Initial risk perception and feeling of preparedness of primary care physicians regarding the COVID-19 pandemic in Belgium, France and Spain in February 2020.

BACKGROUND: The knowledge of risk perceptions in primary care could help health authorities to manage epidemics. METHODS: A European multi-center cross-sectional study was conducted in France, Belgium and Spain to describe the perceptions, the level of anxiety and the feeling of preparedness of primary healthcare physicians towards the COVID-19 infection at the beginning of the pandemic. The factors associated with the feeling of preparedness were studied using multivariate logistic regressions. RESULTS: A total of 511 physicians participated to the study (response rate: 35.2%). Among them, only 16.3% (n=82) were highly anxious about the pandemic, 50.6% (n=254) had the feeling to have a high level of information, 80.5% (n=409) found the measures taken by the health authorities suitable to limit the spread of COVID-19, and 45.2% (n=229) felt prepared to face the epidemic. Factors associated with feeling prepared were: being a Spanish practitioner (adjusted OR=4.34; 95%CI [2.47; 7.80]), being a man (aOR=2.57, 95%CI [1.69; 3.96]), finding the measures taken by authorities appropriate (aOR=1.72, 95%CI [1.01; 3.00]) and being highly informed (aOR=4.82, 95%CI [2.62; 9.19]). CONCLUSIONS: Regarding the dramatic evolution of the pandemic in Europe in the weeks following the study, it appears that information available at this time and transmitted to the physicians could have given a wrong assessment of the spread and the severity of the disease. It seems essential to better integrate the primary care physicians into the information, training and protection channels. A comparison between countries could help to select the most effective measures in terms of information and communication.

[Validation of the SCORE index and SCORE for old people in the Castilla y Léon cardiovascular disease risk cohort]. / Validación del índice SCORE y el SCORE para personas mayores en la cohorte de riesgo de enfermedad cardiovascular en Castilla y León.

INTRODUCTION AND OBJECTIVES: The Systematic Coronary Risk Evaluation (SCORE) is the most extended index in Europe for overall cardiovascular risk assessment. This study aims to validate the calculated risk with the observed 10-year cardiovascular mortality in a population cohort aged 40 to 75 years. METHODS: In 2014 the SCORE and the SCORE OP (for older people) were calculated in a population aged 40 to 64 years-old and 65 to 75 years-old, respectively. In 2014 the 10-year mortality was estimated with the Kaplan-Meier estimator and survival model. Sensitivity, specificity, predictive values, risk ratio of a SCORE value≥5%, and the area under the curve (C statistic) were calculated. RESULTS: Cardiovascular mortality estimated by SCORE was 3 times higher than the observed mortality. The sensitivity of a SCORE≥5% was 20% in women and 28.6% in those less than 65 years old. Predictive positive values were also low, particularly in women with 0.6%. Neither women nor those aged less than 65 years had a significant C statistic. CONCLUSIONS: The SCORE index does not suitably reflect the cardiovascular mortality pattern in Castilla y León. The prediction models for morbidity and mortality need to be periodically updated in order to adjust the prevention and treatment protocols. The SCORE OP has better validity parameters than the SCORE calculated below that age.

Prevalence of cognitive impairment in Spain: The Gómez de Caso study in health sentinel networks. / Prevalencia de deterioro cognitivo en España. Estudio Gómez de Caso en redes centinelas sanitarias.

INTRODUCTION: Cognitive impairment, a clinical entity causing complete or partial intellectual dysfunction, is a major public health concern that poses a challenge for health and social services. The purpose of this study is to estimate the prevalence of this disorder in people aged 65 and older visiting the primary care physician in 5 health sentinel networks. METHOD: A sample of patients visiting their primary care doctor on 4 randomly selected days completed the Mini-Cog screening test. Diagnosis of cognitive impairment was confirmed with the Mini-Mental State Examination and the Alzheimer's Questionnaire. We estimated raw and adjusted rates using demographic and social variables. RESULTS: We included 4,624 patients from 5 autonomous communities and representing a population of 1,723,216 inhabitants. The adjusted prevalence rate was 18.5% (95% CI 17.3-19.7], with differences between sentinel networks. Women showed higher adjusted rates than men: 18.5 vs. 14.3%. The highest prevalence rate was observed in people aged 85 and older (45.3%); prevalence rates vary depending on education level and marital status. CONCLUSIONS: Cognitive impairment is a frequent reason for consultations in primary care. Its prevalence is higher in women and increases exponentially with age. A number of sensitive, validated tools have been proven useful in screening for and confirming cognitive impairment. Using these tools in primary care settings enables early treatment of these patients.

[Factors associated with control of hypertension in the cohort from the study of Cardiovascular Disease Risk in Castilla y León (RECCyL)]. / Factores asociados al control de la presión arterial en la cohorte del estudio del Riesgo de Enfermedad Cardiovascular en Castilla y León (RECCyL).

INTRODUCTION: Cardiovascular diseases and related risk factors suppose a challenge to public health due to the mortality and health costs involved. This study has aimed to assess the blood pressure control in a population cohort and to identify the factors associated with poor control. MATERIAL AND METHODS: A cardiovascular health examination was carried out in a random sample of 4013 individuals aged 15 years and above who were living in Castilla y Leon in 2004. The study included the medical history, physical exam and blood tests. A new health study was performed in 2009, including 2954 people from the initial sample, 1306 of whom were patients with hypertension. Strict blood pressure control was defined as <140/90 mm Hg. Bivariate analysis was performed and odds ratio was calculated by a regression logistic model. RESULTS: Blood pressure levels were above the established levels in 55.9%, without differences between men and women. The regression model showed that diabetes, obesity, smoking habit and previous systolic blood pressure values, with odds ratio of 3.87, 1.58, 1.49 and 1.13 per 5 mm Hg, respectively, are independently associated with uncontrolled blood pressure. Age did not show statistical significance. CONCLUSION: More than half of the patients with hypertension are not well controlled. This study provides information about the characteristics of the patients with poor control of hypertension in Castilla y León, which will allow policy makers to develop new primary and secondary prevention activities.

[Estimation of the prevalence of cerebral palsy in the Autonomous Community of Castilla y León (Spain) using a disabilities register]. / Estimación de la prevalencia de parálisis cerebral en la comunidad de Castilla y León mediante el registro de minusvalías.

INTRODUCTION: The prevalence of cerebral palsy in Western countries is estimated to be around 2 cases/1,000 inhabitants. The objective of this study was to estimate the prevalence of cerebral palsy in the Autonomous Community of Castilla y León and to assess potential differences among the nine provinces of this region. PATIENTS AND METHODS: The number of patients with CP in 1999, separated by provinces and by age groups, was obtained from the Community Sectorial Program for Persons with Disabilities. These data originally came from handicap evaluations carried out in each base center. Prevalences were calculated using population data from the National Institute of Statistics. RESULTS: A total of 335 patients aged 0-13 years were registered as having a diagnosis of cerebral palsy in 1999. The prevalence of cerebral palsy was 1.05 cases/1,000 inhabitants aged 0-13 years. Statistically significant differences were found in the prevalence of cerebral palsy among provinces (p < 0.0001). The highest prevalence was found in Salamanca, with 1.87 cases/1,000 inhabitants, while the lowest prevalence was found in Segovia, with 0.33 cases/ 1,000 inhabitants. CONCLUSIONS: The prevalence of cerebral palsy in childhood in Castilla y León was lower than that reported in western countries. Substantial differences were found among provinces. The prevalence of cerebral palsy is probably underreported in some provinces. These differences could be due to a disparity in diagnostic criteria, especially in young children.

Hábito tabáquico y diabetes mellitus / Smoking and diabetes mellitus

Introducción: El riesgo cardiovascular del individuo diabético se duplica en pacientes fumadores respecto a los no fumadores. Además, el tabaquismo aumenta el riesgo de aparición y deterioro de complicaciones microvasculares. El objetivo del estudio fue conocer la prevalencia del tabaquismo y algunas características del hábito de fumar en la población diabética de nuestro medio. Pacientes y métodos: Se incluyeron en el estudio 806 individuos diabéticos. Los pacientes se clasificaron en: diabetes tipo 1 (n= 70), tipo 2 (n= 674), gestacional (n= 36) y otras diabetes (n= 26). Además, se consideró el lugar de residencia de los pacientes (urbano/rural). En los pacientes que fumaban, se determinó el grado de dependencia al tabaco mediante el test de Fagerström. Resultados: Ciento diez pacientes (13,6%) fumaban, mientras que los 696 restantes (86,4%) no fumaban. Se encontraron diferencias significativas en el porcentaje de fumadores en el grupo de diabetes tipo 1 (38,6%) respecto a los grupos de tipo 2 (10,5%) y gestacional (11,1%). También se encontraron diferencias en el porcentaje de varones fumadores (24,1%) respecto al de mujeres fumadoras (6,8%), así como en el de fumadores que residían en área urbana (18,1%) respecto a los que vivían en el medio rural (11,6%). En el grupo de fumadores, un 33,3% tenía una alta dependencia del tabaco, mientras que el 48,5% presentaba una dependencia moderada y el 18,2% restante una baja dependencia. Conclusiones: Estos resultados demuestran que un porcentaje considerable de individuos diabéticos fuma, en especial en los grupos de diabetes mellitus tipo 1 y otras diabetes. El sexo masculino, junto con la residencia en área urbana, constituyen factores que predisponen al hábito de fumar. El hecho de que sólo uno de cada tres diabéticos fumadores tenga una alta dependencia a la nicotina sugiere que los programas encaminados a la deshabituación tabáquica podrían tener un notable éxito

Introduction: Cardiovascular risk in individuals with diabetes is two-fold higher among smokers as compared to non-smokers. Moreover, smoking increases the risk of the development and deterioration of microvascular complications. The aim of the present study was to determine the prevalence of cigarette smoking and several characteristics of the smoking habit among diabetics in our patient population. Patients and methods: Eight hundred and six diabetic subjects were included in the study. The patients were classified as: type 1 (n= 70), type 2 (n= 674), gestational (n= 36) and other variants (n= 26). Moreover, the place of residence of the patients (urbal/rural) was considered. In the group of smokers, the degree of nicotine dependence was determined by means of the Fagerström test. Results: One hundred and ten patients (13.6%) were smokers, while the remaining 696 (86.4%) were non-smokers. Significant differences were observed in the percentage of smokers among the patients with type 1 diabetes (38.6%) with respect to those with type 2 (10.5%) and gestational (11.1%) diabetes. Moreover, statistically significant differences were observed between the percentage of male smokers (24.1%) as compared to female smokers (6.8%) and between the percentage of urban smokers (18.1%) as compared to those living in rural areas (11.6%). Among the smokers, 33.3% had a strong dependence on nicotine, while 48.5% had a moderate dependence and the remaining 18.2% had a slight dependence. Conclusions: These results show that a substantial percentage of individuals with diabetes are smokers, especially in the group of patients with type 1 diabetes and other variants. Male sex and an urban setting are factors that predispose to the smoking habit. The finding that only a third of the diabetic smokers were strongly dependent on nicotine suggests that the programs focusing on smoking cessation could be highly successful

Estimación de la prevalencia de parálisis cerebral en la comunidad de Castilla y León mediante el registro de minusvalías / Estimation of the prevalence of cerebral palsy in the Autonomous Community of Castilla y León (Spain) using a disabilities register

Introducción La prevalencia de parálisis cerebral en países occidentales se estima en torno a 2 casos/1.000 habitantes. El objetivo de este estudio es estimar la prevalencia de parálisis cerebral en Castilla y León, y sus posibles diferencias entre las nueve provincias de la comunidad autónoma. Pacientes y métodos Se obtuvo el número de casos de parálisis cerebral en el año 1999, por provincia, y estratificados por grupos de edad, provenientes del Plan Regional Sectorial de Atención a las Personas con Discapacidad. Estos datos proceden originalmente de las evaluaciones para el reconocimiento de minusvalía realizadas en cada centro base correspondiente. Se calcularon las prevalencias con los datos de población provenientes del Instituto Nacional de Estadística. Resultados Existían 335 pacientes de 0 a 14 años registrados con diagnóstico de parálisis cerebral en el año 1999. La prevalencia de parálisis cerebral en ese grupo de edad fue de 1,05 casos/1.000 habitantes. Existen diferencias estadísticamente significativas en la cuantía de las prevalencias entre provincias (p < 0,0001). La que tenía mayor prevalencia fue Salamanca, con 1,87 casos/1.000 habitantes, mientras que Segovia, con 0,33, fue la de menor prevalencia registrada. Conclusiones La prevalencia en edad pediátrica de parálisis cerebral en Castilla y León, muestra una cifra inferior a las referidas en países occidentales. Existen importantes diferencias entre provincias. Es probable que los datos infravaloren la prevalencia de parálisis cerebral, en particular, en ciertas provincias. La disparidad de los criterios diagnósticos puede ser fuente de estas diferencias, sobre todo en edades tempranas

Introduction The prevalence of cerebral palsy in Western countries is estimated to be around 2 cases/1,000 inhabitants. The objective of this study was to estimate the prevalence of cerebral palsy in the Autonomous Community of Castilla y León and to assess potential differences among the nine provinces of this region. Patients and methods The number of patients with CP in 1999, separated by provinces and by age groups, was obtained from the Community Sectorial Program for Persons with Disabilities. These data originally came from handicap evaluations carried out in each base center. Prevalences were calculated using population data from the National Institute of Statistics. Results A total of 335 patients aged 0-13 years were registered as having a diagnosis of cerebral palsy in 1999. The prevalence of cerebral palsy was 1.05 cases/1,000 inhabitants aged 0-13 years. Statistically significant differences were found in the prevalence of cerebral palsy among provinces (p < 0.0001). The highest prevalence was found in Salamanca, with 1.87 cases/1,000 inhabitants, while the lowest prevalence was found in Segovia, with 0.33 cases/ 1,000 inhabitants. Conclusions The prevalence of cerebral palsy in childhood in Castilla y León was lower than that reported in western countries. Substantial differences were found among provinces. The prevalence of cerebral palsy is probably underreported in some provinces. These differences could be due to a disparity in diagnostic criteria, especially in young children

Deep-vein thrombosis in high-energy skeletal trauma despite thromboprophylaxis.

We report the incidence and location of deep-vein thrombosis in 312 patients who had sustained high-energy, skeletal trauma. They were investigated using magnetic resonance venography and Duplex ultrasound. Despite thromboprophylaxis, 36 (11.5%) developed venous thromboembolic disease with an incidence of 10% in those with non-pelvic trauma and 12.2% in the group with pelvic trauma. Of patients who developed deep-vein thrombosis, 13 of 27 in the pelvic group (48%) and only one of nine in the non-pelvic group (11%) had a definite pelvic deep-vein thrombosis. When compared with magnetic resonance venography, ultrasound had a false-negative rate of 77% in diagnosing pelvic deep-vein thrombosis. Its value in the pelvis was limited, although it was more accurate than magnetic resonance venography in diagnosing clots in the lower limbs. Additional screening may be needed to detect pelvic deep-vein thrombosis in patients with pelvic or acetabular fractures.

El archivo de ARCHIVOS: 2004 / The ARCHIVOS archive, 2004: an overview of research published in ARCHIVOS DE BRONCONEUMOLOGÍA

No disponible

Hiponatremia posquirúrgica / Postoperative hyponatremia

La hiponatremia posquirúrgica representa un problema frecuente en la práctica clínica diaria. A partir de nuestro caso particular, intentamos llamar la atención sobre la magnitud del problema, insistiendo especialmente en su fácil prevención, basada en el uso restringido de los sueros hipotónicos, y en la obligación de iniciar el tratamiento en cuanto se manifiestan los primeros síntomas (AU)

Fracture stabilization of proximal tibial fractures with the proximal tibial LISS: early experience in Birmingham, Alabama (USA).

This study is a prospective evaluation of the Less Invasive Stabilization System (LTSS) for the treatment of high-energy tibial plateau and proximal tibial fractures treated between November, 1998 and June, 2000. Thirty-two patients sustained thirty-five acute fractures of the tibial plateau (25) or proximal tibia (10). These patients were injured primarily in blunt trauma accidents, with eighteen having multiple fractures, fifteen having ipsilateral extremity fractures, and eleven having major knee ligament injuries. Seventeen patients had open fractures. Thirty-four patients healed their fractures, with one developing a nonunion. Two patients developed infections, both following Type III open fractures. Final range of motion averaged 2 to 116 degrees. Alignment was well maintained, with no patient losing the alignment that was obtained in the operating room. The tibial LISS system worked well at stabilizing difficult fractures of the tibial plateau and proximal tibia with a low incidence of complications in this preliminary study with short-term follow-up.

Elastic and viscoelastic properties of the human pubic symphysis joint: effects of lateral impact joint loading.

The human pelvis is susceptible to severe injury in vehicle side impacts owing to its close proximity to the intruding door and unnatural loading through the greater trochanter. Whereas fractures of the pelvic bones are diagnosed with routine radiographs (x-rays) and computerized tomography (CT scans), non-displaced damage to the soft tissues of pubic symphysis joints may go undetected. If present, trauma-induced joint laxity may cause pelvic instability, which has been associated with pelvic pain in non-traumatic cases. In this study, mechanical properties of cadaveric pubic symphysis joints from twelve normal and eight laterally impacted pelves were compared. Axial stiffness and creep responses of these isolated symphyses were measured in tension and compression (perpendicular to the joint). Bending stiffness was determined in four primary directions followed by a tension-to-failure test. Loading rate and direction correlated significantly (p<0.05) with stiffness and tensile strength of the unimpacted joints, more so than donor age or gender. The impacted joints had significantly lower stiffness in tension (p <0.04), compression (p<0.003), and posterior bending (p<0.03), and more creep under a compressive step load (p<0.008) than the unimpacted specimens. Tensile strength was reduced following impact, however, not significantly. We concluded that the symphysis joints from the impacted pelves had greater laxity, which may correlate with post-traumatic pelvic pain in some motor vehicle crash occupants.

Mechanical prophylaxis against deep-vein thrombosis after pelvic and acetabular fractures.

BACKGROUND: Deep-vein thrombosis is a common complication following pelvic and acetabular fractures. The hypothesis of this study was that pulsatile mechanical compression is superior to standard sequential mechanical compression for decreasing the prevalence of deep-vein thrombosis in patients with pelvic or acetabular fracture. METHODS: A prospective, randomized, blinded study of two methods of mechanical prophylaxis against deep-vein thrombosis was conducted. One hundred and seven patients were randomized into either Group A (fifty-four patients), in which a thigh-calf low-pressure sequential-compression device was used, or Group B (fifty-three patients), in which a calf-foot high-pressure pulsatile-compression pump was used. All patients underwent duplex ultrasonography and magnetic resonance venography. The two groups were comparable with regard to demographics, fracture type, fracture treatment, time from the injury to the prophylaxis, and patient compliance. RESULTS: Deep-vein thrombosis developed in ten patients (19%) in Group A, with seven (13%) having a large or occlusive clot and one (2%) having a documented pulmonary embolism. Deep-vein thrombosis developed in five patients (9%) in Group B, with two (4%) having a large or occlusive clot and none having a documented pulmonary embolism. Nine of the nineteen detected thromboses were in the deep pelvic veins. The difference in the prevalence of large or occlusive clots between the two groups demonstrated a trend but, with the numbers available, was not significant (p = 0.16). Increased patient age and the time elapsed from the injury to the surgery were found to be associated with higher rates of thrombosis. CONCLUSIONS: Pulsatile compression was associated with fewer deep-vein thromboses than was standard compression, with the difference representing a trend but not reaching significance with the number of patients studied.

Estudio clinicoepidemiológico de la bronquiolitis aguda / Clinicalepidemiological study of acute bronchiolitisobjective

OBJETIVO: Conocer la incidencia de hospitalización por bronquiolitis en nuestro medio, analizar las malformaciones neonatales graves como factor de riesgo de ingreso por bronquiolitis y establecer las variables disponibles en el momento del ingreso por bronquiolitis que se asocian a una peor evolución. PACIENTES Y MÉTODOS: Estudio de incidencia de ingreso por bronquiolitis en población general y en niños con malformaciones neonatales graves. Estudio descriptivo y analítico sobre las características clínicas disponibles en el ingreso por bronquiolitis que predicen una peor evolución, sobre 61niños nacidos en el Hospital de Medina del Campo. Todos cumplían los criterios de McConnochie y se clasificaron según la evolución en leve, moderado o grave. RESULTADOS: La incidencia acumulada anual de ingreso por bronquiolitis fue de 1,79 por ciento (intervalo de confianza [IC] del 95 por ciento, 1,37-2,30). La incidencia de hospitalización fue significativamente mayor en los niños con antecedentes de malformaciones neonatales graves (13,11 por ciento) que en los sanos (1,59 por ciento) (RR, 8,26; IC 95 por ciento, 4,10-16,02). La edad fue significativamente menor (p = 0,0056) en el grupo grave (mediana, 1,0; cuartiles, 1,0-2,75) que en los grupos moderado (mediana, 5,0; cuartiles, 2,0-8,0) y leve (mediana, 5,5; cuartiles, 3,25-9,0). Tomando como referencia la evolución leve se relacionaron con una evolución moderada-grave el rechazo de tomas (OR, 4,08; IC 95 por ciento, 1,10-16,80), los vómitos (OR, 4,22; IC 95 por ciento, 1,14-25,30) y la espiración alargada (OR, 5,35; IC 95 por ciento, 1,14-24,30). Tomando como referencia el grupo leve-moderado se relacionaron con evolución grave la presencia de vómitos (p = 0,004), los crepitantes (p = 0,002), la disminución de ventilación (p < 0,001) y la condensación radiológica (p = 0,017). CONCLUSIÓN: La incidencia de ingreso por bronquiolitis se situó en cifras similares a las de otros países. Las variables que presentes en el momento del ingreso se asociaron a una peor evolución fueron: edad inferior a 3meses, vómitos, rechazo de tomas, espiración alargada, crepitantes, disminución de ventilación y condensación radiológica. Las malformaciones neonatales graves son un importante factor de riesgo para requerir ingreso por bronquiolitis (AU)

A review of the treatment of hip dislocations associated with acetabular fractures.

Traumatic dislocation of the hip is an extremely severe injury. Although previously considered an uncommon lesion, it now is seen more often as a result of motor vehicle accidents. In most cases, dislocation of the hip is associated with fractures of the acetabulum, which ultimately can result in a higher incidence of complications than the complications observed in pure simple dislocations. Early recognition and prompt closed reduction of the dislocated hip constitute the cornerstone of proper treatment of this injury. Once the dislocation is reduced, definitive treatment of the acetabular fracture can be delayed to obtain a precise diagnostic evaluation. If surgical reconstruction of the acetabular fracture is indicated, it is done best in the first 10 days after the injury. A few patients in whom nonconcentric reduction, failed closed reduction, or impaired neurologic status occurs after reduction will require early open reduction and internal fixation of the fracture. Complications can be caused by the initial injury or by the treatment. Avascular necrosis of the femoral head, degenerative osteoarthritis, and heterotopic ossification are the main complications encountered in patients with unsatisfactory final results. Despite a perfect reduction of the hip dislocation and anatomic reduction of the acetabular fracture, a significant degenerative process of the hip is expected when the patient is assessed at long-term followup.

Functional outcome of patients with femoral head fractures associated with hip dislocations.

Fracture of the femoral head after hip dislocation is a relatively rare injury often associated with a poor functional outcome. Twenty-six patients who sustained femoral head fractures were evaluated using radiographs, clinical examinations, and a validated outcome scoring system. The Short Form-12 was used to assess functional outcome. Patients whose fractures were stabilized with 3-mm cannulated screws and washers had a poor functional outcome. When evaluated with an odds ratio analysis, the use of Kocher-Langenbeck posterior approach was associated with a 3.2 times higher incidence of the patients having avascular necrosis develop when compared with the Smith-Petersen approach. A literature review combined with the current series confirms that the principles of early reduction of hip dislocation, early stabilization, anatomic reduction of the fracture, and rigid fixation are critical principles to attain good results. The Brumback classification system provides superior differentiation of different fracture types when compared with the Pipkin classification. The Smith-Petersen anterior surgical approach is recommended for the majority of patients with femoral head fractures. Three-millimeter cannulated screws with threaded washers are contraindicated for use in stabilizing femoral head fractures, and should not be used in any joint because of dissociation between the screw and the washer.

A prospective evaluation of the timing of postoperative radiotherapy for preventing heterotopic ossification following traumatic acetabular fractures.

PURPOSE: Preoperative and immediate postoperative irradiation of traumatic acetabular fractures (TAF), although known to reduce heterotopic ossification (HO), can cause significant organizational and logistic difficulties. We sought to determine an acceptable time interval between surgery and radiation without compromising control, as well as to update our large experience and to further validate our treatment philosophy. METHODS AND MATERIALS: Beginning in June 1995, we began a prospective study, irradiating 152 patients on postoperative days 1, 2, or 3. There were also 17 patients delayed further secondary to medical difficulties. RESULTS: All patients treated since June 1995 received 700 cGy/1 fx. Fifty-eight patients received radiation within 24 hours of surgery, 41 within 2 days, 53 within 3 days, 13 within 4 days, and 4 were delayed further. Delaying irradiation for up to 4 days postoperatively caused no statistical increase in HO (p = 0.625). Of 263 patients in our retrospective cohort, HO occurred in 5.3% of patients who received irradiation versus 60% of patients who did not. CONCLUSION: In our prospective study, we noted no perceptible increase in HO with up to a 3-day interval between surgery and radiotherapy. This allows a more structured treatment schedule and allows the patient more time to heal and recover. Updated results from our overall series continue to demonstrate that adjuvant radiation decreases the incidence and severity of HO after TAF.

[Ischemic heart disease risk in the west Valladolid health area]. / Riesgo de enfermedad isquémica del corazón en el área de salud de Valladolid oeste.

INTRODUCTION AND OBJECTIVES: Cardiovascular diseases, especially ischemic heart disease present a high morbidity and mortality rate in our country. The aim of this study is to estimate the average coronary risk of people living in the west Valladolid Health District. METHODS: Cross-sectional study in a random sample of 369 people between 35 and 64 years of age from the general population, of systolic blood pressure, total serum cholesterol and cigarette smoking. With these three factors, plus sex and age, individual coronary risk was calculated through the Dundee Coronary Risk-Disk method. RESULTS: The coronary risk in the studied district, which is to say the individual probability of suffering a coronary event within five years of life, was estimated in 5.22 (95% CL: 4.75-5.69), higher among men, 5.66 (95% CL: 4.95-6.36), than among women, 4.63 (95% CL: 4.15-5.11). A descendent trend in coronary risk as age increases was found. CONCLUSIONS: This method is relatively easy to obtain for community studies and simple to use for individual risk. The coronary risk of a person from the studied population has similar levels to figures found in other studies from our settings. The community levels of isolated coronary risk factors do not permit the establishment the best option in coronary risk control, and only a multicausal approach will allow us to evaluate the most efficient interventions for each age group and sex.

Acetabular fracture patterns: associations with motor vehicle crash information.

BACKGROUND: Motor vehicle crashes are the most common cause of acetabular fractures, which have been associated with significant morbidity and mortality. METHODS: To date, medical and collision information has been collected on 83 acetabular fracture patients treated at the University of Alabama at Birmingham's Level I trauma center. The fractures were grouped according to the Judet-Letournel classification scheme and investigated for correlation with age, sex, vehicle type, impact direction, and seat-belt use. RESULTS: The database included 41 women and 42 men with a combined average age of 32.8 years. Femoral shaft axis loading fractures correlated significantly with male sex, trucks, and frontal impacts. Greater trochanter loading fractures occurred statistically more frequently in side impacts. Women received a significant higher percentage of off-axis loading fractures, which were associated more in angled frontal impacts. CONCLUSION: Acetabular fracture type strongly correlated with impact direction, supporting the fracture mechanisms proposed by Judet and Letournel.

Controversies in acetabular fractures.

Open reduction and internal fixation has become the standard of care for the treatment of most displaced acetabular fractures. As surgical techniques have become refined, long term results of surgical fixation have improved. During the past 10 to 15 years, several controversies have surfaced in the orthopaedic literature regarding the treatment of acetabular fractures. The recent literature regarding acetabular fixation was reviewed. Controversies include the most efficacious surgical approach for complex acetabular fractures; the effectiveness of intraoperative sciatic nerve monitoring; the most effective method of prophylaxis against deep vein thrombosis; and the indications for and method of prophylaxis against heterotopic bone formation.