Detección de problemas en pacientes geriátricos con fractura de cadera. Importancia de la colaboración entre traumatólogo y geriatra / Detection of health conditions in elderly patients with a hip fracture. Importance of collaboration between orthopedic and geriatric specialists

Objetivo. Evaluar el beneficio que proporciona un Equipo Consultor Geriátrico (ECG) a los pacientes geriátricos que ingresan con fractura de cadera en cuanto a la detección de problemas clínicos. Material y método. Estudio prospectivo y controlado que compara dos grupos: los pacientes manejados por el ECG y los que no conoció dicho equipo. Resultados. Fueron estudiados 449 pacientes, con una edad media de 83 años y el 80% mujeres. El ECG detectó más antecedentes personales (5,4 frente a 3,3) y más síndromes geriátricos previos (2 frente 0,4). A lo largo del ingreso el ECG detectó más complicaciones (3,8 frente a 0,4), más nuevos diagnósticos (2,1 frente a 0,4) y más síndromes geriátricos (3,6 frente a 0,5). Las diferencias resultaron significativas en los siguientes problemas: anemia, desnutrición, estreñimiento, delirium, osteoporosis, úlceras por presión, demencia, déficit sensoriales e incontinencia. Algunos de los datos recogidos nos sugieren que pudo haber diagnósticos no detectados en el grupo control. Conclusiones. La revisión diaria por parte del ECG de los pacientes ofrece una evaluación más completa y reduce la probabilidad de infradiagnóstico de problemas clínicos importantes. La colaboración entre traumatólogo y geriatra da como resultado un manejo del paciente más efectivo

Purpose. To assess the benefits of a Geriatric Consultant Team (GCT) to detect health conditions in elderly patients hospitalized for a hip fracture. Materials and methods. This was a prospective controlled study that compared two groups: patients under the care of a GCT and those not under the care of a GCT. Results. A total of 449 patients were studied; mean age 83 years; 80% women. The GCT detected more incidents in clinical records (5.4 compared to 3.3), and more previous geriatric syndromes (2 compared to 0.4). During hospitalization the GCT detected a higher rate of complications (2.1 compared to 0.4) and more geriatric syndromes (3.6 compared to 0.5). Significant differences were seen in the following conditions: anemia, malnutrition, constipation, delirium, osteoporosis, bedsores, dementia, sensory deficits and incontinence. Some of the data collected suggested that there might have been non-detected health conditions in the control group. Conclusions. The GCT reviewed patients daily, which resulted in a more complete assessment and a reduction in the probability of under-diagnosing significant clinical conditions. More effective patient care is achieved when Geriatric and Orthopedic Specialists work together (AU)

[An adrenaline-induced vasospasm as the form of presentation of variant angina]. / Vasoespasmo inducido por adrenalina como forma de presentación de una angina variante.

A 41-year-old-man without previous ischemic heart disease, developed a severe anaphylactic reaction. After administration of epinephrine (0.5 mg) the patient complained of chest pain. The electrocardiogram showed an elevation of ST segment in inferior leads. Myocardial necrosis was ruled out. Coronary arteriography disclosed normal coronary arteries. Eight months later, the patient developed severe chest pain during physical activity. ST elevation was again seen in inferior leads. ECG changes disappeared, when sublingual nitroglycerin was administered. A diagnosis of vasospastic angina was made. Exercise test was negative, during treatment with calcium-blocking agents. The patient subsequently remain free of symptoms taking medication. The physiological mechanisms of vasospastic angina and precipitating factors are discussed.