of deaths in Spain. Prevalence of hypertension (>/=140/90 mmHg), tobacco smoking, excess weight (body mass index >/=25 kg/m(2)), and self-reported diabetes were based on representative samples of the Spanish population in the 1990s. The relative risks came from valid international studies. RESULTS: About 14 000 total deaths (25% of all deaths) were attributable to hypertension in Spain's middle-aged population. A quarter of them were cardiovascular deaths. About 56 000 deaths were attributable to tobacco use in adults >/=35 y (16% of all deaths). Two-thirds of them were deaths for: lung cancer (26.5%), chronic obstructive pulmonary disease (20.9%), coronary heart disease (12.8%), and stroke (9.2%). About 28 000 deaths (8.5% of all deaths) were attributable to excess weight in adults. Two-thirds of them were cardiovascular deaths. About 2800 cardiovascular deaths were attributable to diabetes in adults >/=35 y (6% of all cardiovascular deaths). CONCLUSIONS: Mortality attributable to the risk factors studied is a major avoidable public health problem in Spain. The results presented are only illustrative but clearly show that there is considerable scope for prevention.

[Economic evaluation of eptifibatide]. / Evaluación económica de eptifibatide.

INTRODUCTION AND OBJECTIVES: The aim of this study was to perform an economic evaluation of the PURSUIT trial in Spain, and to measure the cost per year of life saved in patients treated with this drug. PURSUIT is a large, randomised multicentric study on the treatment of unstable angina or non Q wave myocardial infarction with eptifibatide versus placebo, METHODS: The data on resource consumption provided by the PURSUIT trial were grouped in several populations according to geographical and resource consumption criteria. Unitary costs of these resources were calculated using an "upward" approach that combines individual costs to obtain total costs of several processes and lengths of hospital stay. Cost analysis compares the costs of the initial admission and of the following six months (total cost per patient) for both placebo and eptifibatide. Cost-effectiveness analysis is calculated from total costs and years of life saved calculated according to projections made from results of PURSUIT for Western Europe. RESULTS: The average 6 month cost for the patients who received placebo varies from 0.91 to 1.41 million pesetas, and from 0.96 to 1.45 million pesetas for those treated with eptifibatide. The mean survival was 16.07 years in the placebo group versus 16.11 years in eptifibatide group; 2.9 years of life were saved for every 100 patients treated. The incremental cost of each year of life saved ranges from 1.3 to 3.3 million pesetas. CONCLUSIONS: Results vary depending on resource consumption data used. The cost per year of life saved is within the limits considered acceptable for a new technology.

[Expanded pedicled forearm flap for reconstruction of multiple finger amputations]. / Expandierter gestielter Unterarmlappen zur Rekonstruktion von multiplen Fingeramputationen.

Soft-tissue injuries of the hand frequently require flap coverage to preserve structures damaged at the time of injury or to facilitate later reconstruction. The radial forearm flap makes local tissue readily available and offers a simple method of reconstruction. Secondary augmentation of the skin flap by means of tissue expansion appears to be a useful alternative to improve the possibilities of reconstruction. This case report describes a primary reconstruction of a hand with multiple finger amputations using both techniques: Forearm flap and tissue expansion.

[Urinary lithotripsy in children. Multicenter study of the Pediatric Urology Study Group]. / Lithotritie urinaire de l'enfant. Etude multicentrique du Groupe d'Etudes en Urologie Pédiatrique (GEUP).

The authors present the results of a survey conducted among French paediatric urologists belonging to the Groupe d'Etudes en Urologie Pédiatrique (GEUP) (Paediatric Urology Study Group). This study, based on 122 cases observed in 13 centres, is not exhaustive, but is nevertheless statistically significant. The preoperative assessment confirms the usual findings of urinary stones in children: pyelonephritis, haematuria and abdominal pain, the usual presenting complaint, concomitant malformative uropathy (10% of cases) and a predominance of calcium stones. More than 200 stones were treated, larger than 10 millimeters in diameter in one-third of cases. Renal stones, mainly caliceal (more than 50%), included 11 staghorn calculi. This study also included 22 ureteric stones, mainly in the pelvic ureter, and 2 bladder stones. Lithotripsy was ultrasound-guided in 2/3 of cases and required general anaesthesia in about 3/4 of cases. Ureteric catheterization was required in 19 infants preoperatively, but in only 2 infants (stein strasse) postoperatively. One or two lithotripsy sessions were sufficient in most cases, but 4 sessions were necessary in 5 patients, to the same kidney in 1 case. The mean hospital stay was 2 to 3 days, but the procedure was performed on an outpatient basis in 15 cases. The immediate postoperative course was uneventful and asymptomatic. This survey revealed about 10% of complete failures, corresponding to solitary caliceal stones in 2/3 of cases; 29 partial failures were essentially due to lower caliceal stones and staghorn calculi; 84 successes (stone-free), mainly pelvic or simple caliceal stones. Scintigraphy did not reveal any immediate postoperative impairment of renal function. This study reported a success rate of about 70%, regardless of the type of apparatus used. Assessment of the results of ESWL requires sufficient follow-up both concerning the outcome of fragmented stones and evaluation of possible functional repercussions. This survey defines the main indications: although ESWL can be applied to most stones, some stones constitute poor indications (cystine stones, stenotic malformative uropathy) or dubious indications: small lower caliceal stones, densely calcified staghorn calculi in older children. This study confirmed the efficacy and low morbidity of ESWL in children. A prospective study needs to be conducted according to a rigorous protocol in order to refine the technique and indications while reducing the possible long-term risks.

[Incidental prostatic adenocarcinoma in the ere of the PSA]. / Adenocarcinoma de próstata incidental en la era del PSA.

Prostate adenocarcinoma is occasionally and incidentally found in the prostate gland after enucleation through adenomectomy or transurethral resection (incidentaloma). We contribute 17 cases (3.38%) of incidentaloma found among 503 patients who underwent adenomectomy vs. TUR due to prostate obstructive-irritative symptomatology of likely benign etiology. The diagnostic methods, pathological findings, treatment and evolution in our series versus other recent ones are explained.

[Jugular vein thrombosis: a case report]. / Trombosis venosa yugular. A propósito de un caso.

Thrombosis of the internal jugular vein is now rare but was well-known in the pre-antibiotic era, when it was associated with fulminant infections of the head and neck. Now the two major causes of jugular thrombosis are central venous catheterization and intravenous drug use. The clinical findings are a non-specific, painful, poorly delimited mass in neck that often is confused with an abscess or metastasis. CAT is necessary for diagnosis. We report a case secondary to central venous catheterization in which the clinical manifestations appeared three days after removing the catheter. The differential diagnosis of regional inflammations is described.

Acute colonic pseudo-obstruction in a burn patient.

Acute colonic pseudo-obstruction as a syndrome was first described by Ogilvie in 1948 (Br. Med J. 2, 671). It is characterized by colonic dilatation with no mechanical cause which affects critically ill patients. As a result of this complication the prognosis worsens. Initially there are few clinical symptoms, but subsequently colonic obstruction develops which, if not treated, can cause perforation of the caecum resulting in a high mortality rate. The treatment includes decompression via rectal and nasogastric probes, colonoscopy and caecostomy.

Alcoholic beverage consumption and risk of breast cancer in Spain.

The relation between alcoholic beverage consumption and risk of breast cancer was examined. We used data from a population-based, case-control study that included almost all incident cases occurring in five Spanish regions from February 1990 to July 1991. A total of 762 women between 18 and 75 years of age, with a histologically confirmed, first diagnosis of breast cancer, were compared with 988 control women. Alcoholic beverage intake was measured by an interviewer-administered, semiquantitative food-frequency questionnaire. We used 'nondrinkers' as the reference category and divided the remainder into four categories according to alcohol intake. The multiple logistic analyses included not only alcohol intake but also possible confounding factors such as total caloric intake, age, socioeconomic status, and reproductive and medical histories. Even at moderate levels of alcohol intake (less than 8 g/day), a 50 percent increase in risk of breast cancer was found. The trend across categories of intake was statistically significant for wine and distilled drinks, as well as total alcohol intake. Consumption of 20 g or more of alcohol per day was associated with a 70 percent elevation in breast cancer risk compared with that of nondrinkers (adjusted relative risk (RR) = 1.7, 95 percent confidence interval = 1.3-2.3). Although the magnitude of the RR observed in our study was modest, our findings provide further support for a positive association between alcohol consumption and risk of breast cancer.