[The approach to pulmonary ventilation change]. / Aproximación a la alteración ventilatoria pulmonar.

OBJECTIVE: To study the epidemiological behaviour of pulmonary diseases with ventilation disorder to assess their development within primary care. DESIGN: Prospective study. SETTING: Primary care. Tudela West Health Centre (Navarra). PARTICIPANTS: 166 patients with one of the classic patterns of disorder found by Spirometry were chosen and monitored for a year. RESULTS: 72.3% were male with an average age of 63.2. 7.8% were new cases. 62.0% were smokers/ex-smokers. 80.1% had another associated pathology. An overall decrease in ventilatory function values was noted: this was more pronounced in cases of recurrence. 2.08 medicines were used, with smaller FEV1 [correction of FVE1]-fraction of ventricular ejection-leading to more medicines, of which the beta-adrenergics were the most common. 25.3% showed poor therapeutic compliance, deteriorating with age. 55% used inhalers badly. The number of medicines increased with decompensation. There were on average 3.5 consultations per year at the health centre. CONCLUSIONS: Tudela's findings are similar to those in other areas. There is poor therapeutic compliance among people of geriatric age. The burden of control falls on primary care.

[Value of ultrasonography in deep venous thrombosis of the legs]. / Valor de la ecografía en las trombosis venosas profundas de miembros inferiores.

A variety of non-invasive diagnostic procedures for assessing deep vein thrombosis (DVT) have appeared over the last 10 years. One is conventional ultrasound imaging, called B-mode at first and now called the Doppler-duplex mode. Several authors speak of the high level of reliability of this method for diagnosing DVT in the iliofemoral and popliteal regions. We found an initial sensitivity of 84% in a total of 162 ultrasound studies of lower extremities. Specificity was 100% in the 41 cases in which phlebograms were also used.

[A iatrogenic pathology study in an internal medicine service]. / Estudio de la patología iatrógena en un servicio de Medicina Interna.

BASIS: It's obvious that the current medicine practice generates iatrogenesis . However, we are unaware about its magnitude and severity, specially in Spain, where this item has been scarcely studied. METHODS: All the patients admitted to the Department of Internal Medicine were prospectively studied during a 13 months period, selecting among the patients those fulfilling criteria for an iatrogenic problem both of pharmacological origin and not pharmacological. The kind of iatrogenesis, its severity, related mortality, gravity of the basic illness, affected organ and avoidability of the iatrogenesis were evaluated. Infusion phlebitis were recorded only during 6 months. RESULTS: Iatrogenic pathology was found in 228 cases over 1.549 patients admissions, accounting for 14.7% of incidence. Iatrogenic pathology was the reason for admission in 65 cases. The average stay was significantly increased in patients with iatrogenic pathology (p < 0.01). Adverse reactions to drugs accounted for 62% of the total account with 141 cases. The non-steroids antiinflammatory (NSA) drugs were the most frequently troublesome pharmacological agents. The GI tract was the more affected system (84 cases). Infusion phlebitis are not included in the total account of cases. CONCLUSIONS: a) iatrogenic pathology is an illness of very high incidence in our surroundings; b) NSA is a group of drugs generating frequently adverse reactions in off-hospital environment; c) GI hemorrhage is an iatrogenic illness accounting for high percentage of cases; d) many of the iatrogenic events can be catalogued as avoidable and with more accurate attention to some factors the more of them could be prevented.

[Morbidity, mortality and other indicators of health care activities, at a General Internal Medicine Service]. / Morbilidad, mortalidad y otros indicadores de la actividad asistencial, en un Servicio de Medicina Interna General.

More than 50% of all health care expenses are incurred in hospitals, without objectively knowing many times their actual performance. Identification, sex, age, admission channel, date of admission, date of discharge, diagnosis and destination were recorded at discharge for all a local hospital. During those years, 6,410 patients were admitted in such Service (60.18% men and 39.18 women), with an average age of 63 years: 75% of all cases were emergencies, the average length of stay was 3.8 days and the occupation rate, 97.2%. 2.62% patients were referred to another center. The most frequent disease were cardiovascular (24.6%), respiratory (21.6%) and digestive (16.9%). The most frequent nosological entities were: chronic obstructive pulmonary disease (12%), acuter strokes (6.3%), cardiac failure (6.5%), ischemic cardiopathies (6.5%), high digestive hemorrhage (5.6%) and pneumonia (4.3%). The most frequent malignant tumors were those affecting lung, rectum-colon and hematologic. The average mortality rate was 4.3%, mainly due to malignant tumors and acute strokes. Diabetes mellitus and arterial hypertension were the most frequent associated diseases.

[Involuntary weight loss]. / Pérdida de peso involuntaria.

Involuntary weight loss is a clinical situation with unknown incidence, significance and prognosis. We present a retrospective study of 68 patients hospitalized due to involuntary weight loss. The most frequent individual cause was neoplasia; however, globally, non-neoplastic causes were most frequent. None of the symptoms was significantly associated to the diagnosis of a neoplastic or non-neoplastic disease. The mean age of the patients with neoplasia (71.36 +/- 17.19) differed from the mean age of the patients without neoplasia (63.39 +/- 17.19 years) (p < 0.05). The patients with neoplastic and infectious diseases needed a higher number of analysis than the other patients, being the most valuable data the presence of anemia, cholestasis and determination of thyroid hormones. The most useful evaluations were clinical and endoscopical assessments, thoracic radiography and abdominal echography.

[Antibiotic treatment for acute episodes of chronic obstructive pulmonary disease]. / Tratamiento con antibióticos de las agudizaciones de la enfermedad pulmonar obstructiva crónica.

Antibiotic therapy for acute episodes of chronic obstructive pulmonary disease (COPD) is a controversial issue still not clarified. In order to evaluate the effectivity of the antibiotic therapy, we designed a double-blind controlled and randomized clinical trial, in which 90 patients hospitalized due to an acute episode of COPD were divided into three groups: group I, cotrimoxazole (29 patients); group II, amoxicillin-clavulanic acid (32 patients) and group III, placebo (29 patients). Gasometric and spirometric measures were taken in addition to clinical evaluation at hospital admission and discharge using a numerical valoration system. All patients were treated with common bronchodilators. The three groups were homogeneous at their admission and there were no statistical differences at their discharge. We conclude that antibiotics do not play a relevant role in the improvement of acute episodes of COPD.

[The computerization of the clinical history in an internal medicine service]. / Informatización de la historia clínica en un servicio de medicina interna.

BACKGROUND: The following objectives were studied in the implementation of computerization in the registration of clinical histories: gather all the information obtainable from the patient, be able to up-date the information once introduced, use of the information by health care personnel, automatic carrying out of all routine reports, elaboration of hospital indexes, follow the conventional model of clinical history as much as possible and reasonable price. METHODS: The study was carried out in a 40-bed department of internal medicine in a county hospital. A mixed system of partial coding was used combined with free texts, the latter being with no limit of space. The clinical histories were structured in 9 groups which covered from personal data to complementary explorations. A personal computer compatible "AT" was employed. The program was designed and analyzed by internal medicine doctors using CLIPPER and language "C". RESULTS: The thousand one hundred histories were opened with the space occupied in the disc being of 7 Megabytes. Following the premise of: "write all data only once", the obtaining of all type of documents, indexes and listed was automatized facilitating the knowledge of the working of the department directly. Adaptation by medical personnel was good. CONCLUSIONS: The model presented achieved the previously mentioned aims of information gathering and up-dating, use of the information by hospital personnel, automatization of routine reports and indexes, the following of conventional models and economic feasibility. Computerization should not be imposed, must not represent more work and advantages should be obtained by its use.

[Neck-tongue syndrome secondary to abrupt head movements. Clinical study and conservative treatment]. / Síndrome cuello-lengua secundario a giros bruscos de la cabeza. Estudio clínico y tratamiento conservador.

The neck-tongue syndrome is an extremely rare entity consisting of the compression of the second cervical root in the atloaxoid space in relation to certain brusque movements of the neck. Given the infrequency of this syndrome, the authors present a diagnosed and controlled case of the same in the Reina Sofia Hospital in Tudela. A 25 year old patient was consulted who, for some time, had presented paresthesia in the right half of the tongue and contraction of the cervical musculature related to certain neck postures made during sports activities. Clinical examination was completely normal. Radiography only demonstrated a defect in the segmentation between the posterior C2, C3 arches. Herewith, the authors have revised the literature concerning the topic, discuss the physiopathological theories made in other studies and analyze the therapeutic possibilities of the disease inclinning towards conservative treatment.

[Bacteremia and sepsis due to Streptococcus agalactiae. Study of eight cases (author's transl)]. / Bacteriemia y sepsis por Streptococcus agalactiae. Presentación de ocho casos.

During a period of 29 months positive hemocultures to Streptococcus agalactiae corresponding to eight adult patients have been observed. These bacteria were apparently responsible for the clinical picture in five patients. In other two patients S. agalactiae appeared in the course of a sepsis caused by other germ. The remaining patient had a transient bacteremia and no treatment was required. Septic shock and bacterial endocarditis were the cause of death in two patients. Six patients cured. Literature on this subject is reviewed and the better prognosis of sepsis due to S. agalactiae in adults than in neonates is stressed. Endocarditis and meningitis occur as severe complications with poor prognosis. In patients with endocarditis the administration of penicillin and gentamicin as well as the consideration of early surgical replacement of the affected heart valve is recommended. Intravenous penicillin and gentamicin associated with intrathecal gentamicin are indicated in meningeal infections. Vancomycin is a good substitutive antibiotic in patients with penicillin hypersensibility.