Urografía por tomografía computada multicorte (UroTAC): estudio descriptivo utilizando la técnica de split bolus / Multislice CT urography (Uro-CT): a descriptive study using split bolus technique

Multislice computed tomography provides high spatial and temporal resolution images in addition to high quality multiplanar and three-dimensional reconstructions. As a result of this diagnostic efficacy, the Computed Tomography Urography (Uro-CT) has become the technique of choice for evaluating the urinary tract, virtually replacing the traditional urography examination. At Padre Hurtado Hospital, Santiago, Chile, we conducted a retrospective analysis to review our experience with Uro-CT scanning and split bolus technique, which has the potential to yield a synchronous nephrographic and excretory phase of the urinary system, thus reducing radiation dose for patients, number of images and costs generated by MDCT urography. A series of 31 cases is presented, along with description of techniques applied as well as study main findings.

La tomografía computada multicorte permite obtener imágenes de alta resolución espacial y temporal además de reconstrucciones multiplananes y tridimensionales de gran calidad, lo que ha hecho que la Urografía por Tomografía Computada (UroTAC) se convierta en la técnica de elección para la evaluación del tracto urinario, reemplazando prácticamente a la urografía tradicional. En el Hospital Padre Hurtado, revisamos nuestra experiencia con UroTAC y técnica de "split bolus" que permite obtener simultáneamente una fase nefrográfica y excretora del sistema urinario mediante una sola adquisición, lo que disminuye la dosis de radiación al paciente, el número de imágenes y los costos de la UroTAC estándar. Presentamos una serie de 31 pacientes estudiados, describiendo la técnica y los principales hallazgos obtenidos en ellos.

Evaluación geriátrica inicial en una comunidad urbana y una rural en Chile con las "Escalas de la Cruz Roja Española y Social UC Chile" / Initial geriatric evaluations in one urban and one rural community in Chile using the "Spanish Red Cross scale and the social scale of the Universidad Católica in Chile"

La mayoría de los adultos mayores funcionan adecuadamente y no requieren una evaluación geriátrica exhaustiva. No obstante existe un grupo en riesgo de declive, en el cual una detección precoz es vital para evitar mayor deterioro. Este artículo presenta los hallazgos de un estudio a gran escala de cribado geriátrico en una población rural y otra urbana de bajos ingresos, en Chile. Se documenta la utilidad de un instrumento simple, la "Escala de la Cruz Roja y Social UC Chile", para identificar sujetos con deterioro funcional, mental o social, que podrían beneficiarse de una valoración geriátrica integral. Se añade una evaluación social (la Escala Social UC Chile) a las Escalas funcional y mental de la Cruz Roja, lo que agrega importante información. Se encontró que los adultos mayores rurales tenían mayor discapacidad física y mejor soporte social que sus pares urbanos. No hubo diferencias en la evaluación mental de ambas comunidades. La "Escala de la Cruz Roja y Social UC Chile" resultó ser un instrumento útil que puede ayudar a identificar a aquellos adultos mayores que podrían beneficiarse de una valoración geriátrica integral (AU)

Caídas en adultos mayores institucionalizados: descripción y evaluación geriátrica / Falls in institutionalized elderly subjects. Features and geriatric assessment

BACKGROUND: Falls are an important cause of disability and mortality among elderly subjects. AIM: To study the features and incidence of falls in institutionalized elderly subjects. PATIENTS AND METHODS: Prospective recording of all falls, occurring in a period of eight months, to 453 subjects older than 60 years, living a home for the elderly. Evaluation of functional status of subjects suffering falls, using the Spanish Red Cross score. One hundred and two subjects living in the same place, but not suffering falls, were considered as controls. RESULTS: One hundred and three subjects, aged 80 +/- 6 years (24 per cent of the sample) suffered falls. Most falls were during the day and while walking. Seventy percent of subjects suffering falls did not have a history of previous falls. Nine percent of those falling, suffered a fracture. Compared to controls, falling subjects had a more deteriorated functional and mental status and consumed more benzodiazepines and neuroleptics. CONCLUSIONS: There is an association between functional status and psychotropic medication consumption and the incidence of falls in institutionalized elderly subjects.

[Excess of mineralocorticoids in essential hypertension: clinical-diagnostic approach]. / Exceso de mineralocorticoides en hipertensos esenciales: enfoque clínico-diagnóstico.

BACKGROUND: Primary hyperaldosteronism is more frequent among subjects with essential hypertension than previously thought. The prevalence, according to local and international evidence could fluctuate between 9 and 10%. AIM: To investigate if subjects with essential hypertension have different aldosterone and renin plasma levels than normotensive subjects. PATIENTS AND METHODS: One hundred twenty five subjects with essential hypertension, not receiving medications for at least two weeks prior to the study and 168 age and sex matched normotensive controls were studied. Blood was drawn between 9 and 10 AM during a sodium free diet to determine plasma aldosterone, plasma renin activity and potassium. RESULTS: Plasma aldosterone was higher in hypertensive subjects than controls (11.6 +/- 7.6 and 9.9 +/- 5.1 ng/dl respectively; p = 0.04). Plasma renin activity was lower in hypertensives than controls (1.42 +/- 1.28 and 1.88 +/- 1.39 ng/ml/b respectively; p < 0.001). Thus, plasma aldosterone/plasma renin activity ratio was higher in hypertensives (13.8 +/- 13.5 and 8.3 +/- 7.8; p < 0.001). A pathological ratio was defined as over 25, corresponding to the mean plus two standard deviations of the control group. Primary hyperaldosteronism was found in 5/125 hypertensives (4%) and 1/168 normotensive subject (0.6%). None had hypokalemia. CONCLUSIONS: Subjects with essential hypertension have higher plasma aldosterone and lower plasma renin activity than normal controls. A plasma aldosterone/plasma renin activity over 25 was defined as abnormal.