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Resumen Introduccion La desnutricion se asocia a un mayor riesgo de mortalidad y morbilidad, a estancias hospitalarias mas largas y a un deterioro general de la calidad de vida. Este estudio se propone evaluar en pacientes desnutridos hospitalizados el impacto del asesoramiento dietetico. Pacientes y metodos Estudio prospectivo, aleatorizado, abierto, en 106 pacientes hospitalizados con desnutricion (54 grupo control, 52 en el de «intervencion»). El grupo «intervencion» recibio asesoramiento dietetico y el grupo control el tratamiento habitual. Se determino el estado nutricional (indice de masa corporal, parametros analiticos, Malnutrition Universal Screening Tool), el grado de dependencia (indice de Barthel), la calidad de vida (SF-12), el grado de satisfaccion de los pacientes (CSQ-8), el numero y dias de reingresos hospitalarios y la mortalidad. Resultados Los pacientes sometidos a «intervencion» aumentaron de peso a los 6 meses, mientras que los controles perdieron peso (diferencia en el IMC de 2,14 kg/m2 [p Conclusiones El asesoramiento nutricional mejoro el estado nutricional, la calidad de vida y el grado de dependencia de los pacientes, ademas disminuyo el numero de reingresos hospitalarios.

Malnutrition is associated with an increased risk of mortality and morbidity, longer hospital stays and general loss of quality of life. The aim of this study is to assess the impact of dietary counseling for malnourished hospital patients.Prospective, randomized, open-label study of 106 hospital patients with malnutrition (54 in the control group and 52 in the intervention group). The intervention group received dietary counseling, and the control group underwent standard treatment. We determined the patients' nutritional state (body mass index, laboratory parameters, malnutrition universal screening tool), degree of dependence (Barthel index), quality of life (SF-12), degree of satisfaction (CSQ-8), the number and length of readmissions and mortality.The patients who underwent the "intervention" increased their weight at 6 months, while the controls lost weight (difference in body mass index, 2.14kg/m(2); p.001). The intervention group had better results when compared with the control group in the Malnutrition Universal Screening Tool scores (difference, -1.29; p.001), Barthel index (difference, 7.49; p=.025), SF-12 (difference, 13.72; p.001) and CSQ-8 (difference, 4.34, p.001) and required fewer readmissions (difference, -0.37; p=.04) and shorter stays for readmissions (difference, -6.75; p=.035). Mortality and laboratory parameters were similar for the 2 groups.Nutritional counseling improved the patients' nutritional state, quality of life and degree of dependence and decreased the number of hospital readmissions.

Cardiovascular risk factors are present in 85% of patients with stroke. However, up to 6%-15% of patients have a stroke secondary to unusual reasons such as systemic diseases, coagulation disorders, etc., and, in some cases, no reason can be identified even after performing an extensive study. This usually happens in young people. In this regard, the diagnostic screening must consider hereditary causes of stroke. CADASIL, an autosomal dominant brain white matter angiopathy, is emerging as a not uncommon cause of stroke with diverse clinical manifestations. Its clinical diagnosis is controversial because of the diverse role of the brain imaging study, the biopsy of the vessels of skin or other tissues and the DNA study.

Cardiovascular risk factors are present in 85% of patients with stroke. However, up to 6%-15% of patients have a stroke secondary to unusual reasons such as systemic diseases, coagulation disorders, etc., and, in some cases, no reason can be identified even after performing an extensive study. This usually happens in young people. In this regard, the diagnostic screening must consider hereditary causes of stroke. CADASIL, an autosomal dominant brain white matter angiopathy, is emerging as a not uncommon cause of stroke with diverse clinical manifestations. Its clinical diagnosis is controversial because of the diverse role of the brain imaging study, the biopsy of the vessels of skin or other tissues and the DNA study.

Treatment of acute ischemic stroke within three hours with intravenous tissue-type plasminogen activator (t-PA) has been recently approved by the European Drug Agency. We present the development of an internal organization system that has permitted thrombolytic treatment in our center without previous experience as well as the results of the first year.Development of the thrombolysis educational program for the staff informed, of the internal organization system, and combined care protocols among the participating services. Prospective registry of patients treated with t-PA within the period 1/2004-2/2006. We collected demographic data, stroke assessment scales score (NIHSS), time to treatment, seven day and three months mortality, symptomatic hemorrhagic transformation, systemic bleedings, functional independency at three months, early significant improvement and significant deterioration.Fifty-three patients were treated. Mean age: 65 +/- 13 years; 56% women. Mean NIHSS pre-treatment: 14 +/- 4.7. Mean time to hospital arrival: 62 +/- 40 minutes; door-to-treatment: 68 +/- 22 minutes, and mean time from stroke onset to treatment: 130 +/- 31 minutes. Symptomatic hemorrhagic transformation: 5.8%. Systemic bleeding: 3.8%. Seven day mortality: 5.6%; three months mortality: 15.1%. Early significant improvement: 51%. Significant neurological deterioration: 7.5%. Functional independency at three months: 51%.Treatment of acute ischemic stroke within three hours with intravenous t-PA is safe and is associated with a favourable outcome when it is applied by neurologists specifically trained in acute stroke management.

Cardiac function is studied with regular hemodynamic determinations and 2D-doppler echocardiography, in 22 patients with massive ascites. Patients were divided in two groups: 1. Hepatic cirrhosis (n = 12) and 2. Peritoneal carcinomatosis (n = 10). Patients with carcinomatosis showed lowered heart-beat volume, cardiac output, ventricular work and ejection fraction in comparison with cirrhotic patients. In cirrhotic patients the hemodynamic study was done before and after an evacuatory paracentesis, following which an improvement in cardiac function was shown, with significant increments in heart-beat volume, cardiac output, ventricular work, and ejection fraction. 42% of the cirrhotic patients showed an hyperdynamic circulatory status in the baseline study, but after paracentesis this hyperkinetic status was present in 100% of the patients. It is suggested that tension ascites influences negatively in cardiac function because it difficult the venous return. This depression in the ventricular function is more obvious in patients with carcinomas that in cirrhotic patients due to the fact that the former do not have a previous circulatory status.