[Home Enteral Nutrition (NED) in children and adolescents. Recommendations of the Nutrition Branch of the Chilean Society of Pediatrics]. / Nutrición Enteral Domiciliaria (NED) en niños y adolescentes. Recomendaciones de la Rama de Nutrición de la Sociedad Chilena de Pediatría.

The use of home enteral or parenteral nutrition has been a necessary step in the optimization of nu tritional support in patients who, due to several diseases, fail to meet their nutritional requirements by oral feeding. This article presents the recommendations of the Chilean Pediatric Society Nutritio nal Branch, aimed at health teams that treat pediatric patients who require enteral feeding for a long time. The general objective is to provide guidelines for the proper management of these patients. It describes the ideal conformation of the health team for the care and follow-up of those patients, the program admission criteria, and its evaluation method over time. In addition, it describes general characteristics of enteral feeding, routes of administration, available enteral formulas, complications, and patient follow-up.

Nutrición Enteral Domiciliaria (NED) en niños y adolescentes: recomendaciones de la Rama de Nutrición de la Sociedad Chilena de Pediatría / Home Enteral Nutrition (NED) in children and adolescents: recommendations of the Nutrition Branch of the Chilean Society of Pediatrics

Resumen: El uso de apoyo nutricional ambulatorio, enteral o parenteral, ha sido un paso necesario en la opti mización del soporte nutricional en pacientes, que, por diversas patologías, no logran cumplir con sus requerimientos por vía oral (VO). En el presente artículo se presentan las recomendaciones de la Rama de Nutrición, dirigidas a los equipos de salud que atienden pacientes pediátricos, que requieran alimentación enteral por un tiempo prolongado. Su objetivo general es entregar pautas para un co rrecto manejo en estos pacientes. Se describe la conformación ideal del equipo de salud para atención y seguimiento de dichos pacientes, los criterios de ingreso al programa y su forma de evaluación en el tiempo. Además, se describen características generales de la alimentación enteral, vías de admi nistración, fórmulas enterales disponibles, complicaciones de este soporte nutricional y por último monitorización y seguimiento del paciente.

Abstract The use of home enteral or parenteral nutrition has been a necessary step in the optimization of nu tritional support in patients who, due to several diseases, fail to meet their nutritional requirements by oral feeding. This article presents the recommendations of the Chilean Pediatric Society Nutritio nal Branch, aimed at health teams that treat pediatric patients who require enteral feeding for a long time. The general objective is to provide guidelines for the proper management of these patients. It describes the ideal conformation of the health team for the care and follow-up of those patients, the program admission criteria, and its evaluation method over time. In addition, it describes general characteristics of enteral feeding, routes of administration, available enteral formulas, complications, and patient follow-up.

Diagnóstico y tratamiento de las dislipidemias en niños y adolescentes: recomendaciones de la rama de nutrición de la sociedad chilena de pediatría / Dyslipidemia management in children and adolescents: recommendations of the nutrition branch of the chilean society of pediatrics

La prevalencia de dislipidemias ha aumentado en niños y adolescentes, muchas de ellas asociadas al incremento de la obesidad. Puesto que constituyen un factor de riesgo cardiovascular futuro, deben conocerse las bases de su tratamiento. En la gran mayoría de los pacientes, éste consiste en cambios de estilo de vida, con dieta específica y aumento de la actividad física, presentando habitualmente una respuesta favorable. Solo una minoría requiere tratamiento medicamentoso, el que debe ser realizado por especialista en el contexto de una evaluación completa del perfil de riesgo cardiovascular, con la inclusión del paciente y su familia. Sin embargo, la prevención de los factores de riesgo cardiovascular debe ser realizada por todos los miembros del equipo de salud. Este artículo presenta las recomendaciones de la Rama de Nutrición de la Sociedad Chilena de Pediatría para el diagnóstico, tamizaje y tratamiento de las dislipidemias en la niñez.

The prevalence of dyslipidemia has dramatically increased in children and adolescents, and many of these cases are associated with increased obesity. As this condition represents cardiovascular risk in the future, the bases of its treatment should be widely known. In the vast majority of patients, there will be lifestyle changes, specific diet and increased physical activity, usually all of these resulting in a favorable response. Only a minority will require drug treatment, which must be prescribed by a specialist in the context of a comprehensive cardiovascular risk assessment, including the patient and his family. The prevention of cardiovascular risk factors should be performed by all members of the health team. This article presents the recommendations of the Nutrition specialists of the Chilean Society of Pediatrics for screening, diagnosis and treatment of dyslipidemia in childhood.

[Dyslipidemia management in children and adolescents: recommendations of the Nutrition Branch of the Chilean Society of Pediatrics]. / Diagnóstico y tratamiento de las dislipidemias en niños y adolescentes: recomendaciones de la Rama de Nutrición de la Sociedad Chilena de Pediatría.

The prevalence of dyslipidemia has dramatically increased in children and adolescents, and many of these cases are associated with increased obesity. As this condition represents cardiovascular risk in the future, the bases of its treatment should be widely known. In the vast majority of patients, there will be lifestyle changes, specific diet and increased physical activity, usually all of these resulting in a favorable response. Only a minority will require drug treatment, which must be prescribed by a specialist in the context of a comprehensive cardiovascular risk assessment, including the patient and his family. The prevention of cardiovascular risk factors should be performed by all members of the health team. This article presents the recommendations of the Nutrition specialists of the Chilean Society of Pediatrics for screening, diagnosis and treatment of dyslipidemia in childhood.

Adaptación del módulo de 18FDG para la preparación de una disolución inyectable de [18F] fluoruro sódico de conformidad con la Farmacopea Americana (USP 32) y Europea (PhEur 6) / Adaptation of the 18FDG module for the preparation of a sodium fluoride [18F] injection solution in agreement with the United States (USP 32) and European Pharmacopeia (PhEur 6)

Objetivos. Establecer un procedimiento automatizado para la preparación de la disolución inyectable de [18F] NaF utilizando los recursos disponibles en nuestro laboratorio para la preparación de 18FDG, analizando la repercusión del acondicionamiento de la columna de atrapamiento del ion fluoruro sobre las características del producto final. Material y método. Se modificó la secuencia de un módulo de síntesis de 18FDG automatizado de manera que el ion fluoruro procedente del ciclotrón se atrapa en resina de intercambio aniónico y se eluye con cloruro sódico 0,9%. La disolución final se dosifica y autoclava en envase final en equipo automatizado. Dentro del proceso, se estudiaron tres protocolos diferentes de acondicionamiento de columna. Se realizaron los controles de calidad descritos en USP 32 y PhEur 6, añadiendo el control de etanol como disolvente residual y los controles de calidad de la disolución a las 8 h de la preparación. Resultados. La activación de los cartuchos de resina con etanol y agua presenta una atrapamiento del ion fluoruro > 95% y pH en torno a 7, por lo que es el procedimiento de acondicionamiento de elección. La concentración de etanol se mantuvo < 5.000 ppm. Los controles efectuados a las 8 h indicaban que la disolución mantenía las especificaciones de USP 32 y PhEur 6. Conclusiones. Se describe un método automatizado sencillo, económico y reproducible, de preparación de una disolución inyectable de 18F-fluoruro sódico al alcance de cualquier centro con equipamiento convencional para síntesis y control de calidad de 18FDG(AU)

Objective. To establish an automated procedure for the preparation of sodium fluoride 18F injection using the resources available in our laboratory for the preparation of 18FDG and to analyze the repercussion of the conditioning column of the fluoride ion entrapment on the characteristics of the final product. Material and method. The sequence of an 18FDG synthesis module prepared so that it traps the fluoride ion from the cyclotron in ion-exchange resin diluted with 0.9% sodium chloride. The final solution was dosified and sterilized in a final vial in an automatized dispensing module. Three different column conditioning protocols within the process were tested. Quality controls were run according to USP 32 and EurPh 6, adding control of ethanol levels of residual solvent and quality controls of the solution at 8 h post-preparation. Results. Activation of the resin cartridges with ethanol and water was the chosen procedure, with fluoride ion trapping > 95% and pH around 7. Ethanol levels were < 5.000 ppm. Quality controls at 8 h indicated that the solution was in compliance with the USP 32 and EurPh 6 specifications. Conclusion. This is an easy, low-cost, reliable automated method for sodium fluoride preparation in PET facilities with existing equipment for 18FDG synthesis and quality control(AU)

[Adaptation of the (18)FDG module for the preparation of a sodium fluoride [(18)F] injection solution in agreement with the United States (USP 32) and European Pharmacopeia (PhEur 6)]. / Adaptación del módulo de (18)FDG para la preparación de una disolucióninyectable de [(18)F] fluoruro sódico de conformidad con la Farmacopea Americana(USP 32) y Europea (PhEur 6).

OBJECTIVE: To establish an automated procedure for the preparation of sodium fluoride (18)F injection using the resources available in our laboratory for the preparation of (18)FDG and to analyze the repercussion of the conditioning column of the fluoride ion entrapment on the characteristics of the final product. MATERIAL AND METHOD: The sequence of an (18)FDG synthesis module prepared so that it traps the fluoride ion from the cyclotron in ion-exchange resin diluted with 0.9% sodium chloride. The final solution was dosified and sterilized in a final vial in an automatized dispensing module. Three different column conditioning protocols within the process were tested. Quality controls were run according to USP 32 and EurPh 6, adding control of ethanol levels of residual solvent and quality controls of the solution at 8 h post-preparation. RESULTS: Activation of the resin cartridges with ethanol and water was the chosen procedure, with fluoride ion trapping > 95% and pH around 7. Ethanol levels were < 5.000 ppm. Quality controls at 8 h indicated that the solution was in compliance with the USP 32 and EurPh 6 specifications. CONCLUSION: This is an easy, low-cost, reliable automated method for sodium fluoride preparation in PET facilities with existing equipment for (18)FDG synthesis and quality control.

Headspace mass spectrometry methodology: application to oil spill identification in soils.

In the present work we report the results obtained with a methodology based on direct coupling of a headspace generator to a mass spectrometer for the identification of different types of petroleum crudes in polluted soils. With no prior treatment, the samples are subjected to the headspace generation process and the volatiles generated are introduced directly into the mass spectrometer, thereby obtaining a fingerprint of volatiles in the sample analysed. The mass spectrum corresponding to the mass/charge ratios (m/z) contains the information related to the composition of the headspace and is used as the analytical signal for the characterization of the samples. The signals obtained for the different samples were treated by chemometric techniques to obtain the desired information. The main advantage of the proposed methodology is that no prior chromatographic separation and no sample manipulation are required. The method is rapid, simple and, in view of the results, highly promising for the implementation of a new approach for oil spill identification in soils.

Biosorption of cadmium by biomass of brown marine macroalgae.

Five different brown seaweeds, Bifurcaria bifurcata, Saccorhiza polyschides, Ascophyllum nodosum, Laminaria ochroleuca and Pelvetia caniculata were studied for their ability to remove cadmium from aqueous solution. Kinetics of cadmium adsorption by all the algae were relatively fast, with 90% of total adsorption occurring in less than 1h. These experiments could be accurately described by a pseudo-second-order rate equation, obtaining values between 1.66x10(-3) and 9.92x10(-3) g/mgmin for the sorption rate constant k. Several equilibrium adsorption isotherms were obtained for the quantitative description of cadmium uptake. The use of the Langmuir isotherm led to values between 64 and 95 mg/g for qmax and between 0.036 and 0.094 L/mg for b. The effect of pH on biosorption was also studied. Acid-base properties of algae were studied by potentiometry to determine pK values (from 3.54 to 3.98) and the total number of acid groups.

Physicochemical studies of cadmium(II) biosorption by the invasive alga in Europe, Sargassum muticum.

In recent years, there has been a significant increase in the studies concerning brown seaweed as biosorbents for metal removal owing to their high binding ability and low cost. This work reports the results of a study regarding the cadmium binding equilibria of dead biomass from the seaweed Sargassum muticum; this alga is a pest fouling organism that competes with the local fucalean species and may also interfere with the "sea industry"; therefore, it would constitute an ideal material to be used as biosorbent. Seven different treatments were tested in order to obtain a stable biomass that could be suitable for industrial use under a broad range of operational conditions. The treatments employed were protonation, chemical cross-linking with formaldehyde, KOH, Ca(OH)(2) and CaCl(2) or physical treatments with acetone and methanol. The equilibrium adsorption isotherms of Langmuir, Freundlich, and Langmuir-Freundlich were obtained for the quantitative description of the cadmium uptake. The effect of pH on biosorption equilibrium was studied at values ranging from 1 to 6, demonstrating the importance of this parameter for an accurate evaluation of the biosorption process. Maximum biosorption was found pH higher than 4.5. The maximum biosorption uptake for the raw biomass was 65 mg g(-1), while for formaldehyde cross-linking biomass the uptake increases to 99 mg g(-1) and for protonated biomass to 95 mg g(-1). Potentiometric titrations were carried out to estimate the total number of weak acid groups and to obtain their apparent pK value, 3.85, using the Katchalsky model. Kinetic studies varying cadmium concentration, algal dose, and ionic strength were carried out. Over 95% of the maximum cadmium uptake was achieved within 45 min, so the process can be considered relatively fast. A pseudo-second-order model, for the kinetics of cadmium biosorption, was shown to be able to reproduce experimental data points with accuracy.

[Entrapment of the long head of the biceps: the "hourglass biceps". Another cause of pain and locking of the shoulder]. / Le long biceps en sablier ou long biceps piégé: une autre cause de douleur et de blocage de l'épaule.

PURPOSE OF THE STUDY: We describe a mechanical condition affecting the long head of the biceps tendon (LHBT) causing potentially unrecognized entrapment within the joint and subsequent pain and locking. This is caused by a hypertrophic intra-articular portion of the tendon that is unable to slide into the bicipital groove during elevation of the arm. MATERIALS AND METHODS: Twenty one patients were identified, during open (14 cases) or arthroscopic (7 cases) surgery, with a so called "hourglass biceps" i.e., hypertrophic intraarticular portion of the LHBT and incarceration of the tendon during elevation. All cases occurred in conjunction with a rotator cuff rupture except one who had a partial deep tear. All patients were treated by excision of the biceps, after tenodesis or bipolar tenotomy, and appropriate treatment of the concomitant lesions. RESULTS: All patients presented with anterior shoulder pain and loss of passive elevation averaging 10-20 degrees. A dynamic intraoperative test involving forward elevation with the elbow extended demonstrated entrapment of the tendon within the joint in each case. This test creates a characteristic "buckling" of the tendon and "squeezing" of the tendon between the humeral head and the glenoid ("hourglass test"). Excision of the tendon allowed immediate restoration of complete elevation. Mean Constant score increased from 38 points to 76 points postoperatively. DISCUSSION: The "hourglass biceps" is caused by a hypertrophic intraarticular portion of the tendon that is unable to slide into the bicipital groove during elevation of the arm. Loss of 10-20 degrees of passive elevation, bicipital groove tenderness, and radiographic findings of a hypertrophied tendon can aid in diagnosis. The "hourglass biceps" should not be misdiagnosed for a frozen shoulder. Definitive diagnosis is made at surgery with the "hourglass test": incarceration and squeezing of the tendon within the joint during forward elevation of the arm with the elbow extended. Simple tenotomy cannot resolve this mechanical block. Either tenotomy with excision of the intraarticular portion of the LHBT or tenodesis must be performed. The "Hourglass" biceps is an addition to the familiar pathologies of the long head of the biceps tendon (tenosynovitis, prerupture, rupture, instability), and should be considered in any case of chronic anterior shoulder pain associated with a loss of shoulder elevation.

Application of headspace-mass spectrometry for differentiating sources of olive oil.

In the present work we propose the use of headspace-mass spectrometry (HS-MS) for the characterisation of monovarietal olive oils, an issue of interest when the origin of an oil has to be determined. The HS-MS procedure involves the direct introduction of the sample into a vial, headspace generation and automatic injection of the volatiles into a mass spectrometer. The results were compared with those obtained using more conventional approaches, including chromatographic, spectrophotometric and other types of analysis. Linear Discriminant Analysis (LDA) was applied to the data obtained with both analytical methodologies to achieve the differentiation of the three types of samples. The proposed method is faster and cheaper than those usually employed for edible oil analysis and no sample preparation is required. Additionally, the measuring process is simple and the results obtained from chemometric treatment are 100% correct as regards classification and prediction, making it an appropriate method for routine control.

[Identification of doctors with high pharmaceutical expenditure]. / Identificación de médicos con gasto farmacéutico elevado.

OBJECTIVE: [corrected] To identify doctors with high pharmaceutical expenditure through multiple regression of variables not exclusively dependent on the doctor's decision. To compare the agreement with the method of the Spanish national health servicem which only considered the percentage of pensioners of the doctor's list. METHODS: Cross-sectional, retrospective, descriptive study of the pharmaceutical expenditure of 220 general practitioners in the health district of Toledo (Spain) in 1999. The following variables were collected: pharmaceutical expenditure for policy-holder/month (PEP-H); age; sex; habitat; size of the list; percentage of pensioners; frequency of attendance (consults/policy-holder-year) and workload (consultations per day). A multiple regression model with backwards elimination was constructed, taking like PEP-H as the dependent variable and the remaining as the independent variables. The resultant equation enabled calculation of the expected PEP-H for each doctor and the deviation of their real expenditure ofrom the expected. Doctors were considered to have high pharmaceutical expenditure when the deviation was more than the mean plus 1 standard deviation of this distribution. RESULTS: The mean PEP-H was 2,584.4 pesetas. Differences were found (F = 11.665; p < 0.005) in PEP-H per habitat (2,723.2 in rural, 2,521.4 in semi urban and 2,168.2 in urban). A significant correlation was found (p < 0.005) between PEP-H and percentage of pensioners (r = 0.728) and frequency of attendance (r = 0.607). Our final model included percentage of pensioners, frequency of attendance, and age (F = 102.33; p < 0.005; r = 0.767; r² = 0.588; ß = 206.05; ß1 = 48.27; ß2 = 61.26; ß3 = 9.55). This model were identified 25 DHPC. With the INSALUD model the identification were of 31. The Kappa index showed that agreement between both methods was 0.706 (SE 0.056) and simple disagreement was found in the classification of 24 doctors (10.9%). CONCLUSIONS: Frequency of attendance and the percentage of pensioners on doctors' lists are iclosely related to PEP-H. The indicator currently used by the Spanish national health system to identify doctors with high pharmaceutical expenditure could be improved if other variables, such as frenquency of attendance and the doctors' age, were taken into account. The adoption of this method would make budget allocation more impartial and fair.

Identificación de médicos con gasto farmacéutico elevado / Identification of doctors with high pharmaceutical expenditure

Objetivo: Identificar «médicos con gasto farmacéutico elevado» (MGE), mediante regresión múltiple, en función de aquellas variables no dependientes exclusivamente del facultativo. Comparar la concordancia con el método del Insalud, que sólo considera porcentaje de pensionistas del cupo. Métodos: Estudio descriptivo transversal, retrospectivo, delg asto farmacéutico de los 220 médicos de familia del Área de Toledo, durante 1999. Las variables recogidas fueron: gasto farmacéutico por asegurado/mes (GFA), edad, sexo, hábitat, tamaño del cupo, porcentaje de pensionistas, frecuentación (consultas/asegurado-año) y presión asistencial (consultas/día). Se construyó un modelo de regresión múltiple por eliminación (hacia atrás), tomando como variable dependiente el GFA y como independiente el resto. La ecuación resultante nos permitió calcular el GFA «esperado» por médico y la desviación de su gasto real sobre el esperado. Se consideró MGE cuando su desviación superaba la media más una desviación estándar de dicha distribución. Resultados: El GFA medio era 2.584,4 ptas. Encontramos diferencias significativas (F = 11,665; p < 0,005) en el GFA (..) (AU)

Objetive: To identify doctors with high pharmaceutical expenditure through multiple regression of variables not exclusively dependent on the doctor’s decision. To compare the agreement with the method of the Spanish national health servicem which only considered the percentage of pensioners of the doctor’s list. Methods: Cross-sectional, retrospective, descriptive study of the pharmaceutical expenditure of 220 general practitioners in the health district of Toledo (Spain) in 1999. The following variables were collected: pharmaceutical expenditure for policy-holder/month (PEP-H); age; sex; habitat; size of the list; percentage of pensioners; frequency of attendance (consults/policy-holder-year) and workload (consultations perday). A multiple regression model with backwards elimination was constructed, taking like PEP-H as the dependent variable and the remaining as the independent variables. The resultant equation enabled calculation of the expected PEP-Hfor each doctor and the deviation of their real expenditure (..) (AU)

Cloud point preconcentration of rather polar compounds: application to the high-performance liquid chromatographic determination of priority pollutant chlorophenols.

The potential of the cloud point methodology for the preconcentration of relatively polar compounds was studied using the non-ionic surfactant Triton X-114 and five EPA chlorophenols as test analytes. Analyte determination was performed using reversed-phase gradient LC with electrochemical and spectrophotometric detection. The amount of surfactant used is a critical variable in the preconcentration factor because it determines the extraction yield and the volume of surfactant-rich phase obtained. These values were determined as a function of the Triton X-114 concentration, together with the phase ratio, which allows prediction of the maximum preconcentration factor under given conditions.

[Diagnosis of health needs of the elderly population of a community of Puerto Nuevo]. / Diagnóstico de necesidades de salud de la población de adultos viejos de un sector de la comunidad de Puerto Nuevo.

The purpose of this study was to identify the health needs of the non-institutionalized population, 65 years and over, residing in a sector of the community of Puerto Nuevo. This was the first urbanization established in Puerto Rico in the early 50's. The "snowball" technique was use to identify all the residents 65 year and over of the mentioned sector. Eighty five elderly persons were interviewed to gather data of the following variables: demographics, health conditions, preventive measures, activities of daily living (ADLs, IADLs), health services utilization, psychosocial aspects and use of programs and services available for the elderly population. Statistical analysis included descriptive measures and chi-square. Results revealed a population with a higher education and economic level than the average for this age group in Puerto Rico. People over 75 years over reported more functional limitations than the 65-74 years interviewees did. In comparison with men, women were less educated and presented a higher percent of widows, persons living alone and functional limitations. In almost all the interviewees, help was available in case of need. The majority expressed satisfaction with their family and social lives. Very few utilized programs and services available for elderly persons. It is concluded that in order to improve their quality of life, this population needs to be managed in an holistic mode to address their biopsychosocial needs and to be educated in health promotion issues to prevent further functional limitations. They also need education about the available services for elderly persons.

Analytical applications of membrane extraction in chromatography and electrophoresis.

An overview of the analytical applications of membrane-based systems for sample enrichment in chromatography and capillary electrophoresis is presented. A brief introduction to the different types of membranes and the main forces related to the transport through them is also given.

Surfactant cloud point extraction and preconcentration of organic compounds prior to chromatography and capillary electrophoresis.

The use of preconcentration steps based on phase separation by the cloud point technique offers a convenient alternative to more conventional extraction systems. It has been used successfully for the preconcentration of species of widely differing character and nature, such as metal ions, proteins and other biomaterials, or organic compounds of strongly differing polarity. Here we address the most recent analytical applications of this methodology when used as an isolation and trace enrichment step prior to the analysis of organic compounds (polycyclic aromatic hydrocarbons, polychlorinated compounds, pesticides, phenolic derivatives, aromatic amines, vitamins, etc.) via liquid and gas chromatography or capillary electrophoresis.

Automated on-line membrane extraction liquid chromatographic determination of phenols in crude oils, gasolines and diesel fuels.

Determination of phenols in crude oils and derived fuels requires a sample pretreatment step, usually performed by liquid-liquid extraction or preparative chromatography. In this work, sample preparation is accomplished using a silicone membrane separation unit coupled on-line to a high performance liquid chromatograph with amperometric and ultraviolet detection. The contents of phenol, cresols and dimethylphenols were determined in thirty three samples including three crude oils, twenty gasolines and ten diesel fuels. The whole set-up is fully automated through a feed-back system that allows the microcomputer controlling the process to examine the signals in real time and to make decisions while the experiment is running.

[Prognostic factors during rehabilitation after shoulder prostheses for fracture]. / Facteurs pronostiques au cours de la rééducation après prothèses d'épaule pour fracture.

PURPOSE: To evaluate the role, the difficulties of rehabilitation and to diagnose the eventual surgical complications after shoulder prosthesis for 4-part fractures. MATERIAL AND METHODS: Forty three patients (46 shoulders) who underwent shoulder arthroplasty after fracture of the proximal humerus underwent rehabilitation and follow-up at a special reeducation center for an average of 3 months (1 to 6). There were 42 four-part fractures (with 22 fracture-dislocation) and 4 three-part fractures. The patients were send by five different hospitals and have all been operated by senior surgeons. Three types of implants were used: the Modular Shoulder prosthesis (27 cases), the Global prosthesis (2 cases), and the Aequalis prosthesis (17 cases). The rehabilitation followed the protocol recommended by Neer (recovery of passive joint movements, muscular strengthening and stretching) to which were added hydrotherapy, physiotherapy and occupational therapy. Forty patients (43 épaules) were reviewed and radiographed with an average follow-up of 29 months (18 to 72 months). RESULTS: The functional results were disappointing with a normalised Constant score of only 60.2 per cent and an average active elevation of only 96 degrees. There appeared to be two factors which explained these poor results. Firstly, the advanced age of the population (52 per cent older than 70) who was often poorly or non-motivated (22 per cent) and debilitated (21 per cent chronic alcoholics) and who had significant medical and neuro-psychiatric histories. Secondly, incompletely resolved anatomical and surgical problems: damage to the circumflex nerve (6.5 per cent), early migration of the greater tuberosity (6.5 per cent), secondary migration with malunion (15 per cent) and/or nonunion (11 per cent) of the greater tuberosity. Migration of the greater tuberosity should be suspected clinically in three circumstances: 1) in patients who have an abnormally painful shoulder in the immediate post-operative period (16 cases in our series); 2) when there is no progression (24 per cent) or regression (9 per cent) of active shoulder mobility after three months of correct supervised rehabilitation; 3) later, if there is a dissociation between active anterior elevation (deficient) and passive anterior elevation (preserved). DISCUSSION AND CONCLUSION: The age and poor general condition of the patients as well as the difficulty of the surgical technique more than the rehabilitation, explain the disappointing results observed after shoulder prosthesis for four-part fractures. The discrepancy between active and passive elevation suggests that limited motion is not caused by a stiff shoulder because of glenohumeral scarring but instead by weakness of the deltoid (because of axillary lesion) and/or of the external rotators (because of greater tuberosity migration). There is some discordance between the necessity to early mobilise the shoulder and the high rate of tuberosity migration.

Evaluación nutricional en pacientes pediátricos con infección VIH / Nutritional evaluation in paediatric patients with HIV infection

Para conocer el estado nutricional de los niños chilenos infectados por VIH, se evaluaron todos aquellos en control en los Servicios de Salud de Santiago (n = 34) con infección VIH confirmada, en distintas etapas clínicas (agosto a octubre de 1996), 19 mujeres y 15 varones (0,5 a 9,0 años). Se evaluó antropometría y nutrición de zinc (Zn), cobre (Cu), retinol, tocoferol, carnitina y hierro, además de encuesta alimentaria. El estado nutricional P/E o P/T reveló a 12 desnutridos o en riesgo, sin asociación con etapa clínica. Seis tenían Zn en pelo bajo; 23 tenían Zn plasmático bajo, asociado con compromiso antropométrico (p = 0,04) y con enfermedad más avanzada (p = 0,022). Dos tenían hipocupremia, tres tocoferol bajo y todos retinol normal; 11 tenían carnitina total baja, 24 déficit de carnitina libre y 17 carnitina esterificada elevada. La ferritina sérica mostró déficit en 10 pacientes. Las encuestas revelaron ingestas normales de energía y proteína; 23 estaban bajo el 80 por ciento de las recomendaciones y riesgo de deficiencia de Zn y carnitina