Role of x-ray computed tomography in the preoperative evaluation of aneurysm of the abdominal aorta

The authors have studied the files of 50 consecutive patients (1987-89) operated for abdominal aortic aneurysm (AAA) and examined with CT. The criteria for inclusion were surgical features. CT can be made more accurate for the study of AAA: Thus the location of the neck of the aneurysm relative to the renal arteries was defined in 94% of all cases. In addition, CT yields information about the wall of the aneurysm, whether it be thickened (3 inflammatory aneurysms were properly diagnosed) or, mor importantly, weakened (solution of continuity in the wall in the "prior-to-rupture" appearance). Owing to the quality of its performances and to its noninvasive character, the authors regard CT with contrast injection as an essential technique for the preoperative assessment of abdominal aortic aneurysm in most cases. The examination must be carried out strictly, especially for the contiguous sections of the renal arteries and their extension to the crural arch. As it demonstrates weakened areas more easily, a more accurate study of the aneurysmal wall with CT might increase the surgical indications for some smaller aneurysms, the potential evolution of which does not seem to be associated with their diameter only.     

Health care benchmarking: a team approach

The management tool of benchmarking, widely used in industry for more than a decade, is today being adapted for health care organizations. Hospitals and other health care providers are developing ways to compare their practices, processes, and resulting outcomes with other organizations in order to discover "best practices." This article describes a team approach to health care benchmarking and details several projects being conducted by hospitals in The SunHealth Alliance. The examples include benchmarking for both operational and clinical processes.     

Minimum basic set of data of hospital discharges as a source of information for a study of congenital abnormalities

BACKGROUND: The purpose of this study is that of assessing the validity of the computerized diagnoses of hospital discharges of congenital defects by comparing them with the information included in the medical history. METHODS: Based on the discharge records generated over a one-year period at 7 hospitals in the Autonomous Region of Valencia, 100 children were selected at random from each hospital. As a standard, the diagnoses stated in the medical histories were indexed and coded. Solely those discharges having taken place during the first year of life were considered. A study was also made of the type, seriousness and individual or combinations of congenital defects. A calculation was made of the sensitivity, specificity, predictive values and the 95% confidence intervals thereof by the exact binomial method for the case studies (children) and the positive predictive value and sensitivity for the study of diagnoses. RESULTS: 126 children were detected as having congenital defects, and 201 diagnoses in medical records, and 83 children with congenital defects and 108 diagnoses on record. For the detection of cases, the records showed a 64% sensitivity, a 99.1% specificity and some positive and negative predictive values of over 90%. With regard to the detection of diagnoses, the sensitivity was 46% and the positive predictive value 83%. The sensitivity varied a great deal depending upon the diagnoses. CONCLUSIONS: The hospital discharge records revealed a high degree of specificity and high predictive values, but a low degree of sensitivity. These facts must be considered when these records are used as a source of cases for the epidemiological studies of congenital defects.     

Giant inguinal scrotal vesical hernia

Presentation of one case of scrotal hernia in a man of 64 years old patient. Diagnosed by cistography and ultrasound and treated by herniorraphy and posterior transuretral litolaplaxy of a vesical litiasis and RTU of prostate. Postoperative urography showed normal vesical morphology.     

Infravesical obstructive uropathy secondary to extreme vulval atrophy

Lower urinary tract obstruction in women is an uncommon condition resulting from multiple either organic or functional disorders. This paper contributes one case of obstructive uropathy secondary to presence of almost complete vulvar synechia due to extreme genital atrophy, a rare entity that may appear in postmenopausal women. Partial and incomplete vulvar fusion usually occurs in significant postmenopausal atrophies, sometimes associated to urethral meatus stricture; this, however, has no significant repercussion on urination dynamics. No other comparable case was found in the reviewed literature.     

Antihypertensive drug therapy and hypoglycemia in elderly diabetic patients treated with insulin and/or sulfonylureas

We performed this case–control study to evaluate the risk of hypoglycemia associated with the use of antihypertensive drugs in older hospitalized diabetic patients treated with sulfonylureas and/or insulin. All diabetic patients admitted during 4 months in 1988, 1 month in 1991, 4 months in 1993 and 4 months in 1995 (n = 3477, mean age 71.4 ± 0.2 years, 1542 males and 1935 females) were enrolled in the study. During the four annual surveys 86 patients (mean age 71.1 ± 1.4 years, 33 males and 53 females) presented hypoglycemia during hospital stay. The patients who presented hypoglycemia were less frequently users of sulfonylureas and more frequently users of a combination of insulin and sulfonylureas. Use of antihypertensive drugs was similar in the two groups studied, and among potentially interacting drugs considered in the analysis, sulfonamides were more frequently used in patients who experienced hypoglycemia. Moreover, patients with hypoglycemia used a higher number of drugs, had a longer length of stay and had a greater prevalence of hypoglycemia as admission problem. Finally, although not significant, liver and renal diseases were more frequent among patients with hypoglycemia. In the multivariate analysis, contemporary use of insulin and sulfonylureas, liver disease and length of stay were significantly associated with hypoglycemia, while none of the antihypertensive drugs showed a significant association with the occurrence of hypoglycemia during hospital stay. Our results indicate that antihypertensive drugs do not increase the risk of hypoglycemia in elderly diabetic patients.     

The importance of angiogenesis in ovarian cancer

Advanced stage ovarian cancer has a high rate of recurrence even after surgery followed by chemotherapy combining carboplatin and a taxane. New strategies are currently under way to combat this situation and one of the most promising ones is based on the knowledge that angiogenesis, the mechanism of formation of new blood vessels coupled with the degradation of the extracellular matrix for metalloproteinases, could be crucial in the development of this tumor. The principal molecule implicated in angiogenesis process of ovarian cancer is the vascular endothelial growth factor (VEGF). Several studies are now in progress to clarify its role as a diagnostic tool or its therapeutic implication. Presently, there is no indication for the use of VEGF in a preliminary diagnosis seeing that an increase in levels can be seen in both benign and malignant ovarian conditions. VEGF is also responsible for an increase in vascular permeability and is directly related to symptoms such as ascites and pleural effusion, both of which are frequent in ovarian cancer. Several papers have analised the role of VEGF as a prognostic factor and some of them do confirm VEGF as an independent prognostic factor in ovarian cancer. VEGF and the metalloproteinase system coupled with angiogenesis are currently being evaluated as therapeutic targets but no positive results have yet to be seen in this field.