Prevalencia de disfunción diastólica en los pacientes hipertensos de nuevo diagnóstico y sin tratamiento / Prevalence of diastolic dysfunction in non-treated, newly diagnosed hypertensive patients

Objetivo. El propósito de este estudio observacional es conocer la prevalencia de disfunción diastólica (DD) en los pacientes hipertensos de nuevo diagnóstico y sin tratamiento. Pacientes y métodos. Se han incluido 105 pacientes (69 varones y 36 mujeres), con una edad media de 51,11 años los hombres y 54,25 años las mujeres, con hipertensión arterial de nuevo diagnóstico y sin tratamiento antihipertensivo. El estudio tuvo lugar entre junio de 2002 y junio de 2003. Fueron excluidos los pacientes con cardiopatía isquémica, hipertrófica, valvular, dilatada, fibrilación auricular y enfermedad pulmonar obstructiva crónica (EPOC) evolucionada. A todos los pacientes se les practicó un ecocardiograma doppler. Se consideró que existía DD del ventrículo izquierdo al registrarse al menos dos de los siguientes parámetros ecocardiográficos: tiempo de relajación isovolumétrica (TRIV) > 100 mseg, tiempo de desaceleración de la onda E (TDE) > 250 mseg y cociente E/A 130 g/m2 y en mujeres > 110 g/m2. Resultados. El 60 % de los pacientes estudiados tenían parámetros de DD en el ecocardiograma. El 37,1 % presentaban patrón de DD sin hipertrofia ventricular izquierda (HVI), el 16,2 % presentaban patrón de DD con HVI y un 6,7 % presentaban HVI y patrón de DD por mala relajación del VI. Se observaba una clara correlación entre la presencia de DD y la edad, presión arterial sistólica (PAS), presión del pulso (PP) y el índice de masa corporal (IMC), no encontrándose relación con el sexo y otras variables estudiadas (diabetes, insuficiencia renal, dislipemia, presión arterial diastólica [PAD] y frecuencia cardíaca [FC]). Conclusiones. La prevalencia de la DD valorada por ecocardiograma doppler en pacientes hipertensos de nuevo diagnóstico es muy elevada (60%), observando una correlación directa con la edad de los pacientes, PAS, PP y el IMVI

Objective. This study aims to evaluate the prevalence of diastolic dysfunction (DD) in newly diagnosed hypertensive patients without treatment. Patients and method. 105 patients (69 men and 36 women), with a mean age of 51.11 years in men and 54.25 years in women, with newly diagnosed hypertension and without treatment have been included. The study took place between June 2002 and June 2003. Exclusion criteria were ischemic heart disease, hypertrophy, valvular disease, dilated heart disease, atrial fibrillation and fully-developed COPD. A doppler echocardiogram was practiced on all patients. Diastolic dysfunction was considered to exist if two of the following echocardiographic parameters were found: isovolumetric relaxing time (TRI-V) > 100 ms, deceleration time of the E wave (TDE) > 250 ms, early filling rate peak/late filling rate peak ratio (E/A) 130 g/m2 in men and > 110 g/m2 in women. Results. A total of 60 % of patients had DD parameters and 37.1 % had DD without Left Ventricular Hypertrophy (LVH); 6.7 % had LVH and DD due to impaired relaxation of the left ventricle. There is a clear correlation between DD and age, Systolic Blood Pressure (SBP), Pulse Pressure (PP) and Body Mass index (BMI). We found no relationship with gender and other variables (heart rate, diabetes, renal insufficiency, dyslipidemia, diastolic blood pressure). Conclusion. The prevalence of DD evaluated by doppler echocardiogram is very high in newly diagnosed hypertensive patients (60 %), a direct correlation being observed with the patient's age, SBP, PP and LVMI

International comparison of performance measures for screening mammography: can it be done?

OBJECTIVE: Published screening mammography performance measures vary across countries. An inter-national study was undertaken to assess the comparability of two performance measures: the recall rate and positive predictive value (PPV). These measures were selected because they do not require identification of all cancers in the screening population, which is not always possible. SETTING: The screening mammography programs or data registries in 25 member countries of the International Breast Cancer Screening Network (IBSN). METHODS: In 1999 an assessment form was distributed to IBSN country representatives in order to obtain information on how screening mammography was performed and what specific data related to recall rates and PPV were collected. Participating countries were then asked to provide data to allow calculation of recall rates, PPV and cancer detection rates for screening mammography by age group for women screened in the period 1997-1999. RESULTS: Twenty-two countries completed the assessment form and 14 countries provided performance data. Differences in screening mammography delivery and data collection were evident. For most countries, recall rates were higher for initial than for subsequent mammograms. There was no consistent relationship of initial to subsequent PPV, although PPV generally decreased as the recall rate increased. Recall rates decreased with increasing age, while PPV increased as age increased. CONCLUSION: Similar patterns for mammography performance measures were evident across countries.However, the development of a more standardized approach to defining and collecting data would allow more valid international comparisons, with the potential to optimize mammography performance. At present, international comparisons of performance should be made with caution due to differences in defining and collecting mammography data.

[Effect of caries prevention using fluorinated mouth washes. Results of a non-randomized field test after 7 years' follow-up]. / Efecto de la prevención de caries mediante enjuagues fluorados. Resultados de un ensayo de campo no randomizado a los 7 años de seguimiento.

A non-random field test has been run for ascertaining the effectiveness of a cavity prevention program among all the public school students in Mataró. The group under study was comprised of 288 elementary school children (5-6 years of age), on whom rinses of 0.2% FNa were used every two weeks, and the control group, comprised of 167 children, students at private schools not participating in the program. Both groups have been monitored for 7 years (up to the 8th grade) and the number of their cavities compared. A 24% reduction in the net Annual Cavity Rate (broken-down according to sex) has been observed. At the end of the study, only 5% of the control group was Cavity free, as compared to 17.3% of those who had used groups used the fluoride rinses. The differences between the two groups remain statistically significant on taking into account the effect of other factors such as the sex of the individuals in question and some personal care habits.

[Jugular chemodectoma with Garcin syndrome]. / Quemodectoma yugular con sindrome de Garcin.

The authors present an exceptional case of chemodectoma jugulare with important invasion of the skull base involving all the cranial nerves on one side and conforming Garcin's syndrome. Practically all the possible ways of spreading were followed by the tumor, with involvement of the posterior, middle and anterior fossas of the skull base and also orbit, middle ear and neck. The clinical and histopathological difficulties in the diagnosis, especially when the chemodectoma has only neurological signs, are stressed. The association of otologic symptoms makes the diagnosis easier. The patient had an early onset of the symptoms and a rapid evolution considering this type of tumors. The appearance of goitre in this patient is a sign of endocrine disturbance, which is occasionally associated with these tumors. Apparently this chemodectoma was not a secreting tumor, since the blood pressure values were normal. No signs of multicentricity or metastatic growths were detected. The radiological studies, and especially computerized tomography scanning, gave precise information about the spreading of the tumor. The authors consider that the knowledge of this entity is important in order to arrive at a correct diagnosis.

El estudio de la hidatidosis con tomografia computada. / Study of hydatidosis using computed tomography

La presentacion esta basada en 35 casos de quiste hidatico diagnosticados y corroborados quirurgicamente, que se estudiaron durante un periodo de 18 meses en el Centro de Tomografia Computada del Sanatorio Larghero.El quiste hidatico no complicado (hepatico o pulmonar) se presenta como una imagen hipodensa (0 a 10 uH) homogenea, de forma redondeada y limites netos. Las complicaciones vistas incluyen: 1) Infeccion que se traduce en un aumento de la densidad intraquistica en algunos casos aparicion de tabiques e irregularidad del contorno. En el pulmon se ven los fenomenos inflamatorios del parenquima circundante.2) Vesiculizacion, aparicion de vesiculas hijas y contorno polilobulados.3) Multiplicidad 4) Hidatidosis secundaria intraperitoneal. 5) Transito hepato-bronquico. 6) Hidatidosis pleural. En todos los casos se determino exatamente la cantidad de lesiones, el tamano y topografia de cada una de ellas