Evaluation of risperidone in the treatment of behavioral and psychological symptoms and sleep disturbances associated with dementia.

BACKGROUND: Dementia is associated with progressive cognitive impairment and behavioral and psychological symptoms. Sleep-wake cycle disturbances are common in patients with dementia. This study evaluated the efficacy and safety of risperidone in the treatment of the behavioral and psychological symptoms of dementia (BPSD) and associated sleep-wake cycle disturbances. METHODS: In this open-label, 12-week, observational, prospective study, the effects of risperidone were assessed using the Neuropsychiatric Inventory (NPI) total and subscale scores. Sleep-wake cycle disturbances were rated by patients/caregivers using a newly developed sleep behavior questionnaire that included assessment of sleep duration, quality, awakenings, and effects on daily activities. Tolerability assessments included the Udvalg for Kliniske Undersogelser (UKU) subscale for extrapyramidal symptoms (EPS) and the recording of adverse events. RESULTS: A total of 338 patients entered the study, with 321 patients completing. Following 12 weeks of risperidone treatment (mean dose 1.49 mg/day at end-point), the mean NPI score was reduced to 10.6 from a baseline score of 28.7. Compared with baseline, patients/caregivers reported significant improvements following 12 weeks of risperidone in total sleep hours at night (5.5 vs. 7.1 hours), hours awake in bed at night (2.3 vs. 1.2 hours), insomnia (40.1% vs. 8.4%), and other sleep-related variables. Six patients reported a total of 10 adverse events, including somnolence (n = 3) and sialorrhea (n = 2). Scores on the UKU subscale of EPS improved significantly (mean 4.0 at baseline vs. 1.7 at week 12). CONCLUSIONS: Risperidone is effective and well tolerated in the treatment of BPSD and associated sleep disturbances.

Intoxicacion aguda acuosa / Acute water intoxication

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[Acute water intoxication as complication of intravenous urography]. / Intoxicación aguda acuosa como complicación de una urografía intravenosa.

Physiologically, two complementary mechanisms regulate plasma osmolality: antduretic hormone ADH) and thirst. ADH release s supressed, thirst s inhbted and renal water loss occurs when plasma osmolality below a threshold level. The rise in plasma osmolalty causes ADH release, stimulation of thirst and water intake. Acute water intoxication is exceptional in patients without a chronic psychiatric disease. Herein, we describe a case of acute water intoxication in a previously healthy patient, after making an intravenous urography. The excessive water intake and the impossibility of renal water loss because of streee-induced ADH release originated t. Only nine cases have been previously described; almost they all were women preparing for diagnostic procedures.

Intoxicación aguda acuosa como complicación de una urografía intravenosa / Acute water intoxication as a complication of intravenous urography

En circunstancias fisiológicas la osmolalidad plasmática se regula por dos mecanismos complementarias: la hormona antidiurética (ADH) y la sed. Cuando se produce una disminución de la osmolalidad por incremento del agua en el organismo se inhibe la sensación de sed y la secreción de ADH, siendo el exceso de agua eliminado por el riñón. Cuando aumenta la osmolalidad se libera ADH, que disminuye la pérdida de agua por el riñón, y aparece la sed, produciendo ingreso de agua por vía digestiva.La intoxicación acuosa aguda es excepcional en personas sin patología psiquiátrica crónica. Presentamos un caso de intoxicación acuosa aguda durante la realización de una urografía intravenosa. La intoxicación se produjo por una ingesta acuosa excesiva junto con la liberación de ADH por estrés psicológico, que impidió la eliminación de agua por el riñón.De los 9 casos semejantes previamente descritos, la mayoría han sido en mujeres y en el contexto de la preparación de pruebas diagnósticas. (AU)

Prevalence of angina pectoris in Spain. PANES Study group.

The frequency of coronary heart disease in a community is usually measured by myocardial infarction incidence and mortality rates. The measurement of the prevalence of angina pectoris may, however, become a convenient way of assessing coronary heart disease morbidity in the future. The aim of this study was to determine the prevalence of angina and validity of the Rose questionnaire in the Spanish population aged from 45 to 74 years. A cross-sectional study was conducted in 10,248 subjects (45-74 years), representative of the Spanish population. The WHO Rose questionnaire was used and a construct validation against regional mortality rates and cardiovascular risk factor prevalence was devised. The overall angina prevalence increased with age both in men and women, but was higher in the latter (7.3% and 7.7%, respectively). Angina prevalence also increased with the number of cardiovascular risk factors present and correlated with regional CHD mortality rates (r = 0.66). Sensitivity and specificity results of the Rose questionnaire were low when tested against exercise test (52.9% and 52.1%, respectively). As conclusions, Rose questionnaire is a reliable tool for assessing angina prevalence in the Spanish population which is similar to that of other industrialized countries with higher myocardial infarction morbidity and mortality.

[Thyroid disorders associated with interferon treatment in patients with chronic viral hepatitis or multiple sclerosis]. / Alteraciones tiroideas asociadas al tratamiento con interferón en pacientes con hepatitis crónica viral o esclerosis múltiple.

BACKGROUND: Alpha and beta interferon (IFN-alpha and beta) treatment is associated with the synthesis of thyroid autoantibodies and the development of autoimmune thyroid diseases. METHODS AND RESULTS: We have retrospectively evaluated their effect in patients with chronic viral hepatitis (CH) (n = 118) and multiple esclerosis (ME) (n = 10). Thyroid dysfunction has been detected in 7.4% of patients, and seroconversion in 4.7%. CONCLUSIONS: Pre-treatment antithyroid antibodies do not predispose to altered thyroid function, after IFN therapy; their presence should not contraindicate IFN treatment.

Long-term results of the Spanish trial on treatment and survival of patients with predominantly mild heart failure.

A randomized open-label clinical trial was conducted to determine whether mortality, readmission, or quality of life differed between heart failure patients managed with captopril plus diuretics and those with digoxin plus diuretics. A total of 345 heart failure patients in New York Heart Association functional classes 2 and 3 without atrial fibrillation, dyspnea of bronchopulmonary origin, or hypertension not controlled with diuretics was randomized for digoxin (n = 175) or captopril (n = 170) treatment and followed up for a median of 4.5 years. Socioeconomic, demographic, electrocardiographic, echocardiographic, spirometric, and chest radiograph data were obtained at the initial examination. In a random sample of half the patients, ergometric, echocardiographic, and Holter records were obtained at entry and at 3 and 18 months. Patients were followed up for > or = 3 years. The end points were mortality, hospitalization for cardiac events, deterioration in quality of life, worsening of functional class, and need for digoxin or captopril in the captopril and digoxin groups, respectively. The trial had to be terminated prematurely owing to the difficulty in finding candidates free of angiotensin-converting enzyme (ACE)-inhibitor treatment. Baseline patient characteristics were similar in both groups. From the clinical point of view, only the 48-month mortality was relevantly lower (20.9 vs. 31.9%, respectively) among patients treated with captopril than that in those receiving digoxin (log rank test, p = 0.07). No statistically or clinically relevant differences were found in other end points or adverse effects. The results suggest but do not confirm the hypothesis that captopril treatment in mild to moderate heart failure might provide better long-term survival than digoxin.

[The prevalence of angina and cardiovascular risk factors in the different autonomous communities of Spain: the PANES Study. Prevalencia de Angina en España]. / Prevalencia de angina y factores de riesgo cardiovascular en las diferentes comunidades autónomas de España: estudio PANES.

INTRODUCTION AND OBJECTIVE: The study of angina prevalence has received little attention in the analysis of the dimension of coronary heart disease. The aim of this study was to determine the prevalence of angina and cardiovascular risk factors in the 45- to 74-year-old population of the different autonomous regions of Spain. METHODS: A sample of 10,248 subjects was recruited. Sampling was stratified by gender and age groups (45-54, 55-64 and 65 to 74 years), and proportional to the population distribution of the different autonomous regions. A multistage sampling was performed, firstly 200 villages were randomly selected, secondly three different socio-economic household were chosen. Sample unit was neighbouring households. Rose questionnaire of angina and a structured questionnaire to collect socio-demographic and risk factor variables were administered. RESULTS: Angina prevalence in the 45- to 74-year-old Spanish population was 7.5%. The autonomous regions with the higher and lower prevalence were Baleares (11.4%) and Basque Country (3.1%), respectively. The Pearson correlation coefficient between angina prevalence and ischemic heart disease or cardiovascular disease mortality in men and women was 0.52 and 0.55, and 0.31 and 0.44, respectively. The self reported prevalence of hypertension, dyslipemia, diabetes and smoking was 31.1%, 24.2%, 14.3% and 34.6% respectively. CONCLUSIONS: Angina prevalence in Spain is similar to that of developed countries although significant differences were observed among the autonomous regions of Spain. These differences correlate with those observed in ischemic heart disease or cardiovascular mortality among them and are associated with the cardiovascular risk factors prevalence which also varies among communities.

[Description and evaluation of the adequacy of parenteral nutrition in our hospital]. / Descripción y valoración de la adecuación de la nutrición parenteral en nuestro hospital.

INTRODUCTION: Parenteral nutrition (PN) is a form of nutrition that can be very beneficial, but it does have some indications and complications that should be taken into consideration. With this work we would like to describe the characteristics of our patients with PN, as well as their follow up, and to evaluate the appropriateness of its prescription. MATERIAL AND METHODS: Retrospective study carried out at a hospital with 415 beds. All patients who received PN during the first six months of 1996 were reviewed. Inadequacy criteria are established and a nutritional assessment was carried out by means of clinical and analytical parameters. Catheter infections were recorded according to specific criteria and the clinical and analytical evolution of the patients was followed. RESULTS: A total of 83 patients were given parenteral nutrition. The most frequent indication was prolonged fasting after a surgical resection of the digestive apparatus. The most common nutritional status when beginning the PN was severe protein malnutrition (23%). There were 33 cases (39.7%) of PN that was not indicated and/or potentially avoidable. A catheter infection was reported in 7 cases (8.4%).

[The hemodynamic characterization of the diabetic patient with arterial calcifications]. / Caracterizacioón hemodinámica del paciente diabético con calcificaciones arteriales.

This study was designed to describe the presence of calcifications according to the clinical features of the diabetic patient and the hemodynamics of the calcified arteries. With this purpose, 197 lower limbs from diabetic patients (type I and II) and carbon-hydrate intolerant patients, were studied. In all of the patients, the pressure ratio leg/arm was measured. On the same way, the arterial flow velocity was recorded using the Doppler ultrasonography on the pedia and postero-tibial arteries. The arterial calcifications, evident on the radiography of the foot, were more frequent between the type I patients and the neuro-infections diabetic foot. According to the hemodynamics point of view, we found a trend of association of more pathologic arterial flow velocity curves with the presence of calcifications (specially on the intima layer). It was also remarkable that an arterial incomprensibility was always associated with arterial calcifications.

[Hemodynamic bases for the automatized quantification of the degree of obstruction in peripheral arteries in diabetic patients]. / Bases hemodinámicas para la cuantificación automatizada del grado de obstrucción en arterias periféricas de pacientes diabéticos.

In order to improve the early diagnosis of arterial occlusions, we tried to establish the basis of an automatized system that allowed the study of the hemodynamic features of diabetic patients in the different stadii of their disease. Fifty-four patients with Diabetes Mellitus Type II were included in the study. In all of them, arterial flow curves were carried out at different levels: femoral, popliteal, pedia and tibial posterior arteries of both lower limbs. In the distal arteries of patients with hemodynamic injury, normal values of Maximal Systolic Velocity (Max A), Maximal Diastolic Velocity (Max D), Peurcelot's resistance (PR), pulsatility index (PI) and spectral band (SB), were found.

[Hemodynamic bases for the automated quantification of the degree of obstruction in the peripheral arteries of diabetic patients]. / Bases hemodinámicas para la cuantificación automatizada del grado de obstrucción en arterias periféricas de pacientes diabéticos.

In order to improve in the early diagnosis of an arterial occlusion, we proposed the bases of an automatized system that allows to recognize the hemodynamic features of diabetic patients in different stadiums of their disease. Fifty-four patients with type-II diabetes were studied. We recorded the arterial flow curves in the bilateral femoral, popliteal, pedia and tibial-posterior arteries from all of our patients. In the distal arteries from patients with hemodynamics disturbances, we found normal values of the variants measured: maximal systolic speed flow (Max A), maximal diastolic speed flow (Max D), Peurcelot's resistance (RP), pulsatility index (PI) and spectral band (SB).

[Antibiotic treatment in patients amputated for ischemic diabetic foot]. / Antibioticoterapia en pacientes amputados por pie diabético isquémico.

Thirty diabetic patients submitted to a major amputation were tested by humo-celullar assays (retarded hypersensibility assays). Reactive patients were subdivided into two groups: one group was treated postoperatively with antibiotics, and the other group was not treated. Both groups were homogeneous in age, hemoglobin concentrations, hematocrit, total proteins, glucemy and history of sepsis or leukocytosis. Five patients treated with antibiotics (33.3%) presented sepsis, one patient was reamputated and one patient died. Between the not treated patients, only three presented sepsis (20%) without any other complications. Authors conclude that the development of sepsis in reactive, diabetic, amputated patients is independent of antibiotic treatment.

[Microsurgical approach to the foot arteries in diabetic patients with vascular complications]. / Abordaje microquirúrgico de las arterias del pie en pacientes diabéticos con complicación vascular.

This study was made in order to assess the percentage of patients who underwent a by-pass (by saphenous vein) "in situ" on the foot arteries, as an alternative to the amputation for cases of severe ischaemia on the foot. The medium and short-term survival associated to the revascularized limb was also analyzed. Sixteen patients underwent this surgical procedure, 8 of them (50%) lost their limb within the following seven days to the revascularization; one patient lost their limb at the first year and 43.7% of patients maintain the viability of their limbs 3 years latter. This surgical procedure was made by microsurgery using a Carl Zeica amplification optic lens 2,3 X and a OFMI microscope with an amplification lens 40 X.

Dose calculations from routine releases: a new approach of influence area division.

In this article, a new method of dividing the influence area of a nuclear facility is proposed so that dose calculations from both routine airborne and liquid effluents can be performed. The computer codes EDO and MUNDOS were developed by the authors following the guidelines given in U.S. Regulatory Guides 1.109 and 1.111. EDO was written to facilitate the usual division of the area into annular segments and MUNDOS was created for proposed administrative divisions. Differences between the results of both codes are stressed and justified. The main advantages of the proposed division are: direct use of official demography and food production statistics; external and inhalation doses can be calculated for the places where the population centers are located; and combined doses from various facilities can be obtained simply by addition.

Arteriografia femoral y nivel de amputacion en el pie diabetico. / Femoral arteriography and amputation level in diabetic foot

Se realiza un estudio en 192 arteriografias e igual numero de expedientes clinicos correspondentes a pacientes diabeticos que presentan pie isquemico o neuroinfeccioso. Se establecen patrones arteriograficos para cada uno de los niveles habituales de amputacion. Se concluye, ademas, que la arteriografia tiene valor pronostico y gran importancia en cuanto a la decision del nivel de amputacion (AU)

Arteriografia femoral y nivel de amputacion en el pie diabetico. / Femoral arteriography and amputation level in diabetic foot

Se realiza un estudio en 192 arteriografias e igual numero de expedientes clinicos correspondentes a pacientes diabeticos que presentan pie isquemico o neuroinfeccioso. Se establecen patrones arteriograficos para cada uno de los niveles habituales de amputacion. Se concluye, ademas, que la arteriografia tiene valor pronostico y gran importancia en cuanto a la decision del nivel de amputacion

El empleo del omentum en el tratamiento del pie diabético / Omentum use for treatment of diabetic foot

En un grupo de 81 pacientes ingresados con los diagnósticos de pie diabético neuroinfeccioso y pie diabético isquémico, se les practicó en forma aleatoria, tratamiento local de sus lesiones con opiplón mediante aplicaciones del tejido in situ. Se obtuvieron diferencias significativas (p<0,01)cuando se evaluó la aparición del tejido de granulación en el pie diabético neuroinfeccioso y el isquémico (4,37 y 6,96 días, respectivamente). Al igual, fue significativo para p<0,01, al compararse el tiempo de hiperemia máxima en el pie diabético neuroinfeccioso, como consecuencia de practicarse una hiperemia plestimográfica pre y postratamiento. Se plantea además, la reducción de materiales y estadía a obtener con este procedimiento, y su introducción necesaria en el tratamiento del pie diabético(AU)

Control de las macroangiopatías diabéticas del pie / Control of diabetic macroangiopathy of the foot

Se realiza un ensayo clínico controlado en 90 pacientes diabéticos del tipo adulto, dirigido a conocer el efecto de algunos medicamentos sobre la progresión de la macroangiopatía de los miembros inferiores. El fermonmín (diabefén), la vitamina C y la hormona tiroidea demostraron tener un efecto significativamente más beneficioso sobre la evolución de la macroangiopatía que la tolbutamida (diabetón) y la aspirina. La necesidad de estudios ulteriores es enfatizada (AU)

Reversibilidad de la microangiopatía diabética periférica / Reversibility of peripherical diabetic microangiopathy

Se realiza un ensayo clínico controlado, en 46 pacientes diabéticos del tipo adulto, dirigido a conocer el efecto de algunos medicamentos sobre la microangiopatía periférica. Una evolución más favorable con índices de reversibilidad significativa más elevados, pudo apreciarse entre los pacientes que, además del tratamiento con hipoglicemiantes orales, recibieron durante dos años consecutivos aspirina, vitamina C o tiroides desecado, que entre aquéllos que recibieron hipoglicemiantes orales exclusivamente. Se señala el carácter preliminar de estas conclusiones y la necesidad de estudios ulteriores más profundos(AU)