El neuroma de la porción distal del nervio interóseo posterior como causa de dolor dorsal persistente de muñeca / Neuroma of the distal posterior interosseous nerve as a cause of persistent dorsal wrist pain

El dolor en el dorso de la muñeca es una causa frecuente de consulta médica en nuestra práctica clínica habitual. Normalmente este dolor puede ser debido a procesos traumáticos, inflamatorios o degenerativos. Pero en ocasiones el origen del dolor se aleja de estas causas frecuentes. Presentamos un caso de dolor crónico al nivel dorsal de muñeca sin claro antecedente traumático ni componente degenerativo o inflamatorio atribuible. Siendo de etiología neuropática, debido a un neuroma del nervio interóseo posterior precapsular. Se discuten posibles causas, métodos de diagnóstico y opciones de tratamiento (AU)

Dorsal wrist pain is a very common cause of complaint in the clinical practice of the hand surgeon. Such pain can frequently be related to traumatic, inflammatory or degenerative diseases, but sometimes its origin is far away from these common causes. A rare case is reported of chronic dorsal wrist pain of neuropathic origin, due to a pre-capsular neuroma of the posterior interosseous nerve. Possible causes, diagnostic hints, and treatment options are thoroughly discussed (AU)

Neuroma of the distal posterior interosseous nerve as a cause of persistent dorsal wrist pain. / El neuroma de la porción distal del nervio interóseo posterior como causa de dolor dorsal persistente de muñeca.

Dorsal wrist pain is a very common cause of complaint in the clinical practice of the hand surgeon. Such pain can frequently be related to traumatic, inflammatory or degenerative diseases, but sometimes its origin is far away from these common causes. A rare case is reported of chronic dorsal wrist pain of neuropathic origin, due to a pre-capsular neuroma of the posterior interosseous nerve. Possible causes, diagnostic hints, and treatment options are thoroughly discussed.

Monitorización analítica de drogas de abuso en el medio hospitalario / Analytical monitoring of drugs of abuse in the hospital environment

Objetivos. Conocer qué clase de drogas de abuso son más consumidas por la población que acude a nuestro hospital situado en el área 4 de Madrid, qué tipo de policonsumo existe y cuál es el perfil de este tipo de pacientes. Metodología. Se realiza un estudio retrospectivo de todos los pacientes a los que durante el año 2002 se les solicitó un screening de drogas de abuso en orina. Los análisis se realizaron en el autoanalizador AxSym® de Abbott® por inmunoensayo de polarización de fluorescencia (FPIA). Resultados. El 55,1% de los pacientes remitidos a estudio (n = 357) fue positivo en alguna droga de abuso. De ellos, un 23,3% fue por cannabis, 16,2% por cocaína, 9% por anfetaminas y 6,7% por opiáceos. Un 12% de los pacientes era policonsumidor. La combinación más frecuente fue cocaína con opiáceos, seguido de cocaína con cannabis y cocaína con anfetaminas. El consumo de drogas fue más elevado en varones que en mujeres con la excepción de los opiáceos. En los menores de 30 años el consumo mayoritario fue de cannabis y cocaína, mientras que los opiáceos fueron más consumidos por mayores de 30 años. Las muestras analizadas procedían mayoritariamente de los servicios de Psiquiatría (35,6%), Urgencias (34%) e Infecciosas (11%). Aquellos pacientes en los que se confirmó su drogodependencia fueron derivados en su mayoría a centros de atención psiquiátrica especializada para su posterior seguimiento. Conclusión. En nuestro medio el policonsumo es habitual, debiendo tener en cuenta los datos poblacionales para ajustar las solicitudes

Objectives. A study was conducted in order to assess what kind of drugs of abuse are most commonly consumed by the population that comes to our hospital, located in Area 4 in Madrid, as well as policonsumption patterns and patient profiles. Material and methods. A retrospective study was conducted in all patients for whom, during the year 2002, a toxicological urine drug screen was requested. Analysis were made by fluorescence polarization immunoassay (FPIA) using Abbott's( AxSym( autoanalyzer. Results. 55.1% of the studied sample (n = 357) were positive for any of the drugs of abuse. Of these, 23.3% was due to cannabis, 16.2% to cocaine, 9% to amphetamines and 6.7% to opiates. Regarding policonsumption, 12% of the patients conformed this category. The most frequent combination was opiate and cocaine, followed by cocaine plus cannabis and cocaine plus amphetamines. Drug consumption was higher in males than in females except for opiate abuse which was equal for both. In patients uder 30 years old, main consumption was that of cannabis and cocaine, while opiates were consumed in higher proportions by patients over 30 years old. The origins of samples analyzed were primarly Psychiatry (35.6%), Emergency (34%) and Infectious Disease (11%) Departments. Patients for whom a drug dependence diagnosis was confirmed were referred, in most cases, to specialized psychiatry centres for follow up. Conclusion. Policonsumption is usual

[Identification of items for creating a questionnaire for the assessment of instrumental activities of daily living (IADL) in elderly patients]. / Identificación de ítems para la creación de un cuestionario de valoración de actividades instrumentales de la vida diaria en personas mayores.

OBJECTIVE: To identify items to design a questionnaire to assess IADL in the elderly in the community. DESIGN: Delphi study. LOCATION: Community setting, primary health care. PARTICIPANTS: Fifty seven multidisciplinary experts (family doctors, geriatricians, physiotherapists, social workers, male nurses) who are members of the Spanish Society of Family and Community Medicine or the Spanish Geriatrics and Gerontology Society. METHODS: Three consecutive questions sent via e-mail or fax. First: what items you would take into account in a questionnaire to assess IADL in the elderly? Second: out of the groupings select 10 you consider to be of special relevance? Third: among the 14 more most selected items, select, by scoring from 1 to 10, the ones you consider more important? In the end we obtained the 10 items to include in the questionnaire according to their scores. RESULTS: Thirty experts answered the 3 mailings. The 53 initial proposals were grouped into 24 items. In the end we obtained the following selection (from higher to lower score): dealing with medication, use of the telephone, housework, handling money, walking outside the home, security measures and risk avoidance, shopping, dealing with doors and keys, transport use, and means of social contact. CONCLUSIONS: Only 2 items could have gender influence (in contrast to other questionnaires), as "shopping" does not refer only to the household ones and "housework" also includes activities carried out by males. The most important items are "dealing with medication" (due to the high prevalence of problems and clinical outcomes) and "the use of the telephone" (survival item).

Identificación de ítems para la creación de un cuestionario de valoración de actividades instrumentales de la vida diaria en personas mayores / Identification of items for creating a questionnaire for the assessment of instrumental activities of daily living (IADL) in elderly patients

Objetivo. Seleccionar ítems para diseñar un cuestionario de valoración de las actividades instrumentales de la vida diaria (AIVD) en personas mayores residentes en la comunidad. Diseño. Estudio Delphi. Emplazamiento. Medio comunitario, atención primaria. Participantes. Un total de 57 expertos multidisciplinarios (médicos de familia, geriatras, fisioterapeutas, trabajadores sociales, enfermeros) pertenecientes a la Sociedad Española de Medicina de Familia y Comunitaria (semFYC) o a la Sociedad Española de Geriatría y Gerontología (SEGG). Métodos. Se realizaron 3 envíos consecutivos por correo electrónico o fax. En el primer envío se interrogaba acerca de qué ítems incluirían en un cuestionario para valorar las AIVD en personas mayores; en el segundo se pedía que seleccionaran, de los ítems agrupados, los 10 que consideraran más relevantes, y un tercero se solicitaba que, de los 14 ítems más seleccionados, puntuaran de 1 a 10 los más trascendentes. Así pues, se obtuvieron ordenados por puntuación los 10 ítems que debían ser incluidos. Resultados. A los 3 correos contestaron 30 expertos. Las 53 propuestas iniciales se agruparon en 24 ítems y finalmente se seleccionaron (de mayor a menor puntuación) los siguientes: utilización de los fármacos, uso del teléfono, tareas domésticas, utilización del dinero, deambulación fuera del domicilio, medidas de seguridad y evitación de riesgos, realización de compras, uso de puertas y llaves, uso del transporte y medios de relación social. Conclusiones. Sólo 2 ítems podrían estar influidos por el sexo (en contraposición con otros cuestionarios disponibles), aunque «la realización de compras» no se limita a las domésticas y en «tareas domésticas» se incluyen actividades también realizadas por los varones. Los ítems más relevantes son «utilización de los fármacos» (importancia por prevalencia/repercusión clínica) y «empleo del teléfono» (ítem de subsistencia)

Objective. To identify items to design a questionnaire to assess IADL in the elderly in the community. Design. Delphi study. Location. Community setting, primary health care. Participants. Fifty seven multidisciplinary experts (family doctors, geriatricians, physiotherapists, social workers, male nurses) who are members of the Spanish Society of Family and Community Medicine or the Spanish Geriatrics and Gerontology Society. Methods. Three consecutive questions sent via e-mail or fax. First: what items you would take into account in a questionnaire to assess IADL in the elderly? Second: out of the groupings select 10 you consider to be of special relevance? Third: among the 14 more most selected items, select, by scoring from 1 to 10, the ones you consider more important? In the end we obtained the 10 items to include in the questionnaire according to their scores. Results. Thirty experts answered the 3 mailings. The 53 initial proposals were grouped into 24 items. In the end we obtained the following selection (from higher to lower score): dealing with medication, use of the telephone, housework, handling money, walking outside the home, security measures and risk avoidance, shopping, dealing with doors and keys, transport use, and means of social contact. Conclusions. Only 2 items could have gender influence (in contrast to other questionnaires), as "shopping" does not refer only to the household ones and "housework" also includes activities carried out by males. The most important items are "dealing with medication" (due to the high prevalence of problems and clinical outcomes) and "the use of the telephone" (survival item)

Adherence to treatment in inflammatory bowel disease.

AIM: Adherence to therapy is important to ensure success. We wanted to explore this feature in patients with inflammatory bowel disease. PATIENTS AND METHODS: We explored adherence to treatment and its modifiers in 40 patients with inflammatory bowel disease using a battery of tests. RESULTS: A 67% of patients (95% CI: 51-81%) acknowledged a certain degree of involuntary nonadherence, and 35% (95% CI: 20-51%) of voluntary nonadherence. Overall, 72% (95% CI: 56-85%) of patients had some form of nonadherence. An objective correlation of these self-reported data was assessed by the determination of urine salicylate levels in the subset of patients treated with mesalazine or its derivatives (15 cases). Two of them (13%) had no detectable urinary drug levels, indicating complete nonadherence. Voluntary nonadherence was higher in patients with lower scores in the intestinal (p = 0.02) and social areas (p = 0.015) of IBDQ-32, as well as in those with less active Crohn s disease (p < 0.005), patients with high depression scores and high patient-physician discordance (p = 0.01), patients with long-standing disease (p = 0.057), patients who considered themselves not to be well informed about the treatment they were getting (p = 0.04) or who trusted their attending physicians less (p = 0.03). CONCLUSIONS: Intentional nonadherence to therapy is prevalent among patients with inflammatory bowel disease. A correction of factors associated to poor adherence could lead to higher therapeutic success.

Adhesión al tratamiento en la enfermedad inflamatoria intestinal / Adherence to treatment in inflammatory bowel disease

Objetivo: la adhesión al tratamiento es importante para el éxito del mismo. Quisimos conocer este dato en pacientes con enfermedad inflamatoria intestinal. Pacientes y métodos: hemos explorado la adhesión al tratamiento y sus condicionantes en 40 pacientes con enfermedad inflamatoria intestinal, aplicando una batería de pruebas. Resultados: un 67% (IC 95%: 51-81%) de los pacientes presentaba algún grado de falta involuntaria de adhesión. A su vez, un 35% (20-51%) de los pacientes presentaba algún grado de falta voluntaria de adhesión. Globalmente, un 72% (56-85%) de los pacientes presentó uno u otro tipo de falta de adhesión. El correlato objetivo, se obtuvo mediante la determinación de salicilatos en orina en el subgrupo de pacientes bajo tratamiento con mesalazina o derivados (15 casos). Dos de ellos (13%), no tenían niveles detectables, traduciendo falta absoluta de adhesión al tratamiento. La adhesión intencionada era tanto más baja cuanto menores eran las puntuaciones en las áreas intestinal (p=0,02) y social (p=0,015) del IBDQ-32, así como en aquellos con enfermedad de Crohn menos activa (p < 0,005), pacientes con puntuaciones altas de depresión y alta discordancia con el médico (p = 0,01), pacientes con largo tiempo de evolución de su enfermedad (p = 0,057), los que no se consideraban bien informados acerca de sus medicaciones (p = 0,04) o con menos confianza en sus médicos (p = 0,03). Conclusiones: la falta de adhesión intencionada es prevalente en este grupo de pacientes. La corrección de los factores que la predicen puede mejorar los resultados terapéuticos

Aim: adherence to therapy is important to ensure success. We wanted to explore this feature in patients with inflammatory bowel disease. Patients and methods: we explored adherence to treatment and its modifiers in 40 patients with inflammatory bowel disease using a battery of tests. Results: a 67% of patients (95% CI: 51-81%) acknowledged a certain degree of involuntary nonadherence, and 35% (95% CI: 20-51%) of voluntary nonadherence. Overall, 72% (95% CI: 56-85%) of patients had some form of nonadherence. An objective correlation of these self-reported data was assessed by the determination of urine salicylate levels in the subset of patients treated with mesalazine or its derivatives (15 cases). Two of them (13%) had no detectable urinary drug levels, indicating complete nonadherence. Voluntary nonadherence was higher in patients with lower scores in the intestinal (p = 0.02) and social areas (p = 0.015) of IBDQ-32, as well as in those with less active Crohn's disease (p < 0.005), patients with high depression scores and high patient-physician discordance (p = 0.01), patients with long-standing disease (p = 0.057), patients who considered themselves not to be well informed about the treatment they were getting (p = 0.04) or who trusted their attending physicians less (p = 0.03). Conclusions: intentional nonadherence to therapy is prevalent among patients with inflammatory bowel disease. A correction of factors associated to poor adherence could lead to higher therapeutic success