Urinary vanillylmandelic acid:creatinine ratio in dogs with pheochromocytoma.

Pheochromocytoma diagnosis in dogs is challenging because biochemical tests are not always available. In humans, urinary vanillylmandelic acid (VMA) is part of a pheochromocytoma biochemical diagnostic profile, whereas its diagnostic accuracy is currently unknown in dogs with pheochromocytoma. Prospectively, VMA was determined by HPLC and expressed as the ratio with respect to urinary creatinine (VMA:C). The diagnostic accuracy of the VMA:C ratio was evaluated by analyzing the receiver operating characteristic (ROC) curve in 10 healthy dogs, 8 dogs with pituitary-dependent hypercortisolism, 8 dogs with adrenal-dependent hypercortisolism, and 7 dogs with pheochromocytoma. The pheochromocytoma diagnosis was confirmed by histology and immunohistochemistry in all tumors. The VMA:C ratio was significantly higher in dogs with pheochromocytoma (158 [53.4 to 230.8] × 10-3) than in dogs with adrenal-dependent hypercortisolism (48.1 [24.3 to 144.9] × 10-3; P < 0.05), dogs with pituitary-dependent hypercortisolism (37.5 [32 to 47.1] × 10-3; P < 0.001), and healthy dogs (33.8 [13.3 to 87.9] × 10-3; P < 0.001). When using a VMA:C ratio >58.2 × 10-3 for pheochromocytoma diagnosis, a sensitivity of 85.7% and a specificity of 88.4% were obtained. Nevertheless, when using a cut-off ratio of 4 times the median VMA:C ratio determined in healthy dogs, there was no overlap (100% specificity). The area under the ROC curve indicated that the VMA:C ratio test could be used to discriminate between dogs with and without pheochromocytoma, what leads to the conclusion that it is useful for pheochromocytoma diagnosis in dogs.

[Pneumococcal arthritis in paediatric population]. / Artritis neumocócica en población pediátrica.

OBJECTIVE: Cases of septic arthritis in paediatric population by Streptococcus pneumoniae in the Health Area of Santiago de Compostela (Spain) were reviewed. METHODS: A retrospective study from January 2005 to March 2014 was conducted for all S. pneumoniae isolates obtained from joint fluids in children. RESULTS: From the 7,416 joint fluids received in the Microbiology Department, 77 belonged to paediatric patients, and of these, only 8 had positive culture. In total, there were three positive cases for S. pneumoniae, two with positive culture and a third with positive antigen detection. In the three patients (two of them under 15 months) the affected joint was hip, antibiotic treatment was combined with surgical drainage and evolution was favourable. CONCLUSIONS: We conclude that pneumococcal arthritis is an entity that must be taken into account since most cases of arthritis in paediatric population appear as a complication of bacteraemia after a common cold or an ear infection. The greatest risk of sequel is associated with delays in diagnosis, so it is essential clinical and microbiological early diagnosis.

Curva de aprendizaje de la discectomía microendoscópica para el tratamiento de la hernia discal lumbar / Learning curve of microendoscopic discectomy for the treatment of lumbar disc herniation

Objetivo. Evaluar la curva de aprendizaje de la Discectomía Microendoscópica (MED) para el tratamiento de la hernia discal lumbar. Material y métodos. Estudio clínico observacional prospectivo de 120 pacientes intervenidos mediante técnica MED. La curva de aprendizaje se determinó atendiendo a la duración del procedimiento, las complicaciones y la tasa de conversión a cirugía abierta. Además se cuantificó el alivio del dolor, la mejoría del estado funcional y el grado de satisfacción del paciente, con un seguimiento de 5 años en todos los casos. Resultados. La duración de la intervención fue disminuyendo a lo largo de la serie para estabilizarse en torno a 62–69min después de los primeros 48 procedimientos. Se presentó alguna complicación en 14 pacientes (11,7%) la más frecuente fue el desgarro dural (3 casos, todos durante el proceso de aprendizaje de la técnica). En 6 ocasiones (5%) fue preciso reconvertir el procedimiento a técnica abierta (4 de ellos en los primeros 30 casos de la serie). Discusión y conclusiones. El periodo de aprendizaje de la MED abarcó entre 30–48 procedimientos. Superada esta etapa, fue excepcional la conversión a técnica abierta y no se produjeron complicaciones relacionadas con la técnica. La MED es un procedimiento predecible y seguro que permite tratar todo tipo de hernias discales a través de una incisión de 18 mm sin seccionar ni desinsertar la musculatura, y que ofrece unos resultados equiparales a los obtenidos con técnicas convencionales debido a que se basa en sus mismos principios quirúrgicos de descompresión radicular (AU)

Objective. To evaluate the learning curve of the Microendoscopic Discectomy (MED) for the treatment of lumbar disc herniation. Material and methods. Prospective observational clinical study of 120 patients operated by MED technique. The learning curve was assessed using surgery time, complication rate and conversion rate. The relief of pain, improvement of functional status and patient satisfaction were also assessed. The follow-up time after surgery was 5 years in all cases. Results. The duration of surgical operating time decreased over the course of the study to stabilise around 62–69min. There were complications in 14 patients (11.7%), the most frequent of which was incidental durotomy (3 cases, all during the learning curve period). There were six (5%) conversions to open discectomy (4 patients in the first 30 cases). After this stage, conversion to open procedure was exceptional and there were no complications related to technique. The MED is a predictable and safe procedure that can treat all types of herniated discs through an 18 mm incision without detaching the muscles, providing similar results to those obtained with conventional techniques, as it is based on the same surgical principles (AU)

Evaluación de la satisfacción de los familiares en las urgencias pediátricas / Evaluation of family satisfaction of pediatrics emergency services

ObjetivosDeterminar el grado de satisfacción de los familiares usuarios del servicio de urgencias pediátricas, identificar factores que puedan influir en la satisfacción y establecer las áreas de mejora.Material y métodosEstudio retrospectivo y descriptivo. Se incluyó en el estudio a los familiares que acompañaron al niño durante su estancia en urgencias. El muestreo fue aleatorizado, sistemático y se utilizó como instrumento una encuesta telefónica. En el estudio divariado se utilizó el estadístico chi-cuadrado para variables categóricas y análisis de variancia para aquellos que presentaban una distribución continua. El análisis se realizó con el programa SPSS 16.0.ResultadosSe realizaron 120 encuestas, de las cuales se obtuvieron 96 respuestas. El perfil demográfico de los acompañantes fue mujer, casada, en situación laboral activa y estudios medios/universitarios. En el 100% de los casos el acompañante era un familiar, en un 85% era la madre. En un 65% se consideró la enfermedad del niño leve, y se resolvió en el 86% de los casos. Se constató poca discrepancia entre el tiempo objetivo y la percepción subjetiva. Los encuestados manifestaron un alto grado de satisfacción con la información recibida. Se observó una valoración muy positiva (76%) ante el trato humano recibido. Las áreas susceptibles de mejora fueron las relacionadas con la identificación del personal sanitario y las instalaciones.ConclusiónEn las condiciones del estudio se detectó que los factores más determinantes en la satisfacción del familiar son aquéllos relacionados con el acompañamiento, la amabilidad y el respeto(AU)

ObjectiveTo determine the level of satisfaction of families of the pediatric department hospital emergency services; to identify the key service performance factors that could influence their final satisfaction and to find best practices from a review of experiences evaluated.MethodologyA descriptive retrospective study was carried out. Family members who accompanied a child during his stay in the hospital emergency service were included in the study. The sample was defined using a random systematic methodology with telephone surveys as the main tool. The statistical methods used were standard deviation for categorical variables and the analysis of the variance for the continuous variables. The SPSS 16.0 programme was used as the main tool for evaluating the results.ResultsA total of 120 surveys were made with 96 responses obtained. The demographic profile of the main companion of the child was a woman, married, active worker with medium/university education. In 100% of the cases the main companion was a direct member of the family, and 85% of cases it was the child's mother. The pathology was considered mild in 65% of cases, with 86% of them being being resolved. There was very little difference between the actual time and the perceived time. From the information obtained, a high level of general satisfaction was perceived, with a positive assessment (in 76% of the cases), on the way the were treated by hospital staff. The areas for improvement were those associated with the identification of the health staff and facilities.ConclusionAs a general assessment of the study it was shown that the main factors of satisfaction for the family members were those related to being able to accompany the child, and the kindness and the respect(AU)

[Evaluation of family satisfaction of pediatrics emergency services]. / Evaluación de la satisfacción de los familiares en las urgencias pediátricas.

OBJECTIVE: To determine the level of satisfaction of families of the pediatric department hospital emergency services; to identify the key service performance factors that could influence their final satisfaction and to find best practices from a review of experiences evaluated. METHODOLOGY: A descriptive retrospective study was carried out. Family members who accompanied a child during his stay in the hospital emergency service were included in the study. The sample was defined using a random systematic methodology with telephone surveys as the main tool. The statistical methods used were standard deviation for categorical variables and the analysis of the variance for the continuous variables. The SPSS 16.0 programme was used as the main tool for evaluating the results. RESULTS: A total of 120 surveys were made with 96 responses obtained. The demographic profile of the main companion of the child was a woman, married, active worker with medium/university education. In 100% of the cases the main companion was a direct member of the family, and 85% of cases it was the child's mother. The pathology was considered mild in 65% of cases, with 86% of them being being resolved. There was very little difference between the actual time and the perceived time. From the information obtained, a high level of general satisfaction was perceived, with a positive assessment (in 76% of the cases), on the way the were treated by hospital staff. The areas for improvement were those associated with the identification of the health staff and facilities. CONCLUSION: As a general assessment of the study it was shown that the main factors of satisfaction for the family members were those related to being able to accompany the child, and the kindness and the respect.

Tratamiento de la estenosis del receso lateral mediante laminectomía microendoscópica: resultados a un año de evolución / Treatment of lateral recess stenosis by means of microendoscopic decompressive laminectomy: results at one year

Objetivo: valorar la eficacia de la descompresión radicular de la estenosis del receso lateral lumbar por técnica microendoscópica.Material y métodoestudio longitudinal prospectivo de 60 pacientes diagnosticados de estenosis de canal lumbar e intervenidos mediante descompresión por vía microendoscópica usando un retractor tubular METRx de 18mm según la técnica METRx (Medtronic Sofamor Danek, Memphis, Estados Unidos). Se evalúan los resultados con la escala visual analógica del dolor (EVA), el índice de discapacidad de Oswestry (ODI), el grado subjetivo de satisfacción percibido por el paciente y la clasificación modificada de Macnab.Resultadosla media±desviación estándar de edad es 54,5±10 años, 34 (56,7%) son varones y 26 (43,3%), mujeres. El área más afectada es L5 (63,33%). La media de tiempo de la intervención quirúrgica fue 85,17±18min. La media de estancia hospitalaria postoperatoria fue 4±1,2 días. El tiempo de seguimiento de los pacientes fue de 12 meses. Obtuvimos un 66,6% de resultados buenos o excelentes; con una satisfacción subjetiva buena en el 68,3% de los pacientes. La disminución media del ODI al año con respecto al preoperatorio es de 34,3±26,2 puntos, la de EVA de extremidades inferiores es de 6,2±2,6 puntos, y en la EVA lumbar, de 1,6±1,8 puntos, todas con significación estadística (p<0,05).Conclusioneslos datos recabados en nuestra experiencia nos indican que la laminectomía descompresiva microendoscópica es una técnica segura y efectiva para el tratamiento de la estenosis del receso lateral lumbar y una alternativa en las técnicas mínimamente invasivas de la columna (AU)

Purpose: To determine the efficacy of microendoscopic radicular decompression of lumbar lateral recess stenosis.Materials and methodsProspective longitudinal study of 60 patients diagnosed with lumbar spinal stenosis and treated by microendoscopic decompression using a METRx 18-mm tubular retractor according to the METRx (Medtronic Sofamor Danek, Memphis, USA) technique. The results were evaluated using a Visual Analog Scale pain score (VAS), the Oswestry Disability Index (ODI), a patient satisfaction questionnaire and the modified Macnab criteria.ResultsMean age was 54.5±10 years; 34 (56.7%) subjects were male and 26 (43.3%) women. The most affected level was L5 (63.33%). Mean OR time was 85.17±18min. Mean postoperative hospital stay was 4±1.2 days. Follow-up was 12 months. We obtained 66.6% good or excellent results and obtained a good subjective satisfaction level in 68.3% of patients. Mean ODI decrease was 34.3±26.2 points, lower-limb VAS was 6.2±2.6 points, and lumbar VAS 1.6±1.8 points; all these results were statistically significant (p<0.05).ConclusionsThe results obtained indicate that, in our experience, microendoscopic decompressive laminectomy is a safe and effective technique for the treatment of the lumbar lateral recess stenosis (AU)

Neumonía neumocócica con bacteriemia en adultos: estudio descriptivo en el noroeste de España / Pneumococcal pneumonia with bacteremia in adults: a descriptive study from north-west of Spain

Objetivo: Análisis de pacientes mayores de 15 años, con neumonía neumocócica con bacteriemia (NNB), en el Complejo Hospitalario de Pontevedra. Material y métodos: Se estudiaron 83 casos de NNB en los últimos 6 años (1995-2000). Resultados: Había 57 hombres y 26 mujeres. La edad media era de 56 años; en los menores de 40 años, había un 60%, infectado por el VIH. Dos tercios de los pacientes, tenían más de un factor predisponente, destacaban: el tabaquismo, el alcoholismo y la infección por el VIH. La presentación clínica típica de neumonía neumocócica, la encontramos en el 73%. El cálculo del índice de severidad de la neumonía (ISN), encuadró la mitad de los pacientes, en el grupo de bajo riesgo de mortalidad. La resistencia a la penicilina en los aislamientos, fue de 31%. Se modificó el tratamiento antibiótico inicial, en el 11% de los casos. Los fallecidos (10%) tenían: edad superior a 65 años, presencia de confusión mental, una mayor hipoxemia e hipercapnia, ingreso en la UCI, una presentación atípica, existencia de derrame pleural y un ISN mayor de 140. Conclusiones: Los pacientes NNB en nuestra área presentan unas características clínicas similares a las descritas en otras series; la mitad se incluyen en el grupo de bajo riesgo de mortalidad. Aparte de otros factores ya conocidos, un ISN superior a 140, se relaciona directamente con la mortalidad (AU)

[Pneumococcal pneumonia with bacteremia in adults: a descriptive study from the north-west of Spain]. / Neumonía neumocócica con bacteriemia en adultos: estudio descriptivo en el noroeste de España.

OBJECTIVE: Analysis of adults patients (> 15 years of age) with Bacteremic Pneumococcal Pneumonia (BPP), in the Hospital Complex of Pontevedra. MATERIAL AND METHODS: 83 cases of BPP were studied in the last 6 years (1995-2000). RESULTS: There were 57 men and 26 women. The overall mean age was 56 year-old; in those smaller than 40 years, there was 60% infected by the HIV. The patients' two thirds, had > 1 predisposing condition, highlighted: the cigarette smoking, the alcoholism and the HIV infection. The typical clinical presentation of pneumococcal pneumonia, we find it in 73%. The calculation of the pneumonia severity index (PSI, Fine et al.), it framed half of the patients in the group of low risk of mortality. The resistance to the penicillin in the isolations, was of 31%. The initial antibiotic treatment was modified, in 11% of the cases. The fatal cases (10%) had: superior age to 65 years, presence of mental confusion, a bigger hypoxemia and hypercapnia, admission in the ICU, atypical presentation, existence of pleural effusion and a PSI bigger than 140. CONCLUSIONS: The patient with BPP in our area, presents some similar clinical characteristics to those described in other series; the half is included in the group of low risk of mortality. Apart from other factors already well-known, a superior PSI at 140, is related directly with the mortality.