Navigated versus conventional total knee arthroplasty: A prospective study at three years follow-up. / Artroplastia total de rodilla navegada versus convencional; estudio prospectivo a 3 años de seguimiento.

OBJECTIVE: Computer-assisted surgery application in total knee arthroplasty (TKA) has shown more accurate implant alignment compared with conventional instrumentation and is associated with more homogeneous alignment results. Although longer implant survival and superior clinical outcomes should be expected from navigated TKA, currently available evidence does not support this hypothesis. The aim of this study was to compare navigated TKA with conventional TKA regarding clinical and radiological outcomes after a 3-year follow-up under the hypothesis that navigated TKA would provide better outcomes than conventional TKA. MATERIAL AND METHOD: In a prospective multicentre study, 119 patients underwent navigated TKA and 80 patients received conventional instrumentation. Patients were evaluated at the baseline and at postoperative months 3, 12, 24, and 36. Analysis included the American Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form-12 (SF12) Health Survey, and radiographic assessment. RESULTS: All clinical scores improved significantly for all patients during the follow-up but were significantly better in the navigation group. The percentage of patients showing a mechanical axis between 3° of varus and 3° of valgus was significantly higher in the ATR group (93%) than in the conventional TKA group (71%) (P<.01). CONCLUSIONS: The use of computer-assisted surgery in TKA provides more accurate mechanical alignment and superior short-term functional outcomes compared to conventional TKA.

Asthma exacerbations: risk factors for hospital readmissions.

OBJECTIVE: The aim of our study is to analyse hospital readmissions due to asthma, as well as the factors associated with their increase. STUDY DESIGN: We carried out a retrospective study including all admissions of patients over 18 years old due to exacerbation of asthma occurring in our hospital between the years 2000 and 2010. METHODS: The data were gathered by two members of the research team, by reviewing the clinical records. The first hospital admission of each patient was included for this study. An early readmission (ER) was defined as that which occurred in the following 15 days after hospital discharge and late readmission (LR) to that occurring from 16 days after discharge. RESULTS: This study included 2166 hospital admissions and 1316 patients, with a mean age of 62.6 years. Of the 1316 patients analysed, 36 (2.7%) had one ER and 313 (23.8%) one LR. The only factor independently associated with a higher probability of an ER was poor lung function. A higher probability of LR was associated with a greater severity of the asthma (OR: 17.8, for severe asthma versus intermittent asthma), to have had any hospital admission in the previous year (OR: 3.5) and the use of a combination of ICS-LABA as maintenance treatment. CONCLUSIONS: About 25% of the patients in our area admitted to hospital due to asthma exacerbation had repeat episodes of hospitalisation.

Frontal alignment in total knee arthroplasty. Comparative study between radiographic measurement and surgical navigation. / Alineación frontal en la artroplastia total de rodilla. Estudio comparativo entre medición radiográfica y con navegación quirúrgica.

OBJECTIVE: To establish the concordance between angulation of the femoro-tibial mechanical axis measured with x-rays and surgical navigation in both the pre and postoperative period after a total knee arthroplasty (TKA) was implanted. MATERIAL AND METHOD: Pre and postoperative measurements were analyzed in 88 TKA of the same model and all performed with the same surgical navigation system. The mechanical frontal angle (MFA) and femoro-tibial anatomic angle were measured before and after the TKA. The angulation was digitally measured with a teleradiography. In the navigation, the femoro-tibial angle at rest, forced varus and valgus were registered and the average of these three measurements was calculated. RESULTS: The mean preoperative MFA measured on the radiograph was 4.55°. The mean of the same angle measured on the postoperative radiograph was 1.72°, (p=0.05). The mean of the MFA measured with navigation before TKA was 3.12° and after the implant with navigation was 0.53 (P=.013). The concordance coefficient between the MFA in teleradiography and in navigation was 0.869 (P<.001) preoperatively and 0.709 postoperatively (P=.017). CONCLUSIONS: We found a strong concordance between radiographic and surgical navigation measurements of the MFA. This may imply that teleradiography is not necessary when using surgical navigation in TKA.

[Non-compliance with the systemic antibiotic treatment prescribed in Primary Health Care emergency departments (Study INCUMAT')]. / Incumplimiento del tratamiento antibiótico sistémico prescrito en servicios de urgencias de Atención Primaria (Estudio INCUMAT).

INTRODUCTION: Non-compliance with antibiotics treatment has severe consequences. Although antibiotics are commonly prescribed drugs, there are few studies that evaluate therapeutic compliance in acute diseases. The main objective of this study is to determine the percentage of non-compliance with the systemic antibiotics treatment prescribed in emergency departments. MATERIAL AND METHODS: A prospective observational study was performed in the Emergency Department of 2 health centres of the Cantabria Health Service between the months of June and September 2014. The study included patients of any age, and those could be monitored, who were prescribed a systemic antibiotic for any infectious disease. Sociodemographic variables, diseases, and compliance were the variables studied. The Morinsky-Green test was used, plus 3 questions added by the authors. RESULTS: Of the 303 patients included, non-compliance, evaluated using the Morinsky-Green test, was 32.7% (95% CI 27.6-38.1), with this rising to the 44.9% (95% CI 39.4-50.5) when the 3 mentioned questions were added to the test. A downward trend is observed in non-compliance as the age increases. The risk of non-compliance is twice in men than in women: OR=2.02 (95% CI 1.27-3.24). CONCLUSIONS: Almost half (45%) of the patients who are prescribed antibiotics do not comply with the indications. Most of them attribute this fact to forgetfulness in compliance with the prescribed treatment. The elderly and women follow the treatment better, which should be taken into account when designing strategies to improve therapeutic compliance.

Detección de iones metálicos en cabello tras artroplastia de cadera metal-metal / Detection of metal ions in hair after metal-metal hip arthroplasty

Objetivo. Tras el implante de algunos modelos de prótesis de cadera metal-metal se produce una elevación de los niveles de metales en suero y orina. Recientemente se ha demostrado que hay concordancia entre estas cifras y los niveles encontrados en el cabello. Nuestro objetivo ha sido estudiar la presencia de metales en cabello y conocer si ello se modifica con el paso del tiempo o con la extracción del implante. Material y método. En 45 pacientes con una artroplastia de superficie se ha realizado una determinación de los niveles de cromo, cobalto y molibdeno en cabello a los 3, 4, 5 y 6 años desde el implante. La edad media fue de 57,5 años, 2 eran mujeres. En 11 pacientes, en 5 de ellos por metalosis y quiste periarticular, fue necesaria una reintervención para extracción de la artroplastia e implante de un nuevo modelo con fricción metal-polietileno. Resultados. Las cifras medias de metales en cabello fueron cromo 163,27 ppm, cobalto 61,98 ppm y molibdeno 31,36 ppm, muy por encima de los niveles referidos en la población general. En los pacientes reintervenidos para extracción de la artroplastia se observó al año de la intervención una disminución del 43,8% en los niveles de cromo, del 51,1% en molibdeno y del 90,3% en cobalto. Conclusiones. En las artroplastias de cadera con fricción metal-metal se aprecia una alta concentración de metales en el cabello, que disminuye cuando dicho implante es extraído. La determinación de iones en cabello puede ser un buen marcador de la intoxicación por metales que sucede en estos modelos artroplásticos (AU)

Objective. There is an increase in the levels of metals in the serum and urine after the implantation of some models of metal-metal hip prosthesis. It has recently been demonstrated that there is an association between these levels and the levels found in hair. The aim of this study is to determine the presence of metals in hair, and to find out whether these change over time or with the removal of the implant. Material and method. The levels of chromium, cobalt and molybdenum were determined in the hair of 45 patients at 3, 4, 5, and 6 years after a hip surface replacement. The mean age was 57.5 years, and two were female. Further surgery was required to remove the replacement and implant a new model with metal-polyethylene friction in 11 patients, 5 of them due to metallosis and a periarticular cyst. Results. The mean levels of metals in hair were chromium 163.27 ppm, cobalt 61.98 ppm, and molybdenum 31.36 ppm, much higher than the levels found in the general population. A decrease in the levels of chromium (43.8%), molybdenum (51.1%), and cobalt (91.1%) was observed at one year in the patients who had further surgery to remove the prosthesis. Conclusions. High concentrations of metals in the hair are observed in hip replacements with metal-metal friction, which decrease when that implant is removed. The determination of metal ions in hair could be a good marker of the metal poisoning that occurs in these arthroplasty models (AU)

[Detection of metal ions in hair after metal-metal hip arthroplasty]. / Detección de iones metálicos en cabello tras artroplastia de cadera metal-metal.

OBJECTIVE: There is an increase in the levels of metals in the serum and urine after the implantation of some models of metal-metal hip prosthesis. It has recently been demonstrated that there is an association between these levels and the levels found in hair. The aim of this study is to determine the presence of metals in hair, and to find out whether these change over time or with the removal of the implant. MATERIAL AND METHOD: The levels of chromium, cobalt and molybdenum were determined in the hair of 45 patients at 3, 4, 5, and 6 years after a hip surface replacement. The mean age was 57.5 years, and two were female. Further surgery was required to remove the replacement and implant a new model with metal-polyethylene friction in 11 patients, 5 of them due to metallosis and a periarticular cyst. RESULTS: The mean levels of metals in hair were chromium 163.27 ppm, cobalt 61.98 ppm, and molybdenum 31.36 ppm, much higher than the levels found in the general population. A decrease in the levels of chromium (43.8%), molybdenum (51.1%), and cobalt (91.1%) was observed at one year in the patients who had further surgery to remove the prosthesis. CONCLUSIONS: High concentrations of metals in the hair are observed in hip replacements with metal-metal friction, which decrease when that implant is removed. The determination of metal ions in hair could be a good marker of the metal poisoning that occurs in these arthroplasty models.

Timeliness of care and prognosis in patients with lung cancer.

BACKGROUND: Timeliness of care is an important dimension of health care quality. The determining factors of less timely care and their influence on the survival of patients with lung cancer (LC) remain uncertain. AIMS: To analyse the delays in the diagnosis and treatment of LC in our health area, the factors associated with the timeliness of care and their possible relationship with the survival of these patients. METHODS: A retrospective study was conducted on all patients with a cytohistologically confirmed diagnosis of LC between 1 June 2005 and 31 May 2008. The time delays for consultation (specialist delay), diagnosis (diagnosis delay), and treatment (treatment delay), were analysed, as well as the factors associated with these delays and the influence of the timeliness of care on survival. RESULTS: A total of 307 cases were included (87 % males). The mean specialist delay was 53.6 days (median 35 days), diagnosis delay 31.5 days (median 18 days), treatment delay 23.5 days (median 14 days). The greater age of the patient and a more advanced stage were associated with a shorter specialist delay. Male sex, a more advanced stage, and poor general status were associated with a shorter treatment delay. The survival is longer in patients with a longer treatment delay. CONCLUSIONS: The delay in the diagnosis in our population seems to be excessively long. The greater the age, a more advanced tumour stage, male sex, and poor general health status are associated with shorter delays. A longer treatment delay is associated with a longer survival.

[Lung cancer in the Pontevedra health area: incidence, clinical presentation and survival]. / Cancer de pulmon en el area sanitaria de Pontevedra: incidencia, presentación clinica y supervivencia.

BACKGROUND: To describe the clinical and epidemiological characteristics, and survival of patients with lung cancer (LC) in the Pontevedra Health Area. METHODS: A retrospective observational study was conducted on all patients with a diagnosis of LC in the Pontevedra Hospital Complex (CHOP) health area over a three-year period. The data recorded included, age, gender, smoking history, comorbidity, functional status, diagnostic method, histology type, stage, treatment received, and survival. The patients were followed up for 3 years. RESULTS: A total of 358 cases of LC were included in the study, which gave a crude incidence rate adjusted to the standard European population of 37.33/100,000 inhabitants/year in males and 4.88/100,000 inhabitants/year in females. The large majority were males (87%). The mean age was 68.7 years, and 82% were smokers or ex-smokers. The most common histology type was epidermoid, with 35.2% of the cases. The diagnosis was made in stages III-B or IV in 79% of cases. Chemotherapy was the first treatment in 53% of the cases. Survival after the first year was 25%, which decreased to 4% at the third year. CONCLUSIONS: The incidence of LC in our health area continues to be mainly in male smokers, although the incidence in females and in people who never smoked is higher than in other populations in our country. It is diagnosed in the advance stages of the disease, and survival is poor.

Cáncer de pulmón en el área sanitaria de Pontevedra: incidencia, presentación clínica y supervivencia / Lung cancer in the Pontevedra health area: incidence, clinical presentation and survival

Fundamento. Describir las características clínicas, epidemiológicas y supervivencia de los pacientes con cáncer de pulmón (CP) en el área sanitaria de Pontevedra. Material y métodos. Se realizó un estudio observacional, retrospectivo, incluyendo todos los pacientes con diagnóstico de CP en el área sanitaria del Complexo Hospitalario de Pontevedra(CHOP), incluyendo todos los casos diagnosticados en un período de 3 años. De cada paciente se incluyeron edad, sexo, tabaquismo, comorbilidad, estado funcional, método diagnóstico, tipo histológico, estadio, tipo de tratamiento y supervivencia. Los pacientes fueron seguidos durante 3 años Resultados. Se incluyeron en el estudio un total de 358 casos de CP, lo cual supone una tasa cruda de incidencia ajustada a la población europea estándar de 37,33/100.000 habitantes/año en varones y de 4,88/100.000 habitantes/año en mujeres. El 87%fueron varones, de 68,7 años de edad media, el 82% fumadores o exfumadores. El tipo histológico más frecuente fue el epidermoide, con el 35,2% de los casos. En el 79% de los casos se realizó el diagnóstico en estadios III-B o IV. La quimioterapia fue el primer tratamiento en el 53% de los casos. La supervivencia al primer año es del 25%, que se reduce al 4% al tercer año. Conclusiones. La incidencia de CP en nuestra área sanitaria sigue predominando en varones fumadores, aunque la incidencia en el sexo femenino y en nunca fumadores es superior a otras poblaciones de nuestro entorno. El diagnóstico se lleva a cabo en fases avanzadas de la enfermedad y la supervivencia es pobre (AU)

Backgroud. To describe the clinical and epidemiological characteristics, and survival of patients with lung cancer (LC) in the Pontevedra Health Area. Methods. A retrospective observational study was conducted on all patients with a diagnosis of LC in the Pontevedra Hospital Complex (CHOP) health area over a three-year period. The data recorded included, age, gender, smoking history, comorbidity, functional status, diagnostic method, histology type, stage, treatment received, and survival. The patients were followed up for 3 years. Results. A total of 358 cases of LC were included in the study, which gave a crude incidence rate adjusted to the standard European population of 37.33/100,000 inhabitants/year in males and 4.88/100,000 inhabitants/year in females. The large majority were males (87%). The mean age was68.7 years, and 82% were smokers or ex-smokers. The most common histology type was epidermoid, with 35.2% of the cases. The diagnosis was made in stages III-B or IV in 79% of cases. Chemotherapy was the first treatment in 53% of the cases. Survival after the first year was 25%, which decreased to 4% at the third year. Conclusions. The incidence of LC in our health area continues to be mainly in male smokers, although the incidence in females and in people who never smoked is higher than in other populations in our country. It is diagnosed in the advance stages of the disease, and survival is poor (AU)

Obesity and asthma: An association modified by age

Background: Some studies indicate some causal relationship between obesity and asthma, while others show inconsistent results. Our objective was to evaluate the prevalence of asthma according to obesity in children. Methods: A cross-sectional study, following the ISAAC study methodology, was conducted on two randomly selected groups consisting of 6---7 year-old children (n = 7485) and 13-14 year-old adolescents (n = 8496).The asthma symptoms and potential risk factors were determined from the questionnaire. Overweight and obesity were defined based on the body mass index. Multiple logistic regression was used to obtain adjusted prevalence odds ratios (OR) and 95%confidence intervals. Results: Obesity was associated with an increase in wheezing ever (OR: 1.35) and exercise induced asthma (OR: 1.62) in the 6-7 year-old group. No significant relationship was observed in the adolescent population. Conclusion: Obesity was associated with a higher prevalence of asthma in young children, but not in adolescents (AU)

Truck traffic related air pollution associated with asthma symptoms in young boys: a cross-sectional study.

OBJECTIVES: The aim of this study was to evaluate the influence of intensity of truck traffic on asthma symptomatology, and its relationship with age and gender. STUDY DESIGN: A cross-sectional study was conducted on children and adolescents from Galicia (North-West Spain). METHODS: Following the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC): children from schools randomly selected, answered a self-administered questionnaire included questions on asthma symptoms and some risk factors. The association between self-reported truck traffic on the street of residence and symptoms of asthma were investigated by logistic regression adjusted for body mass index, maternal education and parental smoking. RESULTS: Almost 40% of children in Galicia are exposed to the frequent and constant passing of heavy goods vehicles. The odds of 6-7 year-old boys having severe or exercise induced asthma is tripled when they live in streets with the constant passing of heavy goods vehicles, compared with those living in streets where these vehicles never pass. In adolescents and 6-7 year-old girls, no relationship was observed between truck traffic and asthma symptoms. CONCLUSIONS: The results of this study appear to support a distinct effect of truck traffic on asthma symptoms depending on the age and sex of the exposed population, being more harmful for young males.

Obesity and asthma: an association modified by age.

BACKGROUND: Some studies indicate some causal relationship between obesity and asthma, while others show inconsistent results. Our objective was to evaluate the prevalence of asthma according to obesity in children. METHODS: A cross-sectional study, following the ISAAC study methodology, was conducted on two randomly selected groups consisting of 6-7 year-old children (n=7485) and 13-14 year-old adolescents (n=8496). The asthma symptoms and potential risk factors were determined from the questionnaire. Overweight and obesity were defined based on the body mass index. Multiple logistic regression was used to obtain adjusted prevalence odds ratios (OR) and 95% confidence intervals. RESULTS: Obesity was associated with an increase in wheezing ever (OR: 1.35) and exercise-induced asthma (OR: 1.62) in the 6-7 year-old group. No significant relationship was observed in the adolescent population. CONCLUSION: Obesity was associated with a higher prevalence of asthma in young children, but not in adolescents.

Trends of asthma mortality in Galicia from 1993 to 2007.

INTRODUCTION: In the past few years, deaths due to asthma appear to decrease at least in Western countries; but there are significant variations between populations. The aim of this study is to describe the trends in deaths due to asthma between 1993 and 2007 in our community and to analyze any factors associated with this. METHODS: All cases, which had asthma as a cause of death, were included in the study. The mortality data were obtained from the official death certificate from the Deaths Register. Mortality relative risk, based on the calendar year, sociodemographic variables (age and gender), seasons, and days of the week, were estimated using a Poisson generalized linear model with a log-link. RESULTS: In the 15 years of the study period, a total of 1180 people had died due to asthma, mainly in winter (34.5%), women (64.5%), and advanced age (65 years or above; 84.6%). A tendency of decreased mortality in all age groups was observed during the period of the study, which was significant in both the sexes in the 35- to 64-year-old age group, and in males above 65 years. CONCLUSION: Death due to asthma is changing favorably in our community, with a tendency to decrease in the past few years. Advanced age, being female, and the winter period are associated with a higher mortality rate due to asthma.

Endovascular treatment for pseudoaneurysms after surgical correction of aortic coarctation.

Late complications after surgical repair of aortic coarctation are not uncommon. Among these complications pseudoaneurysms are the most frequent complications, occurring between 3 and 38%. Reoperation in these patients is associated with high morbidity and mortality. In the last decade, endovascular techniques emerged as an alternative to conventional surgery with excellent results. We report the case of two patients who presented with pseudoaneurysms after surgical correction for aortic coarctation, which were treated by endovascular means.

Utilización de la estadística en cirugía ortopédica y traumatología / Statistic in orthopaedic surgery and traumatology

Los estudios de investigación epidemiológica se sustentan en los métodos de la estadística. Para poder alcanzar conocimiento sobre poblaciones frecuentemente se estudian muestras representativas de las mismas. Estos estudios se basan en la inferencia estadística. La inferencia se puede realizar mediante la estimación de parámetros por intervalos de confianza o bien mediante el cálculo de la significación estadística –valores p– mediante contrastes de hipótesis. En un intervalo de confianza se busca una solución que proporcione seguridad y precisión. Con los contrastes de hipótesis se cuantifica la probabilidad de que las observaciones muestrales puedan ser explicadas por el azar del muestreo, midiendo los errores tipo I y tipo II. En cada hipótesis de investigación existe un contraste apropiado en función de los tipos de variables estudiadas, su distribución, el número de sujetos estudiados y el número de grupos que se comparan. La utilización de valores p está sujeta a controversia, ante lo que se ofrecen alternativas como la utilización de métodos bayesianos o el enfoque a intervalos de confianza. Los estudios dirigidos a la medición de eventos a lo largo de periodos de observación se denominan estudios de supervivencia. Existen distintos métodos en función del tipo de periodos estudiados y de las variables a analizar. Los métodos estadísticos multivariantes permiten analizar dos o más variables a la vez. Existen métodos exploratorios que pueden simplificar el número de variables o de sujetos y métodos confirmatorios como la regresión logística que permite analizar el papel de variables confusoras y de interacciones (AU)

Objetive: Epidemiologic research is based on statistical methods and usually studies representative samples to attain knowledge about population. These studies are based on statistical inference. There are two ways to make inference. One is the parameter estimation with confidence intervals, another is the hypothesis test. A confidence interval allow us to control the precision (a range of the estimated variable) and the confidence (the probability of the population parameter to be included in that range) of the results. A hypothesis test quantifies the chance that a result could be explained by the random nature of the sample measuring type I and type II errors. Every research question has a matching hypothesis test according to the types of the variables, their distribution, the number of sampled units and the groups to be compared. The use of p-values is subject to controversy. Other methods like Bayesian statistics or confidence intervals offer alternatives. Survival studies measure events along time intervals. There are different methods regarding the type of intervals or the data to be analyzed. Multivariate statistics allow us to analyze two or more variables at a time. The exploratory methods can simplify the data, both the number of subjects and the variables. Confirmatory methods like logistic regression enable the analysis and importance of confounding and interacting variables (AU)

Evolución epidemiológica de las intoxicaciones agudaspor gases tóxicos atendidas durante el periodo de 2004 a 2007en urgencias de un hospital comarcal / Acute toxic gas poisoning cases treated from 2004 through 2007 at a regional hospital

Objetivo: Conocer las variaciones producidas en el agente causal en las intoxicaciones agudas por productos químicos atendidas en el servicio de urgencias (SU) del Hospital San Agustín de Avilés (HSA) durante el periodo 2004-2007.Método: Se realizó un estudio observacional descriptivo. La población objetivo fueron los pacientes intoxicados por productos químicos atendidos en los años 2004-2007 enel SU del HSA. Se recogieron las variables de la ficha de intoxicaciones de la Sección de Toxicología Clínica (STC) de la Asociación Española de Toxicología (AETOX).Resultados: Durante el periodo de 2004 a 2007 se atendieron 204 pacientes intoxicados por productos químicos: gases irritantes 32,8%, productos cáusticos 25%, gases tóxicos 21,6%, disolventes 11,3%, plaguicidas 4,4%, detergentes 2,9% y metales 2%.Las intoxicaciones por gases tóxicos (IGT) en 2004-2005 fueron el 68,2% del total y en2006-2007 el 31,8% (p < 0,001). El grupo de IGT está constituido en el 93,18% por monóxido de carbono (CO). Las intoxicaciones por CO fueron leves-moderadas (78%)con carboxihemoglobina (COHb) del 11-30%. La clínica fue fundamentalmente neurológica(95,5%). El 77,3% se resolvieron en el SU. El tratamiento mayoritario fue oxígeno a alto flujo. El elevado número de intoxicaciones en 2004-2005 fue difundido a los medios de comunicación locales, así como las medidas preventivas en relación a las fuentes de CO. Conclusiones: Se ha producido un descenso significativo de las intoxicaciones por gases tóxicos y de su mayor representante, el CO, en los últimos dos años. El esfuerzo del registro y la difusión de las medidas de mantenimiento de las instalaciones de calefacción y calentadores de los domicilios ha podido tener una influencia positiva (AU)

Objective: To determine changes in agents causing cases of chemical poisoning treated in the emergency department of Hospital San Agustín de Avilés in the period 2004 through 2007.Methods: Descriptive observational study. The target population consisted of patients suffering from chemical poisoning who required emergency care at our hospital from 2004 through 2007. Data were extracted from the records of the clinical toxicology section of the Spanish Toxicology Association (AETOX).Results: Two hundred four patients were treated for chemical poisoning during the study period. The agents involved were irritant gases (32.8%), caustic substances (25%), toxic gases (21.6%), solvents (11.3%), pesticides (4.4%),detergents (2.9%), and metals (2%). Toxic gas poisoning accounted for 68.2% of cases in the first 2 years (2004-2005)and 31.8% of cases in the second 2 years (2006-2007) (P < .001). Carbon monoxide (CO) was involved in 93.2% of the toxic gas cases. CO poisoning was mild-moderate in 78%, with carboxyhemoglobin levels between 11% and 30%. Most patients suffered from neurologic symptoms (95.%); the episode was resolved in the emergency department in 77.3% of the cases, usually by applying high-flow oxygen. The local media reported on the large number of poisonings treated in2004 and 2005, at the same time publicizing measures for preventing CO poisoning. Conclusions: The number of cases of toxic gas poisoning has decreased significantly, mainly due to a lower incidence of CO poisoning in the last 2 years. Efforts made to record cases and publicize information about how to maintain household heaters and heating systems have had a positive influence (AU)

Patrón de agregación y análisis factorial de los factoresde riesgo cardiovascular integrantes del síndrome metabólicoen población española no diabética: estudio VIVA / Aggregation pattern and factorial analysis of cardiovascular risk factors included

Objetivos: Describir las agregaciones más frecuentes de los factoresde riesgo cardiovascular (FRCV) que integran con el síndrome metabólico(SM) en una muestra de población española no diabética. Comprobarmediante análisis factorial si los diferentes FRCV considerados en elSM son manifestaciones de un posible único factor común. Material ymétodos: Estudio poblacional transversal, multicéntrico, realizado en2.583 sujetos de 30-65 años elegidos al azar de 9 registros poblacionales.Para el cálculo de la frecuencia de cada uno de los FRCV y de susagregaciones se utilizaron las definiciones clásicas de cada factor.Las agregaciones de factores se calcularon de forma excluyente. Lacorrelación entre los FRCV se realizó mediante análisis factorial. Resultados:De mayor a menor, la prevalencia de los distintos FRCV clásicosconsiderados en la defi nición del SM según el NCEP ATP III fue: dislipemia34% (intervalo de confi anza [IC] del 95%: 32-35,5); hipertensión32% (IC del 95%: 30,2-33,8); obesidad 27% (IC del 95%: 25,3-28,7) e hiperglucemia 23% (IC del 95%: 21,6-25). Se observan diferenciassignifi cativas entre sexos: predominaba la dislipemia en hombresy la obesidad en mujeres. El 22% de la población mostraba agregaciónde dos FRCV y el 11% de tres FRCV. Las agregaciones más frecuentesfueron: hipertensión-obesidad, 5,3% (IC del 95%: 4,4-6,2), e hipertensión-obesidad-hiperglucemia, 4,1% (IC del 95%: 3,3-5). Los FRCVconsiderados tienden en general a formar tres conglomerados: 1) índicede masa corporal, diámetro sagital abdominal y glucemia; 2) insulina,glucemia a las 2 horas y presión arterial, y 3) razón colesterol total/colesterolunido a las lipoproteínas de alta densidad y triglicéridos. En loshombres pueden identifi carse hasta cuatro conglomerados de FRCV,mientras que en las mujeres éstos pueden reducirse hasta dos (AU)

Aims: The aim of this study is to describe the most frequent cardiovascularrisk factors (CVRF) clustering related to the metabolic syndrome(MS) in a non-diabetic Spanish population sample. Test by factorial analysisif the CVRF in the MS can be considered manifestations of a uniquecommon factor. Materials and methods: Observational, multicenter,transversal epidemiologic study. 2583 subjects aged 30-65 were randomlyassigned from nine population registries. Exclusive aggregationswere considered. Correlation among the MS variables was analyzed usingfactorial analysis. Results: In order of frequency the prevalence ofconventional CVRF was: dyslipidemia: 34% (IC95%: 32-35.5); hypertension:32% (IC95%: 30.2-33.8); obesity: 27% (IC95%: 25.3-28.7);hyperglycaemia: 23% (IC95%: 21.6-25). 22% of the population showed2 CVRF and 11% 3 CVRF. The most common CVRF aggregations werehypertension-obesity (5.3%; IC95%: 4.4-6.2) and hypertension-obesity-hyper glycaemia (4.1%; IC95%: 3.3-5). MS specifi c risk variablestended to aggregate in three factors: factor 1 (BMI, waist circumferenceand basal glycaemia), factor 2 (insulin, glycaemia 2h, and arterial bloodpressure), factor 3 (total cholesterol/HDL, triglycerides). Conclusions:There is a high prevalence of CVRF and MS in the population studied.Analysis of the metabolic syndrome does not contribute with additionalinformation to predict cardiovascular risk in susceptible patients, as comparedto the clustering of CVRF. Factorial analysis do not confi rm theexistence of a unifying factor to explain MS (AU)

[Percutaneous treatment of peripheral vascular malformations with a mixture of polidocanol and CO(2). Initial experience]. / Tratamiento percutáneo de las malformaciones vasculares periféricas con una mezcla de polidocanol y CO2. Experiencia inicial.

OBJECTIVE: The percutaneous treatment of peripheral vascular malformations is currently the first treatment option for these processes. We describe our initial experience using a mixture of polidocanol and CO(2) as an embolizing agent; we analyze the efficacy and complications of the treatment. MATERIAL AND METHODS: Between April 2005 and December 2006, we treated a total of 18 patients, comprising 11 women (61%) and 7 men (39%), with ages ranging from 11 to 80 years. One (5%) vascular malformation was hemodynamically active and the remaining 17 (95%) were hemodynamically inactive. We performed a total of 56 embolizations (mean per patient, 3; range, 1-7) using a mixture of polidocanol and CO(2) (mean, 8 cm(3); range, 1-28 cm(3)). The malformations were studied with Doppler ultrasonography, magnetic resonance imaging, and direct puncture angiography and/or arteriography. Specific approaches and treatments were used in each case in function of the location, size, and characteristics of the malformation. RESULTS: Technical success, defined as the possibility of embolizing the malformation, was achieved in all cases. No technical complications occurred. The mean follow-up period was 9 months (range, 1-20). All patients, except one woman who refused to continue treatment, improved objectively and subjectively, and all were able to return to normal daily activities. After embolization, all patients presented edema, pain, and increased functional incapacity that ceased with medical treatment. CONCLUSION: Percutaneous embolization of vascular malformations using a mixture of polidocanol and CO(2) is efficacious and has a low rate of complications. Our initial results are promising but larger studies are necessary to reach definitive conclusions.