Computed tomography protocols used in staging bronchopulmonary carcinoma: results of a national survey

OBJECTIVES

To know the protocols used for staging bronchopulmonary carcinoma by computed tomography in Spain.

MATERIAL AND METHODS

Radiologists in 129 hospitals were sent email questionnaires about the organization of their department, scanner type and manufacturer, study extension, techniques employed, and protocol for administering contrast material.

RESULTS

A total of 109 hospitals responded with data from 91 teams. Most hospitals were affiliated with a university, and most departments were organized by organ-systems. Scanners were from four manufacturers, and 68% had either 16 or 64 detectors. In 61% of the hospitals, the dose of contrast agent is modified only in patients with extreme body weights, and in 22% the dose is not individualized. Most hospitals do contrast-enhanced studies of the chest and upper abdomen, 42.4% through a single thoracoabdominal acquisition and 55.9% through independent chest and abdominal acquisitions; there was a significant association between these approaches and the scanner manufacturer's protocols and whether the hospital was affiliated with a university. The most commonly used technical parameters were 120kV with dose modulation and variable milliamperage.

CONCLUSION

There is very little variability among hospitals in the type of scanner used, the study extension, and the technical parameters used to stage bronchopulmonary carcinoma. Most centers individualize the dose of contrast agent only in extreme weights. There is a broad division between using one or two acquisitions to image the thorax and abdomen, and the number of acquisitions is related to the scanner manufacturer and whether the hospital is affiliated with a university.

[Assessment of a pharmaceutical interventional programme in patients on medications with renal risk]

OBJECTIVE

To compare the adaptation of medical prescriptions according to the dosage guides in patients with renal disease, before and after applying a pharmaceutical intervention programme. The secondary objectives were to prepare a guide to dosing in renal disease and to measure the prevalence of prescription of drugs with renal risk.

METHOD

Non-randomised, experimental interventional study (before/after) conducted in a general hospital with 800 beds, including hospitalised patients, over the age of 18, with kidney disease and drugs with renal risk prescribed in their pharmacotherapeutic profile. The study was designed to be carried out in two descriptive cross-cutting phases (control group) and a prospective interventional cohort study (intervention group). The primary variable was the percentage non-adaptation according to the stage of renal disease.

RESULTS

The study included 185 patients, 88 in the control group and 97 in the intervention group. In the intervention group, the prevalence of non-compliance before and after the intervention was 18.7 % and 2.1 %, representing a statistically significant reduction in non-adaptation of the dose. The costs saved with the pharmaceutical intervention programme were 1,939.63 euro over two months, the average saving per medication intervened amounting to 62.57 euro (CI 95 %, 23.99-101.14 euro; p = 0.02).

CONCLUSIONS

The results of the study indicate that the application of a pharmaceutical care model based on the prospective validation of drugs with renal risk, very significantly improved the adaptation of dosing regimens in kidney disease.

[Short-Stay Medical Unit, an alternative to conventional hospitalization]

BACKGROUND

The Short-Stay Medical Unit (SSMU) is an alternative to conventional hospitalization. This study has aimed to analyze the evolution of admissions and duration of stay in a SSMU, to outline the characteristics of the patients while studying their relationship to length of time spent in the unit and their destination on discharge as well as to assess how appropriately their cases were resolved.

MATERIAL AND METHODS

A descriptive study was carried out (2000-2005), analyzing their age, sex, destination on discharge and main diagnosis as well as the evolution of admissions and length of stay over this period. In order to determine how appropriately each case was resolved, length of stay and destination on discharge were considered. The data were analyzed using the SPSS program.

RESULTS

During the study period there was an increase in the number of admissions and in length of stay. The average age of the 7,618 patients was 70.6 +/- 16.9 years and the average stay 2.7 +/- 1.4 days. One of the most frequent diagnoses was chronic obstructive pulmonary disease (COPD) (15.9%). On discharge, 85.9% of patients were sent home. A total of 76.4% of cases were resolved satisfactorily, with significant statistical differences related to age, diagnosis and number of diagnoses.

CONCLUSIONS

A progressive increase in admissions and length of stay was observed. Ninety percent of the cases of the younger patients were resolved satisfactorily, this decreasing to 72% for older patients. The number of diagnoses, specific diagnoses and age caused some difficulty in reaching an appropriate resolution.

[Lung cancer risk in shoe manufacturing]

OBJECTIVE

Workers in shoe manufacturing have been reported to be at a greater relative risk for bronchogenic carcinoma. Given the implications for our practice setting, we carried out a study to a) clarify whether working in shoe manufacturing is a risk factor for lung cancer and b) detect histological differences between lung cancers in shoe manufacturers and in other lung cancer patients.

PATIENTS AND METHODS

This case-control study compared all lung cancer patients diagnosed in Hospital Elda, Alicante, Spain, between January 1994 and December 1999, with a control group composed of patients admitted to the same hospital for accidental fractures. Information on occupational history and tobacco dependency was collected from all patients by telephone questionnaire.

RESULTS

One hundred and ninety-one case patients and 192 control patients were included in the study; 52 of the cases (27.2%) and 48 controls (25%) worked in shoe manufacturing. No statistically significant differences were found between the 2 groups, not even when we limited the cases and controls to only those who had worked more than 30 years in shoe manufacturing or when we analyzed only subjects who had had especially high risk occupations. No differences in tumor histology were found between cancer patients who worked in shoe manufacture and those who did not.

CONCLUSIONS

Working in shoe manufacturing has not proven to be a risk factor for bronchogenic carcinoma.

Prognostic Value of the Carcinoembryonic Antigen Found in Pleural Lavage Fluid From Patients With Lung Carcinoma

OBJECTIVE

To detect the tumor marker carcinoembryonic antigen (CEA) in pleural lavage fluid taken during surgery from patients with pulmonary carcinoma without associated pleural effusion and assess its possible prognostic implications.

PATIENTS AND METHODS

A prospective, observational study was undertaken to include consecutive patients who underwent surgical treatment for lung carcinoma in which pleural lavage was performed prior to closure of the thoracic cavity (study group). The same techniques and measurements were used in patients undergoing thoracotomy for benign disease (control group). The preoperative blood level of CEA was also quantified.

RESULTS

In the study group, the median CEA levels in blood and pleural lavage fluid were 2.90 ng/mL and 0.40 ng/mL respectively; these figures are higher than those corresponding to the control group. A CEA level of 0.30 ng/mL in pleural lavage fluid was established as a cutoff point, based on the corresponding receiver operating characteristic curve, with a sensitivity of 68.4% and a specificity of 35.7%. A graph of survival in relation to this cutoff point revealed a statistically significant effect (P<.05).

CONCLUSIONS

It is possible to detect CEA in pleural lavage fluid from the thoracic cavity of patients with lung carcinoma. The values obtained are higher than those found in fluid from patients without neoplastic disease, and this parameter functions as an independent predictor of disease course.

[Utility of verapamil in the treatment of diastolic dysfunction in patients with acromegaly]

INTRODUCTION

Diastolic dysfunction is a common complication in patients with acromegaly. By using the metabolic treatment for acromegaly, an improvement in diastolic function is not always achieved and a group of these patients could obtain some benefit from a specific treatment for such a condition. The objective of the present study was to evaluate the utility of verapamil therapy in acromegalic patients with diastolic dysfunction.

METHODS

Fourteen patients (7 males and 7 females) with the diagnosis of acromegaly and diastolic dysfunction confirmed by echocardiogram were studied. After six months of treatment with verapamil (240 mg/day) the echo-cardiographic parameters and the functional class (NYHA) of patients were reevaluated.

RESULTS

All patients showed an increased basal measurement of the cardiac mass (mean [percentiles 25-75]: 149 g/m2 [128-264]) and no improvement was observed after treatment (182 g/m2 [123-328]). Also, no improvement was found regarding the studied diastolic function parameters: E/A relationship of left ventricle (0.70 [0.54-0.83] versus 0.61 [0.54-0.86]) and isovolumetric relaxation time (146 [119-193] versus 120 [97-169]). A trend towards improvement was indeed found in the functional class, although no statistical differences were observed.

CONCLUSION

Our results did not demonstrate a benefit derived from the treatment with verapamil upon the diastolic function in patients with acromegaly.

[Gastric enteral intolerance in mechanically ventilated patients with traumatic cerebral lesion]

OBJECTIVE

To check the correlation between gastric intolerance and hypertension intracranial pressure and their association with the clinical parameters and severity indexes in patients with severe head injury (HI); to evaluate the advantages of transpyloric feeding.

DESIGN

Prospective and observational clinical study.

SETTING

Intensive Care Unit (ICM) of a General University Hospital.

PATIENTS AND PARTICIPANTS

25 brain injured patients requiring sedation, mechanical ventilation and hypertensión intracranial monitoring.

INTERVENTIONS

Analysis of the incidence of delayed gastric emptying (area under the curve (AUC60)) and of gastrointestinal intolerance; study of their correlation with hypertension intracranial, severity indexes and sedative medication administered; evaluation of the alternative effectiveness of transpyloric feeding.

MEASUREMENTS AND RESULTS

44% of the patients showed GI, which was measured by means of the paracetamol test (AUC60). The sedative medication was related to IG (p < 0.005), HIC (p < 0.01) and AUC60 (p < 0.01). Of the severity indexes, there was a correlation between Glasgow Coma Score and AUC60 (p < 0.01); the Marshall score HIC (p < 0.005) and AUC60 (p < 0.01). Of the quantitative variables, we found a correlation between HIC and IG (p < 0.001), HIC and pneumonia (p < 0.01), IG as well pneumonia (p < 0.001), and AUC60 (p < 0.001) and AUC60 and pneumonia (p < 0.05).

CONCLUSIONS

Enteral intolerance in patients with HI is due to delayed gastric emptying (DGE) which is proportional to the severity of the head injury and to the intensity of the systemic response. The high incidence of GI makes transpyloric feeding advisable in order to attain the nutritional objective and to reduce the risk of aspirative nosocomial pneumonia.

[Protocol for sino-nasal tumors in our service]

Tumors of the nasal fossa and paranasal region are uncommon and have non-specific initial clinical features. This complicates the diagnosis and delays treatment. We reviewed all our cases of nasal sinus tumors (84 benign, 50 malignant and 15 moderately malignant) and the relevant literature. This data was use to develop a protocol for classifying the symptoms, clinical and radiological features, coded diagnosis, and the most suitable treatment and follow-up.

[Clinical course and prognostic factors in newborns with very low birth weight]

OBJECTIVE

We report the results of survival and incidence of neurodevelopmental sequelae in a group of 249 infants treated in our hospital between 1986-91, whose birth weight was under 1,500 grams.

METHOD

We perform a follow-up at corrected ages of 3, 6, 10, 18, 36 months and 5 years thought results only included children followed until 18. Sequelae were classified in three groups, according to the disability degree.

RESULTS

Survival resulted to be 69.87% (174), 38.7% for the group under 1,000 grams and 84.7% for those over 1,000 grams. Sequelae were present in 22.6% (11.6% moderate and 10.9% severe). The incidence of severe sequelae was very different on basis of the birth weight, 25.8% for children under 1,000 grams, 13.9% for 1,000-1,249 grams and 1.6% for 1,250-1,500 grams.

CONCLUSIONS

Intracranial haemorrhage, hyperbilirubinemia, assisted ventilation and persistence of ductus arteriosus were significantly associated sequelae. We didn't find differences with respect to multiple pregnancy, seizures, sepsis or neonatal hypoxia.

[The value of age as a prognostic factor in the severity of acute pancreatitis]

Age has been considered as a risk factor for the development of complications in acute pancreatitis. To confirm the above a retrospective study was designed including 526 cases of acute pancreatitis which were classified, according to age, into two groups: group I: > 65 years, and group II: < or = 65 years. The evolution of pancreatitis was classified as mild or severe according to the criteria of the Atlanta Meeting. Furthermore, other variables which may influence in the development of complications, such as the etiology or the presence of other associated diseases at the time of the appearance of pancreatitis were taken into account. On comparison of the severity of pancreatitis in both groups significant differences were only found in the appearance of acute renal failure. A relationship was, however, observed between the existence of certain diseases (arterial hypertension, diabetes mellitus and chronic renal failure) present at the time of the appearance of acute pancreatitis and the development of complications of the latter. In addition, on comparing the epidemiologic and etiologic data of the two groups, it was found that acute pancreatitis in the elderly is more often of biliary etiology, is more frequent in females and is usually accompanied by other diseases at the time of appearance. Age in itself is not a risk factor for the development of complications in acute pancreatitis. The association of diseases at the time of the initiation of pancreatitis implies a worse prognosis.

[Epidemiology of designer drug use in Spain]

BACKGROUND

To provide epidemiological information on the extent of design drug use in Spain, the characteristics of users, and the types of substances consumed.

MATERIALS AND METHODS

We analyzed two surveys on drug use carried out in 1993 and 1994 (one in the general population older than 15 years and the other in heroin and/or cocaine users who were not in treatment) as well as data on designer drug seizures confiscated by the General Police Headquarters and Ministry of Health laboratories.

RESULTS

According to the general population survey, 4.5% of persons 16-40 years of age have tried design drugs at some time, 2.1% more than once, and 0.6% are current users. Design drug use is associated with age of 20-24 years and use of crack (odds ratio [OR] = 28.6), cannabis (OR = 12.5), cocaine (OR = 7.6) or heroin (OR = 3.8). According to the survey of heroin/cocaine users, 25% of cocaine users have used design drugs in the last 30 days, 11% of heroin users, and 18% of those who use both substances. Use is associated with the use of hallucinogens (OR = 4.8), non-use of the injected route (OR = 2), and having been interviewed in recreational areas (OR = 1.8). Police data reflect a stability in the quantities of amphetamines confiscated, a large increase in those of MDMA, and an absence of MDA and MDEA. Ministry of Health laboratories show an increase in confiscations of amphetamines and the presence of MDA, MDMA and MDEA in all years and areas studied, as well as the appearance of MBDB in 1994.

CONCLUSIONS

The occasional use of different design drugs has spread to some degree among young people, varies considerably by geographic region, and is associated with the use of other legal and illegal substances, specially stimulants.

[Quality of the certification of death due to acute reaction to opiates and cocaine among inhabitants of the City of Madrid]

BACKGROUND

Deaths by acute reaction from drugs consumption (RAD) particularly heroine or cocaine, collected in routine morality statistics, have not changed substantially during the last ten years, whereas an specific collection system (State Information System on Drug-Abuse SISD) presented a great increase. For this reason, we try to measure the validity of drug-related deaths certificate.

METHODS

The cause of death, corresponding to the persons, from 15 to 39 years of age, decreased in 1988 and residing in the Municipality of Madrid, registered in the Civil Register Decease Book and in the death Statistics Bulletins (DSB) was compared with the cause present in the autopsy report.

RESULTS

A detection rate of 2.45% for the CR and 3.27% for the DSB were obtained. With the consequent correction, the RAD for this age group would be the second cause of mortality in the Municipality of Madrid and deaths related to circulatory and respiratory system would decrease in a great measure.

CONCLUSIONS

It is necessary to improve substantially the collection of this cause of death in mortality statistics if we want a correct measurement of drug abuse lethal effects and the effectiveness of control programmes on this health problem.