La invenció de Baltasar Porcel

Abstract not availabl

Factores pronósticos de recurrencia y progresión vesical en el tumor de vía urinaria superior

Objetivos: Estudiar factores asociados al tumor de urotelio superior (TUS) como predictores de recurrencia y progresión vesical. Pacientes y métodos: Estudio retrospectivo sobre 79 pacientes con tumor de urotelio superior (TUS) tratados con nefroureterectomía. El seguimiento medio es de 5.8 años (70 meses). Se ha estudiado la asociación de factores en el TUS como estadio y grado tumoral, tamaño, historia previa de tumor vesical, localización, sexo, edad y asociación con carcinoma in situ (CIS), en relación con recurrencia y progresión vesical. Para ello se ha realizado análisis univariante y multivariante, utilizando el método de Kaplan-Meier (log-rank) y regresión múltiple de Cox, respectivamente. Resultados: Observamos una recurrencia vesical de 54% (43 casos) (I.C 95%: 43-65) y una progresión vesical del 11% (9 casos). El CIS asociado a TUS (p = 0,020) (OR 2.3; IC 95%: 1,1-4,7) y estadio del TUS (p = 0,018) (OR 2.5; IC 95%: 1,1- 5,3) son variables independientes significativas en relación con recurrencia vesical. El CIS asociado a TUS (p = 0,006; OR 19 ; IC 95%: 2,3-157,6), y el tamaño del TUS (p = 0,060) (OR 3,8; IC 95%: 0,9-15,5) son variables independientes significativas relacionadas con progresión vesical. Conclusiones: El CIS asociado a TUS es el factor pronóstico independiente más importante para predecir la evolución vesical después de TUS, ya que se relaciona con recurrencia, y es factor más importante para predecir progresión vesical. El estadio del TUS es factor pronóstico independiente de recurrencia vesical. El tamaño del TUS (≥ 4 cm) es factor pronóstico independiente de progresión vesical. Los pacientes con estos factores son los que deberían tener un seguimiento más estricto de la vejiga, y plantearnos la necesidad de realizar instilaciones endovesicales posteriores al tratamiento del TUS.Purpose:We evaluated the prognostic factors of subsequent bladder recurrence and bladder progression in patients with transitional cell carcinoma of the upper urinary tract. Material and methods: We studied a cohort of 79 patients with upper urinary tract tumor (UUTT) treated with nephroureterectomy. Mean follow-up was 5.8 years. Statistical analysis was performed using the Kaplan-Meier method and multivariate analysis was done with Cox proportional hazards model with stepwise forward selection. All p-values were 2-sided, with odds ratios and 95% confidence interval. Results: Bladder recurrence was found in 54% (43 cases), bladder progression was found in 11% (9 cases). Carcinoma in situ of UUTT (odds ratio 2.3) and tumor stage of UUTT (greater than pT1) (odds ratio 2.5) increased the risk of subsequent bladder recurrence. Carcinoma in situ of UUTT (odds ratio 19.3) and tumor size (greater than 3 cm) (odds ratio 3.8) increased the risk of subsequent bladder progression. Conclusions: Neither tumor grade nor localization of UUTT influenced tumor evolution. Tumor stage of UUTT (greater than pT1) was a risk factor of bladder recurrence. Tumor size of UUTT (greater than 3 cm) was a risk factor of bladder progression. Finally, carcinoma in situ of UUTT influenced bladder recurrence and bladder progression. This finding could help identify patients at greater risk for disease recurrence and progression who would benefit from close followup and early adjuvant therapy after nephroureterectomy for upper urinary transitional cell carcinoma

Factores predictores de días de hospitalización en pacientes con ictus

Introducción: La elevada morbilidad del ictus supone un gran coste tanto para los pacientes como para el sistema sanitario. Este estudio pretende determinar qué factores del paciente, de la enfermedad o del propio sistema sanitario se relacionan con un aumento en los días de hospitalización. Material y métodos: Estudio observacional longitudinal y prospectivo. Se analizaron todos los casos incidentes de primer ictus atendidos en un hospital comarcal durante un año (n=101). Las variables estudiadas se recogieron durante las 48 horas de ingreso de los pacientes en la unidad de Urgencias. Los factores estudiados fueron analizados mediante la comparación de las curvas de supervivencia (log-rank test) y análisis multivariante mediante regresión de Cox. Resultados: Se incluyeron 101 pacientes, permanecieron ingresados una mediana de 7 días (Media 10 días; rango 1-73), el 15,9% fueron hemorrágicos y el 84% isquémicos (29,5% infartos lacunares y el 54,5% infartos isquémicos cerebrales). Las variables que demostraron estar relacionados con los días de hospitalización fueron: edad, hipertensión, insuficiencia cardiaca, paresia o anestesia/hipoestesia facial y de las extremidades, alteración de la mirada conjugada y afectación visio-espacial. Las variables independientemente relacionadas con los días de hospitalización en el análisis multivariante fueron: infarto isquémico cerebral (HR=3,5; IC95%, 1,7-7,5), Ictus hemorrágico (HR=4,9; IC95%, 1,8-12,9), paresia de la extremidad superior (HR=4,5; IC95%, 2,3-8,8) y edad (HR=0,98; IC95%, 0,96-0,99) Conclusiones: La mayor permanencia en un hospital de agudos se relaciona principalmente con una menor edad, parálisis de la extremidad superior e ictus hemorrágico.Introduction: The high morbibity of stroke has a great economic impact in patients and healthcare. Since the main cost to healthcare is length of stay, the aim of this study was to analyse characteristics of patients, stroke and healthcare related to length of stay. Results: 101 patients were included, median length of stay was 7 days (Mean, 10 days, range 1-73), 15,9% were haemorragic strokes and 84% were ischemic strokes, (of those 25,7% were lacunar infarcts). 13% were patients with no tomographic sings of stroke. Variables associated to length of stay were: age, hypertension, heart failure, extremities and facial paresis or anesthesia/hipoesthesia, conjugate eye deviation and visual field loss. Variables independently associated to length of stay in the multivariate Cox regression model were: nonlacunar- ischemic stroke (HR=3,5; CI95%, 1,7-7,5), haemorragic stroke (HR=4,9; CI95%, 1,8-12,9) arm paresis (HR=4,5; CI95%, 2,3-8,8) and age (HR=0,98; CI95%, 0,96-0,99). Conclusions: Age, arm paresis and stroke subtype are strongly related to length of stay

Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury: a randomized controlled trial

Introduction: Experimental research has demonstrated that the level of neuroprotection conferred by the various barbiturates is not equal. Until now no controlled studies have been conducted to compare their effectiveness, even though the Brain Trauma Foundation Guidelines recommend that such studies be undertaken. The objectives of the present study were to assess the effectiveness of pentobarbital and thiopental in terms of controlling refractory intracranial hypertension in patients with severe traumatic brain injury, and to evaluate the adverse effects of treatment. Methods: This was a prospective, randomized, cohort study comparing two treatments: pentobarbital and thiopental. Patients who had suffered a severe traumatic brain injury (Glasgow Coma Scale score after resuscitation ≤ 8 points or neurological deterioration during the first week after trauma) and with refractory intracranial hypertension (intracranial pressure > 20 mmHg) first-tier measures, in accordance with the Brain Trauma Foundation Guidelines. Results: A total of 44 patients (22 in each group) were included over a 5-year period. There were no statistically significant differences in ' baseline characteristics, except for admission computed cranial tomography characteristics, using the Traumatic Coma Data Bank classification. Uncontrollable intracranial pressure occurred in 11 patients (50%) in the thiopental treatment group and in 18 patients (82%) in the pentobarbital group (P = 0.03). Under logistic regression analysis - undertaken in an effort to adjust for the cranial tomography characteristics, which were unfavourable for pentobarbital - thiopental was more effective than pentobarbital in terms of controlling intracranial pressure (odds ratio = 5.1, 95% confidence interval 1.2 to 21.9; P = 0.027). There were no significant differences between the two groups with respect to the incidence of arterial hypotension or infection. Conclusions: Thiopental appeared to be more effective than pentobarbital in controlling intracranial hypertension refractory to first-tier measures. These findings should be interpreted with caution because of the imbalance in cranial tomography characteristics and the different dosages employed in the two arms of the study. The incidence of adverse effects was similar in both groups

Interaction between cardiovascular risk factors and body mass index and 10-year incidence of cardiovascular disease, cancer death, and overall mortality

The effect of above-normal body mass index (BMI) on health outcomes is controversial because it is difficult to distinguish from the effect due to BMI-associated cardiovascular risk factors. The objective was to analyze the impact on 10-year incidence of cardiovascular disease, cancer deaths and overall mortality of the interaction between cardiovascular risk factors and BMI. We conducted a pooled analysis of individual data from 12 Spanish population cohorts with 10-year follow-up. Participants had no previous history of cardiovascular diseases and were 35-79years old at basal examination. Body mass index was measured at baseline being the outcome measures ten-year cardiovascular disease, cancer and overall mortality. Multivariable analyses were adjusted for potential confounders, considering the significant interactions with cardiovascular risk factors. We included 54,446 individuals (46.5% with overweight and 27.8% with obesity). After considering the significant interactions, the 10-year risk of cardiovascular disease was significantly increased in women with overweight and obesity [Hazard Ratio=2.34 (95% confidence interval: 1.19-4.61) and 5.65 (1.54-20.73), respectively]. Overweight and obesity significantly increased the risk of cancer death in women [3.98 (1.53-10.37) and 11.61 (1.93-69.72)]. Finally, obese men had an increased risk of cancer death and overall mortality [1.62 (1.03-2.54) and 1.34 (1.01-1.76), respectively]. In conclusion, overweight and obesity significantly increased the risk of cancer death and of fatal and non-fatal cardiovascular disease in women; whereas obese men had a significantly higher risk of death for all causes and for cancer. Cardiovascular risk factors may act as effect modifiers in these associations

Dietary α‐Linolenic Acid, Marine ω‐3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study

Background: Epidemiological evidence suggests a cardioprotective role of α‐linolenic acid (ALA), a plant‐derived ω‐3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine ω‐3 fatty acids (long‐chain n‐3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary ALA (0.7% of total energy) at baseline was related to all‐cause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for long‐chain n‐3 polyunsaturated fatty acids (≥500 mg/day). Methods and Results: We longitudinally evaluated 7202 participants in the PREvención con DIeta MEDiterránea (PREDIMED) trial. Multivariable‐adjusted Cox regression models were fitted to estimate hazard ratios. ALA intake correlated to walnut consumption (r=0.94). During a 5.9‐y follow‐up, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting ALA recommendation (n=1615, 22.4%) were 0.72 (95% CI 0.56–0.92) for all‐cause mortality and 0.95 (95% CI 0.58–1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for long‐chain n‐3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95% CI 0.67–1.05) for all‐cause mortality, 0.61 (95% CI 0.39–0.96) for fatal cardiovascular disease, 0.54 (95% CI 0.29–0.99) for fatal coronary heart disease, and 0.49 (95% CI 0.22–1.01) for sudden cardiac death. The highest reduction in all‐cause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95% CI 0.45–0.87]). Conclusions: In participants without prior cardiovascular disease and high fish consumption, dietary ALA, supplied mainly by walnuts and olive oil, relates inversely to all‐cause mortality, whereas protection from cardiac mortality is limited to fish‐derived long‐chain n‐3 polyunsaturated fatty acids. Clinical Trial Registration URL: http://www.Controlled-trials.com/. Unique identifier: ISRCTN35739639

Innovative treatment for pes cavovarus: a pilot study of 13 children

Background and purpose — Pes cavovarus (PCV) is a complex deformity, frequently related to neurological conditions and associated with foot pain, callosities, and walking instability. The deformity has the tendency to increase during growth. Orthotic treatment is ineffective and surgery may be troublesome. We present the preliminary results of a new mini-invasive surgical technique for correction of this foot deformity. Patients and methods — We operated on 13 children (24 feet), age 7–13 years. In 7 children the deformity was neurological in origin. The surgical technique included a dorsal hemiepiphysiodesis of the 1st metatarsal, and a plantar fascia release. The clinical deformity, hindfoot flexibility, and foot callosities, together with a radiological assessment (Meary angle, calcaneal pitch, and talo-calcaneal angle), was done pre- and postoperatively. At final check-up, after a median of 28 months (12–40), the Oxford Ankle Foot Questionnaire for children (OXAFQ-C) was used to assess patient satisfaction. The primary outcome was the hindfoot varus correction. Results — All the operated feet improved clinically and radiologically. Heel varus improved from a mean 6° preoperatively to 5° valgus postoperatively. In those children where treatment was initiated at a younger age, full correction was achieved. Footwear always improved. Interpretation — This treatment may offer a less aggressive alternative in the treatment of PCV in young children and may eventually reduce the amount of surgery needed in the future