Drug-eluting stents for off-label indications in real clinical world: evidence based or 'intuition' based clinical practice?

Background: The use of drug-eluting stents (DES) is an example of the disparity between recommendations given by regulatory agencies and the real clinical world. Such disparity might lead cardiologists to adopt different routines in the use of DES. We aimed to assess variability of off-label DES use between hospitals and to what extent it can be explained by differences in patient or hospital characteristics.

Traumatic floating clavicle: a case report.

Most published reports of a floating clavicle consist of a dislocation of both ends of the clavicle and are associated with a high-energy injury. We report a 71 year old patient with a fracture of the medial end of the clavicle with anterior sternoclavicular dislocation and a nondisplaced fracture of the lateral end of the same clavicle distal to the insertion of coracoclavicular ligaments due to a low velocity fall.

[Pathophysiology of CADASIL disease].

The pathogenic mechanism underlying Cerebral Autosomal Dominant Artheriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) remains elusive although the disease is well characterized at clinical, histological and genetic level. The conservation of the Notch pathway among species allowed the development of several animal and cellular models in order to study it. This review analyzes the reliability of the 7 pathogenic models raised for CADASIL disease: autoimmune origin, mitochondrial dysfunction, loss of Notch3 function, granular osmiophilic material (GOM) toxicity and long term unfolded protein response (UPR) activation.

[Profile of the patient who wants to quick smoking seen in the Primary Care and Specialized consultations in Spain].

Objective: To determine the profile of the smoker who wants to stop smoking. Subjects and methods. A cross-sectional, multicenter study was conducted in 1634 smokers attended by General Practitioners and Specialized Physicians in Spain who had expressed their desire to stop smoking when explicitly asked.

[Usefulness of a new index for mortality after hospitalization in adults older than 70 years].

Background And Objective: Walter et al developed and validated a mortality prognostic index in older adults after hospitalization. Our objective was to evaluate the Walter index utility and to compare it with Charlson index and Barthel index in our population.

Patients And Method: 455 patients were included (224 men and 231 women), medium age was 81.

[Dilated cardiomyopathy secondary to atrial ectopic tachycardia].

Ectopic atrial tachycardia is an uncommon cause of supraventricular tachycardia in children. It can resolve spontaneously or induce dilated cardiomyopathy. It is important to recognize this entity as a reversible cause of dilated cardiomyopathy, characterized by the presence of an abnormal focus located in the atrial myocardium and distinct to sinus node.

[Characteristics of road accident victims with positive blood alcohol levels].

Objective: To identify the differential features of positive blood alcohol level (BAL) in people injured in road crashes who were attended an acute care service.

Methods: Cross-sectional study of persons aged 18 years old or older injured in motor vehicle crashes who were attended in the Traumatology Emergency Department of Vall d'Hebron Hospital (Spain) between July 2001 and February 2002.

Results: The study sample included 431 patients.

[Group B Streptococcus late-onset disease presenting as cellulitis-adenitis syndrome].

Cellulitis-adenitis syndrome is a rare clinical manifestation of group B Streptococcus (GBS) late-onset disease. Its significance lies in the fact that local infection may be the only initial sign of systemic infection that is often concurrent with meningitis. Soft tissue involvement (cellulitis-adenitis) can sometimes be the only initial manifestation of GBS infection.

[Mechanical ventilation in pediatrics (III). Weaning, complications and other types of ventilation. Weaning from mechanical ventilation].

Weaning from mechanical ventilation can be defined as the process that allows the transition from mechanical ventilation to spontaneous breathing. This process can account for a significant proportion of total ventilation time and failure to resume spontaneous breathing affects patient outcome. Thus, to ensure maximum success, patient readiness for weaning and extubation should be evaluated through the following steps: the patient must fulfill pre-established clinical and ventilatory support criteria for extubation, the patient should be observed during a breathing trial on minimal or no ventilatory support, and variables used to predict weaning success should indicate a favorable outcome.

[Assesing the GRDOSIS Software program as a tool to analyse drug usase by DRGs].

Objective: To validate the GRDOSIS software program as a tool to calculate Spanish drug weights within diagnosis-related groups (DRGs), and to analyse information used in this calculation.

Material And Methods: Information corresponding to a 7-hospital sample is analysed after exchanging data between the minimum basic data set processed by the DRG-grouping program Estación Clínica -3M and unit-dose drug consumption. Data are purged by eliminating cases with an unusual (either long or short) length of stay in each DRG, and both weights and pondered weights are calculated.

[Decreasing incidence of perinatal group B streptococcal disease (Barcelona 1994-2002). Relation with hospital prevention policies].

Introduction: To analyze the incidence of perinatal sepsis due to group B streptococcus (GBS) as related to compliance with recommendations for its prevention issued by the Catalan Societies for Obstetrics, for Pediatrics, and for Infectious Diseases and Clinical Microbiology in 1997.

Methods: The study was conducted from 1994 to 2001 in 10 Barcelona-area hospitals, where 157,848 live infants were born.

Results: GBS disease was diagnosed in 129 neonates.

[Retinopathy of prematurity: incidence, severity and outcome].

Objective: The aim of this study was to evaluate the incidence, severity and outcome of retinopathy of prematurity (ROP) in neonates with birth weights of less than 1,501 g in our environment.

Methods: A prospective study of infants with birth weights of less than 1,501 g was performed from January 1999 to June 2000. One hundred seventy-eight infants were enrolled in the study.

[Cardiac surgery in elderly patients].

Objective: The morbimortality of elderly patients, (age 70 years or older), who underwent surgery for valvular and coronary artery disease in the last 17 years was analyzed.

Patients And Method: A total of 1,305 patients (654 valvular, 531 coronary and 120 combined) operated from January 1985 to December 2000 were retrospectively studied. Mean age was 73.

[Descriptive study of first visits in a multiple sclerosis specialised unit].

Background: The need for optimal care has led to implementation of multiple sclerosis care units, specialised in diagnosis and follow-up of multiple sclerosis patients. Since information on multiple sclerosis prognosis is crucial, accurate diagnosis is one of their major roles.

Method: Prospective analysis of first visits during a year (origin and diagnosis) at the Unidad de Neuroinmunología Clínica of Hospital Vall d'Hebron.

[Posterior spinal artery infarction and nonbacterial thrombotic endocarditis].

Nonbacterial thrombotic endocarditis (NBTE) has been described as an important complication in patients affected by different kind of illnesses, above all underlying malignancies. Fifty % of the patients affected by NBTE will have embolic events in different organs. The poverty of specific symptomatology appears to difficult seriously its diagnosis.

[Conversion to clinically definite multiple sclerosis after isolated spinal cord syndrome: value of brain and spinal MRI].

Background: Isolated spinal cord syndrome might be due to a first episode of multiple sclerosis. The aim of the study was to determine the clinical usefulness and paraclinical characteristics and of spinal and brain MR imaging predicting conversion to clinically definite multiple sclerosis (CDMS) in patients with an isolated spinal cord syndrome.

Patients And Methods: We have evaluate thirty-eight patients with isolated spinal cord syndrome.