Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement.

OBJECTIVES: To study responsiveness and establish the minimal clinically important differences (MCIDs) and minimal detectable change (MDC) in patients undergoing total knee replacement (TKR) using the Short Form 36 (SF-36) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). METHODS: Prospective observational study in three public hospitals of all consecutive patients on waiting lists to undergo TKR intervention with diagnosis of knee osteoarthritis (OA). Patients were asked to complete before the intervention and at 6 months and 2 years afterward the SF-36 and the WOMAC health-related quality of life questionnaires (HRQoL), and additional transition questions which measured the changes in their joint at 6 months. In both questionnaires the possible range of values is from 0 to 100 points. RESULTS: In WOMAC improvement at 6 months after a TKR was between 27 (stiffness) and 31 points (pain). The SF-36 showed improvements between the 28.3 points of role physical and 2.79 of general health. From 6 months to 2 years, WOMAC improvements were between 2 and 6 points. The MCID ranged from 14.52 (stiffness) to 22.87 (pain) on the WOMAC and in the physical domains of SF-36 from 11.56 (physical function) to 16.86 (bodily pain). On the WOMAC, the MDC ranged from 13.11 (function) to 29.12 (stiffness), and on SF-36 from 19.50 (physical function) to 41.23 (social functioning). CONCLUSIONS: The MCID for TKR is around 15 on WOMAC, while with the SF-36 of at least 10 points. These values should not be considered as absolute thresholds.

Responsiveness and clinically important differences for the WOMAC and SF-36 after hip joint replacement.

OBJECTIVES: To study responsiveness and establish the minimal clinically important differences (MCID) and minimal detectable change (MDC) in patients undergoing total hip replacement (THR) using the Short Form 36 (SF-36) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). METHODS: We conducted a prospective observational study in three public hospitals of all consecutive patients with a diagnosis of hip osteoarthritis (OA) on waiting lists to undergo THR. Patients completed the SF-36 and the WOMAC (subscales transformed to 0 to 100), which measured the health-related quality of life (HRQoL), before intervention and 6 months and 2 years later, and additional transitional questions, which measured the changes in the joint 6 months postoperatively. RESULTS: Improvements at 6 months after a THR were between 37 (stiffness) and 39 points (pain), depending on the WOMAC domain. The SF-36 domains also showed improvements: physical function (31.91), physical role (33.71), and bodily pain (29.77). From 6 months to 2 years, improvements ranged from 2 to 5 points, except for role physical (13.25). A ceiling effect was detected on some WOMAC domains as well as a floor effect on the SF-36. The MCID ranged from 25.91 (stiffness) to 29.26 (pain) on the WOMAC and from 10.78 (physical role) to 20.40 (physical function) on the SF-36. The MDC ranged from 21.38 (pain) to 27.98 (stiffness) on the WOMAC and from 18.99 (physical function) to 42.05 (social function) on the SF-36. CONCLUSIONS: These values indicate expected gains after THR. However, the MCID and MDC values must be viewed cautiously due to the uncertainty of these estimators and should not be considered as absolute thresholds.

Milk fatty acid composition of cows fed a total mixed ration or pasture plus concentrates replacing corn with fat.

Thirty-one Holstein cows (six ruminally cannulated) were used to evaluate milk fatty acids (FA) composition and conjugated linoleic acid (CLA) content on three dietary treatments: 1) total mixed rations (TMR), 2) pasture (Avena sativa L.) plus 6.7 kg DM/d of corn-based concentrate (PCorn), and 3) pasture plus PCorn with 0.8 kg DM/d of Ca salts of unsaturated FA replacing 1.9 kg DM/d of corn (PFat). No differences were found in total (22.4 kg/d) or pasture (18.5 kg/d) dry matter intake, ruminal pH, or total volatile fatty acids concentrations. Fat supplementation did not affect pasture neutral detergent fiber digestion. Milk production did not differ among treatments (19.9 kg/d) but 4% fat-corrected milk was lower for cows fed the PFat compared to cows fed the TMR (16.1 vs. 19.5 kg/d) primarily because of the lower milk fat percentage (2.56 vs. 3.91%). Milk protein concentration was higher for cows fed the TMR than those on both pasture treatments (3.70 vs. 3.45%). Milk from the cows fed the PCorn had a lower content of short- (11.9 vs. 10.4 g/100 g) and medium-chain (56.5 vs. 47.6 g/100 g) FA, and a higher C18:3 percentage (0.07 vs. 0.57 g/100 g) compared with TMR-fed. Cows fed the PFat had the lowest content of short- (8.85 g/100 g) and medium-chain (41.0 g/100 g) FA, and the highest of long-chain FA (51.4 g/100 g). The CLA content was higher for cows in PCorn treatment (1.12 g/100 g FA) compared with cows fed the TMR (0.41 g/100 g FA), whereas the cows fed the PFat had the highest content (1.91 g/100 g FA). Pasture-based diets increased the concentrations of long-chain unsaturated FA and CLA in milk fat. The partial replacement of corn grain by Ca salts of unsaturated FA in grazing cows accentuated these changes. However, those changes in milk FA composition were related to a depression in milk fat.

[Congenital diaphragmatic hernia: evaluation of two ways of management]. / Hernia diafragmática congénita: análisis de dos formas de tratamiento.

OBJECTIVE: The aim of this study was to analyze the treatment and evolution of congenital diaphragmatic hernia in the last 16 years, distinguishing two ways of management, and to look for parameters that can predict the evolution. MATERIALS AND METHODS: Between 1978 and 1994, 29 cases of congenital diaphragmatic hernia were treated in our NICU. During the first period (1978-1988) 17 cases (group 1) were treated after birth as a surgical emergency. In the second period (1989-1994), preoperative stabilization was performed before surgery (12 cases, group 2). Two cases of group 2 were excluded because of the association of other malformations that were the cause of death. RESULTS: Both groups were similar in gestational age, birth weight and Apgar score at 5 minutes. Overall mortality was 48.1% (47.0% in group 1 and 50.0% in group 2). No infants with PaCO2 greater than 40 mmHg and OI greater than 40 or VEI over 1,000 survived. CONCLUSION: Despite preoperative stabilization, there is no difference in the mortality rate of the two groups. With congenital diaphragmatic hernia, as with other entities of low incidence, collaborative studies are needed to obtain enough cases to analyze the results more precisely.

[Argininosuccinic aciduria. Comparative studies and detection of carriers in 3 affected families]. / Aciduria argininsuccínica. Estudios comparativos y detección de portadores en tres familias afectas.

Three patients with argininosuccinic aciduria are described. One of them is a neonatal form, with typical acute course and severe hyperammonemia who died on the sixth day of life. Postmortem analysis showed a marked plasmatic accumulation of argininosuccinic acid. Later on, red blood cell ASA-lyase levels demonstrated the heterozygosity of her parents and sisters. The two other patients are late onset forms and were diagnosed after detection of ASA and its anhydrides in plasma and urine. Levels of these metabolites did not correlate with levels of residual ASA-lyase in erythrocytes. Treatment with a hypoproteic diet supplemented with arginine has improved their clinical state. Carriers have been detected in both families. Importance of rapid diagnosis and treatment of hyperammonemic patients in order to prevent neurologic damage is emphasised.