[What is the opinion of Spanish internists on osteoporosis?]. / 'Qué opinan los internistas españoles de la osteoporosis?

OBJECTIVE: To conduct an opinion survey on osteoporosis in Spanish internists. METHOD: Survey sent by mail and by personal visit to members of the Spanish Internists Society. Collection of data on opinion on the disease, diagnostic and therapeutic attitude and means available (general laboratory analyses, conventional radiology, biochemical markers of bone remodeling, densitometry and ultrasounds) and preference when choosing a certain treatment. RESULTS: A total of 538 internists answered. More than 90% of those surveyed consider that osteoporosis is a disease that should be treated by internists. A total of 93% consider that osteoporosis is a prevalent disease. More than 80% have access to densitometry. CONCLUSIONS: The majority of Spanish internists consider that osteoporosis is a disease that should be treated by internists and that it is a disease that enters into their action scope. In general, they have the means necessary for its study and treatment. Bisphosphonates constitute the drug of choice and calcium and vitamin D supplements are indicated in almost all the cases.

¿Qué opinan los internistas españoles de la osteoporosis? / What is the opinion of Spanish internists on osteoporosis?

Objetivo. Realizar una encuesta de opinión sobre osteoporosis en internistas españoles. Método. Encuesta remitida por correo y por visita personal a miembros de la Sociedad Española de Medicina Interna. Recogida de datos sobre opinión acerca de la enfermedad, actitud diagnóstica y terapéutica y medios disponibles (analítica general, radiología convencional, marcadores bioquímicos de remodelamiento óseo, densitometría y ultrasonidos) y preferencias a la hora de elegir un determinado tratamiento. Resultados. Contestaron un total de 538 internistas. Más del 90% de los encuestados opina que la osteoporosis es una enfermedad que deben tratar los internistas. El 93% considera que la osteoporosis es una patología prevalente. Más del 80% tiene acceso a una densitometría. Conclusiones. Los internistas españoles opinan mayoritariamente que la osteoporosis es una enfermedad que deben tratar los internistas y que entra en su ámbito de actuación. Por lo general disponen de los medios que necesitan para su estudio y tratamiento. Los bifosfonatos constituyen el fármaco de elección y en la práctica totalidad de los casos indican un suplemento de calcio y vitamina D

Objective. To conduct an opinion survey on osteoporosis in Spanish internists. Method. Survey sent by mail and by personal visit to member of the Spanish Internists Society. Collection of data on opinion on the disease, diagnostic and therapeutic attitude and means available (general laboratory analyses, conventional radiology, biochemical markers of bone remodeling, densitometry and ultrasounds) and preference when choosing a certain treatment. Results. A total of 538 internists answered. More than 90% of those surveyed consider that osteoporosis is a disease that should be treated by internists. A total of 93% consider that osteoporosis is a prevalent disease. More than 80% have access to a densitometry. Conclusions. The majority of Spanish internists consider that osteoporosis is a disease that should be treated by internists and that it is a disease that enters into their action scope. In general, they have the means necessary for its study and treatment. Bisphosphonates constitute the drug of choice and calcium and vitamin D supplements are indicated in almost all the cases

[Endoscopic third ventriculostomy: risk factors for failure and evolution of ventricular size]. / Ventriculostomía endoscópica: influencia de factores predisponentes al fallo y evolución del tamaño ventricular.

INTRODUCTION: Endoscopic third ventriculostomy is the treatment of choice for non communicating hydrocephalus at our institution. Several factors have been associated with failure of endoscopic third ventriculostomy. The goals of the study have been to evaluate the outcome, the influence of factors theoretically prone to failure of ventriculostomy and the evolution of ventricular size. MATERIAL AND METHODS: Fifty-six patients (mean age 48.5 yrs) treated with an endoscopic third ventriculostomy during the period 1997-2002 were analysed retrospectively. Hydrocephalus was classified as acute (68%) and chronic forms. Etiology was classified in space-occupying lesions (59%), primary aqueductal stenosis (34%) and Chiari malformation (7%). The presence of the following factors theoretically prone to failure was considered: age below one year, history of mielomeningocele, cerebrospinal fluid (CSF) infection, intracranial haemorrhage, radiotherapy, craniotomy and previous treatment of hydrocephalus with a shunt. Ventricular size was measured linearly with four ventricular index pre- and postoperatively. RESULTS: The global success rate was 71.4% (mean follow-up 26 months). Endoscopic third ventriculostomy for hydrocephalus secondary to cerebral metastases obstructing CSF pathways was associated with a higher risk of failure (p=0.006). None of the risk factors considered was associated with a higher risk of failure. The evolution of the ventricular size measured with linear methods is associated with outcome. Evans ratio, third ventricle index, cella media index and ventricular score decreased in patients whose outcome is satisfactory and increased in those cases deemed clinical failures (p< 0.05). CONCLUSION: The risk of failure increases in patients with cerebral metastases close to CSF pathways, likely due to the concurrence of mechanisms other than obstruction. Changes in ventricular size are associated with outcome.

[Analysis of cerebrospinal fluid related complications (hydrocephalus, fistula, pseudomeningocele and infection) following surgery for posterior fossa tumors]. / Análisis de complicaciones licuorales (hidrocefalia, fistula, pseudomeningocele e infeccion) en la cirugía de tumores de fosa posterior.

INTRODUCTION: Hydrocephalus, cerebrospinal fluid (CSF) leak, pseudomeningocele and CSF infection are potential complications related to surgical treatment of posterior fossa tumors. The objectives of this study were to review the incidence of such complications and to identify contributing factors related to them. MATERIAL AND METHODS: This study is based on a retrospective review of the medical records of 71 consecutive patients who underwent posterior fossa surgery for a tumor between the period January 1997 and December 2001. Postoperative hydrocephalus was defined as enlargement of the ventricles and the subsequent clinical worsening requiring surgical treatment. Criteria for CSF leakage were:observed leak of CSF through the wound, rhinorrhea or otorrhea. Pseudomeningocele was determined when there was a large epidural CSF collection diagnosed in the postoperative period or by magnetic resonance imaging performed at least three months after posterior fossa surgery. Finally, CSF infection was defined on clinical ground and positive biochemical examination, but not necessarily positive cultures. RESULTS: The series included 84 operations for resection of posterior fossa tumors on 71 patients. There were CSF related complications in 31% (26/84)with the following detailed incidence: 9.5% (8/84) postoperative hydrocephalus; 14.3% (12/84) CSF leak, 7.1% (6/84) pseudomeningocele; 8.3% (7/84) CSF infection. The mortality rate is 5.9% (5/84). The tumor size was the only statistically significant factor associated with the occurrence of CSF related complications (mean 39.43 mm, SD 18.51 mm vs.29.80 mm, SD 14.12 mm, p=0.015). In the subgroup of patients, in which hydrocephalus was managed preoperatively, the election of an external ventricular drain vs.other strategies (subcutaneous reservoir, definite shunt or endoscopic third ventriculostomy) was associated with a higher occurrence of CSF related complications (p=0.006). The mortality rate was associated with age (mean 63.60 years, SD 5.86 years vs.49.18 years, SD 16.39 years; p=0.002). The occurrence of CSF related complications also influenced mortality (p=0.030), particularly postoperative hydrocephalus (p< 0.001). Inpatient hospital stay was longer in the subgroup of patients who developed CSF related complications (p=0.002). CONCLUSIONS: Tumor size was the only factor associated with the development of CSF related complications after surgery for posterior fossa tumors. In the subgroup of patients in which hydrocephalus was surgically treated preoperatively, the election of an external ventricular drain compared to other surgical modalities was associated with a higher rate of CSF related complications. The development of such complications, particularly hydrocephalus, was related with mortality.

Análisis de complicaciones licuorales (hidrocefalia, fístula, pseudomeningocele e infección) en la cirugía de tumores de fosa posterior / Analysis of cerebrospinal fiuid related complications (hydrocephalus, fistula, pseudomeningocele and infection) following surgery for posterior fossa tumors

Introducción. Hidrocefalia, fístula de líquido cefalorraquídeo (LCR), pseudomeningocele e infección son complicaciones potenciales en la cirugía de los tumores de fosa posterior agrupadas bajo el término complicaciones licuorales. El objetivo de este estudio ha sido identificar variables relacionadas con la aparición de estas complicaciones en la cirugía de los procesos expansivos de fosa posterior.Material y métodos. La población objeto de estudio es una serie de 71 pacientes consecutivos intervenidos de un proceso expansivo de fosa posterior durante el período Enero 1997 - Diciembre 2001. Mediante revisión de historias clínicas se recogió la presencia de dichas complicaciones de acuerdo a los siguientes criterios: hidrocefalia postquirúrgica siempre que un mayor grado de dilatación ventricular respecto a las pruebas de neuroimagen preoperatorias y el cuadro clínico asociado a dicha dilatación condicionara una maniobra quirúrgica; fístula, cuando se detectara fuga de LCR a través de la herida quirúrgica, nariz u oído; pseudomeningocele, ante una colección epidural significativa de LCR detectada en el postoperatorio inmediato o en una resonancia magnética realizada más de tres meses después de la intervención; e infección de LCR, ante un cuadro clínico y un examen bioquímico de LCR compatibles con o sin cultivo positivo de LCR.Resultados. La serie incluye 84 procedimientos quirúrgicos de fosa posterior realizados a 71 pacientes. En el 31 por ciento (26/84) de los procedimientos se detectaron complicaciones licuorales con la siguiente incidencia pormenorizada: 9.5 por ciento (8/84) hidrocefalia postoperatoria; 14.3 por ciento (12/84) fístula de LCR; 7.1 por ciento (6/84) pseudomeningocele; 8.3 por ciento (7/84) infección de LCR. La mortalidad de la serie es del 5.9 por ciento (5/84). La única variable relacionada con la aparición de complicaciones licuorales fue el tamaño de la lesión (media 39.43 mm, DE 1851 mm vs. 29.80 mm, DE 14.12 mm, p=0.015). En el subgrupo de pacientes en que se efectuó una intervención quirúrgica para el control preoperatorio de la hidrocefalia, la elección de un drenaje ventricular externo vs. otras opciones (reservorio subcutáneo, shunt o ventriculostomía endoscópica) se asoció con una mayor tasa de complicaciones licuorales (p=0.006). La mortalidad se relacionó con la edad (media 63.60 años, DE 5.86 años vs. 49.18 años, DE 16.39 años, p=0.002) y con la presencia de complicaciones licuorales (p=0.030), particularmente con el desarrollo de hidrocefalia postoperatoria (p<0.001). La estancia hospitalaria postoperatoria fue más prolongada en el subgrupo de pacientes que desarrolló complicaciones licuorales (p=0.002).Conclusiones. El tamaño del tumor es la única variable relacionada con la aparición de complicaciones licuorales en la cirugía de los tumores de fosa posterior. En el subgrupo de pacientes en que se hace alguna maniobra quirúrgica para el control preoperatorio de la hidrocefalia, la elección de un drenaje ventricular externo comparado a otras opciones se asocia con una tasa mayor de complicaciones licuorales. La mortalidad quirúrgica está relacionada con el desarrollo de complicaciones licuorales, sobre todo con la hidrocefalia postoperatoria (AU)

[Paraneoplastic ataxia due to laryngeal carcinoma]. / Ataxia paraneoplásica por carcinoma laríngeo.

Paraneoplastic syndromes are not common in ear, nose and throat disease, but they can cause disease in various organ systems. We report a case of supraglottic laryngeal carcinoma in a patient examined for ataxia. Surgical removal of the tumor resolved the cerebellar symptoms.