Radioterapia combinada con quimioterapia en el tratamiento del cáncer de pulmón

El empleo conjunto de radioterapia y quimioterapia en el cáncer de pulmón no metastásico (microcítico y no microcítico) permite combi- nar los benefi cios de la radioterapia en términos de control local con aquellos conseguidos por la quimioterapia erradicando la enfermedad micrometastásica. Diversos estudios aleatorizados han demostrado que la radioterapia radical combinada con quimioterapia mejora la supervi- vencia de estos pacientes, a expensas de un incremento de la toxicidad. El desarrollo tecnológico y los avances en programas informáticos han posibilitado la introducción de nuevos aceleradores lineales comunicados con sofi sticados sistemas de planifi cación tridimensional que permiten administrar dosis mayores de irradiación al volumen tumoral diana y menores dosis de irradiación sobre estructuras sanas (pulmón, corazón, esófago y médula espinal). El resultado fi nal es un incremento del índice terapéutico debido a un probable benefi cio en el control local y una disminución de los efectos adversos de la irradiación. El volumen de irradiación, la dosis total a administrar, el fraccionamiento de la dosis, el tipo de esquema de combinación de la radioterapia con la quimiotera- pia, así como la infl uencia en la supervivencia de la irradiación cerebral profi láctica en el caso del cáncer microcítico de pulmón son temas de discusión en la actualidad. INGLÉS: The combination of radiotherapy and chemotherapy in lung cancer (locally advanced non-small and small cell) may offer the benefits of radiotherapy in terms of local control and those of chemotherapy in terms of reducing metastatic dissemination of the disease. Several randomized studies have showed that radical radiotherapy combined with chemotherapy improves the survival of these patients at the expense of an increase in toxicity. The technological development and the improvements in software have allowed the introduction of new linear accelerators and a three-dimensional planning system with the intention of delivering higher irradiation doses in the tumor target, and minimizing the dose in adjacent normal tissues (lung, heart, esophagus and spinal cord). The volume of irradiation, the total dose, the fractionation, the schedule for the combination of radiotherapy and chemotherapy, as well as the influence of the prophylactic cranial irradiation in small cell lung cancer are points for discussion at the moment

Surveillance of congenital anomalies in Spain during the last 24 years

Resultados de Vigilancia Epidemiológica de los defectos congénitos sobre los datos del ECEMCAs a part of the usual surveillance of congenital anomalies performed in the ECEMC (Spanish Collaborative Study of Congenital Anomalies) database, we have analysed the information gathered in the period 1980-2003, during which a total of 1,941,742 newborn infants were surveyed. The ECEMC registry covered 26.48% of total births occurred in Spain in 2002. We have studied the global prevalence of infants with congenital anomalies in 3 different periods: a) before the passing of the law permitting voluntary interruption of gestation -VIG- following prenatal detection of anomalies (1980-85); b) after such passing (1986-2002); and c) year 2003. The baseline frequency of congenital anomalies corresponds to the period 1980-1985. Comparisons with this baseline mainly indicate the impact of VIG on the birth prevalence for defects which are prenatally detectable. The global prevalence continues diminishing over the years, and the significant decrease can also be observed in 13 out of 17 Spanish Autonomic Regions. All these decreases are mostly attributable to the impact of VIG. When studying the time distribution of the frequency of some selected anomalies, as well as their geographical distribution, we have observed that VIG plays an important role. However, it is difficult to get information on VIGs. The problem is that if it is not registered on a routine basis and with complete data on exposures and other variables, it will be impossible to perform analytic studies on the causes of birth defects . A question that has recently raised is the increasing number of immigrants in Spain. We have analysed the distribution of the control group of the ECEMC by country from which the parents come from. On the other hand, we have also analysed the evolution along the time of the proportion of different ethnic groups in the control group. Finally, in spite of the decreasing frequency of congenital anomalies, it should be considered that such decrease is mainly due to the impact of VIG, so we underline the need of investigating in order to reach primary prevention of birth defects, and applying the known preventive measures, getting infants being born healthy.N

Indicadors de salut perinatal a Catalunya - 2022

Salut perinatal; Estadístiques; CatalunyaPerinatal care; Statistics; CataloniaSalud perinatal; Estadísticas; CataluñaLes dades que es presenten en aquest document provenen del monitoratge de salut perinatal que es realitza sistemàticament mitjançant el registre de nadons de la Subdirecció General de Vigilància i Resposta a Emergències de Salut Pública de l’Agència de Salut Pública de Catalunya. Aquest registre es nodreix, des del 1993, del Programa de detecció precoç neonatal de metabolopaties congènites.The data presented in this document comes from perinatal health monitoring that is systematically carried out by registering newborns of the Public Health Agency's Emergency Surveillance and Response Subdirectorate for Public Health. This record is nourished, since 1993, from the Early Childbirth Screening Program for Congenital MetabolopathiesLos datos que se presentan en este documento provienen de la monitorización de salud perinatal que se realiza sistemáticamente mediante el registro de bebés de la Subdirección General de Vigilancia y Respuesta a Emergencias de Salud Pública de la Agencia de Salud Pública de Cataluña. Este registro se nutre, desde 1993, del Programa de detección precoz neonatal de metabolopatías congénita

Integration of the clinical aspects into the epidemiological analysis of the newborn infants with congenital defects registered through the ECEMC: 30 years getting ready for the future

Dismorfología, Citogenética y Clínica: Resultados de estudios sobre los datos del ECEMCAn epidemiological analysis of the main clinical aspects of the infants with congenital defects registered by the ECEMC (Spanish Collaborative Study of Congenital Malformations) between 1980 and 2005, has been performed. It is remarkable that the ECEMC programme is defined, as stated in its Operating Manual, as a clinical and epidemiological research program on congenital defects, based on an ongoing case-control, hospital-based registry of newborn infants in Spain. The analyzed material corresponds to 2,152,479 total newborns surveyed, of which 34,066 (1.58%) had congenital defects detected during the first 3 days of life. All these infants with congenital anomalies were analyzed by applying the classification system developed in the ECEMC [Martínez-Frías et al., 1991: Am J Med Genet 41:192-195; Martínez-Frías and Urioste, 1994: Am J Med Genet 49:36-44; Martínez-Frías et al., 2000: Am J Med Genet 90:246-249], based on the most modern concepts in Dysmorphology [Martínez-Frías et al., 1998: Am J Med Genet 76:291-296]. Infants registered were distributed according to their clinical presentation as isolated, multiply malformed, and syndromes, and other subgroups into these 3 groups. The time distribution of the 3 main groups of clinical presentation was studied and all of them have decreased along the years, probably as a consequence of the impact of interruption of pregnancy of some affected fetuses. Apart from the study for all infants with congenital defects, the clinical presentation of a group of 17 defects (selected according to: their relatively high frequency at birth, or the high morbidity/mortality that they bear, and their monitoring in other countries) was also analysed. There was a considerable clinical heterogeneity in most of them, although some (gastroschisis, hypospadias, or anencephaly) tend to present as isolated anomalies, and other (anophthalmia/microphthalmia, abdominal wall defects and bilateral renal agenesis) appear more frequently associated to other defects. The etiologic distribution of infants with congenital anomalies in the ECEMC resulted similar to that shown by other authors, and the lists of syndromes, classified by their etiology, is also provided, detailing their gene map locations if known (OMIM database accessed in June 2006), and their minimum birth prevalence in Spain (according the ECEMC database). To conclude, a commentary is made on the possibility of including not only clinical and genetic information, but also molecular data in the registries coding systems, in order to integrate all the available biological knowledge in the epidemiological approach to identify the causes of congenital defects, to be prevented.N

Surveillance of congenital anomalies in Spain in the last 23 years (period 1980-2002)

Resultados de Vigilancia Epidemiológica de los defectos congénitos sobre los datos del ECEMCWe have analysed data from the ECEMC database, gathered in the period 1980-2002, during which a total of 1,838,654 newborn infants were surveyed. The ECEMC programme covered 25.6% of total births occurred in Spain in 2001. We have calculated the global frequency of infants with congenital anomalies in different periods of time (before or after the passing of the law permitting voluntary interruption of gestation -VIG- following prenatal detection of anomalies). This allows to figure out the baseline frequency of congenital anomalies (corresponding to the period 1980-1985), and to assess the impact of VIG on the birth prevalence by comparing the baseline frequency of congenital anomalies with the frequency registered after 1985. The global frequency is decreasing over the years, and in 11 out of 17 Spanish Autonomic Regions we have also observed significant decreases of the frequency along the time. All those decreases are attributable to VIG. We have also studied the time distribution of the frequency of some selected anomalies, as well as their geographical distribution, and both are highly influenced by VIG. Nevertheless, the information on VIG is rather scarce. We consider that if it is not registered on a routine basis, it will be impossible to perform analytic studies on the causes of birth defects and to evaluate any preventive measure. Another question that will have to be approached in years to come is the distribution of birth defects depending on the country the parents come from, as immigration from other countries is increasing in Spain. Finally, we consider that even though the birth prevalence of these pathologies is decreasing as a consequence of the prenatal diagnosis and the possibility of voluntarily interrupting the gestation, it is necessary to search for primary prevention measures in order to get infants being born healthy.N

Anomalías Congénitas en España: Vigilancia epidemiológica en el último cuarto de siglo (1980-2004)

Resultados de Vigilancia Epidemiológica de los defectos congénitos sobre los datos del ECEMCThe main results of the annual surveillance of congenital anomalies performed in the ECEMC (Spanish Collaborative Study of Congenital Anomalies) are presented here. The analysed data correspond to the last 25 years (1980-2004). A total of 2,045,751 newborn infants were surveyed, for an overall coverage of 23.39% of births in Spain. Among those infants, 32,883 were registered because of the presence of congenital defects detected during the first three days of life, for a prevalence of 1.61%. A statistically significant decrease of the global prevalence has been observed after the passing of the law permitting terminations of pregnancy (TOP) following prenatal detection of malformations. According to the ECEMC's data, that decrease can be attributable to the impact of TOP on the neonatal frequency, as there is an increasing number of defects that can be prenatally detected. The global decrease is also observed in most of the 17 Spanish Autonomic Regions, and is statistically significant in 11 of them. After studying the secular trend for some selected anomalies, either globally or by Autonomic Regions, the decrease is the rule. However, given the difficulties to routinely gather data on TOP, the epidemiological and etiological analyses including them are still almost unfeasible. Another circumstance that has to be taken into consideration in any investigation on congenital defects in our country, is the increasing number of immigrant people having infants in Spain, as it has been observed in the ECEMC's data. Finally, the versatility of the ECEMC registry to adapt itself to changes in the surveyed population and in knowledge, is highlighted, as well as the accomplishment, in the ECEMC, of the objectives summarized by the NBDPN (National Birth Defects Prevention Network), from the USA, in their guidelines for conducting birth defects surveillance, edited in 2004.N

Clinical aspects and etiologic distribution of the newborn infants with congenital defects registered in the ECEMC

Dismorfología, Citogenética y Clínica: Resultados de estudios sobre los datos del ECEMCAn epidemiological analysis of the main clinical aspects of the infants with congenital defects registered by the ECEMC (Spanish Collaborative Study of Congenital Malformations) between 1980 and 2006, has been performed. Among a total of 2,254,439 newborn surveyed, 35,246 (1.56%), had congenital defects detected during the first 3 days of life. This group of malformed infants was distributed according to their clinical presentation as isolated (74.01%), multiply malformed (13.43%), and syndromes (12.56%). The etiologic distribution of infants with congenital anomalies in the ECEMC showed a 20.42% of genetic cause, 21.03% multifactorial, 1.22% produced by environmental cause, and in the remaining 57.33% the etiology of the defects was unknown. The secular distribution of the 3 main groups of clinical presentation (isolated, multiply malformed and syndromes) was studied and all of them showed a decreasing trend along the years, probably as a consequence of the impact of the interruption of pregnancy of some affected fetuses. The different types of syndromes and their minimal frequency values were also presented separated by type of cause.N

Clinical and genetic aspects of the hamartoneoplastic syndromes that can be diagnosed during the three first days of life.

Dismorfología, Citogenética y Clínica: Resultados de estudios sobre los datos del ECEMCThe hamartoneoplastic syndromes are an heterogeneous group of diseases characterized by their risk to develop malignant tumors among other clinical features that vary from one syndrome to another. Most of these pathologies also share endocrinological abnormalities and sometimes, genetic characteristics, including the autosomal dominant mode of inheritance. Therefore, pediatricians must be aware of their main characteristics in order to prevent as soon as possible further complications and to provide the appropiate genetic counseling to the affected patients and their families. In this chapter, we have classified these pathologies in seven different groups according to the more frequently affected tissue by the development of hamartomas. For each of these groups we reviewed the hamartoneoplastic syndromes that have some manifestations at birth. Finally, some practical guidelines are provided for their clinical, genetic diagnosis, and management.N

Analysis of the main clinical-epidemiological aspects of newborn infants with congenital defects registered through the ECEMC.

Dismorfología, Citogenética y Clínica: Resultados de estudios sobre los datos del ECEMCSome clinical aspects of the total set of infants registered by the Spanish Collaborative Study of Congenital Malformations (ECEMC) during the period 1980-2004, have been analyzed through an epidemiological approach. The ECEMC is defined as a clinical-epidemiological research program on congenital defects, and is built on an ongoing case-control, hospital-based registry of newborn infants in Spain. The ECEMC database for the study period is constituted by a total of 32,883 infants with congenital anomalies detected during the first 3 days of life, that represent 1.61% of the total births surveyed (2,045,751). In order to study the clinical presentation of infants with birth defects, the classification system developed in the ECEMC [Martínez-Frías et al., 2002: Rev Dismor Epidemiol V(1):2-8], which is based in the most modern concepts in Dysmorphology, has been applied. The infants were distributed in the 3 main groups of isolated, multiply malformed, and syndromes, as well as some other subgroups. The analysis of the time distribution of the prevalence of the 3 main groups of clinical presentation confirmed a significant decrease for all of them, that may be considered, at least in great part, as a consequence of the impact of the interruption of some affected pregnancies after the prenatal detection of anomalies. After studying the distribution by clinical presentation of 17 defects that were selected (based on their relative high frequency at birth, or the high morbidity/mortality that they bear, and their monitoring in other countries), a high clinical heterogeneity was evident, since most of them are presented as isolated, or associated to other birth defects. Some, such as gastroschisis, hypospadias, or anencephaly, tend to present isolated, while other, such as anophthalmia/microphthalmia, abdominal wall defects and bilateral renal agenesis, use to be associated to other developmental abnormalities. The etiologic distribution of infants with congenital anomalies has also been studied, and the different syndromes identified in the ECEMC has been detailed, indicating their respective gene map location if known (based on the OMIM database up to July 2005), as well as their minimum birth prevalence in the Spanish population (based on the ECEMC database). The study concludes highlighting the importance of accurate case definition and classification in clinically homogeneous groups in order to optimize, not only the power of epidemiological studies in investigating the causes of birth defects, but the molecular analysis of patients with accurate clinical diagnoses. Thus, probably molecular genetic studies implemented to birth defects epidemiology will also help to reach the final objective of infants being born healthy.N

Analysis of POSSUM score and postoperative morbidity in patients with rectal cancer undergoing surgery

The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and later modifications (P-POSSUM y CR-POSSUM) have been used to predict morbidity and mortality rates among patients with rectal cancer undergoing surgery. These calculations need some adjustment, however. The aim of this study was to assess the applicability of POSSUM to a group of patients with rectal cancer undergoing surgery, analysing surgical morbidity by means of several variables. METHODS: between January 1995 and December 2004, 273 consecutive patients underwent surgery for rectal cancer. Information was gathered about the patients, tumour and therapy. To assess the prediction capacity of POSSUM, subgroups for analysis were created according to variables related to operative morbidity and mortality. RESULTS: The global morbidity rate was 23.6% (31.2% predicted by POSSUM). The mortality rate was 0.7% (6.64, 1.95 and 2.08 predicted by POSSUM, P-POSSUM and CR-POSSUM respectively). POSSUM predictions may be more accurate for patients younger than 51 years, older than 70 years, with low anaesthetic risk (ASA I/II), DUKES stage C and D, surgery duration of less than 180 minutes and for those receiving neoadjuvant therapy. CONCLUSION: POSSUM is a good instrument to make results between different institutions and publication comparable. We found prediction errors for some variables related to morbidity. Modifications of surgical variables and specifications for neoadjuvant therapy as well as physiological variables including life style may improve future prediction of surgical risk. More research is needed to identify further potential risk factors for surgical complications