Diagnosis of lesions of the acetabular labrum, of the labral-chondral transition zone, and of the cartilage in femoroacetabular impingement: Correlation between direct magnetic resonance arthrography and hip arthroscopy.

OBJECTIVE: To determine the sensitivity and accuracy of direct MR arthrography in the diagnosis of intra-articular lesions associated with femoroacetabular impingement. MATERIAL AND METHODS: We used direct MR arthrography to study 51 patients with femoroacetabular impingement who underwent arthroscopic hip surgery. Surgery demonstrated 37 labral tears, 44 lesions in the labral-chondral transitional zone, and 40 lesions of the articular cartilage. We correlated the findings at preoperative direct MR arthrography with those of hip arthroscopy and calculated the sensitivity, specificity, positive predictive value, negative predictive value, and validity index for direct MR arthrography. RESULTS: The sensitivity and specificity of MR arthrography were 94.5% and 100%, respectively, for diagnosing labral tears, 100% and 87.5%, respectively, for diagnosing lesions of the labral-chondral transition zone, and 92.5% and 54.5%, respectively, for diagnosing lesions of the articular cartilage. The negative predictive value of MR arthrography for lesions of the labral-chondral transitional zone was 100%. MR arthrography accurately defined extensive lesions of the cartilage and the secondary osseous changes (the main factor in poor prognosis), although its diagnostic performance was not so good in small chondral lesions. CONCLUSION: In patients with femoroacetabular impingement, direct MR arthrography can adequately detect and characterize lesions of the acetabular labrum and of the labral-chondral transitional zone as well as extensive lesions of the articular cartilage and secondary osseous changes.

[Validation of the Scale of Behavior Indicators of Pain (ESCID) in critically ill, non-communicative patients under mechanical ventilation: results of the ESCID scale]. / Validación de la Escala de Conductas Indicadoras de Dolor para valorar el dolor en pacientes críticos, no comunicativos y sometidos a ventilación mecánica: resultados del proyecto ESCID.

OBJECTIVE: To determine the reliability and validity of the "Scale of Behavior Indicators of Pain" (Escala de Conductas Indicadoras de Dolor: ESCID) as a tool to assess pain in the critically ill, non-communicative patients with mechanical ventilation. METHODS: An observational study of development and validation of this scale as an instrument for pain measurement in ICU patients over 18 years of age, who are uncommunicative and under mechanical ventilation. Their pain was assessed with the Behavioral Pain Scale (BPS) and the ESCID simultaneously, by two independent observers, when the painful maneuvers (PM), secretion aspiration and mobilization, were applied. Measurements were obtained before, during and after the PM. A descriptive analysis of the general characteristics of the population was carried out. The reliability of the ESCID was measured through the internal consistency of each item using Cronbach's alpha. Intraobserver and interobserver concordance was measured with the repeated measurements analysis of variance test. The components of the two pain scales were compared to obtain the change between the results obtained based on time, observer and procedure. The correlation between the scales was measured with the Pearson's correlation. RESULTS: A total of 480 observations were obtained in 42 patients, 62% were males; age 57.33 ± 16.35 years. The most frequent ICU admission was due to infectious disease (36%) and neurological disease (35%). Glasgow Coma Scale 8.45±1.2 and Richmond Agitation-Sedation Scale -2.55±1.5. Arterial blood pressure, heart rate and respiratory rate remained stable. Cronbach's s Alpha Coefficient for ESCID ranged from 0.70-0.80. There is a good correlation between the ESCID and BPS in the three measurement points in time: Pearson's correlation: before 0.97, during 0.94 and after 0.95. CONCLUSIONS: ESCID is a reliable and valid tool to assess pain in critically ill, non-communicative patients under mechanical ventilation.

[Latency values of 248 H reflexes in 124 normal subjects]. / Valores de latencia de 248 reflejos H en 124 sujetos normales.

INTRODUCTION: The Hoffmann reflex or H reflex is an electrical counterpart of the myotatic reflex. In normal adults is elicited with stimulating the tibial and the median nerves. It is useful as an adjunct study of neuroexamination and assesses the corresponding arc reflexes in their integrity. SUBJECTS AND METHODS: 248 H reflexes were studied stimulating the tibial nerve in 124 healthy subjects. RESULTS: The latency values were: minimum 23.6 ms; maximum 29.8 ms; mean value 27.6 ± 1.41 ms. CONCLUSION: This work explains the technique to obtain the H reflex and discusses the need for normalized values for each neurophysiology lab.

[Prognosis of urinary tract infections with discordant antibiotic treatment]. / Pronóstico de las infecciones urinarias con tratamiento antibiótico discordante.

INTRODUCTION: This study aims to evaluate the prognosis of urinary tract infections (UTI) treated empirically with inadequate antibiotic treatment. MATERIAL AND METHODS: Prospective cohort study of patients over 18 years of age, attended in the hospital emergency service between 01/02 and 31/05 of 2007, due to micturation symptoms, accompanied by pyuria (>10 leukocytes/mm(3) of uncentrifuged urine) or positive reactive strip for nitrites-leukocytes and urine culture with >10(3) colony forming units. It was considered that the antibiotic treatment prescribed empirically was adequate if the bacteria isolated was sensitive and had been prescribed for the correct time. It was considered that there was therapeutic failure when the symptoms persisted after 5 days of treatment. Age, gender, presence of indwelling bladder catheter, type of UTI, hospitalization in the previous 3 months, origin of the patient and associated diseases were recorded. RESULTS: A total of 177 bacteria were isolated in 168 patients. In 29 cases (17.3%), the microorganism isolated was resistant to the antibiotic prescribed. There was thereaputic failure in only 6 patients, although they did not required hospital admission. The patients who lived in a residential home for the elderly (13.7% vs 2.2%, P = 0.015) or who had been hospitalized during the previous 3 months (20.6% vs 4.3%, p = 0.039) had a greater risk of receiving inadequate treatment. CONCLUSIONS: The prognosis of the patients attended in the emergency hospital service due to UTI with discordant antibiotic treatment is favorable in most of the cases. Performing urine culture in patients with greater risk of suffering UTI due to a resistant microorganism would be recommendable.

[Prevalence and risk factors associated to malnutrition in elderly inpatients]. / Prevalencia y factores asociados a malnutrición en ancianos hospitalizados.

BACKGROUND: Malnutrition is a frequent clinical finding in elderly inpatients that is deleterious to the physiologic function of several body's organs or systems that is accompanied of an increase of the length of hospitalization, economic burden and mortality. Protein-energy malnutrition risk factors in elderly patients are not well defined. METHOD: A transversal study of inpatients over 70 years in a internal medicine ward was undertaken in order to know the protein-energy malnutrition's prevalence a possible risk factors. It was considered that a patient suffered from had protein-energy malnutrition if he or she had a tricipital skinfold thickness or an arm circumference under 10th percentile and/or had low levels of two of the following clinical parameters: plasmatic albumin (under 3.5 mg/100 ml). Plasmatic transferrin (under 150 mg/100 ml) or a lymphocytic cell count (under 1,500 cells/ml). RESULTS: A hundred and five patients were included. Mean age was 83.0 +/- 6.4 years with a predominance of the female sex (61%). Thirty-three patients (31%) were sent from nursing homes. A 35% were very dependent and frail elderly patients. Fifty-eight patients presented at hospital with protein-energy malnutrition (prevalence = 57.1%; CI 95% 47.1%-66.8%). Chronic obstructive pulmonary disease (COPD) and a acute infectious disease were independent risk factors associated protein-energy malnutrition (prevalence ratio of 1.4 and 0.5, respectively). CONCLUSIONS: Protein-energy malnutrition's prevalence in elderly inpatients is very important. Infectious diseases and COPD are positively and negatively associated with protein-energy malnutrition.

[A pharmacoeconomic study of in-hospital treatment against community-acquired pneumonia]. / Estudio farmacoeconómico del tratamiento hospitalario de numonía adquirida en la comunidad.

INTRODUCTION: A computer-driven unit-dose drug-dispensing system allows for improved knowledge on pharmaceutical costs per DRG and clinical department, between-hospital pharmacoeconomic studies to be carried out, as well as deviation analysis. METHODS: A retrospective, cost-minimization study was undertaken to both analyze and compare prescriptions for a number of antibiotics and bronchodilators, and their costs in both 89 and 90 DRGs, as well as their cost per hospital stay in patients admitted to the Internal Medicine Departments of two hospitals in Areas 6 (HUPH) and 9 (SVO) in CAM (Autonomous Community of Madrid). A statistical analysis was performed using the Kolmogorov-Smirnov test, Student 's "t" test, Mann-Whitney test, and least squares method. RESULTS AND CONCLUSIONS: Patient samples are similar, with no significant differences existing in clinical status at admission or in cure percentage. Also, no significant differences exist in antibiotic use, except for clarithromycin and ceftriaxone, which were more commonly used at SVO (P = 0.001 and P = 0.003, respectively), and levofloxacin, which was more commonly prescribed at HUPH (P < 0.001). For identical results measured by using the cure index and mean stay, the cost of antibiotic therapy was significantly higher at HUPH (113.57 euro) versus SVO (78.32 euro), which related to a wider use of levofloxacin; while no statistical relation to clinical status was found that warranted its choice. No differences were seen in bronchoinhaler use which, together with antibiotics, represent 82.6% of cost at HUPH and 72% at SVO.

[Factors related to mortality of aged patients hospitalized with community-acquired pneumonia]. / Factores relacionados con la mortalidad de ancianos hospitalizados por neumonía adquirida en la comunidad.

BACKGROUND: Community-acquired pneumonia (CAP) frequently determines inpatient treatment and has a high mortality. It is desirable to know which factors predicts a favorable outcome of elderly patients with CAP. This fact could allow that a growing number of patients could be treated in their home. OBJECTIVE: To investigate the variables related with the survival of hospitalized elderly patients for with CAP. METHODS: We carried out a retrospective study of 158 patients aged more than 65 years, that were admitted to our hospital for CAP. RESULTS: Mean age was 80.3 +/- 8.2 years (66-98 years). Eighty nine (56%) patients were men and 69 (44%) were women. Twenty seven patients (17%) died during their stay in the hospital. By multivariate analysis, independent variables associated with survival were: confusion (p = 0.0001), treatment with H2 receptor antagonists (p = 0.01), respiratory frequency (above 30 per minute, p = 0.01) and arterial pH (below 7.40, p = 0.03). Sensibility and specificity about prediction of survival in elderly patients with PAC who hadn't any variables above pointed out were 0.89 and 0.64, respectively. CONCLUSIONS: Application of this results could help physicians make decisions about hospitalization for elderly patients with PAC.

[Colorectal carcinoma. Multifactorial analysis of prognostic factors following curative resection]. / Carcinoma colorrectal. Análisis multifactorial de factores pronósticos tras resección curativa.

Cox regression analysis was used in the study of 151 cases of surgically treated colorrectal carcinoma. A "curative" resection was performed in all of them. Clinical data from medical records, histology, biochemical determinations, and intraoperative findings were assessed. Four of the studied variables were significantly related to tumor recurrence: Dukes stage, tumor spread, histological variety and preoperative CEA level. Age, sex, tumor location, surgical technique, lymphocytes in the peripheral blood, preoperative levels of acute phase reactants and hepatic enzymes did not provide information about the final outcome of these patients. An index of prognosis was statistically obtained in order to identify a high risk of recurrence group of patients, who may benefit from adjuvant therapy.

Automatic treatment of assay data by competitive protein binding and radioimmunoassay.

A method is devised for the automatic computation of data obtained from a series of determinations by radioimmunoassay or by competitive protein binding. The input data is introduced by means of an automatic paper tape punch attached to the sample counter. A series of programs is set up for a Hewlett Packard computer, model 2116B with 16K, which calculates bound and free fractions with control processes for varying possible errors. From experimental data, by linear least squares regression, a standard curve of best fit is derived and is considered in three different ways. The curve of best fit is selected by comparing the correlation coefficients obtained and by calculating the unknown sample concentrations. The program presents the results graphically together with a list of results which is for use within the Radiochemistry laboratory. Individual reports are also prepared for sending to those departments that requested the test.