[The cost of cerebrovascular accident]. / Coste de la enfermedad cerebrovascular aguda.

INTRODUCTION AND AIM: One out of three persons will die of cerebrovascular accident (CVA), another one will be disabled, and the third one will recover. This research has been taken to estimate the costs of CVA in the Basque Country. MATERIALS AND METHODS: The cost of illness is studied from a societal perspective. It is based on the prevalence of the disease. Population costs has been estimated from the use of resources of a randomized sample of patients admitted to hospital with stroke during the year 2000, and followed for 12 months. Transitions costs (those that happen just once) and state costs (those remaining in patients lifetime) have been studied separately. RESULTS: The prevalence of CVA was 1.780 x 10(5). Average transition cost per patient was 4,762 euros and average state cost for patient/year was 10,506 euros. The estimated cost for the Basque Country is 120,249,986 euros in the year 2000. Transition costs were 16,460,729 euros and state costs 103,789,257 euros in the same year. State costs were due to disability. CONCLUSIONS: The analysis of the costs of CVA from a societal perspective gets us to the heart of illness causing disability, the social costs of CVA are 74.3% of the total cost.

Coste de la enfermedad cerebrovascular aguda / The cost of cerebrovascular accident

Introducción y objetivo. Una de cada tres personas habrá muerto al año de padecer una enfermedad cerebrovascular aguda (ECVA), otra presentará algún grado de dependencia y la tercera estará completamente recuperada. Este trabajo se ha realizado para conocer el coste de la ECVA en el País Vasco. Pacientes y métodos. Realizamos un análisis del coste de la enfermedad desde la perspectiva de la sociedad, en base a la prevalencia. Los costes poblacionales se han estimado a partir de los consumos de una muestra aleatoria de pacientes ingresados por ECVA el año 2000 y seguidos durante 12 meses tras el alta. Se han diferenciado costes de transición, que ocurren una única vez, y costes de estado, que permanecerán el resto de la vida del paciente. Resultados. La prevalencia de la ECVA el año 2000 fue de 1.780 × 10 5 . El coste medio de transición por paciente alcanzó los 4.762 € , y el de estado, 10.506 € /paciente/año. El coste estimado en un año para el País Vasco fue de 120.249.986 €. Los costes de transición supusieron 16.460.729 € y los de estado 103.789.257 € . Estos últimos fueron producidos casi en su totalidad por la atención a las personas dependientes. Conclusiones. El análisis del coste de la ECVA desde una perspectiva del conjunto de la sociedad nos sitúa en el núcleo de la discusión sobre las enfermedades generadoras de dependencia: los costes sociales de esta enfermedad representan el 74,3% del total

Introduction and aim. One out of three persons will die of cerebrovascular accident (CVA), another one will be disabled, and the third one will recover. This research has been taken to estimate the costs of CVA in the Basque Country. Materials and methods. The cost of illness is studied from a societal perspective. It is based on the prevalence of the disease. Population costs has been estimated from the use of resources of a randomized sample of patients admitted to hospital with stroke during the year 2000, and followed for 12 months. Transitions costs (those that happen just once) and state costs (those remaining in patients lifetime) have been studied separately. Results. The prevalence of CVA was 1.780 × 10 5 . Average transition cost per patient was 4,762 € and average state cost for patient/year was 10,506 € . The estimated cost for the Basque Country is 120,249,986 € in the year 2000. Transition costs were 16,460,729 € and state costs 103,789,257 € in the same year. State costs were due to disability. Conclusions. The analysis of the costs of CVA from a societal perspective gets us to the heart of illness causing disability, the social costs of CVA are 74,3% of the total cost

[Hospital care of cerebrovascular accident and the state of patients 12 months after]. / Atención hospitalaria a la enfermedad cerebrovascular aguda y situación de los pacientes a los 12 meses.

OBJECTIVES: Cerebrovascular accident should be of key importance due to its magnitude in terms of mortality and disability. In this study we describe hospital care of patients and follow them one year after. The aims is to uncover areas of improvement in the care of patients. PATIENTS AND METHODS: Observational study of a randomized sample of 535 patient with a diagnosis of cerebrovascular disease, during de acute phase and 12 months after, using clinical records and telephone interview. RESULTS: Thirty five percent of patients arrived within 6 hours of the occurrence of the event. Thirty six percent had a CAT/MNR within 6 hours. Mortality at hospital was 13.8% increasing up to 26% at 12 months. At discharge 49% had a neurological deficiency. At 12 months 35.8% of the survivors interviewed showed a Barthel Index of less than 95 points. CONCLUSIONS: Organizational measures that guarantee a quick and systematic assessment of brain lesions, early diagnosis and active therapeutic offer, have to be implemented. In the sample studied, only 3% of the patient were candidates to thrombolytic therapy. Rehabilitation can and should play a more relevant role in the prevention of sequelae.

Atención hospitalaria a la enfermedad cerebrovascular aguda y situación de los pacientes a los 12 meses / Hospital care of cerebrovascular accident and the state of patients 12 months after

Objetivos. La enfermedad cerebrovascular aguda (ECVA) constituye una prioridad sanitaria por su impacto en términos de mortalidad y dependencia. En este trabajo describimos la atención hospitalaria a la ECVA y la situación de los pacientes al año, con el objetivo de detectar áreas de mejora en el abordaje de esta enfermedad. Pacientes y métodos. Estudio de observación de la fase aguda de la enfermedad y control clínico a los 12 meses, en una muestra aleatoria de pacientes, a través de la revisión de historias clínicas y de entrevista telefónica. Resultados. De los 535 pacientes, el 34,6% llegó al hospital en menos de seis horas desde el inicio de síntomas. En el 35,7% se realizó una TAC/RM en menos de seis horas. La mortalidad intrahospitalaria fue del 13,8% y aumentó al 26,0% al año. Al alta, el 49,0% presentó alguna secuela neurológica. A los 12 meses, el 35,8% de los supervivientes entrevistados presentaba un índice de Barthel inferior a 95 puntos. Conclusiones. No se pueden demorar medidas organizativas que garanticen una valoración rápida y sistematizada del daño cerebral, un diagnóstico temprano y una oferta terapéutica activa. En esta muestra solamente el 3% de los pacientes hubiese sido candidato a beneficiarse del tratamiento trombolítico. El tratamiento rehabilitador puede y debe desempeñar un papel más relevante en la prevención de secuelas invalidantes

Objectives. Cerebrovascular accident should be of key importance due to its magnitude in terms of mortality and disabilty. In this study we describe hospital care of patients and follow them one year after. The aims is to uncover areas of improvement in the care of patients. Patients and methods. Observational study of a ramdomized sample of 535 patient with a diagnosis of cerebrovascular disease, during de acute phase and 12 months after, using clinical records and telephone interview. Results. Thirty five percent of patients arrived within 6 hours of the occurrence of the event. Thirty six percent had a CAT/MNR withim 6 hours. Mortality at hospital whas 13,8% increasing up to 26% at 12 months. At discharge 49% had a neurological deficiency. At 12 months 35,8% of the survivors interviewed showed a Barthel Index of less than 95 points. Conclusions. Organizational mesures that guarantee a quick and systematic assessment of brain lesions, early diagnosis and active therapeutic offer, have to be implemented. In the sample studied, only 3% of the patient were candidates to thrombolytic therapy. Rehabilitation can and should play a more relevant role in the prevention of sequelae

Técnica de Krogius-Lecène en el tratamiento de la luxación habitual de rótula. Resultados a largo plazo / Krogius-Lecène technique in the treatment of recurrent patellar dislocation. Long-term results

Objetivo. La luxación habitual de rótula se trata de una patología en la que se produce una luxación de la misma cada vez que el paciente realiza una flexión de la rodilla, volviendo a su posición correcta en el surco intercondíleo con la rodilla en extensión. El tratamiento debe ir encaminado al recentraje rotuliano, y es importante realizarlo de forma precoz, para evitar daños irreparables producidos por las constantes luxaciones y choques de los cóndilos con el cartílago rotuliano. Cuando esta patología se produce en pacientes en los que el cartílago de crecimiento se encuentra todavía activo, la cirugía ósea no se puede llevar a cabo. El objeto del trabajo es valorar en este grupo de pacientes la cirugía de realineamiento rotuliano actuando exclusivamente sobre partes blandas. Material y método. Estudiamos la evolución de las rodillas de 11 pacientes (14 rodillas) afectos de luxación habitual de rótula antes de la madurez esquelética en los que se realizó realineamiento rotuliano mediante la técnica Krogius-Lecène. Resultados. El seguimiento medio de estos pacientes fue de 21,9 años, período tras el cual los resultados clínicos obtenidos fueron excelentes en 10 rodillas, buenos en tres y regulares en una. En ningún caso la rodilla volvió a sufrir episodios de luxación. Conclusión. La técnica de Krogius-Lecène para el tratamiento de la luxación habitual de rótula es un método que consigue buenos resultados a largo plazo en pacientes con el cartílago de crecimiento activo (AU)

Frozen cancellous bone allografts: positive cultures of implanted grafts in posterior fusions of the spine.

We have carried out a study on the behaviour pattern of implanted allografts initially stored in perfect conditions (aseptically processed, culture-negative and stored at -80 degrees C) but which presented positive cultures at the implantation stage. There is no information available on how to deal with this type of situation, so our aim was to set guidelines on the course of action which would be required in such a case. This was a retrospective study of 112 patients who underwent a spinal arthrodesis and in whom a total of 189 allograft pieces were used. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV (via PCR techniques) were negative. The allografts were stored by freezing them at -80 degrees C. A sample of the allograft was taken for culture in the operating theatre just before its implantation in all cases. The results of the cultures were obtained 3-5 days after the operation. There were 22 allografts with positive culture results (12%) after implantation. These allografts were implanted in 16 patients (14%). Cultures were positive for staphylococci coagulase negative (ECN) in 10 grafts (46%), Pseudomonas stutzeri in two grafts (9%), Corynebacterium jeikeium in two grafts (9%), staphylococci coagulase positive in two grafts (9%) and for each of the following organisms in one case each (4%): Corynebacterium spp., Actinomyces odontolyticus, Streptococcus mitis, Peptostreptococcus spp., Rhodococcus equi and Bacillus spp. No clinical infection was seen in any of these patients. Positive cultures could be caused by non-detected contamination at harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment different from our antibiotic protocol is required in the case of positive culture results of a graft piece after implantation.

Tratamiento de la espondilolistesis en niños y adolescentes / Treatment of spondylolisthesis in children and adolescents

La espondilolistesis es una de las causas identificables de dolor lumbar más frecuentes en la infancia, llegando a afectar al 6 por ciento de los niños mayores de 6 años. Cómo tratar esta patología ha sido motivo de controversia dado que no se pueden dar reglas generales. El tratamiento debe ser individualizado para cada paciente. Asimismo es importante recalcar el hecho de que aunque un paciente no necesite tratamiento, mientras tenga capacidad de crecer, podrá tener un avance en la deformidad, especialmente en las espondilolistesis displásicas, por lo que el seguimiento periódico de estos pacientes es obligatorio. Con este trabajo pretendemos mostrar nuestra experiencia en el tratamiento de esta patología presentando una serie de 139 pacientes con una media de edad en el diagnóstico de 11,8 años (9 meses-19años) controlados en nuestro centro con una evolución superior a los dos años (AU)

[Sarcoidosis and idiopathic intracranial hypertension. A case report]. / Sarcoidosis e hipertension intracraneal idiopática. A proposito de un caso.

INTRODUCTION: Sarcoidosis is a multisystemic disease of unknown etiology, characterized by non caseating granulomas in different organs. The respiratory system is the most frequently involved organ system. Up to 90% of patients with sarcoidosis have pulmonary involvement. The neurological involvement is rare and only occurs in the 5 7% of the patients. CASE REPORT: We present the case of a 41 years old woman who had severe headache and a sixth nerve palsy. Diagnosis of sarcoidosis was made in association with idiopathic intracranial hypertension (IIH). CONCLUSIONS: Sarcoidosis can involve any portion of the nervous system. An etiologic association between sarcoidosis and IIH could be identified in this case. Treatment with corticosteroids, repeated lumbar punctures and diuretics were prescribed and induced a significant clinical improvement.

[Radiologic evaluation of idiopathic congenital clubfoot and its clinical correlation in Codivilla's surgical technique]. / Valoración radiológica del pie zambo congénito idiopático y su correlación clínica en la operación de Codivilla.

Thirty-seven patients (52 idiopathic clubfeet) were treated with Codivilla's technique between 1971 and 1985. Radiological measurements and clinical evaluation before and after surgery were performed; a correlation was carried out between these evaluations and personal satisfaction. The results were rated as follows: poor in 4 feet (7.7%), fair in 18 feet (34.6%), good in 24 feet (46.2%) and excellent in 6 feet (11.5%) with a total percentage of satisfactory results amounting to 57.7%. Our conclusion is that when the indications are properly established, Codivilla's technique is a good procedure to correct clubfoot.

[Sociodemographic differences in adherence to the Mediterranean dietary pattern in Spanish populations]. / Diferencias sociodemográficas en la adhesión al patrón de dieta mediterránea en poblaciones de España.

OBJECTIVES: Lower social classes tend to eat a less healthy diet. The aim of this study was to compare adherence to the Mediterranean dietary pattern among different demographic and social groups in the adult population. METHODS: A cross-sectional study was performed in southern and northern regions of Spain in healthy volunteers (15,634 men and 25,812 women), aged 29-69 years, who were members of the European Prospective Investigation on Cancer cohort in Spain. Nine groups of food were included in the definition of the Mediterranean diet: vegetables and garden products, fruits, pulses, cereals, red meat, fish, olive oil, milk and milk products, and wine. Two techniques were used in the analysis: comparison of the mean daily intake of each group and calculation of an overall score for all the foods according to educational level and original social class. RESULTS: Groups with the lowest educational levels consumed more cereals and pulses and lower quantities of vegetables, olive oil (women), milk and milk products (men). Wine consumption was positively associated with education in women and was negatively associated in men. Calculation of a score to measure overall adherence to the Mediterranean dietary pattern eliminated differences according to each food category. No variations were found according to educational level, but small differences were found in original social class. The adherence score was lowest in young adults and women and was slightly higher in the south than in the north of Spain. CONCLUSIONS: The results suggest that the Mediterranean dietary pattern is fairly uniform, at least in the adult population of the regions included in this study.

[Congenital synostoses of the tarsus. Concept, classification, diagnosis and therapeutic approach]. / Sinostosis congénitas del tarso. Concepto, clasificación, diagnóstico y planteamiento terapéutico.

The incidence of congenital tarsal coalition is about 1%. It is recognized as the main etiology of painful, rigid flatfoot in the pediatric population. Talonavicular (50%) and talocalcaneal (40%) coalition are the most common presentation. We must suspect a tarsal coalition in a child with mechanical pain and shoes deformity. Rigid and painful planovalgus deformity are found in physical exam which led to describe in the pass this entity as peroneal spastic flatfoot. Lateral and oblique (35 degrees-45 degrees) radiographs must be practice to observe the coalition. The presence of a beak in the head of the talus or a half moon condensation image as the result of the superposition of the talus over the calcaneus are commonly described. CT-scan is also useful to delineate the size of the coalition and its location. Resection of the bar is the surgical treatment of choice. Excision of the coalition and interposition of fat or a graft must be tried in young patients in order to preserve foot biomechanical properties and to avoid long term problems associated with arthrodesis. Triple arthrodesis or subtalar arthrodesis must be used in older patients with degenerative signs in radiographs or in those cases of multiple coalition or if resection has failed.

Femoral anteversion osteotomy for the treatment of hip dislocation in Down syndrome: long-term evolution.

We propose a femoral desrotational osteotomy to antevert the femoral head associated with plication of the anterior and superior capsule for treatment in the early stages of hip dislocation in Down syndrome. Eight patients (10 hips) with Down syndrome and hip dislocation were reviewed. Five children (seven hips) were operated. We used the proposed surgical technique in three patients (four hips). The average follow-up was 11 years (range, 5-16 years). No infections or complications were observed. In our short experience, this is the recommended procedure in the early stages of hip dislocation in Down syndrome.

Sinostosis congénitas del tarso Concepto, clasificación, diagnóstico y planteamiento terapéutico / Congenital tarsal coalition. Concept, classification, diagnostic and therapy

La incidencia de las sinostosis congénitas del tarso se estima en torno al 1 por ciento de la población, siendo una de las causas más comunes de pie plano rígido doloroso en la población pediátrica. La barra calcáneoescafoidea (50 por ciento) y el puente astragalocalcáneo (40 por ciento) son las formas de presentación más frecuentes. La restricción de la movilidad, el dolor mecánico en el lugar de la fusión y la deformidad del calzado referida en la anamnesis deben hacernos sospechar esta entidad. En la exploración física destaca la rigidez del retropió con limitación dolorosa característica de la pronosupinación que ha motivado clásicamente la errónea denominación de pie plano peroneo espástico. El diagnóstico radiológico se hace normalmente con radiografías simples (proyecciones laterales y oblicuas entre 35 y 45°), en las que observamos el osteofito anterior de la cabeza del astrágalo o la imagen de condensación en "media luna" del astrágalo superpuesto con el calcáneo, siendo necesario en ocasiones recurrir al TAC. Entre las posibilidades terapéuticas, el tratamiento quirúrgico es el único resolutivo del problema de base. La resección-artroplastia de interposición debe intentarse en pacientes jóvenes en los que se quiera preservar la biomecánica normal del pie, evitándose los problemas a largo plazo de la artrodesis. La triple artrodesis o la artrodesis subastragalina, se reservan para pacientes mayores con signos degenerativos, en casos de fusiones tarsianas múltiples y tras fracaso de la resección-artroplastia (AU)

Types of fat intake and body mass index in a Mediterranean country.

BACKGROUND: Although the fatty acid fractions provide similar metabolizable energy, the type of dietary fat consumed could be relevant to the development of obesity. OBJECTIVE: To investigate the relationship between body mass index (BMI), obesity and the consumption of different types of fat and olive oil in a Mediterranean country with high prevalence of obesity, and high intake of monounsaturated fatty acids (MUFA) and olive oil. SUBJECTS: The study was carried out in Spain among 23 289 women and 14 374 men, aged 29-69 years, who were participants of a large European prospective cohort. METHODS: : Information on usual food intake was collected by interviewers by means of a dietary history questionnaire. The association between obesity (BMI >/= 30 kg m2), dietary fat, other dietary patterns and other non-dietary factors were tested using multilinear regression analysis. The ratio of reported energy intake to energy requirement was used as an estimation of dietary underreporting. RESULTS: The association between fatty acid fractions intake (saturated fatty acids (SFA) in women, and MUFA and polyunsaturated fatty acids (PUFA) in both sexes) and BMI was very weak, accounting for less than 1% of variance. All dietary and non-dietary variables accounted for 21% of variance in the measurement of BMI in women and only 6.7% of variance in men. Estimated underreporting of energy intake was 17.5% in obese women and 5.5% in obese men. CONCLUSIONS: The association between consumption of specific types of dietary fat, olive oil and obesity in Spain is not very important. However, because of the cross-sectional design and some level of underreporting of energy intake observed in overweight subjects and overreporting in underweight subjects, systematic bias cannot be completely discarded.

[Factors associated with the accumulation of abdominal fat estimated with anthropometric indexes]. / Factores asociados a la acumulación de grasa abdominal estimada mediante índices antropométricos.

BACKGROUND: To evaluate lifestyle and dietary intake factors influencing the accumulation of abdominal fat in a Mediterranean population. SUBJECTS AND METHOD: A cross-sectional study was carried-out in Spain (Asturias, Granada, Murcia, Navarra and Guipuzkoa) among 23,228 women and 14,332 men aged 29-69 years, participants of a large European prospective cohort (EPIC). Information on usual food intake and other non-dietary factors were collected by interviews. Height, weight, waist circumference and hip circumference were taken by previously trained interviewers. RESULTS: In a multiple-linear regression analysis sports activities and educational level were negatively associated with abdominal obesity, while body mass index, age, tobacco and alcohol consumption, saturated fat intake and increased prevalence of hypertension, diabetes and myocardial infarction were positively associated. All dietary and non-dietary variables accounted for 22 and 27% of variance in the waist/hip ratio and 74 and 66% of variance in the waist circumference, in women and men respectively. CONCLUSIONS: Body mass index and age are the most important factors influencing the accumulation of abdominal fat. Dietary factors and other lifestyle factors seem to play a minor role in increasing abdominal obesity.

Osteochondritis dissecans: a multicenter study of the European Pediatric Orthopedic Society.

To assess of the value of conservative and operative treatment of osteochondritis dissecans of the knee, a multicenter study was performed. In 12 European countries, 798 cases of osteochondritis of the knee have been collected from 44 hospitals. Results were based on 452 patients with 509 affected knees with minimum follow-up was 1 year (mean follow-up, 3 years and 11 months) and sufficient data for evaluation: 61% were male patients; 39% female patients; 318 affected knees were found in juvenile patients; 191 affected knees were in adult or premature patients. The localization was the medial femoral condyle on the lateral side in 51% (typical site) of patients. Various other sites were involved. Of the 509 affected knees, 154 were treated conservatively, 355 were treated surgically (many with multiple operations). For evaluation, the initial situation (at the time of the diagnosis) was favorable in 198 patients (no effusion, diameter of the lesion < 20 mm and no gross dissection on imaging) and unfavorable (one of the parameters did not meet these prerequisites) in 311 patients. The results were better in young patients than in adult patients. However, in the adolescent group, 22% of patients had abnormal knee at follow-up. The classical localization has a better prognosis than an unusual one. Patients with a favorable situation at diagnosis have significantly better results after conservative treatment than those who have undergone operation. When there are signs of dissection, the results are better after operative than after conservative treatment.

Dietary intake of vegetables and fruits among adults in five regions of Spain. EPIC Group of Spain. European Prospective Investigation into Cancer and Nutrition.

OBJECTIVE: To assess the consumption of vegetables and fruits (V&F) in adults from five regions in Spain according to sex, age and educational level. DESIGN: Cross-sectional study within the members of the EPIC cohort in Spain. SETTING: Three regions of the north of Spain (Asturias, Guipúzcoa and Navarra) and two regions of the south of Spain (Granada and Murcia). SUBJECTS: 41448 healthy volunteers (15365 men, 25813 women), aged 29-69 y. INTERVENTIONS: Information on habitual diet during the previous year was collected by means of a computerised version of a diet history questionnaire. RESULTS: Among men, the mean daily consumption of vegetables and of fruits was 273.7 g (3.4 servings) and 348.3 g (4.4 servings) respectively. Among women, the corresponding vegetables and fruit intakes per day were 244.4g (3.1 servings) and 349.4g (4.4 servings). The total V&F intake tended to increase with age and educational level. Overall, 74% of subjects consumed 400 g/d (5 servings) of vegetables and fruit. CONCLUSIONS: Consumption of vegetables and fruits in healthy adults in Spain is considerably higher than in most European countries and the United States; this complies with what is considered to be the Mediterranean diet. Despite some regional differences, there were no clearly differentiated patterns of V&F intake between southern and northern regions within Spain.