Orthogeriatric activity in a general hospital of Castilla-La Mancha, Spain. / Actividad ortogeriátrica en un hospital general de Castilla-La Mancha.

AIM: To describe the orthogeriatric activity in the elderly with hip fractures in the Hospital Mancha Centro, based on the recommendations of the main guidelines. MATERIAL AND METHOD: Observational prospective study, comprising all patients over 65 years of age admitted to the Traumatology Unit with a hip fracture between April 2015 and December 2015. Patients were admitted under the care of the Traumatology Unit with cross-consultation carried out with the Geriatrics Department, which then carried out a pre-operative geriatric assessment and the post-operative follow-ups. RESULTS: The mean pre-surgery waiting time was 48h and the overall time in hospital was 10.3±8.2 days. Patients who suffered from delirium (42.1%) did not improve as well, and were referred to nursing homes. Blood transfusions were received by 54.7% of the patients, despite 53.5% of them having received intravenous and/or oral iron after the surgery. Treatment with calcium and vitamin D was prescribed in 79% of the patients on discharge. The Rehabilitation Unit assessed 36% of the patients, with 4.8% fully, and 16.7% partially recovering their prior functional status. Upon discharge, 55% of the patients returned to their homes, and 22% were referred to short-term assisted living facilities. DISCUSSION: This article describes how the main clinical problems are handled in the elderly with hip fractures in our hospital, based on recommendations of the main guidelines and publications. CONCLUSIONS: Our hospital follows the recommended guidelines. Aspects for improvement include the management of anaemia during admission and rehabilitation.

MR imaging of the developing human brain. Part 2. Postnatal development.

In vivo magnetic resonance (MR) images of the brain in neonates and infants up to 24 months of age were retrospectively studied to evaluate normal maturation patterns in the brain. Sequential changes in myelination of various brain structures and development of the corpus callosum were noted. At birth and for the first 4-6 months of life, signal intensities of gray and white matter are the reverse of those seen in an adult brain, with the signal intensity of white matter being lower than that of gray matter on T1-weighted images and higher than that of gray matter on T2-weighted images. With advancing age, white matter shows a progressive increase in signal intensity on T1-weighted images. On T2-weighted images, high-signal-intensity unmyelinated white matter progressively changes to myelinated white matter of a signal intensity lower than that of gray matter. At birth, the corpus callosum is isointense relative to white matter and progressively increases in signal intensity, so that at age 8 months the corpus callosum has an appearance identical to that of an adult. Familiarity with the temporal sequence of normal myelination as seen with MR imaging is helpful in the diagnosis of pathologic processes involving white matter.

MR imaging of the developing human brain. Part 1. Prenatal development.

To establish a baseline of the magnetic resonance (MR) imaging appearance of the fetal brain in early stages of development, the authors undertook a study of fixed and fresh specimens of embryos and fetuses of 6-28 weeks gestational age. Images of formalin-preserved and fresh specimens were comparable in their depiction of anatomic structures. On MR images of embryos of 6 weeks gestational age, the rhombic and cervical flexures, aqueduct of Sylvius, diencephalon, cerebellum, cerebral hemisphere, and fourth ventricle could be differentiated. The optic recess and chiasm, pituitary gland, pineal recess, third ventricle, pons, olfactory lobe, corpus striatum, insula, and parietal and temporal lobes could be distinguished as early as 11 weeks gestation. Although MR imaging is impractical as a screening tool for intrauterine abnormalities, it can demonstrate the fetus in great detail and allows a more specific evaluation of fetal anatomy. With the information provided by MR imaging, it may be possible to establish guidelines for assessment of the stage of development during intrauterine life.