[Gout, beyond the joint: How should we treat it?] / La gota, más allá de la articulación: ¿cómo debemos tratarla?

Gout is a disease caused by the chronic deposition of monosodium urate crystals. Its clinical presentation as an acute, self-limiting arthritis and the belief that it is a banal, self-inflicted disease have led to its poor management. Despite advances in the knowledge of the disease and the simplicity of its management, no more than 30% of patients are well treated. In Spain, the prevalence of gout is 2.5% and its incidence is increasing. In the following article we will review the pathogenesis of gout and hyperuricaemia, highlighting the greater weight of genetics and renal function over diet. We will look at the consequences of crystal deposition. Gout, in addition to its joint presentation and renal involvement, has been shown to be an independent cardiovascular risk factor. Hypouricemic therapy is the most important treatment, as it is the one that dissolves the crystals and cures the disease. This requires the sustained achievement of uricemia levels below 6mg/dl. We will also review preventive and flares treatment, as well as the role of patient education in terms of both lifestyle and dietary habits and adherence to pharmacological treatment.

Formulation and development of paediatric orally disintegrating carbamazepine tablets.

Carbamazepine is a medicine used to manage epilepsy and partial or tonic-clonic seizures. This study aimed at formulating and obtaining carbamazepine orodispersible tablets for paediatric use at a 50 mg dose, with a diameter not greater than 6 mm and a tablet weight of 80 mg, through a direct compression process. The SeDeM pre-formulation/formulation method was used to define the characteristics of both carbamazepine and the selected excipients for direct compression. This study succeeded in formulating and obtaining the proposed tablets. Following the application of the SeDeM method, the tablets met the mass uniformity test and showed appropriate hardness values for orodispersible tablets. The tablets also met the United States Pharmacopeia (USP) test specifications at t = 60 min. The orodispersible tablets obtained may improve compliance with paediatric treatment with carbamazepine, ensuring the safety and effectiveness of the medicine.

Clot Burden Score and Collateral Status and Their Impact on Functional Outcome in Acute Ischemic Stroke.

BACKGROUND AND PURPOSE: Collateral status and thrombus length have been independently associated with functional outcome in patients with acute ischemic stroke. It has been suggested that thrombus length would influence functional outcome via interaction with the collateral circulation. We investigated the individual and combined effects of thrombus length assessed by the clot burden score and collateral status assessed by a FLAIR vascular hyperintensity-ASPECTS rating system on functional outcome (mRS). MATERIALS AND METHODS: Patients with anterior circulation acute ischemic stroke due to large-vessel occlusion from the ASTER and THRACE trials treated with endovascular thrombectomy were pooled. The clot burden score and FLAIR vascular hyperintensity score were determined on MR imaging obtained before endovascular thrombectomy. Favorable outcome was defined as an mRS score of 0-2 at 90 days. Association of the clot burden score and the FLAIR vascular hyperintensity score with favorable outcome (individual effect and interaction) was examined using logistic regression models. RESULTS: Of the 326 patients treated by endovascular thrombectomy with both the clot burden score and FLAIR vascular hyperintensity assessment, favorable outcome was observed in 165 (51%). The rate of favorable outcome increased with clot burden score (smaller clots) and FLAIR vascular hyperintensity (better collaterals) values. The association between clot burden score and functional outcome was significantly modified by the FLAIR vascular hyperintensity score, and this association was stronger in patients with good collaterals, with an adjusted OR = 6.15 (95% CI, 1.03-36.81). CONCLUSIONS: The association between the clot burden score and functional outcome varied for different collateral scores. The FLAIR vascular hyperintensity score might be a valuable prognostic factor, especially when contrast-based vascular imaging is not available.

Tuberculosis meningoencefálica y espinal tras parto / Postpartum meningoencephalitis and spinal tuberculosis

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Reducción de la tasa de broncoaspiración con el test 2 volúmenes/3 texturas con pulsioximetría en una unidad de ictus / Lowering bronchoaspiration rate in an acute stroke unit by means of a 2 volume/3 texture dysphagia screening test with pulsioximetry

Introducción: En la fase aguda del ictus el 30% de los pacientes presentan disfagia, y de ellos, el 50% experimentarán broncoaspiración. Nuestro objetivo fue evaluar los resultados de mortalidad y broncoaspiración del test del agua comparado con el test 2 volúmenes/3 texturas controlado con pulsioximetría (2v/3t-P) en una unidad de ictus. Pacientes y métodos: Durante 5 años se analizaron de forma prospectiva y consecutiva todos los pacientes con infarto cerebral en la Unidad de Ictus. Del año 2008 al 2010 se utilizó el test del agua (grupo 0 o G0), y del 2011 al 2012, el test 2v/3t-P (grupo 1 o G1). Se recogieron las siguientes variables: demográficas, factores de riesgo vascular, gravedad neurológica con la escala NIHSS, subtipo etiológico según criterios TOAST, subtipo clínico según la clasificación Oxfordshire, prevalencia de disfagia, broncoaspiración y exitus. Resultados: Se analizaron 418 pacientes con infarto cerebral agudo (G0 = 275, G1 = 143). Se detectaron diferencias significativas entre ambos grupos en el porcentaje de pacientes con TACI (17% en G0 vs. 29% en G1, p = 0,005) y en la mediana de NIHSS (4 puntos en G0 vs. 7 puntos en G1, p = 0,003). Con el test 2v/3t-P se detectó un aumento no significativo en el porcentaje de disfagia (22% en G0 vs. 25% en G1, p = 0,4), una menor tasa de mortalidad (1,7% en G0 vs. 0,7% en G1, p = 0,3) y una reducción significativa de broncoaspiración (6,2% en G0 vs. 2,1% en G1, p = 0,05). Conclusiones: El nuevo test 2v/3t-P, comparado con el test del agua, mejoró significativamente los resultados de broncoaspiración en los pacientes con infarto cerebral agudo

Introduction: During acute stroke, 30% of all patients present dysphagia and 50% of that subgroup will experience bronchoaspiration. Our aim was to compare mortality and bronchoaspiration rates associated with the water test compared to those associated with a 2 volume/3 texture test controlled with pulse oximetry (2v/3t-P test) in our stroke unit. Patients and methods. Over a 5-year period, we performed a prospective analysis of all consecutive acute ischaemic stroke patients hospitalised in the Stroke Unit. Dysphagia was evaluated using the water test between 2008 and 2010 (group 0 or G0), and the 2v/3t-P test (group 1 or G1) between 2011 and 2012. We analysed demographic data, vascular risk factors, neurological deficit on the NIHSS, aetiological subtype according to TOAST criteria, clinical subtype according to the Oxfordshire classification, prevalence of dysphagia, percentage of patients with bronchoaspiration, and mortality. Results: We examined 418 patients with acute stroke (G0 = 275, G1 = 143). There were significant differences between the 2 groups regarding the percentage of patients with TACI (17% in G0 vs. 29% in G1, P = .005) and median NIHSS score (4 points in G0 vs. 7 points in G1, P = .003). Since adopting the new swallowing test, we detected a non-significant increase in the percentage of dysphagia (22% in G0 vs. 25% in G1, P = .4), lower mortality (1.7% in G0 vs. 0.7% in G1, P = .3) and a significant decrease in the bronchoaspiration rate (6.2% in G0 vs. 2.1% in G1, P = .05). Conclusions: Compared to the water test used for dysphagia screening, the new 2v/3t-P test lowered bronchoaspiration rates in acute stroke patients

Lowering bronchoaspiration rate in an acute stroke unit by means of a 2 volume/3 texture dysphagia screening test with pulsioximetry. / Reducción de la tasa de broncoaspiración con el test 2 volúmenes/3 texturas con pulsioximetría en una unidad de ictus.

INTRODUCTION: During acute stroke, 30% of all patients present dysphagia and 50% of that subgroup will experience bronchoaspiration. Our aim was to compare mortality and bronchoaspiration rates associated with the water test compared to those associated with a 2 volume/3 texture test controlled with pulse oximetry (2v/3t-P test) in our stroke unit. PATIENTS AND METHODS: Over a 5-year period, we performed a prospective analysis of all consecutive acute ischaemic stroke patients hospitalised in the Stroke Unit. Dysphagia was evaluated using the water test between 2008 and 2010 (group 0 or G0), and the 2v/3t-P test (group 1 or G1) between 2011 and 2012. We analysed demographic data, vascular risk factors, neurological deficit on the NIHSS, aetiological subtype according to TOAST criteria, clinical subtype according to the Oxfordshire classification, prevalence of dysphagia, percentage of patients with bronchoaspiration, and mortality. RESULTS: We examined 418 patients with acute stroke (G0=275, G1=143). There were significant differences between the 2 groups regarding the percentage of patients with TACI (17% in G0 vs. 29% in G1, P=.005) and median NIHSS score (4 points in G0 vs. 7 points in G1, P=.003). Since adopting the new swallowing test, we detected a non-significant increase in the percentage of dysphagia (22% in G0 vs. 25% in G1, P=.4), lower mortality (1.7% in G0 vs. 0.7% in G1, P=.3) and a significant decrease in the bronchoaspiration rate (6.2% in G0 vs. 2.1% in G1, P=.05). CONCLUSIONS: Compared to the water test used for dysphagia screening, the new 2v/3t-P test lowered bronchoaspiration rates in acute stroke patients.

[Trunk control test: early predictor of gait balance and capacity at 6 months of the stroke]. / Test de control de tronco: predictor precoz del equilibrio y capacidad de marcha a los 6 meses del ictus.

INTRODUCTION: It has been challenging to establish a prognostic tool in the acute period following stroke to predict gait outcomes. The purpose of this study is to determine the relationship between trunk control and other early functional prognostic measures with equilibrium and the capacity to ambulate at six months following acute stroke. METHODS: Sixty-eight patients with stoke admitted consecutively to the Physical Medicine and Rehabilitation unit were followed prospectively. At one and two weeks following admission, the following data were collected: sex, age, type of stroke, urinary incontinence, National Institutes of Health Stroke Scale (NIHSS) and the Trunk Control Test (TCT). At six months following acute stroke, balance was assessed with the Berg Balance score, baropodometry, and computerized posturography as well as gait capacity (measured as velocity and gait ability and limits) RESULTS: This study found a significant correlation between age, sex, urinary incontinence, TCT and NIHSS at one and two weeks from onset of stroke and the results of equilibrium and gait capacity at six months (p<0.05). When the TCT is <37 in the second week following acute stroke, the Berg Balance score was found to be lower, and with worse gait characteristics (<0.001). The TCT score in the second week is predictive of the achieving functional gait at the six month endpoint (area beneath the curve 0.920). CONCLUSIONS: The TCT is a simple and quick test which may be considered as an early prognostic indicator for functional motor endpoints in the patient with stroke.

Test de control de tronco: predictorprecoz del equilibrio y capacidadde marcha a los 6 meses del ictus / Trunk control test: early predictor of gait balance and capacity at 6 months of the stroke

Introducción. Es un reto difícil establecer en las fases inicialesun pronóstico de capacidad de marcha tras sufrir un ictus. El objetivode este estudio es determinar la relación del control de tronco yotros factores de pronóstico funcional evaluados precozmente con elequilibrio y la capacidad de marcha a los 6 meses.Métodos. Se estudian prospectivamente 68 pacientes consecutivosingresados en nuestro servicio de medicina física y rehabilitación. Ala semana y a las 2 semanas del ictus se recogen los siguientes datos:sexo, edad, tipo de ictus, incontinencia urinaria, NIHSS (National Institutesof Health Stroke Scale) y el test de control de tronco (TCT). A los 6meses del ictus se mide el equilibrio (escala de Berg, baropodometría yposturografía computarizada), así como la capacidad de marcha (velocidad,grado de autonomía y ámbito).Resultados. Existe una relación significativa de la edad, sexo, incontinenciaurinaria, TCT y NIHSS a la semana y a las 2 semanas del ictuscon el equilibrio y capacidad de marcha a los 6 meses (p<0,05).Cuando el TCT es <37 en la segunda semana del ictus, a los 6 meses elvalor de Berg es menor, y la autonomía y ámbito de marcha peor(<0,001). El TCT de la segunda semana del ictus es un predictor de conseguirmarcha funcional a los 6 meses (area bajo la curva ROC 0,920).Conclusiones. El TCT es un test sencillo y rápido que puede considerarsecomo un factor pronóstico precoz de función motora finalen el ictus (AU)

Introduction. It has been challenging to establish a prognostictool in the acute period following stroke to predict gaitoutcomes. The purpose of this study is to determine the relationshipbetween trunk control and other early functional prognosticmeasures with equilibrium and the capacity to ambulate atsix months following acute stroke.Methods. Sixty-eight patients with stoke admitted consecutivelyto the Physical Medicine and Rehabilitation unit were followedprospectively. At one and two weeks following admission,the following data were collected: sex, age, type of stroke, urinaryincontinence, National Institutes of Health Stroke Scale(NIHSS) and the Trunk Control Test (TCT). At six months followingacute stroke, balance was assessed with the Berg Balancescore, baropodometry, and computerized posturography as wellas gait capacity (measured as velocity and gait ability and limits)Results. This study found a significant correlation betweenage, sex, urinary incontinence, TCT and NIHSS at one and twoweeks from onset of stroke and the results of equilibrium andgait capacity at six months (p<0.05). When the TCT is <37 in thesecond week following acute stroke, the Berg Balance score wasfound to be lower, and with worse gait characteristics (< 0.001).The TCT score in the second week is predictive of the achievingfunctional gait at the six month endpoint (area beneath the curve0.920).Conclusions. The TCT is a simple and quick test which maybe considered as an early prognostic indicator for functional motorendpoints in the patient with stroke (AU)

[Renal failure stages as predictors of mortality following acute coronary syndrome]. / El grado de insuficiencia renal como predictor de mortalidad tras un síndrome coronario agudo.

INTRODUCTION: renal glomerular filtration rate on hospital admission in patients presented with an acute coronary syndrome as a predictor for mortality. PATIENTS AND METHODS: The study analysed 290 patients admitted on hospital with an acute coronary syndrome during one year (2003). Renal function was estimated using the renal glomerular filtration rate by the MDRD formula. Patients were stratified in three groups: patients with a GFR > or = 60 ml/min/1,73 m2; n = 186, patients with GFR < 60 or > 30; n = 93 and patients with GFR < 30; n = 11. RESULTS: 66.6% of patients were males and 66.5% were older than 65 years old. 54.5% suffered from hypertension and 39% were diabetics. All patients with GFR < 30 ml/min had an acute coronary syndrome without elevation of ST segment. They were the oldest with a major proportion of previous cardiovascular events as cerebrovascular disease, peripheral vascular disease or myocardial infarction. Diagnostic procedures and treatments were less administered in patients with GFR < 30 ml/min. Although in the univariate analysis demonstrated that hospital mortality was related to GFR < 30 ml/min, sex, ageing, Killip > 1, ventricular function and cTnT elevation, only GFR < 30 ml/min, ageing, heart failure and ventricular dysfunction persisted significant in the multivariate analysis. Hospital mortality was 27.3% in patients with GFR < 30 ml/min, 7.5% in patients with GFR between 30-60 ml/min and 3.8% in patients with a GFR > or = 60 ml/min. Mortality after two years follow up was 27.3% in patients with GFR < 30 ml/min, 20.4% in patients with GFR between 30-60 ml/min and 10.2% in patients with a GFR > or = 60 ml/min. Mortality (hospital mortality and after two years of follow up) was increased in patients with GFR< 30 ml/min, ageing, heart failure and diabetes after adjusted for other prognostic factors. CONCLUSIONS: A reduced glomerular filtration rate is an independent risk factor for mortality in patients with an acute coronary syndrome. Estimation of the renal glomerular filtration rate might be used as prognostic value in these patients.

Renal failure stages as predictors of mortality following acute coronary syndrome

Introducción: determinar el filtrado glomerular al ingreso como predictor de mortalidad tras un Síndrome Coronario Agudo (SCA). Pacientes y método: se analizaron 290 pacientes que ingresaron por SCA durante el año 2003. Se valoró la función renal al ingreso mediante la fórmula de estimación del Filtrado Glomerular (FG) MDRD. Se estratificaron en tres grupos: pacientes con FG ≥60 ml/min/1,73 m2; n = 186, pacientes con FG <60 y >_30; n = 93 y pacientes con FG <30; n = 11. Resultados: todos los pacientes con FG <30 ml/min presentaron un SCA sin elevación del segmento ST, los cuales eran de edad más avanzada con mayor prevalencia de eventos cardiovasculares previos (accidente vascular cerebral, de arteriopatía periférica, y de infarto de miocardio). La realización de pruebas diagnósticas fue menor. La mortalidad hospitalaria fue del 27,3% en los pacientes con FG <30 ml/min, 7,5% en los pacientes con FG entre 30 y 60 ml/min, y del 3,8% en los pacientes con FG ≥60 ml/min. Tras dos años de seguimiento, la mortalidad fue del 27,3% en los pacientes con FG <30 ml/min, del 20,4% en los pacientes con FG entre 30 y 60 ml/min, y del 10,2% con FG ≥60 ml/min. Al ajustar por otras variables pronósticas, los pacientes con FG <30 ml/min presentaron una mayor mortalidad tanto durante el ingreso como en el seguimiento a dos años. Conclusiones: la reducción del FG es un factor de riesgo independiente de mortalidad tras un SCA. El uso de las fórmulas de estimación del FG en el seguimiento de dichos pacientes tiene valor pronóstico (AU)

Introducción: determinar el filtrado glomerular al ingreso como predictor de mortalidad tras un Síndrome Coronario Agudo (SCA). Pacientes y método: se analizaron 290 pacientes que ingresaron por SCA durante el año 2003. Se valoró la función renal al ingreso mediante la fórmula de estimación del Filtrado Glomerular (FG) MDRD. Se estratificaron en tres grupos : pacientes con FG >_60 ml/min/1,73 m2; n = 186, pacientes con FG <60 y >_30; n = 93 y pacientes con FG <30; n =11. Resultados: todos los pacientes con FG <30 ml/min presentaron un SCA sin elevación del segmento ST, los cuales eran de edad más avanzada con mayor prevalenc ia de eventos cardiovasculares previos (accidente vascular cerebral , de arteriopatía periérica, y de infarto de miocardio) . La realización de pruebas diagnósticas fue menor. La mortalidad hospitalaria fue del27,3% en los pacientes con FG <30 ml/min, 7,5% en los pacientes con FG entre 30 y 60 ml /min, y del 3,8% en los pacientes con FG >_60 ml/min. Tras dos años de seguimiento, la mortalidad fue del 27,3% en los pacientes con FG <30 ml/min, del 20,4% en los pacientes con FG entre 30 y 60 ml /min, y del 10,2% con FG >_60ml /min. Al ajustar por otras variables pronósticas , los pacientes con FG <30 ml /min presentaron una mayor mortalidad tanto durante el ingreso como en el seguimiento a dos años . Conclusiones : la reducción del FG es un factor de riesgo independiente de mortalidad tras un SCA. El uso de las fórmulas de estimación del FG en el seguimiento de dichos pacientes tiene valor pronóstico (AU)

Calidad de vida en pacientes con amputación de extremidad inferior / Health-related quality of life in patients with lower limb amputations

Objetivos. Averiguar la calidad de vida percibida (CV) de los pacientes con amputación del miembro inferior. Conocer la relación entre factores funcionales, clínicos y sociales con la percepción de calidad de vida. Metodología.Se realiza estudio transversal en pacientes afectos de amputación de miembro inferior y que realizan controles periódicos en nuestro servicio. Las variables recogidas fueron: demográficas; sociales (convivencia, ingresos económicos, características del domicilio); clínicas: causas de amputación, lateralidad, tiempo medio de deambulación al día (TMD). Escalas de valoración funcional (Barthel y Houghton), escala de depresión de Yesavage (GDS), índice de comorbilidad de Charlson, escala cognitiva de Pfeiffer, escala de calidad de vida percibida Short Form-36 (SF-36) y valoración de estado de salud global medido con escala visual analógica (EVAsalud). Resultados. Se reclutaron un total 56 pacientes, con una edad media de 67 años. Sexo: 49 hombres y 7 mujeres. 41 unilaterales y 15 bilaterales. El 90 % de los pacientes estaban protetizados. La mediana de Houghton fue 8; Barthel 90, GDS 2, Charslon 3, Pfiffer 0, EVAsalud 63,5. Los resultados del cuestionario SF-36 fueron inferiores a la media observada en la población general, agrupados por edad. La media del componente resumen físico SF-36 fue 36,7 y del componente resumen mental 45. Se establecieron correlaciones moderadas pero significativas del SF-36 con Barthel; TMD; GDS; Charlson; Pfeiffer y características del domicilio. Conclusiones. La calidad de vida percibida de nuestra muestra es inferior a la de la población no amputada y se ve influida por factores demográficos, clínicos y sociales

Aim. This study aimed to assess health-related quality of life (HRQOL) in patients with lower limb amputation (LLA). The relationship between HRQOL and demographic, clínical, social and functional evaluation was also studied. Methods. Observational study. A cross-sectional study was conducted in patients with lower-limb amputation who had periodic controls in our service. The variables collected were demographic, social (living arrangement, income, home characteristics), clínical: causes of amputation, laterality, mean time of deambulation/day (Tdd); functional assessment scales (Barthel score and Houghton); Yesavage's Geriatric depression scale (GDS), Charlson Comorbidity index; Pfeiffer Cognitive scale, Quality of life. Short Form-36 (SF-36) and subjective score of health (visual analogical score of health; Health-VAS). Results. A total of 56 in-patients were enrolled. They had a mean age of 67 years. Gender: 49 men, 7 women; 41 were unilateral and 15 bilateral lower limb amputation. Ninety percent of the patients had prosthetic fitting. The mean Houghton values was 8, Barthel 90, GDS 2, Charlson 3, Pfiffer 0, Health-VAS 63,5. Mean physical components score SF-36 was 36,7 and mental components score 45. The quality of life correlated significantly with Barthel, Tdd, GDS, Charlson, Pfiffer and home living circumstances. Conclusions. HRQOL scores in subjects with LLA are lower than those observed in the general population. The HRQOL values are related to clinical, functional and demographic circumstances

Experiencia en el uso de prótesis vasculares de poliuretanurea tipo Vectra en una unidad de hemodiálisis / Use of vascular polyurethane-urea prosthesis of the of the vectra type in a hemodialysis unit

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[Short form 36 health questionnaire in hemiplegic patients 2 years after stroke]. / Cuestionario de salud Short Form 36 en pacientes hemipléjicos a los 2 años postictus.

INTRODUCTION: Many studies show that subjects with sequelae after stroke have a worse health perception in western societies. Due to the shortage of papers on the Spanish population in this regard, a study was carried out to assess health perception in hemiplegic patients 2 years after stroke in comparison with that of the general population and correlate health perception with demographic, clinical and functional variables. METHODS: Cross-sectional study of 212 community stroke survivors. The main variables collected were: health perception assessed with the Short Form 36 (SF-36), disability assessed with the motor Functional Independence Measure (FIM) and Geriatric Depression Scale (GDS). Statistical tests used: chi2, Student t test and Spearman correlation coefficient. RESULTS: In comparison with the Spanish general population, health perception in hemiplegic male stroke patients is diminished in all areas. In hemiplegic female patients, physical function is the only subscale significantly affected in all age groups. Variables related to worse health perception are: presence of depression, dependence and the belief of the need for kind of social support, A significant correlation was observed between SF-36 values and the motor FIM (r = 0.737 with physical function) and the GDS (r = -0.821 with mental health). CONCLUSIONS: Health perception in hemiplegic patients 2 years after stroke is diminished in comparison with that 348 of the general population. Factors which determine worst health perception are depression, motor dependence, need of caregiver assistance and need of social support.

Short form 36 health questionnaire in hemiplegic patients 2 years after stroke / Cuestionario de salud Short Form 36 en pacientes hemipléjicos a los 2 años postictus

Introduction: Many studies show that subjects with sequelae after stroke have a worse health perception in western societies. Due to the shortage of papers on the Spanish population in this regard, a study was carried out to assess health perception in hemiplegic patients 2 years after stroke in comparison with that of the general population and correlate health perception with demographic, clinical and functional variables. Methods: Cross-sectional study of 212 community stroke survivors. The main variables collected were: health perception assessed with the Short Form 36 (SF-36), disability assessed with the motor Functional Independence Measure (FIM) and Geriatric Depression Scale (GDS). Statistical tests used: chi2, Student t test and Spearman correlation coefficient. Results: In comparison with the Spanish general population, health perception in hemiplegic male stroke patients is diminished in all areas. In hemiplegic female patients, physical function is the only subscale significantly affected in all age groups. Variables related to worse health perception are: presence of depression, dependence and the belief of the need for kind of social support, A significant correlation was observed between SF-36 values and the motor FIM (r = 0.737 with physical function) and the GDS (r = -0.821 with mental health). Conclusions: Health perception in hemiplegic patients 2 years after stroke is diminished in comparison with that 348 of the general population. Factors which determine worst health perception are depression, motor dependence, need of caregiver assistance and need of social support (AU)

Introducción. Diferentes estudios señalan la afectación de la salud percibida de individuos con secuelas por enfermedad cerebrovascular en sociedades anglosajonas. Dada la escasez de trabajos en la población española, se diseña un estudio cuyo principal objetivo es comparar la salud percibida de pacientes con hemiplejía a los 2 años postictus respecto a la población general y relacionarla con variables demográficas, clínicas y funcionales. Métodos. Estudio transversal de 212 pacientes no institucionalizados. Principales variables recogidas: la percepción de salud medida con el cuestionario Short Form 36 (SF-36), la medida de la independencia funcional (FIM) motora y la Escala de depresión geriátrica (GDS). La pruebas estadísticas utilizadas fueron: Ç2, t de Student y el coeficiente de correlación de Spearman. Resultados. La percepción de salud de los hombres con hemiplejía postictus se encuentra disminuida en prácticamente todas las subescalas del SF-36 respecto a la población general. En las mujeres hemipléjicas la función física es la única subescala que se encuentra disminuida de manera significativa en todos los grupos de edad. Las variables que determinan una mayor afectación de la percepción de salud son: la presencia de depresión, la dependencia de tercera persona y el manifestar la necesidad de ayuda social. Existe una correlación significativa del SF-36 con la FIM motora (r = 0,737 para la función física) y con la GDS (r = -0,821 para la salud mental). Conclusiones. La percepción de salud de los pacientes hemipléjicos a los 2 años postictus se encuentra disminuida respecto a la población general española. Los factores que determinan una mayor afectación son la depresión, la dependencia de tercera persona en las áreas de función motora y el manifestar la necesidad de ayuda social (AU)

[Peritoneal implants in patients affected by chronic renal failure in hemodialysis programme]. / Implantes peritoneales en pacientes con insuficiencia renal crónica en programa de hemodiálisis.

The presence of peritoneal implants detected by computered axial tomography (CT) is usually related to mesothelial primary neoformative processes or, more frequently to peritoneal metastasis or peritoneal carcinomatosis. Although the higher prevalence of neoplastic processes in the chronic renal failure population, the association of peritoneal implants and constitutional syndrome is not always correlated to peritoneal carcinomatosis. We present the case of two patients with chronic renal failure in hemodialysis programme, with abdominal insidious clinical, constitutional syndrome and similar peritoneal implants seen by CAT: the histologic analysis of peritoneal implants gave the definitive diagnostic of secondary amyloidosis and peritoneal tuberculosis respectively.

Implantes peritoneales en pacientes con insuficiencia renal crónica en programa dehemodiálisis / Peritoneal implants in patients affected by chronic renal failure in hemodialysis programme

La presencia de implantes peritoneales detectados por tomografía axial computerizada(TAC) suele estar asociada a procesos neoformativos primarios del mesotelioo, más frecuentemente, a metástasis peritoneales o carcinomatosis peritoneal.A pesar de la mayor prevalencia de procesos neoplásicos en la poblaciónafecta de insuficiencia renal crónica, la asociación de implantes peritoneales y síndromeconstitucional no siempre se correlaciona con carcinomatosis peritoneal.Presentamos dos pacientes con insuficiencia renal crónica en programa de hemodiálisis,con clínica insidiosa abdominal, síndrome constitucional e implantesperitoneales de similares características visualizados por TAC. El análisis histológicode los implantes peritoneales permitió el diagnóstico definitivo de amiloidosissecundaria y tuberculosis peritoneal respectivamente

The presence of peritoneal implants detected by computered axial tomography(CT) is usually related to mesothelial primary neoformative processes or, more frequentlyto peritoneal metastasis or peritoneal carcinomatosis. Although the higherprevalence of neoplastic processes in the chronic renal failure population, the associationof peritoneal implants and constitutional syndrome is not always correlatedto peritoneal carcinomatosis. We present the case of two patients with chronicrenal failure in hemodialysis programme, with abdominal insidious clinical,constitutional syndrome and similar peritoneal implants seen by CAT: the histologicanalysis of peritoneal implants gave the definitive diagnostic of secondary amyloidosisand peritoneal tuberculosis respectively