Hierarchical nomenclature in rheumatology. / Nomenclátor jerarquizado en reumatología.

INTRODUCTION: One of the missions of the Spanish Society of Rheumatology is to provide the necessary tools for excellence in health care. Currently, there is no reference point to quantify medical actions in this specialty, and this is imperative. MATERIAL AND METHOD: A list of actions was drawn up and a hierarchical classification system was established by developing a complexity index, calculated based on the completion time and difficulty level of each action. RESULTS: The results of the Delphi method tended to the consensus opinion within a group (mean σ2 - σ1=0.75-1.43=-0.68, mean IQR2 - IQR1=0.8-1.9=-1.1). The values of the complexity index ranged between 48 and 465 points. Among consultation actions, those reaching the highest scores were the first inpatient visit (366) and visits to the patient's home (369). Among diagnostic techniques, biopsies were prominent, those with the highest score were: bone biopsy (465), sural nerve biopsy (416) and synovial biopsy (380). Ultrasound scan scored 204, capillaroscopy 113 and densitometry 112. Among therapeutic techniques, infiltration/ arthrocentesis/articular injection in children reached the highest difficulty (388). The score for ultrasound-guided articular injection was 163. The score for clinical report on disability was 323 and expert report 370. CONCLUSIONS: A nomenclature of 54 actions in Rheumatology was compiled. Biopsies (bone, sural nerve, synovial), inpatient visits, visits to the patient's home, infiltrations in children, and the preparation of the expert report were identified as the most complex actions. Musculoskeletal ultrasound is twice as complex as subsequent visits, capillaroscopy or bone densitometry.

Intermittent versus continuous androgen deprivation therapy to biochemical recurrence after external beam radiotherapy: a phase 3 GICOR study

Purpose. We compared biochemical control and quality of life with intermittent (6 months) versus continuous (36 months) androgen deprivation therapy (ADT) in a non-inferiority randomized phase 3 trial in patients with biochemical failure (BF) after external beam radical radiotherapy (EBRT). Materials and methods. Patients were stratified according to the Gleason score (GS) and were classified as low risk with a GS < 6 and 7 (3 + 4) and high risk with a GS of 7 (4 + 3) and >7. Patients were followed with PSA determinations and quality-of-life assessments (QLQ C-30 and QLQ PR-25) every 6 months for a period of 3 years. BF after radiation was defined as a PSA level of nadir +2 ng/ml. Disease progression (DP) after ADT was defined as PSA ≥4 ng/ml (BF) and/or metastases. Results. Seventy-seven patients were included in this multicenter phase 3 trial from 2005 to 2009. Thirty-eight and 39 patients were included in the intermittent and continuous groups, respectively. The median follow-up for both groups was 48 months (40-68). DP after ADT in the intermittent group was seen in three patients (distant metastases in one patient) versus 0 in the continuous group. The QLQ-C30 and QLQ PR-25 scores did not show any statistically difference between the two ADT groups. Conclusions. No significant differences were seen in DP and QLQ between intermittent (6 months) and continuous (36 months) ADT in patients with BF after EBRT (AU)

No disponible

Análise da nova classificação de laudos de densitometria óssea / Analysis of the new classification of bone densitometry reports

OBJETIVO: Comparar a nova normatização de laudos densitométricos de coluna lombar proposta pela International Society for Clinical Densitometry (ISCD) em 2005 com a classificação rotineiramente usada da Organização Mundial da Saúde (OMS) desde 1994. MATERIAIS E MÉTODOS: Foram analisados 200 exames de densitometria óssea da coluna lombar realizados na Universidade Católica de Brasília e no Hospital das Forças Armadas. Os critérios de inclusão foram: sexo feminino, idade mínima de 20 anos e máxima de 49 anos, e ausência de alterações morfológicas na coluna lombar visualizadas no exame densitométrico. Como critério de exclusão, foram consideradas as mulheres com mais de 50 anos ou em menopausa. RESULTADOS: Pela classificação da OMS, obtivemos 29 pacientes com osteoporose na coluna lombar, 76 com osteopenia e 95 em níveis de normalidade. Entretanto, pela nova classificação da ISCD 2005, apenas 32 pacientes foram classificados em valores "abaixo do estimado para a faixa etária" e 162, em valores "dentro do estimado para a faixa etária". CONCLUSÃO: Importante diferença foi encontrada na classificação dos resultados densitométricos ao se confrontar a classificação tradicional da OMS e a nova classificação proposta pela ISCD, o que ressalta a importância da divulgação da classificação entre os médicos que realizam e os que solicitam os exames, para a correta interpretação, explicação e orientação ao paciente.

OBJECTIVE: To compare the new normatization of bone densitometry reports on findings at the level of the lumbar spine (L1-L4) proposed by International Society for Clinical Densitometry (ISCD) in 2005, with the classification of World Health Organization (WHO) that was routinely been utilized since 1994. MATERIALS AND METHODS: Bone densitometry studies performed on the lumbar spine of 200 patients at Universidade Católica de Brasília and Hospital das Forças Armadas, Brasília, DF, Brazil, have been evaluated. Inclusion criteria were: female gender, age ranging between 20 and 49 years, and absence of spine morphological changes visualized on the images. The exclusion criteria were: women more than 50 years or menopausal women. RESULTS: Analyzing the bone densitometry reports under the WHO classification, 29 patients were found with osteoporosis, 76 with osteopenia and 95 within normality levels. On the other hand, according to the new ISCD 2005 classification, only 32 patients presented results "below the expected range for age", and 162 "within the expected range for age". CONCLUSION: Significant differences were found when comparing the traditional WHO densitometric classification versus the new one proposed by ISCD 2005. So, this new classification should be known and understood by physicians who request or perform bone densitometry studies, aiming at the correct interpretation, explanation and orientation to the patients.

Valores de contenido mineral óseo (CMO), densidad mineral ósea (DMO) y densidad mineral ósea volumétrica (DMOv) en niños y adolescentes a nivel de la columna lumbar y femoral / Bone mineral conten (BMC), bone mineral density (BMD) and volumetric bone mineral density (vBMD) values in children and adolescents in the lumbar spine and femoral

No disponible

Neuronal network analysis of serum electrophoresis.

AIMS: To advise a system of neuronal networks which can classify the densitometric patterns of serum electrophoresis. METHODS: Digitised data containing 83 normal and 132 pathological serum protein electrophoresis patterns were presented to four neuronal networks containing 1900 neurons. Network 1 evaluates the integrated values of the albumin, alpha 1, alpha 2, beta and gamma fractions together with total protein (Biuret method). Networks 2, 3, and 4 analyse the shape of the albumin, beta and gamma fractions. To increase the sensitivity for the detection of monoclonal gammopathies a Fourier transformation was applied to the beta and gamma fractions. RESULTS: After a learning period of 20 minutes (back-propagation learning algorithm) the system was tested with a set of electrophoresis patterns comprising 446 routinely collected samples. It differentiated between physiological and pathological curves with a sensitivity of 97.5% and a specificity of 98.8%, with 86% correct diagnoses. All monoclonal gammopathies were recognised by the Fourier detector. CONCLUSIONS: Neuronal networks could be useful for certain medical uses. Unlike rule based systems, neuronal networks do not have to be programmed but have the capacity to "learn" quickly.