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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 patientś 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 patientś assistance.

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.

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.

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.