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UNLABELLED: The Internal Medicine service of the Hospital General de Vic (Barcelona) takes part in the mortality committee by revising and discussing in-hospital mortality. BACKGROUND: to establish the characteristics of the deceased, death causes and to revise possible changes in the last six-years time or problems related to the exitus, to evaluate and improve hospitalized patients assistance. METHODOLOGY: Every case was revised following a specific register: demographical data, diagnosis and death cause, hospital death, documentation data, terminal or agonic situation when hospitalized, autopsies and death quality data. Exitus due to hospital problems were analyzed and classified in different groups. The statistical analysis was performed with measures of central tendency and of standard deviation. RESULTS: During the revised six years, there were 819 exitus (5.1%). Global average death age was 79 +/- 1.8 years: 52.5% were men and 47.4% were women; 22.8% died in less than forty-eight hours after hospitalization. The most frequent death causes were cerebrovascular accident (24%), chronic obstructive pulmonary disease (14.4%) and pneumonia (9.6%). There were a small number of autopsies (4.8%). Ratio of exitus due to hospital problems was stable during the six years (0.5%), in which nosocomial infection was the severest problem. CONCLUSIONS: The total percentage of exitus was 5.1%, higher than the common standards. Mortality causes coincide with other series. Ratio of exitus due to hospital problems was according to recommended objectives. The number of autopsies was very small. A correct completing and revision of the clinical recording is indispensable to spot a shortage in the hospitalized patients assistance.

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El Servicio de Medicina Interna del Hospital General de Vic (Barcelona) forma parte del comité de mortalidad revisando y discutiendo los fallecimientos hospitalarios. Fundamento y objetivo: Establecer las características de los fallecidos, causas de muerte y revisar si existen cambios en los últimos 6 años o problemas en relación con el éxitus, para evaluar y mejorar la asistencia de los pacientes ingresados. Sujetos y métodos: Se realizó revisión de cada caso a través de un registro específico con: datos demográficos, diagnóstico y causa de muerte, problemas hospitalarios, datos de documentación, situación terminal/agónica al ingreso, si se realizó autopsia y datos de calidad de muerte. Se analizan los éxitus secundarios a problemas hospitalarios (ESPHS). Para el análisis estadístico se utilizaron las medidas de centralización y dispersión estándar. Resultados: En los 6 años revisados hubieron 819 éxitus (5,1 por ciento), la edad media global fue de 79 ± 1,8 años. el 52,5 por ciento eran varones y el 47,4 por ciento mujeres, el 22,8 por ciento fallecieron en menos de 48 horas de ingreso. las causas más frecuentes de muerte fueron: el accidente vascular cerebral (24 por ciento), la enfermedad pulmonar obstructiva crónica (14,4 por ciento), la pneumonia (9,6 por ciento).el número de autopsias fue muy reducido (4,8 por ciento) los esphs se mantuvieron estables durante los 6 años, con una tasa del 0,5 por ciento siendo la infección nosocomial el problema más importante. Conclusiones: El porcentaje total de éxitus fue del 5,1 por ciento, superior a los estandards aconsejados. Las causas de mortalidad coinciden con otras series. La tasa de ESPHs se ajustó a los objetivos recomendados. El número de autopsias fue muy reducido. La correcta cumplimentación y revisión de la historia clínica es imprescindible para detectar déficits en la asistencia de los pacientes ingresados (AU)

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BACKGROUND: The use of calcitonin is very common in patients diagnosed with osteoporosis. The objective of this study was to determine the percentage of adequate prescriptions of calcitonin for patients with osteoporosis and to estimate the costs due to inadequate prescription. PATIENTS AND METHODS: Observational study. Four pharmacies in Osona County (Barcelona) were randomly selected. During two time periods, July-September and November-December of 1994, all women filling prescriptions for calcitonin in any of the eight pharmacies were invited to participate in the study. Adequate and inadequate prescription of calcitonin was determined based on the patient's clinical record. Justifiable and non-justifiable prescriptions were then determined after implementing a protocol and reviewing X-rays of the spine. RESULTS: Forty-eight women agreed to participate (participation rate: 68%). In the first analysis, 58.3% (95% CI: 43-72) of prescriptions were determined to be inadequate whereas in the second analysis 29.2% (95% CI: 17-44) were considered non-justifiable. Chronic back pain was associated with non-justifiable prescription of calcitonin (odds ratio: 5.2; 95% CI: 1.3-33.4). In the best of situations, the excess in annual spending due to inadequate prescription was estimated at 13 million pesetas for Osona County, 1,300 million for Catalonia, and 4,300 million for Spain. CONCLUSIONS: Between one-third and one-half of patients prescribed calcitonin in the study area apparently do not need it. Many cases of chronic back pain are being treated as osteoporosis without being properly studied. The costs derived from this incorrect practice are important. This study highlights the need for better practices in the diagnosis of osteoporosis.

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OBJECTIVES: To analyse the association between chondrocalcinosis and osteoarthritis (OA) of the hands and knees in an unselected elderly rural population. METHODS: A community based cross sectional study was performed in individuals randomly selected from a previous epidemiological survey on the prevalence of chondrocalcinosis in people older than 60 years from Osona county, Catalonia, northeastern Spain. Radiological OA (grade 2 or more of Kellgren's classification) was evaluated in 26 individuals with chondrocalcinosis and in 104 controls. A total of 18 articular areas of both knees (medial and lateral tibiofemoral compartments) and hands (first, second and third metacarpophalangeal (MCP), first carpometacarpal, trapezium-scaphoid, radiocarpal and distal radioulnar joints) were studied. RESULTS: Radiological changes of OA in the knees were more common in subjects with chondrocalcinosis than in those without it, with an odds ratio adjusted for age and gender (aOR) of 4.3 (95% confidence interval (CI) 1.6 to 11.8, p = 0.005). OA was also more frequent in almost all areas of the hands in individuals with chondrocalcinosis, though the difference reached statistical significance only in the MCP joints (aOR 3.1; 95% CI 1.1 to 8.8; p = 0.033). However, taking into account the side and the different joint compartments analysed, the association between chondrocalcinosis and OA was significant only in the lateral tibiofemoral compartment and the left MCP joints. CONCLUSIONS: In an elderly population unselected for their rheumatic complaints, there was a real association between OA and chondrocalcinosis. This association was particularly relevant in the lateral tibiofemoral compartment of the knee and in the first three left MCP joints.

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In a case-controlled study, serum creatinine kinase (CK) activity was significantly lower in 40 patients with RA than in 40 age- and sex-matched patients with non-inflammatory arthropathies [mean 37.6 (S.D. 29.2) vs 77.7 (S.D. 45.3) IU/l respectively P < 0.0001]. In contrast, serum levels of aldolase and myosin were not significantly lower in RA patients. A significant inverse correlation between CK activity and ESR, CRP and platelet count was observed in RA. There was also a positive correlation between haemoglobin levels and CK values. No correlation was found between CK activity and a meager mass index, disease duration and radiological erosion. No inhibitor of CK activity in the sera of RA patients was found. CK serum activity was markedly reduced in RA, and is related to the inflammatory activity of the disease. This finding may stimulate further exploration on the effect of inflammatory response in muscle metabolism.

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Studies on tendon involvement in articular chondrocalcinosis (ACC) are scarce, with little data focusing on its prevalence and characteristics. We carried out a radiological survey on 75 patients with ACC in order to establish the frequency and radiological appearance of calcific deposits at the origin of the adductor tendons on the ischium. In 19 of these patients, radiological visible linear calcifications compatible with chondrocalcinosis were observed at this site. There is a high correlation between the existence of pelvic tendon calcifications and the extension and intensity of calcific deposits in other articular areas. Calcifications of the adductor tendons are not uncommon in ACC, the amount of calcium pyrophosphate deposits may be the most important factor leading to tendon involvement in this disorder.

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BACKGROUND: There are different diseases which are associated with articular chondrocalcinosis (ACC) although in some it is debated whether this is a real association or an accidental coexistence. The aim of the present study was to analyze the prevalence and type of associated diseases in a series of patients with ACC and to compare with other series in the literature, as well as determine the performance of a protocol directed to the search for such diseases in patients with ACC. METHOD: A total of 95 patients diagnosed of ACC and attended in the out patients department of Rheumatology in a general hospital over a 5 year period (1987-1991) were included in a protocol specially designed to search for diseases associated to ACC. RESULTS: Twelve (13%) of these patients had one of the diseases classically associated to ACC: gout in 8 cases, hypothyroidism in 2 cases and hyperparathyroidism, adult hemochromatosis and hypophosphatasia in one case each (in one patient two of these diseases coexisted). In most of the patients with secondary ACC the coexisting disease had already been diagnosed. Only two patients (one with hypothyroidism and the other with adult hypophosphatasia) were aided by the application of the protocol and were diagnosed having ACC as the only guiding sign. CONCLUSIONS: The number of diseases associated in patients with articular chondrocalcinosis is relatively low. In the absence of clinical suspicion the performance of different laboratory investigations for diagnosis of diseases related with articular chondrocalcinosis is of little benefit.

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OBJECTIVES: To undertake an epidemiological survey of the prevalence of radiological chondrocalcinosis in the elderly population of Osona, a rural area of Catalonia, north east Spain. METHODS: Knee and wrist radiographs were performed on 261 subjects (141 women, 120 men) aged at least 60 years, who attended a series of 35 general practitioners for various medical problems. RESULTS: Twenty seven subjects had articular chondrocalcinosis, which represents a crude prevalence of 10%. Articular chondrocalcinosis was more often observed in women than in men (14 v 6%). Articular chondrocalcinosis increases in occurrence with age, rising from 7% in subjects aged 60-69 years to 43% in subjects older than 80 years. A similar occurrence of articular chondrocalcinosis was noted in the indigenous population, in which several cases of familial chondrocalcinosis have previously been reported, and in subjects born in other areas of Spain. All but one subject with articular chondrocalcinosis had chondrocalcinosis of the knee. The occurrence of rheumatic disorders did not differ significantly between subjects with articular chondrocalcinosis and those without. CONCLUSIONS: Articular chondrocalcinosis is an age related disorder, which could partly explain the discrepancies in its prevalence reported in previous studies. In most subjects with articular chondrocalcinosis recruited from an unselected population the clinical manifestations are probably mild or even absent.

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The familial study of three patients from the Osona region (Barcelona) with early onset (fourth decade) of articular chondrocalcinosis (CCA) disclosed the occurrence of CCA in other members of the three families. The clinical and radiological features were heterogeneous, with polyarticular forms with marked clinical expression in one family, oligoarticular forms with few symptoms in another, and both types in the third family. These first reports of familial CCA in Catalonia can be added to those found in other parts of Spain, and they support the idea that familial cases of CCA are not exceptional if adequately investigated.

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The relationship between behavior problems and adolescent peer relations was examined in 30 black male adolescents divided into three equal-sized groups on the basis of individual psychosocial functioning (conduct-disordered, anxious-withdrawn, well-adjusted). Groups were matched on age, IQ, and father absence. An observational method was used to evaluate dominance, conflict, affect, and social competence manifested with a friend and with a well-adjusted stranger. Conduct-disordered and anxious-withdrawn adolescents displayed less social competence and less positive affect than well-adjusted adolescents when interacting with both friends and strangers. Anxious-withdrawn adolescents evidenced more personal apprehension than their well-adjusted counterparts. All groups showed greater leadership ability, talked more, and showed less personal apprehension with friends than with strangers. The findings support the role of peer relations in the maintenance and exacerbation of adolescent psychosocial difficulties.

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