Calcium and phosphorus metabolism and lithogenic factors in patients with osteoporotic fracture.

OBJECTIVES: To demonstrate the attendance of mineral metabolism disorders and lithogenic factors in patients' urine with osteoporotic fracture without previously known stones MATERIAL AND METHODS: 67 patients with osteoporotic fractures surgically treated in trauma service are included. The area of the fracture site, fracture mechanism and the presence of osteoporosis were the factors taken into account to diagnose osteoporotic fracture. Mineral metabolism, calciuria, oxaluria, uricosuria and citraturia in 24hours urine were analyzed. The presence of abnormal calcium and phosphorus metabolism was proved comparing hypercalciuria patients with normocalciuria ones. RESULTS: 12 men and 55 women with mean age 68.8±14.5 years old were included. Mean Body Mass Index (BMI) was 27.4±4.1kg/m2. 42% of patients showed hypercalciuria, 34% hyperoxaluria, 34% hypocitraturia and 7% hyperuricosuria. Statistically significant differences were observed only in fasting calcium/creatinine ratio (0.17 vs. 0.08; P<.0001) when comparing patients with hypercalciuria with those with normocalciuria. CONCLUSIONS: Patients with osteoporotic fractures show different lithogenic factors in urine, mainly hypercalciuria, always in fasting conditions.

Réplica a los comentarios al artículo "Uso del videolaringoscopio de Mcgraft junto con la guía frova en el manejo de la vía aérea difícil" / No disponible

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Comentarios al artículo "Sedación con sevoflurano para resonancia magnética en pediátría: estudio clínico retrospectivo de 5.864 casos" / No disponible

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Rendimiento cognitivo y percepción de problemas de memoria en pacientes con dolor crónico: con fibromialgia versus sin fibromialgia / Cognitive performance and memory complaints in chronic pain patients: with fibromyalgia versus without fibromyalgia

Objetivos: 1) Comparar la percepción de problemas de memoria y el rendimiento cognitivo (memoria verbal, atención concentrada, rapidez de procesamiento) en pacientes con y sin diagnóstico de fibromialgia. 2) Comparar estos mismos procesos entre pacientes con fibromialgia primaria y pacientes con fibromialgia concomitante a otras patologías de dolor crónico. Sujetos: Ciento diez pacientes de sexo femenino [21-64 años].Edad 47.6 años. 68 pacientes con fibromialgia [28 fibromialgia primaria, 40 fibromialgia concomitante con otras patologías de dolor] y 42 pacientes con otros diagnósticos de dolor crónico. Material y método: El examen neuropsicológico se realizó de forma individual. Los problemas de memoria se evaluaron con el Cuestionario de Fallos de Memoria en la Vida Cotidiana (MFE), la memoria con el Test de Aprendizaje Verbal (TAVEC), las aptitudes perceptivas y de atención con el Test Toulouse-Piéron (TP) y la rapidez de procesamiento e interferencia con el Test de Colores y Palabras (STROOP). También se aplicó la Escala de Ansiedad y Depresión (HADS). Resultados: No hubo diferencias entre los distintos grupos en duración e intensidad del dolor, nivel de estudios o tipo de ocupación. No se encontraron diferencias significativas entre pacientes con y sin fibromialgia en ninguna de las sub-escalas de los tests TAVEC, TP y STROOP. Tampoco en la sub-escala ansiedad del HADS. Por el contrario, sí hubo diferencias entre pacientes con y sin fibromialgia en percepción de problemas de memoria (MFE-FBM=100,4; MFE-No FBM=77.9;F (1,106)=7,754, p<0,007) y depresión (Dep FBM=9,54; DepNoFBM=6,61; F(1,106)=9,770, p<0.002). Entre pacientes con fibromialgia primaria y fibromialgia concomitante con otras patologías de dolor no hubo ningún tipo de diferencia. La depresión demostró ser una variable relacionada con el rendimiento en memoria verbal y atención concentrada. También con la percepción de problemas de memoria (...) (AU)

Aims: 1) To compare memory complaints and cognitive performance (verbal memory, attention and information processing) in chronic pain patients with and without fibromyalgia. 2) To compare those processes in patients with primary fibromyalgia and concomitant fibromyalgia. Subjects: One hundred and ten female patients [21-64 years old].Mean age 47.6 years. 68 patients with fibromyalgia [28 with primary fibromyalgia, 40 with concomitant fibromyalgia] and42 with others chronic pain conditions. Material and methods: Neuropsychological tests were individually performed. Memory complaints were assessed with the Memory Failures in Everyday Memory (MFE), memory with the Verbal Learning Test (TAVEC), attention and perceptual skills with the Toulouse-Piéron Test (TP) and interference with the Stroop Color and Word Test (STROOP). The Hospital Anxiety and Depression Scale (HADS) was also applied. Results: No differences were obtained between groups in duration of pain, pain intensity, educational level and work occupation. Neither difference was obtained between patients with fibromyalgia and without fibromyalgia in TAVEC, TP, STROOP and anxiety scale of the HADS. At the contrary, significant differences were obtained in memory complaints (MFEFBM=100.4; MFE-No FBM=77.9; F (1,106)=7,754, p<0,007) and depression (Dep FBM=9,54; Dep NoFBM=6,61;F (1,106)=9,770, p<0.002). No differences were obtained between patients with primary fibromyalgia and concomitant fibromyalgia. Depression was a significant variable related to performance in verbal memory and attention (...) (AU)

La escala de dolor BS-21: datos preliminares sobre su fiabilidad y validez para evaluar la intensidad del dolor en geriatría / BS-21 Pain scale: preliminary data regarding reliability and validity for the evaluation of pain in Geriatrics

Objetivos: Los objetivos de este estudio eran: 1) determinar las principales propiedades psicométricas de la BS-21 en una muestra española de pacientes geriátricos hospitalizados y 2) comparar el grado de preferencia de la BS-21 en relación a otra escala ampliamente utilizada en la evaluación de la intensidad del dolor en ancianos, la PPI del cuestionario de dolor de McGill. Material y métodos: Para cada una de las escalas se evaluó el número relativo de errores cometidos al responderla y se contrastaron los índices de fiabilidad intra-clase, así como los índices de validez convergente y de constructo. También se evaluó el grado de preferencia ante cada una de las escalas. En este estudio participaron 112 ancianos con dolor crónico, que estaban ingresados en un hospital socio-sanitario (media de edad: 76.9 años). Se evaluó la intensidad del dolor mediante las escalas BS-21 y PPI en dos momentos del día (mañana y tarde) y por un período de siete días consecutivos. Cada tarde, además del dolor de ese momento, también se solicitaba una valoración retrospectiva de la intensidad máxima, mínima y usual del dolor padecido en ese día y en el séptimo día, de todo el período semanal. Resultados: Al comparar los resultados de la BS-21 con los obtenidos mediante la McGill-PPI, se aprecia que los valores de la BS-21 son más consistentes en fiabilidad intra-clase y en validez de constructo. Tanto la carga factorial del constructo “intensidad de dolor” como el grado de correlación entre valores retrospectivos de dolor y el total de las puntuaciones actuales de dolor son mayores en la BS-21. Este resultado se mantiene tanto en el grupo de pacientes que presentan deterioro cognitivo, como en el de pacientes sin déficit cognitivo. En cuanto a la validez convergente, la correlación entre las escalas McGill-PPI y BS-21 es significativa. Por el contrario, los pacientes realizan un mayor número de errores con la escala BS-21 (p<0.0001) y es la menos preferida por los pacientes que participaron en el estudio (p<0.0001). Conclusiones A la luz de los datos recogidos, cabe considerar que la BS-21 es una escala fiable y válida para evaluar la intensidad del dolor, también en ancianos de habla española, incluso en aquellos que presentan deterioro cognitivo leve o moderado. No obstante, son necesarios más estudios antes de recomendar su utilización sistemática en la práctica clínica (AU)

Objectives: The aims of this study were: 1) to determine the main psy-chometric properties of the BS-21 in a sample of Spanish hospitalised elderly patients, and 2) to compare the grade of preference of the BS-21 in relation to another pain intensity rating scale widely used in older adults, the PPI of the McGill Pain Questionnaire. Methods: The relative rate of incorrect responses, intraclass reliability, convergent validity, construct validity and grade of preference for each scale were evaluated. 112 older adults (mean age 76.9 years) with chronic pain, living in long term care facilities, participated in this study. Patients assessed current pain intensity with the BS-21 and the PPI twice a day for a period of seven consecutive days. In the afternoon, they also made a retrospective daily and weekly ratings of the worse, least and usual pain level. Results: Our results indicate that the BS-21 has a better intraclass reliability and construct validity, when compared to the BS-21. Moreover factor loading of the “pain intensity” construct, as well as the correlation between retrospective and actual pain ratings of pain are higher for the BS-21. On the other hand, the correlation between the scales is significant, suggesting a good convergent validity valué. The results in this study also show that the rate of incorrect responding was higher with the BS-21 (p<0.0001). The BS-21 is the less preferred scale by the participating patients (p<0.0001). Conclusions: The BS-21 seems to be a valid and reliable scale to measure the intensity of pain in Spanish speaking elderly individuáis, even with those with low or modérate cognitive impairment. However, more studies are needed to recommend the systematic use of the BS-21 in clinic practice (AU)

Comparison between lecture-based approach and case/problem-based learning discussion for teaching pre-anaesthetic assessment.

BACKGROUND AND OBJECTIVE: The case/problem-based learning discussion method was recently introduced into the theory-based training program for residents run by the Catalan Society of Anaesthesiology. This study was designed to assess and compare its effectiveness with that of the lecture-based approach for teaching pre-anaesthetic assessment, applying an objective tool for knowledge evaluation before and after teaching. METHODS: A prospective randomized study of two consecutive year groups of first year anaesthesiology residents was conducted. Twenty-nine residents attended a lecture, and 25, a case/problem-based learning discussion session. Their knowledge of pre-anaesthetic assessment was assessed before and after the teaching session with tests on four different clinical cases measuring six fields: (1) 'recognizing clinical data with anaesthetic implications'; (2) 'reasoning clinical data with anaesthetic implications'; (3) 'ASA class'; (4) 'Mallampati class'; (5) 'choice of anaesthetic technique'; (6) 'reasoning choice of anaesthetic technique'. RESULTS: Before the teaching session, the lecture group scored significantly higher on field 1 (P = 0.006). Both teaching methods improved scores on fields 1, 2 and 4. The case/problem group also improved on fields 3 and 6. After the teaching session, the field 1 score was still significantly higher in the lecture group (P = 0.005), and the field 3 score was significantly higher in the case/problem group (P = 0.044). CONCLUSIONS: The effectiveness of lecture and case/problem-based learning discussion differed little in terms of improving participants' immediate knowledge of 'pre-anaesthetic assessment'.

Éxito de la web de la SED / No disponible

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The effect of bariatric surgery on adipocytokines, renal parameters and other cardiovascular risk factors in severe and very severe obesity: 1-year follow-up.

AIMS: To evaluate the effect of weight loss after bariatric surgery (BS) on peripheral adipocytokines, renal parameters and other cardiovascular risk factors (CVRFs). METHODS: A total of 70 (41 women) extremely obese adults were prospectively studied before and 12 months after surgery. CONTROLS: 24 (15 women) normal-weight adults. Anthropometric, biochemical and renal parameters were recorded. RESULTS: Presurgery, adiponectin (ADPN) was lower, whereas leptin, insulin resistance, C-reactive protein, creatinine clearance and albuminuria were higher in patients than controls (P<0.001). All parameters improved postsurgery. Changes in ADPN correlated negatively with leptin, insulin resistance, albumin, C-reactive protein, and creatinine clearance. Multiple regression analysis: using changes in ADPN as the dependent variable, only changes in insulin resistance (P=0.005) and albumin (P=0.019) were significant independent determinants for changes in ADPN. No statistical differences were found in relation to the degree of obesity. CONCLUSION: Patients changed to obesity type I after surgery. This implies a substantial improvement of CVRFs including ADPN, creatinine clearance and albuminuria. Changes in plasma ADPN correlated negatively with insulin resistance and with albuminemia but not with renal parameters. The lack of differences between different degrees of obesity suggests that the relationship between weight and CVRFs no longer exists when obesity becomes very extreme.

Manejo de buprenorfina transdérmica en pacientes que no han usado previamente opioides / Transdermal buprenorphine in opioid naive patients

Tras una breve revisión de las características de la buprenorfina transdérmica y de sus efectos secundarios, se describe el inicio del tratamiento en el paciente que previamente no ha recibido opioides (AU)

After a brief survey of the characteristics and side effects of transdermal fentanyl, its use in an opioid naive patient is described (AU)

El suicidio como balance vital en el anciano / No disponible

No disponible

Control del dolor postoperatorio en hemorroidectomía ambulatoria mediante infusión endovenosa continua domiciliaria / Management of postoperative pain in outpatient hemorrhoidectomy with home continuous endovenous infusion

Introducción:El dolor postoperatorio moderado-severo sigue siendoun problema en cirugía ambulatoria, ya que provoca problemasde flujo de pacientes, retrasando el alta de los pacientes,siendo uno de los principales motivos de reingresoen los hospitales, y por tanto un importante indicadorde calidad de estas Unidades. El empleo de técnicas analgésicasinvasivas domiciliarias, en todos sus regímenes,puede controlar el dolor postoperatorio en estas intervencionesy permitir incluirlas en los programas de cirugíaambulatoria.Objetivos:El objetivo de nuestro estudio es valorar la viabilidad y laseguridad de la utilización de bombas de perfusión continuaelastoméricas para la administración de analgesia endovenosacontinua domiciliaria, a la vez que valorar la eficaciaanalgésica y el grado de satisfacción de los pacientesintervenidos de hemorroidectomía en régimen ambulatorio.Material y métodos:Estudio prospectivo simple en 61 pacientes. Una vez intervenidosbajo estrategia de analgesia multimodal, se lescoloca una bomba elastomérica endovenosa a 5 ml.h-1 con16.000 mg de metamizol, 500 mg de tramadol y 16 mg deondansetrón en un reservorio de 275 ml. En el domicilio,la Unidad de Atención Domiciliaria realiza revisiones de laintegridad del sistema infusor y de la vía endovenosa, detecciónde efectos secundarios e incidentes atribuibles alsistema y retiradas precoces durante las 48 horas delpostoperatorio.Resultados:De los 61 pacientes, sólo se registra un caso (1,63%) dedolor severo durante el primer día del postoperatorio. Un81,96% de los pacientes no tienen dolor durante el primerdía, 95% el segundo y 98,35% el tercer día. Un 9,83% delos pacientes precisan rescate con tramadol. Veinte pacientespresentan efectos secundarios atribuibles a los analgésicos.Dos casos de retirada precoz del sistema infusor porintolerancia al tramadol. En un 91,8% de los pacientes semostró un alto grado de satisfacción con el sistema infusory el procedimiento.Conclusión:Nuestro estudio demuestra la viabilidad y seguridad de lautilización de infusores elastoméricos endovenosos comométodo de analgesia postoperatoria, que permiten controlarlos casos de dolor moderado a severo en procedimientosaplicados a la cirugía ambulatoria. Sin embargo se necesitanmás estudios comparativos con técnicas analgésicasconvencionales, así como con diferentes regímenes de infusión

Introduction:Moderate to severe postoperative pain is still a problemin outpatient surgery, since it causes patient flow problemsand delays the discharge of patients, being one of the majorcauses of re-hospitalization and hence a relevant qualityindicator of these Units. The use of home invasive analgesictechniques, in all their regimes, can be effective for themanagement of postoperative pain in these surgical proceduresand allow them to be included in outpatient surgeryprograms.Objectives:The aim of our study was to determine the feasibilityand safety of the use of elastomeric continuous perfusionpumps for the administration of home continuous endovenousanalgesia, as well as to assess analgesic effectivenessand degree of satisfaction of patients undergoing outpatienthemorrhoidectomy. Material and methods:We conducted a simple prospective study in 61 patients.After the surgical procedure was performed under multimodalanalgesia, an elastomeric endovenous pump operatingat 5 ml.h-1 with 16,000 mg of metamizol, 500 mg oftramadol and 16 mg of ondansetron in a 275 ml reservoirwas used. At home, the Home Care Unit checked the perfusionsystem and the endovenous access, detected side effectsand events attributable to the system and withdrewthe system prematurely during the first 48 hours of postoperative.Results:Just 1 out of 61 patients of the study (1.63%) had severepain during the first day of postoperative, compared to81.96% of patients that did not have pain at day 1, 95% atday 2 and 98.35% at day 3. The 9,83% of patients requiredrescue therapy with tramadol and 20 patients reportedside effects attributable to analgesics. There were two casesof early withdrawal of the infusion system because ofintolerance to tramadol. A 91.8% of patients reported ahigh degree of satisfaction with the infusion system and theprocedure.Conclusion:Our study has shown the feasibility and safety of the useof endovenous elastomeric infusion pumps as a method ofpostoperative analgesia that allow to manage cases of moderateor severe pain after outpatient surgical procedures.However, further studies are required to compare this techniquewith conventional analgesic techniques, as well aswith different infusion regimes

Uso combinado de Fastrach y fibrobroncoscopio en pacientes con estómago lleno / Combined use of the Fastrach mask and fiberoptic bronchoscope in patients with full stomachs

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Abordaje multidisciplinar del dolor de espalda / Interdisciplinary approach of back pain

No disponible

HLA-DRB1 alleles encoding the "shared epitope" are associated with susceptibility to developing rheumatoid arthritis whereas HLA-DRB1 alleles encoding an aspartic acid at position 70 of the beta-chain are protective in Mexican Mestizos.

The risk to develop rheumatoid arthritis (RA) has been associated with the presence of HLA-DRB1 alleles encoding the "shared epitope" (SE). Additionally, HLA-DRB1 alleles encoding an aspartic acid at position 70 (D70+ ) have been associated with protection against the development of RA. In this study we tested the association between either SE or D70+ and rheumatoid arthritis in Mexican Mestizos. We included 84 unrelated Mexican Mestizos patients with RA and 99 unrelated healthy controls. The HLA-typing was performed by PCR-SSO and PCR-SSP. We used the chi-squared test to detect differences in proportions of individuals carrying at least one SE or D70+ between patients and controls. We found that the proportion of individuals carrying at least one HLA-DRB1 allele encoding the SE was significantly increased in RA cases as compared to controls (p(c) = 0.0004, OR = 4.1, 95% CI = 2.2-7.7). The most frequently occurring allele was HLA-DRB1*0404 (0.161 vs 0.045). Moreover, we observed a significantly increased proportion of HLA-DRB1 SE+ cases with RF titers above the median (p = 0.005). Conversely, the proportion of individuals carrying at least one HLA-DRB1 allele encoding the D70+ was significantly decreased (p(c) = 0.004, OR = 0.4, 95% CI 0.2-0.7) among RA patients compared with controls. In conclusion, the SE is associated with RA in Mexican Mestizos as well as with the highest titers of RF.

[National survey of preoperative management and patient selection in ambulatory surgery centers]. / Encuesta nacional sobre manejo preoperatorio y criterios de selección de pacientes en las unidades de cirugía mayor ambulatoria españolas.

BACKGROUND: The objective of this study was to determine both the selection and preparation criteria in patients in various Spanish ambulatory surgery centers, as well as the impact of these criteria on their results. The results were compared according to the type of functional structure of the units (autonomous or integrated). MATERIAL AND METHODS: We performed a cross sectional, descriptive study through postal survey. The survey contained the following items: type of unit, surgical procedures, selection criteria, preoperative assessment and management, and qualitative and quantitative indexes of the activity performed in 2000. A total of 123 units were included with a response rate of 39%. RESULTS: The selection criteria showed a high degree of consensus. The outpatient anesthesia clinic was used for preoperative assessment by 97.9% of the units. Most units routinely requested preoperative tests (hemostasis and hemogram by 89%; biochemical parameters by 72.9%) and to a lesser extent chest X-ray (33.3%) and electrocardiogram (35.4%). The introduction of procedures for the management of coexisting diseases was scarce (25-64.6%). Units using the outpatient anesthesia clinic in all patients had a lower cancellation rate (1.5% vs 4.4%). Autonomous units were significantly more likely to accept patients with high surgical-anesthetic risk than integrated units. Autonomous units also showed a significantly lower number of admissions (1.2% vs 1.9%, p = 0.003), mean stay (240 min vs 367 min, p = 0.002), and recovery time (150 min vs 212 min, p = 0.001) than integrated units. No statistically significant differences were found in the remaining parameters. CONCLUSIONS: Scientifically based protocols for patient selection, preoperative assessment and perioperative management of distinct processes and for the rational use of laboratory tests should be more widely used. The need for an outpatient anesthesia clinic for preoperative assessment was notable. The results of our survey indicate that better results in performance indexes are achieved in autonomous ambulatory surgery units than in integrated units. Given the possibility of defining and validating quality standards, further multicenter studies should be performed.

Encuesta nacional sobre manejo preoperatorio y criterios de selección de pacientes en las unidades de cirugía mayor ambulatoria españolas / National survey of preoperative management and patient selection in ambulatory surgery centers

Introducción: El objetivo de este estudio es conocer los criterios de selección y preparación de los pacientes en las diferentes unidades de cirugía mayor ambulatoria (UCMA) españolas y su impacto en los resultados de éstas; también se comparan dichos resultados según el tipo de estructura funcional de las unidades (autónoma o integrada).Material y método: Estudio descriptivo transversal mediante encuesta postal. Encuesta con los siguientes apartados: tipo de unidad, cartera de servicios, criterios de selección, evaluación, manejo preoperatorio e indicadores cualitativos y cuantitativos de la actividad realizada en el año 2000. Se incluyeron 123 unidades, con un nivel de respuesta del 39 por ciento. Resultados: Existe un alto grado de consenso en los criterios de selección. En el 97,9 por ciento de las unidades se utiliza la consulta de anestesia para la evaluación preoperatoria. La solicitud sistemática de las pruebas de laboratorio es elevada (89 por ciento para la hemostasia y el hemograma, 72,9 por ciento para la bioquímica), mientras que para la radiografía de tórax (33,3 por ciento) y el ECG (35,4 por ciento) se utilizan criterios más selectivos. La implantación de protocolos para el manejo de afecciones asociadas está poco extendida (25-64,6 por ciento). El índice de cancelaciones es ventajoso para las unidades que utilizan la consulta de anestesia en todos los pacientes (el 1,5 frente al 4,4 por ciento).Existe una significativa aceptación de pacientes de mayor riesgo quirúrgico-anestésico en las unidades de tipo autónomo respecto a las integradas, así como una significativa disminución del número de ingresos (el 1,2 frente al 1,9 por ciento; p = 0,003) de las estancias (240 frente a 367 min; p = 0,002), y del tiempo de recuperación (150 frente a 212 min; p = 0,001). Las diferencias en el resto de los indicadores analizados no revisten significación. Conclusiones: Es necesario profundizar en la consecución de protocolos basados en evidencias científicas para la se lección de los pacientes, la evaluación preoperatoria y el manejo perioperatorio de las diferentes enfermedades, así como para la utilización racional de las pruebas de laboratorio. Se constata la necesidad de la consulta anestésica para la evaluación preoperatoria. Los resultados de nuestra encuesta apuntan hacia unos mejores resultados en los indicadores de funcionamiento en las UCMA autónomas frente a las integradas. Existe la posibilidad de definir estándares de calidad y validarlos, para lo cual serán necesarios futuros estudios multicéntricos (AU)

Analgesia postoperatoria en cirugía mayor ambulatoria / Postoperative analgesia in outpatient major surgery

La aplicación de nuevas técnicas analgésicas en el ámbito de la cirugía ambulatoria puede ser un factor importante para aumentar el número de procedimientos tributarios de realizarse sin ingreso hospitalario. La utilización de regímenes analgésicos multimodales mediante la utilización de nuevos fármacos no opioides y anestésicos locales se ha demostrado eficaz en la disminución de los marcadores del dolor postoperatorio y en la disminución de los requerimientos analgésicos. La analgesia preventiva, aunque discutida, parece tener un lugar en los protocolos de analgesia para cirugía ambulatoria. En casos de dolor postoperatorio severo puede ser útil el empleo de técnicas analgésicas invasivas mediante el mantenimiento de vías endovenosas o subcutáneas para la administración de analgésicos, o la utilización de técnicas regionales continuas para la infusión de anestésicos locales, contando siempre con la supervisión y el apoyo del personal de Unidades de Atención Domiciliaria (AU)

Intra-articular corticosteroid preparations: different characteristics and their effect during inflammation induced by monosodium urate crystals in the rat subcutaneous air pouch.

OBJECTIVE: To examine the effects of three commonly used intra-articular depot corticosteroid preparations tested in a rat air pouch model and their effect against monosodium urate (MSU) crystal-induced inflammation. Rheumatologists use intra-articular corticosteroid preparations to relieve pain and inflammation of acute monoarthritis without really knowing their effects on the synovial fluid and membrane or the differences between distinct preparations. This work compares the effect of three commonly used corticosteroid preparations in vivo, showing that they behave differently. METHODS: A subcutaneous air pouch was formed in male Sprague-Dawley rats. A first group of 6-day-old air pouches were injected with 10 ml of 6 mg/ml normal saline solution, 6 mg/ml betamethasone containing both depot betamethasone acetate and soluble betamethasone phosphate (Celestone) in 9 ml of normal saline solution, 20 mg/ml of prednisolone tebutate (Hydeltra) in 9 ml of normal saline solution or 20 mg/ml of triamcinolone hexacetonide (Aristospan) in 9 ml of normal saline solution. A second group (group 2) of air pouches were injected with 15 mg of synthetic MSU crystals and 24 h later they were reinjected with 1 ml of the same three corticosteroid suspensions. For each condition four rats were killed at 6, 24, 48 h and 7 days. Pouch fluid and tissue were analysed. RESULTS: In the first 6 h after normal saline solution or corticosteroid injection into the air pouch there were mildly increased leucocyte counts in the air pouch fluid. Betamethasone-injected pouches showed no cells in the fluid after 6 h and no crystals after 24 h, triamcinolone-injected pouches still showed rare cells at 7 days. Both triamcinolone and prednisolone crystals persisted in higher numbers and lasted longer in the fluid than did betamethasone (P<0.05). In group 2 MSU crystal phagocytosis in the fluid was decreased in the betamethasone- (P<0.01), prednisolone- (P<0.003) and triamcinolone- (P<0.006) injected pouches when compared with the MSU crystal-injected pouches alone. Pouches injected with MSU crystals alone showed the most intense tissue inflammation at all times. After MSU, betamethasone-injected pouches had a rapid but mild decrease in the number of lining cells and inflammation. In contrast, triamcinolone- and prednisolone-injected pouches showed a very thin tissue with few or no vessels and almost no inflammation at 7 days. The pouches injected with MSU crystals and any of the corticoid preparations had three times more tophus-like structures and persistent crystals identified than the ones injected with MSU crystals alone. CONCLUSION: Each of the corticosteroid preparations by themselves produced very mild transient inflammation. The betamethasone preparation with a soluble steroid component had a quicker but milder anti-inflammatory effect on MSU crystal-induced inflammation. In contrast to the doses used, prednisolone tebutate and triamcinolone hexacetonide preparations dramatically suppressed urate crystal-induced inflammation at 7 days, but both produced atrophy and necrosis of the membrane, yielding a very thin membrane with almost no vessels. When used for MSU crystal-induced inflammation these corticosteroid preparations suppressed some aspects of inflammation but may actually promote the persistence of MSU crystals and the formation of tophi.