Influencia de diversos factores en la discapacidad producida tras esguince cervical por accidente de tráfico / Influence of various factors in the disability produced by whiplash after traffic accident

Objetivos: El síndrome de latigazo cervical constituye un problema sociosanitario creciente; los objetivos planteados son: 1) establecer las posibles relaciones entre factores clínicos, funcionales y psicosociales, y su influencia en la rehabilitación; 2) comprobar si las alteraciones observadas en las pruebas complementarias influyen en la magnitud de la clínica y resultado de la rehabilitación. Material y métodos: Ciento quince pacientes con esguince cervical (por accidente de tráfico) acceden voluntariamente a formar parte del estudio; se analizan los síntomas y signos, rasgos psicológicos, elementos laborales y sociales y capacidad funcional (cuestionarios de Occhipinti y Northwick). Las determinaciones se efectúan antes y después de un programa de rehabilitación, evaluándose mediante las escalas de Norris y Gargan. En 55 pacientes se valora la resonancia magnética nuclear, radiología y estudio neurofisiológico. Resultados: No existe una relación clara entre la severidad de los síntomas y los signos físicos, excepto en la fase inicial (p<0,05). La alteración funcional es proporcional a la intensidad del trastorno clínico (p<0,001). Existe cierta contribución de los rasgos psicosociales en la intensidad del dolor referido y restricción funcional (p<0,05). La gravedad del trastorno se relaciona con un tratamiento más prolongado (p<0,01) pero no hay diferencia significativa del resultado del tratamiento en los tipos clínicos. La capacidad funcional no se ve afectada en mayor grado ante alteraciones en las pruebas complementarias. Conclusiones: Los factores analizados parecen ser predictivos de la duración del tratamiento pero no del resultado del mismo. La cronicidad del dolor y la discapacidad parecen ser independiente de las alteraciones evidenciadas en las pruebas complementarias (AU)

Background and objectives: Whiplash syndrome constitutes an increasing sociosanitary problem, the objectives are: 1) To establish the possible relationships between clinical, functional and psychosocial factors and their influence on rehabilitation; 2) To check if the alterations observed in the complementary test influences the magnitude of symptoms and rehabilitation outcomes. Subjects and methods: 115 patients with cervical sprain (because of a traffic accident), voluntarily agree to take part of the study, symptoms and signs, psychological features, occupational and social factors and functional capacity are analized (Occhipinti and Northwick questionnaires). Determinations are carried out before and after a rehabilitation program, beging evaluated by Norris′scales and Gargan. In 55 patients MRI values, radiology and neurophysiological study are valued. Results: A clear relationship doesn′t exist between the severity of the symptoms and the physical signs, except in the initial phase (p<0.05). Functional alteration is proportional to the intensity of the clinical disorder (p<0001). Certain contribution of the psycho-social features in the intensity of referred pain and functional limitation (p<0.05). The severity of the disorder is associated with longer treatment (p<0.01) but there is no significant difference of the outcome of the treatment in the clinical types. The functional capacity is not affected in major degree in view to changes in the tests. Conclusions: The analyzed factors seem to predict the duration of treatment but not the outcome of the same one. The chronic pain and the disability they seem to be independent from the alterations demonstrated in the complementary tests (AU)

Reeducacion propioceptiva en la lesion articular deportiva: bases teóricas / Rehabilitation propioceptive in joint injury athlete: theoretical basis

La propiocepción, en el contexto de la lesión deportiva, se relaciona con el control neuromuscular del movimiento y de la estabilidad articular. El presente artículo trata de revisar algunos aspectos teóricos que fundamentan el tratamiento conocido como trabajo propioceptivo. El sistema aferente, además de contribuir a la percepción de las sensaciones de movimiento y de la posición articular, tiene un importante papel en los frenos dinámicos de estabilidad articular. Existe cierta confusión en la terminología de las sensaciones articulares e igualmente sobre la definición de la propiocepción. Se conocen diversos factores que han demostrado su influencia en este tipo de sensibilidad, como son la edad, la actividad física, el entrenamiento, la fatiga y el deterioro del cartílago articular. La alteración de la propiocepción sucede tras la lesión de las cápsulas y ligamentos y este defecto sensorial parece ser muy prolongado, no estando claro el origen central o periférico del trastorno propioceptivo. La consecuencia de la desaferentización es la alteración de los programas motores que parece predisponer a la recidiva lesional en el deportista. Finalmente, se presentan las bases conceptuales y los objetivos de la reeducación propioceptiva (AU)

Ejercicio fisico en el paciente en hemodialisis / Physical exercise in hemodialysis patients

Se ha estudiado la modificación de la capacidad de esfuerzo en un grupo de 23 pacientes sometidos a hemodiálisis tras realizar un programa de ejercicio físico (dinámico, aeróbico; 30-60 minutos de sesión, 3 días a la semana, intensidad entre el 50-70 por ciento de la frecuencia cardiaca máxima obtenida en una prueba de esfuerzo, duración de 4,5 meses). Para ello se les realizó una prueba de esfuerzo antes de iniciar dicho programa y tras realizarlo. Otros 11 pacientes fueron tomados como grupo control, realizándoles 2 pruebas de esfuerzo con el mismo intervalo de tiempo que el grupo de estudio. En el grupo control no se observan modificaciones en ningún parámetro estudiado. El grupo de estudio, tras el periodo de entrenamiento, muestra un descenso de la TAS (tensión arterial sistólica) y de la TAD (tensión arterial diastólica) en reposo (p<0,01). La prueba de esfuerzo revela un incremento significativo del consumo máximo de oxígeno (VOZ) del 26,06 por ciento, sin llegar a alcanzar las cifras obtenidas por sujetos sedentarios de sus mismas características morfométricas. El incremento del VOZ máximo, después del protocolo de entrenamiento va asociado a una elevación de VCO2 (p<0,001). El tiempo y la potencia alcanzada al final de la prueba es también superior, con un incremento medio del 32,82 por ciento (P<0,001) y del 38,33 por ciento (P<0,001) respectivamente. Este grupo no muestra cambios sustanciales de la frecuencia cardiaca ni de las cifras tensionales sistólicas al esfuerzo máximo, pero, al considerar que la intensidad del esfuerzo post-entrenamiento es mayor en términos de VOZ máximo, se deduce que con menor frecuencia cardíaca pueden lograr el nivel de esfuerzo realizado en la prueba inicial (AU)

[Experimental cryptorchism in the Wistar rat]. / Criptorquidia experimental en rata Wistar.

Experimental cryptorchidism was performed on Wistar rats, fixing the left testicle into the peritoneum for a month. Animals under study (84) were divided into four groups: control, control treated with hCG, cryptorchid and cryptorchid treated with hCG. Cryptorchid testes were biopsied at three, five and eight months and all were excised at 12 months. Cellular counts on spermatogonia, young and late spermatocytes, Sertoli cells and vacuolized Sertoli cells, together with the slough tubular and germinal cell percentage and the tubular diameter, let us affirm by means statistical studies (ANOVA, Chi square) that a testes recovering is already shown at the age of five months, although this recovering still differs from the one shown in the control groups.

[Mortality trends in gynecologic tumors in Soria. 1950-1985]. / Tendencias de mortalidad por tumores ginecológicos en Soria. 1950-1985.

We have carried out in the province of Soria neoplastic mortality tendency curves for tumors in the breast, uterus and ovaries, on the basis of their adjusted rates of mortality during four periods: three decades (1950-59/60-69/70-79) and one six-year period (1980-85). We have observed an increased risk of mortality due to breast tumors in women, which is statistically significant (p less than 0.01) in the global provincial figure, which has gone from an adjusted rate of 6.08 deaths per 10(5) women in 1950-59 to 14.25 in the years 1980-85. We have also detected an increased risk of ovarian tumors in the provincial total, rising from 0.48 to 2.0 deaths per 10(5) women, while those located in the uterus show a virtually stable mortality over the 36 years under study (5.89/1950-59) (5.24/1980-85) x 10(5) women. In relation to other existing figures, our rates are, in the case of breast and ovarian tumors, similar to the global Spanish figures and lower than those for Cataluña and Navarra. In the case of tumors of the uterus, the adjusted mortality rates are lower than the national average and lower than any other Spanish figures available.

[Mortality trends caused by neoplasms of the digestive system. Soria, 1950-1985]. / Tendencias de mortalidad por neoplasias de aparato digestivo. Soria, 1950-1985.

The deaths caused by tumours of the digestive system (oesophagus, stomach, colon-rectum, gallbladder and pancreas) recorded in the province of Soria between 1950 and 1985 have been analyzed according to risk and mortality rates. Standardized (adjusted) rates in relation to sex and site of residence (urban-rural) of the deceased were calculated for the decades 1950-1959, 1960-1969, 1970-1979 and the period between 1980 and 1985. Standard errors were calculated to establish confidence limits according to Miettinen's method. The data were obtained from the death certificates of the various registries of the Soria province, including name and surnames, sex, age and site of the tumour according to the 9th revision of the International Classification of Diseases. There is a significant decrease in the mortality risk for tumours of the stomach in both sexes (p less than 0.01) and in liver tumours in females (p less than 0.01). On the other hand, there is an increased risk in both sexes for pancreatic cancer (p less than 0.05 M, p less than 0.01 F) and for oesophageal tumours in men (p less than 0.05). Similarly, during 1980-1985 men were at a significantly greater risk of dying from oesophageal, gastric and liver cancer (p less than 0.01) as well as rectum and colon (p less than 0.05). As far as stomach tumours are concerned there are significant differences between rural and urban areas both in males (p less than 0.01) and in females (p less than 0.05).

[Relationship among the neoplasm incidence and mortality rates in the province of Soria. 1981-85]. / Relación entre las tasas de incidencia y mortalidad neoplásica en la provincia de Soria 1.981-85.

During the years 1981 to 1985, every single death and neoplastic illness in the province of Soria was recorded, and tabulated in relation to age, sex, location, and place of residence. Adjusted Rates (Direct method) were obtained for all locations, both in mortality and in incidence, as well as their Standard Errors. The deceased and the neoplastically ill were grouped in areas--Urban an Rural--in order to establish risk differences in both areas, the intervals of confidence being established according to the Miettinem method. The neoplastic risk is always higher in males, both incidence and Global Mortality being statistically significant (p less than 0.01), as well as most of the locations. Gastric tumors have the highest rate of incidence (global and in males) and mortality (global and in both sexes), with higher presence in rural areas than in urban ones (p less than 0.05). On the other hand, in males, there is a higher incidence in urban areas of Lung Tumors (p less than 0.01) and Larynx (p less than 0.05). The latter, in males, and in the bladder in both sexes, have the highest survival ratio (Standard rate of incidence/Standard rate of mortality).

[Wilms' tumor associated with membranous glomerulonephritis]. / Tumor de Wilms asociado a una glomerulonefritis membranosa.

We report on a case of Wilms tumor associated with segmental, focal membranous glomerulonephritis in the contralateral kidney of a 4-year-old boy. The possible etiopathogenesis and outcome of this rare disease entity are discussed. Except for rare cases, this condition usually progresses to end-stage renal failure.

Multiple cavernous hemangioma of the kidney.

A case of renal angiomas, located on the tip of the papillae, presented with severe hematuria which required several blood transfusions. Radiological studies including arteriography were negative. The diagnosis was confirmed by intraoperative nephroscopy and histology.