Quality of life for up to 18 months after low-energy hip, vertebral, and distal forearm fractures-results from the ICUROS

This study used data from the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) to estimate the quality of life (QoL) impact of fracture. Hip, vertebral, and distal forearm fractures incur substantial QoL losses. Hip and vertebral fracture results in markedly impaired QoL for at least 18 months.

INTRODUCTION

The International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) is a multinational observational study that aims to describe costs and quality of life (QoL) consequences of osteoporotic fractures. To date, 11 countries have participated in the study: Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, the UK, and the USA. The objective of this paper is to describe the QoL impact of hip, vertebral, and distal forearm fracture.

METHODS

Data were collected at four time-points for five QoL point estimates: within 2 weeks after fracture (including pre-fracture recall) and at 4, 12, and 18 months after fracture. Quality of life was measured as health state utility values (HSUVs) derived from the EQ-5D-3L. Complete case analysis was conducted as the base case with available case and multiple imputation performed as sensitivity analyses. Multivariate analysis was performed to explore predictors of QoL impact of fracture.

RESULTS

Among 5456 patients enrolled using convenience sampling, 3021 patients were eligible for the base case analysis (1415 hip, 1047 distal forearm, and 559 vertebral fractures). The mean (SD) difference between HSUV before and after fracture for hip, vertebral, and distal forearm fracture was estimated at 0.89 (0.40), 0.67 (0.45), and 0.48 (0.34), respectively (p < 0.001 for all fracture types). Eighteen months after fracture, mean HSUVs were lower than before the fracture in patients with hip fracture (0.66 vs. 0.77 p < 0.001) and vertebral fracture (0.70 vs. 0.83 p < 0.001). Hospitalization and higher recalled pre-fracture QoL were associated with increased QoL impact for all fracture types.

CONCLUSIONS

Hip, vertebral, and distal forearm fractures incur substantial loss in QoL and for patients with hip or vertebral fracture, QoL is markedly impaired for at least 18 months.

The International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS)--quality of life during the first 4 months after fracture

The quality of life during the first 4 months after fracture was estimated in 2,808 fractured patients from 11 countries. Analysis showed that there were significant differences in the quality of life (QoL) loss between countries. Other factors such as QoL prior fracture and hospitalisation also had a significant impact on the QoL loss.

INTRODUCTION

The International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS) was initiated in 2007 with the objective of estimating costs and quality of life related to fractures in several countries worldwide. The ICUROS is ongoing and enrols patients in 11 countries (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, UK and the USA). The objective of this paper is to outline the study design of ICUROS and present results regarding the QoL (measured using the EQ-5D) during the first 4 months after fracture based on the patients that have been thus far enrolled ICUROS.

METHODS

ICUROS uses a prospective study design where data (costs and quality of life) are collected in four phases over 18 months after fracture. All countries use the same core case report forms. Quality of life was collected using the EQ-5D instrument and a time trade-off questionnaire.

RESULTS

The total sample for the analysis was 2,808 patients (1,273 hip, 987 distal forearm and 548 vertebral fracture). For all fracture types and countries, the QoL was reduced significantly after fracture compared to pre-fracture QoL. A regression analysis showed that there were significant differences in the QoL loss between countries. Also, a higher level of QoL prior to the fracture significantly increased the QoL loss and patients who were hospitalised for their fracture also had a significantly higher loss compared to those who were not.

CONCLUSIONS

The findings in this study indicate that there appear to be important variations in the QoL decrements related to fracture between countries.

[Benign familial hyperphosphatasemia. A report of one case and diagnostic considerations]

Benign familial hyperphosphatasemia is a rare biochemical abnormality characterized by the presence of persistently elevated levels of serum alkaline phosphatase in several members of the same familiy, in the absence of disease or any known cause of hyperphosphatasemia. We describe one family affected with this biochemical abnormality and the epidemiology, genetic, isoenzymatic patterns and clinical significance of this entity are discussed.A 61-year-old man was referred to the Unit of Metabolic Bone Diseases for investigation of a lumbar pain with a history of urolithiasis and inguinofemoral hernia repair. The results of the physical examination and laboratory analysis were normal except for a high serum alkaline phosphatase level of 690 UI/l (reference range 40-129 UI/l). Isoenzymatic profile showed a 50% of intestinal variant, 33% of bone variant and 17% of liver variant isoenzymes. Skeletal radiographs and lumbar magnetic resonance imaging showed signs of osteoarthritis in the spine, bone scan showed a skeletal distribution of the radioisotope.One year later the biochemical exams showed similar raised levels of alkaline phosphatase. Family investigation revealed that one of the three sons of the patient had the same biochemical disorder.

Postmenopausal women with Colles' fracture have bone mineral density values similar to those of controls when measured with calcaneus quantitative ultrasound

BACKGROUND

It is a matter of controversy whether or not Colles' fracture is an osteoporotic fracture. Indeed, the usefulness of quantitative ultrasound in distinguishing Colles' fracture from normal fractures is also unclear.

METHODS

A cross-sectional case-control study was done on 469 postmenopausal Spanish women, 121 with Colles' fracture and 348 controls. Assessment of risk factors for osteoporosis and measurement of calcaneus quantitative ultrasound were carried out using a Sahara, Hologic device.

RESULTS

Patients with Colles' fracture had BUA, SOS, and QUI values that were similar to those of controls, and no statistically significant differences were found. We estimated ROC curves for SOS and a score based on a linear combination of height and SOS (SH-Score). The areas under both curves were 0.56 and 0.61, respectively, which was statistically significant. To obtain 5% false-negative and 10% false-positive figures, the T-score cut-off for SOS was -2.45 and -0.045, respectively. Of these, only 9.2% were classified as high risk and 11% as low risk with 79.8% undetermined.

CONCLUSIONS

Patients with Colles' fracture had BUA, SOS, and QUI values that were similar to those of controls. Nevertheless, ROC curves calculated by a combination of height and SOS showed that quantitative calcaneus ultrasound may be a useful tool for identifying postmenopausal women with Colles' fracture. These results indicate that measuring bone mineral density with ultrasound only captures limited aspects of the pathophysiology of Colles' fractures.

¿Qué opinan los internistas españoles de la osteoporosis?

OBJECTIVE

To conduct an opinion survey on osteoporosis in Spanish internists.

METHOD

Survey sent by mail and by personal visit to members of the Spanish Internists Society. Collection of data on opinion on the disease, diagnostic and therapeutic attitude and means available (general laboratory analyses, conventional radiology, biochemical markers of bone remodeling, densitometry and ultrasounds) and preference when choosing a certain treatment.

RESULTS

A total of 538 internists answered. More than 90% of those surveyed consider that osteoporosis is a disease that should be treated by internists. A total of 93% consider that osteoporosis is a prevalent disease. More than 80% have access to densitometry.

CONCLUSIONS

The majority of Spanish internists consider that osteoporosis is a disease that should be treated by internists and that it is a disease that enters into their action scope. In general, they have the means necessary for its study and treatment. Bisphosphonates constitute the drug of choice and calcium and vitamin D supplements are indicated in almost all the cases.

Pravastatin therapy increases procollagen I N-terminal propeptide (PINP), a marker of bone formation in post-menopausal women

BACKGROUND

The aim of our study was to evaluate whether pravastatin treatment affected biochemical markers of bone turnover.

METHODS

Thirty-six hypercholesterolemic post-menopausal women, not on hormonal replacement therapy, were selected from a population study evaluating factors affecting cholesterol response to pravastatin. After a 6-week period on a 30% fat diet, participants received treatment with 20 mg/day of pravastatin during a 16-week follow-up period. Pre- and post-treatment samples were analyzed for procollagen I aminoterminal peptide (PINP) and bone alkaline phosphatase (bAP) as markers of bone formation, carboxyterminal telopeptide of collagen I (CTX) as a marker of bone resorption, and procollagen III aminoterminal propeptide (PIIINP) as a marker of fibrogenesis.

RESULTS

Total cholesterol decreased from 7.26+/-0.83 to 6.1+/-0.77 mmol/l with pravastatin treatment. PINP levels significantly increased (from 33.6+/-13 to 37.4+/-16, p=0.03) without changes in bAP or CTX. Individual changes in PINP correlated with individual reduction in cholesterol levels (r=0.337, p=0.04). There was no significant change in PIIINP concentration.

CONCLUSIONS

Pravastatin treatment increased PINP levels, a marker of bone formation, in hypercholesterolemic, post-menopausal women, without affecting bone resorption. PIIINP concentration, a marker of liver fibrogenesis, was not affected by the treatment.

[Prevalence of osteoporosis assessed by densitometry in the Spanish female population]

BACKGROUND

Osteoporotic fractures represent an important clinic and socioeconomic problem. Although it is well known the incidence of fractures in Spain, we do not know how many persons are at risk. The World Health Organization (WHO) has approved a densitometric criteria to define osteopenia (OSPE) and osteoporosis (OSP). The aim of this study has been to evaluate the prevalence of OSP and OSPE in women of the Spanish population.

SUBJECTS AND METHOD

With the data of a study of bone mass in the Spanish population, stratified according to age, using dual-energy X-ray absortiometry (DXA) with a QDR/1000 Hologic device and according the WHO criteria, we have calculated the prevalence of OSP and OSPE in normal Spanish women at the lumbar spine (LS) and/or femoral neck (FN).

RESULTS

The prevalence of osteoporosis at LS is: 0.34% in the group aged 20-44 years; 4.31% in the group aged 45-49 years; up to 9.09% in the group aged 50-59 years; 24.29% in the 60-69 years, and 40.0% in the group aged 70-79 years. The overall prevalence of osteoporosis is 11.13%, confidence interval (CI) 95% from 9.4 to 12.8%. The prevalence of osteoporosis at FN is: 0.17% in the group aged 20-44 years, 0% in the 45-49 years, up to 1.3% in the 50-59 years, 5.71% in the 60-69 years and 24.24% in the group aged 70-79 years. The overall prevalence of osteoporosis is 4,29% (CI 95% 3.2-5.4%). The prevalence in female older than 50 years was 22.8% at LS and 9.1% at FN. 12.73% of Spanish women population has osteoporosis at LS or FN, which represent about 1,974,400 women; 2.68% of total population has osteoporosis in both sites.

CONCLUSIONS

Even we do not include in this study women with established osteoporosis (with fractures), the number of Spanish women with osteoporosis is very high.

Femoral Bone Mineral Density, Neck-Shaft Angle and Mean Femoral Neck Width as Predictors of Hip Fracture in Men and Women

The effect of femoral bone mineral density (BMD) and several parameters of femoral neck geometry (hip axis length, neck-shaft angle and mean femoral neck width) on hip fracture risk in a Spanish population was assessed in a cross-sectional study. All parameters were determined by dual-energy X-ray absorptiometry. There were 411 patients (116 men, 295 women; aged 60-90 years) with hip fractures in whom measurements were taken in the contralateral hip. Controls were 545 persons (235 men, 310 women; aged 60-90 years) who participated in a previous study on BMD in a healthy Spanish population. Femoral neck BMD was significantly lower, and neck-shaft angle and mean femoral neck width significantly higher, in fracture cases than in controls. The logistic regression analysis adjusted by age, height and weight showed that a decrease of 1 standard deviation (SD) in femoral neck BMD was associated with an odds ratio of hip fracture of 4.52 [95% confidence interval (CI) 2.93 to 6.96] in men and 4.45 (95% CI 3.11 to 6.36) in women; an increase of 1 SD in neck-shaft angle of 2.45 (95% CI 1.73 to 3.45) in men and 3.48 (95% CI 2.61 to 4.65) in women; and an increase of 1 SD in mean femoral neck width of 2.15 (95% CI 1.55 to 2.98) in men and 2.40 (95% CI 1.79 to 3.22) in women. The use of a combination of femoral BMD and geometric parameters of the femoral neck except for hip axis length may improve hip fracture risk prediction allowing a better therapeutic strategy for hip fracture prevention.

Usefulness of serum pyridinoline cross-linked carboxy-terminal telopeptides of type I collagen and osteocalcin in the study of the bone resorption rate in oophorectomized rats

The aim of this work was to determine sensitivity and specificity of serum pyridinoline cross-linked carboxy-terminal telopeptides of type I collagen (ICTP), a new biochemical marker of bone resorption, in order to study the rate of bone resorption associated with osteopenia development after oophorectomy in rats. The diagnostic accuracy of the bone formation marker osteocalcin (BGP) was also evaluated. Twelve-week-old female Wistar rats were used: (1) control group: sham-operated, treated with a placebo (n = 25); (2) OOX: oophorectomized rats treated with a placebo (n = 12), and (3) OE: oophorectomized rats treated with 17alpha-ethinyl estradiol 0.1 mg/kg/day for 3 months. The rats were sacrificed after treatment, and lumbar bone mineral density, BGP, and ICTP (serum assays specific for rat) were determined. As expected, OOX animals developed osteopenia. OOX rats showed a significant decrease (p < 0. 05) in bone mineral density as compared with the control group, and OE rats showed no significant differences with respect to the control group. With respect to biochemical markers of bone remodeling, the OOX group showed a significant increase in BGP and ICTP (p < 0.005 and p < 0.05, respectively) with respect to control rats. However, the values of BGP and ICTP were similar in the OE group and in control animals. Areas under receiver operation characteristic curves corresponding to BGP and ICTP were 95 and 87%, respectively (p = 0.523). The results of the present work show that BGP and ICTP, the new resorption assay developed for rats, are reliable markers to be used in the study and follow-up of bone remodeling in OOX rats.

Speed of sound, bone mineral density and bone strength in oophorectomized rats

BACKGROUND

The aim of this study was to determine the sensitivity of bone mineral density (BMD), ultrasounds (SOS) and resistance to torsion (T) to detect experimental osteopenia induced in rats 3 and 6 months after ooforectomy.

MATERIALS AND METHODS

Seventy-four rats were used, divided into four groups, ooforectomized rats analysed 3 and 6 months after the operation and their respective control groups, in which BMD (Hologic QDR 1000 S/N 277), SOS (DBM Sonic 1200) and T (adapted test machine) were determined in the right femur.

RESULTS

The results of the three techniques distinguished the ooforectomized groups from the controls, both 3 and 6 months after the ooforectomy, obtaining more significant differences with BMD (P = 0.0006, P = 0. 001, respectively) than SOS and T, where a significance of only P = 0.05 was obtained. In the correlation study among the three techniques, a significant correlation was observed between BMD and SOS (r = 0.39, P = 0.0008), as well as between BMD and T (r = 0.31, P = 0.03). However, significance was not observed between the SOS and T tests.

CONCLUSION

In the study of sensitivity and specificity of the techniques used to detect the osteopenia caused by the ooforectomy, by means of calculation of the area under the receiver operation characteristic (ROC) curve, it was proven that although the three techniques distinguished between the two analysed populations, BMD presented an area under the ROC curve that was superior (0.87, 0.85) to that obtained with SOS (0.73, 0.67) and T (0.73, 0.68), both 3 and 6 months after the operation.

Femoral bone mineral density, neck-shaft angle and mean femoral neck width as predictors of hip fracture in men and women. Multicenter Project for Research in Osteoporosis

The effect of femoral bone mineral density (BMD) and several parameters of femoral neck geometry (hip axis length, neck-shaft angle and mean femoral neck width) on hip fracture risk in a Spanish population was assessed in a cross-sectional study. All parameters were determined by dual-energy X-ray absorptiometry. There were 411 patients (116 men, 295 women; aged 60-90 years) with hip fractures in whom measurements were taken in the contralateral hip. Controls were 545 persons (235 men, 310 women; aged 60-90 years) who participated in a previous study on BMD in a healthy Spanish population. Femoral neck BMD was significantly lower, and neck-shaft angle and mean femoral neck width significantly higher, in fracture cases than in controls. The logistic regression analysis adjusted by age, height and weight showed that a decrease of 1 standard deviation (SD) in femoral neck BMD was associated with an odds ratio of hip fracture of 4.52 [95% confidence interval (CI) 2.93 to 6.96] in men and 4.45 (95% CI 3.11 to 6.36) in women; an increase of 1 SD in neck-shaft angle of 2.45 (95% CI 1.73 to 3.45) in men and 3.48 (95% CI 2.61 to 4.65) in women; and an increase of 1 SD in mean femoral neck width of 2.15 (95% CI 1.55 to 2.98) in men and 2.40 (95% CI 1.79 to 3.22) in women. The use of a combination of femoral BMD and geometric parameters of the femoral neck except for hip axis length may improve hip fracture risk prediction allowing a better therapeutic strategy for hip fracture prevention.

Effects of LY-117018 HCl on bone remodeling and mineral density in the oophorectomized rat

OBJECTIVE

LY-117018 HCl is a recently developed, selective estrogen receptor modulator and an analog of raloxifene. Its mode of action on the skeleton is similar to that of estrogens, although it does not have the same side effects. The aim of the current study was to compare the effects produced by the administration of 17alpha-ethinyl estradiol (0.1 mg/kg/day) and LY-117018 HCl (1 mg/kg/day) on bone remodeling, bone mineral density, and body and uterus weight in sham-operated and oophorectomized rats (experimental model of postmenopausal osteoporosis).

STUDY DESIGN

Twelve-week-old female Wistar rats were used. Treatment was given for 3 months after oophorectomy or sham operation. Bone mineral density was determined in the lumbar spine (L2, L3, and L4) and in the left femur with use of a Hologic QDR 1000 (S/N 277) densitometer. Bone remodeling was estimated with use of the formation markers osteocalcin (bone gla protein) and alkaline phosphatase and the resorption markers type I collagen carboxyterminal telopeptide and tartrate-resistant acid phosphatase.

RESULTS AND CONCLUSIONS

The newly developed derivative of raloxifene, LY-117018 HCl, offsets the reduction in bone mineral density and the accompanying increase in bone remodeling markers observed in oophorectomized rats compared with control animals. 17Alpha-ethinyl estradiol also prevents the loss of bone mass attributed to oophorectomy, but this is accompanied by an increase in body mass and a greater increase in uterus weight than that observed after treatment with LY-117018 HCl.

Variable efficacy of bone remodeling biochemical markers in the management of patients with Paget's disease of bone treated with tiludronate

The aim of this work was to evaluate the response of different biochemical bone markers to tiludronate administration in Paget's disease of bone. Ten patients (five men and five women), 56-77 years old (67 +/- 6.5), were treated for 3 months with tiludronate tablets (400 mg/day). Bone formation markers: alkaline phosphatase (AP), bone alkaline phosphatase (bAP), osteocalcin (BGP), and procollagen I carboxyterminal propeptide (PICP) in serum; and bone resorption markers: serum cross-linked carboxyterminal telopeptides of type I collagen (ICTP), urinary hydroxyproline/creatinine (Hyp/Cr), pyridinoline/Cr (Pyr/Cr), and alpha-1 collagen chain products degradation (CrossLaps) were assessed. Samples were taken before and at monthly intervals for 3 months after treatment began. The results of the present work show that serum AP and bAP are sensitive and reliable biochemical markers of bone formation in the follow-up of tiludronate in this disease. Serum PICP shows less sensitivity than serum AP, and serum BGP is not indicated as biochemical marker in these types of studies. Urinary hydroxyproline seems to be the most reliable biochemical marker of bone resorption. More studies should be performed with urinary Pyr and CrossLaps determinations. Serum ICTP is not adequate for the follow-up of tiludronate treatment in Paget's disease of bone.

[Psoas abscess: report of 8 cases and review of the literature]

Eight cases of psoas abscesses (PA) are reported and a comparative study is made with other series as well as a review of the literature. Cases in our series are analysed and an assessment is made of microbiological etiologies, the presence of an origin and its spreading into the surrounding tissues or their primary character, and particularly the diagnostic and therapeutic usefulness of CT-guided percutaneous drainage. Diagnosis was ascertained by CT in all seven cases in which it was performed; percutaneous drainage was performed in five cases and allowed the microbiological categorization of the abscess and an appropriate antibiotic therapy. Laparotomy was performed in only one case; and in two other cases only antibiotics were administered. A favourable outcome occurred in seven out of the eight cases. One of the two patients treated with antibiotics only died. Blood cultures were positive in only three patients. In summary, PA in our series were secondary to bone, urologic or digestive origins in 87.5% of cases. With regard to the causative agent, 37.5% of cases were caused by S. aureus and 50% by gram negative and/or anaerobic organisms. The diagnostic yields of echocardiography and CT were 40% and 100%, respectively. Percutaneous drainage ascertained the microbiological diagnosis in 100% of cases when it was performed, as well as a therapeutic regimen associated with the use of antibiotics. No relapses were recorded in the follow-up of patients. Therefore, we believe that therapy of PA should be based on the association of percutaneous drainage and antibiotics.

[Spontaneous bacterial peritonitis in the cirrhotic patient]

Spontaneous bacterial peritonitis in cirrhotic patients is a severe complication which frequently decompensate the underlying disease and which is associated, even in our days, to a 50% mortality. Hence, the relevance of an adequate exploration, as weil as an early treatment. The acknowledge of several variants, as are the concepts of bacterascites and neutrocytic ascites with negative culture required the use of updated diagnostic criteria. In addition to the already known clinical and bacteriological characteristics of the ascitic fluid infection, we have also intended to review new aspects of this entity referred to in the literature published in the past years, as are the followings; study of possible predictive factors of this complication and factors which have an influence on its mortality, in order to be able to implement the most adequate preventive its mortality, in order to be able to implement the most adequate preventive its mortality, in order to be able to implement the most adequate preventive and curative therapeutics.

[Differences in the cellular response of the immune system in patients with Paget's disease of bone after elcatonin and etidronate administration]

A cellular immunological defect is present in patients with Paget's disease of the bone. Low counts of CD4, high counts of CD8, and a low CD4/CD8 ratio were observed in 58 patients compared with controls. These findings were not correlated with the metabolic activity of the disease. After therapy with Elcatonine an improvement in the cellular immunological defect was observed in 15 patients. Etidronate improved the biochemical bone patterns but no changes were observed in the number of lymphocytic subpopulations. These changes can be related to the improvement in the bone metabolic disorder or be the result of an effect on the altered immunity in this disease.

[Nephrolithiasis and bone involvement in primary hyperparathyroidism. The relative role of vitamin D]

In order to analyze the role of 1,25(OH)2 D3 in bone and renal presentation forms of primary hyperparathyroidism (PHP), 61 patients, whose diagnosis had been confirmed surgically, were studied. An increase in serum 1,25(OH)2 D3 levels was found in PHP when compared to normal controls (49.1 +/- 2.8 pg/ml vs 34.1 +/- 1.4 pg/ml) (p less than 0.5). This increase directly correlates with serum alkaline phosphatase and creatinine clearance and inversely correlates with age. When patients were divided into two groups: A (n = 35) and B (n = 26) according to normal or increased 1,25(OH)2 D3 respectively, no difference was found in the clinical presentation forms of PHP. However, higher values of the biochemical parameters and bone remodeling markers were found in group B than in group A. This suggests the role of 1,25(OH)2 D3 as a modulator of metabolic activity in PHP and its possible therapeutic character in the clinical control of asymptomatic forms.

[Cortical and trabecular bone lesions in insulin-dependent diabetes mellitus]

To determinate which type of bone is damaged in IDDM, we assessed the bone mineral content (BMC) in both cortical and trabecular bones, in a group of 48 IDDM patients without hepatic or kidney diseases, or any other pathology with implications in the mineral metabolism. For the evaluation techniques of single photon absorptiometry (SPA) and double photon absorptiometry (DPA) were used. All the patients controlled their disease with insulin. The results showed the presence of osteopenia in both types of bone. It was more evident in male group. In the patients group the mean value of serum osteocalcin (BGP) was significantly decreased (2.34 +/- 1.05) in comparison with the controls (p less than 0.001). The deficient of BMC is neither related with the parameters of new bone formation nor with the time of disease evolution.

[A microbiological and clinical study of 57 cases of spontaneous bacterial peritonitis in liver cirrhosis patients]

We studied fifty seven episodes of cirrhotic spontaneous bacterial peritonitis in order to know its microbiological, clinical and evolutive characteristics. One third of the patients had presented some previous peritonitis episodes. Ninety three percent of the patients referred some symptoms at time of diagnosis. Ascitic fluid Gram stain showed the presence of bacteria in 72% of the samples. Culture of ascitic fluid was positive for a single microorganism in 50 cases (88%). Seventy seven percent of microorganisms were Gram negative being Escherichia Coli in 63% of cases. Hemoculture was positive in 68% of cases with an almost complete correspondence with germs found in ascites. Seventy four percent of patients presented some complication throughout their hospital stay being the most frequent renal failure (49%) and encephalopathy (46%). Sixty three percent of patients died being the mortality rate higher amongst the older patients and amongst those who did not present neither high temperature or peritonism, or those who developed some complication.

[Endocarditis caused by Staphylococcus aureus in drug addicts and non-addicts: the same microbe in 2 diseases]

46 Staphylococcus aureus endocarditis episodes diagnosed with strict criteria in non drug addict patients, and 25 episodes in drug addict patients have been comparatively analyzed. Infection was found in the left side of the heart in 87% of the non addict patients and in 16% of the addicts. On the contrary, 84% of the addicts had endocarditis of the tricuspid and pulmonary valves while only 13% of the non addicts had right heart involvement. The right side endocarditis in the non addicts was always due to intracardiac catheters. 54% of the endocarditis episodes in the non addicts were fatal. Only two addicts, both when had left side endocarditis, died. Mortality was conditioned by infection of the left side of the heart as well as by the existence of heart failure. No significant differences were found between the evolution of patients treated with only one agent or of those treated with a beta-lactam antibiotic plus gentamicin. The emergency valve replacement significantly improved the prognosis of patients with prosthetic valve endocarditis.