[Report on continuing care in 1990 at the Health Center I of Ciudad Real]. / Informe de la atención continuada de 1990 en el Centro de Salud I de Ciudad Real.

OBJECTIVE: To determine what justification there is for Continuous Attention (CA). Secondly the ranking of processes, derivations and effect of the time of year. DESIGN: Descriptive longitudinal and retrospective study. Observational, non-controlled and without random distribution (all cases) and non-blind. SITE. Primary Attention (PA). PATIENTS: All people who attended the Health Centre (HC) from 3-5 pm, in 1990. INTERVENTION: None that would affect the results. MAIN MEASUREMENTS AND RESULTS: Most of those attending did so for IRA's, contusions, wounds, sprains and abdominalgias (table 1). 6.6% were derived, mainly digestive and traumatological processes (table 2). CONCLUSIONS: Compared with similar studies, the demand generated by our population is optimal both in numbers and in justification. Among the, subjectively-speaking non-justified visits the reasons were to avoid ordinary doctors appointments, to get second opinions, to obtain prescriptions, complementary analyses and hospitalisation, and obtain results more quickly, under the emergency service. A significant number of children are attended by general practitioners (GPs), and this induces private consultation. Derived cases are 6.6%, less than the standard 15%. One third of these cases are not hospitalised, especially in months when hospital demand is at its maximum. The lack of coordination between our service and the hospital casualty service is obvious, leading to amongst other things, the "rebound" effect on the user. Closeness between the two services means that an estimated 15% go directly to hospital, a fact which could diminish comparability between this and other studies, although in treating the whole series, the reliability of this study is improved.

[The response of the growth hormone to acute effort is a function of training]. / La respuesta de la hormona de crecimiento al esfuerzo agudo está en función del entrenamiento.

BACKGROUND: The increase of the growth hormone (GH) during exercise is known although the relationship of this response with other hormones, the type and intensity of the exercise, nutritional state and with the degree of training are reasons for discussion. The aim of this investigation was to study the response of the HG on a group of young adults with different degrees of training, according to the maximum consumption of oxygen (VO2 max) achieved over a short period of time. METHODS: Thirty-nine healthy subjects who underwent maximum effort on the treadmill were grouped according to VO2 max reached (less than 3,000 ml/min; 3,000-4,500 ml/min and greater than 4,500 ml/min). Systolic blood pressure (SBP) and diastolic blood pressure (DBP), respiratory quotient (RQ), O2 pulse, cardiac frequency (CF) respiratory equivalence (RE), glycemia, plasma insulin (PI), C peptide, lactic acid, venous pH, plasma renin activity (PRA), plasma aldosterone, thyrotropine (TSH), triodothyronine (T3), thyroxine (T4), adrenocorticotropine (ACTH), cortisol and GH were measured basally and following achievement of VO2 max. RESULTS: The GH was only increased in those subjects with a VO2 max higher than 3,000 ml/min with a significant positive correlation found between the GH and VO2 max and a significant negative correlation was found between the GH and lactic acid at the end of the test. The increase of glycemia at the end of the test correlated with the VO2 max. The PI and C peptide increased at the end of the test in the subjects with greater VO2 max capacity and correlated positively with the VO2 max and with the GH upon completion of the exercise. CONCLUSIONS: These results suggest that the response of the growth hormone to exercise is a function of maximum oxygen consumption although this only explains 24% of the variants of the growth hormone. Despite important hormonal and metabolic mobilization during exercise, no model of multiple regression has been found which substantially improves the association found between the growth hormone and maximum oxygen consumption.

[Computerized tomography of the pituitary gland in the diagnosis of prolactinoma: a concordance study]. / La tomografía computadorizada de hipófisis en el diagnóstico de los prolactinomas: estudio de concordancia.

BACKGROUND: The diagnostic capacity of computed tomography (CT) of the pituitary gland in the diagnosis of prolactinomas is difficult to define in terms of specificity and sensitivity since, up to the present, there is no definite diagnostic test for prolactin producing tumors. The aim of this study is to establish the consistency of CT of the hypophysis in the diagnosis of the prolactinomas based on a concordance design. METHODS: In the follow-up study of 48 patients diagnosed as affected of prolactinoma a concordance study was carried out on the blind lecture of 35 pituitary gland CT by two radiologists. RESULTS: The degree of concordance for all the diagnosis (kappa = 0.58) was greater than what might be expected by chance. The degree of concordance was also different for the different diagnosis given by the two radiologists: empty sella turcica, kappa = 0.84 (p less than 0.01); macroprolactinoma, kappa = 0.68 (p less than 0.01); microprolactinoma, kappa = 0.45 (p less than 0.01) and normal sella turcica, kappa = 0.28 (NS). CONCLUSIONS: CT of the hypophysis must be less sensitive (more false negatives) in cases of high prolactin due to microprolactinomas and less specific (more false positives) in cases of high prolactin due to a cause other than pituitary tumor, thereby making it a complementary diagnostic test to clinical evaluation and to prolactin determinations.