Evaluación de la actividad de una unidad de media estancia de psicogeriatría / Evaluation of the activity in a mean stay unit of psychogeriatrics

OBJETIVO: Evaluar la actividad de una unidad de media estancia de psicogeriatría a los 10 meses de su implantación. MÉTODO: Estudio descriptivo prospectivo sobre 64 pacientes en el que se analizaron perfil clínico-social, objetivos al ingreso, tiempo de estancia, cambios en funcionalidad, trastornos de conducta o uso de fármacos, complicaciones, procedencia y destino final. Para el análisis de datos se utilizó el programa estadístico SPSSv10. RESULTADOS: Medias: edad 78,3 años, estancia hospitalaria 42 días, I. Charlson 2,1. Tenían GDS > 4 el 86 per cent. Como síndromes geriátricos predominaron incontinencia e inmovilidad. El objetivo fue evaluador/terapéutico en el 73 per cent de casos y contención social en el resto. La media de I. Barthel al ingreso/alta fue 32/43, la presencia de agresividad o trastorno del sueño al ingreso/alta fueron 22 per cent/12 per cent y 34 per cent/3 per cent, la media de fármacos y psicofármacos al ingreso/alta fue respectivamente 5,2/4,7 y 2,2/1,9. Los principales diagnósticos neuropsiquiátricos fueron demencia y depresión. La procedencia mayoritaria fue domicilio, seguida de hospital. El destino final fue domicilio en un 50 per cent e institucionalización definitiva en un 36 per cent. CONCLUSIONES: Hubo mejoría global de funcionalidad y de trastornos de agresividad y sueño, así como reducción del número de fármacos. Se observó un importante porcentaje de institucionalización al alta (AU)

[Normal values for transcranial doppler studies in our medium]. / Valores de normalidad del estudio Doppler transcraneal en nuestro medio.

OBJECTIVE: Transcranial Doppler is a technique which is being used ever more frequently in the study of intracranial arteries and is very useful in the study of cerebrovascular disease. The typical values of a healthy population in our country are unknown. The aim of this study was determine mean velocity and pulsatility index reference values in a healthy population. PATIENTS AND METHOD: Transcranial Doppler basal examination was carried out on 118 healthy volunteers without prior haematological or cerebrovascular conditions. Those found to have extracranial arterial stenoses were excluded as were those in whom bilateral temporal bone hyperostosis did not permit insonation in either middle cerebral arteries. The nine intracranial arteries were sounded systematically at fixed depths. The mean and standard deviations of each variable were calculated for side, age group and sex. RESULTS: 49% were males and average age was of 56 years (range, 21-87 years). A sufficient signal to determine the parameters of the study was obtained in 89% of middle cerebral arteries. Statistically significant differences in mean velocity and pulsatility index were found between age groups and sexes. CONCLUSIONS: Sex and age must be taken into account in establishing typical patterns in transcranial Doppler examination. Our results enable parameters of typical values to be established for the adult population in Spain.

[Acute sensory neuropathy associated with a varicella-zoster infection]. / Neuronopatía aguda sensitiva asociada a infección por virus varicela-zoster.

INTRODUCTION: Sensory neuropathy is a clinical entity which has been considered to be found in relation to neoplasia, Sjogren's syndrome, long-term pyridoxine treatment, or to be idiopathic. CLINICAL CASE: We present the case of a 33 year old woman who developed acute sensory neuropathy after being diagnosed as having varicella. She had no previous history of weight loss or other signs of neoplasia, no dryness of the mucous membranes or history of arthritis and had taken no toxic substances or pyridoxine, thus ruling out other causes of sensory neuropathy. The acute varicella infection was apparent from the clinical characteristics and the presence of specific IgM in serum. CONCLUSION: The clinical signs, in the absence of other circumstances which might have been related, together with the presence of acute varicella-zoster virus infection seems to indicate that the two conditions were related.

[Record of neurological emergencies at a tertiary care hospital]. / Registro de urgencias neurológicas en un hospital de tercer nivel.

INTRODUCTION AND OBJECTIVE: There is a progressive increase in the demand for multidisciplinary attention from the Emergency Medical Services. The objective of this study was to determine the proportion of neurological conditions in the total hospital emergency workload, their demographic composition and medical needs. PATIENTS AND METHODS: We present an observational study of a cohort of histories of neurological emergencies at a tertiary hospital during a period of one year. RESULTS: On analysis of all emergencies, 1,592 were neurological conditions. The duty neurologist was consulted in 87.9% of the cases. The average age was 59, and the majority were women (56.3%). Maximum demand was between 14.00 and 19.59 hours. Monday was the day of the week when most were seen. The commonest causes of consultation were change in strength or language, headache and epileptic crises. The complementary investigation done most frequently was a blood test. Cerebral CT scan were done in 31.9% of the patients. The diagnoses most often made, as a group, were cerebrovascular disease followed by epilepsy and headache. The majority of the patients were referred to Primary Care Centres or for neurological consultation. When the patients were grouped according to the specialties with doctors on duty, the second largest group were seen by the emergency neurologist at our hospital. CONCLUSION: In view of the above results, we consider the presence of a neurologist in the Emergency Department to be fully justified.