[Knee arthroplasty revision in Uruguay over a 10-year period: survival and results]. / Recambios de artroplastía de rodilla en el Uruguay en un período de 10 años: supervivencia y resultados.

INTRODUCTION: According to the NRF (National Resource Fund) there has been an increase in the number of TKA (total knee arthroplasty) in our country. There are no studies evaluating their results. The objective of the study was to analyze survival, evaluate results and analyze the population of ATR replacements. MATERIAL AND METHODS: A retrospective observational and descriptive cohort study of 156 cases of ATR turnover registered in the NRF was conducted between 2004 and 2014. The analysis of the cumulative percentage of survival was performed with the Kaplan-Meier method, using re-revision as an event of interest. The WOMAC, KOOS and SANE score were used to assess functional outcomes. RESULTS: The cumulative percentage of survival was 85% at 10 years. The average scores were: KOOS 61.5, WOMAC 29.8 and SANE 65. Complications were recorded in 25% of cases (infection 14.10%). The average age was 71 years and 60.9% of the cases were in women. 62.82% of the replacements were of aseptic cause and in the vast majority (89.1%) constricted prostheses were used. CONCLUSION: The cumulative percentage of survival of revision TKA was 86% at 10 years according to the Kaplan-Meier method. Only 51% of revisions were functional at 10 years. We must be cautious when interpreting the results obtained with this method. Acceptable functional outcomes were recorded compared to other registries, although patient satisfaction was low in more than one third of cases and there was a high percentage of complications. A trend towards an increase in the turnover rate was observed between 2004 (1.4%) and 2014 (2%).

INTRODUCCIÓN: Según el FNR (Fondo Nacional de Recursos) se ha observado un aumento del número de recambios de ATR (artroplastía total de rodilla) en nuestro país. No hay estudios que evalúen sus resultados. El objetivo del estudio fue analizar la supervivencia, evaluar resultados y analizar la población de los recambios de ATR. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo de cohorte observacional y descriptivo de 156 casos de recambio de ATR registrados en el FNR, entre 2004 y 2014. El análisis del porcentaje acumulado de supervivencia se realizó con el método de Kaplan-Meier, utilizando la re-revisión como evento de interés. Se utilizó el puntaje WOMAC, KOOS y SANE para evaluar los resultados funcionales. RESULTADOS: El porcentaje acumulado de supervivencia fue de 85% a 10 años. Los puntajes promedio fueron: KOOS 61.5, WOMAC 29.8 y SANE 65. Se registraron complicaciones en 25% de los casos (infección 14.10%). El promedio de edad fue de 71 años y 60.9% de los casos fueron en mujeres. De los recambios, 62.82% fue de causa aséptica y en la gran mayoría (89.1%) se utilizó prótesis constreñida. CONCLUSIÓN: El porcentaje acumulado de supervivencia de los recambios de ATR fue de 86% a 10 años según el método de Kaplan-Meier. Sólo 51% de los recambios era funcional a 10 años. Hemos de ser precavidos al interpretar los resultados obtenidos con este método. Se registraron resultados funcionales aceptables comparados con otros registros, aunque el grado de satisfacción de los pacientes fue bajo en más de un tercio de los casos y existió un alto porcentaje de complicaciones. Se observó una tendencia hacia el aumento de la tasa de recambio entre 2004 (1.4%) y 2014 (2%).

Recambios de artroplastía de rodilla en el Uruguay en un período de 10 años: supervivencia y resultados / Knee arthroplasty revision in Uruguay over a 10-year period: survival and results

Resumen: Introducción: Según el FNR (Fondo Nacional de Recursos) se ha observado un aumento del número de recambios de ATR (artroplastía total de rodilla) en nuestro país. No hay estudios que evalúen sus resultados. El objetivo del estudio fue analizar la supervivencia, evaluar resultados y analizar la población de los recambios de ATR. Material y métodos: Se realizó un estudio retrospectivo de cohorte observacional y descriptivo de 156 casos de recambio de ATR registrados en el FNR, entre 2004 y 2014. El análisis del porcentaje acumulado de supervivencia se realizó con el método de Kaplan-Meier, utilizando la re-revisión como evento de interés. Se utilizó el puntaje WOMAC, KOOS y SANE para evaluar los resultados funcionales. Resultados: El porcentaje acumulado de supervivencia fue de 85% a 10 años. Los puntajes promedio fueron: KOOS 61.5, WOMAC 29.8 y SANE 65. Se registraron complicaciones en 25% de los casos (infección 14.10%). El promedio de edad fue de 71 años y 60.9% de los casos fueron en mujeres. De los recambios, 62.82% fue de causa aséptica y en la gran mayoría (89.1%) se utilizó prótesis constreñida. Conclusión: El porcentaje acumulado de supervivencia de los recambios de ATR fue de 86% a 10 años según el método de Kaplan-Meier. Sólo 51% de los recambios era funcional a 10 años. Hemos de ser precavidos al interpretar los resultados obtenidos con este método. Se registraron resultados funcionales aceptables comparados con otros registros, aunque el grado de satisfacción de los pacientes fue bajo en más de un tercio de los casos y existió un alto porcentaje de complicaciones. Se observó una tendencia hacia el aumento de la tasa de recambio entre 2004 (1.4%) y 2014 (2%).

Abstract: Introduction: According to the NRF (National Resource Fund) there has been an increase in the number of TKA (total knee arthroplasty) in our country. There are no studies evaluating their results. The objective of the study was to analyze survival, evaluate results and analyze the population of ATR replacements. Material and methods: A retrospective observational and descriptive cohort study of 156 cases of ATR turnover registered in the NRF was conducted between 2004 and 2014. The analysis of the cumulative percentage of survival was performed with the Kaplan-Meier method, using re-revision as an event of interest. The WOMAC, KOOS and SANE score were used to assess functional outcomes. Results: The cumulative percentage of survival was 85% at 10 years. The average scores were: KOOS 61.5, WOMAC 29.8 and SANE 65. Complications were recorded in 25% of cases (infection 14.10%). The average age was 71 years and 60.9% of the cases were in women. 62.82% of the replacements were of aseptic cause and in the vast majority (89.1%) constricted prostheses were used. Conclusion: The cumulative percentage of survival of revision TKA was 86% at 10 years according to the Kaplan-Meier method. Only 51% of revisions were functional at 10 years. We must be cautious when interpreting the results obtained with this method. Acceptable functional outcomes were recorded compared to other registries, although patient satisfaction was low in more than one third of cases and there was a high percentage of complications. A trend towards an increase in the turnover rate was observed between 2004 (1.4%) and 2014 (2%).

Myopericarditis versus viral or idiopathic acute pericarditis.

OBJECTIVE: To investigate the relative incidence, clinical presentation and prognosis of myopericarditis among patients with idiopathic or viral acute pericarditis. DESIGN: Prospective observational clinical cohort study. SETTING: Two general hospitals from an urban area of 220 000 inhabitants. PATIENTS: 274 consecutive cases of idiopathic or viral acute pericarditis between January 2001 and June 2005. MAIN OUTCOME MEASURES: Relative prevalence of myopericarditis. Clinical features at presentation including echocardiographic data (ejection fraction (EF), wall motion score index (WMSI)) and follow-up data at 12 months including complications, results of echocardiography, electrocardiography and treadmill testing. RESULTS: Myopericarditis was recorded in 40/274 (14.6%) consecutive patients. At presentation, the following clinical features were independently associated with myopericarditis: arrhythmias (odds ratio (OR) = 17.6, 95% confidence interval (CI) 5.7 to 54.1; p<0.001), male gender (OR = 6.4, 95% CI 2.3 to 18.4; p = 0.01), age <40 years (OR = 6.1, 95% CI 2.2 to 16.9; p = 0.01), ST elevation (OR = 5.4, 95% CI 1.4 to 20.5; p = 0.013) and a recent febrile syndrome (OR = 2.8, 95% CI 1.1 to 7.7; p = 0.044). After 12 months' follow-up an increase of EF (basal EF 49.6 (5.1)% vs 12-month EF 59.1 (4.6)%; p<0.001) and decrease of WMSI (basal WMSI 1.19 (0.27) vs 12-month WMSI 1.02 (0.09); p<0.001) were recorded in patients with myopericarditis, with a normalisation of echocardiography, electrocardiography and treadmill testing in 98% of cases. Use of heparin or other anticoagulants (OR = 1.1, 95% CI 0.3 to 3.5; p = 0.918) and myopericarditis (OR = 2.3, 95% CI 0.7 to 7.6; p = 0.187) was not associated with an increased risk of cardiac tamponade or recurrences. CONCLUSIONS: Myopericarditis is relatively common and shows a benign evolution also in spontaneous cases not related to vaccination.

Peak exercise oxygen consumption in chronic heart failure: toward efficient use in the individual patient.

OBJECTIVES: This study sought to 1) assess the short-, medium-and long-term prognostic power of peak oxygen consumption (VO2) in patients with heart failure; 2) verify the consistency of a nonmeasurable anaerobic threshold (AT) as a criterion of nonapplicability of peak VO2; 3) develop simple rules for the efficient use of peak VO2 in individualized prognostic stratification and clinical decision making. BACKGROUND: Peak VO2, when AT is identified, is among the indicators for heart transplant eligibility. However, in clinical practice the application of defined peak VO2 cutoff values to all patients could be inappropriate and misleading. METHODS: Six hundred fifty-three patients consecutively considered for eligibility for heart transplantation were followed up. Outcomes (cardiac death and urgent transplantation) were determined when all survivors had a minimum of 6 months of follow-up. RESULTS: Contraindication to the exercise test identified very high risk patients. The relatively small sample of women did not allow inferences to be drawn. In men, peak VO2 stratified into three levels (< or = 10, 10 to 18 and >18 ml/kg per min) identified groups at high, medium and low risk, respectively. The prognostic power of peak VO2 < or = 10 ml/kg per min was maintained even when the AT was not detected. In patients in New York Heart Association functional class III or IV, peak VO2 did not have prognostic power. In patients in functional class I or II, peak VO2 stratification was prognostically valuable, but less so at 6 than at 12 or 24 months. Age did not influence peak VO2 prognostic stratification. CONCLUSIONS: A contraindication to exercise testing should be considered a priority for listing patients for heart transplantation. Only in less symptomatic male patients does a peak VO2 < or = 10 ml/kg per min identify short-, medium- and long-term high risk groups. A peak VO2 >18 ml/kg per min implies good prognosis with medical therapy.

Completeness of reporting trial results: effect on physicians' willingness to prescribe.

Clinical trials may lead to conflicting results. We studied how different ways of reporting results affected physicians' recommendations. A questionnaire distributed to 148 general practitioners presented results of a clinical trial where a reduction of cardiac events and an increase of mortality was reported. Results were shown in four different ways--relative risk reduction, absolute risk reduction, percentages of event-free patients, number needing to be treated to prevent an event--as if they derived from different trials. A fifth presentation was the reduced rate of cardiac events along with the increased rate of mortality. Physicians were asked to estimate how much they would be willing to prescribe each drug. The mean agreement of physicians' decisions was 77 (28)% for relative risk reduction, 24 (28)% for absolute risk reduction, 37 (37)% for different percentages event-free patients, 34 (34)% for number need to treat, and 23 (28)% for events reduction and mortality for increase (p < 0.001 relative risk vs others). The method of reporting trial results and the completeness of information in the case of controversial results affects physicians willingness to prescribe.

How the exercise electrocardiogram is used in clinical practice in patients with suspected coronary artery disease.

Clinical use of a test should be evaluated not only on the change of pretest probability but also on the increased confidence in the judged probability, and on the decision of recommending additional tests or therapy after test results. Before and after the test, cardiologists referring a patient for exercise electrocardiogram for suspected coronary artery disease were asked to estimate the probability of coronary artery disease and the minimal and maximal value of their estimate (plausible range), to judge whether to refer the patient for coronary angiography, and to specify patient's treatment. After the test, the percentage of patients with estimated probability < or = 20% increased (from 53 to 69%; p = 0.005) and the percentage of patients with intermediate probability (between 21 and 80%) decreased (from 37 to 16%; p = 0.0001). The mean plausible range decreased from pre- to post-test assessment (31 +/- 23 to 15 +/- 16%; p = 0.0001), indicating an increase in cardiologists' confidence in their estimates. After the test, the percentage of cardiologists who wished to either refer or not refer patients for coronary angiography increased (from 4 to 13%, p < 0.005; and from 37 to 65%, p < 0.0001, respectively). Test results enable cardiologists to change the assessment of disease probability, the confidence in their own estimates, and their judgment of whether to refer patients for coronary angiography.

[The lipid profile after heart transplantation in relation to the preoperative cholesterolemia and to the main pathology]. / Assetto lipidico dopo trapianto cardiaco rispetto alla colesterolemia pre-intervento e alla patologia di base.

Serum cholesterol plays a role only in the etiology of ischemic cardiomyopathy and increases in patients after heart transplantation. Aim of the present investigation was to verify whether lipid profile change is related to pre-intervention type of cardiomyopathy and serum cholesterol level. Lipid profile was monthly monitored for at least 6 months in 21 consecutive patients after heart transplantation (19 males and 2 females, mean age 47 +/- 10 years). Serum cholesterol and triglycerides increased in all patients 2 months after surgery and thereafter it persisted significantly elevated. The increase was statistically significant only in patients with dilated cardiomyopathy and with normal cholesterolemia before surgery. In conclusion, lipid profile after heart transplantation should be especially monitored in patients with dilated cardiomyopathy and in those with normal serum cholesterol before heart transplantation.