Body size phenotypes comprehensively assess cardiometabolic risk and refine the association between obesity and gut microbiota.

OBJECTIVE: The gut microbiota associates with obesity and related disorders, but recent meta-analyses have found that this association is, at best, of small effect. We argue that such analyses are flawed by the use of body mass index (BMI) as sole proxy for disease, and explore a classification method that distinguishes the cardiometabolic health status of individuals to look for more comprehensive associations between gut microbes and health. DESIGN: We analyzed a 441 community-dwelling cohort on which we obtained demographic and health information, anthropometry and blood biochemistry data that served to categorize participants according to BMI, cardiometabolic health status and body size phenotypes. In addition, the participants donated fecal samples from which we performed 16S rRNA gene sequencing to analyze the gut microbiota. RESULTS: We observed that health-related variables deteriorate with increased BMI, and that there are further discrepancies within a given BMI category when distinguishing cardiometabolically healthy and unhealthy individuals. Regarding the gut microbiota, both obesity and cardiovascular disease associate with reductions in α-diversity; having lean, healthy individuals the most diverse microbiotas. Moreover, the association between the gut microbiota and health stems from particular consortia of microbes; the prevalence of consortia involving pathobionts and Lachnospiraceae are increased in obese and cardiometabolically abnormal subjects, whereas consortia including Akkermansia muciniphila and Methanobrevibacter, Oscillospira and Dialister have higher prevalence in cardiometabolically healthy and normoweight participants. CONCLUSIONS: The incorporation of cardiometabolic data allows a refined identification of dissimilarities in the gut microbiota; within a given BMI category, marker taxa associated with obesity and cardiometabolic disease are exacerbated in individuals with abnormal health status. Our results highlight the importance of the detailed assessment and classification of individuals that should be carried out prior to the evaluation of obesity treatments targeting the gut microbiota.

Impacto de la diabetes en la carga hospitalaria / Impact of diabetes on hospital consumption

Objetivo: Analizar el impacto de la diabetes en el consumo de recursos hospitalarios. Método: Se analizaron todos los ingresos de un hospital terciario en 2006, registrados en el conjunto mínimo básico de datos (CMBD). Se estudiaron las características demográficas, de complejidad y de uso de servicios de pacientes con y sin diabetes. Resultados: En el 14,11 % constaba el diagnóstico de diabetes. El 66,4 % fueron ingresos urgentes y un 6,2 % fallecieron en el hospital. El 24 % tuvo más de un ingreso durante el año de estudio. La estancia media fue de 10,26 días frente a los 7,72 de los no diabéticos (p < 0,001). Complejidad, número de diagnósticos secundarios, sexo, tipo de ingreso y tipo de GRD influyeron en la duración de la estancia. Conclusiones: El diagnóstico de diabetes es frecuente en los pacientes hospitalizados (14 %) y estos pacientes presentan estancias más elevadas (AU)

Objective: To analyze the impact of diabetes on hospital resources utilization by inpatients. Method: We analyzed all the episodes of hospitalisation in the year 2006 of a tertiary hospital by means of the Basic Minimun data Set (CMBD).We studied demographic characteristics, case-mix, and use of hospital services for patients with and without diabetes. Results: A total of 28.383 episodes of hospitalisation wereregistered and out of these: 14.11 % were diabetic patients. Out of the total episodes, 66.4 % were emergency admissions with a hospital mortality rate of 6.2 %. Of these patients 24 % had more than one episode of hospitalisation during the study time period. The mean stay in the hospital was 10.26 days. Variables such as the complexity, the number of secondary diagnosis, sex, type of admission and the type of GRD’S affects the mean hospital stay in these patients. Conclusions: Diabetic patients account for more than 14 % of hospital admissions, and have a higher average stay than non-diabetics (AU)

Implantes biodegradables en el tratamiento de pseudoartrosis de escafoides / Biodegradable implants in the management of scaphoid pseudoarthrosis

Objetivo: Presentamos los resultados del tratamiento quirúrgico de la ausencia de consolidación del escafoides mediante reducción abierta, injerto óseo y fijación interna biodegradable. Material y métodos: Estudio prospectivo de 16 pacientes con pseudoartrosis de escafoides tratados quirúrgicamente mediante reducción abierta, injerto óseo y fijación interna con tornillos biodegradables de ácido poli-Lláctico reforzado entre los años 2002 a 2006. Se valoran la movilidad, escala visual analógica (EVA) del dolor, cuestionario DASH, complicaciones, resultado radiológico y laboral a los 37 meses de seguimiento prospectivo medio (rango, 12-104 meses). Resultados: El 90% de los pacientes volvio a su mismo puesto de trabajo y nivel de actividad a las 16 semanas (rango, 9-24 semanas). Al final del seguimiento, el arco de movilidad medio fue 103,3º de flexoextensión y 47º de desviación lateral, EVA 1.6 y DASH 4.6, sin diferencias estadísticamente significativas entre ambos grupos. Conclusión: El curetaje con aporte de injerto procedente de la cresta iliaca es una buena alternativa para el tratamiento de la pseudoartrosis de escafoides. Los implantes biodegradables hacen innecesario retirar el material, facilitan la cirugía de revisión y permiten realizar estudios con resonancia magnética para evaluar la viabilidad ósea. Los resultados del presente estudio ofrecen una alternativa válida de fijación en la pseudoartrosis de escafoides (AU)

Objetive: Results of the surgical management of the lack of scaphoid consolidation via open reduction, bone grafting and biodegradable internal fixation. Material and methods: 16 patients with scaphoid pseudoarthrosis subjected to surgery with open reduction, bone grafting and internal fixation using biodegradable reinforced polylactic acid screws between the years 2002- 2006. Antebrachial plaster immobilization was carried out for 8 weeks after surgery. Evaluations were made of mobility and pain (visual analog scale, VAS), DASH questionnaire, complications, and radiological and occupational results after an average of 37 months of prospective follow-up (range 12-104 months). Results: Most patients (90%) were able to return to the same work and level of activity, after an average of 16 weeks (range 9-24). At the end of follow-up, the mean mobility range was 103.3 degrees in flexion-extension and 47 degrees in lateral deviation, with a VAS score of 1.6 and a DASH score of 4.6. There were no statistically significant differences between the two treatment groups. Conclusion: Curettage with bone grafting from the iliac crest is a good alternative for the management of scaphoid pseudoarthrosis. Biodegradable implants eliminate the need to remove the material, facilitate revision surgery, and allow magnetic resonance imaging studies to assess bone viability. The results of the present study offer a valid fixation alternative in patients with scaphoid pseudoarthrosis (AU)

Bilateral inguinal hernia repair: laparoscopic or open approach?

BACKGROUND: The aim of this study was to investigate outcomes in the treatment of bilateral inguinal hernia, comparing the laparoscopic totally extraperitoneal (TEP) and open tension-free mesh repair (LICHT) approaches. METHODS: We performed a prospective controlled non randomized clinical study in 128 patients with bilateral inguinal hernia over a period of 3 years. LICHT was used in 106 cases (53 patients) while TEP was employed in 150 cases (75 patients). The main outcome measurements were: recurrence rate, operating time, hospital stay and postoperative complications. RESULTS: There were three recurrences (2.3%): two in the LICHT group (3.8%) and one (1.3%) in the TEP group P = NS. The TEP procedure was faster than LICHT repair (48.8 ± 10.8 vs. 70.4 ± 11.2 min) P < 0.01. Postoperative complications were more frequent in LICHT group (16%) than TEP group (5.3%) P < 0.01. Hospital stay was significantly shorter in the TEP group (0.6 ± 0.8 vs. 1.3 ± 1.2 days) P < 0.001. CONCLUSIONS: The TEP approach is an effective option for the treatment of bilateral inguinal hernia when performed by experienced surgeons.

Fractura-luxación radiocarpiana transestiloidea con luxación dorsal de la articulación radiocubital distal asociada: caso clínico y revisión de la literatura / Trans-styloid radiocarpal fracture-luxation with associated dorsal luxation of the distal radioulnar joint: clinical case and literature review

Introducción: Presentamos un caso de luxación dorsal de la articulación radio cubital distal (ARCD) que asociaba una luxación radiocarpiana con fractura de la estiloides radial y se revisa la bibliografía publicada sobre el tema. Caso clínico: Un varón de 28 años presenta una luxación dorsal (ARCD) con fractura de la estiloides radial y luxación radiocarpiana. No se objetivan otras lesiones asociadas. Se trata mediante reducción cerrada, fijación percutánea con agujas de Kischner y yeso cerrado por encima del codo. Resultados: A las 20 meses se encuentra sin dolor y con un rango de movilidad completo en codo y ambas muñecas. No ha precisado nuevas cirugías y presenta signos leves de inestabilidad escafolunar que no han necesitado tratamiento posterior. Conclusiones: La luxación de la ARCD es una complicación infrecuente de las fracturas de alta energía de la muñeca. La combinación de luxación RCD y fractura-luxación transestiloidea de la muñeca es excepcional y los autores solo hemos encontrado un caso similar publicado (AU)

Introduction: We present a case of dorsal luxation of the distal radioulnar joint (DRUJ) associated to radiocarpal luxation with fracture of the radial styloid process, together with a literature review on the subject. Clinical case: A 28-year-old male presented with dorsal luxation (DRUJ) associated to radial styloid fracture and radiocarpal luxation. No other lesions were identified. Treatment consisted of closed reduction, percutaneous fixation with Kirschner pins, and a plaster cast sealed above the elbow. Results: After 20 months, the patient is free of pain, and with full movement range of the elbow and both wrists. No further surgery proved necessary; the patient presents signs of slight scapholunar instability that has required no posterior treatment. Conclusions: DRUJ luxation is an infrequent complication of high-energy wrist fractures. The combination of DRUJ luxation and trans-styloid fracture-luxation of the wrist is exceptional, and we have found only one similar case published to date (AU)

Tratamiento quirúrgico de la tenosinovitis estenosante de De Quervain / Surgical treatment of De Quervain´s stenosing tendovaginitislBtù

Objetivos: El objetivo del trabajo es presentar los resultados clínicos y la repercusión laboral del tratamiento quirúrgico de la tenosinovitis de De Quervain. Material y métodos: Se estudiaron retrospectivamente 93 pacientes con tenosinovitis de De Quervain tratados quirúrgicamente, entre los años 2004 y 2007, con un seguimiento medio de 17 meses y mínimo de 1 año. La edad media era 38 años (21-59 años) y el 75% eran mujeres. En el 69% se afectó la muñeca dominante. En el 92% el test de Finkelstein fue positivo y el 40% recibieron infiltraciones de corticoides previas a la cirugía. Se valoraron las complicaciones, reintervenciones, resultado funcional y reincorporación laboral. Resultados: La recuperación completa se consiguió en el 96% de los pacientes. El 7% presentaron recaídas y el 38% complicaciones, de las que 12 casos necesitaron una reintervención. El 97% de los pacientes se reincorporaron a su puesto de trabajo con el mismo nivel de actividad, a los 97 dias de media (rango, 21-330 dias). Tres pacientes presentaban secuelas incapacitantes que les obligaron a cambiar su puesto de trabajo por uno de menor demanda funcional o con restricciones de hasta el 33%, tras su paso por tribunal médico de valoración de incapacidades. Conclusiones: El tratamiento quirúrgico de la tenosinovitis de De Quervain presenta unos resultados clínico-laborales a medio plazo satisfactorios. Los pacientes tratados preoperatoriamente con infiltraciones tuvieron menor número de complicaciones, reintervenciones y recaídas y los que presentaban variantes anatómicas se asociaron con peor evolución

Objective: A presentation is made of the clinical results and occupational repercussions of the surgical managementof De Quervain’s tenosynovitis. Material and methods: a retrospective study was made of 93 patients with De Quervain’s tenosynovitis subjected to surgical treatment between 2004-2007, and with amean follow-up of 17 months (minimum 1 year). The mean patient age was 38 years (range 21-59), and 75% were women. The dominant wrist was affected in 69% of cases.The Finkelstein test proved positive in 92% of cases, and 40% received corticoid infiltrations prior to surgery. An evaluation was made of the complications, reinterventions, functional outcome and occupational reinsertion. Results: complete recovery was recorded in 96% of the patients. Relapses were recorded in 7% of cases, complications in 38%, and reintervention proved necessary in 12 patients. A full 97% of the patients were able to return to work with the same level of activity, after an average of 97 days (range21-330 days). Three patients suffered disabling sequelae requiring a change in workplace to an occupation with lesser functional demands or with restrictions of up to 33%, following the evaluation of disability by a medical board. Conclusions: The surgical management of De Quervain’s tenosynovitis offers satisfactory clinical-occupational results over the middle term. Patients subjected to preoperative infiltration had fewer complications, reinterventions and relapses, while those with anatomical variants showed a poorer course

Clasificación de las fracturas de la extremidad distal del radio dentro del medio laboral / Classification of distal radius fractures in the occupational setting

Desde que Abraham Colles describió la primera fractura del radio distal son muchas las clasificaciones utilizadas para establecer unas pautas de tratamiento y establecer el pronóstico de la fractura. La mayoría de las clasificaciones se basan en el grado de conminución, afectación articular, grado de desplazamiento o en el mecanismo de producción. Presentamos una nueva clasificación, adaptada al medio laboral, que valora el tipo de fractura, la gravedad objetiva y el desplazamiento de los fragmentos de una forma sencilla y eficaz, que se correlaciona con los criterios estabilidad de la misma y define la pauta a seguir en el tratamiento de la lesión en estudio

Since Abraham Colles first described distal radius fracture, many classifications have been used to define fracture treatment and prognosis. Most such classifications are based on the degree of comminution, joint involvement, degree of displacement, or mechanism of fracture. We present a new classification, adapted to the occupational setting, that assesses the type of fracture, its objective severity and fragment displacement in a simple and effective manner, in correlation to the fracture stability criteria, and defining the approach to treatment

Reducción indirecta y fijación percutánea en fracturas del radio distal / Indirect reduction and percutaneous pinning as treatment of distal radius fractures

Introducción y objetivos: Las fracturas intraarticulares del radio distal se asocian a traumatismos de alta energía y se caracterizan por su complejidad y la dificultad de obtener una reducción estable, que precisa tratamiento quirúrgico. El objetivo del trabajo es presentar los resultados clínicos, radiológicos y laborales del tratamiento mediante reducción indirecta, fijación percutánea e inmovilización con yeso para este tipo de fracturas. Material y métodos: Se realiza un estudio prospectivo de 24 pacientes con fracturas intraarticulares desplazadas de la extremidad distal del radio tratados entre los años 2003 y 2005, con un seguimiento mínimo de 1 año. La edad media era 40 años (22-65 años) y todos tenian trabajos de alta demanda funcional. En el 40% se afectó la muñeca dominante. Se trataron mediante reducción indirecta con fijación percutánea con agujas de Kirschner en forma de triangulo de fuerzas y se inmovilización con yeso por 4 semanas, seguido de tratamiento rehabilitador. Se valora el dolor (escala analógico visual), rango de movilidad, parámetros radiológicos, fuerza (test isocinéticos), funcionalidad (escala DASH) y resultados laborales a los 3, 6 y 12 meses. Resultados: Se obtuvo la consolidación completa en todos los casos a las 7 semanas. 2 pacientes precisaron una reintervención. A los 12 meses los pacientes presentaron una escala analógico visual del dolor (0-10) de 2,9, 11º de pérdida de flexo-extensión con respecto a la muñeca contralateral y el 35% presentaban resultados radiológicos no aceptables. La puntuación obtenida en el cuestionario DASH fue de 29 puntos y presentaban un 23% de pérdida de fuerza isométrica. Todos volvieron a trabajar con el mismo nivel de actividad a las 14 semanas de media. Conclusiones: El tratamiento quirúrgico de las fracturas intraarticulares del radio distal mediante reducción indirecta y fijación percutánea ofrece unos excelentes resultados clínicos, radiológicos y laborales comparables a otras técnicas quirúrgicas

Introduction and objectives: Intraarticular fractures of distal radius are associated with high energy mechanisms, are severe and difficult to obtain a surgical reduction. The aim of this study is to compare the clinical, radiographically and activity results in workers treated with indirect reduction and percutaneous pinning. Material and methods: A prospective study was organized in 24 heavy-labour workers with unstable fractures of distal radius. The minimal follow-up was of one year. The mean age were 40 years (22-65 years) and dominant limb was involved in 40% of the cases. All patients were surgically treated with indirect reduction and percutaneous fixation with K-wires and cast immobilization. Pain (visual analogue score), mobility and radiograhs were evaluated and also strength (isokinetics), functionality (DASH score) and, finally, the return to work at 3, 6 and 12 months. Results: Fracture healing was obtained at 7 weeks but. Pain score, at 12 months, were 2,9 points. The flexion - extension mobility loss, in relation to the contralateral wrist, was 11º. Radiographs corrections were non-anatomically in 35% of the cases. The mean DASH score was 29 and the loss of grip strength related to contralateral wrist was 23%. All the patients return to the same work activity 14 weeks after surgery. Conclusions: Indirect reduction with percutáneous pinning with triangle fixation frame, allows excellents clinical, X-ray and laboral results, comparable with another surgical techniques

Artrodesis total de muñeca tras fracturas del radio distal / Total wrist arthrodesis secundary to distal radius fractures

Introducción y objetivos: El objetivo del presente estudio es valorar los resultados funcionales y laborales de los pacientes tratados con artrodesis total de muñeca por secuelas de fracturas del radio distal con el grupo general. Material y métodos: Se revisan prospectivamente 37 pacientes (36 hombres y 1 mujer, edad media 39 años) tratados mediante artrodesis total de muñeca con placa dorsal adaptada. El 30% presentaban secuelas por fracturas del radio distal. El seguimiento medio fue de 42 meses (12-72 meses). La edad media era 39 años (23-57 años) y todos tenían trabajos de media o alta demanda funcional. La muñeca dominante fue intervenida en el 55% de las ocasiones. La extremidad distal del cúbito se resecó en el 14%. Se utilizó injerto local de radio en 74% y en el 69% de los pacientes con fracturas del radio distal. Resultados: La valoración del dolor pasó de 94,2 a 15,2 puntos. La escala de la Clínica Mayo, pasó de 8,75 a 70,6 puntos tras la cirugía. La medición de fuerza fue de 79% al final del seguimiento. El periodo de baja laboral tras la cirugía fue de 16,2 semanas. El 72% se reincorporaron al mismo empleo y el 28% a un trabajo distinto y con menor demanda. El 50% de los pacientes tratados por secuelas por fracturas del radio distal necesitaron un cambio de puesto de trabajo distinto. Conclusiones: La artrodesis total de muñeca ofrece un resultado funcional y laboral satisfactorio en pacientes jóvenes y activos. Los pacientes tratados por secuelas de fracturas de la extremidad distal del radio no presentan diferencias con respecto a resto de patologías postraumáticas, excepto un mayor porcentaje de incapacidad para realizar su trabajo habitual previo al accidente

Introduction and aims: The present study evaluates the functional and occupational results of patients subjected to total wrist arthrodesis, due to the sequelae of distal radial fractures, compared with the general patient group. Material and methods: A prospective study was made of 37 patients (36 males and one female; mean age 39 years) subjected to total wrist arthrodesis with an adapted dorsal plate. Thirty percent suffered sequelae following distal radius fracture. Mean follow-up was 42 months (12-72 months). The mean patient age was 39 years (23-57 years), and all were employed in medium to high functional demand occupations. The dominant wrist was operated upon in 55% of cases. The distal cubital end was resected in 14%. Local radial grafting was used in 74% of the cases, and in 69% of those with distal radial fractures. Results: The pain score decreased from 94.2 to 15.2 points. The Mayo Clinic scale increased from 8.75 to 70.6 points after surgery. Strength measurement reached 79% by the end of follow- up. The mean work leave period after surgery was 16.2 weeks. 72% returned to the same job, while 28% returned to a different job characterized by lesser functional demand. Fifty percent of the patients with distal radial fractures needed to change to a different occupational post. Conclusions: Total wrist arthrodesis offers satisfactory functional and occupational results in young active patients. Patients treated for the sequelae of distal radius fractures showed no differences versus other post-traumatic pathologies, except for a greater percentage of individuals unable to return to their original occupation

¿Qué opinan de nuestros Servicios Sanitarios los usuarios de Servicios de Urgencias Hospitalarios? / How do users of the Hospital Emergency Services view our Health Services?

El objetivo de este trabajo es el de conocer las opiniones de la población que acude a los Servicios de Urgencias Hospitalarios (SUH) e identificar las motivaciones que llevan a los pacientes a utilizar estos servicios. Se efectuó un estudio observacional retrospectivo mediante encuesta telefónica. Los usuarios de los SUH tienen buena opinión sobre los profesionales de Atención Primaria, aunque los usuarios del medio urbano y laboralmente activos resaltan la insuficiencia de tiempo. El 76% de los atendidos en los SUH desconocen la existencia de otros dispositivos de asistencia urgente, y de ellos el 42,7% no considera que puedan resolver problemas urgentes. Los resultados sugieren la existencia de un perfil del frecuentador de los SUH caracterizado por desconfianza o desconocimiento respecto a los dispositivos asistenciales de atención primaria o de urgencias extrahospitalarias, y con insatisfacción respecto a la atención especializada ambulatoria. En este grupo de pacientes la utilización está relacionada con la consideración de los SUH como centros con alta disponibilidad de medios y pruebas diagnósticas y con capacidad para la resolución inmediata de los problemas

No disponible

[Implementation and evaluation of case management in Catalonia: the ISP-SMD program]. / La implementación y evaluación del modelo de gestión de casos (case management) en Cataluña: el programa PSI-TMS.

INTRODUCTION: The pilot study of the Individualized Service Program for people with Severe Mental Disorders (ISP-SMD) consists of the implementation of case management services in Catalonia. METHODOLOGY: The ISP-SMD has been implemented in two health care sectors and will be expanded to the rest of Catalonia in the next years. The program serves people with persistent mental disorders who have serious social or family problems and/or who have inadequate mental health service use (high use of inpatient services, no use of community services). The ISP-SMD is a community intervention program that focuses its activities on direct care and coordination between services. Thirty patients have been included in the evaluation. RESULTS: The results of the pilot study have shown that, compared to the year before entering the program, the patients show better clinical status, they decrease their unmet need level, they have more appropriate use of health services and have lower treatment costs. Satisfaction of the patients, family members and professionals with the program is very high. CONCLUSION: It is possible to adapt and implement case management services in Catalonia. When implemented, they improve patient quality of life.

[Prevalence and detection of depressive disorders in primary care]. / Prevalencia y detección de los trastornos depresivos en atención primaria.

AIM: To study the prevalence of depression in primary care, the detection of depressive disorders by primary care physicians, and the factors that influence detection. DESIGN: Cross-sectional, descriptive study. SETTING: Gavà II Primary Care Center, in Barcelona, Spain. PARTICIPANTS: A total of 400 people between the ages of 18 and 65 years were chosen randomly from among those who attended appointments with their primary care physician. MAIN MEASURES: A sociodemographic questionnaire and the Beck Depression Inventory (BDI) screening test were administered, and the participant s medical record was reviewed. In a subsample of 40 participants, the Mini-International Neuropsychiatric Interview (MINI) was also administered. The optimum cutoff score for the BDI was estimated with reference to the MINI results. RESULTS: A cutoff score of 20/21 for the BDI had a sensitivity of 86.7% and a specificity of 92%, when the MINI score was used as a reference. The adjusted prevalence of depressive disorder in our primary care setting was 20.2% overall, 8.1% in men, and 26.8% in women (odds ratio 4.15, p < 0.01). The physician detected depressive symptoms in 55.7% of all likely cases of depression. Persons who scored >= 21 on the BDI made more visits to their primary care physician, and had more stressful life events, than those who scored 20. CONCLUSIONS: The prevalence of depression in our primary care setting is high. The disorder was underdiagnosed in as many as 44.3% of the persons likely to have depressive disorder (especially women, widows and widowers, retired persons, persons who had experienced stressful life events, and frequent users of primary care services).

[Effects of air pollution on daily mortality in the city of Zaragoza, Spain, 1991-1995]. / Efectos de la contaminación atmosférica sobre la mortalidad diaria en la ciudad de Zaragoza, España, 1991-1995.

OBJECTIVE: To analyze the short-term impact of air pollution on daily mortality in the City of Zaragoza (Spain). MATERIAL AND METHODS: This ecologic study was conducted in Zaragoza, Spain, from 1991 to 1993. Poisson autoregressive models were constructed to assess the association between air particulate matter and sulphur dioxide SO2 and daily deaths. Four outcome variables were studied: overall mortality (excluding external deaths), mortality in subjects over 69 years of age, mortality due to respiratory disease, and mortality due to cardiovascular disease. A sample size was not obtained. Data analysis was conducted using the statistical software EGRET and SPSS. RESULTS: SO2 levels were significantly associated with cardiovascular deaths (RR = 1.018 IC 95%: 1.001-1.036) and particulate matter levels with respiratory deaths (RR = 1.028 IC 95%: 1.006-1.051). During the warm season, a significant relationship was found between particulate mater and cardiovascular deaths (RR = 1.020 IC 95%: 1.001-1.040). CONCLUSIONS: Low levels of air pollution were found in Zaragoza, with considerable variation in the concentration of air pollutant concentrations and daily respiratory and cardiovascular deaths, particularly during the warm season. The English version of this paper is available at: http://www.insp.mx/salud/index.html

Cost-analysis of high-dose chemotherapy and peripheral blood stem-cell support in patients with solid tumors.

BACKGROUND: The use of High-dose chemotherapy (HDC) with peripheral blood stem cells (PBSC) rescue in the treatment of solid tumors is controversial, and may be an important determinant of HDC and PBSC use in the future. Until the use of these procedures is proven through disease-free survival and overall survival compared with standard-dose chemotherapy, the associated cost is also under discussion. PATIENTS AND METHODS: We evaluate 27 consecutive patients with solid tumors who underwent HDC and PBSC rescue, through an accurate review of medical records and cost estimate for each patient. RESULTS: Median age was 45 years. Fifteen had breast cancer, six non-Hodgkin's lymphoma and six other solid tumors. The mean hospital length of stay was 21 days and mean cost was 21,445 US dollars (21,232 euro). Mean cost was clearly lower for the 9 patients treated within phase III trials, 17,571 US dollars (17,747 euro) than for the remaining 18 patients, treated in phase I-II trials, 22,747 US dollars (22,975 euro) (P < 0.001). The distribution of costs shows that wages and pharmacy account for 72% of total cost. The distribution of pharmacy costs per patient shows that chemotherapy (56% of pharmacy costs) and antibiotics (26%) account for most of the cost of medication. CONCLUSIONS: Our cost estimates agree with those of most countries with national health insurance programs, and are lower than those from the USA. As wages and pharmacy account for more than 70% of the costs, the great different among the costs estimates compared are due essentialy to doctors fees or salary and drugs utilization. Anyway, taking HDC with PBSC rescue as a model for a therapy that is more aggressive than standard, and that is associated to a possible survival improvement in indications such as relapsed high-grade non-Hodgkin's lymphoma, an adequate cost analysis is crucial both to measure cost-effectiveness and to establish payment to health care providers.

Human trichinellosis in Sourthern Spain: serologic and epidemiologic study.

An outbreak of trichinellosis caused by wild boar meat occurred in the Iruela (Jaen) in southern Spain in February 1996. Thirty-five people were diagnosed on the basis of epidemiologic data, but only 24 patients agreed to participate in this study. Twenty-three (96%) had symptoms suggestive of trichinellosis. Immunofluorescent and Western blot test results for trichinellosis were positive in 18 persons, and 15 had circulating Trichinella spiralis antigens. These findings suggest that results of tests for circulating antigens in conjunction with clinical presentation are useful for the diagnosis of trichinellosis.

Pancreaticoduodenectomy due to cancer in the elderly.

The elderly have traditionally been excluded from pancreaticoduodenectomy due to the high morbimortality of this procedure. Six cases of pancreaticoduodenectomy) 5 cephalic and 1 total) for periampullary tumors in patients over 70 are reported. There was no mortality. We conclude that, in selected cases, pancreaticoduodenectomy can be performed safely in the elderly.

[Drug-induced parkinsonism. Clinical aspects compared with Parkinson disease]. / Parkinsonismo inducido por fármacos. Aspectos clínicos comparativos con la enfermedad de Parkinson.

INTRODUCTION: Drug-induced Parkinsonism (DIP) is the second commonest cause of Parkinson syndrome, after Parkinson disease (PD) and represents between 10% and 30% of all patients with Parkinsonism. OBJECTIVES: To study the frequency and drugs responsible for DIP and to compare some of the clinical characteristics of these patients and those with PD. PATIENTS AND METHODS: A retrospective community based study in Bajo Aragon district to determine the frequency of PD and other Parkinsonism, including DIP. PD was diagnosed on the criteria proposed by the United Kingdom Parkinson's Disease Society Brain Bank and DIP on the criteria of Jiménez et al. RESULTS: Calcium antagonists were the cause of 73% of the DIP, followed by neuroleptic drugs (11.5%). There were 73% women (19/26). The patients with DIP were older than those with PD when their symptoms started (p = 0.02). In patients with DIP, 48% presented with bilateral symptoms as compared with 7% in PD (p < 0.0001). CONCLUSIONS: 1. Cinarizine is the main drug responsible for DIP (58%) 2. As compared with patients with PD, patients with DIP are mainly women, older, more frequently have bilateral onset of symptoms and consult the doctor sooner.

[Comparative clinical study of patients with Parkinson disease and essential tremor]. / Estudio clínico comparativo entre pacientes con enfermedad de Parkinson y temblor esencial.

INTRODUCTION AND OBJECTIVE: Some studies have shown that essential tremor (ET) occurs more frequently in Parkinson disease (PD) patients and opposite, suggesting these disorders are pathogenically related. To evaluate this relationship, we have compared some clinical features between patients with ET and with PD. PATIENTS AND METHODS: PD patients (N = 134) and patients with ET (N = 46), were collected from Bajo Aragon district. A diagnosis of PD was taken according to the United Kingdom Parkinson's Disease Society Brain Bank criteria. A diagnosis of ET was confirmed on the basis of Rajput et al criteria. RESULTS: A statistically significant higher number of females with ET were founded (p < 0.05). An earlier mean age at tremor onset was observed in ET patients (p < 0.0001). More than half ET patients had a positive had a positive family history of ET (p < 0.0001). Interval period between tremor onset and first medical consulting was higher in ET patients (p < 0.01). Depression was more common in PD patients (p < 0.05). CONCLUSIONS: A statistically significant differences about mean age at tremor onset, duration of illness, positive family history of ET, one side or bilateral tremor onset and frequency of depression were observed between these two disorders. The differences found in clinical features and others described previously about necropsy findings and TEP with 18F-Dopa studies, don't support the possibility that PD and ET are pathogenically related.

Prognostic factors in a series of 297 patients with gastric adenocarcinoma undergoing surgical resection.

BACKGROUND: Gastric cancer has a poor prognosis. The aim of this study was to determine the influence of several clinicopathological variables on outcome in a series of 297 Western patients undergoing surgical resection for gastric adenocarcinoma. METHODS: The results were analysed retrospectively and prognostic factors were identified in a univariate and Cox proportional hazards regression model. Mean patient age at the time of operation was 61.9 years; 65.7 per cent were men. Mean follow-up was 7.8 (range 1-15) years. Of the 297 patients undergoing surgery, 70 per cent had subtotal gastrectomy, 26.3 per cent underwent total gastrectomy and 3.7 per cent had proximal gastrectomy. RESULTS: The overall survival rate was 38.9 per cent at 5 years. In th univariate analysis, survival-related factors were weight loss (P < 0.05), abdominal mass (P < 0.01), dysphagia (P < 0.001), type of gastrectomy (subtotal gastrectomy versus total gastrectomy, P < 0.001), intention of resection (curative versus palliative resection, P < 0.001), tumour site (P < 0.001), histopathological grade (low versus high grade, P < 0.05), tumour diameter less than 3 cm (P < 0.001), degree of gastric wall invasion (P < 0.001), degree of lymph node invasion (P < 0.001) and stage of the neoplasia (P < 0.001). Other variables had no significant influence. In the multivariate analysis, degree of gastric wall invasion, lymph node invasion, tumour size and dysphagia at presentation were the only independent prognostic variables. CONCLUSION: From these data it was possible to derive a prognostic index with which patients could be classified as at low, intermediate or high risk.