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Objective: To know the specific health problems referred as ambulatory care sensitive conditions (ACSC) and to identify the primordial interventions of primary health care (PHC) in reducing hospitalisations due to ACSC., Design: Descriptive study of hospital discharges generated in Catalonia during 1998-1999, and a Delphi study to reach information about PHC primordial interventions., Measures: Diagnostic codes of ACSC selected as markers of PHC effectiveness were used. We analysed hospital discharge distribution by age groups and overall, and hospitalisation rates with its 95% confidence intervals. Descriptive analysis of consensus reached by experts using self-administrated questionnaires was done., Results: The 8.42% of total discharges were due to ACSC. The majority of these (86.9%) fell in 4 of the 13 diagnostic categories included in the ACSC list. A great variety of pathologies with different frequencies were identified. Primary prevention and early diagnoses and treatment were considered as primordial interventions. Chronic health problems needed multimodal interventions., Conclusions: Diagnostic codes included in each diagnostic category were congruent with the diseases identified. Interventions that could prevent hospitalisations due to ACSC are contemplated as role of PHC. Indicator validity to assess PHC effectiveness is maintained by both results.

Background: The presence of dyspeptic symptoms is a common finding in patients treated with non-steroidal anti-inflammatory drugs (NSAIDs). Some studies seem to support the involvement of Helicobacter pylori infection in the dyspeptic symptoms reported by these patients, and suggest that eradication may be useful., Objective: To determine the variables related to dyspepsia in rheumatology patients requiring NSAID treatment, assessing in particular the role of Helicobacter pylori infection., Methods: One hundred and eighty six consecutive patients with a rheumatological disorder requiring NSAID treatment (68 male, 118 female; mean (SD) age 55 (15) years) were included in a cross sectional study; dyspeptic symptoms were measured by a previously validated scale. Helicobacter pylori infection was determined by serology. Variables related to the severity of symptoms and the need for antisecretory drugs were determined by multivariate analysis., Results: No relation was found between Helicobacter pylori infection and dyspepsia or any of its surrogate markers (antisecretory drug use or NSAID intolerance). Female sex and treatment with antisecretory drugs were found to be independent predictors for the appearance and severity of dyspeptic symptoms. The only independent predictive variables of the requirement for antisecretory drugs were age, previous ulcer disease, taking NSAIDs with a medium or high anti-inflammatory potential, and the symptoms score., Conclusion: Helicobacter pylori infection does not seem to play any part in the gastric symptoms of patients treated long term with NSAIDs.

Background: Osteoporosis in the elderly is a common and severe disease, vitamin D deficiency being an important causative factor. Hypovitaminosis D is frequent in old people, particularly those living in nursing homes., Subjects and Method: We performed a cross-sectional study of 100 randomly recruited elderly institutionalized subjects. The prevalence of hypovitaminosis D and its possible repercussion on the phosphocalcium metabolism were assessed. The degree of sun exposure and the existence of co-morbidity were also recorded. Individuals with hypovitaminosis D were included in a longitudinal study (6 months' duration) aimed at assess the efficacy of treatment with calcium and two different therapeutic regimens with calcidiol (16,000 IU/week or 16,000 IU every 3 weeks)., Results: 87% of individuals had hypovitaminosis D; 21.8% of them had secondary hyperparathyroidism. The study population had a low degree of sun exposure and a high level of co-morbidity. The two doses of calcidiol led to a normalization of 25-OHD3 levels, increased calciuria and compensated secondary hyperparathyroidism, yet higher 25-OHD3 levels were achieved with the weekly therapeutic scheme., Conclusions: Hypovitaminosis D prevalence appears to be very high In the elderly institutionalized population. Calcium and calcidiol supplementation normalized 25-OHD3, improved calcium absorption and compensated secondary hyperparathyroidism. Calcium and vitamin D supplementation should be employed routinely in the elderly institutionalized population.

Objective: To analyze whether inflammatory disease activity plays a substantial role in the loss of bone mass observed in ankylosing spondylitis (AS) patients who have not yet developed ankylosis., Methods: A longitudinal cohort study of 34 patients with early AS (duration <10 years) without ankylosis was conducted. The mean followup was 19 months. Loss of bone mass in defined regions of the lumbar spine and femoral neck was analyzed by dual x-ray absorptiometry. Patients were grouped according to biologic parameters of disease activity (erythrocyte sedimentation rate or C-reactive protein level). Group 1 consisted of 14 patients with active disease; group 2 comprised 20 patients with inactive disease. Serum levels of interleukin-6 (IL-6) and of hormones (sex, thyroid, and calciotropic), vertebral mobility (Schober test), daily physical activity, and treatment administered were recorded every 6 months for all patients., Results: At the end of the followup period, patients with active AS showed a significant reduction in bone mass in the lumbar spine (mean 1.01 gm/cm2 at study entry versus 0.961 gm/cm2 at followup [P = 0.005]) and femoral neck (0.849 gm/cm2 versus 0.821 gm/cm2 [P = 0.015]), which represented losses of 5% and 3%, respectively. In contrast, no significant reduction in bone mass was observed in patients with inactive AS. As expected, serum IL-6 levels were significantly higher in patients with active AS than in those with inactive disease (mean +/- SD 8.3 +/- 9 pg/ml versus 2.8 +/- 5 pg/ml [P = 0.008]). No significant differences were observed between the 2 groups in any of the other variables analyzed., Conclusion: The observation that loss of bone mass in AS occurred only in patients with persistent active disease strongly suggests that inflammatory activity of the disease itself plays a major role in the pathophysiology of the early bone mineral disorders observed in these patients.

Renal involvement is unusual in giant cell (temporal) arteritis (GCA). Microscopic hematuria and minimal proteinuria responsive to steroid therapy have been described as the most frequent renal alterations. The nephrotic syndrome in GCA has been rarely reported. We describe 2 cases of GCA with nephrotic syndrome, one at the time of diagnosis, the other 2 years after treatment. Percutaneous renal biopsy in both cases disclosed secondary renal amyloidosis confirmed by permanganate sensitivity and immunohistochemical analysis. To our knowledge, cases of GCA and secondary amyloidosis have not been reported.

Central nervous system depression is the predominant response to acute trichloroethylene exposure. Cranial or peripheral nerves are also affected. The paper is a case report of a bilateral retrobulbar optic neuritis caused by occupational trichloroethylene poisoning. The urinary concentration of trichloroacetic acid one week after the onset of symptoms was positive. Visual fields and visual evoked potentials recovered eight months later. Other neurological diseases, such as multiple sclerosis were excluded.