Isolation of two triterpenoids from Phlomis purpurea, one of them with anti-oomycete activity against Phytophthora cinnamomi, and insights into its biosynthetic pathway.

Phytophthora cinnamomi is an important plant pathogen responsible for dieback diseases in plant genera including Quercus, Fagus, Castanea, Eucalyptus, and Pinus, among others, all over the world. P. cinnamomi infection exerts tremendous ecological and economic losses. Several strategies have been developed to combat this pathogenic oomycete, including the search for novel anti-oomycete compounds. In this work, a Mediterranean vascular plant, Phlomis purpurea, has been screened for secondary bioactivity against this pathogen. The genus Phlomis includes a group of herbaceous plants and shrubs described as producers of many different bioactive compounds, including several triterpenoids. Triterpenoids are well-known molecules synthesized by plants and microorganisms with potent antioxidant, antitumoral, and antimicrobial activities. We have isolated by HPLC-DAD and characterized by HPLC-MS and NMR two nortriterpenoid compounds (phlomispentaol A and phlomispurtetraolone) from the root extracts of P. purpurea. One of them (phlomispentaol A) is active against the plant pathogenic oomycete P. cinnamomi (based on in vitro inhibition bioassays). Based on their chemical structure and their relationship to other plant triterpenoids, oleanolic acid is proposed to be the common precursor for these molecules. The anti-oomycete activity shown by phlomispentaol A represents a promising alternative to counteract the worldwide-scale damage caused to forest ecosystems by this pathogen.

Are the unreamed nails indicated in diaphyseal fractures of the lower extremity? A biomechanical study.

INTRODUCTION: Intramedullary nailing is generally accepted as the first choice for the treatment of diaphyseal fractures of femur and tibia, with a gradual incease in the use of unreamed nails. Different studies during last years show controversial outcomes. Some authors strongly favor unreamed nailing, but most of the authors conclude that reamed nailing have proved to be more successful. MATERIAL AND METHODS: This study simulates unreamed intramedullary nailing of four femoral and three tibial fracture types by means of Finite Element (FE) models, at early postoperative stages with a fraction of physiological loads, in order to determine whether sufficient stability is achieved, and if the extent of movements and strains at the fracture site may preclude proper consolidation. RESULTS: The behavior observed in the different fracture models is very diverse. In the new biomechanical situation, loads are only transmitted through the intramedullary nail. Mean relative displacement values of fractures in the femoral bone range from 0.30 mm to 0.82 mm, depending on the fracture type. Mean relative displacement values of the tibial fractures lie between 0.18 and 0.62 mm, depending on the type of fracture. Concerning mean strains, for femoral fractures the maximum strains ranged between 12.7% and 42.3%. For tibial fractures the maximum strains ranged between 10.9% and 40.8%. CONCLUSIONS: The results showed that unreamed nailing provides a very limited mechanical stability, taking into account that analyzed fracture patterns correspond to simple fracture without comminution. Therefore, unreamed nailing is not a correct indication in femoral fractures and should be an exceptional indication in open tibial fractures produced by high-energy mechanism.

A diet based on cured acorn-fed ham with oleic acid content promotes anti-inflammatory gut microbiota and prevents ulcerative colitis in an animal model.

BACKGROUND: Diets based on meat products are not recommended in the case of ulcerative colitis (UC). The objective here is to test if some traditional cured meat products, as acorn-fed ham (high levels of oleic acid), may be useful for controlling inflammatory diseases as UC in animal models, which could represent a new dietary complementary intervention in the prevention of this inflammatory disease in humans. METHODS: Two rat cohorts have been used: conventional vegetable rat feed and acorn-fed ham. UC was induced with DSS in drinking water ad libitum for 1 week. Short-chain fatty acids (SCFAs) and 16S rRNA metagenomics from bacterial populations were analyzed in cecum samples. Colon samples were analyzed for histological parameters. RESULTS: Acorn-fed ham diet induced changes in gut microbiota composition, with pronounced enrichments in anti-inflammatory bacterial genera (Alistipes, Blautia, Dorea, Parabacteroides). The animals with this diet showed a strong reduction in most parameters associated to ulcerative colitis: disease activity index, macroscopic score of colitis, epitelium alteration in colon mucosa, inflammatory cell density in colon, myeloperoxidase titers in colon, proinflammatory cytokines (IL-17, IFN-γ). Also, acorn-fed ham diet animals showed increased total antioxidant activity an oleic acid levels in plasma, as well as higher short-chain fatty acid concentrations in cecum (isobutyric, isovaleric and valeric). CONCLUSIONS: In the acorn-fed ham cohort, as a result of the dietary intake of oleic acid and low intake of omega-6 fatty acids, a strong preventive effect against UC symptoms was observed.

Evaluación de la proteína C reactiva, alfa1-antitripsina y lipoproteína(a) como potenciales marcadores biológicos asociados al crecimiento del aneurisma de aorta abdominal / Evaluation of C-Reactive protein, Alpha1-Antitrypsin and lipoprotein (a) as potential biomarkers associated with abdominal aortic aneuriysm growth

Introducción. Actualmente, la valoración del aneurisma de aorta abdominal (AAA) infrarrenal asintomáticose realiza únicamente con pruebas de imagen seriadas. Buscamos un marcador plasmático útil como indicador de la actividaddel AAA y potencial valor pronóstico. Pacientes y métodos. Obtuvimos muestras de sangre periférica de 35 pacientescon AAA (13 AAA 30-39 mm; 11 40-49 mm; 11 >= 50 mm) y 35 controles. Determinamos la concentración plasmáticade proteína C reactiva (PCR), alfa1-antitripsina y lipoproteína(a). Registramos: datos clínicos, diámetro aórtico(ecografía/TC) en el momento de la extracción y crecimiento del AAA en el año previo. Analizamos la correlación entrecada proteína y el diámetro y crecimiento aórticos con los tests de Mann-Whitney, Kruskal-Wallis, Spearman y regresiónlineal. Resultados. Los pacientes eran mayoritariamente varones (n =33; 94,3%), con edad 71 ± 6,8 (54-83) años. El diámetrodel AAA (n = 35) era 45 ± 12 (30-71) mm, con crecimiento (n = 25) 3,1 ± 3,1 (0-10) mm/año previo. Las tres proteínaspresentaban concentraciones mayores en los pacientes que los controles: PCR 4,1 (1,9-7,3) frente a 1,9 (0,5-4,9)mg/L (p = 0,026); alfa1-antitripsina 147 (131-168) frente a 125,5 (113,8-135,5) mg/dL (p < 0,0001); lipoproteína(a) 47(20-117,5) frente a 27 (9-47) mg/dL (p = 0,022). Encontramos correlaciones positivas PCR-diámetro AAA (r = 0,46; p =0,007) y alfa1-antitripsina-crecimiento AAA (r = 0,55; p = 0,004), sin correlación entre lipoproteína(a)-diámetro/crecimientoAAA (p > 0,52). Las concentraciones de PCR estaban influidas por la toma de estatinas (p = 0,036). No existíancorrelaciones en los controles para ninguno de los marcadores (p > 0,22). Conclusiones. La alfa1-antitripsina pareceprometedora como marcador biológico de la actividad del AAA. La PCR muestra correlación con el tamaño del AAA, perose ve influida por las estatinas. Se descarta la utilidad de la lipoproteína(a)(AU)

Introduction. Current assessment of asymptomatic infrarenal abdominal aortic aneurysms (AAA) is donesolely with serial image techniques. We try to find a useful serological biomarker of AAA activity with potentialprognostic value. Patients and methods.We obtained peripheral blood samples from 35 AAA patients (13 3-3.9 cm AAA;11 4-4.9 cm AAA; 11 >= 5 cm AAA) and 35 controls. We quantified the serum concentration of C-reactive protein(CRP), alpha1-antitrypsin and lipoprotein(a). We registered: clinical data, aortic diameter (ultrasound/CT) at the timeof blood sample harvest, and AAA growth in the previous 12 months. We analysed the correlation between each proteinand the aortic diameter and growth, using Mann-Whitney, Kruskal-Wallis and Spearman’s tests and linear regression.Results. The AAA patients were mostly male (n = 33; 94.3%) and aged 71 ± 6.8 (54-83) years. The AAA diameter (n =35) was 45 ± 12 (30-71) mm, with expansion (n = 25) 3,1 ± 3,1 (0-10) mm/previous year. The levels of the three proteinswere significantly higher in the AAA patients compared to the controls: CRP 4.1 (1.9-7.3) v. 1.9 (0.5-5) mg/L (p = 0.026);alpha1-antitrypsin 147 (131-168) v. 125.5 (114-135.5) mg/dL (p < 0.0001); lipoprotein(a) 47 (20-117.5) v. 27 (9-47)mg/dL (p = 0.022). We found positive correlations CRP-AAA diameter (r = 0.46; p = 0.007) and alpha1-antitrypsin-AAAgrowth (r = 0,55; p = 0,004), but no association between lipoprotein(a) and AAA diameter or expansion (p > 0.52). CRPconcentrations were influenced by statin intake (p = 0.036). There were no correlations for any of the proteins in thecontrol group (p > 0.22). Conclusions. Alpha1-antitrypsin seems promising as a biomarker of AAA activity. CRP showscorrelation with AAA size, but is influenced by statin intake. Lipoprotein(a) has not proved useful(AU)

Detección de víctimas de bullying en un centro de Atención Primaria / Detection of bullying victims in a Primary Care site

INTRODUCCIÓN. El término bullying hace referencia al acoso escolar. Los estudios publicados hasta ahora se han realizado en centros escolares. Artículos publicados demuestran que ser víctima de bullying tiene consecuencias en la salud, por lo que este trabajo analiza la detección de víctimas de acoso escolar en un centro de Atención Primaria. MATERIAL Y MÉTODOS. La población diana son los 1.256 adolescentes de 13 a 16 años pertenecientes a un centro de salud de la periferia de Madrid. Se hace un estudio descriptivo transversal de una muestra aleatorizada de 90 adolescentes, siendo los criterios de inclusión estar escolarizado y dar consentimiento escrito, y los criterios de exclusión no saber leer o escribir, no hablar castellano, padecer algún tipo de enfermedad mental o no disponer de teléfono de contacto. Las variables recogidas fueron: sexo, edad, nacionalidad, núcleo de convivencia, repetidor, índice de masa corporal (IMC), patología previa, víctima de violencia escolar, criterios de ser víctima de acoso escolar, problema de autoestima, fumador, bebedor y consumo de drogas. RESULTADOS. El 37,8% de la muestra alguna vez habían sido agredidos física, verbal o psicológicamente, encontrando relación con el IMC. El 3,3% cumplía criterios de ser víctima de acoso escolar. El 12,2% eran fumadores, el 11,1% bebían alcohol y el 3,3% consumían drogas. Un 16,7% tenían problema de autoestima, siendo esto más frecuente en las mujeres. CONCLUSIONES. El estudio demuestra que si preguntamos en la consulta por este problema, la detección de víctimas de bullying es similar a la de los centros escolares. Por lo tanto, el abordaje de este problema debe ser interdisciplinar, y en él se debe implicar el médico de familia (AU)

INTRODUCTION. "Bullying" refers to abuse at school. The studies published up to date have been conducted in schools. They show that there are consequences for the health of those bullied, so that this work analyzes the detection of school bullying victims in a primary health care center. MATERIAL AND METHODS. The target population is 1256 teenagers aged between 13 to 16 years assigned to a Primary Care Center located in the Madrid suburbs. A cross-sectional, descriptive study was made using a random sample of 90 teenagers, the inclusion criteria being in school and having given written consent. The exclusion criteria were not knowing how to read or write, not being able to speak Spanish, suffering any kind of mental illness or those who could not be contacted via telephone. The variables gathered were: gender, age, nationality, living environment, whether they had repeated a year, body mass index (BMI), previous diseases, instances of being a victim of school violence or other forms of harassment, self-esteem problems, smoker, drinker and drugs use. RESULTS. A total of 37.8% of the persons surveyed indicated that had experienced some form of physical, verbal or psychological abuse and a relationship was found with BMI. A total of 3.3% of the people met the criteria of bullying, 12.2% were smokers, 11.1% drank alcohol and 3.3% took drugs and 16.7% had self-esteem problems. This last point was more frequent among women. CONCLUSIONS. Detection of bullying victim in this work-place is similar to those found in schools. Thus, the approach to this problem should be interdisciplinary and the family doctor should be involved (AU)

Veinte años en la reparación abierta electiva de los aneurismas de aorta abdominal infrarrenal / Twenty years of elective open repair of aneurysms in the infrarenal abdominal aorta

Objetivos. Presentar la morbimortalidad de nuestro servicio en la reparación abierta electiva de los aneurismasde aorta abdominal (AAA) y estudiar los diversos factores que pueden influir en ella. Pacientes y métodos. Desde1987 hasta 2006 estudiamos 309 pacientes a quienes se practicó una reparación abierta electiva de su AAA. De ellos,304 eran varones (98,4%), y la edad media, de 67,9 ± 7,1 años. Se clasificaron en cuatro períodos quinquenales para suestudio. Resultados. Ciento trece pacientes (36,6%) se clasificaron, de acuerdo con la clasificación de la American Societyof Anesthesiologists (ASA), como ASA II, 168 (54,4%) como ASA III y 28 (9,1%) como ASA IV. Fallecieron postoperatoriamentenueve pacientes (2,9%), y la principal causa fue la pulmonar (55,5%). Las complicaciones postoperatoriasfueron 56 (18,1%), 44 generales (14,2%) y 12 debidas a la técnica (3,9%). Con el tiempo aumentaron de forma significativalos pacientes operados por aumento de diámetro aórtico (de 3,3 a 40%) y los pacientes con ASA III (de 57 a 73,4%).Disminuyeron significativamente la mortalidad en pacientes ASA III (de 10 a 0%) y la estancia en la Unidad de CuidadosIntensivos (de 3,4 a 3,1 días). Sin embargo, aumentó significativamente el tiempo de oclusión aórtica (de 53,6 a 68,5min). Con un seguimiento medio de 77,3 meses, la supervivencia fue del 77,3%, y la principal causa de muerte, la cardiopatía(12,7%). Se presentaron 19 complicaciones tardías derivadas del injerto (6,3%); la más frecuente fue el aneurismaanastomótico distal (2%). Conclusiones. En la actualidad, la reparación abierta electiva es una excelente técnica para eltratamiento quirúrgico de los AAA, con muy baja mortalidad hospitalaria y escasas complicaciones en su seguimiento a largo plazo

Aim. To present the morbidity and mortality rates in the open repair of abdominal aortic aneurysms (AAA) inour service and to study the different factors that can influence them. Patients and methods. We studied 309 patients whohad undergone elective open repair of their AAA between 1987 and 2006. Three hundred and four were males (98.4%)and the mean age was 67.9 ± 7.1 years. Cases were divided into four five-year periods for the study. Results. Onehundred and thirteen patients (36.6%) were classified, according to the American Society of Anaesthesiologists (ASA)classification, as ASA II, 168 (54.4%) were ASA III and 28 (9.1%) as ASA IV. Nine patients (2.9%) died during the postoperativeperiod, the main cause being the pulmonary (55.5%). There were 56 cases of post-operative complications(18.1%), 44 general complications (14.2%) and 12 arising from the technique employed (3.9%). The number of patientswho underwent surgery to increase the aortic diameter rose significantly with time (from 3.3 to 40%), and the sameoccurred with patients with ASA III (from 57 to 73.4%). There was a significant decrease in mortality in ASA III patients(from 10 to 0%) and in the time spent in the intensive care unit (from 3.4 to 3.1 days). The aortic occlusion time, however,rose significantly (from 53.6 to 68.5 min). With a mean follow-up of 77.3% months, the survival rate was 77.3%, and themain cause of death was heart disease (12.7%). There were a total of 19 late complications deriving from the graft(6.3%), the most frequent being distal anastomotic aneurysms (2%). Conclusions. At the present time, elective openrepair is an excellent technique for AAA treatment, with a very low rate of in-hospital mortality and few complicationsin its long-term follow-up

Complicaciones vasculares secundarias a la administración parenteral de drogas de abuso / Vascular complications due to parenteral drug abuse

Introducción. La administración parenteral de drogas de abuso puede generar complicaciones arteriales y venosas,que pueden afectar a la extremidad, e incluso a la vida del paciente. Casos clínicos. Caso 1: varón, 36 años, VIH+,VHC+. Tras inyección intraarterial de benzodiacepinas, refiere dolor brusco, cianosis y disminución de sensibilidad y motilidaden territorio radial de la mano izquierda. Con diagnóstico de necrosis isquémica irreversible, se practica amputaciónen tercio distal de antebrazo. Caso 2: mujer, 24 años, VHC+. Presenta tumoración pulsátil con hemorragia activa enflexura de codo izquierdo secundaria a arteriopunción de heroína. Se realiza exclusión del pseudoaneurisma roto, con ampliodesbridamiento, y reconstrucción de la arteria humeral mediante parche de vena safena interna. Se aísla Staphylococcusaureus en el trombo extraído, y se complementa el tratamiento con antibioterapia específica. Caso 3: varón, 38años, VIH+, VHC+. Refiere cuadro brusco de dolor, cianosis y disminución de sensibilidad y motilidad en territorio radialde mano izquierda, secundario a inyección intraarterial de heroína más cocaína. A pesar de intentar delimitar las lesionescon anticoagulación y prostaglandinas intravenosas, sufre necrosis isquémica irreversible, precisando amputación en terciodistal de antebrazo. Caso 4: varón, 40 años, VIH+, VHC+. Tras venopunción de cocaína, presenta dolor y edema en laextremidad inferior izquierda asociado a fiebre. Se diagnostica trombosis venosa profunda séptica iliofemoral, que se tratacon anticoagulación sistémica y antibioterapia. Conclusiones. La inyección de drogas de abuso produce un espectro variablede afectación vascular, habitualmente en pacientes jóvenes y frecuentemente con infección asociada. Las posibilidadesterapéuticas deben ser individualizadas

Introduction. Parenteral drug administration can cause a variety of arterial and venous complications whichcan even compromise limb viability and the patient’s life. Case reports. Case 1: a 36-years-old, HIV+, HCV+, male,referred sudden pain, cyanosis, anesthesia and paralysis on the radial territory of his left hand, after arterial injectionof benzodiacepine. He developed irreversible necrosis and required distal forearm amputation. Case 2: a 24-years-old,HCV+, female, suffered an acute event of active bleeding from a pulsatile mass on her left elbow, after previous arterialheroin injection. We resected the rupture pseudoaneurysm, performed extensive debridement and repaired the brachialartery with a saphenous vein patch. We isolated Staphylococcus aureus in the thrombus and we completed the surgicaltreatment with specific antibiotics. Case 3: a 38-years-old, HIV+, HCV+, male, referred sudden pain, cyanosis,anesthesia and paralysis on the radial territory of his left hand, after arterial injection of heroin + cocaine. We tried tolimit the tissue damage with anticoagulation and intravenous iloprost but he suffered irreversible necrosis and requireddistal forearm amputation. Case 4: a 40-years-old, HIV+, HCV+, male, was admitted with fever and a painful swollenleft lower limb, after venous injection of cocaine. We diagnosed a septic ilio-femoral deep venous thrombosis, whichwe treated with anticoagulation and antibiotics. Conclusions. Parenteral drug abuse can cause a wide spectrum ofvascular disease, mainly in young patients, and it frequently associates infection. The therapeutic possibilities must beindividualized

Causas de muerte en pacientes con aneurisma de aorta abdominal quirúrgico no tratado de forma electiva / Causes of death in patients with an abdominal aortic aneurysm that was not treated with elective surgery

Introducción. La evolución natural de los aneurismas de aorta abdominal (AAA) grandes es su rotura si no se resecan en el momento oportuno. Objetivo. Conocer las causas de muerte en los pacientes con un AAA quirúrgico que no han sido operados mediante reparación abierta. Pacientes y métodos. Se estudia de forma retrospectiva a 128 pacientes con un AAA a los que no se realizó reparación abierta de forma electiva, en 38 casos (29,7%) por negativa del paciente a ser intervenido, en 64 (50%) por tener diversos factores de riesgo que aumentaban la mortalidad hospitalaria de forma significativa y en 26 (20,3%) por estar contraindicada la cirugía. Resultados. La edad media de los pacientes fue de 78 años y 107 eran varones (83,6%) (53-96). Se llevó a cabo un seguimiento medio de 32,7 meses (rango: 0,1-146 meses). Fallecieron 107 pacientes (83,6%), de los cuales 27 (25,2%) lo hicieron por causa cardíaca y 19 (17,8%) por rotura del AAA. De los 38 pacientes que rechazaron la cirugía, fallecieron 30 (78,9%), 9 de ellos (30,0%) por rotura del AAA. De los 64 pacientes no operados por riesgo quirúrgico elevado, fallecieron 51 (79,7%), pero sólo en 6 de ellos (9,4%) la causa fue la rotura aórtica. Finalmente, todos los pacientes no operados por contraindicación fallecieron, el 15,4% por rotura del aneurisma. Conclusiones. En este trabajo, la principal causa de muerte en los pacientes que rechazaron la cirugía electiva fue la rotura del AAA, mientras que en el resto, su fallecimiento se debió a la patología de base

Introduction. Large abdominal aortic aneurysms (AAA) naturally progress towards rupture if they are not excised in time. Aim. To determine the causes of death in patients with a surgical AAA who did not undergo open repair surgery. Patients and methods.We conducted a retrospective study of 128 patients with an AAA in whom open repair was not performed electively, in 38 cases (29.7%) because the patient refused to undergo surgery, in 64 (50%) due to their having a number of risk factors that significantly increased the hospital mortality rate and in 26 (20.3%) because surgery was contraindicated. Results. The mean age of the patients was 78 years and 107 were males (83.6%) (53-96). Mean follow-up time was 32.7 months (range: 0.1-146 months). Altogether 107 patients (83.6%) died, 27 (25.2%) of whom did so due to cardiac causes and 19 (17.8%) because of rupture of the AAA. Of the 38 patients who refused surgery, 30 (78.9%) died, 9 of them (30.0%) due to rupture of the AAA. Of the 64 patients who were not operated on because of a high surgical risk, 51 (79.7%) died but death was caused by aortic rupture in only 6 cases (9.4%). Finally, all the patients who did not undergo surgery because it was contraindicated died, in 15.4% of cases due to rupture of the aneurysm. Conclusions. In this work the main cause of death in the patients who refused elective surgery was rupture of the AAA, whereas in the others their deaths were due to their underlying conditions

Vacunación antigripal y antineumocócica en pacientes ingresados en un servicio de Medicina Interna / Influenza vaccination and pneumococcal vaccination in patients cared in an Internal Medicine department

No disponible

[Epidemiology and impact of urinary incontinence in women between 40 and 65 in a health area of Madrid]. / Epidemiología e impacto de la incontinencia urinaria en mujeres de 40 a 65 años de edad en un área sanitaria de Madrid.

OBJECTIVES: To study the epidemiology and the social and health repercussions of urinary incontinence (UI) in women aged between 40 and 65. DESIGN: Observational and descriptive cross-sectional study.Setting. Area 6 of primary care (PC) in Madrid. PARTICIPANTS: Sample of 485 women aged between 40 and 65, obtained by randomised sampling of the census of health cards, stratified by the three kinds of health districts (rural, urban and peri-urban). MAIN RESULTS: Mean age was 52, with 15.4% prevalence of UI (2.6% stress, 10.6% urge and 2.1% mixed). In the multivariate logistic regression, association with the number of vaginal deliveries (OR = 2; 95% CI, 1.2-3.1) and with constipation (OR = 2.5; 95% CI, 1-6) was found. CONCLUSIONS: The prevalence found situates UI as a relevant problem in the population under study. Most women had not consulted the doctor on the problem. Several associated risk factors could be prevented, which justifies the setting-up within PC of coordinated programmes of UI education and prevention for this group of women.

Epidemiología e impacto de la incontinencia urinaria en mujeres de 40 a 65 años de edad en un área sanitaria de Madrid / Epidemiology and impact of urinary incontinence in women between 40 and 65 in a health area of Madrid

Objetivos. Estudiar la epidemiología y la repercusión sociosanitaria de la incontinencia urinaria (IU) en mujeres entre 40 y 65 años de edad. Diseño. Observacional, descriptivo y transversal. Emplazamiento. Área 6 de Atención Primaria (AP) de Madrid. Participantes. Muestra de 485 mujeres entre 40 y 65 años de edad, obtenida por muestreo aleatorio del censo de la tarjeta sanitaria, estratificada por los tres tipos de distritos sanitarios (rural, urbano y periurbano).Resultados principales. La media de edad fue de 52 años, con una prevalencia de IU del 15,4 por ciento (un 2,6 por ciento de esfuerzo, un 10,6 por ciento de urgencia y un 2,1 por ciento mixta). En el análisis de regresión logística multivariante se encontró una asociación con el número de partos vaginales (odds ratio [OR] = 2; intervalo de confianza [IC] del 95 por ciento, 1,2-3,1) y el estreñimiento (OR = 2,5; IC del 95 por ciento, 1-6). Conclusiones. La prevalencia encontrada sitúa la IU como un problema relevante en la población estudiada. La mayoría no ha consultado por el problema. Varios de los factores de riesgo asociados se pueden prevenir, lo que justifica la puesta en marcha de programas coordinados de educación y prevención de la IU en este grupo de mujeres y en el marco de la AP (AU)

Cirugía endovascular como tratamiento de elección en el sector femoropoplíteo y distal en isquemia crónica de miembros inferiores en un servicio de angiología y cirugía vascular (1995-2001) / Endovascular surgery as first choice treatment in the femoralpopliteal and distal sector in chronic ischemia of the lower limbs in an angiology and vascular surgery service (1995-2001)

Objetivo. Analizar nuestra experiencia en el tratamiento endovascular de la isquemia crónica arteriosclerosa de miembros inferiores. Pacientes y métodos. Estudio retrospectivo: enero 1995-diciembre 2001. 46 procedimientos (43 pacientes). Edad media: 63,2ñ10,2 años. Diabetes: 34,8 per cent. Indicación: isquemia crítica, 80,4 per cent.Claudicación incapacitante: 19,6 per cent. Indicación topográfica: lesiones tipo A-B (n= 45) y tipo C (n= 1); estenosis, 54,3 per cent, y obstrucciones, 45,7 per cent. Run-off: 0-1 vasos, 39,1 per cent; 2-3 vasos, 60,9 per cent. Angioplastia aislada, 78,2 per cent, y angioplastia+stent, 21,8 per cent. Seguimiento: 0,5-66 meses (media, 19,1 meses).Calculamos la permeabilidad primaria, secundaria, salvamento de la extremidad y supervivencia actuariales en función de seis variables: sector topográfico, tipo de lesión, grado clínico, tipo de procedimiento, run-off y diabetes. Tests estadísticos: Kaplan-Meier, log-rank. Paquete estadístico SPSS. Resultados. A 30 días: permeabilidad primaria, 93,4 per cent; secundaria, 95,6 per cent; salvamento de la extremidad, 93,4 per cent. Supervivencia, 100 per cent.Tardíos: permeabilidad primaria global, 59,4 per cent (run-off: 0-1 vasos, 40,3 per cent; 2-3 vasos, 70,6 per cent; p< 0,05; el resto de variables no son significativas). Permeabilidad secundaria global, 66,6 per cent (run-off: 0-1 vasos, 48,3 per cent; 2-3 vasos, 78,6 per cent; p< 0,05). No existe ninguna relación significativa entre el resto de las variables y la permeabilidad secundaria. Conservación de la extremidad global, 74 per cent (claudicantes, 100 per cent; dolor en reposo, 85,8 per cent; lesiones tróficas, 46,9 per cent; p< 0,05. En runoff: 0-1 vasos, 19,7 per cent; 2-3 vasos, 100 per cent; p< 0,05). Supervivencia global, 80 per cent a 5,5 años. Conclusiones. Consideramos la cirugía endovascular como el tratamiento de elección en la isquemia crítica de miembros inferiores en lesiones con morfologías tipo A y B. El drenaje de salida (2-3 vasos) es el factor pronóstico más importante en nuestra serie para el éxito de esta técnica (AU)

Hemodynamic monitoring in a model of shock induced by intestinal reperfusion in the rat.

OBJECTIVE: An experimental model to monitor hemodynamics during intestinal reperfusion syndrome is presented. EXPERIMENTAL DESIGN: A) Three groups of rats were monitored during four hours: 1) CONTROL: sham operated, 2) Ischemic: clamping the superior mesenteric artery for 60' and 3) Saline: adding 2 ml of saline during the last 15' minutes of ischemia. Blood mean pressure, heart rate, breath rate and diuresis are monitored, while mortality is assessed 48 hours later, B) Blood gases, haematimetry and electrolytes were assessed both in control animals and in rats subjected to intestinal ischemia and reperfusion (at the beginning and concluding the ischemic period, and 5', 60' and 180' following reperfusion). RESULTS: Mortality rate was 0% for control animals, while 83% for both ischemic-reperfused groups (p < 0.01). Hemodynamic parameters remained stable during intestinal ischemia. Starting reperfusion, blood pressure and diuresis dropped sharply, while heart and breath rates showed a steady increase. The other parameters assessed also remained constant during ischemia. However, during reperfusion acidosis progressed (pH = 7.15, p < 0.01; HCO3 = 8, p < 0.01), hyperkalaemia appeared (6 mEq/l, p < 0.01), and haematocrit rose (56%, p < 0.01). CONCLUSION: This experimental model is easy to establish, allows an appropriate hemodynamic monitoring of shock during intestinal reperfusion syndrome, and seems appropriate for considering the impact of drug intervention.

[Differential diagnosis of acute myocardial infarction caused by electrocution]. / Diagnóstico diferencial de infarto agudo de miocardio por electrocución.

Electrical injury can affect many organ systems, it seems that the damage results from the conversion of electrical energy into heat. Electrical injuries to the heart are far less frequent and thus, less known. Additionally, it is very difficult to interpret electrocardiographic and enzymatic changes, which are, in other situations, diagnostic of a myocardial infarction. We report two cases of young men without coronary risk factors. They present a rise in enzyme levels and electrocardiographic changes suggestive of acute myocardial infarction after alternating current electrocution. The difficulties in evaluating the myocardial damage in these situations are also discussed. We recommend ECG monitoring and long-term cardiac evaluation of these patients.

[Nursing research on epidural analgesia for chronic cancer pain]. / Papel de la enfermera en la analgesia epidural para el dolor cronico por cancer.

A retrospective study was made on 9 cases with pains due to advanced head and neck cancer, attended to at the Pain Clinic of the National Institute of Oncology and Radiobiology between 1988 and 1991. An epidural catheter was implanted to these patients at the CNS level for the administration of a morphine solution. 7 patients (77.8%) showed total pain relief; and 2 cases showed easily-controlled slight pains. The most frequent complications were; fever (3 cases) and alterations of the level of consciousness (2 cases). No infections were reported. The importance of an adequate preparation of the patient and a strict follow up, where oncology nursing personnel play an important role, is pointed out.