Colaboración entre distintos eslabones: una de las claves del sistema teleictus. Réplica / Collaboration between different links: one of the keys to the telestroke system. Reply

No disponible

[Endovenous thrombolysis in a district hospital using the telestroke system]. / Trombolisis endovenosa en un hospital comarcal mediante el sistema teleictus.

INTRODUCTION: In January 2007, a telestroke system was established between a community hospital lacking a neurologist on call and a stroke centre 70 km away for acute stroke care. AIM: To study the impact of a telemedicine system for acute stroke care in a community hospital and the security of thrombolytic treatment. PATIENTS AND METHODS: Observational study of acute stroke patients attended in the emergency room in a community hospital between 2007 and 2010. RESULTS: 662 acute stroke patients were attended. 133 'tele-consults' were done (37.6% ischemic stroke established). 39 patients (29.3%) were transferred to the stroke centre, 5 (12.8%) of them were considered unnecessary. 46 patients received thrombolytic treatment in the community hospital. The average time door-needle was 53.4 ± 38.2 minutes. 60.9% patients were treated during the first three hours since symptoms onset, and 100% in less than 4.5 hours. 9 patients received intra-arterial treatment. 4 patients (8.69%) presented hemorrhagic transformation 2 (4.3%) were symptomatic. 71.7% presented neurological improvement in 24 hours. 53.65% were functionally independent (mRS equal or less than 2) to three months. The mortality was 10.86%. CONCLUSIONS: Tele-stroke allows a specialized attention for acute stroke in a community hospital, to administer thrombolytic treatment and could be an indispensable tool for select patient to transfer to the stroke centre for intra-arterial rescue procedures.

[Calcitonin prescriptions: an estimate of the expenditure due to inadequate prescription]. / Estudio de las prescripciones de calcitonina: estimación del gasto por prescripción inadecuada.

BACKGROUND: The use of calcitonin is very common in patients diagnosed with osteoporosis. The objective of this study was to determine the percentage of adequate prescriptions of calcitonin for patients with osteoporosis and to estimate the costs due to inadequate prescription. PATIENTS AND METHODS: Observational study. Four pharmacies in Osona County (Barcelona) were randomly selected. During two time periods, July-September and November-December of 1994, all women filling prescriptions for calcitonin in any of the eight pharmacies were invited to participate in the study. Adequate and inadequate prescription of calcitonin was determined based on the patient's clinical record. Justifiable and non-justifiable prescriptions were then determined after implementing a protocol and reviewing X-rays of the spine. RESULTS: Forty-eight women agreed to participate (participation rate: 68%). In the first analysis, 58.3% (95% CI: 43-72) of prescriptions were determined to be inadequate whereas in the second analysis 29.2% (95% CI: 17-44) were considered non-justifiable. Chronic back pain was associated with non-justifiable prescription of calcitonin (odds ratio: 5.2; 95% CI: 1.3-33.4). In the best of situations, the excess in annual spending due to inadequate prescription was estimated at 13 million pesetas for Osona County, 1,300 million for Catalonia, and 4,300 million for Spain. CONCLUSIONS: Between one-third and one-half of patients prescribed calcitonin in the study area apparently do not need it. Many cases of chronic back pain are being treated as osteoporosis without being properly studied. The costs derived from this incorrect practice are important. This study highlights the need for better practices in the diagnosis of osteoporosis.

Analytical and clinical performance of an automated immunoassay system (Immulite) for estradiol in serum.

The analytical and clinical performance of a commercial automated immunoassay system (Immulite) for estradiol (E2) in serum was evaluated. The functional sensitivity for E2 was 0.07 nmol/l, and analytical imprecision (<13%, <9% and <7% at 0.22, 0.51 and 1.51 nmol/l, respectively) for concentrations above this detection limit met published analytical goals. The assay recovery was good and the assay was linear over a wide concentration range. No sample carryover was found, and interferences from common substances present in serum were observed only at very high concentrations. Most of samples from men and postmenopausal women showed E2 concentrations below the detection limit. Longitudinal estradiol profiles from 11 healthy menstruating women showed characteristic menstrual cycle patterns (12 samples per subject obtained during a 30-day period). Longitudinal studies on women during induction of ovulation showed that E2 concentrations are highly correlated with the total number of follicles. Our results demonstrate the reliability of this system for routine use in the clinical laboratory.

Costs of asthma according to the degree of severity.

An increase in asthma-related morbidity and mortality has been reported recently, resulting in a substantial increase in the economic impact of this condition. Little information is available relating to the costs of asthma depending on the degree of severity of the disease. Total, direct and indirect costs generated by asthma patients who sought medical care for asthma control over a one-year period in a northern area of Spain were determined. Data were obtained from the patients themselves and severity of illness was classified into mild, moderate and severe according to the International Consensus Report on Diagnosis and Treatment of Asthma, 1992. The average total annual asthma-derived cost was estimated at US$2,879 per patient, with averages of US$1,336 in mildly asthmatic patients, US$2,407 in moderate asthma and US$6,393 in severe asthma. At all levels of severity, indirect costs were twice as high as direct costs, and at the same degree of severity, direct costs due to medication and hospitalization were higher among females than males. A minority of severe asthmatics incurred some 41% of the total costs. The cost of asthma was surprisingly high and varied substantially depending on the degree of severity of the disease. Further knowledge of the costs of asthma across various levels of severity will contribute to a better characterization of optimal intervention strategies for asthma care.

[Clinical characteristics and morbidity in stable asthma. A descriptive analysis of asthma in a Mediterranean community]. / Características clínicas y morbilidad en el asma estable. Análisis descriptivo del asma en una comunidad mediterránea.

UNLABELLED: Scarce clinical and epidemiological data related to asthma are available in Spain. OBJECTIVES: a) to determine the severity of disease and morbidity among symptomatic asthmatics, and b) to determine whether international recommendations for the treatment of asthma are being followed. A prospective descriptive study enrolling asthmatics older than 14 years of age who experienced symptoms within the past year. The study was performed in the Osona district, a semi-rural area north of Barcelona. Spirometric tests were given and case histories taken, including symptoms caused by the disease. The international guidelines analyzed were those published in 1992 by the National Institutes of Health for the International Consensus Report on Diagnosis and Treatment of Asthma. We studied 333 patients; 214 (64%) were women and 119 (36%) men. Asthma was mild in 140 (42%), moderate in 116 (35%) and severe in 77 (23%). The need for short-term oral corticosteroids, visits to primary care physicians, and missed work days were all significantly greater among patients with severe asthma than for those with mild or moderate asthma. However, 23% of the patients with mild asthma missed work at least once. Drugs used were beta-adrenergic agonists of short duration of effect (76%) and inhaled corticosteroids (66%). CONCLUSIONS: a) in most symptomatic asthma patients, disease is mild; b) although patients with severe asthma have higher rates or morbidity, patients with mild disease also have marked symptoms; c) the drugs used for treatment are in compliance with the 1992 international guidelines.

Mesenchymal chondrosarcoma of the foot, an unusual location: case report and review of the literature.

We present a case of primary mesenchymal chondrosarcoma of the proximal phalanx of the first toe. The bones of the foot represent an infrequent primary site for this neoplasm. The tumour consisted of layers of undifferentiated round cells with scanty cytoplasm and hyperchromatic nuclei. The presence of brain, lung, and left auricle metastasis was demonstrated, and the patient died due to brain edema 18 days after admission. Mesenchymal chondrosarcoma is a rare tumor that more frequently involves the pelvic bones, the femur, and the humerus. To our knowledge, only nine cases of primary mesenchymal chondrosarcoma arising from the bones of the foot have been previously reported, with none involving the phalanx of the toe.

High adenosine deaminase level in pleural effusion due to Waldenström's macroglobulinemia.

A case with a high adenosine deaminase (ADA) level in pleural effusion due to Waldenström's macroglobulinemia is reported. This is the first case of this disease which is described as a cause of an increased pleural ADA.

[Have the causes of hemoptysis changed? An analysis of 213 patients undergoing fiber bronchoscopic exploration]. / Han variado las causas de hemoptisis? Análisis de 213 pacientes sometidos a exploración fibrobroncoscópica.

For decades the most frequent causes of hemoptysis have been bronchiectasis, tuberculosis and bronchogenic carcinoma. A recent study, however, has shown that the etiology has changed, as the incidence of hemoptysis due to tuberculosis or bronchiectasis has decreased while that due to bronchitis has increased. To determine the causes of hemoptysis in patients who underwent fiberoptic bronchoscopy (FB). We conducted a retrospective analysis of clinical profiles and radiologic and FB findings for 213 patients who came to our hospital with hemoptysis between 1990 and 1994. The site of bleeding was located by FB in 139 (64%) patients and a conclusive diagnosis of the cause of hemoptysis was achieved in 170 (78%) cases. The main causes were chronic bronchitis in 64 (29%) patients, neoplasia in 61 (28%) and bronchiectasis in 22 (10%). Tuberculosis was responsible for hemoptysis in only 7 patients (3%). The incidences of the various causes of hemoptysis requiring FB for diagnosis have changed substantially in recent years. Chronic bronchitis and neoplasia are now the most frequent causes. Tuberculosis has become less important. Bronchiectasis, on the other hand, continues to cause of a significant number of cases of hemoptysis in our area.

Mesenteric panniculitis presenting as fever of unknown origin.

A 40-yr-old man was admitted for fever of unknown origin. Mesenteric panniculitis was suspected as a result of ultrasonography, computed tomography, and nuclear magnetic resonance findings, and that diagnosis was confirmed by laparoscopy with retroperitoneal mass biopsy. Mesenteric panniculitis is a rare disease characterized by an inflammatory process of the mesenteric adipose tissue. Abdominal pain, weight loss, and abdominal mass are the most frequent symptoms. High fever and leukocytosis are uncommon. To the best of our knowledge, only two reports of mesenteric panniculitis presenting as fever of unknown origin have been described previously, with no cases published in the English literature. In the case reported, steroid therapy was started with initial improvement. Despite the temporary addition of azathioprine and the maintenance of the prednisone treatment, no further improvement has been achieved. Two years and 5 months after admission, the patient presents intermittent episodes of fever and muscle pain.

In vitro effect of dipyrone on several peroxidase labelled immunoassays.

We studied the in vitro effect of dipyrone on the determination of free triiodothyronine (free T3), cortisol, progesterone, estradiol, carcinoembryonic antigen, human chorionic gonadotropin and alpha-fetoprotein measured with an immunoenzyme assay based on enhanced luminescence that uses peroxidase as label. We found significant interference from dipyrone (p < 0.01) in the determination of all the analytes mentioned: for progesterone and estradiol the interference was present at high doses of dipyrone; for free T3 and cortisol the minimum dipyrone concentration producing interference was 712 mumol/l and for carcinoembryonic antigen, human chorionic gonadotropin and alpha-fetoprotein 44 mumol/l. Dipyrone has an analytically and statistically significant interference effect on the determination of the mentioned analytes.

[Effectiveness of the treatment of spontaneous pneumothorax using small caliber pleural catheter]. / Eficacia del tratamiento del neumotórax espontáneo mediante catéter pleural de pequeño calibre.

BACKGROUND: The aim of this study was to evaluate the efficacy of the treatment of spontaneous pneumothorax (PT) by small caliber pleural catheter (SCPC) carried out by physicians with no surgical experience in the emergency department. METHODS: Forty-eight patients with spontaneous PT (23 total, 4 of them tensional) were included in the study. An 8 French caliber polyethylene SCPC was inserted in all the patients requiring pleural drainage. RESULTS: Thirty-two patients (67%) required pleural drainage. The catheter was carried for a mean of 4 days (1-7) resolving PT in 27 (84%) with no resolution being achieved in 5 (15%) and posterior surgical treatment being required. No major complications were observed during the evolution. CONCLUSIONS: The use of small caliber pleural catheters in the treatment of spontaneous pneumothorax (both total and to pressure) performed by physicians with no previous surgical knowledge is safe and effective.

Evaluation of Ciba Corning ACS:180 automated immunoassay system.

We evaluated the technical performance of the Ciba Corning ACS:180 automated immunoassay system for the following analytes: thyroid-stimulating hormone, free thyroxine, luteinizing hormone, follicle-stimulating hormone, prolactin, human chorionic gonadotropin, carcino-embryonic antigen, and prostate-specific antigen. The characteristics evaluated were: precision, carryover, linearity, lower limit of detection, analytical interferences, and comparison with other methods. Satisfactory results were obtained in the within-run and between-run precision studies. Neither sample nor reagent carryover was found for any assay. The range of linearity was acceptable. For some of the assays evaluated, the lower limit of detection was better than that claimed by the manufacturer. Correlation between ACS:180 methods and compared methods was adequate. We conclude that the ACS:180 offers good reliability, practicability, and performance capabilities.

Tendon calcifications of the hip adductors in chondrocalcinosis: a radiological study of 75 patients.

Studies on tendon involvement in articular chondrocalcinosis (ACC) are scarce, with little data focusing on its prevalence and characteristics. We carried out a radiological survey on 75 patients with ACC in order to establish the frequency and radiological appearance of calcific deposits at the origin of the adductor tendons on the ischium. In 19 of these patients, radiological visible linear calcifications compatible with chondrocalcinosis were observed at this site. There is a high correlation between the existence of pelvic tendon calcifications and the extension and intensity of calcific deposits in other articular areas. Calcifications of the adductor tendons are not uncommon in ACC, the amount of calcium pyrophosphate deposits may be the most important factor leading to tendon involvement in this disorder.

[Diseases associated with articular chondrocalcinosis: an analysis of a series of 95 cases]. / Enfermedades asociadas a la condrocalcinosis articular: análisis de una serie de 95 casos.

BACKGROUND: There are different diseases which are associated with articular chondrocalcinosis (ACC) although in some it is debated whether this is a real association or an accidental coexistence. The aim of the present study was to analyze the prevalence and type of associated diseases in a series of patients with ACC and to compare with other series in the literature, as well as determine the performance of a protocol directed to the search for such diseases in patients with ACC. METHOD: A total of 95 patients diagnosed of ACC and attended in the out patients department of Rheumatology in a general hospital over a 5 year period (1987-1991) were included in a protocol specially designed to search for diseases associated to ACC. RESULTS: Twelve (13%) of these patients had one of the diseases classically associated to ACC: gout in 8 cases, hypothyroidism in 2 cases and hyperparathyroidism, adult hemochromatosis and hypophosphatasia in one case each (in one patient two of these diseases coexisted). In most of the patients with secondary ACC the coexisting disease had already been diagnosed. Only two patients (one with hypothyroidism and the other with adult hypophosphatasia) were aided by the application of the protocol and were diagnosed having ACC as the only guiding sign. CONCLUSIONS: The number of diseases associated in patients with articular chondrocalcinosis is relatively low. In the absence of clinical suspicion the performance of different laboratory investigations for diagnosis of diseases related with articular chondrocalcinosis is of little benefit.

Prevalence of articular chondrocalcinosis in elderly subjects in a rural area of Catalonia.

OBJECTIVES: To undertake an epidemiological survey of the prevalence of radiological chondrocalcinosis in the elderly population of Osona, a rural area of Catalonia, north east Spain. METHODS: Knee and wrist radiographs were performed on 261 subjects (141 women, 120 men) aged at least 60 years, who attended a series of 35 general practitioners for various medical problems. RESULTS: Twenty seven subjects had articular chondrocalcinosis, which represents a crude prevalence of 10%. Articular chondrocalcinosis was more often observed in women than in men (14 v 6%). Articular chondrocalcinosis increases in occurrence with age, rising from 7% in subjects aged 60-69 years to 43% in subjects older than 80 years. A similar occurrence of articular chondrocalcinosis was noted in the indigenous population, in which several cases of familial chondrocalcinosis have previously been reported, and in subjects born in other areas of Spain. All but one subject with articular chondrocalcinosis had chondrocalcinosis of the knee. The occurrence of rheumatic disorders did not differ significantly between subjects with articular chondrocalcinosis and those without. CONCLUSIONS: Articular chondrocalcinosis is an age related disorder, which could partly explain the discrepancies in its prevalence reported in previous studies. In most subjects with articular chondrocalcinosis recruited from an unselected population the clinical manifestations are probably mild or even absent.

[Inhalation chambers: an alternative to the conventional inhalator?]. / Cámaras de inhalación: alternativa al inhalador convencional?

BACKGROUND: Aerosol inhalers constitute the most commonly used form of administration of medication by most of the patients with respiratory disease although incorrect usage is a demonstrated fact in many studies. A previous study demonstrated that, despite correct instruction by health care staff and the patients, 30% of the same use these inhalers incorrectly. In the present study, the efficacy of inhalation chambers (750 ml) and spacers (50 ml) versus the conventional inhaler was evaluated by quantification of bronchodilator response. METHODS: Fifty-six stable patients with chronic obstruction to air flow in habitual treatment with aerosol inhalers (AI) were studied. For this study 27 patients used the chamber and 29 the spacer. The patients using the maneuvers correctly (n = 42) and those that did not (n = 14) were studied together and separately. RESULTS: Patients using the inhaler incorrectly were found to benefit significantly from either of the procedures. Upon comparison of the chambers (750 ml) with the spacers (50 ml) a significant improvement was observed with the former. CONCLUSIONS: The response to bronchodilator treatment in patients not using aerosol inhalers correctly improves significantly upon use of either inhalation chambers or spacers with the former demonstrating the best results.

Bezafibrate induced rhabdomyolysis.

The case is presented of a 70 year old woman with mild hypercholesterolaemia and hypertension who was readmitted to hospital six months after a previous admission for angina pectoris. The patient was treated with verapamil, nifedipine, and aspirin, and had been receiving bezafibrate (400 mg every 12 hours) for the previous 40 days. Twenty four hours after admission she developed podagra, which was treated with indomethacin (100 mg daily). Eight days after admission myocardial infarction was suspected, and the next day she presented with symptoms of rhabdomyolysis, which was confirmed by laboratory tests. Bezafibrate was withdrawn and the patient became asymptomatic after seven days. It is recommended that doctors should be aware of the possibility of patients, especially those with impaired renal function, developing rhabdomyolysis while being treated with bezafibrate.