[Quality of life in patients undergoing mitral valve substitution]. / Qualità di vita in pazienti sottoposti ad intervento di sostituzione valvolare mitralica.

AIM: The aim of the present study was to evaluate the quality of life after mitral valve replacement through the analysis of behavioural, psychological, functional, economic and working changes, as well as alterations in social and sexual life after surgery. SETTING: The study was performed before and after surgery in a cardiological ward. POPULATION: The population studied included 206 patients undergoing mitral valve replacement surgery. Results were compared with a control population of patients suffering from mitral valve disease and receiving medical therapy. METHOD: All patients were asked by medical staff to compile a series of five self-evaluation questionnaires: General Well-Being Schedule, Physical Symptoms Distress Index B, Social Participation, Sexual Satisfaction Unified Test and Work Performance and Satisfaction. RESULTS: Our results showed a significant improvement in the perception of quality of life after mitral valve replacement. In particular, the state of general well-being improved significantly with a clear reduction in symptoms. This was accompanied by a reduction in sexual activity and no change in social life or working capacity. Data obtained in the group of patients operated showed a significant improvement in the perception of the quality of life and psycho-physical well-being compared to patients receiving medical treatment alone. CONCLUSIONS: From this study it can be seen that patients undergoing mitral valve replacement surgery experience a marked improvement in the quality of life compared to pre-operative conditions and to the group of patients receiving medical therapy for mitral valve diseases. The use of specific working and social rehabilitation programmes can certainly optimise the results also with regard to affective relations.

[Productivity before and after installing a computerized system in a clinical laboratory]. / Productividad antes y después de instalar un sistema de cómputo en un laboratorio clínico.

A laboratory information system was installed on January 1991 in the clinical laboratory of the Instituto Nacional de Cancerologia. Our main objective was to speed up the administrative work and integrate its operations under one management. We evaluated the productivity before (1990) and after installing the system (1992), using the parameters proposed by the College of American Pathologists. In 1990 there were 30,764 patients who underwent 191,070 laboratory studies, resulting in 131 tests/clerk/day and 21 patients/clerk/day. In 1992 these figures were 43,679 patients, 245,280 tests, 168 tests/clerk/day and 30 patients/clerk/day. The productivity indexes showed a 41% increase in the number of patients and of 28% in the number of tests. In addition, the laboratory personnel started activities in teaching and research which had been non existent before, i.e. in 1992 they started three research projects and participated in three national or international scientific meetings. In summary, no additional personnel was required even though there was an increase in the workload, basically due to a more efficient organization of the work when using a computerized system.

[Metachronous tumors of the breast. Mammographic findings]. / Tumori metacroni della mammella. Rilievi mammografici.

In breast carcinoma patients the risk to develop a second lesion in the contralateral breast is two to six times higher than in control subjects. The second lesion is called metachronous and classified among bilateral breast cancers. This kind of lesion affects the patients who were mastectomized for breast carcinoma; it may be a primary lesion, when the histologic type is different from that of the first breast cancer or secondary, when the histologic type is the same as that of the first tumor and the second lesion is therefore a metastasis. This study was made to assess the incidence of metachronous lesions and the average time between the first and the second tumor and to investigate the value of mammographic followup. We selected 375 patients who had undergone mastectomy for different histologic types of breast carcinoma and examined the contralateral breast with mammography 6 months after surgery and then every 12 months, January 1990 through January 1992. Mammography showed metachronous lesions in 23 cases: 15 infiltrating ductal carcinomas, 6 infiltrating lobular carcinomas and 2 in situ carcinomas, the latter with histologic confirmation in the patients operated on for benign breast lesions. The incidence of metachronous tumors was 6%, including both the primary and the metastatic lesions; the average time between the first and the second tumors was 20 months. Mammography allowed metachronous lesions to be diagnosed in a very early stage, much earlier than in other studies not including mammography. Prognosis is definitely improved by the early diagnosis of primary breast cancer, when no metastatic spread is present, and also in case of primary metachronous lesions, which are very uncommon.

En busca de la calidad en el Laboratorio de Patología Clínica / In search of quality in the Laboratory of Clinical Patology

Marco téorico: Calidad en la atención médica es otorgar el máximo beneficio con el menor riesgo y costo. Desde el punto de vista analítico, control de calidad en el estudio de las variaciones que son responsabilidad del laboratorio y el establecimiento de procedimientos para reconocerlos y minimizarlos. Objetivo: Evaluar el impacto del control de calidad analítico en el crecimiento de la productividad y eficiencia departamental a lo largo de 11 años (1982-1992). Tipo de estudio: prospectivo, longitudinal, descriptivo, comparativo y analítico en el que se observan: glucosa, urea, creatinina, ácido úrico, colesterol, bilirrubinas, protéinas y albúmina. Para medir la eficiencia y la productividad departamental se consideran indicadores por día hábil de trabajo. Resultados: precisión media en programa interno: (CV= 5.5 por ciento). Exactitud promedio en programa externo: (Rm = 0.91). Indice de variación media (IV = 98.5). El número de pacientes se incrementó en un 37 por ciento y el volumen de estudio creció en 394 por ciento. La eficiencia mejoró de 31.5 a 17.4 minutos/paciente/recepcionista mientras que en las áreas técnicas pasó de 20.6 a 10.3 minutos/estudio/técnico. Conclusión: La confiabilidad de los resultados es el factor más importante en el aumento en la demanda de los estudios. Los índices de productividad permiten evaluar las cargas de trabajo para asignar recursos que permitan mejorar la eficiencia

Living kidney transplantation between spouses: results in 100 cases.

The use of unrelated living donors in kidney transplantation is still controversial but many transplant centres have accepted this procedure. The main argument against this approach is usually an ethical one. Because of this, at our institution we accept biologically unrelated donors only if they have an emotional closeness to the recipient. From January 1983 to October 1993, out of 654 kidney transplantations we performed at our institution, 364 kidney allografts were from living donors. Of these living donors, 245 were first-degree relatives of the recipient (LRD) while 119 were unrelated (LURD); 100 cases were spouses--wife to husband in 76 cases and husband to wife in 24 cases. Statistical analysis of the results (chi-square) revealed actuarial patient and graft survival rates of 89.8% and 86.8% at 1 year, 82.9% and 72.3% at 5 years and 72.3% and 60.3% at 9 years, respectively. In our series, the result of living donor kidney transplantation in this group were similar to those obtained in the LRD group, while they were significantly better than those from cadaver donors (P = 0.003). In conclusion, cadaver organs given the shortage of kidney transplantation between spouses may be a good alternative and can be performed successfully, providing a "gift of life" for both the patient and the family.

Control de calida en la determinacion de gases sanguineos. / Quality control in the assay of blood gases

Respondiendo a la necesidad de un adecuado control de calidad para los gases sanguineos, nuestro programa consistio en la medicion de pH, PO2 y PCO2 de ampulas acuosas disponibles en tres niveles: acidosis, normal y alcalosis, en dos analizadores de gases sanguineos. Se presentan los resultados de precision en tablas que muestran la media, desviacion estandar y coeficientes de variacion para cada una de las variables. Asimismo se hace analisis de regresion linear y correlacion para cada uno de los electrodos, en busca de diferencias sistemicas entre los analizadores