El manejo conjunto Geriatría-Neurocirugía de pacientes mayores de 75 años reduce la estancia media, la morbilidad, los reingresos hospitalarios y la mortalidad al año / The joint management of Geriatrics-Neurosurgery of patients older than 75 years reduces the average stay, morbidity, hospital readmissions and mortality per year

OBJETIVO: El envejecimiento de la población es una realidad objetivable para la que los sistemas de salud no están adaptados. La Organización Mundial de la Salud ya ha avisado de la importancia de la implementación de medidas específicas, que abarcan desde la formación pregrado hasta la instauración de un número adecuado de geriatras, para seguimiento de los pacientes mayores. Nos proponemos analizar si la intervención del geriatra en el seguimiento del paciente neuroquirúrgico aporta beneficios. MATERIAL Y MÉTODOS: Se lleva a cabo un estudio descriptivo de cohortes, parcialmente prospectivo, analizando a todos los pacientes mayores de 75 años ingresados a cargo del servicio de Neurocirugía y que fueron atendidos en seguimiento compartido por Geriatría desde junio de 2015 hasta febrero de 2017. Se comparan con los pacientes mayores de 75 años ingresados en Neurocirugía entre octubre de 2013 y mayo de 2015 (periodo equivalente) en el que los geriatras solo intervinieron como unidad de valoración sociosanitaria a la hora de derivar al paciente a otro nivel asistencial. Se analizaron edad media, sexo, entidad neuroquirúrgica que motivó el ingreso, estancia media, complicaciones infecciosas, referencia escrita de síndrome confusional, ingreso en unidad de cuidados intensivos, necesidad de interconsulta con otros servicios, reintervención quirúrgica, mortalidad durante el ingreso, derivación a recurso sociosanitario, reingreso al mes y mortalidad al año. RESULTADOS: Se comparó a un total de 173 pacientes en seguimiento conjunto con 189 del periodo previo. Ambas cohortes presentaron características demográficas similares. Durante el periodo de manejo conjunto se redujeron la estancia media hospitalaria, la incidencia de complicaciones infecciosas, la necesidad de ingreso urgente en unidad de cuidados intensivos, la necesidad de interconsulta con otras especialidades, la tasa de readmisión a los 30 días y la mortalidad anual, todas ellas con diferencias estadísticamente significativas. CONCLUSIONES: El seguimiento compartido entre Neurocirugía y Geriatría disminuye la estancia media, la morbilidad, la necesidad de interconsulta con otras especialidades, el reingreso precoz y la mortalidad al año en los mayores de 75 años. Además, prioriza una atención centrada en la persona, disminuye costes y racionaliza los recursos

OBJECTIVE: Population ageing is a reality for which national health systems are not adapted. The World Health Organisation has already raised awareness about the implementation of specific measures, from undergraduate training to dedicated elderly care units, to tackle this situation. In this article, the aim is to analyse the potential benefits of geriatric monitoring on elderly neurosurgical patients. MATERIAL AND METHODS: A descriptive analysis was performed in this medical centre, comparing the information collected from elderly patients (over 75 years of age) admitted into the neurosurgical department during 2periods: June 2015 to February 2017, in which a shared geriatric monitoring was implemented, and between October 2013 and May 2015, equivalent period, in which only the geriatrician performed the evaluation of the patients' general condition, before referring them to other social-healthcare units. A number of factors were considered, including mean age, gender, the neurosurgical condition that led to admission, mean stay, infectious complications, acute confusional syndrome, admission into an intensive care unit, need for support from other medical departments, reoperations, mortality during hospitalisation, referral to social-health units, readmission within a month, and mortality within a year. RESULTS: A total of 173 patients on shared monitoring were compared to 189 patients from the previous period. Both groups had similar demographic characteristics. During the analysis, a significant reduction was observed in shared monitoring as regards, mean hospitalisation, infectious complications, admissions into an intensive care unit, the need for support from other medical departments, readmissions within a month, and mortality within a year. CONCLUSIONS: On patients of over 75 years of age, shared geriatric-neurosurgical monitoring reduces mean hospitalisation, morbidity, the need for support from other medical departments, early readmission, and mortality within a year. This strategy prioritises patient care, reduces costs, and rationalises resources

[The joint management of Geriatrics-Neurosurgery of patients older than 75 years reduces the average stay, morbidity, hospital readmissions and mortality per year]. / El manejo conjunto Geriatría-Neurocirugía de pacientes mayores de 75 años reduce la estancia media, la morbilidad, los reingresos hospitalarios y la mortalidad al año.

OBJECTIVE: Population ageing is a reality for which national health systems are not adapted. The World Health Organisation has already raised awareness about the implementation of specific measures, from undergraduate training to dedicated elderly care units, to tackle this situation. In this article, the aim is to analyse the potential benefits of geriatric monitoring on elderly neurosurgical patients. MATERIAL AND METHODS: A descriptive analysis was performed in this medical centre, comparing the information collected from elderly patients (over 75 years of age) admitted into the neurosurgical department during 2periods: June 2015 to February 2017, in which a shared geriatric monitoring was implemented, and between October 2013 and May 2015, equivalent period, in which only the geriatrician performed the evaluation of the patients' general condition, before referring them to other social-healthcare units. A number of factors were considered, including mean age, gender, the neurosurgical condition that led to admission, mean stay, infectious complications, acute confusional syndrome, admission into an intensive care unit, need for support from other medical departments, reoperations, mortality during hospitalisation, referral to social-health units, readmission within a month, and mortality within a year. RESULTS: A total of 173 patients on shared monitoring were compared to 189 patients from the previous period. Both groups had similar demographic characteristics. During the analysis, a significant reduction was observed in shared monitoring as regards, mean hospitalisation, infectious complications, admissions into an intensive care unit, the need for support from other medical departments, readmissions within a month, and mortality within a year. CONCLUSIONS: On patients of over 75 years of age, shared geriatric-neurosurgical monitoring reduces mean hospitalisation, morbidity, the need for support from other medical departments, early readmission, and mortality within a year. This strategy prioritises patient care, reduces costs, and rationalises resources.

Réplica a la carta al editor titulada: "Efectividad y seguridad de la eritropeyetina alfa en el paciente (ortopédico) mayor de 65 años" / Reply to the letter to the editor entitled: "Effectiveness and safety of erythropoietin alpha in the patient (orthopaedic) over 65 years"

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[Osteoporotic pubic rami fracture: a benign injury?] / Fracturas osteoporóticas de ramas pélvicas: ¿Son una lesión benigna?

Objective: We analized patients treated for osteoporotic rami fractures in our hospital. Methods: We examined the records of patients presenting to the emergency department with osteoporotic low-impact rami fractures. We describe demographic, previously ambulatory ability, diagnosis, associated injuries, comorbility, complications and 1 year mortality. Results: 60 patients (51 women) with a mean age of 83,5 (range, 65,1-99) years had osteoporotic rami fracture. Six patients had previously a rami fracture and 23 a osteoporotic fracture. 27 patients associated other pelvic fracture. Three pacientes had other extrapelvic fracture and six a craneoencephalic trauma. 41 patients had any complication at follow up. Eigth patients (13,3%) were admitted to hospital with a median length of stay in the hospital of 18 days. Eight (13,3%) patients died within 1 year of injury. Conclusions: Low-impact rami fractures affect predominantly elderly women with pre-existing comorbidities. A substantial amount of complications are described in this fractures with a high 1 year mortality. Early rehabilitation therapy with adequate analgesic therapy should be recommended.

Objetivo: Analizar los pacientes tratados por fractura osteoporótica de ramas pélvicas en nuestro hospital. Métodos: Analizamos retrospectivamente pacientes con fracturas de ramas pélvicas atendidos en el Servicio de Urgencias de nuestro hospital. Los parámetros analizados incluyen datos demográficos, diagnósticos, lesiones asociadas, comorbilidades, autonomía previa, complicaciones y mortalidad al año. Resultados: 60 pacientes (51 mujeres) con una edad media de 83,5 años (rango, 65,1-99) presentaron fractura osteoporótica de ramas pélvicas. 6 pacientes presentaban antecedentes de fractura de ramas pélvicas y 23 de fractura osteoporótica de otra localización. En 27 casos se asociaban a lesiones en otras localizaciones de la pelvis. 3 pacientes asociaban fracturas extrapélvicas y 6 traumatismos craneoencefálicos. 41 pacientes experimentaron complicaciones de algún tipo. Se requirió ingreso hospitalario en 8 casos, con una estancia media de 18 días. La mortalidad al año fue de 13,3%. Conclusiones: Las fracturas osteoporóticas de ramas pélvicas afectan predominantemente a mujeres con numerosas comorbilidades. Muchas son las complicaciones descritas en estos pacientes con una mortalidad anual elevada. Es remendable un adecuado tratamiento analgésico que permita una movilización precoz del paciente tras descartar lesiones asociadas en la pelvis.

Agentes estimuladores de la eritropoyetina: revisión bibliográfica de los usos e indicaciones en enfermedad avanzada oncológica y no oncológica en el anciano / Erythropoiesis stimulating agents: Literature review of uses and indications in advanced oncological and non-oncological disease in the elderly

El objetivo de este artículo es revisar las posibles indicaciones y controversias sobre los usos más frecuentes de los agentes estimuladores de la eritropoyetina (AEE) en el tratamiento de la anemia de los pacientes ancianos, con enfermedad oncológica y no oncológica avanzada. Para ello, hemos realizado una revisión sistemática en Pubmed, de artículos publicados desde 1985 hasta septiembre del 2016. Hemos realizado también la revisión de las principales guías de consenso españolas, europeas y americanas, en relación con el manejo de la anemia relacionada con las enfermedades reseñadas en el artículo. Hemos encontrado que existen barreras para su uso en pacientes ancianos con enfermedad avanzada, sobre todo por la falta de uniformidad y consenso en las recomendaciones, y por la ausencia de ensayos prospectivos a gran escala para explorar la eficacia de los AEE en esta población. Parece haber consenso en la utilización en los pacientes con enfermedad renal crónica avanzada, en pacientes con tumores no mieloides, en tratamiento con quimiterapia con intención no curativa, y en pacientes con síndrome mielodisplásico, todavía respondedores, para espaciar el soporte transfusional. En el resto, debe individualizarse, ya que el riesgo de mortalidad y morbilidad cardiovascular está claramente aumentado. No debe ser la solución para tratar la anemia, en casos de urgencia o de necesidad transfusional a corto plazo, muchas veces presentes en este paciente

The aim of this article is to review possible indications and controversies about the most frequent uses of ESAs in the treatment of anaemia in elderly patients with oncological and non-oncological diseases. Using PubMed a systematic review was carried out on articles published from 1985 to September 2016, as well as a review of the main Spanish, European, and American consensus guidelines on each of the following diseases in which could pose the treatment of anaemia associated with ESA. A review was also carried out on the main Spanish, European and American consensus guidelines regarding the management of anaemia related to the diseases outlined in this article. It was found that there are limitations of its use in elderly patients with advanced disease, mainly due to the lack of uniformity and consensus in the recommendations, and the absence of large-scale prospective trials to determine the effectiveness of ESA in this population. There seems to be consensus in the use in patients with advanced chronic kidney disease, individualised in patients with non-myeloid cancer on treatment without curative intent, and in patients with myelodysplastic syndrome, still responders to space transfusional support. In the remainder, it should be individualised, since the risk of mortality and cardioembolic morbidity is clearly increased. It should not be the solution to treat anaemia, in cases of urgency or short-term transfusional need, which are often present in these patients

[Erythropoiesis stimulating agents: Literature review of uses and indications in advanced oncological and non-oncological disease in the elderly]. / Agentes estimuladores de la eritropoyetina: revisión bibliográfica de los usos e indicaciones en enfermedad avanzada oncológica y no oncológica en el anciano.

The aim of this article is to review possible indications and controversies about the most frequent uses of ESAs in the treatment of anaemia in elderly patients with oncological and non-oncological diseases. Using PubMed a systematic review was carried out on articles published from 1985 to September 2016, as well as a review of the main Spanish, European, and American consensus guidelines on each of the following diseases in which could pose the treatment of anaemia associated with ESA. A review was also carried out on the main Spanish, European and American consensus guidelines regarding the management of anaemia related to the diseases outlined in this article. It was found that there are limitations of its use in elderly patients with advanced disease, mainly due to the lack of uniformity and consensus in the recommendations, and the absence of large-scale prospective trials to determine the effectiveness of ESA in this population. There seems to be consensus in the use in patients with advanced chronic kidney disease, individualised in patients with non-myeloid cancer on treatment without curative intent, and in patients with myelodysplastic syndrome, still responders to space transfusional support. In the remainder, it should be individualised, since the risk of mortality and cardioembolic morbidity is clearly increased. It should not be the solution to treat anaemia, in cases of urgency or short-term transfusional need, which are often present in these patients.

Fracturas osteoporóticas de ramas pélvicas: A Benign Injury? / Fractures ostéoporotiques des branches pubiennes, est-ce qu'elles sont bénignes? / Osteoporotic Pubic Rami Fracture

Objetivo: analizar los pacientes tratados por fractura osteoporótica de ramas pélvicas en nuestro hospital. Métodos: se analizan retrospectivamente pacientes con fracturas de ramas pélvicas atendidos en el Servicio de Urgencias de nuestro hospital. Los parámetros examinados incluyen datos demográficos, diagnósticos, lesiones asociadas, comorbilidades, autonomía previa, complicaciones y mortalidad al año. Resultados: 60 pacientes (51 mujeres) con una edad media de 83,5 años (rango, 65,1-99) presentaron fractura osteoporótica de ramas pélvicas; 6 pacientes presentaban antecedentes de fractura de ramas pélvicas y 23 de fractura osteoporótica de otra localización. En 27 casos se asociaban a lesiones en otras localizaciones de la pelvis, 3 pacientes asociaban fracturas extrapélvicas y 6 traumatismos craneoencefálicos; 41 pacientes experimentaron complicaciones de algún tipo. Se requirió ingreso hospitalario en 8 casos, con una estancia media de 18 días. La mortalidad al año fue de 13,3 por ciento. Conclusiones: las fracturas osteoporóticas de ramas pélvicas afectan predominantemente a mujeres con numerosas comorbilidades. Muchas son las complicaciones descritas en estos pacientes con una mortalidad anual elevada. Es recomendable un adecuado tratamiento analgésico que permita la movilización precoz del paciente tras descartar lesiones asociadas en la pelvis(AU)

Objective: we analysed patients treated for osteoporotic rami fractures in our hospital. Methods: the records of patients were examined presenting to the emergency department with osteoporotic low-impact rami fractures. Demographic, previously ambulatory ability, diagnosis, associated injuries; comorbidity, complications, and 1-year mortality were described. Results: 60 patients (51 women) with mean age of 83,5 (range, 65,1-99) years had osteoporotic rami fracture. Six patients had previous rami fracture and 23 a osteoporotic fracture. Twenty-seven patients had other pelvic fracture associated. Three patients had other extra pelvic fracture and six had crane encephalic trauma. Forty-one patients had some kind of complication at follow up. Eight patients (13, 3 percent) were admitted to hospital with median length of stay in the hospital of 18 days. Eight (13, 3 percent) patients died within 1 year of injury. Conclusions: low-impact rami fractures affect predominantly elderly women with pre-existing comorbidities. A substantial amount of complications is described in these fractures with high annual mortality. Early rehabilitation therapy with adequate analgesic therapy is recommended(AU)

Objectif: l'objectif de cette étude est d'analyser les patients traités à cause de fractures ostéoporotiques des branches pubiennes à l'hôpital universitaire Miguel Servet, hôpital de référence du secteur 2 à Zaragoza (Espagne). Méthodes: une étude rétrospective de patients atteints de fractures des branches pubiennes, et soignés au service d'urgences de cet hôpital, a été réalisée. On a examiné des paramètres, tels que données démographiques, diagnostics, lésions associées, comorbidités, autonomie préalable, complications, et taux de mortalité par an. Résultats: soixante patients (51 femmes), dont l'âge moyen a été 83,5 ans (rang 65,1-99), souffraient de fractures ostéoporotiques des branches pubiennes ; 6 patients avaient une histoire de fractures des branches pubiennes, et 23 étaient atteints de fractures ostéoporotiques ayant une autre localisation. Dans 27 cas, les fractures étaient liées à des lésions ayant d'autres localisations du bassin, 3 patients souffraient de fractures extra-pelviennes associées, et 6 des traumatismes cranio-encéphaliques ; 41 patients ont éprouvé des complications de quelque type. Huit patients ont été hospitalisés, ayant un séjour hospitalier de 18 jours en moyenne. Le taux de mortalité par an a été 13,3 pourcent. Conclusions: les fractures ostéoporotiques pelviennes touchent souvent les femmes souffrant plusieurs comorbidités. Un grand nombre de complications se produisent chez ces patients, provoquant ainsi un haut taux de mortalité par an. Après avoir écarté la possibilité de lésions associées au niveau du bassin, il est conseillé d'appliquer un traitement analgésique permettant la mobilité précoce du patient(AU)

Horner's Syndrome due to a Spontaneous Internal Carotid Artery Dissection after Deep Sea Scuba Diving.

Internal carotid artery dissection (ICAD) is a rare entity that either results from traumatic injury or can be spontaneously preceded or not by a minor trauma such as sporting activities. It represents a major cause of stroke in young patients. The diagnosis should be suspected with the combination of Horner's syndrome, headache or neck pain, and retinal or cerebral ischaemia. The confirmation is frequently made with a magnetic resonance angiography (MRA). Although anticoagulation with heparin followed by vitamin-K-antagonists is the most common treatment, there is no difference in efficacy of antiplatelet and anticoagulant drugs at preventing stroke and death in patients with symptomatic carotid dissection. We describe a patient with ICAD following deep sea scuba diving, who presented with Horner's syndrome and neck pain and was successfully treated with anticoagulants.

[Evaluation of general health status by SF-36 tool in Hip Osteoarthritis]. / Valoración subjetiva de salud en el paciente joven con coxoartrosis: aplicación del cuestionario SF-36.

OBJECTIVE: To determine the general health status perceived by patients undergoing total hip arthroplasty with mini-stem. MATERIAL AND METHODS: Health questionnaire SF-36 has been used to assess health perceived by 13 male patients with a mean age of 46.62 (34-53) years after the implantation of an uncemented, MiniHip® (CorinMedical) total hip arthroplasty, after a mean follow up of 23.2 (12-47) months. Results were compared with the reference values of Spanish men population from 45 to 54 years. RESULTS: Differences were found in areas such as physical and emotional role, physical function, social function and pain; while scores of the remaining items were similar to the population of reference. DISCUSSION: It is important to know how our surgical actions affect the quality of life of patients and how it is perceived by them to complement the results of our surgeries.

Objetivo: Determinar el estado de salud general percibida por los pacientes sometidos a artroplastia total de cadera con mini-vástago. Material y Método: Se ha administrado el cuestionario de salud SF-36 para evaluar el estado de salud percibido por 13 pacientes varones con una edad media de 46,62 (34-53) años en los que se implantó una artroplastia total de cadera no cementada tipo MiniHip® (CorinMedical) tras un seguimiento medio de 23,2 (12-47) meses. Los resultados obtenidos se compararon con los valores de referencia de la población española en varones de 45 a 54 años. Resultados: Se hallaron diferencias en aspectos como rol físico y emocional, función física, función social y dolor; mientras que en el resto de los ítems la puntuación fue similar a la de la población de referencia. Discusión: Existe la necesidad de conocer en qué grado afectan nuestras intervenciones a la calidad de vida del paciente y la manera en que es percibida por él mismo para complementar los resultados de nuestras intervenciones. Conclusión: Es necesaria una nueva perspectiva para la valoración funcional y de calidad de vida de los pacientes jóvenes sometidos a una artroplastia total de cadera.