Processing of the platelet amyloid precursor protein in the mild cognitive impairment (MCI).

It has been suggested that mild cognitive impairment (MCI) patients deteriorate faster than the healthy elderly population and have an increased risk of developing dementia. Certain blood molecular biomarkers have been identified as prognostic markers in Alzheimer's disease (AD). The present study was aimed to assess the status of the platelet amyloid precursor protein (APP) metabolism in MCI and AD subjects and establish to what extent any variation could have a prognostic value suggestive of predictive AD in MCI patients. Thirty-four subjects diagnosed with MCI and 45 subjects with AD were compared to 28 healthy elderly individuals for assessing for protein levels of APP, ß-APP cleaving enzyme 1 (BACE1), presenilin 1 (PS1) and a disintegrin and metalloproteinase-10 (ADAM-10) by western blot, and for the enzyme activities of BACE1 and γ-secretase by using specific fluorogenic substrates, in samples of platelets. A similar pattern in the healthy elderly and MCI patients was found for BACE1 and PS1 levels. A reduction of APP levels in MCI and AD patients compared with healthy elderly individuals was found. Augmented levels of ADAM-10 in both MCI and AD were displayed in comparison with age-matched control subjects. The ratio ADAM-10/BACE1 was higher for the MCI group versus AD group. Whereas BACE1 and PS1 levels were only increased in AD regarding to controls, BACE1 and γ-secretase activities augmented significantly in both MCI and AD groups. Finally, differences and similarities between MCI and AD patients were observed in several markers of platelet APP processing. Larger sample sets from diverse populations need to be analyzed to define a signature for the presence of MCI or AD pathology and to early detect AD at the MCI stage.

Nonagenarios en los servicios de Medicina Interna españoles / Nonagenarian patients admitted to Spanish Internal Medicine Hospital Departments

Objetivo. Describir el perfil demográfico y clínico de los pacientes nonagenarios ingresados en servicios de Medicina Interna en los hospitales españoles, y compararla con los pacientes más jóvenes. Métodos. Se identificaron a través del CMBD (Conjunto Mínimo Básico de Datos) a todos los pacientes con edad superior a los 90 años ingresados en servicios de Medicina Interna de los hospitales públicos españoles Servicio Nacional de Salud entre 2005 a 2008. Los datos se obtuvieron del alta hospitalaria. Para cada paciente se identificó un grupo de diagnóstico relacionado (GRD). Se utilizó el GRD versión 21.0. Comparamos este grupo de nonagenarios de personas adultas más jóvenes. Se utilizó el índice de comorbilidad de Charlson (ICC) como elemento comparativo. Todos los análisis estadísticos se realizaron con SPSS 14.0. Resultados. La muestra incluye 131.434 pacientes mayores de 90 años (6% del total de pacientes atendidos). Dos mil doscientos veintidós pacientes fueron más de 100 años. Eran mujeres un 45,3% de los pacientes menores de 90 años y un 67,3% los mayores de 90 años (p<0,001). Los 10 primeros GRD que figuran en el grupo de mayor edad incluyen 3 nuevas entidades que no se presenta en el más joven: edema pulmonar (GRD: 87), infección grave de las vías urinarias (GRD: 320) e infección severa del tracto respiratorio (GRD: 540). Los 5 primeros GRD por encima de 89 años fueron: neumonía/bronquitis (541): 11,9%, la insuficiencia cardiaca (127): 8,9%, trastornos del ritmo (544): 7,5%, edema pulmonar (87): 3,8%, y otras enfermedades respiratorias (89): 3,24%. La tasa de aparición de estas entidades fue superior a la encontrada en pacientes más jóvenes. Dentro del «top ten» solo la EPOC y la angina de pecho tenían una tasa mayor en el grupo más joven. La mortalidad hospitalaria fue del 9,1% en el grupo más joven y el 21,8% entre los nonagenarios (p<0,001). Si tomamos a cuenta solo las primeras 48 h después de la admisión, las proporciones fueron del 2,2 frente al 6% (p<0,001). El 78,2% de los pacientes nonagenarios volvieron a su domicilio tras el alta médica. Conclusiones. 1) El número de pacientes nonagenarios ingresados en los servicios hospitalarios de Medicina Interna es muy alto; 2) La tasa de las mujeres aumenta con la edad; 3) La lista de diagnósticos varía según la edad; 4) La mortalidad hospitalaria aumenta con la edad, tanto si tenemos en cuenta los 2 primeros días o el total de la estancia, y 5) Una mayoría de los nonagenarios regresan a su domicilio tras el alta (AU)

Objetive. To describe the demographic and clinical profile of nonagenarian patients admitted to Internal Medicine departments in Spanish hospitals, and to compare it with younger patients. Methods. We identified, through the MBDS (Basic Minimum Data Set), every patient older than 90 years admitted to Internal Medicine Departments of the Spanish National Health Service public hospitals between 2005- 2008. Hospital discharge data were obtained from the MBDS. A diagnosis-related group (DRG) was identified for every patient. The DRG 21.0 version was used. We compared this nonagenarian group with data of younger adult people. All centres submit this information to the Spanish Health Ministry. The Charlson Index (CCI) was used to determine comorbidity. All statistical analyses were performed using SPSS 14.0. Results. The sample included 131,434 patients over 90 years (6% of total patients admitted), with 2,222 patients being over 100 years. There were 45.3% female patients under 90 years, compared to 67.3% over 90 years (P<.001). The top ten DRGs listed in the older group included three new conditions not present in the younger one: pulmonary oedema (DRG: 87), severe urinary tract infection (DRG: 320), and severe respiratory tract infection (DRG: 540). The first 5 DRG were: pneumonia/bronchitis (541): 11.9%, heart failure (127): 8.9%, rhythm disorders (544): 7.5%, pulmonary oedema (87): 3.8%, and other respiratory diseases (89): 3.24%. In any case the incidence of these conditions was higher than those found in younger patients. Among this top ten, only COPD and angina had a higher rate in the younger group. The incidence of hospital deaths were 9.1% among the younger group, and 21.8% among the nonagenarians (P<.001). If only the first 48hours after admission are taken into account, the rates were 2.2% vs 6% (P<.001). The majority (78.2%) of nonagenarian patients return home after discharge Conclusions. 1) There are a high number of nonagenarians patients admitted in hospital Internal Medicine Departments; 2) The number of women increases with age; 3) List of diagnosis varies according with age; 4) Hospital death rates increase with age, both in first two days and total stay, and 5) The majority of these patients are able to return home after discharge(AU)

[Nonagenarian patients admitted to Spanish internal medicine hospital departments]. / Nonagenarios en los servicios de Medicina Interna españoles.

OBJECTIVE: To describe the demographic and clinical profile of nonagenarian patients admitted to Internal Medicine departments in Spanish hospitals, and to compare it with younger patients. METHODS: We identified, through the MBDS (Basic Minimum Data Set), every patient older than 90 years admitted to Internal Medicine Departments of the Spanish National Health Service public hospitals between 2005- 2008. Hospital discharge data were obtained from the MBDS. A diagnosis-related group (DRG) was identified for every patient. The DRG 21.0 version was used. We compared this nonagenarian group with data of younger adult people. All centres submit this information to the Spanish Health Ministry. The Charlson Index (CCI) was used to determine comorbidity. All statistical analyses were performed using SPSS 14.0. RESULTS: The sample included 131,434 patients over 90 years (6% of total patients admitted), with 2,222 patients being over 100 years. There were 45.3% female patients under 90 years, compared to 67.3% over 90 years (P<.001). The top ten DRGs listed in the older group included three new conditions not present in the younger one: pulmonary oedema (DRG: 87), severe urinary tract infection (DRG: 320), and severe respiratory tract infection (DRG: 540). The first 5 DRG were: pneumonia/bronchitis (541): 11.9%, heart failure (127): 8.9%, rhythm disorders (544): 7.5%, pulmonary oedema (87): 3.8%, and other respiratory diseases (89): 3.24%. In any case the incidence of these conditions was higher than those found in younger patients. Among this top ten, only COPD and angina had a higher rate in the younger group. The incidence of hospital deaths were 9.1% among the younger group, and 21.8% among the nonagenarians (P<.001). If only the first 48 hours after admission are taken into account, the rates were 2.2% vs 6% (P<.001). The majority (78.2%) of nonagenarian patients return home after discharge CONCLUSIONS: 1) There are a high number of nonagenarians patients admitted in hospital Internal Medicine Departments; 2) The number of women increases with age; 3) List of diagnosis varies according with age; 4) Hospital death rates increase with age, both in first two days and total stay, and 5) The majority of these patients are able to return home after discharge.

Hospitalizations for ambulatory care sensitive conditions and quality of primary care: their relation with socioeconomic and health care variables in the Madrid regional health service (Spain).

BACKGROUND: Hospitalizations for ambulatory care sensitive conditions (ACSH) have been proposed as an indirect indicator of the effectiveness and quality of care provided by primary health care. OBJECTIVE: To investigate the association of ACSH rates with population socioeconomic factors and with characteristics of primary health care. RESEARCH DESIGN: Cross-sectional, ecologic study. Using hospital discharge data, ACSH were selected from the list of conditions validated for Spain. SETTING: All 34 health districts in the Region of Madrid, Spain. SUBJECTS: Individuals aged 65 years or older residing in the region of Madrid between 2001 and 2003, inclusive. MEASURES: Age- and gender-adjusted ACSH rates in each health district. RESULTS: The adjusted ACSH rate per 1000 population was 35.37 in men and 20.45 in women. In the Poisson regression analysis, an inverse relation was seen between ACSH rates and the socioeconomic variables. Physician workload was the only health care variable with a statistically significant relation (rate ratio of 1.066 [95% CI; 1.041-1.091]). These results were similar in the analyses disaggregated by gender. In the multivariate analyses that included health care variables, none of the health care variables were statistically significant. CONCLUSIONS: ACSH may be more closely related with socioeconomic variables than with characteristics of primary care activity. Therefore, other factors outside the health system must be considered to improve health outcomes in the population.

Metalloproteinase's activity and oxidative stress in mild cognitive impairment and Alzheimer's disease.

Matrix metalloproteinases (MMPs) and oxidative stress have been implicated in neurological diseases such as Alzheimer's disease (AD). Plasma MMP-2 and MMP-9 activities were assessed in Mild Cognitive Impairment (MCI) and AD subjects compared with aged-matched controls, and subsequently analysed in relation to oxidative stress markers. Both MMP-2 and MMP-9 showed no significant changes versus control subjects. Plasma glutathione peroxidase Se-dependent (GPx-Se) activity and malondialdehyde (MDA) levels were higher in AD than in controls (P < 0.05), suggesting a role for GPx-Se in controlling oxidative stress in AD. Negative correlations were observed between MMPs and MDA in AD and MCI patients (P < 0.05). In conclusion, oxidative stress events did not include activation of MMPs and this similar pattern in AD and MCI suggests that both are biochemically equivalent.

Neutrophils of centenarians show function levels similar to those of young adults.

OBJECTIVES: To analyze several functions and antioxidant parameters of peripheral blood neutrophils from healthy centenarians (men and women) and compare them with those of healthy young (aged 25-35) and middle-aged (aged 65-75) men and women. DESIGN: Cross-sectional study. SETTING: Community-based. PARTICIPANTS: Twenty-one healthy centenarians (8 men), 30 young adults (15 men), and 30 middle-aged adults (15 men). MEASUREMENTS: Several neutrophil functions (adherence, chemotaxis, phagocytosis, and stimulated and nonstimulated intracellular superoxide anion levels) and antioxidant parameters (glutathione levels and catalase activity) were measured in peripheral blood neutrophil suspension in the three study groups. RESULTS: Neutrophil functions of the middle-aged group were worse than those of young adults and centenarians (lower chemotaxis and phagocytosis and higher adherence and superoxide anion levels). The neutrophil functions of the centenarians were closer to those of the young adults. Age-related differences in neutrophil functions were fundamentally similar in men and women, except for intracellular superoxide anion levels, which were lower in young adult women than in young adult men. With normal aging, total glutathione levels decrease, but the centenarians in this study showed levels similar to those of young adults. Centenarians showed the highest catalase activity of the three groups. CONCLUSION: Progressive impairment of the immune system accompanies aging. The better preservation of function and antioxidant systems in the neutrophils of centenarians could play a key role in the longevity of these subjects.

The glutathione precursor N-acetylcysteine improves immune function in postmenopausal women.

Aging is a chronic oxidation process in which the immune system is involved. Because leukocyte functions is a good health marker and longevity predictor, the effects of daily oral administration of N-acetylcysteine (NAC, 600 mg) on several lymphocyte (adherence, chemotaxis, proliferation, natural killer activity) and neutrophil (adherence, chemotaxis, phagocytosis, superoxide) functions, as well as cytokine levels (interleukin-2, tumor necrosis factor alpha, interleukin-8), were studied in 36 healthy postmenopausal women: 18 aged 50-69 years and 18 aged > 69 years. In addition, plasma and leukocyte oxidative stress markers (glutathione, superoxide, malondialdehyde) were evaluated. These parameters were analyzed within 2 and 4 months of of NAC intake and 3 months after the end of the supplementation. In parallel, samples from 18 healthy adult women aged 30-49 years were used as a control age group. the results showed general impairment of immune function and increased oxidation markers in postmenopausal women as compared with the control group; however, NAC administration significantly improved the parameters studied, bringing their values closer to those of younger women and thus exerting a modulatory, rather than a merely stimulatory, action on the immune system. These effects were also observed 3 months after the end of supplementation. The present finding suggest that a short period of NAC supply (i.e., 2-4 months) at the dose used may lead to prolonged strengthening of immune defence in postmenopausal women, likely by increasing the leukocyte glutathione pool. Thus, NAC could contribute to maintenance of good health and quality of life in postmenopausal women by decreasing the probability of immune system-related diseases, such as infections, in aging.

Differences of peripheral inflammatory markers between mild cognitive impairment and Alzheimer's disease.

Multiple pathogenic factors may contribute to the pathophysiology of Alzheimer's disease (AD). Peripheral markers have been used to assess biochemical alterations associated with AD and mild cognitive impairment (MCI) involved in its pathophysiology. The present study was conducted to evaluate inflammatory peripheral markers in elderly patients with MCI, patients with AD and normal elderly subjects. We measured plasma levels of different cytokines (IL-6, TNF-alpha and IFN-alpha) and platelet levels of cyclooxigenase-2 (COX-2) from 34 patients with MCI, 45 patients with AD and 28 age-matched control subjects. MCI and AD patients showed similarities in TNF-alpha and COX-2 levels, and differences in IL-6 and INF-alpha. Whereas augmented IL-6 levels have been found in AD patients, a significant increase in INF-alpha has been detected only in patients with MCI possibly associated with the depression stage frequently found in cognitive impairment. In conclusion, inflammatory response may be an early factor in AD development and these changes in circulating markers are possibly related to the progression of MCI to AD.

Geographic variations in avoidable hospitalizations in the elderly, in a health system with universal coverage.

BACKGROUND: The study of Hospitalizations for ambulatory care sensitive conditions (ACSH) has been proposed as an indirect measure of access to and receipt of care by older persons at the entryway to the Spanish public health system. The aim of this work is to identify the rates of ACSH in persons 65 years or older living in different small-areas of the Community of Madrid (CM) and to detect possible differences in ACSH. METHODS: Cross-sectional, ecologic study, which covered all 34 health districts of the CM. The study population consisted of all individuals aged 65 years or older residing in the CM between 2001 and 2003, inclusive. Using hospital discharge data, avoidable ACSH were selected from the list of conditions validated for Spain. Age- and sex-adjusted ACSH rates were calculated for the population of each health district and the statistics describing the data variability. Point graphs and maps were designed to represent the ACSH rates in the different health districts. RESULTS: Of all the hospitalizations, 16.5% (64,409) were ACSH. Globally, the rate was higher among men: 33.15 per 1,000 populations vs. 22.10 in women and these differences were statistically significant (p < 0.05) in each district. For men the range was 70.82 and the coefficient of variation (CV) was 0.47, while for women the range was 43.69 and the CV was 0.48. In 93.1% of cases, the ACSH were caused by hypertensive cardiovascular disease, heart failure or pneumonia. A centripetal pattern can be observed, with lower rates in the districts in the center of the CM. This geographic distribution is maintained after grouping by sex. CONCLUSION: A significant variation is demonstrated in "preventable" hospitalizations between the different districts. In all the districts the men present rates significantly higher than women. Important variations in the access are observed the Primary Attention in spite of existing a universal sanitary cover.

Peripheral levels of glutathione and protein oxidation as markers in the development of Alzheimer's disease from Mild Cognitive Impairment.

There is a great interest in the relationship between Mild Cognitive Impairment (MCI) and the progression to Alzheimer's disease (AD). Several studies show the importance of oxidative stress in the pathogenesis of AD. The purpose of this study was the link between oxidative damage, MCI and AD. It analysed protein carbonyls and erythrocyte glutathione system plasma levels of 34 subjects with MCI, 45 subjects with AD and 28 age-matched control subjects. The results showed an increase in protein modification, a decrease in GSH levels and GSH/GSSG ratio in AD and MCI patients compared to age-matched control subjects (p<0.05). The present study shows that some peripheral markers of oxidative stress appear in MCI with a similar pattern to that observed in AD, which suggests that oxidative stress might represent a signal of the AD pathology. AD and MCI are biochemically equivalent. MCI does not necessarily need to progress to AD on a biochemical level.

Negative blood culture infective endocarditis in the elderly: long-term follow-up.

BACKGROUND AND AIM: Since the appearance of transesophageal echocardiography, the long-term prognosis of patients with negative blood culture infective endocarditis (NBCIE) has been found to be similar to that of patients with positive blood culture infective endocarditis (PBCIE). Nevertheless, the prognostic implications of NBCIE in the elderly (>65 years) has not, to date, been well documented. Our aim was to study the long-term prognosis of elderly patients with NBCIE and compare it with that of elderly patients with PBCIE. METHODS: Our study group was composed of 60 consecutive patients >65 years old with a diagnosis of IE (confirmed by vegetation analysis or following Duke's criteria). Every patient underwent transthoracic and transesophageal echocardiography. Fifty patients (83.3%) had PBCIE and 10 (16.7%) had NBCIE. All patients were followed up long-term, and the study end point was a composite one of death or need for valvular heart surgery. RESULTS: Mean age was 72.9 +/- 5 years (56.7% male). Similar clinical and echocardiographic characteristics were found in both groups. Global mortality, need for surgery, predisposing factors and infection location were also similar in both groups. In addition, no differences were found in the long-term prognosis (log rank p = 0.29). CONCLUSIONS: In our series, the long-term prognosis in elderly patients with IE is independent of the presence of a negative or positive blood culture. Thus, age cannot be considered an independent risk factor of negative outcome in elderly patients with NBCIE.

Cambios con el envejecimiento en los valores de glutatión de células inmunitarias y plasma. Efecto de la administración de N-acetilcisteína / Changes with ageing in immune cell and plasma glutathione levels. Effect of N-acetylcysteine administration Beta

Introducción: en trabajos previos hemos demostrado el deterioro con la edad de una serie de funciones de las células inmunitarias descritas como marcadores de salud y longevidad, e igualmente, hemos comprobado cómo éstas mejoran tras la administración del antioxidante precursor del glutatión: N-acetilcisteína (NAC). Pacientes y métodos: se estudió a 36 mujeres posmenopáusicas seleccionadas aleatoriamente, 18 de 50-60 años y 18 de más de 70 años. La NAC se administró en dosis diaria de 600 mg, durante 4 meses. Antes de iniciarse el tratamiento, a los 2 meses de comenzar el mismo, una vez concluido y 3 meses después de su finalización, se procedió a la extracción de sangre periférica. Como control de edad se empleó a 18 mujeres de 30-40 años, a las que se extrajo sangre una única vez. Se estudiaron los valores de glutatión total en linfocitos, neutrófilos y plasma mediante cinética enzimática por espectrofotometría. Resultados: con el envejecimiento se produce una disminución en los valores de glutatión. El tratamiento con NAC es capaz de aumentarlos en los leucocitos, efecto que no se ve reflejado en el plasma. El aumento en las células inmunitarias se aprecia ya a los 2 meses de tratamiento, es más relevante a los 4 meses y se mantiene a los 3 meses tras su finalización. Conclusiones: la disminución en los valores de glutatión de las células inmunitarias con la edad podría explicar el deterioro funcional que éstas experimentan. La administración de NAC podría mejorar la función inmunitaria mediante el aumento de esos valores. Por otra parte, la determinación del glutatión plasmático no es una medida adecuada para conocer los valores de este antioxidante en el organismo y, consecuentemente, de su estado de estrés oxidativo, ya que puede no relacionarse con el experimentado por los leucocitos circulantes

Introduction: we previously demonstrated the ageing-associated decline of certain immune functions, which have been described as markers of health and longevity and confirmed that administration of the antioxidant N-acetylcysteine (NAC), which is a glutathione precursor, improves these functions. Patients and methods: thirty-six randomly selected postmenopausal women, 18 aged 50-60 years old and 18 aged more than 70 years were studied. NAC administration consisted in a daily 600 mg dose for 4 months. Peripheral blood samples were collected before starting administration, after 2 months' administration, at the end of the treatment period, and 3 months later. A group of 18 women aged 30-40 years was used as a control group. Samples from controls were drawn only once. Total glutathione levels in lymphocytes, neutrophils and plasma were studied by enzymatic kinetics using a spectrophotometer assay. Results: glutathione levels declined with ageing in both leucocytes and plasma. NAC administration increased glutathione levels in leucocytes but not in plasma. The increase in immune cell glutathione levels was observed as early as 2 months after the start of NAC administration and was greater at 4 months. This effect continued for 3 months after the end of the treatment. Conclusions: the age-related decline of glutathione levels in immune cells could play an important role in the functional impairment of these cells during the ageing process. Additionally, NAC could exert its beneficial effects on immune function via the increase in the glutathione content present in immune cells. Determination of plasma glutathione is not an accurate indication of the body's oxidative stress condition, since plasma levels migth not be related to the levels of this antioxidant in blood leucocytes

[Elderly patients with recurrent falls. Role of posturographic studies]. / Valor de la posturografía en ancianos con caídas de repetición.

BACKGROUND AND OBJECTIVE: Our purpose was to provide information about static and dynamic balance posturographic disorders in elderly people with recurrent falls, and to compare the results with a healthy elderly group. PATIENTS AND METHOD: We included 95 subjects: 57 patients who fell (86% women; age, 78.1 years) and 38 controls. Posturography by Balance Master (Neurocom). Tests performed included: a) weight bearing squat (WBS); b) modified clinical test for the sensory interaction on balance (MCT); c) sit to stand (SS); d) walk across (WA), and e) step and over (SO). RESULTS: No differences in the WBS test between both groups. MCT test: The speed of the movement of the gravity center standing on a firm surface was faster in the fallers group, both with open (p = 0.034) and closed eyes (p = 0.003). The same was seen when we assessed the balance on a foam surface (p < 0.005). 45% of subjects with falls showed instability and fell when they tried to stand if we altered propioceptive conditions and nullified visual afference, as compared to only 18.4% of the control group (p = 0.009). SS test: The elapsed time (in seconds) in order to stand was greater in the study group. d) WA test: Walking velocity was faster in the fallers group. SO test: Non-fallers made more body pressure when they went down a step, without interaction with age or gender. CONCLUSIONS: There was an increase in the number of individuals in the fallers group who fell after nullifying visual and propioceptive afferences. It seems necessary to identify these patients in order to establish early intervention programs. The abnormal results in tests which assess daily life activities could be associated with an after-fall anxiety syndrome. Posturography could be a good way to detect the after-fall anxiety syndrome and to develop effective strategies for prevention and treatment.

Valor de la posturografía en ancianos con caídas de repetición / Elderly patients with recurrent falls: role of posturographic studies

FUNDAMENTO Y OBJETIVO: Describir las alteraciones del equilibrio estático y dinámico en ancianoscon caídas de repetición y comparar los resultados con un grupo sin caídas.PACIENTES Y MÉTODO: Se incluyó a 95 sujetos, 57 en el grupo de estudio (un 86% eran mujeres yla edad media de 78,1 años) y 38 controles. La posturografía se realizó con Balance Master deNeurocom. Las pruebas seleccionadas fueron: a) desplazamiento (WBS); b) mantenimiento debipedestación (MCT); c) bipedestación desde sentado (SS); d) marcha (WA), y e) subir y bajarescalones (SO).RESULTADOS: No se observaron diferencias entre ambos grupos en la prueba WBS. En la pruebaMCT se obtuvo una diferencia a favor del grupo con caídas en velocidad de desplazamiento delcentro de gravedad sobre superficie firme en bipedestación con los ojos abiertos (p = 0,034) ycerrados (p = 0,003). Al igual que sobre superficie almohadillada con ojos abiertos (p = 0,002)y cerrados (p = 0,015). Los sujetos con caídas de repetición tenían inestabilidad y caída(44,9%) al intentar mantener la bipedestación debido a una disminución de la sensibilidadpropioceptiva y anulación de la aferencia visual frente a los controles (18,4%) (p = 0,009). Enla prueba SS, los sujetos con antecedentes de caídas tardaron un tiempo mayor en alcanzar labipedestación desde la posición de sentado y sin apoyos (p = 0,001). Respecto a la prueba WAse observó una mayor velocidad de la marcha en el grupo de caídas (p < 0,001). Finalmente,en la prueba SO, los pacientes sin antecedentes de caídas ejercieron mayor presión corporal alsubir escalones independientemente de la edad y el sexo.CONCLUSIONES: La anulación conjunta de las aferencias visuales y propioceptivas facilita la apariciónde nuevas caídas. Identificar esta situación puede ser útil para establecer políticas preventivas.Los resultados alterados de las pruebas que valoran las actividades básicas de la vidadiaria podrían estar relacionados con el síndrome poscaída. La posturografía es una técnica útilen el estudio de estos pacientes y puede permitir la puesta en marcha de programas efectivosde tratamiento

BACKGROUND AND OBJECTIVE: Our purpose was to provide information about static and dynamic balanceposturographic disorders in elderly people with recurrent falls, and to compare the resultswith a healthy elderly group.PATIENTS AND METHOD: We included 95 subjects: 57 patients who fell (86% women; age, 78.1years) and 38 controls. Posturography by Balance Master (Neurocom). Tests performed included:a) weight bearing squat (WBS); b) modified clinical test for the sensory interaction on balance(MCT); c) sit to stand (SS); d) walk across (WA), and e) step and over (SO).RESULTS: No differences in the WBS test between both groups. MCT test: The speed of the movementof the gravity center standing on a firm surface was faster in the fallers group, bothwith open (p = 0.034) and closed eyes (p = 0.003). The same was seen when weassessed the balance on a foam surface (p < 0.005). 45% of subjects with falls showed instabilityand fell when they tried to stand if we altered propioceptive conditions and nullified visualafference, as compared to only 18.4% of the control group (p = 0.009). SS test: The elapsedtime (in seconds) in order to stand was greater in the study group. d) WA test: Walkingvelocity was faster in the fallers group. SO test: Non-fallers made more body pressure whenthey went down a step, without interaction with age or gender.CONCLUSIONS: There was an increase in the number of individuals in the fallers group who fell afternullifying visual and propioceptive afferences. It seems necessary to identify these patientsin order to establish early intervention programs. The abnormal results in tests which assessdaily life activities could be associated with an after-fall anxiety syndrome. Posturography couldbe a good way to detect the after-fall anxiety syndrome and to develop effective strategies forprevention and treatment

Disección intramiocárdica postinfarto de la pared posterior del ventrículo izquierdo con comunicación con el seno coronario / Intramyocardial Dissection of the Posterir Wall of the Left Ventricle with a Shunt to the Coronary Sinus after Myocardial Infarction

Paciente diabética de 83 años ingresada en nuestro centro por infarto agudo de miocardio posteroinferior en evolución. Al cuarto día de estancia presentó un soplo pansistólico en mesocardio y ápex de nueva aparición. El ecocardiograma transtorácico puso de manifiesto acinesia de la pared posterior e inferior con imagen indicativa de disección de la pared posterior del ventrículo izquierdo, que se originaba en el segmento medio-distal de la misma, con orificio de entrada de 7 mm de diámetro. Se apreciaba flujo turbulento en el interior de la aurícula derecha, indicativo de proceder del seno coronario. Con el ecocardiograma transesofágico se confirmó la disección intramiocárdica de la pared posterior del ventrículo izquierdo y su comunicación con el seno coronario, identificando el flujo turbulento de la aurícula derecha como procedente del mismo. Tras optar por el tratamiento médico, la paciente ha sido seguida por espacio de dos años. El diámetro del orificio de entrada del trayecto disecante permaneció sin cambios, si bien se observó crecimiento del diámetro de la zona disecada y del seno coronario, aunque no dilatación significativa de las cavidades derechas (AU)