Nonsurgical Procedures for Keratoconus Management.

OBJECTIVES: To describe the past 20 years' correction modalities for keratoconus and their visual outcomes and possible complications. METHODS: A review of the published literature related to the visual outcomes and possible complications in the context of keratoconus management using nonsurgical procedures for the last 20 years (glasses and contact lenses) was performed. Original articles that reported the outcome of any correction modalities of keratoconus management were reviewed. RESULTS: The most nonsurgical procedure used on keratoconus management is the contact lens fitting. Soft contact lenses and soft toric contact lenses, rigid gas-permeable contact lenses, piggyback contact lens system, hybrid contact lenses, and scleral and corneoscleral contact lenses form the contemporary range of available lens types for keratoconus management with contact lenses. All of them try to restore the vision, improve the quality of life, and delay surgical procedures in patients with this disease. Complications are derived from the intolerance of using contact lens, and the use of each depends on keratoconus severity. CONCLUSIONS: In the context of nonsurgical procedures, the use of contact lenses for the management of keratoconic patients represents a good alternative to restore vision and improve the quality of live in this population.

Epidemiological usefulness of population-based electronic clinical records in primary care: estimation of the prevalence of chronic diseases.

BACKGROUND: Chronic health problems are the main cause of disease, disability and death in developed countries, and their prevalence is increasing. OBJECTIVE: To estimate the prevalence of selected chronic illnesses based on electronic clinical records in primary care (ECRPC) and to assess its usefulness for epidemiological research, by comparing ECRPC data against those reported by a contemporary health survey. DESIGN: Descriptive cross-sectional study. SETTING: All primary care medical consultations in the Madrid Regional Public Health System (PHS). SUBJECTS: A total of 23 535 182 ECRPC-registered episodes of illness, generated by PHS patients over 15 years of age seeking medical care during 2005-06. MAIN OUTCOME MEASURES: Prevalences of chronic diseases estimated on the basis of medically examined cases registered in ECRPC and morbidity as reported by a contemporary health survey covering the same geographic area. RESULTS: A total of 52.5% of the adult population had some chronic health problem. The highest overall prevalences were hypertension (14.8%), mental disorders (12.0%) and allergy (11.6%). Prevalences were generally highest among women, elderly and the native population. Depending on the specific disease, ECRPC-based prevalences were similar to (e.g. diabetes), higher (e.g. chronic skin problems) or lower (e.g. asthma and dyslipidaemia) than those reported by surveys, with certain age- and sex-related variations. CONCLUSIONS: Prevalences estimated from ECRPC and survey data present variations depending on the disease, age and sex. Both data sources provide complementary information about chronic disease prevalence. ECRPC have the advantage of generating an ongoing standardized register and entailing no additional effort for health professionals.

Diarrea crónica y colitis microscópica: ¿una asociación frecuente en medicina geriátrica? / Chronic diarrhoea and microscopic colitis: a frequent association in geriatric medicine?

La diarrea es un problema clínico frecuente que puede ser expresión de enfermedades sistémicas, intestinales o bien estar en relación con formas de colitis de descripción relativamente reciente que pueden plantear dificultades de diagnóstico diferencial, por lo que se debe estar preparado para reconocerlas. En este sentido, la colitis microscópica es una causa no excesivamente infrecuente de diarrea crónica en el paciente geriátrico con colonoscopia normal y que requiere biopsias colónicas para llegar al diagnóstico. Esta entidad tiene dos subtipos, colitis colágena y linfocítica, según la presencia o ausencia de una banda colágena subepitelial engrosada, y que posiblemente correspondan a variantes de la misma enfermedad, con una clínica similar en ambas. Aunque un escaso porcentaje de pacientes presenta remisión espontánea, la evolución es por lo habitual intermitente y destaca que, a pesar del escaso número de ensayos terapéuticos controlados, dispone de un tratamiento eficaz para el control sintomático. (AU)

[Outpatient care of patients with Parkinson disease]. / Asistencia extrahospitalaria a pacientes con enfermedad de Parkinson.

INTRODUCTION: Some neurology clinics have been set up in specialist centres during the last ten years and their activities described. The group of patients with Parkinson's disease attended in the clinics of specialist centres have the distinguishing feature of where they are treated, which makes them different to other groups with the same disorder. OBJECTIVE: In this article we describe the general data of neurological attention for patients with Parkinson's disease, seen in two clinics belonging to specialist centres. PATIENTS AND METHODS: This article is based on records of patients made by neurologists of two structured centres in Hospital La Fe. RESULTS: In a period of 18 months 228 patients with Parkinson's disease were recorded out of a total case register of 5,101. Patients with Parkinson's disease made up between 4% and 5% of the patients attending the clinic. Between 30% and 50% of the patients seen in these clinics were evaluated only once during the period recorded. CONCLUSIONS: There seems to be a large number of cases recorded and these represent 70% of the estimated number of cases in the area. It seems that some patients do not keep in contact with the neurologist. Differences in function noted in clinics of specialist centres, between each other and compared with hospitals, are due to specific organizations and structures.

Physicochemical properties of calcium phosphate coatings produced by pulsed laser deposition at different water vapour pressures.

Calcium phosphate coatings were produced by pulsed laser deposition from targets of non-stoichiometric hydroxyapatite (Ca/P = 1.70) at a substrate temperature of 485 degrees C and different processing pressures of water vapour: 0.15, 0.30, 0.45, 0.60 and 0.80 mbar. The physicochemical properties of these coatings were studied using Fourier-transform IR spectroscopy (FT-IR) and energy dispersive X-ray analysis (EDX). A minimum pressure of water vapour was necessary in order to obtain a crystalline coating, as deduced from the FT-IR spectroscopy of these coatings. This analysis also revealed that when the deposition pressure of water vapour was further increased, the coatings were less crystalline and the content of hydroxyl groups, the carbonate substitution for phosphate, and the Ca/P ratio, as measured by EDX, were lower. These effects can be explained by a combined substitution of carbonate and HPO4(2-) for phosphate, being predominant the carbonate substitution at low pressures and the HPO4(2-) substitution at high pressures.

Hydroxyapatite coatings: a comparative study between plasma-spray and pulsed laser deposition techniques.

A comparative study between hydroxyapatite coatings produced by two different techniques, plasma spray (PS) and pulsed-laser deposition (PLD) was carried out. Plasma spray is currently commercially used for coating dental and orthopaedical implant devices, and pulsed-laser deposition (or laser-ablation deposition) gave good results in the field of high critical temperature superconductive thin films, and is being applied to produce calcium phosphate coatings for biomedical purposes. X-ray diffraction was used to control the crystallinity of the coatings, scanning electron microscopy for the surface and cross-sectional morphology, and the pull test to determine the tensile strength of the coatings. This study reveals that the pulsed-laser deposition technique appears to be a very good candidate to replace the plasma spray in many biomedical applications, because it overcomes most of the drawbacks of the plasma spray.

Structural analysis of calcium phosphate coatings produced by pulsed laser deposition at different water-vapour pressures.

Calcium phosphate coatings have been produced by pulsed laser deposition (PLD) at different water-vapour pressures. Rietveld refinement of X-ray diffraction (XRD) data allows us to determine that the structure of these coatings is apatitic with carbonate substitution for phosphate. The carbonate substitution decreases when the chamber pressure is raised, a fact that has been corroborated by Fourier transform-infrared (FT-IR) spectroscopy. Carbonate concentrations between 5 and 17 wt% have been calculated for the crystalline samples. Amorphous coatings are produced at the lowest and highest pressures due to the high carbonate concentration in the first case, and possibly to another type of substitution (Mg(2+), HPO(2-)4, P2O(4-)7) or the inherent kinetics of the PLD process, in the second case.

[New forms of Parkinsonism in hospice care]. / Parkinsonismos de novo en ámbito extrahospitalario.

Parkinson's disease is a well known phenomenon with characteristic evolution and clinical picture although having considerable variation in its presenting symptoms. From an extra-hospital consulting room we carried out a study of the characteristics of the clinical presentation of parkinsonisms in a series of one hundred cases so diagnosed from onset. The average age of the patients was around 66 years with a slight female predominance. Most patients had been referred to us by their own GPs. Some 70% of patients came suffering from shaking, 23% for slowness or clumsiness and 10% for unsteadiness. 71% of cases had unilateral onset and 29% had bilateral onset. Most of the patients we saw arrived at level 2 on the Hoehn and Yahr scale. The duration of the symptoms was approximately one year. In some 27% of cases drug consumption might have brought on parkinsonism. Almost two-thirds of these cases brought about by medicaments were being treated with cinaricine or flunaricine and nearly one third were undergoing neuroleptic treatment. Practically one out of every four cases, and one out of three women, could be considered as having iatrogenic parkinsonism. The onset of shaking with bilateral affectation is particularly suggestive of drug induced parkinsonism.

[Internal jugular vein catheterization performed by resident and staff physicians]. / Cateterización de la vena yugular interna realizada por médicos residentes y adjuntos.

OBJECTIVES: To analyse complications in the catheterization of the internal jugular vein using the Boulanger technique and to establish a rating of difficulty and risk when the procedure is carried out by physicians in training. MATERIAL AND METHODS: This was a prospective study of 296 internal jugular vein (IJV) catheterizations by the Boulanger technique carried out by physicians in training (group R2 and group R3-4) or by departmental staff physicians (group staff). Time taken for venous catheterization, rate of success and complications were recorded for each physician performing the procedure. RESULTS: The complication most often observed (11.4%) was puncture of the carotid artery (14.3% group R2, 10% group R3-4 and 8.2% staff), followed by arrhythmia upon insertion of the metal guide (1.6%). There were no instances of pneumothorax or hemothorax, nor any other of the early complications considered infrequent. Success ranged from 68.8% for group R2 to 85.7% for staff. Mean time used in group R2 was 238.7 seconds, while for staff it was 118.3 seconds. CONCLUSION: We suggest that the Boulanger technique for catheterization of the internal jugular vein is a good one and is not particularly hazardous when performed by resident physicians in training.

[Rapid diagnosis of streptococcal pharyngo-tonsillitis in a primary care unit]. / Diagnóstico rápido de faringoamigdalitis estreptocócica en un equipo de atención primaria.

One of the main consulting motives in ambulatory pediatric practice is acute pharyngotonsillitis. This work values the efficacy of a test to confirm rapid diagnosis (30 minutes) of streptococcal pharyngitis. Authors selected 100 children in a office of primary health care whose ages were between two and seven years, from February to July in 1986. They have considered classical clinical symptoms of pharyngitis and have applied a throat culture and rapid test in all. After comparing test results and culture results, obtained sensibility and specificity have been 80% and 95% (p less than 0.01) respectively. According to these results, they believe on the necessity of a test that permits a rapid diagnosis and which enables to treat acute pharyngitis in a more suitable way in ambulatory pediatrics.