Muscle Assessment by Ultrasonography: Agreement with Dual-Energy X-Ray Absorptiometry (DXA) and Relationship with Physical Performance.

BACKGROUND: Different methods have been proposed to study skeletal muscle mass in sarcopenia diagnosis, although all have inherent drawbacks. The aim of this study was to evaluate the utility of muscle ultrasound in muscle assessment by studying its correlation with dual-energy x-ray absorptiometry (DXA) and calf circumference (CC), cut-off values for ultrasound-based detection of low muscle mass, and the correlation with muscle performance. METHODS: Fifty-seven participants older than 70 years, underwent a muscle ultrasound study, DXA, calf circumference (CC) and functional assessment. Ultrasound measurements were taken in the femoral quadriceps (transverse plane) and in the medial gastrocnemius (transverse and longitudinal planes). Muscle function was assessed by gait speed, Short Physical Performance Battery (SPPB) and grip strength. RESULTS: Median age was 78.9 years (IQR 74.9 - 81.9), and 33 were women (57.9%). We found good correlation between muscle thickness of gastrocnemius muscle in transverse and longitudinal plane and appendicular lean mass measured by DXA (r=0.546 and r=0.689 respectively) and good correlations between muscle thickness of gastrocnemius in transverse and longitudinal plane with CC (r=0.651 and r=0.447 respectively). The thickness of gastrocnemius medialis optimal cut-off points for low muscle mass were 18,5mm in the transverse plane (Sensitivity: 77,8%, Specificity: 77,1%), and 17.3mm in the longitudinal plane (Sensitivity: 100%,Specificity: 68.8%). Muscle thickness was also significantly correlated with gait speed, SPPB and grip strength. CONCLUSIONS: Measures of gastrocnemius medialis thickness obtained by ultrasound are reliable and correlate well with DXA and CC values and muscle performance.

Ecografía clínica en las enfermedades autoinmunes sistémicas / Clinical ultrasonography in systemic autoimmune diseases

La ecografía clínica se debe considerar, hoy por hoy, como una exploración complementaria que puede modificar la práctica clínica. Es una herramienta más de la historia clínica. Las enfermedades autoinmunes sistémicas (EAS) son enfermedades en las que se pueden ver implicados múltiples estructuras y órganos. La ecografía tiene utilidad aplicada de forma genérica para detectar complicaciones, como la presencia de líquido libre intraabdominal, pleural o pericárdico en las poliserositis, la presencia de disfunción sistólica del ventrículo izquierdo en pacientes con miocarditis o para confirmar la existencia de una trombosis venosa profunda en un paciente con síndrome antifosfolípido. También, de forma específica en las EAS, la ecografía nos permite explorar las glándulas salivales en pacientes con síndrome de Sjögren, determinar la presencia del signo del halo en la arteritis de células gigantes, la presencia de inflamación tendinosa o articular, cuantificar la hipertensión pulmonar en pacientes con esclerodermia o valorar la presencia de enfermedad pulmonar intersticial en una dermatomiositis. La ecografía clínica realizada por el internista es, por tanto, una técnica extremadamente útil en el diagnóstico y seguimiento de los pacientes con EAS

Clinical ultrasonography should be considered a complementary examination that can change clinical practice, as well as a tool to add to the medical history. Systemic autoimmune diseases (SAD) can involve numerous structures and organs. Ultrasonography has broad applied utility in detecting complications such as the presence of free intraabdominal, pleural and pericardial fluid in polyserositis, left ventricular systolic dysfunction in myocarditis and deep vein thrombosis in antiphospholipid syndrome. Specifically for SAD, ultrasonography helps examine the salivary glands in Sjögren's syndrome, determines the presence of the halo sign in giant cell arteritis and the presence of tendon or joint inflammation, quantifies pulmonary hypertension in scleroderma and assesses the presence of interstitial pulmonary disease in dermatomyositis. Clinical ultrasonography performed by internists is therefore an extremely useful technique in the diagnosis and follow-up of patients with SAD

Clinical ultrasonography in systemic autoimmune diseases. / Ecografía clínica en las enfermedades autoinmunes sistémicas.

Clinical ultrasonography should be considered a complementary examination that can change clinical practice, as well as a tool to add to the medical history. Systemic autoimmune diseases (SAD) can involve numerous structures and organs. Ultrasonography has broad applied utility in detecting complications such as the presence of free intraabdominal, pleural and pericardial fluid in polyserositis, left ventricular systolic dysfunction in myocarditis and deep vein thrombosis in antiphospholipid syndrome. Specifically for SAD, ultrasonography helps examine the salivary glands in Sjögren's syndrome, determines the presence of the halo sign in giant cell arteritis and the presence of tendon or joint inflammation, quantifies pulmonary hypertension in scleroderma and assesses the presence of interstitial pulmonary disease in dermatomyositis. Clinical ultrasonography performed by internists is therefore an extremely useful technique in the diagnosis and follow-up of patients with SAD.

Mortalidad en Medicina Interna. Importancia de los pacientes en situación terminal / No disponible

Introducción y objetivo: muchos pacientes en situación terminal son atendidos en las últimas etapas de su vida en servicios médicos y fuera de unidades de cuidados paliativos. Por ello nos propusimos estudiar y describirlas historias clínicas de los pacientes fallecidos en nuestro servicio durante el año 2006. Pacientes y métodos: estudio retrospectivo descriptivo de las historias clínicas de los pacientes fallecidos durante el año 2006 en el Servicio de Medicina Interna del Hospital Virgen de la Torre (HVTR) -Madrid-. Se analizaron datos sociodemográficos, clínicos, criterios de terminalidad, causas de muerte y tipo de cuidados recibidos, instrumentalización, existencia de Voluntades Anticipadas e inclusión en protocolo de paliativos. Se analizaron los resultados con el programa estadístico SPSS 14.0. Resultados: se obtuvieron 172 historias clínicas (64,5% mujeres,35,5% varones, edad media 85,76 ± 7,0) de los 188 pacientes fallecidos en dicho periodo. El 69% de los pacientes tenía criterios de terminalidad, siendo la enfermedad de base: demencias 52%, oncológicas 14%, obstrucción crónica del flujo aéreo (OCFA) 10%, e insuficiencia cardiaca (IC) 9%. Las causas del éxitus fueron respiratorias (70%), neurológicas (52%), cardiovasculares(35%) y sepsis (31%). Ningún paciente tenía voluntades anticipadas. Se incluyeron en protocolo de paliativos el 81% de los pacientes terminales. Conclusiones: un alto porcentaje de los pacientes que fallecieron en nuestro servicio cumplían criterios de terminalidad. El perfil del paciente más común fue el de una anciana de edad avanzada, pluripatológica, con alto nivel de dependencia, cuidada por su familia y con demencia en fase terminal. Ningún paciente tenía voluntades anticipadas (AU)

Background and objectives: many patients with end-stage chronic illnesses are cared for in medical services, outside specific palliative care resources. This encouraged us to review the patients that had died in our department during 2006, describing their characteristics and the care they were given. Patients and methods: a retrospective descriptive study of the clinical records of patients who died during 2006 at Internal Medicine Service, Virgen de la Torre Hospital, Madrid, Spain. We analyzed their sociodemographic and clinical information, end-stage disease criteria, causes of death, type of care and treatments, degree of instrumentalization, and presence of a living will. The results were analyzed with the statistical programSPSS 14.0. Results: we obtained 172 clinical records of 188 deceased patients during this period (64.5% women, 35.5% males, mean age 85.76 ± 7.0);69% of patients had end-stage disease, and diseases included dementia in 52%, cancer in 14%, COPD in 10%, and heart failure in 9%. Death was most commonly of respiratory (70%), neurological (52%), cardiovascular(35%), or septic (31%) cause. No patient had a living will; 81% of terminal patients were included in a palliative protocol. Conclusions: a high percentage of the patients that had died in our service had a terminal chronic disease. Patient type was a woman of advanced age, with multiple chronic diseases, with a high level of dependency, cared after by her family, and with end-stage dementia. No patient had a living will (AU)

Apendicitis aguda como forma de presentación de una tuberculosis intestinal

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