[Quality of life of patients after periprosthetic hip fracture surgery]. / Calidad de vida en los pacientes postoperados de fracturas periprotésicas de cadera.

INTRODUCTION: The quality of life of patients with periprosthetic fracture is complex; it interacts with the severity of the lesion, their independence level, and available resources, all of which could cause alterations secondary to their condition. OBJECTIVE: To know the quality of life and clinical course of patients after periprosthetic hip fracture surgery. MATERIAL AND METHODS: Patients with periprosthetic hip fracture were assessed. Physical exam was performed and the SF-36 questionnaire was applied. RESULTS: A total of 15 patients were included, 8 (53.3%) females and 7 (46.7%) males, with mean age 74 years (SD 12.51). Concerning underlying conditions, 5 patients had none (33.3%), one had hypertension (6.7%), one had a neoplasia (epidermoid), and 8 had more than one underlying condition. A predictive variable model was designed. In the overall score a 75.6% positive correlation was found, and a 57.2% determination coefficient. There was no statistical significance (p = 0.162). The same variables as in the previous model were included. Correlation was 0.678 and determination 45.9%, without statistical significance, p = 0.332. CONCLUSIONS: Patients reported feeling fair from the perspective of their overall health, physical function, physical role, emotional role, and social function; mental health wise, 50% reported feeling calm and full of life, and 50% reported anxiety and fear.

Use of statins for the treatment of spontaneous intracerebral hemorrhage: results of a pilot study.

BACKGROUND AND STUDY AIMS: Spontaneous intracerebral hemorrhage (ICH) represents the most fatal kind of stroke, and there is still no treatment available that improves the outcome. Statins are cholesterol reducers, and during the last few years many additional effects have been demonstrated that might be neuroprotective. We designed a pilot clinical study in order to evaluate whether the administration of statins is associated with a better outcome. PATIENTS AND METHODS: From August to December 2006 we carried out a prospective/retrospective non-randomized clinical study. The prospective group was treated with rosuvastatin (20 mg) and the retrospective control group was taken from our clinical records with a relation of 1:3. We included patients of both sexes, aged > or =15 years with proven ICH in CT-scan. Exclusion criteria were a history of neoplasm, head injury four weeks before admission, non-hypertensive reasons, brainstem hemorrhage, steroid administration, cranial surgery, initial hydrocephalus, and NIHSS > or =30. RESULTS: We analyzed 18 patients treated with rosuvastatin and 57 controls with similar basic characteristics. The mortality rate during hospitalization was 1 (5.6%) patient in the statin group and 9 (15.8%) in the control group; the hazard ratio adjusted by the initial Glasgow Coma Scale (GCS), intubation, admission in intensive care unit, disruption into the subarachnoid space was 0.20 (95% CI 0.02-1.67). The odds ratio for NIHSS > or =15 at release was 0.04 (95% CI 0.003-0.93). CONCLUSIONS: The use of statins during the acute phase of ICH could be associated with a better outcome. Further clinical trials are necessary to confirm a possible therapeutic effect and evaluate the toxicity of statins.

[Intervertebral disc pathologies from an immunological perspective]. / Perspectiva inmunológica de la patología del disco intervertebral.

INTRODUCTION: The back pain associated to intervertebral prolapsed disc is a frequent pathology, that produces in many cases severe work-disability. The mechanisms of pain generation are controversial, the mechanical theories of nerve compression have been weak for explaining severe pain in patients with low protrusion grades. DEVELOPMENT: In the last years several studies have been accomplished in order to determinate the contribution of inflammatory phenomena into the intervertebral disc disease's evolution. Abnormal values of cytokines like TNF-alpha, IL-1 beta, IL-6, and other molecules related with the immune system have been found, although the available studies are inconsistent. The analysis of immune cells in the intervertebral disc is in the same way contradictory, but the presence of macrophages appears constantly. The variability might be originated by the self-heterogeneity of the immune system in a disease with repeated episodes of injury-reparation that could conduce to deregulation and progressive tissular damage. CONCLUSION: Until now it seems clear the association of macrophages in the pathologic degeneration of the intervertebral disc, but the interaction of these in this microenvironment not totally. The understand of the cellular and molecular networks is fundamental for explaining the poor correlation between clinical and radiological findings, in addition to the potential impact on the actual management applied.

Perspectiva inmunológica de la patología del disco intervertebral / Intervertebral disc pathologies from an inmunological perspective

Introducción. La lumbalgia asociada a herniación del disco intervertebral es una patología con alta prevalencia en la población y frecuentemente condiciona discapacidad laboral importante. Los mecanismos de generación del dolor son aún controvertidos, y las teorías mecánicas de compresión del nervio han sido débiles para explicar el dolor en pacientes con grados mínimos de protrusión. Desarrollo. En los últimos años, se han realizado múltiples estudios con el fin de determinar la contribución del proceso inflamatorio en la evolución de la enfermedad del disco intervertebral. Se han encontrado niveles anormales de diversas citocinas, como factor de necrosis tumoral-alfa, interleucina-1beta e interleucina-6, así como otras moléculas estrechamente relacionadas con el sistema inmunológico; sin embargo, los estudios disponibles en humanos son contradictorios. También se ha analizado el tipo de células inmunes presentes en el disco, igualmente con resultados controvertidos, pero con cierta consistencia en la presencia de poblaciones de macrófagos. La variabilidad puede deberse a la heterogeneidad misma del sistema inmune en una enfermedad con ciclos de lesión-reparación repetidos en el tiempo, los cuales pueden conducir a una desregulación y lesión tisular progresiva. Conclusión. Hasta ahora parece clara la asociación de los macrófagos en la degeneración patológica del disco intervertebral; sin embargo, la interacción de éstos en este microambiente es poco clara. El entendimiento de estas redes celulares y moleculares es indispensable para explicar la poca correlación que llega a existir entre los hallazgos clínicos y radiológicos, además del potencial impacto que podría tener en el tratamiento usado actualmente (AU)

Introduction. The back pain associated to intervertebral prolapsed disc is a frequent pathology, that produces in many cases severe work-disability. The mechanisms of pain generation are controversial, the mechanical theories of nerve compression have been weak for explaining severe pain in patients with low protrusion grades. Development. In the last years several studies have been accomplished in order to determinate the contribution of inflammatory phenomena into the intervertebral disc disease’s evolution. Abnormal values of cytokines like TNF-alpha, IL-1beta, IL-6, and other molecules related with the immune system have been found, although the available studies are inconsistent. The analysis of immune cells in the intervertebral disc is in the same way contradictory, but the presence of macrophages appears constantly. The variability might be originated by the self-heterogeneity of the immune system in a disease with repeated episodes of injuryreparation that could conduce to deregulation and progressive tissular damage. Conclusion. Until now it seems clear the association of macrophages in the pathologic degeneration of the intervertebral disc, but the interaction of these in this microenvironment not totally. The understand of the cellular and molecular networks is fundamental for explaining the poor correlation between clinical and radiological findings, in addition to the potential impact on the actual management applied (AU)

[A clinical-epidemiological approximation to intracerebral hemorrhage in a Mexican hospital: analysis of factors associated to mortality]. / Aproximacion clinicoepidemiológica de la hemorragia intracerebral en un hospital mexicano: analisis de factores asociados a la mortalidad.

INTRODUCTION: Intracerebral hemorrhage (ICH) is the most lethal type of stroke. There are some clinical and radiological factors related to mortality. The time for obtaining medical care could be related with poor prognosis, but there are not available studies in Hispanics that evaluated this one. AIM: To determinate the association between epidemiological factors, time to obtain medical care, origin, and clinical characteristics with hospital mortality due to ICH. SUBJECTS AND METHODS: Study of cases and controls in a regional third level center, between January 2000 and December 2006 with patients of both sexes, older than 15 years with tomographic diagnosis of ICH. We excluded patients with NIHSS undetermined or traumatic head injury 4 weeks before. We studied demographic variables, time between beginning of symptoms and medical care, origin in kilometers until hospital, clinical characteristics at admission, including Glasgow and NIHSS. RESULTS: We analyzed 74 men and 101 women with mean age of 65 years. The etiology was hypertension in 77.4% and localization lobar in 39.4%. Eighty-five percent receipt medical care after 3 hours and 75.4% came from a radius < 100 km. Mortality in hospital was 16.6% with an explicative model of regression that included blood pressure < 130/80 mmHg, intubation, Glasgow < 9 at admission or NIHSS > 15, and hospitalization days. CONCLUSIONS: Demographic characteristics, causes, and localization are similar to previously informed series. The time for obtaining medical care is far from ideal, this could delay treatment; allow progression of disease, and then worse prognosis.

Aproximación clinicoepidemiológica de la hemorragia intracerebral en un hospital mexicano: análisis de factores asociados a la mortalidad / Clinical-epidemiological approximation to intracerebral hemorrhage in a Mexican hospital: analysis of factors associated to mortality

La hemorragia intracerebral (HIC) espontánea es la forma más letal de enfermedad cerebrovascular.Existen factores clínicos y radiológicos descritos asociados a mortalidad. El tiempo en recibir atención podría relacionarse con peor pronóstico; sin embargo, no existen estudios en la población latina que hayan analizado esta asociación. Objetivo.Determinar la asociación entre factores epidemiológicos, el tiempo de atención, la procedencia y características clínicas con la mortalidad hospitalaria por HIC. Sujetos y métodos. Es un estudio de casos y controles en un centro regional de tercer nivel,entre enero de 2000 y diciembre de 2006, con pacientes de ambos sexos, mayores de 15 años, con diagnóstico tomográfico de HIC. Se excluyeron aquéllos con la escala del Instituto Nacional de Salud para enfermedades cardiovasculares (NIHSS) basal indeterminada o traumatismo craneal en las cuatro semanas previas. Se estudiaron variables demográficas, tiempo entre inicio de síntomas y atención médica, lugar de procedencia en kilómetros y características clínicas en el momento del ingreso, incluyendo la puntuación de Glasgow y NIHSS. Resultados. Analizamos 74 hombres y 101 mujeres con edad promediode 65 años. La etiología fue hipertensión arterial en el 77,3% y localización lobar en el 39,4%. El 84,5% recibió atención despuésde tres horas y el 75,4% procedía de un radio menor de 100 km. La mortalidad hospitalaria fue del 16,6%, con un modeloexplicativo de regresión logística que incluyó: tensión arterial < 130/80 mmHg, intubación, Glasgow < 9 o NIHSS >15en el momento del ingreso y los días de hospitalización. Conclusiones. Las características demográficas, causas y localizaciónse asemejan a lo descrito en la bibliografía. El tiempo de atención dista de lo ideal, lo que puede retrasar el tratamiento,permitir la progresión de la enfermedad y empeorar el pronóstico

Intracerebral hemorrhage (ICH) is the most lethal type of stroke. There are some clinical andradiological factors related to mortality. The time for obtaining medical care could be related with poor prognosis, but there are not available studies in Hispanics that evaluated this one. Aim. To determinate the association between epidemiologicalfactors, time to obtain medical care, origin, and clinical characteristics with hospital mortality due to ICH. Subjects and methods. Study of cases and controls in a regional third level center, between January 2000 and December 2006 with patients of both sexes, older than 15 years with tomographic diagnosis of ICH. We excluded patients with NIHSS undetermined or traumatic head injury 4 weeks before. We studied demographic variables, time between beginning of symptoms and medicalcare, origin in kilometers until hospital, clinical characteristics at admission, including Glasgow and NIHSS. Results. We analyzed 74 men and 101 women with mean age of 65 years. The etiology was hypertension in 77.4% and localization lobar in 39.4%. Eighty-five percent receipt medical care after 3 hours and 75.4% came from a radius < 100 km. Mortality inhospital was 16.6% with an explicative model of regression that included blood pressure < 130/80 mmHg, intubation, Glasgow < 9 at admission or NIHSS > 15, and hospitalization days. Conclusions. Demographic characteristics, causes, and localization are similar to previously informed series. The time for obtaining medical care is far from ideal, this could delaytreatment; allow progression of disease, and then worse prognosis

[Statins and brain protection mechanisms]. / Estatinas y mecanismos de proteccion cerebral.

INTRODUCTION: The 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA) inhibitors or statins are drugs used in the treatment of dyslipidemies. The clinical trials performed for evaluation of the efficacy observed a reduced incidence of stroke and other trials have demonstrated a better outcome after stroke and subrachnoid hemorrhage. DEVELOPMENT: In the last years, new actions of statins have been described (pleiotropics). The statins seem to originate neuroprotector effects, such as up-regulation of endothelial nitric oxide synthase; creation of a fibrinolytic profile with suppression of the intravascular stability of the clot; immunomodulation by regulation of cytokines and cellular adhesion molecules; anti-oxidation by reduction of lipidic peroxidation; induction of neuroplasticity by increment of neurotrophic factors and protection of neuroexcitotoxicity, maybe by regulation of intracellular calcium or depletion of intracellular sterols. All these actions can be explained by decreament of isoprenoids synthesis. CONCLUSION: The pleiotropic properties of the statins offer the possibility to consider them as possible neuroprotectors, which should be evaluated in pathologies where the molecular ways interfered are involved, for example head injury and stroke.