Calidad de vida a los 6 meses tras un ictus / Quality of life 6 months after a stroke

Objetivo. Describir la calidad de vida (CV) de los pacientes a los 6 meses de evolución del ictus y su relación con variables sociodemográficas, clínicas y funcionales. Material y métodos. Estudio multicéntrico de cohortes longitudinal (n = 157). Los pacientes incluidos ingresaron en la fase subaguda tras un ictus en 2 Servicios de Rehabilitación. Se recogieron los siguientes datos a los 6 meses postictus: género, edad, riesgo social, comorbilidad, disfagia, afasia, estado cognitivo, depresión y grado de discapacidad evaluado mediante el índice de Barthel modificado. Se evaluó la influencia de estas variables en la CV, para lo que se empleó la escala específica de calidad de vida para el ictus ECVI-38. Resultados. La media de edad fue de 70,93 ± 11,85 años; fue significativamente superior en las mujeres. El paciente tipo presentó una elevada comorbilidad, un bajo riesgo social y dependencia moderada. La puntuación media total de la escala ECVI-38 fue de 35,30 ± 16,17 y los dominios más afectados los referentes a las actividades comunes y básicas de la vida diaria. Las variables que más se relacionan con la CV fueron el género, la afasia, la disfagia, la depresión, el déficit cognitivo y el estado funcional. El dolor de elevada intensidad estuvo presente en un 21% de los pacientes. Conclusión. Son muy diversas las variables que influyen en la CV del paciente con ictus que se deben considerar, para su potencial abordaje, en la planificación de las intervenciones rehabilitadoras (AU)

Objective. To describe quality of life (QoL) in patients at 6 months poststroke and its relationship with sociodemographic, clinical and functional characteristics. Material and method. This multicenter longitudinal cohort study (n = 157) included patients from 2 hospital rehabilitation services who were admitted for stroke in the subacute phase. The following data were gathered at 6 months poststroke: gender, age, social risk, comorbidity, dysphagia, aphasia, cognitive status, depression, and disability measured by the modified Barthel Index. The influence of these variables on QoL was evaluated using the stroke-specific quality of life scale, ECVI-38. Results. The mean age was 70.93 ± 11.85 years and was significantly higher in women. Most of the patients had high comorbidity, low social risk and moderate dependence. The mean total score on the ECVI-38 scale was 35.30 ± 16.17 and the most affected domains were those concerning common and basic activities of daily living. The variables associated with QoL were gender, aphasia, dysphagia, depression, cognitive impairment, and functional status. High-intensity pain was present in 21% of patients. Conclusion. Numerous variables influence QoL in patients with stroke and should be considered in the planning of rehabilitation interventions (AU)

Atención subaguda al paciente con ictus. Satisfacción y resultados / Subacute care of stroke-affected patients. Satisfaction and results

Objetivo: Conocer la satisfacción de los pacientes con ictus y sus cuidadores durante su hospitalización en rehabilitación y analizar la efectividad del tratamiento, el riesgo social y el destino del paciente al alta. Material y método: Estudio multicéntrico de cohorte longitudinal prospectivo. Se valoró el riesgo social (escala Gijón), la comorbilidad (índice de Charlson), la discapacidad (índice de Barthel), la efectividad del tratamiento rehabilitador, la satisfacción con la atención (cuestionario de Pound) y el destino al alta en 241 pacientes. De 119 cuidadores evaluados a los 6 meses postictus se recogieron la edad, el parentesco, las horas diarias dedicadas al cuidado y la satisfacción con la información/formación y con la accesibilidad del equipo rehabilitador. Resultados: El perfil del paciente era el de un varón de 71 años, con riesgo social bajo/intermedio, comorbilidad alta y dependencia total/severa. Un 27,1% vivían solos. El 96,6% referían estar satisfechos/muy satisfechos con el tratamiento, siendo menor la satisfación con la recuperación (80,3%). La efectividad fue de 32,5 ± 20,4. El 81,7% de los pacientes regresaron a su domicilio. La media de edad de los cuidadores fue de 58,8 ± 12,3 años y el 73,9% eran mujeres. La dedicación a los cuidados era superior a 6 h diarias en el 62%. El 89,9% de los cuidadores estaban satisfechos/muy satisfechos con la información recibida. Conclusiones: Los pacientes ingresados para tratamiento rehabilitador tras un ictus obtienen una ganancia funcional significativa durante su hospitalización y regresan a su domicilio en la mayoría de los casos. La satisfacción con el tratamiento rehabilitador y la información es elevada. Un campo especialmente mejorable es la formación del cuidador (AU)

Objective: To determine the satisfaction of the stroke inpatients and their caregivers in Rehabilitation Service and to analyze the effectiveness, social risk, and discharge destination. Material and method: Prospective longitudinal cohort multicenter study. An analysis was made of the social risk (Gijón Scale), co-morbidity (Charlson Index), disability (Barthel Index), effectiveness of the rehabilitation treatment, satisfaction (Pound Questionnaire) and discharge destination of 241 patients. An evaluation was also made on 119 caregivers 6 months post-stroke, recording age, family relationship, time care-giving, satisfaction with the information/training, and accessibility to the rehabilitation team. Results: The patient profile is a 71 year-old male, with low/intermediate social risk, high comorbidity and total/severe dependence, with 27.1% living alone. Almost all (96.6%) of the patients claimed to be satisfied/very satisfied with the treatment, with satisfaction with the recovery being lower (80.3%). The effectiveness was 32.5 ± 20.4. Home was the discharge destination of 81.7% of the patients.The average age of the caregivers was 58.8 ± 12.3 years, and 73.9% were women. The time dedicated to care-giving was over 6 hours per day in the 62% of the cases. Being satisfied/very satisfied with the received information was recorded by 89.9% of the caregivers. Conclusions: Los pacientes ingresados para tratamiento rehabilitador tras un ictus obtienen una ganancia funcional significativa durante su hospitalización y regresan a su domicilio en la mayoría de casos. Patients admitted for stroke rehabilitation achieve significant functional gain during hospitalization and return to their homes in most cases. The satisfaction with the rehabilitation treatment and received information is high. The training of the caregiver is an aspect that needs improving

[Subacute care of stroke-affected patients. Satisfaction and results]. / Atención subaguda al paciente con ictus. Satisfacción y resultados.

OBJECTIVE: To determine the satisfaction of the stroke inpatients and their caregivers in Rehabilitation Service and to analyze the effectiveness, social risk, and discharge destination. MATERIAL AND METHOD: Prospective longitudinal cohort multicenter study. An analysis was made of the social risk (Gijón Scale), co-morbidity (Charlson Index), disability (Barthel Index), effectiveness of the rehabilitation treatment, satisfaction (Pound Questionnaire) and discharge destination of 241 patients. An evaluation was also made on 119 caregivers 6 months post-stroke, recording age, family relationship, time care-giving, satisfaction with the information/training, and accessibility to the rehabilitation team. RESULTS: The patient profile is a 71 year-old male, with low/intermediate social risk, high co-morbidity and total/severe dependence, with 27.1% living alone. Almost all (96.6%) of the patients claimed to be satisfied/very satisfied with the treatment, with satisfaction with the recovery being lower (80.3%). The effectiveness was 32.5 ± 20.4. Home was the discharge destination of 81.7% of the patients.The average age of the caregivers was 58.8 ± 12.3 years, and 73.9% were women. The time dedicated to care-giving was over 6 hours per day in the 62% of the cases. Being satisfied/very satisfied with the received information was recorded by 89.9% of the caregivers. CONCLUSIONS: Patients admitted for stroke rehabilitation achieve significant functional gain during hospitalization and return to their homes in most cases. The satisfaction with the rehabilitation treatment and received information is high. The training of the caregiver is an aspect that needs improving.

Rehabilitation efficiency and destination on discharge after stroke.

BACKGROUND: Predicting functional recovery of patients is key for setting the objectives of the rehabilitation programme and making decisions on their destination on discharge. Many variables have an impact on disability and quality of life after stroke, including patient age, comorbidity, severity of neurological deficit, state of mind and social risk. Accordingly, it is also essential from a care perspective to optimise the functional recovery and efficiency of rehabilitation programmes, exploring their relationship with these variables. AIM: To analyze the efficiency of post-stroke rehabilitation, identifying factors that most strongly influence functional recovery and destination on discharge. DESIGN: Multicentre prospective cohort study SETTING/POPULATION: All patients admitted to the Rehabilitation Units of the two hospitals after stroke over eight months METHODS: Collected data on sociodemographic characteristics, social risk (Gijón Scale), comorbidity (Charlson Index), neurological severity (National Institute of Health Stroke Scale), daily living functioning scale (Barthel Index), length of hospital stay and destination on discharge. RESULTS: We included 241 patients, with a mean stay of 35±22 days, 81.5% returning home on discharge. On admission 45.2% were totally dependent, and this figure fell to 12.8% on discharge, the mean Barthel Index score increasing by 32.5 points. Neurological severity, hemiparetic severity, impairment of deep sensation and trunk control on admission were the mayor variables influence on rehabilitation efficiency (P<0.001). Destination on discharge was most closely associated with civil status, social risk and Barthel Index score (P<0.001). The likelihood of transferring to residential care is 3- and 2.71-fold higher among patients with total dependence and high comorbidity scores, respectively. CONCLUSION: Many variables influence on outcomes of stroke inpatient rehabilitation. CLINICAL REHABILITATION IMPACT: Comprehensive assessments are required to predict patient recovery, efficiency and plan for discharge.

Contribución a la patogénesis de la endometriosis desde la histeroscopia quirúrgica / Contribution to the endometriosis pathogenesis since the surgical histeroscopy

La teoría más aceptada en la patogénesis de la endometriosis, propuesta en 1920, es que esta alteración se origina desde un flujo menstrual retrógrado de tejido endometrial a través de las trompas de Falopio a la cavidad peritoneal. Aportamos dos casos clínicos en los que una resección endometrial incompleta originó un aumento del flujo menstrual, por persistir endometrio funcional en los ostium y una oclusión de la cavidad endometrial. Estas pacientes desarrollaron una endometriosis grado IV al año de la intervención, habiéndose verificado que no existía previo a la misma

The most widely accepted theory on the pathogenesis of endometriosis, proposed in the 1920s, is that the disorder originates from retrograde menstruation of endometrial tissue sloughed through patent fallopian tubes into the peritoneal cavity. We contribute two clinical cases in which an incomplete endometrial resection originated an increase of retrograde menstrual flow by persist functional endometrium in the ostium and occlusion of the endometrial cavity. Theses patients developed an endometriosis degree IV in a year postintervention, having verified that did not exist previously to the one

Efectos del tamoxifeno en el epitelio vaginal y los ovarios / Tamoxifen effects on vaginal epithelium and ovaries

Objetivo: Realizar un análisis de los efectos que el tamoxifeno tiene en el epitelio vaginal y los ovarios de pacientes que han recibido tratamiento con este fármaco por un cáncer de mama dependiente de estrógenos. Pacientes y método: Hemos estudiado a 92 mujeres que recibieron tratamiento con tamoxifeno por cáncer de mama entre los años 2000 y 2003. Analizamos los efectos del tamoxifeno en el epitelio vaginal y la relación del tamoxifeno con la presencia de formaciones ováricas. Resultados: Hemos encontrado un efecto estrogénico en el epitelio vaginal de mujeres en estado posmenopáusico, a pesar de que recibían un fármaco cuyo efecto es antiestrogénico. El 87% de las mujeres en menopausia que recibían tamoxifeno mostraron unos frotis estrogénicos, frente al 20,9% del grupo control (mujeres en menopausia con cáncer de mama que no tomaban tamoxifeno); p < 0,001. El 13% (población joven, premenopáusica o de menos de 1 año de menopausia) de la población estudiada presentó una formación ovárica que desaparece espontáneamente. Sólo se intervino a una paciente por presentar un Doppler patológico que se correspondió con un carcinoma lúteo hemorrágico

Objective: To analyze the effects of tamoxifen on the vaginal epithelium and ovaries in patients treated with this drug for estrogen-dependent breast cancer. Patients and method: We studied 92 women who received tamoxifen therapy for breast cancer from 2000 to 2003. The effects of tamoxifen on the vaginal epithelium and the association between this drug and the presence of ovarian cysts were analyzed. Results: Although tamoxifen is an antiestrogenic drug, in postmenopausal women an estrogenic effect on the vaginal epithelium was found. Vaginal swabs showed estrogen stimulation in 87% of menopausal women receiving tamoxifen compared with 20.9% of the control group (menopausal women with breast cancer not receiving tamoxifen; p < 0.001). Ovarian cysts were found in 13% of the population studied, corresponding to women who were younger, premenopausal or with less than a year of menopause; the cysts resolved spontaneously. Only one patient underwent surgery due to abnormal Doppler findings corresponding to a hemorrhagic luteal cyst

Sarcomas de útero después de tratamiento con tamoxifeno por cáncer de mama / Uterine sarcomas after breast cancer treatment with tamoxifen

• Propósito: Descripción de dos casos de sarcomas en mujeres que recibieron tamoxifeno después del tratamientoquirúrgico de cáncer de mama.• Material y métodos: Se describen dos casos de dos mujeres de 74 y 53 años que recibieron tratamientocon 20 mg diarios de tamoxifeno después del tratamiento quirúrgico de un cáncer de mama. Cuatro y dosaños después de iniciar el tratamiento, desarrollaron un tumor Mülleriano mixto maligno heterólogo (EstadioIII) y un sarcoma del estroma endometrial (Estadio I).• Discusión: Los carcinosarcomas y otros sarcomas uterinos son raros, y ocurren en menos del 4% de lostumores uterinos. En la mayoría de los estudios se refieren tasas altas de estos tumores en mujeres postmenopáusicas,con cáncer de mama, tratadas con tamoxifeno, en comparación a las no tratadas, especialmente aquellasexpuestas a largos periodos de tratamiento

• Purpose: Description of two cases of sarcoma in women who received tamoxifen after the surgical treatment of breast cancer. • Material and methods: We report two cases of 74 and 53 years old women that received tamoxifen 20 mg daily after the surgical treatment of breast cancer. Four and two years after initiation of tamoxifen treatment, they developed an heterologous malignant mixed Müllerian tumor (stage III) and an endometrial stromal sarcoma (stage I), respectively. • Discussion: : Carcinosarcomas and other uterine sarcomas are rare, accounting for fewer than 4% of uterine tumors. Most studies reported on a higher rate of these sarcomas among postmenopausal women with breast cancer treated with tamoxifen when compared with non-treated patients, especially those exposed to a long term treatment