Quality of life against seasonal vs perennial allergens: ESPRINT-15 modified in the pediatric population

Introduction: Allergic rhinitis (AR) is a clinical syndrome characterized by IgE-mediated inflam-mation of the nasal mucosa. The present study investigates the quality of life (QoL) with AR among adults, using widely validated questionnaires, unlike in pediatric patients.Materials and methods: A cross-sectional descriptive observational study was conducted, analyzing the QoL of 102 children with AR aged between 10-15 years, belonging to two health centers (HC) in Zaragoza and two HC in Coruña. The comparison of means between the two groups is carried out using the Student's test or the Mann-Whitney test, considering a value of p<0.05 to be significant.Results: Around 102 children were studied, with a majority (59.8%) being male and a mean age of 12 years. Around 76.5% have a family history of atopy. It was found that AR is more prevalent in Zaragoza (p <0.005), and asthmais highly prevalent in Coruña (p <0.001). The most import-ant sensitizations are pollen in Zaragoza (p <0.05) and dust mites in A Coruña (p <0.001). More treatment needs and associated comorbidities (p<0.05) were observed in A Coruña. The results of the ESPRINT-15 show that 63% of the patients have a good QoL, 27% fair, and 8.8%, poor. Those sensitized to mites have a worse score (p = 0.02). It was found that 52% of children expe-rienced improvement during home confinement, with no notable differences between the two populations. The use of the mask favored QoL in patients from Zaragoza (p <0.0 01 (AU)

Hypogonadism and Mortality in Aged Hospitalized Male Patients: A 5-Year Prospective Observational Study.

OBJECTIVE: To investigate the relationship between hypogonadism and mortality in aged hospitalized male patients. DESIGN: A 5-year prospective observational study was conducted. Gonadal function was assessed at hospital admission and mortality was registered in the follow-up period. PATIENTS AND METHODS: We studied all patients≥65 years admitted for any reason during 2010 and 2011. Serum T concentrations were quantified in all patients. Hypogonadism was defined by the presence of serum T levels<200 ng/dl. Number of deaths and all-cause and cardiovascular (CV) mortality were registered until December 31(st), 2014. RESULTS: During the study 150 patients were admitted and 103 (68.7%) of them died during follow-up. Hypogonadism was positively associated with mortality (P=0.036). The percentage of hypogonadal patients was significantly (P=0.02) higher in the group of patients who died in hospital compared with those who died after hospital discharge and those who survived. CV disease was the main cause of death in 52 patients (50.5%). Kaplan-Meier analysis showed a median survival time for all-cause mortality of 2.0 (0-16.5) months and 21.0 (5.0-33.2) months for patients with and without hypogonadism, respectively (P<0.001). Similar findings were found when analyzing mortality due to CV disease (P=0.009). Hypogonadism was a strong independent predictor for all-cause (adjusted multivariate analysis, HR 3.35; 1.55-7.23, P=0.002) and CV mortality (HR 2.14; 1.18-3.86, P=0.012). CONCLUSIONS: Hypogonadism discovered during hospitalization is associated with in-hospital and long-term mortality in elderly male patients and predicts both all-cause mortality and CV mortality in this population.

Natural course of hypogonadism diagnosed during hospitalization in aged male patients.

Our aim was to assess short-term natural course of hypogonadism diagnosed during hospitalization for acute disease in aged male patients after discharge. A group of 43 hypogonadal males, aged 86.7±5.7 year, was studied. Serum concentrations of testosterone (T) and gonadotropins (follicle-stimulating hormone, FSH, and luteinizing hormone, LH) were measured in every patient both at admission and one month after discharge. Mean serum T at entry was 115.4±48.0 ng/dl. Hypogonadism was hyper-, hypo-, and normogonadotropic in 20 (46.5%), 20 (46.5%), and 3 (7.0%) patients, respectively. One month after discharge serum T concentrations increased significantly (230.9±135.6 ng/dl, p<0.001). At this point, more than half of the patients (n=27, 62.8%) showed normal serum T concentrations. Both gonadotropins, FSH (p<0.001), and LH (p=0.04) also increased one month after discharge. Approximately, half of the patients (13, 48.1%) who normalized serum T concentrations also showed normal serum gonadotropin concentrations. Patients who normalized their serum T concentrations one month after discharge showed significantly higher baseline values of T (134.7±33.9 ng/dl) than those who persisted with hypogonadism (n=16, 32.7%; 82.8±51.6 ng/dl, p<0.001). Lastly, serum T was the only independent predictor for achieving eugonadal status (OR 1.030; CI 95%, 1.010-1.050; p<0.001). In conclusion, about 63% of aged patients hospitalized for acute illness with hypogonadism discovered during hospitalization spontaneously normalize their serum T concentrations one month after discharge. Serum gonadotropin concentrations also increased after discharge. Serum T levels at admission was an independent predictor for the normalization of serum T concentrations.

Características clínicas de los enfermos centenarios hospitalizados / Clinical characteristics of centenarian hospitalized patients

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Hypogonadism in aged hospitalized male patients: prevalence and clinical outcome.

OBJECTIVE: Male hypogonadism is common in the elderly and has been associated with increased risk of mortality. Our objective has been to assess the prevalence of primary and central hypogonadism in elderly male patients admitted to the hospital because of acute illness. We also evaluated the relationships between gonadal dysfunction and in-hospital mortality. PATIENTS AND METHODS: 150 patients, aged ≥65 years, admitted during 2010 and 2011 in our geriatric unit, were studied. Serum concentrations total, bioavailable and free testosterone, as well as of follicle-stimulating hormone and luteinizing hormone were quantified in every patient. Hypogonadism was defined by the presence of serum testosterone levels lower than 200 ng/dl. RESULTS: Hypogonadism was found in 80 patients (53.3 %). Serum gonadotropin concentrations were elevated in 43.7 % of these patients, whereas 41.3 % of hypogonadic patients showed normal and 15 % low gonadotropin concentrations. Respiratory tract infection and congestive heart failure were the main causes of hospitalization in hypogonadal men, whereas acute cerebrovascular disease was the main reason for admission in eugonadal patients. Of the 13 patients who died during hospitalization, 12 were hypogonadic. Patients who died showed significantly lower serum levels of total, free and bioavailable testosterone than those found in patients who survived. CONCLUSION: Our results show that about half of patients admitted for acute illness have hypogonadism, mainly of non-hypergonadotropic type. Gonadal hypofunction is significantly related with in-hospital mortality. A low value of serum testosterone may be a predictor for mortality in elderly male patients.

Toxina botulínica tipo A tópica con iontoforesis para el tratamiento de lahiperhidrosis axilar. Efecto y persistencia / Topic type a botulinum toxin with iontophoresis in the treatment of armpit hyperhidrosis effect and persistency

La sobreproducción de sudor se denomina hiperhidrosis (HH) y frecuentemente conlleva en el ser humano tanto problemas dermatológicos como de índole social. En la actualidad, existen múltiples tratamientos para controlar la HH axilar, siendo entre ellos el uso de la terapia con Toxina Botulínica tipo A (TXB-A) uno de los más efectivos, con la limitante de que la toxina tiene que ser inyectada mediante múltiples punciones en la axila, por lo que tiende a ser un tratamiento rechazado por los pacientes. La iontoforesis es un método que utiliza corriente galvánica y se emplea de forma clínica para la introducción transdermal de medicamentos. Realizamos un ensayo clínico simple ciego sobre 10 pacientes altos que se les aplicó gel inerte mezclado con Toxina Botulínica tipo A (TXB-A) de la marca Dysport® mediante una sesión de iontoforesis en una axila al tiempo que en la otra axila se les aplicó la TXB-Ade forma tradicional, inyectada. Los resultados fueron evaluados con el Minor Test (Test Yodo-almidón) comparativamente en ambas axilas y en cada paciente a los 10 días, 2 meses y 5 meses de la aplicación. Empleamos el mismo número de unidades y la misma dilución de TXB-A tanto para la administrada vía tópica, como para la inyectada. Los resultados presentaron una disminución de la HH axilar en ambas axilas durante todo el estudio, siendo la forma inyectada la que más altos porcentajes de efecto presentó. En general un 74.67% de disminución de la secreción sudoral para la forma tópica con iontoforesis y un 90.33% para la forma inyectada. En cuanto a la duración del efecto, ambas aplicaciones tuvieron resultados estadísticamente significativos para la persistencia del efecto a los 5 meses. Por lo tanto, en base al presente trabajo, concluimos que la TXBA aplicada tópicamente mediante iontoforesis mejora la HH axilar y además presenta una persistencia del efecto de un mínimo de 5 meses (AU)

The overproduction of sweat by the exocrine glands is termed Hyperhidrosis (HH) and frequently become a dermatologic and social problem for humans. Nowadays, we have multiple treatments that controls the armpit HH. Botulinum toxin type A (TXB-A) is known to be the best treatment to eliminate this problem but the needing of multiple injections in the armpit limits patients´ acceptance. Clinical iontophoresis method uses galvanic current to introduce many transdermal medications. We perform a simple blind clinical assay over 10 patients with armpit HH in who we apply an inert gel blended with Botulinum toxin type A (TXB-A) Dysport® using one session of iontopheresis in one armpit; in the same moment the other armpit was injected with the toxin in the conventional way. The results where evaluated and compare by Minor Test (starch-iodine test) in each patient at day 10th, 2months and 5 months after the application. The same number of units and dilution of TXB-A where used in the topic and injected administration way. Results shows a diminished armpit HH in both sides over the whole study, been higher percentage of the effect in the injected way. In general a 74.67% decrease of armpit sweat for the topical way with iontopheresis and 90.33% of decrease of armpit sweat for the injected way. In the 5 months control of the persistency of the effect, both ways of administration of TXB-A reports with statistical significant results. Therefore in the present study we conclude that TXB-A apply topically with iontopheresis improves the armpit HH and shows a persistency of the effect at least for 5 months period (AU)

Fasting hyperglycaemia and in-hospital mortality in elderly population.

BACKGROUND: Admission hyperglycaemia has shown to be a marker of poor clinical outcome. The prevalence of admission hyperglycaemia and its relationship with in-hospital mortality in elderly population has not been clearly defined. We assessed the prevalence and prognostic significance of admission fasting hyperglycaemia in aged patients. METHODS: A total of 808 elderly patients were studied. Patients were classified into group I (serum glucose < 126 mg/dl), II (126-180 mg/dl) and III (> 180 mg/dl). Groups II and III were considered newly recognised fasting hyperglycaemia (NRFH) in non-diabetic patients. RESULTS: NRFH was present in 18.6%. After excluding diabetic patients (n = 206, 25.5%), the distribution of patients (n = 602, 74.5%) was as follows: group I (n = 452, 55.9%), group II (n = 122, 15.1%) and group III (n = 28, 3.5%). In the whole cohort, median fasting glucose was lower in patients who survived [105 mg/dl (88-135)] than in those who died [127 mg/dl (93-159), p < 0.001]. This significant difference was maintained only when non-diabetic patients were considered [100 mg/dl (87-122) vs. 118 mg/dl (92-149), p < 0.001]. In-hospital mortality rate in groups I, II and III was 8.5%, 14.1% and 22.9%, respectively (p < 0.001). Mortality rate was 8.4%, 18.0% and 32.1% (p < 0.001) in groups I, II and III, respectively in non-diabetic population. Both low albumin and high glucose serum concentrations were the only independent risk factors for in-hospital all-cause mortality in non-diabetic patients. CONCLUSIONS: In non-diabetic elderly patients admitted for acute disease, serum glucose concentration is an important, simple and independent predictor of hospital mortality.

Serum thyrotropin concentration is an early marker of normalization of low triiodothyronine syndrome in aged hospitalized patients after discharge.

OBJECTIVES: To assess short-term spontaneous evolution of alterations in thyroid function tests in aged hospitalized patients after discharge. METHODS: A group of 146 patients (mean age±SD 85.9±6.2 yr) was studied. Serum concentrations of TSH, free T4 (FT4), and free T3 (FT3) were evaluated in every patient both after admission and 1 month after discharge. RESULTS: At entry, both serum TSH [median (interquartile range), 2.19mU/l (0.89-2.31)] and FT4 (mean±SD, 16.7±3.4 pmol/l) concentrations were into the normal range, whereas serum FT3 concentrations were low (3.3±0.7 pmol/l). After discharge TSH and FT4 concentrations remained normal and FT3 low. However, both serum TSH [2.53 mU/l (1.24-3.33); p<0.01] and FT3 (3.7±1.0 pmol/l; p<0.001) concentrations significantly increased. Most patients (no.=124, 84.9%) showed the euthyroid sick syndrome (ESS). After discharge, ESS diminished to 76 (52.1%) subjects. Patients who normalized thyroid function tests showed significantly lower TSH values at entry compared with those who persisted with altered thyroid function tests [1.27 mU/l (0.69-1.89) vs 1.69mU/l (0.96-2.91), p<0.05]. Logistic regression analysis showed that serum levels of TSH at admission was the only variable negatively related to normalization of thyroid function [odds ratio 0.730; confidence interval 95%, 0.567-0.940; p=0.01). CONCLUSIONS: About 35%of aged patients hospitalized for acute illness spontaneously normalize their thyroid function tests 1 month after discharge, mainly due to the correction of ESS. Serum TSH levels at admission seem to be the only variable negatively related to normalization of thyroid function at this time.

[Elderly patients with chronic kidney disease: what happens after 24 months of follow-up]. / Ancianos con enfermedad renal crónica: ¿qué ocurre a los 24 meses de seguimiento?

INTRODUCTION: Systematic application of mathematical formulae to estimate the glomerular filtration rate (eGFR) of the general population, according to KDOQI classification of Chronic Kidney Disease (CKD), has permitted to calculate its high prevalence, so as to be considered as a public health problem. Many patients with CKD according to this classification (at least stage 3) are elderly with a low GFR and without any other typical manifestations of renal damage, which is generating a worry between nephrologists due to a significant increment in non justified referrals to their clinics. Our aim in this study is to follow-up during twenty-four months a group of elderly with a low eGFR. PATIENTS AND METHODS: 80 clinically stable patients, with a mediane age of 83 years (range 69-97), recruited alleatory in a consultation of Geriatric and Nephrology General, within January and April 2006, were followed up during twenty-four months. We separated them in two groups based in serum creatinine: Group 1: 38 patients with serum creatinine >_ 1,1 mg/dl (range 0,7-1,1), and Group 2: 42 patients with serum creatinine >1.1 mg/dl (range 1,2-3). Clinically we registered morbimortality and treatments received, and biochemically we measured in serum: creatinine and calculated eGFR at the time of recruitment and after twenty-four months of follow-up using two equations: Cockroft and abreviated MDRD. In urine we determinated basic urinalysis in all patients, protein/creatinine in group 1 and determinated protein in collection urine 24 hours group 2. Statistical comparisons were made using repeated measures, chisquare, and logistic regression of the SPSS 11.0 program. RESULTS: 22,5% of the patients died during the follow up. Heart and infectious problems were the kind of morbidity more frequently found. Only a small proportion (23,3%) of group 2 patients were receiving erithropoietin treatment. Estimated GFR and proteinuria remained stable at the end of twenty-four months independently of basal eGFR. We found no significant differences between both groups in the rest of analytical parameters studied except a significant decrease of hematocrit in the elderly of group 2. Only a small proportion (23,3%) of group 2 patients were receiving erithropoietin treatment. CONCLUSION: In old patients without proteinuria, the stability of its renal function along the time allows us to give a soothing message at the moment of facing the so called CKD "epidemic" in this population.

Elderly patients with chronic kidney disease: what happens after 24 months of follow-up?

Introduction: Introduction: Systematic application of mathematical formulae to estimate the glomerular filtration rate (eGFR) of the general population, according to KDOQI classification of Chronic Kidney Disease (CKD), has permitted to calculate its high prevalence, so as to be considered as a public health problem. Many patients with CKD according to this classification (at least stage 3) are elderly with a low GFR and without any other typical manifestations of renal damage, which is generating a worry between nephrologists due to a significant increment in non justified referrals to their clinics. Our aim in this study is to follow-up during twenty-four months a group of elderly with a low eGFR. Patients and methods: 80clinically stable patients, with a mediane age of 83 years(range 69-97), recruited alleatory in a consultation of Geriatric and Nephrology General, within January and April 2006, were followed up during twenty-four months. We separated them in two groups based in serum creatinine: Group 1: 38 patients with serum creatinine >_ 1,1 mg/dl (range 0,7–1,1), and Group 2: 42patients with serum creatinine >1.1 mg/dl (range 1,2–3).Clinically we registered morbimortality and treatments received, and biochemically we measured in serum: creatinine and calculated eGFR at the time of recruitment and after twenty-four months of follow-up (AU)

Introducción: La aplicación sistemática de fórmulas matemáticas para estimar el filtrado glomerular (FGe) de la población general, atendiendo a la clasificación KDOQI de la enfermedad renal crónica (ERC), ha permitido conocer su prevalencia, considerándose un problema de Salud Publica. Muchos pacientes etiquetados de ERC (al menos estadio 3) son ancianos con un FGe disminuido sin otras manifestaciones típicas del daño renal, lo que está generando una preocupación entre los nefrólogos ante el incremento considerable de consultas no justificadas en esta población. Nuestro objetivo en este estudio es hacer un seguimiento prospectivo a 24 meses de ancianos con un FGe disminuido, para valorar qué ocurre tanto desde el punto de vista clínico como con su función renal (FR) y valorar si realmente nos tenemos que preocupar por esta "epidemia" de ERC en los ancianos. Pacientes y métodos: 80 pacientes clínicamente estables con una mediana edad de 83 años (rango 69-97) reclutados aleatoriamente en una consulta de Geriatría y en una de Nefrología General, entre enero y abril de 2006 fueron seguidos durante 24 meses. Hacemos dos grupos según niveles de creatinina sérica (Crs): grupo 1: 38 pacientes con creatinina sérica (Crs) £1,1 mg/dl (rango 0.7-1.1) y grupo 2: 42 pacientes, con Cr s > 1.1 mg/dl (rango 1.2-3). El 70% del total de pacientes tenía un estadio 3 ó 4 de ERC, de acuerdo con el FGe (MDRD abreviado). Clínicamente se estudiaron la morbi-mortalidad y los fármacos empleados. Analíticamente en sangre se determinó la Crs y se estimó el FG basal y 24 meses después según fórmulas de Cockroft y MDRD abreviado. En orina se realizó un sistemático a todos los pacientes para despistaje de proteinuria, cociente proteinas/creatinina en grupo 1 y cuantificación de proteinas en orina de 24 horas en el grupo 2. La estadística se realizó con el programa SPSS 11.0 usando medidas repetidas en el tiempo, chi-cuadrado y regresión logística. Resultados: Un 22,5% de los pacientes falleció antes de los 24 meses. Las patologías cardíaca e infecciosa fueron la comorbilidad más frecuente. No encontramos diferencias significativas entre ambos grupos en lo referente a morbimortalidad. La FR y la proteinuria permanecieron estables al cabo de los 24 meses, con independencia del grado de FGe previo. No hubo diferencias significativas en la evolución del resto de los parámetros analíticos estudiados salvo un descenso significativo del hematocrito en los ancianos del grupo 2 siendo sólo un 23,3% de los pacientes del grupo 2 los que continuaban con eritropoyetina al final del estudio Conclusión: en ancianos sin proteinuria, la estabilidad de la FR en el tiempo nos permite dar un mensaje tranquilizador a la hora de enfrentarnos a la "epidemia" de ERC en esta población (AU)

Renal function in the elderly and its association with comorbidity

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Alterations in thyroid function tests in aged hospitalized patients: prevalence, aetiology and clinical outcome.

BACKGROUND: Thyroid dysfunction is common in aged people and has recently been associated to mortality. AIMS: Our aims have been (1) to assess the prevalence of alterations in thyroid function tests in hospitalized patients over age 60 years and (2) to study the relationship between thyroid functional status and mortality during hospitalization. METHODS: We studied a group of 447 patients (62% women), aged 61-101 year, hospitalized during 2005. Thyroid dysfunction was assessed by measuring serum concentrations of thyrotrophin (TSH), free thyroxine (FT4), and free thriiodothyronine (FT3). Thyroid autoimmune status was evaluated through thyroid peroxidase (TPO) and thyroglobulin (TG) antibodies quantification. RESULTS: Twenty-one patients (4.7%, 19 women) showed previously known thyroid dysfunction. 332 patients (74.3%) showed alterations in thyroid function tests. Euthyroid sick syndrome (ESS) was the derangement more frequently found (n = 278, 62.2%). After excluding ESS patients, 60 patients (13.4%) showed thyroid dysfunction: overt hypothyroidism, 14 (3.1%); subclinical hypothyroidism, 25 (5.6%); overt hyperthyroidism, 11 (2.5%), and subclinical hyperthyroidism, 10 patients (2.2%). Thyroid autoimmunity was positive in only 4.0% and 2.3% of patients, for TPOAb and TgAb, respectively. The presence of alterations in thyroid function tests was positively associated with the age of the patients and mortality during hospital stay (P < 0.001). Serum levels of FT3 were negatively related to death during hospitalization (OR 0.56; CI 95%, 0.38-0.81; P < 0.01). CONCLUSIONS: About three quarters of patients admitted in our geriatric unit exhibited alterations in thyroid function tests. This finding was associated with elevated age and poor prognosis. The reduction of FT3 values was a powerful predictor for mortality during hospitalization in elderly patients.

Nasal angiocentric lymphoma: an entity that should be remembered.

After four nasal aesthetic functional surgeries in a period of 18 months, a 46-year-old woman was evaluated who presented with moderate functional alteration, saddle-nose deformity, and total loss of the septal cartilage. Four months before presentation the patient sustained severe nasal trauma, resulting in depression of the nasal bridge without loss of function. Her problem was diagnosed initially as a consequence of an infected septal hematoma and loss of the septal cartilage. Based on this diagnosis, the patient was subjected, in an 18-month period, to four reconstructive surgeries by different specialists, without any improvement and with worsening of clinical presentation. During the authors' physical examination of the patient, she demonstrated marked nasal cutaneous retraction, atrophic nasal conchae with total loss of the septal cartilage, and a large loss of septal bone. Three nasal mucosa biopsies were acquired and the authors proceeded to carry out complete nasal reconstruction using external cranial table and rib cartilage. Histopathologically, a lesion was noted that was compatible with angiocentric lymphoma, for which treatment was administered according to this type of illness. The authors point out the importance of establishing an adequate diagnosis in the face of an apparently obvious clinical case, present cross-disciplinary treatment, and discuss the study protocol that should be used for this type of pathology. They present their reconstructive technique of the nasal structure using a combination of bone tissue and cartilage, the results, and the current state of the patient.

Use of cartilaginous autografts in nasal surgery: 8 years of experience.

Although the cartilaginous autografts are one of the tissues more utilized in nasal surgery, a comparative study does not exist to determine which are better options and their precise indications. It is for this reason that a histopathologic analysis was carried out comparing the characteristics and properties of the four principal cartilages that are utilized in aesthetic functional surgery of the nose. Considering these particularities, the precise indications for the employment of the different cartilage as nasal autografts were determined. Of 1120 aesthetic functional rhinoplasties during a period of 8 years, 930 (83 percent) required cartilaginous autografts, 86 percent were primary, 11 percent were secondary, and 3 percent had two or more surgeries. Eighty-three percent of the grafts used were from nasal septum, 12 percent from the auricle, 3 percent from alar cartilages, and 2 percent from the rib. The anatomic sites in which they were employed consisted of the following: 64 percent between the medial crura, 28 percent as in Sheen's graft, 19 percent in the nasal dorsum, 8 percent as spreader grafts, 8 percent as in Peck's graft, and 3 percent in the rim to improve alar collapse. We followed at all times the previous indications for obtaining and placing the nasal autografts. Eighty-four percent of the patients were totally satisfied and only 8 percent required a second surgical procedure to achieve the results desired. Based on this study, it is recommended to utilize the cartilaginous autografts in nasal surgery considering three parameters: the physical and histologic characteristics of each cartilage, the anatomic site in which they are to be placed, and the effect desired with their application.

Cartilaginous behavior in nasal surgery: a comparative observational study.

Cartilaginous autografts, either from the ribs, auricular concha, nasal septum, or even the alar cartilages, are some of the most widely used materials in nasal surgery. Nevertheless, no comparative study exists on these four cartilages in which their physicoelastic properties are analyzed based on their histological architecture and their function within the organism. The studies that do exist on structure and classification of cartilages differ widely. In this study, cartilage specimens obtained from the nasal septum, rib, auricular pavilion, and alar of 7 fresh cadavers were analyzed. They were subjected to special tincturing to be able to histologically observe their architecture, cellularity, intercellular substance, the relationship between cellularity and intercellular substance, the primary components of the matrix, and the distribution of fibers. Many similarities were found among the septal, costal, and alar cartilages. All three exhibit little cellularity and much intercellular substance. The intercellular substance is made up of homogeneously distributed collagen fibers. Auricular cartilage has many cells and little intercellular substance, being made up of irregularly distributed elastic fibers. On the basis of these findings, we propose a simpler classification and make recommendations for the use of these four cartilages in nasal surgery.

[Assessing quality of life in Parkinson's disease using the PDQ-39. A pilot study]. / Valoración de la calidad de vida en la enfermedad de Parkinson mediante el PDQ-39. Estudio piloto.

The aim of this pilot study was to analyze an adaptation of the PDQ-39, a Parkinson's disease (PD) quality of life questionnaire, for use in Spanish. Fifty patients were enrolled. Patient characteristics and medical histories were recorded, including scores on the following scales: Hoehn and Yahr (HY), PD unified (UPDRS), Schwab and England (SE), Intermediate Scale for Assessment of PD (ISAPD). Barthel Index (BI), Pfeiffer's SPMSQ, Global Deterioration Scale (GDS), Geriatric Depression Scale (GDS). Hospital Depression and Anxiety Scale (HDA) and the PDQ-39. Descríptive statistics were recorded, as well as Spearman's r and ANOVA results. The dimensions that correlated well with PD scale scores were mobility, daily life activities and cognitive deterioration. The dimension stigma correlated with complications on the UPDRS and the ISAPD. Emotional well-being correlated with subscale I of the UPDRS, the GDS and the HDA (r = 0.39-0.79, p < 0.01-0.001). Physical discomfort correlated only with depression and anxiety. Stage of disease and level of depression influenced most dimensions assessed by the PDQ-39. Some psychosocial factors that are important components of well-being are scarcely reflected by the clinical scales usually applied.