Compassion fatigue and anxiety in critical care emergency nurses: In between efficiency and humanity.

OBJECTIVES: To determine the emotional impact of permanent proximity to trauma and death in the Emergency and ICU's nurses establishing prevalence of Compassionate Fatigue (burnout and Secondary Traumatic Stress) and anxiety. Analyze its relationship with sociodemographic, training, workplace and psychological variables. METHODS: Descriptive, cross-sectional and multicentre study. The validated ProQOL v. IV and STAI scales and an ad-hoc questionnaire with the variables of the second objective were used in 710 nurses from nine highly complex hospitals in Catalonia (Spain). RESULTS: In both units, the prevalence of professionals affected with high scores of burnout was higher than 20%, on Secondary Traumatic Stress was 30% and, 12% on anxiety. Each subscale was significantly associated with the intention to leave units and the career. 97% of participants stated that they needed to be trained in emotional management. CONCLUSION: The prevalence of burnout and Secondary Traumatic Stress were higher in our study than those offered in the reference literature in emergency and ICU nurses. The prevalence of each construct was individually related to the desire to leave work units and career. This fact, together with the participants' desire to be better trained in emotional management exposes the need to establish educational plans, as well as institutional measures to prevent and support nurses for Compassion Fatigue.

Fatiga por compasión y ansiedad en enfermeras de cuidados críticos y emergencias. Entre eficiencia y humanidad / Compassion fatigue and anxiety in critical care emergency nurses: In between efficiency and humanity

Objetivos: Determinar el impacto emocional de la proximidad al trauma y la muerte en enfermeras de urgencias y de UCI mediante las prevalencias de fatiga de compasión (burnout y estrés traumático secundario) y ansiedad. Analizar su relación con variables de tipo sociodemográfico, formativas, laborales y psicológicas. Método: Estudio descriptivo, transversal y multicéntrico. Se utilizaron las escalas validadas ProQOL v.IV y STAI y un cuestionario ad-hoc con las variables del segundo objetivo, en 710 enfermeras de nueve hospitales de alta complejidad de Cataluña (España). Resultados: En ambas unidades, la proporción de profesionales afectados en alto grado de burnout fue superior al 20%, al 30% en estrés traumático secundario y al 12% en ansiedad. Cada subescala se asoció con la intención de abandonar la unidad y la profesión. El 97% de participantes manifestaron que era necesario recibir formación en gestión emocional. Conclusiones: Las prevalencias de burnout y de estrés traumático secundario fueron superiores en nuestro estudio respecto a la literatura de referencia en las enfermeras de urgencias y en las de UCI. La prevalencia de cada constructo se relacionó individualmente con el deseo de abandono de las enfermeras de sus unidades y de su profesión. Este hecho, junto al deseo de recibir formación de los participantes, expone la necesidad de establecer planes formativos, así como medidas institucionales de prevención y apoyo para la fatiga por compasión.(AU)

Objectives: To determine the emotional impact of permanent proximity to trauma and death in the Emergency and ICU's nurses establishing prevalence of Compassionate Fatigue (burnout and secondary traumatic stress) and anxiety. Analyze its relationship with sociodemographic, training, workplace and psychological variables. Methods: Descriptive, cross-sectional and multicentre study. The validated ProQOL v.IV and STAI scales and an ad-hoc questionnaire with the variables of the second objective were used in 710 nurses from nine highly complex hospitals in Catalonia (Spain). Results: In both units, the prevalence of professionals affected with high scores of burnout was higher than 20%, on secondary traumatic stress was 30%, and 12% on anxiety. Each subscale was significantly associated with the intention to leave units and the career. 97% of participants stated that they needed to be trained in emotional management. Conclusion: The prevalence of burnout and secondary traumatic stress were higher in our study than those offered in the reference literature in emergency and ICU nurses. The prevalence of each construct was individually related to the desire to leave work units and career. This fact, together with the participants’ desire to be better trained in emotional management exposes the need to establish educational plans, as well as institutional measures to prevent and support nurses for Compassion Fatigue.(AU)

Trichilemmal carcinoma of the scalp.

This report describes the case of an 86-year-old male who presented with a large scalp tumour. Imaging revealed a large vertex mass, without intracranial extension, and multiple nodular subcapsular hepatic lesions suspected to be secondary in nature. Surgical resection was performed. Pathological examination revealed an adnexal carcinoma of follicular origin, thus a trichilemmal carcinoma. Controlled wound healing (budding of the diploë) was completely successful within 12 months. The patient refused the assessment and treatment of his metastases.

Breast tomosynthesis: What do we know and where do we stand?

Digital breast tomosynthesis (DBT) is a new imaging technology that addresses the limitation caused by overlapping structures in conventional two-dimensional digital mammography owing to the acquisition of a series of low-dose projection images. This unique technique provides a dual benefit to patients screened for breast cancer. First, DBT increases the cancer detection rate mostly by highlighting architectural distortions and allowing better assessment of masses shape and margins. Second, DBT helps reduce recall rate by discarding asymmetries related to overlapping tissue. However, DBT is not included in the majority of cancer screening programs worldwide. Several issues still need to be addressed such as over-diagnosis and over-treatment, lack of reduction of interval breast cancer, quality control and storage, and radiation dose. In the diagnostic setting, DBT increases the diagnostic accuracy and reduces the number of indeterminate lesions in symptomatic women. Its aforementioned performances regarding asymmetries, masses and architectural distortions allow reducing the number of additional views while working-up a screening-detected lesion. Tumor size is also better assessed at DBT as well as multicentricity, two significant benefits in the staging of breast cancer. Finally, DBT allows a better analysis of scars and helps reduce the rate of indeterminate findings after surgery. Although somewhat limited by high breast density, DBT globally outperforms digital mammography in both screening and diagnostic breast imaging. Additional research is however needed, particularly on relevant screening outcomes. This review describes the main performances of breast DBT in breast cancer screening and diagnosis and the resulting consequences in both settings.

Magnetic resonance imaging in breast cancer management in the context of neo-adjuvant chemotherapy.

This review discusses the clinical applications of magnetic resonance imaging (MRI) for the assessment of neo-adjuvant chemotherapy (NAC) indication, axillary lymph node status, preNAC cancer prognosis, early and intermediate response to NAC, and post-NAC residual disease in patients with breast cancer. Contrast-enhanced MRI with analysis of the tumor morphological features and qualitative enhancement kinetics must be considered as the standard method for pre-NAC breast cancer staging and post-NAC residual disease assessment. Diffusion-weighted imaging (DWI) is easy to perform and may increase the specificity of breast MRI for tumor staging, and also for the assessment of tumor multifocality and multicentricity and lymph node status. It also provides an ancillary added value in the early and post-NAC response evaluation. Changes in the functional tumor volume are the main criterion for the early response analysis. Other MRI methods, such as quantitative perfusion analysis, MR spectroscopy and texture analysis, are still under study.

CT of gastro-duodenal obstruction.

Gastro-duodenal obstruction encompasses a spectrum of benign and malignant disease. Historically, chronic peptic ulcer disease was the main cause of gastro-duodenal obstruction, whereas now malignant cause with gastric carcinomas for gastric obstruction and pancreatic tumors for duodenal obstruction predominate. This paper reviews the role of CT in diagnosing gastro-duodenal obstruction, its level, its cause by identifying intraluminal, parietal, or extrinsic process, and the presence of complication.

Correlation between MR imaging - prognosis factors and molecular classification of breast cancers.

The molecular classification of breast cancers defines subgroups of cancer with different prognoses and treatments. Each molecular type representing the intrinsic signature of the cancer corresponds to a histological profile incorporating hormone receptors, HER2 status and the proliferation index. This article describes the correlations between this molecular classification obtained in routine clinical practice using histological parameters and MRI. It shows that there is a specific MRI profile for triple-negative cancers: distinct demarcation, regular edges, hyperintensity on T2 weighted signals and, particularly, a crown enhancement. It is important for the radiologist to understand this molecular classification, firstly because of the relatively suggestive appearance of triple-negative basal-like cancers in the molecular classification, secondly, and particularly, as cancers in patients with the BRCA1 mutation are often triple-negative meaning that the criteria for reading the MRI needs to be tailored to this feature of the cancers, and finally because the efficacy of MRI in assessing response to neoadjuvant chemotherapy depends on the molecular class of cancer treated.

Mechanical occlusions: diagnostic traps and key points of the report.

Management of mechanical occlusion, particularly of the small intestine, has altered considerably over recent years, with a change of paradigm and the indication for surgery depending on the cause of the occlusion and any signs of entrapment or strangulation. It is therefore important today to make a positive diagnosis of mechanical occlusion, to assess its degree, its location and its cause, and to look for signs of entrapment and strangulation. Only computer tomography can provide the answers to these different questions. The aim of this paper is to provide a reminder of the CT signs that enable us to confirm diagnosis of the various aspects of mechanical occlusion of the stomach and duodenum, small intestine or colon, to emphasize and illustrate the diagnostic traps in CT and to set out the key points of a CT report of mechanical occlusion.

Infection of the right iliac fossa.

Febrile pain in the right iliac fossa is one of the most common reasons for consulting at an emergency service. Within this framework, the main diagnosis that is considered is appendicitis, the main complication of which is perforation. However, a certain number of other conditions can be responsible for this clinical picture, primarily including digestive tract and mesentery disorders including mesenteric lymphadenitis, Crohn's disease, infectious enterocolitis, small intestine or colonic diverticulitis, ischaemic colitis or cancer of the caecum. This article illustrates the imaging semiology of the various right colonic, iliac, mesenteric and appendicular conditions that could potentially cause an infection of the right iliac fossa. It specifies the indications of ultrasound and CT scans, respectively, which depend on the age of the patient and the clinical signs and symptoms. Though the CT scan is commonly used in abdominal emergencies in general, and particularly in clinical pictures of infection of the right iliac fossa, ultrasound remains recommended as first line imaging when confronted with suspected appendicitis or lymphadenitis in a young subject or in the monitoring of Crohn's disease.

Epidemiological factors associated with the exposure of cattle to Coxiella burnetii in the Madrid region of Spain.

Domestic ruminants are considered to be the major source of Coxiella burnetii, the causative agent of Q fever. Even though Q fever is considered to be present worldwide, its distribution in many areas and countries remains unknown. Here, a serological assay was used to estimate the seroprevalence of C. burnetii in cattle in the Madrid region of Spain, to assess its spatial distribution, and to identify risk factors associated with positive results. Ten animals from each of 110 herds (n=1100) were randomly selected and analyzed using an ELISA test. In addition, epidemiological information, at both the herd and individual level, was collected. Variables for which an association with test results was detected in a bivariate analysis were included as predictors (main effects) in a multivariable logistic regression model. Herd and individual seroprevalences were 30% (95% CI=22.2-39.1) and 6.76% (95% CI=5.42-8.41), respectively, and a strong spatial dependence was identified at the first neighbour level using the Cuzick-Edwards test. Production type (dairy >beef >bullfighting) and age of animals (old vs. young) were the only variables significantly associated (P<0.05) with positive serological results at the herd and individual levels, respectively. These results indicate that cattle are exposed to C. burnetii in the Madrid region The high herd seroprevalence found in dairy herds (75%) indicates a higher risk of infection (probably for management reasons) whereas no C. burnetii positive bullfighting herds were identified.

Exposure to medicines among patients admitted for hip fracture and the case-fatality rate at 1 year: a longitudinal study.

PURPOSE: To describe the demographic and clinical characteristics and the pre-fracture exposure to medicines of patients admitted for a hip fracture, and to explore their association with fatal outcome 1 year after the fracture. METHODS: All patients ≥ 65 years old admitted for a hip fracture in a tertiary hospital in Barcelona between January 1 and December 31 2007 were included. Data on the patients' clinical characteristics before and during hospital admission and on pre-fracture exposures to medicines were collected from the clinical records. One-year mortality was checked by approaching the patients and their families and was cross-checked with the national mortality statistics database. A Cox proportional hazards analysis was carried out. RESULTS: Four hundred and fifty-six patients [mean age (SD) 82.9 (7.2) years, 73.5 % female], were admitted with hip fracture during the study period. Almost 80 % of the patients (363, 79.6 %) had three or more associated conditions, and 41.7 % received pre-fracture treatment with five or more drugs. The case-fatality rate during hospital admission was 4.6 % (21 patients). One hundred and seven patients died within 1 year (23.5 %). Advanced age, male gender, two or more associated chronic conditions, cancer, severe cognitive impairment, and treatment with opiates before fracture were significantly associated with the risk of dying. An inverse association was recorded between mortality and pre-hospital exposure to medicines for osteoporosis. CONCLUSIONS: One-quarter of patients admitted for hip fracture died within 1 year after the fracture. Exposure to opiates before hip fracture was associated with an increased 1-year death rate, whereas treatment with drugs for osteoporosis was associated with a decrease in death rate. These results should be confirmed in studies with detailed prospective collection of information on exposure to medicines.

Roturas tendinosas bilaterales del aparato extensor de la rodilla: serie de casos / Bilateral tendon tears of the extensor mechanism of the knee: a series of cases

Las roturas bilaterales del aparato extensor de la rodilla son infrecuentes y se asocian clásicamente a enfermedades sistémicas. Estas lesiones pueden ser óseas, de patela o tuberosidad tibial anterior, musculares o tendinosas. Las más comunes de todas son las fracturas de rótula, seguidas de roturas del tendón cuadricipital o rotuliano. Las roturas bilaterales tanto del tendón rotuliano como cuadricipital, al ser infrecuentes, pueden ser infradiagnosticadas retrasando el tratamiento quirúrgico y la posterior rehabilitación; suelen ser traumáticas. En la literatura existen publicaciones sobre algunos casos de roturas tendinosas bilateral del aparato extensor de la rodilla asociadas a enfermedades sistémicas como isuficiencia renal, diabetes mellitus o artritis reumatoide o al uso prolongado de quinolonas o corticoides. En este trabajo describimos 4 casos clínicos de roturas tendinosas bilaterales del aparato extensor, sin y con enfermedades sistémicas asociadas (AU)

Bilateral injuries of the knee extensor mechanism are uncommon and are generally related to systemic diseases. Such injuries may be muscle tears, bone fractures (patella and tibial tubercle) and tendinous disruptures. Patella fractures are described as being the most common of these, followed by injuries of the quadriceps and patellar tendons. As bilateral disruption of either patellar and/or quadricipital tendons is uncommon, it may be underdiagnosed, thus delaying the surgical treatment and subsequent rehabilitation. They are generally traumatic. There are publications in the literature on some cases of bilateral tendinous disruptions of the knee extensor complex associated to systemic diseases such as renal failure, diabetes mellitus or rheumatoid arthritis or the continued use of steroids or fluoroquinolones. We report four cases of bilateral knee tendon disruption in patients with and without systemic disease (AU)

Pearls and pitfalls in breast MRI.

At our academic institution, we have noticed repeated examples of both false-positive and false-negative MR diagnoses in breast cancer. The most common diagnostic errors in interpreting MRI of the breast are discussed in this review and experience-based advice is provided to avoid similar mistakes. The most common reasons for false-positive diagnoses are misinterpretation of artefacts, confusion between normal enhancing structures and tumours and, above all, insufficient use of the American College of Radiology breast imaging reporting and data system lexicon, whereas false-negative diagnoses are made as a result of missed tiny enhancement, a background-enhancing breast, or enhancement interpreted as benign rather than malignant.

[MR Imaging of primary ovarian tumors with pathologic correlation]. / Corrélations anatomopathologiques: IRM des tumeurs ovariennes primitives.

Ovarian tumors are classified based on the cell of origin into epithelial tumors, germ cell tumors and sex cord-stromal tumors. This pictorial essay illustrates the MR imaging features of the main ovarian tumors with pathologic correlation. These key features are helpful to suggest a specific diagnosis or narrow the differential diagnosis, in order to optimize the surgical approach.

Artroplastia de cadera / Hip arthroplasty

La artroplastia total de cadera (ATC) es una intervención coste-efectiva para disminuir el dolor, mejorar la función y la calidad de vida de los pacientes con patología degenerativa o inflamatoria de la cadera. La mayoría de sistemas disponibles actualmente son modulares y la fijación de los componentes protésicos al hueso puede conseguirse mediante dos técnicas: la cementación y la osteointegración. Tanto los vástagos cementados como los no cementados pueden ser considerados el patrón oro para la supervivencia a largo plazo; sin embargo, las técnicas no cementadas son hoy en día el método preferido para la mayoría de reemplazos acetabulares. Actualmente la superficie de carga con par de fricción metal-polietileno entrelazado es la más utilizada. La mayoría de complicaciones después de una ATC son infrecuentes, y pueden ser prevenidas y tratadas fácilmente. El objetivo inmediato de la rehabilitación en la fase aguda se centra en reducir el dolor, mejorar la movilidad, restaurar la función e identificar y prevenir las complicaciones postoperatorias inmediatas. Las guías clínicas para los pacientes intervenidos de una prótesis de cadera, y más específicamente los protocolos de ejercicios terapéuticos, varían dependiendo de las instituciones u hospitales y del ámbito de actuación. Una adecuada valoración de los resultados de la artroplastia requiere el uso de instrumentos genéricos de medición de la calidad de vida, siendo el más utilizado el Medical Outcomes Study-Short Form 36, y de instrumentos específicos que sean lo suficientemente sensibles para detectar los cambios clínicos de interés, como la escala de cadera de Harris (Harris Hip Score). Los resultados publicados demuestran una mejoría excelente tanto clínica, como funcional y radiográfica después de la ATC y aproximadamente el 90 % de las ATC tienen éxito, en términos de no dolor ni complicaciones a los 10-15 años de la cirugía

Total hip arthroplasty (THA) is a cost-effective intervention to decrease pain, improve function and quality of life of the patients with degenerative or inflammatory disease of the hip. Most of the currently available systems are modular and fixation of the prosthetic components to the bone may be achieved with two techniques: cementation and osteointegration. Both the cemented stems and non-cemented ones may be considered the gold standard for long term survival. However, the non-cemented techniques are presently the preferred method for most of cetabular replacements. Currently friction of metal on polyethylene bearing surface is used most. Most of the complications after a THA are uncommon and may be easily prevented and treated. The immediate objective of rehabilitation in the acute phase is focused on reducing pain, improving mobility, restoring function and identifying and preventing immediately postoperative complications. Clinical guidelines for the patients operated on for a hip prosthesis and more specifically the therapeutic exercise protocols, vary according to the institutions or hospitals and action setting. An adequate assessment of the results of the arthroplasty requires the use of generic instruments of measurement of quality of life. That used most is the Medical Outcomes Study-Short Form 36. It is also necessary to use specific instruments that are sufficiently sensitive to detect clinical changes of interest, such as the Harris Hip Score. The results published show excellent clinical, functional and radiological improvement after the THA. Approximately 90 % of the THAs are successful in terms of no pain or complications at 10 to 15 years of the surgery (AU)

Artroplastia de cadera / Hip arthroplasty

La artroplastia total de cadera (ATC) es una intervención coste-efectiva para disminuir el dolor, mejorar la función y la calidad de vida de los pacientes con patología degenerativa o inflamatoria de la cadera. La mayoría de sistemas disponibles actualmente son modulares y la fijación de los componentes protésicos al hueso puede conseguirse mediante dos técnicas: la cementación y la osteointegración. Tanto los vástagos cementados como los no cementados pueden ser considerados el patrón oro para la supervivencia a largo plazo; sin embargo, las técnicas no cementadas son hoy en día el método preferido para la mayoría de reemplazos acetabulares. Actualmente la superficie de carga con par de fricción metal-polietileno entrelazado es la más utilizada. La mayoría de complicaciones después de una ATC son infrecuentes, y pueden ser prevenidas y tratadas fácilmente. El objetivo inmediato de la rehabilitación en la fase aguda se centra en reducir el dolor, mejorar la movilidad, restaurarla función e identificar y prevenir las complicaciones postoperatorias inmediatas. Las guías clínicas para los pacientes intervenidos de una prótesis de cadera, y más específicamente los protocolos de ejercicios terapéuticos, varían dependiendo de las instituciones u hospitales y del ámbito de actuación. Una adecuada valoración de los resultados de la artroplastia requiere el uso de instrumentos genéricos de medición dela calidad de vida, siendo el más utilizado el Medical Outcomes Study-Short Form 36, y de instrumentos específicos quesean lo suficientemente sensibles para detectar los cambios clínicos de interés, como la escala de cadera de Harris (Harris Hip Score).Los resultados publicados demuestran una mejoría excelente tanto clínica, como funcional y radiográfica después dela ATC y aproximadamente el 90 % de las ATC tienen éxito, en términos de no dolor ni complicaciones a los 10-15 años de la cirugía (AU)

Total hip arthroplasty (THA) is a cost-effective intervention to decrease pain, improve function and quality of life of the patients with degenerative or inflammatory disease of the hip. Most of the currently available systems are modular and fixation of the prosthetic components to the bone may beachieved with two techniques: cementation and osteointegration. Both the cemented stems and non-cemented ones may be considered the gold standard for long term survival. However, the non-cemented techniques are presently the preferred method for most of cetabular replacements. Currently friction of metal on polyethylene bearing surface is used most. Most of the complications after a THA are uncommon and may be easily prevented and treated. The immediate objective of rehabilitation in the acute phase is focused on reducing pain, improving mobility, restoring function and identifying and preventing immediately postoperative complications. Clinical guidelines for the patients operated on for a hip prosthesis and more specifically the therapeutic exercise protocols, vary according to the institutions or hospitals and action setting. An adequate assessment of the results of the arthroplasty requires the use of generic instruments of measurement of quality of life. That used most is the Medical Outcomes Study-Short Form 36. It is also necessary to use specific instruments that are sufficiently sensitive to detect clinical changes of interest, such as the Harris Hip Score. The results published show excellent clinical, functional and radiological improvement after the THA. Approximately 90 % of the THAs are successful in terms of no pain or complications at 10 to 15 years of the surgery (AU)

Up to 21-day banked red blood cells collected by apheresis and stored for 14 days after automated wash at different times of storage.

BACKGROUND AND OBJECTIVES: A closed-system technology (ACP-215, Haemonetics, Braintree, MA) enables automated washing and extended storage of frozen red blood cells (RBC). This technology was applied to wash banked RBC for removal of undesirable protein and metabolites before transfusion. We studied protein and metabolite depletion as well as RBC metabolism and viability up to 14 days postwash with regard to various pre-storage times. MATERIALS AND METHODS: Thirty RBC units were collected by means of apheresis and subdivided into three arms based on prewash storage time period (6 days/group 1, 14 days/group 2, 21 days/group 3). Wash efficacy (protein depletion, IgA), RBC metabolism (pH, lactate, potassium, haemolysis) and cell viability (ATP) were analysed immediately and 14 days after washing. RESULTS: Total protein and IgA postwash were lowered by automated wash in all groups and uniformly met EC guidelines. Potassium (mmol/l) was below 1.2 mmol/l postwash and significantly below prewash values in all groups, even after 14 days of storage (prewash vs. postwash; P < 0.05). RBCs washed after 14 and 21 days, respectively, showed significantly lower pH values and lower ATP content than RBCs washed after only 6 days of storage. Haemolysis rate remained significantly below 0.8%, the maximum level recommended by the EC guidelines, immediately and 14 days after washing in all units. CONCLUSION: Our data confirm that RBC units banked up to 21 days can be effectively protein- and potassium-depleted with the ACP-215 independent from prewash storage time. With respect to high ATP levels and pH, postwash storage of 2 weeks should be limited to units not older than 7 days before wash. This new washing technology ensures better standardization in washed RBC and provides blood centres with a logistical alternative to 24-h washed RBC products.

Prótesis total de rodilla estándar. Análisis de supervivencia del implante a los 5 años / Standard total knee replacement. Analysis of 5-year implant survival rates

El objetivo de este estudio es realizar un análisis de supervivencia del implante en las artroplastias totales de rodilla estándar a los 5 años de la intervención, así como el estudio de los factores relacionados con dicha supervivencia. Pacientes y métodos. Se ha realizado un estudio prospectivo que incluye 271 pacientes que fueron intervenidos de prótesis total de rodilla estándar en el período comprendido entre 1988 y 1993 y posteriormente trasladados al servicio de Rehabilitación. Para la recogida de datos utilizamos el cuestionario modificado de la British Orthopaedic Association. Para el análisis de supervivencia hemos utilizado la función de Kaplan-Meier y consideramos como evento o acontecimiento final para la supervivencia la retirada de la prótesis. Resultados. El porcentaje de supervivencia de esta serie a los 5 años es del 94,98 por ciento. Los factores asociados significativamente con la supervivencia a los 5 años han sido: valgo al alta hospitalaria (p < 0,001), luxación de rótula (p < 0,001; supervivencia 70,59 por ciento), infección (p < 0,001; supervivencia 28,57 por ciento), descementación (p < 0,001; supervivencia 50 por ciento), inestabilidad (p < 0,001; supervivencia 25 por ciento) y dolor de etiología desconocida (p < 0,001; supervivencia 92 por ciento). Los resultados funcionales y de impresión subjetiva a los 5 años han sido excelentes o buenos en el 72,2 por ciento de los casos. Conclusiones. En esta serie los resultados de las prótesis totales de rodilla estándar a los 5 años de la cirugía son predecibles, constatándose una alta supervivencia del implante y unos resultados funcionales y de impresión subjetiva excelentes o buenos en la gran mayoría de los casos (AU)

Prótesis total de rodilla. Estudio de los factores determinantes del alta hospitalaria en rehabilitación / Total knee prosthesis. Study of the determining factors of hospital discharge in rehabilitation

Introducción: El objetivo de este estudio es analizar qué factores son determinantes del alta hospitalaria en la rehabilitación de los pacientes intervenidos de prótesis total de rodilla. Pacientes y métodos: Se ha realizado un estudio prospectivo que incluye 162 pacientes que fueron intervenidos consecutivamente de prótesis total de rodilla en el período de tiempo comprendido entre junio de 1999 y junio de 2000 y posteriormente trasladados al Servicio de Rehabilitación para realizar tratamiento médico rehabilitador en régimen de hospitalización. Para la recogida de datos utilizamos el cuestionario modificado de la British Orthopaedic Association. Se ha realizado un análisis de regresión lineal múltiple, para estudiar qué variables están asociadas con la estancia hospitalaria en rehabilitación (variable dependiente), ajustando por el efecto de las demás. Resultados: En el análisis bivariable han sido factores asociados con una menor estancia hospitalaria en rehabilitación: la edad avanzada (p<0,05), el índice de masa corporal elevado (p<0,0002), la no presencia de complicaciones quirúrgicas (p<0,01), el mayor balance articular en flexión a la semana del postoperatorio (p<0,004) y la menor media de días de movilización pasiva continua (p<0,02); pero en el análisis multivariable, los dos únicos factores determinantes del alta hospitalaria con correlación inversa, son la edad (p<0,001; IC 95 por ciento 1,86-2,06) y el balance articular en flexión a la semana del postoperatorio (p<0,01; IC 95 por ciento 1,92-1,99).Conclusiones: La edad y el balance articular en flexión a la primera semana son las dos únicas variables determinantes del alta hospitalaria (AU)

Prótesis total de rodilla. Valoración funcional y satisfacción personal del paciente a los cinco años / Total knee prosthesis. Funcrional assessment and personal satisfaction of the patient at five years

Objetivo: El objetivo de este estudio ha sido determinar el nivel funcional de los pacientes intervenidos de prótesis total de rodilla en nuestro medio a los cinco años de dicha intervención, valorando individualmente el dolor, la marcha, las actividades de la vida diaria y la satisfacción personal. Asimismo hemos intentado identificar las variables responsables o asociadas a una satisfacción personal mala o regular. Pacientes y métodos: Se ha realizado un estudio prospectivo que incluye 311 pacientes que fueron intervenidos de prótesis total de rodilla entre 1988 y 1993. Posteriormente fueron trasladados al Servicio de Rehabilitación para realizar tratamiento médico rehabilitador en régimen de hospitalización. Para la recogida de datos utilizamos el cuestionario modificado de la British Orthopaedic Association. La encuesta de valoración funcional y de satisfacción personal se realizó a los cinco años de la cirugía. Se ha realizado un análisis de regresión logística múltiple para identificar las variables responsables o asociadas a una satisfacción personal mala o regular. Resultados: La mayoría de pacientes portadores de la prótesis a los cinco años presentaron un buen resultado en cuanto a balance articular [extensión media -2,6º (ñ5,9) y flexión media 97,89º (ñ17)], dolor inexistente o ligero (88,5 por ciento), y perímetro de marcha de al menos un kilómetro (73,57 por ciento). La satisfacción personal fue excelente o buena en el 75,4 por ciento del total de pacientes. En el análisis multivariable sólo el dolor (OR=8,16; IC 95 por ciento=3,59-18,5) y las ayudas para la marcha (OR=2,52; IC 95 por ciento=1,41-4,49) son factores determinantes de tener una satisfacción personal regular o mala en los pacientes portadores de la prótesis a los cinco años (AU)