Objective: To assess the reliability of the interpretation of a new technique for the ultrasound evaluation of the level of neurological lesion in fetuses with myelomeningocele.Methods: Observational study including myelomeningocele fetuses, referred to our center for the sonographic assessment of the fetal lower-limb movements, made and recorded by an expert in Maternal-fetal medicine and a specialist in Rehabilitation. Two observers, with different levels of expertise and blinded to each other's results, interpreted each recorded scan two different times. The agreement for the segmental levels assigned between the observers and the gold standard, the inter-observer and intra-observer reproducibility were tested using the weighed Kappa (w) index.Results: Twenty-eight scans were recorded and evaluated. The agreement between the observers and the gold standard remained constant for the expert observer (w=0.82) and increased (w=0.66-w=0.72) for the other one. The inter-observer and the intra-observer variability for the expert observer were w=0.72 and w=0.94, respectively.Discussion: The agreement for the prenatal evaluation of the segmental neurological level was excellent, after a short training period, for observers with different degrees of expertise. The interpretation of this technique is reproducible enough and this supports its value for the prediction of postnatal motor function in myelomeningocele fetuses.

This paper studies the reliability of the Rehabilitation Gaming System (RGS) on the evaluation of motor function in stroke patients. We developed a virtual reality (VR) scenario for motor function assessment and we tested it in 18 stroke patients. We found strong correlations between the parameters obtained from the virtual reality scenario (work area, covered distance, and fingers excursion) and standardized clinical scales for motor function, spasticity, and performance in activities of daily living.

Las roturas bilaterales del aparato extensor de la rodilla son infrecuentes y se asocian clásicamente a enfermedades sistémicas. Estas lesiones pueden ser óseas, de patela o tuberosidad tibial anterior, musculares o tendinosas. Las más comunes de todas son las fracturas de rótula, seguidas de roturas del tendón cuadricipital o rotuliano.Las roturas bilaterales tanto del tendón rotuliano como cuadricipital, al ser infrecuentes, pueden ser infradiagnosticadas retrasando el tratamiento quirúrgico y la posterior rehabilitación; suelen ser traumáticas. En la literatura existen publicaciones sobre algunos casos de roturas tendinosas bilateral del aparato extensor de la rodilla asociadas a enfermedades sistémicas como isuficiencia renal, diabetes mellitus o artritis reumatoide o al uso prolongado de quinolonas o corticoides.En este trabajo describimos 4 casos clínicos de roturas tendinosas bilaterales del aparato extensor, sin y con enfermedades sistémicas asociadas.

PURPOSE:To describe the demographic and clinical characteristics and the pre-fracture exposure to medicines of patients admitted for a hip fracture, and to explore their association with fatal outcome 1 year after the fracture.METHODS:All patients ≥ 65 years old admitted for a hip fracture in a tertiary hospital in Barcelona between January 1 and December 31 2007 were included. Data on the patients' clinical characteristics before and during hospital admission and on pre-fracture exposures to medicines were collected from the clinical records. One-year mortality was checked by approaching the patients and their families and was cross-checked with the national mortality statistics database. A Cox proportional hazards analysis was carried out.RESULTS:Four hundred and fifty-six patients [mean age (SD) 82.9 (7.2) years, 73.5 % female], were admitted with hip fracture during the study period. Almost 80 % of the patients (363, 79.6 %) had three or more associated conditions, and 41.7 % received pre-fracture treatment with five or more drugs. The case-fatality rate during hospital admission was 4.6 % (21 patients). One hundred and seven patients died within 1 year (23.5 %). Advanced age, male gender, two or more associated chronic conditions, cancer, severe cognitive impairment, and treatment with opiates before fracture were significantly associated with the risk of dying. An inverse association was recorded between mortality and pre-hospital exposure to medicines for osteoporosis.CONCLUSIONS:One-quarter of patients admitted for hip fracture died within 1 year after the fracture. Exposure to opiates before hip fracture was associated with an increased 1-year death rate, whereas treatment with drugs for osteoporosis was associated with a decrease in death rate. These results should be confirmed in studies with detailed prospective collection of information on exposure to medicines.

La artroplastia total de cadera (ATC) es una intervención coste-efectiva para disminuir el dolor, mejorar la función y la calidad de vida de los pacientes con patología degenerativa o inflamatoria de la cadera.La mayoría de sistemas disponibles actualmente son modulares y la fijación de los componentes protésicos al hueso puede conseguirse mediante dos técnicas: la cementación y la osteointegración. Tanto los vástagos cementados como los no cementados pueden ser considerados el patrón oro para la supervivencia a largo plazo; sin embargo, las técnicas no cementadas son hoy en día el método preferido para la mayoría de reemplazos acetabulares. Actualmente la superficie de carga con par de fricción metal-polietileno entrelazado es la más utilizada.La mayoría de complicaciones después de una ATC son infrecuentes, y pueden ser prevenidas y tratadas fácilmente.El objetivo inmediato de la rehabilitación en la fase aguda se centra en reducir el dolor, mejorar la movilidad, restaurar la función e identificar y prevenir las complicaciones postoperatorias inmediatas. Las guías clínicas para los pacientes intervenidos de una prótesis de cadera, y más específicamente los protocolos de ejercicios terapéuticos, varían dependiendo de las instituciones u hospitales y del ámbito de actuación.Una adecuada valoración de los resultados de la artroplastia requiere el uso de instrumentos genéricos de medición de la calidad de vida, siendo el más utilizado el Medical Outcomes Study-Short Form 36, y de instrumentos específicos que sean lo suficientemente sensibles para detectar los cambios clínicos de interés, como la escala de cadera de Harris (Harris Hip Score).Los resultados publicados demuestran una mejoría excelente tanto clínica, como funcional y radiográfica después de la ATC y aproximadamente el 90 % de las ATC tienen éxito, en términos de no dolor ni complicaciones a los 10-15 años de la cirugía.

BACKGROUND AND OBJECTIVE: The Hospital at Home Unit (HHU) is a medical care model effective in different fields of medical and surgical conditions. The objective of the study was to analyse the utility of moving acute nephrologic patients to a HHCU.PATIENTS AND METHOD: We review the Nephrology Service requests to move patients to the HHU the last 3 years. The results were compared with those obtained from the rest of patients admitted at the HHU during the same period.RESULTS: The requests number was 85 and 79 (93%) patients were included for the study. Patients had high comorbility (Charlson index mean, 3.75) and acute medical problems. The length of stay at the HHU was 12.65 days. The total intervention rate was 1.23 interventions/day. In 71 cases (89.9%) the hospital discharge was at the patient's home. In 8 cases the readmission at the hospital was required to solve the medical process. Hospital re-admissions after the HHCU discharge before 30 days was 6.3%. No statistical differences were found between nephrology patients and the rest of HHU patients when comparing the intervention rates, the percentage of home discharges and the hospital readmissions.CONCLUSIONS: The moving of nephrologic acute patients to a HHU is a save choice and well accepted by patients and their families.

Patients and methods Eighty patients with myelomeningocele were randomly chosen from a roster of > 500 patients with (MMC) followed at a multidisciplinary spina bifida unit in a thirdlevel public university hospital, which serves as the referral centre for these patients in our country. Patients with known metabolic acidosis, renal insufficiency, or other metabolic bone disease (i.e., hyperparathyroidism) were excluded from this study. We measured Bone Mineral Density (BMD) with total-body DXA scan with subregional areas values and the biochemical markers of bone mineral metabolism in blood and urine. To study relationships among the variables, the Chi-squared, ANOVA and lineal regression tests were applied

El objetivo de este estudio es realizar un análisis de supervivencia del implante en las artroplastias totales de rodilla estándar a los 5 años de la intervención, así como el estudio de los factores relacionados con dicha supervivencia. Pacientes y métodos Se ha realizado un estudio prospectivo que incluye 271 pacientes que fueron intervenidos de prótesis total de rodilla estándar en el período comprendido entre 1988 y 1993 y posteriormente trasladados al servicio de Rehabilitación. Para la recogida de datos utilizamos el cuestionario modificado de la British Orthopaedic Association. Para el análisis de supervivencia hemos utilizado la función de Kaplan-Meier y consideramos como evento o acontecimiento final para la supervivencia la retirada de la prótesis. Resultados El porcentaje de supervivencia de esta serie a los 5 años es del 94,98 %. Los factores asociados significativamente con la supervivencia a los 5 años han sido: valgo al alta hospitalaria (p < 0,001), luxación de rótula (p < 0,001; supervivencia 70,59 %), infección (p < 0,001; supervivencia 28,57 %), descementación (p < 0,001; supervivencia 50 %), inestabilidad (p < 0,001; supervivencia 25 %) y dolor de etiología desconocida (p < 0,001; supervivencia 92 %). Los resultados funcionales y de impresión subjetiva a los 5 años han sido excelentes o buenos en el 72,2 % de los casos. Conclusiones En esta serie los resultados de las prótesis totales de rodilla estándar a los 5 años de la cirugía son predecibles, constatándose una alta supervivencia del implante y unos resultados funcionales y de impresión subjetiva excelentes o buenos en la gran mayoría de los casos.

IntroducciónEl objetivo de este estudio es analizar qué factores son determinantes del alta hospitalaria en la rehabilitación de los pacientes intervenidos de prótesis total de rodilla.Pacientes y métodosSe ha realizado un estudio prospectivo que incluye 162 pacientes que fueron intervenidos consecutivamente de prótesis total de rodilla en el período de tiempo comprendido entre junio de 1999 y junio de 2000 y posterior-mente trasladados al Servicio de Rehabilitación para realizar tratamiento médico rehabilitador en régimen de hospitalización. Para la recogida de datos utilizamos el cuestionario modificado de la British Orthopaedic Association. Se ha realizado un análisis de regresión lineal múltiple, para estudiar qué variables están asociadas con la estancia hospitalaria en rehabilitación (variable dependiente), ajustando por el efecto de las demás.ResultadoEn el análisis bivariable han sido factores asociados con una menor estancia hospitalaria en rehabilitación: la edad avanzada (p<0,05), el índice de masa corporal elevado (p<0,0002), la no presencia de complicaciones quirúrgicas (p<0,01), el mayor balance articular en flexión a la semana del postoperatorio (p<0,004) y la menor media de días de movilización pasiva continua (p<0,02); pero en el análisis multivariable, los dos únicos factores determinantes del alta hospitalaria con correlación inversa, son la edad (p<0,001; IC 95% 1,86–2,06) y el balance articular en flexión a la semana del postoperatorio (p<0,01; IC 95% 1,92–1,99).ConclusioneLa edad y el balance articular en flexión a la primera semana son las dos únicas variables determinantes del alta hospitalaria.

ObjetivoEl objetivo de este estudio ha sido determinar el nivel funcional de los pacientes intervenidos de prótesis total de rodilla en nuestro medio a los cinco años de dicha intervención, valorando individualmente el dolor, la marcha, las actividades de la vida diaria y la satisfacción personal. Asimismo hemos intentado identificar las variables responsables o asociadas a una satisfacción personal mala o regular.Pacientes y métodosSe ha realizado un estudio prospectivo que incluye 311 pacientes que fueron intervenidos de prótesis total de rodilla entre 1988 y 1993. Posteriormente fueron trasladados al Servicio de Rehabilitación para realizar tratamiento médico rehabilitador en régimen de hospitalización. Para la recogida de datos utilizamos el cuestionario modificado de la British Orthopaedic Association. La encuesta de valoración funcional y de satisfacción personal se realizó a los cinco años de la cirugía. Se ha realizado un análisis de regresión logística múltiple para identificar las variables responsables o asociadas a una satisfacción personal mala o regular.ResultadosLa mayoría de pacientes portadores de la prótesis a los cinco años presentaron un buen resultado en cuanto a balance articular [extensión media −2,6º (±5,9) y flexión media 97,89º (±17)], dolor inexistente o ligero (88,5%), y perímetro de marcha de al menos un kilómetro (73,57%). La satisfacción personal fue excelente o buena en el 75,4% del total de pacientes. En el análisis multivariable sólo el dolor (OR=8,16; IC 95%=3,59–18,5) y las ayudas para la marcha (OR=2,52; IC 95%=1,41–4,49) son factores determinantes de tener una satisfacción personal regular o mala en los pacientes portadores de la prótesis a los cinco años.

BackgroundPhysicians can recognise and treat osteoporosis before the occurrence of fracture. Unfortunately, there is ample evidence that clinicians have not heard or heeded the message that condition is treatable, and that selected patients, particularly those who have already suffered a fracture, should be counselled to received preventive therapy.1 Epidemiologic studies have demonstrated that a history of osteoporotic fracture places a patient at very high risk of future fractures.2ObjectivesThe purpose of this study was to investigate whether elderly patients admitted to our hospital with a principal diagnosis of hip fracture had a prior diagnosis of osteoporosis or a previous osteoporotic fracture and their previous prescribed treatment.MethodsWe performed a prospective chart review of all elderly (> = 65 years) patients admitted with the diagnosis of acute hip fracture in a public hospital in Barcelona, Spain, from January 1, 1999, to December 31, 2000. Data were collected by interviewing each patient immediately after their fracture with a structured questionnaire including patient age, sex, residence, the number, type and causes of fractures, as well as previous history of osteoporosis or osteoporotic fracture, and previous treatment for osteoporosis.ResultsA total of 741 patients were included. Mean age was 81.54 (range 65–103) and 74.14% were women. Six hundred seven (81.91%) patients were admitted from their own home. Thirty (4.05%) patients had other associated fracture; the most common was a subcapital humeral fracture, which occurred in 13 patients. There were 447 (60.32%) extracapsular fractures. A fall was the most common cause of hip fracture (94.87% of cases). A prior diagnosis of osteoporosis was recorded in 50 (6.74%) patients; of them 23 (46%) were using calcium, vitamin D, alendronate or calcitonin. A history of hip, vertebral, wrist or another osteoporotic fracture, was recorded in 221 (29.82%) patients but only 18 (8.14%) were using any treatment for osteoporosis. Moreover 66 patients (8.91%) had suffered from more than one fracture. Forty-seven patients (6.34%) were on long term systemic steroids treatment for 6 months or more; ten (21,28%) were treated with calcium, vitamin D, alendronate or calcitonin. Eight patients admitted with a hip fracture in 1999 had a second hip fracture in 2000, but only two were receiving preventive therapy.ConclusionRates of utilisation of pharmacological treatment for osteoporosis were low. Prior diagnosis of osteoporosis was the condition that implied a better (less than half) preventive treatment, but clinicians dis not consistently initiate treatment for skeletal fragility after one or more fractures had occurred.ReferencesBauer DC. Osteoporotic fractures: ignorance is bliss?. Am J Med. 2000;109:338–9 Cummings SR, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med. 1995;332:767–73

Study design: In some young adults non-shunted myelomeningocele (MMC) patients without symptoms or with unspecific clinical findings, moderate or severe stabilised ventriculomegaly are observed in control CT scans. Physicians are then faced with the so-called `Arrested Hydrocephalus' (AH) syndrome. The present study is part of a prospective protocol in which patients with hydrocephalus associated with MMC and long-term clinical diagnosis of AH were included. Objectives: To evaluate myelomeningocele patients never shunted with clinical and/or CT scan criteria compatible with AH. Setting: Multidisciplinary Spina Bifida Unit in a tertiary university hospital in Barcelona, Spain. Methods: Fourteen MMC patients were selected, in all of them, continuous intracranial pressure (ICP) monitoring was performed. Analysis of the ICP records was done using the method described by Børgesen in mmHg. All patients were also studied by intelligence quotient (IQ) testing before and after shunting. Results: The CT in all the study cases showed an Evans ratio ⩽0.30. The majority of patients (11/14) presented continuous high or intermittently raised ICP (active or unstable compensated hydrocephalus group) and in three (3/14) cases we confirmed the diagnosis of arrested hydrocephalus. There were no complications associated with ICP monitoring. Conclusions: In view of our results, we believe that in all non-shunted cases with clinical and/or CT scan criteria compatible with AH, the use of an objective method, such as continuous ICP monitoring, is necessary to diagnose arrested hydrocephalus, and a more comprehensive method that includes extensive neuropsychological valoration should be developed for the diagnosis and treatment of arrested hydrocephalus. Sponsorship: Supported in part by Grant number 97-0923 from the Fondo de Investigaciones Sanitarias de la Seguridad Social (FISS).

OBJECTIVES:To establish whether surgery can improve the neuropsychological functioning of young adult patients with spina bifida and apparent clinically arrested hydrocephalus showing abnormal intracranial pressure.METHODS:Twenty three young adults with spina bifida and assumed arrested hydrocephalus (diagnosed as active or compensated by continuous intracranial pressure monitoring) underwent surgery. All patients received neuropsychological examination before surgery and 6 months later. Neuropsychological assessment included tests of verbal and visual memory, visuospatial functions, speed of mental processing, and frontal lobe functions.RESULTS:Shunt placement in this subgroup of patients improves neuropsychological functioning, especially in verbal and visual memory and attention and cognitive flexibility.CONCLUSIONS:Young adults with spina bifida and suspected non-functioning shunt or non-shunted ventriculomegaly should be carefully monitored to identify those who could benefit from shunting.