La tomografía computarizada helicoidal sin contraste en comparación con la ecografía y la radiografía simple de abdomen en el estudio del paciente con dolor lumbar agudo / Comparision of unenhanced helical computed tomography with ultrasoun and abdominal plain radiography in patients with acute flank pain

FUNDAMENTO: El objetivo del presente estudio es evaluar la eficacia diagnóstica de la tomografía computarizada helicoidal no contrastada (TCHNC) en el diagnóstico del dolor lumbar agudo. MÉTODOS: Se trata de un estudio prospectivo en el que se evalúan 82 pacientes adultos que consultaron por dolor lumbar agudo entre enero de 1999 y junio de 2000. Se realizó radiografía simple de abdomen en 78 casos, ecografía abdominal en 73, y TCHNC en 46 pacientes. RESULTADOS: La radiografía simple detectó el 49,1 por ciento de las litiasis existentes. La ecografía mostró una sensibilidad para la localización de la litiasis del 48%, y una especificidad del 96%. La TCHNC mostró una sensibilidad del 100% y especificidad del 84% en el diagnóstico de la litiasis, permitiendo además el diagnóstico de otras patologías en 11 casos. CONCLUSIONES: La TCHNC es una técnica radiológica muy eficaz en el diagnóstico del dolor lumbar agudo. En nuestro centro la consideramos la técnica de elección en la evaluación inicial de los pacientes que consultan por dolor lumbar agudo al permitir, no sólo la localización de la litiasis urinaria cuando se trate de esta etiología, sino que además diagnosticar otras patologías abdominopélvicas (AU)

[Contrast-free helical computerized tomography compared with ultrasonography and simple abdominal radiography in the study of patients with acute lumbar pain]. / La tomografía computarizada helicoidal sin contraste en comparación con la ecografía y la radiografía simple de abdomen en el estudio del paciente con dolor lumbar agudo.

OBJECTIVE: Evaluation the diagnostic ability of unenhanced helical computed tomography in the evaluation of patients with acute flank pain. PATIENTS AND METHODS: Prospectively evaluation of 82 patients referred for acute flank pain between january 1999 and june 2000. 78 patients were imaged with, 73 abdominal ultrasound and 46 with TCHNC. RESULTS: Plain radiography shows 49.1% of diagnosed lithiasis. Ultrasound was 48% sensitive and 96% specific. TCHNC was 100% sensitive and 84% specific in the diagnosis of lithiasis, allowing in 11 patients a diagnosis unrelated to stone disease. CONCLUSIONS: TCHNC is a valuable radiologic technique for patients presenting with acute flank pain and consider the TCHNC as initial evaluation technique in patients with acute flank pain, allowing not only the localization of the stone as well as the diagnosis of extraurinary pathologies.

Effect of smoking on sudden and premature death.

BACKGROUND: Smoking has been related to coronary heart disease, and, in men, to sudden death. The results of a case-control study designed to assess the relationship between smoking and all causes of sudden and premature death are reported. METHODS: A questionnaire on the previous history and causes of death of all people buried in the Municipal Cemetery of Valencia (1986-1987) was administered to the relatives of the deceased. Among 4718 deaths, 284 victims of sudden death were identified, and 495 people who had not died suddenly were randomly sampled as controls. RESULTS: The proportion of smokers among the women studied was extremely low in contrast to 58.9% of men in the sudden death study group and 59.2% of men in the non-sudden death study group who smoked. Smokers died on average 10 years younger than non-smokers in the sudden-death group (63.3 +/- 12.3 and 73.3 +/- 11.0 years respectively; P < 0.001), and 8 years earlier in the non-sudden death group (68.5 +/- 13.3 and 76.8 +/- 13.2 years, respectively; P < 0.001). A logistic regression model showed that smokers had an adjusted relative risk of 0.81 for sudden death compared with non-smokers (95% confidence interval [CI]: 0.45-1.46). Smokers 65 years of age or under had a 2.7 times greater risk (95% CI: 1.49-5.04) of premature death than non-smokers. Similar results were found in patients from the coronary- and cardiac-death subgroups. CONCLUSIONS: Smoking is an independent risk factor for premature death but not for sudden death.

[Peripheral vascular reflexes during ventricular overdriving and cardiac ischemia. An experimental study]. / Reflejos vasculares periféricos durante sobreestimulación ventricular e isquemia cardíaca. Estudio experimental.

The aim of this paper is to analyze the behaviour of the muscular arteries during ventricular tachycardia in normal and in ischemic hearts. In 19/30 anaesthetized dogs in which a resistance vessel (gracilis muscle artery) was isolated (while innervation and venous backflow remained intact), we performed transient (20 min) coronary artery occlusions and ventricular overdriving (30 sec). A systolic left ventricular pressure decrease (144.2 +/- 18.2 mmHg vs 114 +/- 16.1) (p < 0.001) was produced with the coronary circumflex obstruction. Changes in the end-diastolic left ventricular pressure and muscular artery pressure were not significant. A new systolic left ventricular pressure decrease (114 +/- 16.1 mmHg vs 64.8 +/- 27) (p < 0.001) was induced when the ventricular overdriving (272.2 +/- 46.1 bpm) was added to the coronary circumflex obstruction. The end-diastolic left ventricular pressure increased (6.8 +/- 10.1 mmHg vs 18.3 +/- 4.8) (p < 0.001) and the muscular artery pressure increased (121 +/- 27.3 mmHg vs 158.1 +/- 21.3) (p < 0.01) in these circumstances. When the ventricular overdriving (275 +/- 70.7 bpm) was added to the left descendent anterior coronary occlusion a significative decrease of left systolic ventricular pressure (141 +/- 23 mmHg vs 84.4 +/- 28.4) (p < 0.01) and an increase of the muscular artery pressure (124.3 +/- 25 mmHg vs 149 +/- 25.1) (p < 0.01) was produced. Ventricular overdriving-induced hypotension produced an isolated muscular artery response with clear vasoconstrictor predominance, which indicates that there is a natural compensatory capacity with predominance of efferent sympathetic activity.(ABSTRACT TRUNCATED AT 250 WORDS)

[Peripheral vascular reflexes in obstructions of the left ventricular outflow tract. Experimental study]. / Reflejos vasculares periféricos en las obstrucciones del tracto de salida del ventrículo izquierdo. Estudio experimental.

UNLABELLED: The aim of this work is to analyze the vascular tone behaviour of the muscular arteries in relation to the reflexes generated during aortic root obstruction when spontaneous heart rate is permitted and also with induced tachycardia. An experimental model used involved anaesthetized and intubated dogs in which a resistance vessel (gracilis muscle artery) was isolated, while innervation and venous backflow remained intact. Moderate (54.4 +/- 23.2 mmHg of mean increase in left ventricular pressure) and severe (240.1 +/- 92.5 mmHg) aortic obstructions for 30 s were provoked during spontaneous heart rate (n = 15) and during ventricular overdriving (n = 13) at 200, 250 and 300 bpm for 30 s. Ventricular overdriving at 200, 250, 300 and 400 bpm for 30 s without aortic root obstruction was induced in 20 dogs. Ventricular overdriving in intact hearts produced an initial decrease in the isolated muscular artery pressure of 12.0 +/- 7.2 mmHg (p < 0.01), 9.5 +/- 5.7 mmHg (p < 0.001), 13.6 +/- 8.6 mmHg (p < 0.001) and 14.3 +/- 8.7 mmHg (p < 0.01) at 200, 250, 300 and 400 bpm respectively followed by a recovery, so that at the end of overdriving (30 s), exceeded basal values in 11.9 +/- 10.0 mmHg (p < 0.05), 21.1 +/- 12.4 mmHg (p < 0.001), 21.9 +/- 10.4 mmHg (p < 0.001) and 36.1 +/- 21.3 mmHg (p < 0.001) for each overdriving rate respectively. Aortic obstruction during spontaneous heart rate produced and initial decrease in the isolated muscular artery pressure of 12.0 +/- 7.3 mmHg (p < 0.01), when the aortic obstruction were moderate, and 31.4 +/- 15.7 mmHg (p < 0.01) when the obstructions were severe, followed by a recovery of its basal values at the end of the obstruction time. Ventricular overdriving with aortic root obstruction did not produced significant changes in the isolated muscular artery pressure except in the highest rates of overdriving, that produced an increase of isolated muscular artery pressure of 23.9 +/- 16.2 mmHg (p < 0.01). IN CONCLUSION: ventricular overdriving-induced hypotension in intact hearts produces an isolated muscular artery response with clear vasoconstrictor predominance. Aortic obstruction-induced hypotension does not produce a vasoconstrictor response in the isolated muscular artery but rather an initial vasodilation response which does not revert to vasoconstriction at any point during the hypotensive process. Overdriving was not capable of inducing a peripheral vasoconstriction in presence of aortic root obstruction except in the highest rates of overdriving.