Arthritis in acute febrile neutrophilic dermatosis (Sweet's Syndrome)

Sir: Acute febrile neutrophilic dermatosis or Sweet's syndrome' is an uncommon condition characterised by fever, polymorphonuclear leucocytosis, painful erythematous cutaneous plaques, and a dense dermal infiltrate of neutrophils without vasculitis at the site of the skin lesions. Although many investigators suggest that acute febrile neutrophilic dermatosis is a hypersensitivity reaction,2 no defmitive cause is known. The role of the neutrophil as a cause or effect in this syndrome has not been clarified. Acute febrile neutrophilic dermatosis is histologically and clinically mimicked by several disorders, and the differential diagnosis with pyoderma gangrenosum3 and with some reactive erythemas such as erythema multiforme2 is usually difficult

Evaluation of circulating type I procollagen propeptides in patients with Paget's disease of bone

We evaluated circulating aminoterminal and carboxyterminal propeptides of type I procollagen and total alkaline phosphatase levels in eighty consecutive patients affected by Paget's disease of bone. We compared the biochemical data with the extent of bone disease calculated on the basis of the bone scintigraphic indices. Serum aminoterminal propeptide of type I procollagen levels were high in 77% of patients, serum carboxyterminal propeptide of type I procollagen levels in 22% and serum total alkaline phosphatase levels in 76%. We found significant correlations between the three markers studied. The three biochemical markers correlated significantly with the bone scintigraphic activity indices, but the highest correlation coefficient was between the aminoterminal propeptide and total alkaline phosphatase. We conclude that there is a discrepancy between serum levels of the propeptides studied in relation to Paget's disease of bone. The sensitivity of the carboxyterminal propeptide of type I procollagen in this disease is low. In contrast the aminoterminal propeptide may be as sensitive a marker for the evaluation of this disorder as total alkaline phosphatase, and in addition may be more specific

Tratamiento de las coxitis reumáticas con prótesis total cementada

Se estudia una serie de 82 prótesis totales de cadera cementadas tipo Muller implantadas en enfermos afectos de coxitis reumáticas, fundamentalmente artritis reumatoide. Los casos tienen un seguimiento medio de cuatro años y una edad media de cincuenta y un años; la mitad de ellos tenían afectados entre siete y 10 articulaciones y en la cadera el 28 por 100 presentaban protrusión acetabular. En el postoperatorio consta un 2,5 por 100 de complicación séptica y 2,5 por 100 de tromboembolismos. El análisis clínico de los resultados se basa en el dolor, la movilidad y la marcha según el baremo de Merle d'Aubigne y en la capacidad funcional segiin los criterios de STEINBROCKER. En grupo aparte se ha estudiado el resultado en los casos con un seguimiento mínimo de cinco años, en los que tenían dolor importante y en los que presentaban protrusión. En conjunto obtienen resultado muy bueno el 52,5 por 100 y bueno o aceptable el 30 por 100. El aflojamiento aumenta con el paso del tiempo y es del 18 por 100 en la serie global, pero alcanza al 30 por 100 en los casos con seguimiento de cinco años o más y las profusiones. El resultado funcional depende de las varias intervenciones practicadas en las extremidades y con el programa quirúrgico complejo conseguimos que algo más de la mitad de los enfermos recuperen una autonomía para la vida diaria fuera de su casa

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Fiscalitat empresarial, setembre 2015

Material docent de la Universitat Oberta de CatalunyaMaterial docente de la "Universitat Oberta de Catalunya"Learning material of the "Universitat Oberta de Catalunya

Fiscalitat empresarial, setembre 2015

Material docent de la Universitat Oberta de CatalunyaMaterial docente de la "Universitat Oberta de Catalunya"Learning material of the "Universitat Oberta de Catalunya

Tratamiento de las coxitis reumáticas con prótesis total cementada

Se estudia una serie de 82 prótesis totales de cadera cementadas tipo Muller implantadas en enfermos afectos de coxitis reumáticas, fundamentalmente artritis reumatoide. Los casos tienen un seguimiento medio de cuatro años y una edad media de cincuenta y un años; la mitad de ellos tenían afectados entre siete y 10 articulaciones y en la cadera el 28 por 100 presentaban protrusión acetabular. En el postoperatorio consta un 2,5 por 100 de complicación séptica y 2,5 por 100 de tromboembolismos. El análisis clínico de los resultados se basa en el dolor, la movilidad y la marcha según el baremo de Merle d'Aubigne y en la capacidad funcional segiin los criterios de STEINBROCKER. En grupo aparte se ha estudiado el resultado en los casos con un seguimiento mínimo de cinco años, en los que tenían dolor importante y en los que presentaban protrusión. En conjunto obtienen resultado muy bueno el 52,5 por 100 y bueno o aceptable el 30 por 100. El aflojamiento aumenta con el paso del tiempo y es del 18 por 100 en la serie global, pero alcanza al 30 por 100 en los casos con seguimiento de cinco años o más y las profusiones. El resultado funcional depende de las varias intervenciones practicadas en las extremidades y con el programa quirúrgico complejo conseguimos que algo más de la mitad de los enfermos recuperen una autonomía para la vida diaria fuera de su casa

Computed digital absorptiometry of the hand: screening method of bone loss in postmenopausal women with RA.

Dual energy x ray absorptiometry (DXA) is the most commonly used method of measuring bone mineral density (BMD); it has been shown to be a good predictor of the future risk of fracture.1Unfortunately, the generalised use of DXA is limited as it is expensive and time consuming, is not portable, and is available only in specialised clinics.#N##N#Computed digital absorptiometry (CDA) of the hand is a new bone densitometry technique, designed to assess the BMD of the middle phalanx of the third finger using a direct, automated measurement of x ray attenuation.2This technique is similar to radiographic absorptiometry but provides immediate results; in current radiographic absorptiometry, radiographs are sent to an off site processing centre and the results are received a few days later. CDA is cheap and quick. Its precision and accuracy seem to be acceptable, but its ability to discriminate between patients with osteoporosis and normal subjects, to predict risk of