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Perurena-Prieto J, Callejas-Moraga EL, Sanz-Martínez MT, Colobran R, Guillén-Del-Castillo A, Simeón-Aznar CP. Prognostic value of anti-IFI16 autoantibodies in pulmonary arterial hypertension and mortality in patients with systemic sclerosis. Med Clin (Barc) 2024; 162:370-377. [PMID: 38302398 DOI: 10.1016/j.medcli.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVES To determine the diagnostic value of anti-interferon gamma inducible protein 16 (IFI16) autoantibodies in systemic sclerosis (SSc) patients negative for all tested SSc-specific autoantibodies (SSc-seronegative patients) and to evaluate the clinical significance of these autoantibodies, whether isolated or in the presence of anti-centromere autoantibodies (ACA). METHODS Overall, 58 SSc-seronegative and 66 ACA-positive patients were included in the study. All patients were tested for anti-IFI16 autoantibodies by an in-house direct ELISA. Associations between clinical parameters and anti-IFI16 autoantibodies were analysed. RESULTS Overall, 17.2% of SSc-seronegative and 39.4% of ACA-positive patients were positive for anti-IFI16 autoantibodies. Anti-IFI16 autoantibodies were found only in patients within the limited cutaneous SSc (lcSSc) subset. A positive association between anti-IFI16 positivity and isolated pulmonary arterial hypertension (PAH) was found (odds ratio [OR]=5.07; p=0.014) even after adjusting for ACA status (OR=4.99; p=0.019). Anti-IFI16-positive patients were found to have poorer overall survival than negative patients (p=0.032). Cumulative survival rates at 10, 20 and 30 years were 96.9%, 92.5% and 68.7% for anti-IFI16-positive patients vs. 98.8%, 97.0% and 90.3% for anti-IFI16-negative-patients, respectively. Anti-IFI16-positive patients also had worse overall survival than anti-IFI16-negative patients after adjusting for ACA status in the multivariate Cox analysis (hazard ratio [HR]=3.21; p=0.043). CONCLUSION Anti-IFI16 autoantibodies were associated with isolated PAH and poorer overall survival. Anti-IFI16 autoantibodies could be used as a supplementary marker of lcSSc in SSc-seronegative patients and for identifying ACA-positive patients with worse clinical outcome.
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Affiliation(s)
- Janire Perurena-Prieto
- Immunology Division, Vall d'Hebron University Hospital (HUVH), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Translational Immunology Group, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Cell Biology, Physiology and Immunology, Autonomous University of Barcelona (UAB), Bellaterra, Spain
| | | | - María T Sanz-Martínez
- Immunology Division, Vall d'Hebron University Hospital (HUVH), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Roger Colobran
- Immunology Division, Vall d'Hebron University Hospital (HUVH), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Translational Immunology Group, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Department of Cell Biology, Physiology and Immunology, Autonomous University of Barcelona (UAB), Bellaterra, Spain; Department of Clinical and Molecular Genetics, Vall d'Hebron University Hospital (HUVH), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | - Alfredo Guillén-Del-Castillo
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Vall d'Hebron University Hospital (HUVH), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | - Carmen P Simeón-Aznar
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Vall d'Hebron University Hospital (HUVH), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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Mils K, Lladó L, López-Domínguez J, Barrios O, Leiva D, Santos C, Serrano T, Ramos E. Have we improved postoperative and long-term outcomes of liver surgery for colorectal cancer metastasis? Analysis of 1736 hepatectomies performed over 3 decades in a single center. Cir Esp 2024:S2173-5077(24)00044-9. [PMID: 38346559 DOI: 10.1016/j.cireng.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/27/2023] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Surgery is the only potentially curative treatment for colorectal cancer liver metastases (CRLM) and its indication and results have varied in the last 30 years. METHODS All patients operated on for CRLM in our centre from 1990 to 2021 were prospectively collected, establishing 3 subgroups based on the year of the first surgery: group A 1990-1999, group B 2000-2010, group C 2011-2021. Clinical characteristics and the results of survival, recurrence and prognostic factors were compared. RESULTS 1736 hepatectomies were included (Group A n = 208; Group B n = 770; Group C n = 758). Patients in group C had better survival at 5 and 10 years (A 40.5%/28.2%; B 45.9%/32.2%; C 51.6%/33.1%, p = 0.013), although there were no differences between groups in overall recurrence at 5 and 10 years (A 73%/75.7%; B 67.6%/69.2%, and C 63.9%/66%, p = 0.524), nor in liver recurrence (A 46.4%/48.2%; B 45.8%/48.2%; and C 44.4%/48.4%, p = 0.899). An improvement was observed in median survival after recurrence, being 19 months, 23 months, and 31 months (groups A, B and C respectively). Prognostic factors of long-term survival changed over the 3 study periods. The only ones that remained relevant in the last decade were the presence of >4 liver metastasis, extrahepatic disease at the time of hepatectomy, and intraoperative blood transfusion. CONCLUSIONS Survival after surgery for CRLM has improved significantly, although this cannot be explained by a reduction in overall and hepatic recurrence, but rather by an improvement in post-recurrence survival. Involvement of the resection margin has lost prognostic value in the last decade.
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Affiliation(s)
- Kristel Mils
- Unidad de Cirugía Hepato-Biliar y Trasplante Hepático, Servicio de Cirugía General y Digestiva, Hospital Universitario de Bellvitge, Cataluña, Spain.
| | - Laura Lladó
- Unidad de Cirugía Hepato-Biliar y Trasplante Hepático, Servicio de Cirugía General y Digestiva, Hospital Universitario de Bellvitge, Cataluña, Spain
| | - Josefina López-Domínguez
- Unidad de Cirugía Hepato-Biliar y Trasplante Hepático, Servicio de Cirugía General y Digestiva, Hospital Universitario de Bellvitge, Cataluña, Spain
| | - Oriana Barrios
- Unidad de Cirugía Hepato-Biliar y Trasplante Hepático, Servicio de Cirugía General y Digestiva, Hospital Universitario de Bellvitge, Cataluña, Spain
| | - David Leiva
- Servicio de Radiología, Hospital Universitario de Bellvitge, Cataluña, Spain
| | - Cristina Santos
- Servicio de Oncología, Hospital Universitario de Bellvitge, Cataluña, Spain
| | - Teresa Serrano
- Servicio de Anatomía Patológica, Hospital Universitario de Bellvitge, Cataluña, Spain
| | - Emilio Ramos
- Unidad de Cirugía Hepato-Biliar y Trasplante Hepático, Servicio de Cirugía General y Digestiva, Hospital Universitario de Bellvitge, Cataluña, Spain
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Moreno-Vílchez C, Servitje O, Íñiguez-Arroyo Ó, Muniesa C. Survival Analysis and Prognostic Factors in a Case Series of 148 Cutaneous T-Cell Lymphomas. Actas Dermosifiliogr 2023:S0001-7310(23)01008-6. [PMID: 38159841 DOI: 10.1016/j.ad.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Cutaneous T-cell lymphomas (CTCL) such as mycosis fungoides (MF) and Sézary syndrome (SS) are rare lymphomas with varying prognoses. The aim of the study was to describe the survival of a cohort of patients with MF/SS and evaluate the prognostic factors impacting disease survival. MATERIALS AND METHODS All cases of MF/SS diagnosed from 2008 through 2022 were retrospectively analyzed. The demographic variables, histological parameters, and analytical data were analyzed too. Progression-free survival (PFS) and disease-specific survival (DSS) were calculated. RESULTS A total of 148 cases were included. A total of 121 (82%) and 27 cases were diagnosed with MF, and SS, respectively. A total of 37 patients (25%) experienced progression at some point disease progression. The median PFS and median DSS were 127 and 135 months, respectively. Age >60 years, diagnosis of SS, the presence of large cell transformation (LCT) at diagnosis, folliculotropism in early stages, high Ki-67 expression, the presence of the clonal T-cell receptor (TCR) in blood, elevated LDH and B2M levels, and advanced stages (IIB, IVA, T3, T4, N3/Nx) were associated with worse prognosis across the entire cohort. CONCLUSIONS Stage IVA and the presence of LCT at diagnosis stood out as independent factors of unfavorable prognosis. LCT was the variable that most significantly impacted the patients' survival and was closely associated with tumor skin involvement and stage IIB.
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Affiliation(s)
- C Moreno-Vílchez
- Servicio de Dermatología, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, España
| | - O Servitje
- Servicio de Dermatología, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, España
| | - Ó Íñiguez-Arroyo
- Facultad de Medicina y Ciencias de la Salud, Campus Bellvitge, Universitat de Barcelona, Barcelona, España
| | - C Muniesa
- Servicio de Dermatología, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, España.
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Sabater-Martos M, Martínez-Pastor JC, Morales A, Ferrer M, Antequera A, Roqué M. Overview of systematic reviews of risk factors for prosthetic joint infection. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:426-445. [PMID: 37116750 DOI: 10.1016/j.recot.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Prosthetic joint infection is one of the most serious complications in orthopedics. Prognostic systematic reviews (SR) detecting and assessing factors related to prosthetic joint infection, allow better prediction of risk and implementation of preventive measures. Although prognostic SR are increasingly frequent, their methodological field presents some knowledge gaps. PURPOSE To carry out an overview of SR assessing risk factors for prosthetic joint infection, describing and synthesizing their evidence. Secondarily, to assess the risk of bias and methodological quality. MATERIAL AND METHODS We conducted a bibliographic search in 4databases (May 2021) to identify prognostic SR evaluating any risk factor for prosthetic joint infection. We evaluated risk of bias with the ROBIS tool, and methodological quality with a modified AMSTAR-2 tool. We computed the overlap degree study between included SR. RESULTS Twenty-three SR were included, studying 15 factors for prosthetic joint infection, of which, 13 had significant association. The most frequently studied risk factors were obesity, intra-articular corticosteroids, smoking and uncontrolled diabetes. Overlapping between SR was high for obesity and very high for intra-articular corticoid injection, smoking and uncontrolled diabetes. Risk of bias was considered low in 8SRs (34.7%). The modified AMSTAR-2 tool showed important methodological gaps. CONCLUSIONS Identification of procedural-modifiable factors, such as intra-articular corticoids use, can give patients better results. Overlapping between SR was very high, meaning that some SR are redundant. The evidence on risk factors for prosthetic joint infection is weak due to high risk of bias and limited methodological quality.
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Affiliation(s)
- M Sabater-Martos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, España.
| | - J C Martínez-Pastor
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, España
| | - A Morales
- Fisioterapia Vestibular, Rehabilitación del Vértigo y el Equilibrio, Fisioterapia del Aparato Locomotor, Barcelona, España
| | - M Ferrer
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, España
| | - A Antequera
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España
| | - M Roqué
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España
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Sabater-Martos M, Martínez-Pastor JC, Morales A, Ferrer M, Antequera A, Roqué M. [Translated article] Overview of systematic reviews of risk factors for prosthetic joint infection. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T426-T445. [PMID: 37364724 DOI: 10.1016/j.recot.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/23/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Prosthetic joint infection is one of the most serious complications in orthopedics. Prognostic systematic reviews (SRs) detecting and assessing factors related to prosthetic joint infection, allow better prediction of risk and implementation of preventive measures. Although prognostic SRs are increasingly frequent, their methodological field presents some knowledge gaps. PURPOSE To carry out an overview of SR assessing risk factors for prosthetic joint infection, describing and synthesizing their evidence. Secondarily, to assess the risk of bias and methodological quality. MATERIAL AND METHODS We conducted a bibliographic search in 4 databases (May 2021) to identify prognostic SR evaluating any risk factor for prosthetic joint infection. We evaluated risk of bias with the ROBIS tool, and methodological quality with a modified AMSTAR-2 tool. We computed the overlap degree study between included SR. RESULTS Twenty-three SRs were included, studying 15 factors for prosthetic joint infection, of which, 13 had significant association. The most frequently studied risk factors were obesity, intra-articular corticosteroids, smoking and uncontrolled diabetes. Overlapping between SR was high for obesity and very high for intra-articular corticoid injection, smoking and uncontrolled diabetes. Risk of bias was considered low in 8 SRs (34.7%). The modified AMSTAR-2 tool showed important methodological gaps. CONCLUSIONS Identification of procedural-modifiable factors, such as intra-articular corticoids use, can give patients better results. Overlapping between SR was very high, meaning that some SRs are redundant. The evidence on risk factors for prosthetic joint infection is weak due to high risk of bias and limited methodological quality.
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Affiliation(s)
- M Sabater-Martos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - J C Martínez-Pastor
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Morales
- Fisioterapia Vestibular, Rehabilitación del Vértigo y el Equilibrio, Fisioterapia del Aparato Locomotor, Barcelona, Spain
| | - M Ferrer
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Antequera
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - M Roqué
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
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Abou-Jokh Casas E, Martínez-Lago N, Mallón Araujo MC, Cabezas Agrícola JM, Nogareda Seoane Z, Cousillas Castiñeira A, Ruibal Morell A, Pubul Núñez V. Role of systemic inflammatory factors in gastroenteropancreatic neuroendocrine tumors (GEP-NETs) treated with peptide receptor radionuclide therapy (PRRT): From biology to theragnosis. Rev Esp Med Nucl Imagen Mol 2023; 42:156-162. [PMID: 37147033 DOI: 10.1016/j.remnie.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/16/2022] [Indexed: 05/07/2023]
Abstract
AIM Systemic inflammatory factors have been validated as indicators of ongoing systemic inflammation that could be predictive markers of poor prognosis for oncological outcomes. However, the prognostic impact of systemic inflammation markers is unknown in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) treated with peptide receptor radionuclide therapy (PRRT). METHODS We conducted an observational, retrospective, multicentric study of 40 patients with GEP or unknown origin NETs treated with PRRT between 2016 and 2020. The systemic inflammatory markers were calculated as follows: neutrophil to lymphocyte ratio (NLR)=neutrophil count/lymphocyte count, monocyte to lymphocyte ratio (MLR)=monocyte count/lymphocyte count, platelet to lymphocyte ratio (PLR)=platelet count/lymphocyte count, albumin to lymphocyte ratio (ALR)=albumin levels/lymphocyte count and derived Neutrophil to Lymphocyte ratio (dNLR)=neutrophil count/(leucocytes count - neutrophils count). Baseline analysis and after the second dose were used for the calculation of different ratios. RESULTS The median age was 63 years (range 41-85), 55% were male. The baseline cut-off values for NLR were 2.61, for MLR 0.31, for PLR 110.14, for ALR 2.39 and for dNLR 1.71. The cut-off values after the 2° dose were, for NLR 2.3, for MLR 0.3, for PLR 131.61, ALR 4.16, and dNLR 1.48. Median progression-free survival (PFS) was 21.7 months (95% CI 10.7-32.8 months) and overall survival (OS) was 32.1 months (95% CI 19.6-44.7 months), PFS was shorter in patients with elevated NLR (p=0.001), ALR (0.03), and dNLR (p=0.001) in baseline analysis. DCR was 81% and ORR 18%. CONCLUSIONS In GEP or unknown origin NETs treated with PRRT, we have identified the predictive and prognostic impact of baseline systemic inflammatory factors.
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Affiliation(s)
- E Abou-Jokh Casas
- Department of Nuclear Medicine, Santiago de Compostela University Hospital, Spain
| | - N Martínez-Lago
- Department of Oncology, Complexo Hospitalario Universitario A Coruña, Spain
| | - M C Mallón Araujo
- Department of Nuclear Medicine, Santiago de Compostela University Hospital, Spain.
| | | | - Z Nogareda Seoane
- Department of Nuclear Medicine, Lucus Augusti University Hospital, Spain
| | | | - A Ruibal Morell
- Professor Emeritus Ad Honorem USC, Santiago de Compostela University Hospital, Spain
| | - V Pubul Núñez
- Department of Nuclear Medicine, Santiago de Compostela University Hospital, Spain
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Plúa-Muñiz K, Bailón-Cuadrado M, Pérez-Saborido B, Pacheco-Sánchez D, Pinto P, Asensio-Díaz E. Survival analysis and identification of prognostic factors in colorectal liver metastasis after liver resection. Cir Esp 2023; 101:160-169. [PMID: 36108955 DOI: 10.1016/j.cireng.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/25/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Liver resection is the only curative treatment for colorectal liver metastasis. The identification of predictive factors leads to personalize patient management to enhance their long-term outcomes. This population-based study aimed to characterize factors associated with, and survival impact of patients who received hepatectomy for colorectal liver metastasis. METHODS A retrospective cohort study of all the hepatectomies for colorectal liver metastasis performed at third-level hospital of Spain (2010-2018) was conducted. The Kaplan-Meier method was used for survival analyses. Multivariable Cox and regression models were used to determine prognostic factors associated with overall survival. RESULTS The 5-year overall survival and disease-free survival were 42 and 33%, respectively. Survival analysis showed that metastasis features (number, largest size, distribution, and extrahepatic disease) and postsurgical factors (transfusion, major complications, and positive margin resection), as well as non-mutated KRAS, showed a significant association with survival. Otherwise, on multivariate analysis, only 5 independent risk factors were identified: major size metastasis >4 cm, RAS mutation, positive margin resection, intraoperative transfusion, and major complications. CONCLUSIONS According to our findings, major size metastasis >4 cm, intraoperative transfusion, and major postoperative complications continue to be traditional prognostic factors. Meanwhile, the KRAS biomarker has a powerful impact as a survival prognostic factor.
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Affiliation(s)
- Katherine Plúa-Muñiz
- Unidad de Cirugía Hepatobiliopancréatica, Hospital Universitario Río Hortega, Valladolid, Spain.
| | - Martín Bailón-Cuadrado
- Unidad de Cirugía Hepatobiliopancréatica, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Baltasar Pérez-Saborido
- Unidad de Cirugía Hepatobiliopancréatica, Hospital Universitario Río Hortega, Valladolid, Spain
| | - David Pacheco-Sánchez
- Unidad de Cirugía Hepatobiliopancréatica, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Pilar Pinto
- Unidad de Cirugía Hepatobiliopancréatica, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Enrique Asensio-Díaz
- Unidad de Cirugía Hepatobiliopancréatica, Hospital Universitario Río Hortega, Valladolid, Spain
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Lozano MD, Benito A, Labiano T, Pijuan L, Tejerina E, Torres H, Gómez-Román J. Recommendations for optimizing the use of cytology in the diagnosis and management of patients with lung cancer. Rev Esp Patol 2023; 56:58-68. [PMID: 36599601 DOI: 10.1016/j.patol.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/01/2022] [Indexed: 01/31/2023]
Abstract
Non-small cell lung cancer (NSCLC) is one of the oncological entities with the greatest evolution in molecular diagnosis due to the large number of diagnostic biomarkers and new treatments approved by international regulatory agencies. An accurate, early diagnosis using the least amount of tissue is the goal for the establishing and developing precision medicine for these patients. Rapid on-site evaluation (ROSE) provides cytological samples of optimal quantity and quality for a complete diagnosis of NSCLC. The usefulness of cytological samples has been demonstrated, not only for massive parallel sequencing but also for the quantification of the expression of programmed death-ligand 1 (PD-L1) and tumour mutational burden (TMB). Pre-analytical, analytical, and post-analytical recommendations are made for the management and appropriate use of cytological samples in order to obtain all the information necessary for the diagnosis and treatment of patients with NSCLC according to current quality parameters.
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Affiliation(s)
| | | | | | - Lara Pijuan
- Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Eva Tejerina
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Héctor Torres
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Javier Gómez-Román
- Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Spain
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Loizaga Iriarte A, Lacasa Viscasillas I, Rey Gonzalez S, Santos Martin A, Gonzalo Aparicio D, Ugalde Olano A, Carracedo Pérez A, Unda Urzaiz M. Identifying prognostic parameters related to surgical technique in patients treated by robotic radical prostatectomy. Actas Urol Esp 2023; 47:47-55. [PMID: 36328875 DOI: 10.1016/j.acuroe.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/06/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION AND OBJECTIVE The most frequently studied factors in patients treated by robotic radical prostatectomy are PSA and pathological features of the biopsy and prostatectomy specimen. Studies on the factors associated with the surgical technique are scarce and with controversial results. The objective is to identify all possible surgical factors and their relationship with disease-free and metastasis-free survival. PATIENTS AND METHOD Prospective study approved by the Ethics Committee, including patients who underwent robotic radical prostatectomy since January 2009 with a minimum follow-up of 5 years. Surgeon, surgical time, blood loss, fascial access, continence techniques, preservation of the fascia, neurovascular bundles, bladder neck, urethra, learning curve and surgical complications, were analyzed as possible prognostic factors. We performed univariate and matched comparisons of survival using Kaplan-Meier estimation and long-rank tests. The significance level for multiple comparisons was established with False Discovery Rate-adjustment (adjusted p). RESULTS Cohort of 667 patients with a median follow-up of 69 months. In univariate analysis, surgeon (adjp=0.018), preservation of puboprostatic ligaments (adjp=0.02), preservation of endopelvic fascia (adjp=0.001) and performing periurethral suspension (adjp<0.001) are poor prognostic factors for disease-free survival. Fascia preservation also negatively affects metastasis-free survival (adjp=0.04). Previous abdominal surgeries, prostate, surgical time, blood loss, type of residual urethra, middle lobe, fascial access, fascia or bladder neck preservation, have no statistical significance. CONCLUSIONS The surgeon and specific aspects of the surgical technique are determining factors in disease-free survival. Preservation of the fascia is the only factor that negatively affects metastasis-free survival.
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Affiliation(s)
- A Loizaga Iriarte
- Servicio de Urología. Hospital Universitario Basurto, Bilbao. Spain.
| | | | - S Rey Gonzalez
- Servicio de Urología. Hospital Universitario Basurto, Bilbao. Spain
| | - A Santos Martin
- Servicio de Urología. Hospital Universitario Basurto, Bilbao. Spain
| | - D Gonzalo Aparicio
- Servicio de Urología. Hospital Universitario Basurto, Bilbao. Spain; Traslational Prostate Cancer Research Lab, CIC bioGUNE-Basurto, Bilbao. Spain
| | - A Ugalde Olano
- Servicio de A. Patológica, Hospital Universitario Basurto, Bilbao, Spain
| | - A Carracedo Pérez
- Traslational Prostate Cancer Research Lab, CIC bioGUNE-Basurto, Bilbao. Spain; Centro de Investigación Biomedica en Red de Cáncer (CIBERONC), Madrid, Spain; CIC bioGUNE, Parque Tecnológico de Bizkaia, Derio, Spain
| | - M Unda Urzaiz
- Servicio de Urología. Hospital Universitario Basurto, Bilbao. Spain; Traslational Prostate Cancer Research Lab, CIC bioGUNE-Basurto, Bilbao. Spain; Centro de Investigación Biomedica en Red de Cáncer (CIBERONC), Madrid, Spain
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Muñoz Cuevas C, Asencio Egea MÁ, Franco Huerta M, Huertas Vaquero M, Arias Arias Á, Carranza González R. Case-control study of Clostridioides difficile in a rural health care area. Gastroenterol Hepatol 2023; 46:1-9. [PMID: 35104606 DOI: 10.1016/j.gastrohep.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 12/12/2021] [Accepted: 01/20/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine the risk and prognostic factors for Clostridioides difficile infection (CDI). PATIENTS AND METHODS Prospective, case-control study with 61 cases and 64 controls, aged ≥2 years with diarrhoea, carried out in Castilla-La Mancha Health Care Area for 14 months. The diagnosis was made by immunochromatography technics (glutamate dehydrogenase and toxin A/B), confirming discordant cases by isothermal amplification. Demographic variables, comorbidities, type of acquisition, previous administration of antibiotics, antacids and immunosuppressants, and evolution were collected. The data were analysed using the chi-square test and the effect of risk and prognostic factors was quantified using an odds ratio with 95% confidence intervals. RESULTS Hospital admission 4 weeks prior to infection, hypoalbuminemia, and previous administration of antibiotics were identified as independent risk factors for CDI. Presenting these 3 factors constitutes nearly 3-fold increase in the risk of becoming infected. A greater number of hospital admissions in the 4-12 weeks prior to CDI were found in the group of nosocomial acquisition. Although there was a greater tendency to recurrence and an unfavourable prognosis among nosocomial cases, these differences were not significant. We found that fever and hospital admission in the 4 weeks prior to infection were unfavourable prognostic factors of CDI. CONCLUSIONS The independent risk factors for CDI were: Hospital admission in the 4 weeks prior to infection, hypoalbuminemia, and previous administration of antibiotics. Fever and hospitalisation in the previous 4 weeks were also identified as prognostic factors of unfavourable evolution.
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Affiliation(s)
- Cristina Muñoz Cuevas
- Laboratorio de Microbiología, Hospital General La Mancha Centro, Ciudad Real, España
| | | | - María Franco Huerta
- Servicio de Medicina Interna, Hospital General La Mancha Centro, Ciudad Real, España
| | - María Huertas Vaquero
- Laboratorio de Microbiología, Hospital General La Mancha Centro, Ciudad Real, España
| | - Ángel Arias Arias
- Unidad de Apoyo a la Investigación, Hospital General La Mancha Centro, Ciudad Real, España
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Rodríguez-Baz Í, Rodríguez-Pérez MC, Medina Rodríguez A, Hernández Cabezudo I, Sosa Cabrera Y. Associated factors with functional prognosis of patients with acute ischemic stroke undergoing thrombectomy. Med Clin (Barc) 2022; 159:313-320. [PMID: 35042605 DOI: 10.1016/j.medcli.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/12/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Mechanical thrombectomy (MT) has meant a change in natural history of acute ischemic stroke. Our aim is to assess the possible association between different factors and prognosis in patients treated with MT in a third degree Spanish hospital. METHODS Cross-sectional study including 198 patients underwent MT because of acute ischemic stroke between 2012 and 2020. Sociodemographic, vascular risk factors (VRF) and clinical-radiologic factors were recorded. Functional outcome was evaluated based on modified Rankin Scale (mRS) at 90 days, being mRS≤2 favorable and mRS≥3 unfavorable outcome. RESULTS Mean age 67.7±13.5 years, 50.5% women. Arterial hypertension was the most prevalent VRF (65.7%). National Institute of Health Stroke Scale (NIHSS) median value at admission was 17.0 (8.0; 22.0). 40.9% of cases also received fibrinolytic treatment. Conscious sedation was performed in 66.7% patients. Median passes of MT were 2, and median duration 41min. Successful recanalization was achieved in 79.9% and mRS≤2 at 90 days was registered at 59.5% cases. Age, type 2 diabetes (T2D), number of MT passes and procedure duration were associated with mRS≥3. Successful recanalization was associated with mRS≤2. Regression model confirmed these associations in age (OR: 1.56CI%: 1.11; 2.20); T2D (OR: 3.51CI%: 1.38; 8.97) and successful recanalization (OR: 0.07CI%: 0.02; 0.28). CONCLUSION Age, T2D and failed recanalization increase risk for unfavorable outcome at 90 days in patients with AIS treated with MT. Procedure time duration should be considered as a possible determinant factor in functional outcome.
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Affiliation(s)
- Íñigo Rodríguez-Baz
- Servicio de Neurología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España.
| | | | - Antonio Medina Rodríguez
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - Ignacio Hernández Cabezudo
- Servicio de Radiología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - Yolanda Sosa Cabrera
- Servicio de Neurología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
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12
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Uranga A, Villanueva A, Lafuente I, González N, Legarreta MJ, Aguirre U, España PP, Quintana JM, García-Gutiérrez S. Risk factors for clinical deterioration in patients admitted for COVID-19: A case-control study. Rev Clin Esp 2022; 222:22-30. [PMID: 34556435 PMCID: PMC8426292 DOI: 10.1016/j.rceng.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/25/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION There is controversy regarding the best predictors of clinical deterioration in COVID-19. OBJECTIVE This work aims to identify predictors of risk factors for deterioration in patients hospitalized due to COVID-19. METHODS DESIGN Nested case-control study within a cohort. SETTING 13 acute care centers of the Osakidetza-Basque Health Service. PARTICIPANTS patients hospitalized for COVID-19 with clinical deterioration-defined as onset of severe ARDS, ICU admission, or death-were considered cases. Two controls were matched to each case based on age. Sociodemographic data; comorbidities; baseline treatment; symptoms; date of onset; previous consultations; and clinical, analytical, and radiological variables were collected. An explanatory model of clinical deterioration was created by means of conditional logistic regression. RESULTS A total of 99 cases and 198 controls were included. According to the logistic regression analysis, the independent variables associated with clinical deterioration were: emergency department O2 saturation ≤90% (OR 16.6; 95%CI 4-68), pathological chest X-ray (OR 5.6; 95%CI 1.7-18.4), CRP > 100 mg/dL (OR 3.62; 95%CI 1.62-8), thrombocytopenia with <150,000 platelets (OR 4; 95%CI 1.84-8.6); and a medical history of acute myocardial infarction (OR 15.7; 95%CI, 3.29-75.09), COPD (OR 3.05; 95%CI 1.43-6.5), or HT (OR 2.21; 95%CI 1.11-4.4). The model's AUC was 0.86. On the univariate analysis, female sex and presence of dry cough and sore throat were associated with better clinical progress, but were not found to be significant on the multivariate analysis. CONCLUSION The variables identified could be useful in clinical practice for the detection of patients at high risk of poor outcomes.
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Affiliation(s)
- A Uranga
- Servicio de Respiratorio, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - A Villanueva
- Unidad de Investigación Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - I Lafuente
- Unidad de Investigación Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - N González
- Unidad de Investigación Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain; Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Galdakao, Bizkaia, Spain
| | - M J Legarreta
- Unidad de Investigación Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - U Aguirre
- Unidad de Investigación Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain; Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Galdakao, Bizkaia, Spain
| | - P P España
- Servicio de Respiratorio, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - J M Quintana
- Unidad de Investigación Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain; Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Galdakao, Bizkaia, Spain
| | - S García-Gutiérrez
- Unidad de Investigación Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain; Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Galdakao, Bizkaia, Spain.
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Martos Pérez F, Luque Del Pino J, Jiménez García N, Mora Ruiz E, Asencio Méndez C, García Jiménez JM, Navarro Romero F, Núñez Rodríguez MV. Comorbidity and prognostic factors on admission in a COVID-19 cohort of a general hospital. Rev Clin Esp 2021; 221:529-535. [PMID: 34752264 PMCID: PMC7437480 DOI: 10.1016/j.rceng.2020.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/24/2020] [Indexed: 02/07/2023]
Abstract
ANTECEDENTS AND OBJECTIVE To describe clinical features, comorbidity, and prognostic factors associated with in-hospital mortality in a cohort of COVID-19 admitted to a general hospital. MATERIAL AND METHODS Retrospective cohort study of patients with COVID-19 admitted from 26th February 2020, who had been discharged or died up to 29th April 2020. A descriptive study and an analysis of factors associated with intrahospital mortality were performed. RESULTS Out of the 101 patients, 96 were analysed. Of these, 79 (82%) recovered and were discharged, and 17 (18%) died in the hospital. Diagnosis of COVID-19 was confirmed by polymerase chain reaction to SARS-CoV2 in 92 (92.5%). The mean age was 63 years, and 66% were male. The most frequent comorbidities were hypertension (40%), diabetes mellitus (16%) y cardiopathy (14%). Patients who died were older (mean 77 vs 60 years), had higher prevalence of hypertension (71% vs 33%), and cardiopathy (47% vs 6%), and higher levels of lactate dehydrogenase (LDH) and reactive C protein (mean 662 vs 335 UI/L, and 193 vs 121mg/L respectively) on admission. In a multivariant analysis the variables significantly associated to mortality were the presence of cardiopathy (CI 95% OR 2,58-67,07), levels of LDH≥345 IU/L (CI 95% OR 1,52-46,00), and age≥65 years (CI 95% OR 1,23-44,62). CONCLUSIONS The presence of cardiopathy, levels of LDH≥345 IU/L and age≥65 years, are associated with a higher risk of death during hospital stay for COVID-19. This model should be validated in prospective cohorts.
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Affiliation(s)
- F Martos Pérez
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain.
| | - J Luque Del Pino
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - N Jiménez García
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - E Mora Ruiz
- Servicio de Neumología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - C Asencio Méndez
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain
| | | | - F Navarro Romero
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - M V Núñez Rodríguez
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain
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Rafecas A, Torras J, Fabregat J, Lladó L, Secanella L, Busquets J, Serrano T, Ramos E. Intrahepatic cholangiocarcinoma: Prognostic factors for recurrence and survival in a series of 67 patients treated surgically at a single center. Cir Esp 2021; 99:506-513. [PMID: 34229980 DOI: 10.1016/j.cireng.2021.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/04/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Intrahepatic cholangiocarcinoma is a primary liver neoplasm whose only curative treatment is surgery. The objective of this study was to determine the prognostic factors for survival of intrahepatic cholangiocarcinoma treated surgically with curative intent. METHODS Sixty-seven patients who had been treated surgically for this neoplasm were collected at Bellvitge University Hospital between 1996 and 2017. Epidemiological, clinical, surgical, anatomopathological, morbidity, mortality and survival data have been analysed. RESULTS Postoperative study reflects our centre's experience in the surgical treatment of intrahepatic cholangiocarcinoma over a period of 21 years. Lymphadenectomy was associated with increased morbidity, and vascular invasion in the pathological study was the most important risk factor in the survival analysis. CONCLUSIONS This study reflects our centre's experience in the surgical treatment of intrahepatic cholangiocarcinoma over a period of 21 years. Lymphadenectomy was associated with increased morbidity, and vascular invasion in the pathological study was the most important risk factor in the survival analysis.
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Affiliation(s)
- Antoni Rafecas
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), Spain.
| | - Jaume Torras
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Joan Fabregat
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Laura Lladó
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Lluís Secanella
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Juli Busquets
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Teresa Serrano
- Servicio de Anatomía Patológica, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Emilio Ramos
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), Spain
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de la Espada Piña V, Ganga PLQ, Junquero JMG, Fosalba NA, Girón FF, Huete MJE, Ortega MP, Barrero GV, Salazar AM, Martínez FM, Guerrero MJM, de Mota EE, Cabrero SS, Rodríguez CR. Two decades of analysis of peritonitis in peritoneal dialysis in Andalusia: Epidemiological, clinical, microbiological and progression aspects. Nefrologia 2021; 41:417-425. [PMID: 36165110 DOI: 10.1016/j.nefroe.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 10/02/2020] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND This study focuses on the main complication associated with peritoneal dialysis, peritonitis. Its relevance derives from its high morbidity, the negative effect it has on the peritoneum as a dialysis membrane and its financial cost. METHODS Analytical, non-interventional, observational cohort study, whose main objective is the analysis of peritonitis in patients on peritoneal dialysis in Andalusia from 1 January 1999 to 31 December 2017, with a total of 2904 peritonitis cases. The database used is the Andalusian Autonomous Transplant Coordination Information System (SICATA). OBJECTIVES To ascertain how the rate of peritonitis is evolving in our community, analyse descriptive data pertaining to patients and peritonitis, ascertain the course of these infectious complications and analyse the factors that influence these cases of peritonitis and their outcomes: germ, hospitalisation and date. RESULTS The rate of peritonitis decreased progressively during the study period, from 0.7 peritonitis per patient in 1999 to 0.33 at the end of the period. Most infections were treated on an outpatient basis (72.5%). The most common germs were Gram-positive (55.9%), including coagulase-negative staphylococci (28.1%). Most cases of peritonitis progressed to healing (77.8%). The factors that significantly influence the need for hospitalisation and peritonitis progression were the causative germ and associated exit site infection. CONCLUSIONS In our population, the rate of peritonitis decreased progressively during the study period, meeting guideline recommendations.
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Brandariz RN, Esteves TA, Cafruni VM, Abrego MO, Bosio ST, Puigdevall MH. Radius shortening as a limiting factor for closed reduction in pediatric forearm fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 66:17-22. [PMID: 33715982 DOI: 10.1016/j.recot.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Diaphyseal forearm fractures in skeletally immature patients are common injuries that account for 30% of upper extremity fractures in this age group. There are cases with unstable injuries or unacceptable reductions, in which surgical resolution by reduction and stabilisation with percutaneous elastic endomedullary nailing is indicated. One of the advantages of this system is that it avoids an approach to the fracture site, allowing closed reduction in the vast majority of fractures. However, it is not always possible to achieve an acceptable closed reduction and opening of the fracture site is necessary. The aim of this study was to determine whether there are preoperative factors to predict the difficulty of performing closed reduction in these patients. METHODS A retrospective study of skeletally immature patients with acute diaphyseal forearm fractures treated with elastic endomedullary nailing by the same paediatric surgeon was performed. The primary outcome variable was defined as the need for open reduction; considered as a direct surgical approach to the fracture site. Demographic characteristics of the included patients and radiographic characteristics of the fracture were analysed. RESULTS We found that the median percentage of preoperative radial shortening in the closed reduction and open reduction groups was 1 and 5%, respectively; resulting in a statistically significant difference (p = 0.04). CONCLUSION Radial shortening on preoperative radiographs predicts an increased risk of requiring an open reduction of the fracture (39% association); thus we understand that this variable should be considered by the general traumatologist as a prognostic factor in defining the referral of these patients.
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Affiliation(s)
- Rodrigo Nicolás Brandariz
- Departamento de Ortopedia y Traumatología, Instituto Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Tomás Alfredo Esteves
- Departamento de Ortopedia y Traumatología, Instituto Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Virginia María Cafruni
- Departamento de Ortopedia y Traumatología, Instituto Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mariano Oscar Abrego
- Departamento de Ortopedia y Traumatología, Instituto Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Santiago Tomás Bosio
- Departamento de Ortopedia y Traumatología, Instituto Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Miguel Hector Puigdevall
- Departamento de Ortopedia y Traumatología, Instituto Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Cinesi Gómez C, Trigueros Ruiz N, de la Villa Zamora B, Blázquez González L, Piñera Salmerón P, Lázaro Aragüés P. Predictors of noninvasive mechanical ventilation weaning failure in the emergency department. Emergencias 2021; 33:9-14. [PMID: 33496394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To analyze factors related to the failure of noninvasive mechanical ventilation (NIV) weaning in a hospital emergency department (ED). MATERIAL AND METHODS Prospective, observational cohort study with enrolled a sample of consecutive patients who required NIV during ED care. The dependent variable was NIV weaning failure, defined by the need to restart NIV in the ED after a first attempt to withdraw the respirator. RESULTS Of a total of 675 candidates, we included 360 patients (53.4%). Exclusions were 100 patients (31.7%) who were on NIV at home; 58 (18.4%) in whom NIV initially failed; and 157 (49.9%) in whom weaning was attempted outside the ED. Seventy-two (17.3%) cases of weaning failure in the ED were observed. Factors independently associated with failure were the bicarbonate (HCO3) concentrations before attempted weaning (adjusted odds ratio [aOR], 1.06; 95% CI, 1.01-1.12; P = .014), time on NIV in hours (aOR, 1.10; 95% CI, 1.04-1.16; P .001), and a pH less than 7.35 before weaning (aOR, 2.48; 95% CI, 1.16-5.31; P = .019). CONCLUSION Weaning failure occurs in 17% of ED patients on NIV. Time on NIV, HCO3 concentration, and a pH less than 7.35 before weaning are independently associated with failure to wean from the respirator.
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Affiliation(s)
- César Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, España
| | | | | | | | | | - Paula Lázaro Aragüés
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, España. HealthKit Sciences PhD Program, Universidad Católica de Murcia UCAM, Murcia, España
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de la Espada Piña V, Quirós Ganga PL, Gil Junquero JM, Aresté Fosalba N, Fernández Girón F, Espigares Huete MJ, Peña Ortega M, Velasco Barrero G, Moreno Salazar A, Morales Martínez F, Marco Guerrero MJ, Esquivias de Mota E, Soriano Cabrero S, Remón Rodríguez C. Two decades of analysis of peritonitis in peritoneal dialysis in Andalusia: Epidemiological, clinical, microbiological and progression aspects. Nefrologia 2021. [PMID: 33422301 DOI: 10.1016/j.nefro.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND This study focuses on the main complication associated with peritoneal dialysis, peritonitis. Its relevance derives from its high morbidity, the negative effect it has on the peritoneum as a dialysis membrane and its financial cost. METHODS Analytical, non-interventional, observational cohort study, whose main objective is the analysis of peritonitis in patients on peritoneal dialysis in Andalusia from 1 January 1999 to 31 December 2017, with a total of 2,904 peritonitis cases. The database used is the Andalusian Autonomous Transplant Coordination Information System (SICATA). OBJECTIVES To ascertain how the rate of peritonitis is evolving in our community, analyse descriptive data pertaining to patients and peritonitis, ascertain the course of these infectious complications and analyse the factors that influence these cases of peritonitis and their outcomes: germ, hospitalisation and date. RESULTS The rate of peritonitis decreased progressively during the study period, from 0.7 peritonitis per patient in 1999 to 0.33 at the end of the period. Most infections were treated on an outpatient basis (72.5%). The most common germs were Gram-positive (55.9%), including coagulase-negative staphylococci (28.1%). Most cases of peritonitis progressed to healing (77.8%). The factors that significantly influence the need for hospitalisation and peritonitis progression were the causative germ and associated exit site infection. CONCLUSIONS In our population, the rate of peritonitis decreased progressively during the study period, meeting guideline recommendations.
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Franco-Jiménez JA, Ceja-Espinosa A, Álvarez-Vázquez L, Vaca-Ruíz MA. Associated factors for Tracheostomy in adults with severe traumatic brain injury. Score proposal. CIR CIR 2020; 88:200-205. [PMID: 32116326 DOI: 10.24875/ciru.19001247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background In patients with severe traumatic brain injury (TBI), there is a lack of consensus about the need and time to perform a tracheostomy. Nowadays, the decision is individualized to each case. It is considered that patients that will need a tracheostomy profit by performing it earlier. Patients and methods An observational and prospective study was performed. One hundred and twenty patients in a period of 18 months between 2016 and 2018, older than 18 years, with severe TBI at the first 24 h of trauma were analyzed. Clinical, biochemical, and radiological findings at admission were measured; patients were followed up until discharge. The statistical analysis was made with Student's t-test, χ2, and prevalence risk ratio. Results Ten associated factors were grouped according to the prevalence risk ratio. The principal factors were CRASH score, IMPACT score, SAPS II score, APACHE II score, age, revised trauma score, Glasgow Coma Scale, subdural hematoma, uni or bilateral abnormal pupil reactivity, and collapse of basal cisterns. Conclusions We conclude that there are multiple factors associated with the need for tracheostomy in adult patients with severe TBI and it is possible to predict according to our findings from admission which patients will profit by this procedure.
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Affiliation(s)
- José A Franco-Jiménez
- Departamento de Neurocirugía, Centro Médico "Lic. Adolfo López Mateos", Instituto de Salud del Estado de México, Estado de México, México
| | - Alejandro Ceja-Espinosa
- Departamento de Neurocirugía, Centro Médico "Lic. Adolfo López Mateos", Instituto de Salud del Estado de México, Estado de México, México
| | - Leonardo Álvarez-Vázquez
- Departamento de Neurocirugía, Centro Médico "Lic. Adolfo López Mateos", Instituto de Salud del Estado de México, Estado de México, México
| | - Miguel A Vaca-Ruíz
- Departamento de Neurocirugía, Centro Médico "Lic. Adolfo López Mateos", Instituto de Salud del Estado de México, Estado de México, México
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Duaso E, Gamboa-Arango A, Formiga F, Marimón P, Salgado MT, Murga V, Lumbreras C, Tarrida A. [Prognostic factors of mortality one year after a hip fragility fracture. Anoia hip study]. Rev Esp Geriatr Gerontol 2020; 56:18-23. [PMID: 33081979 DOI: 10.1016/j.regg.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 08/11/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Most of the patients who had a hip fragility fracture are characterized by advanced age, frailty, multimorbidity and high mortality rate into the first year. Our aim is to describe the prognostic factors of mortality one year after a hip fragility fracture. MATERIAL AND METHODS Observational prospective study. During the study period we included patients older than 69 years with hip fragility fracture who were admitted to the Acute Geriatric Unit. RESULTS We have followed 364 patients, 100 of them died (27.5%). The independent prognostic factors of mortality one year after a hip fragility fracture had been: have a less basis score in Lawton and Brody Scale 0.603 (0.505-0.721) (p< 0.001); have a higher score in Charlson Comorbidity Index 2.332 (1.308-4.157) p = 0.04); have a surgical waiting time ≥ 3 days 3.013 (1.330-6.829) p = 0.008); finding hydroelectrolytic disorders and/or deterioration of glomerular filtration 1.212 (1.017-1.444) p = 0.031) during hospital stay; discriminatory capacity of the area under the curve (AUC) (± 95%): 0.888 (0.880-0.891). CONCLUSIONS Prognostic predictors of mortality at one year after a hip fragility fracture are those variables that reflect a worse state of health, complications during hospital stay and a longer surgical waiting time.
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Affiliation(s)
- Enric Duaso
- Unidad Geriátrica de Agudos. Servicio de Geriatría. Hospital de Igualada, Igualada, Barcelona.
| | - Andrés Gamboa-Arango
- Unidad Geriátrica de Agudos. Servicio de Geriatría. Hospital de Igualada, Igualada, Barcelona
| | - Francesc Formiga
- Programa de Geriatría. Medicina Interna. Hospital Universitario de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, España
| | - Patrícia Marimón
- Unidad Geriátrica de Agudos. Servicio de Cirugía Ortopédica y Traumatología. Hospital de Igualada, Igualada, Barcelona
| | - Maria Teresa Salgado
- Servicio de Fisioterapia. Fundación Sociosanitaria Sant Josep de Igualada, Igualada, Barcelona
| | - Victor Murga
- Unidad Geriátrica de Agudos. Servicio de Anestesiología. Hospital de Igualada, Igualada, Barcelona
| | - Célia Lumbreras
- Unidad Geriátrica de Agudos. Servicio de Geriatría. Hospital de Igualada, Igualada, Barcelona
| | - Anna Tarrida
- Unidad Geriátrica de Agudos. Servicio de Geriatría. Hospital de Igualada, Igualada, Barcelona
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Rafecas A, Torras J, Fabregat J, Lladó L, Secanella L, Busquets J, Serrano T, Ramos E. Intrahepatic cholangiocarcinoma: Prognostic factors for recurrence and survival in a series of 67 patients treated surgically at a single center. Cir Esp 2020. [PMID: 32921420 DOI: 10.1016/j.ciresp.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Intrahepatic cholangiocarcinoma is a primary liver neoplasm whose only curative treatment is surgery. The objective of this study was to determine the prognostic factors for survival of intrahepatic cholangiocarcinoma treated surgically with curative intent. METHODS Sixty-seven patients who had been treated surgically for this neoplasm were collected at Bellvitge University Hospital between 1996 and 2017. Epidemiological, clinical, surgical, anatomopathological, morbidity, mortality and survival data have been analysed. RESULTS Postoperative morbidity was 47.76%, and postoperative mortality was 1.5%. Lymphadenectomy was associated with increased morbidity. Overall survival was 91%, 49.2% and 39.8% after 12, 36 and 60 months, respectively, and disease-free survival was 67.2%, 32.8% and 22.4%. Postoperative morbidity (reoperation, vascular invasion, adjuvant chemotherapy) were shown to be factors for a poor prognosis. Vascular invasion in the pathological study was the most important risk factor in the survival analysis. CONCLUSIONS This study reflects our centre's experience in the surgical treatment of intrahepatic cholangiocarcinoma over a period of 21 years. Lymphadenectomy was associated with increased morbidity, and vascular invasion in the pathological study was the most important risk factor in the survival analysis.
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Affiliation(s)
- Antoni Rafecas
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España.
| | - Jaume Torras
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España
| | - Joan Fabregat
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España
| | - Laura Lladó
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España
| | - Lluís Secanella
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España
| | - Juli Busquets
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España
| | - Teresa Serrano
- Servicio de Anatomía Patológica, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España
| | - Emilio Ramos
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España
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Salvador P, Gomes P, Silva F, Fonseca R. Type I Tympanoplasty: surgical success and prognostic factors. Acta Otorrinolaringol Esp (Engl Ed) 2020; 72:182-189. [PMID: 32862972 DOI: 10.1016/j.otorri.2020.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/11/2020] [Accepted: 04/30/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate success rate of type I tympanoplasty in adults and to investigate the importance of selected prognostic factors on graft uptake. MATERIAL AND METHODS Retrospective medical chart review of 155 patients who underwent Type I Tympanoplasty, in our department, from January 2013 to December 2017. Graft uptake rate was evaluated and the effects of prognostic factors on surgical outcome such as sex, smoking and otological surgery history, status of the contralateral ear, size and location of the perforation, middle ear mucosa status, surgical approach and graft material. Preoperative and postoperative audiometric data were collected, and the functional success was determined. RESULTS The overall surgical anatomical success rate was 75%. Analysis of the selected variables, identified as independent prognostic factors of anatomical unsuccess (95% CI): smoking (OR=3.29, p<.01), middle ear tympanosclerosis (OR=2.96; p=.04). Perforations above 50% of the tympanic membrane area had a borderline effect on graft uptake (p=.05). There was a significative improvement in the average air conduction thresholds of 7.44dB and an ABG closure rate at 10dB and 20dB was achieved in 47% and 84.5%, respectively. Patients who received temporalis fascia graft had similar hearing gain compared to patients who underwent cartilage tympanoplasty (7.7 vs. 7.3dB, p=.79). CONCLUSION Type I tympanoplasty is an effective and safe procedure with a high anatomical success rate in the treatment of mucosal COM. Poorer outcomes were found in patients with smoking habits, in those with tympanosclerosis of middle ear mucosa and in larger perforations. These prognostic factors should be considered in surgical planning and patients should be advised to quit smoking. Tympanoplasty with cartilage graft had a hearing outcome comparable to temporalis fascia graft and should be considered in high-risk patients.
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Affiliation(s)
- Pedro Salvador
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal.
| | - Patrícia Gomes
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Francisco Silva
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Rui Fonseca
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
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Martos Pérez F, Luque Del Pino J, Jiménez García N, Mora Ruiz E, Asencio Méndez C, García Jiménez JM, Navarro Romero F, Núñez Rodríguez MV. Comorbidity and prognostic factors on admission in a COVID-19 cohort of a general hospital. Rev Clin Esp 2020; 221:S0014-2565(20)30179-X. [PMID: 32680592 PMCID: PMC7318985 DOI: 10.1016/j.rce.2020.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/21/2020] [Accepted: 05/24/2020] [Indexed: 01/15/2023]
Abstract
ANTECEDENTS AND OBJECTIVE To describe clinical features, comorbidity, and prognostic factors associated with in-hospital mortality in a cohort of COVID-19 admitted to a general hospital. MATERIAL AND METHODS Retrospective cohort study of patients with COVID-19 admitted from 26th February, who had been discharged or died, up to 29th April, 2020. A descriptive study and an analysis of factors associated with intrahospital mortality were performed. RESULTS Out of the 101 patients, 96 were analysed. Of these, 79 (82%) recovered and were discharged, and 17 (18%) died in the hospital. Diagnosis of COVID-19 was confirmed by polymerase chain reaction to SARS-CoV-2 in 92 (92.5%). The mean age was 63 years, and 66% were male. The most frequent comorbidities were hypertension (40%), diabetes mellitus (16%) and cardiopathy (14%). Patients who died were older (mean 77 vs 60 years), had higher prevalence of hypertension (71% vs 33%), and cardiopathy (47% vs 6%), and higher levels of lactate dehydrogenase (LDH) and reactive C protein (mean 662 vs 335UI/L, and 193 vs 121mg/L respectively) on admission. In a multivariant analysis the variables significantly associated to mortality were the presence of cardiopathy (CI 95% OR 2,58-67,07), levels of LDH≥345IU/L (CI 95% OR 1,52-46,00), and age≥65 years (CI 95% OR 1,23-44,62). CONCLUSIONS The presence of cardiopathy, levels of LDH≥345IU/L and age ≥65 years are associated with a higher risk of death during hospital stay for COVID-19. This model should be validated in prospective cohorts.
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Affiliation(s)
- F Martos Pérez
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, España.
| | - J Luque Del Pino
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, España
| | - N Jiménez García
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, España
| | - E Mora Ruiz
- Servicio de Neumología, Hospital Costa del Sol, Marbella, Málaga, España
| | - C Asencio Méndez
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, España
| | - J M García Jiménez
- Servicio de Neumología, Hospital Costa del Sol, Marbella, Málaga, España
| | - F Navarro Romero
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, España
| | - M V Núñez Rodríguez
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, España
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Castellote J, Gea F, Morano LE, Morillas RM, Pineda JA, Vergara M, Buti M. Factors influencing hepatitis C cure in the era of direct-acting antivirals. Gastroenterol Hepatol 2020; 42 Suppl 1:1-7. [PMID: 32560767 DOI: 10.1016/s0210-5705(20)30181-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Direct-acting antiviral agents are highly potent drugs with a strong genetic barrier. Consequently, the factors influencing hepatitis C cure have been reduced and have progressively lost importance. Host factors, such as the presence of cirrhosis, race, and treatment adherence, influence sustained viral response. Adherence, together with treatment errors and drug interactions, are also important, especially in older patients. Viral factors, such as viral load, genotype, and the presence of baseline resistances affect the response rate but their influence can be minimised by using pan-genotypic regimens. Treatment simplification and the high efficacy of new antiviral treatments will allow treatment universalisation and will hopefully enable elimination of the infection in the next few decades. Supplement information: This article is part of a supplement entitled "The value of simplicity in hepatitis C treatment", which is sponsored by Gilead. © 2019 Elsevier España, S.L.U. All rights reserved.
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Affiliation(s)
- José Castellote
- Servicio de Aparato Digestivo, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.; Universitat de Barcelona, Barcelona, España.
| | - Francisco Gea
- Unidad de Sistema Digestivo, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Luis Enrique Morano
- Unidad de Patologías Infecciosas, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - Rosa M Morillas
- Servicio de Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; CIBEREHD, Instituto Carlos III, Madrid, España
| | - Juan Antonio Pineda
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Nuestra Señora de Valme, Sevilla, España
| | - Mercedes Vergara
- CIBEREHD, Instituto Carlos III, Madrid, España; Unidad de Hepatología, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - María Buti
- Unidad de Hepatología, Hospital General Universitario Vall d'Hebron, Barcelona, España
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Lorente D, Arevalo J, Salcedo M, Trilla E, de Torres I, Meseguer A, Morote J. Analysis of the nuclear expression of pSer727-STAT3 as a prognostic factor in patients with clear cell renal carcinoma. Actas Urol Esp 2020; 44:245-250. [PMID: 32247519 DOI: 10.1016/j.acuro.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/29/2019] [Accepted: 11/30/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Currently, clear cell renal carcinoma (CCRCC) has no prognostic markers. STAT3 protein (Signal Transducer and Activator of Transcription 3) is involved in the carcinogenesis of CCRCC. Its activation is produced by phosphorylation of the serine 727 residue, translocating to the nucleus where it is involved in carcinogenesis and tumor progression. The primary objective of the study was to evaluate cancer-specific survival rates in a series of 166 patients with CCRCC, and its subsequent correlation with the expression of pSer727-STAT3 as a prognostic marker of CCRCC. MATERIAL AND METHODS We conducted a retrospective study on 166 patients with CCRCC undergoing partial or radical nephrectomy between 2000 and 2010. A tumor tissue microarray was constructed for immunohistochemical analysis of pSer727-STAT3 expression. The main variable of the study was cancer-specific survival. RESULTS Patients were classified according to the UICC risk groups as follows: low in 78 patients (47%), intermediate in 52 (31.3%) and high 36 (21.7%); 11 patients (6.7%) were diagnosed with metastatic disease. During a mean follow-up of 97.2 months (1-208), 37 patients (22.3%) developed local and/or distant recurrence. Cancer-specific and overall mortality rates were 28.3% and 67.5%, respectively. The mean expression of pSer727-STAT3 was 92.9 (95% CI: 84.6-101.1) without showing any relationship with risk groups or other prognostic factors. In a Cox logistic regression analysis, pSer727-STAT3 did not behave as an independent predictor of cancer-specific mortality. However, in high-risk and metastatic patients, cancer-specific survival was significantly higher when the expression of pSer727-STAT3 was lower than 110, HR: 5.4 (96% CI: 1.8-16.4) and HR: 2.3 (95% CI: 1.1-4.6) respectively, P<.001. CONCLUSIONS pSer727-STAT3 is not a survival marker in patients with CCRCC. However, it is a cancer-specific survival marker in high-risk patients, even in metastatic patients undergoing treatment with antiangiogenic agents.
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del Pozo Jiménez G, Herranz Amo F, Subirá Ríos D, Rodríguez Fernández E, Bueno Chomón G, Moralejo Gárate M, Durán Merino R, Escribano Patiño G, Carballido Rodríguez J, Hernández Fernández C. Mortality prediction model for patients with bladder urothelial tumor after radical cystectomy. Actas Urol Esp 2020; 44:215-223. [PMID: 32035808 DOI: 10.1016/j.acuro.2019.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 07/02/2019] [Accepted: 08/27/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Based on preoperative clinical and postoperative pathological variables, we aim to build a prediction model of cancer specific mortality (CSM) at 1, 3, and 5 years for patients with bladder transitional cell carcinoma treated with RC. MATERIAL AND METHODS Retrospective analysis of 517 patients with diagnosis of cell carcinoma treated by RC (1986-2009). Demographic, clinical, surgical and pathological variables were collected, as well as complications and evolution after RC. Comparative analysis included Chi square test and ANOVA technique. Survival analysis was performed using Kaplan-Meier method and log-rank test. Univariate and multivariate analyses were performed using logistic regression to identify the independent predictors of CSM. The individual probability of CSM was calculated at 1, 3 and 5 years according to the general equation (logistic function). Calibration was obtained by the Hosmer-Lemeshow method and discrimination with the elaboration of a ROC curve (area under the curve). RESULTS BC was the cause of death in 225 patients (45%). One, three and five-year CSM were 17%, 39.2% and 46.3%, respectively. The pT and pN stages were identified as independent prognostic variables of CSM at 1, 3 and 5 years. Three prediction models were built. The predictive capacity was 70.8% (CI 95% 65-77%, p=.000) for the 1st year, 73.9% (CI95% 69.2-78.6%, p=.000) for the third and 73.2% (CI% 68.5-77.9%, p=.000) for the 5th. CONCLUSIONS The prediction model allows the estimation of CSM risk at 1, 3 and 5 years, with a reliability of 70.8, 73.9 and 73.2%, respectively.
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Del Pozo Jiménez G, Herranz Amo F, Arranz Arija JA, Rodríguez Fernández E, Subirá Ríos D, Lledó García E, Bueno Chomón G, Cancho Gil MJ, Carballido Rodríguez J, Hernández Fernández C. Effect of adjuvant chemotherapy in locally advanced urothelial carcinoma of the bladder treated with cystectomy. Actas Urol Esp 2020; 44:94-102. [PMID: 31866159 DOI: 10.1016/j.acuro.2019.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 07/09/2019] [Accepted: 08/27/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Currently, the role of adjuvant chemotherapy (ADJ) in muscle invasive bladder tumor remains controversial. OBJECTIVE To evaluate the effect of ADJ on cancer specific survival of muscle invasive bladder tumor after radical cystectomy (RC). MATERIAL AND METHODS Retrospective analysis of 292 patients diagnosed with urothelial bladder tumor pT3-4pN0 / + cM0 stage, treated with RC between 1986-2009. Total cohort was divided in two groups: 185 (63.4%) patients treated with ADJ and 107 (36.6%) without ADJ. Median follow-up was 40.5 months (IQR 55-80.5). Comparative analysis was performed with Chi-square test and Student's t test /ANOVA. Survival analysis was carried out with the Kaplan-Meier method and log-rank test. Multivariate analysis (Cox regression) was made to identify independent predictors of cancer-specific mortality (CSM). RESULTS 42.8% of the series presented lymph node involvement after RC. At the end of follow-up, 22.9% were BC-free and 54.8% had died due to this cause. The median cancer specific survival was 30 months. No significant differences were observed in cancer specific survival regarding the treatment with ADJ in pT3pN0 (p=.25) or pT4pN0 (p=.29) patients, but it was significant in pT3-4pN+ (p=.001). Multivariate analysis showed pathological stage (p=.0001) and treatment with ADJ (p=.007) as independent prognostic factors for CSM. ADJ reduced the risk of CSM (HR:0.59,95% CI 0.40-0.87, p=.007). CONCLUSIONS pT and pN stages were identified as independent predictors of CSM after RC. The administration of ADJ in our series behaved as a protective factor reducing the risk of CSM, although only pN+ patients were benefited in the stage analysis.
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Affiliation(s)
- G Del Pozo Jiménez
- Servicio de Urología, Hospital Universitario Puerta de Hierro, Madrid, España.
| | - F Herranz Amo
- Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - J A Arranz Arija
- Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | - D Subirá Ríos
- Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - E Lledó García
- Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - G Bueno Chomón
- Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - M J Cancho Gil
- Servicio de Urología, Hospital Universitario Gregorio Marañón, Madrid, España
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Ocaña J, Sanjuanbenito A, García A, Molina JM, Lisa E, Mendía E, Saavedra C, Lobo E. Relevance of positive resection margins in ductal pancreatic adenocarcinoma and prognostic factors. Cir Esp 2020; 98:85-91. [PMID: 31395275 DOI: 10.1016/j.ciresp.2019.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/16/2019] [Accepted: 06/27/2019] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Currently, R1 resection is defined by the presence of tumor cells within <1mm of the resection margin. The main aim of this study was to analyze the impact of positive margins (R1) on survival outcomes in pancreatic cancer. METHODS We performed a retrospective analysis with multivariate regression analysis of a prospective database from 2008-2017, which included resection margin status, expanded resection margin (R1<1mm), vascular resection, lymphatic involvement, surgical complications, tumor differentiation grade and adjuvant treatment. RESULTS A total of 80 patients were analyzed: 42 (52%) R1; 38 (48%) R0. No differences were found in the composition of the two groups except for the vascular resection, which was more frequent in the R1 group: 12 (21%) vs 2 (3%). Overall survival in the R0 group was 19 months vs 24 months in the R1 group (p=0.13). Wide R1 (R1<1mm) had an overall survival of 21 months versus 31 months in wide R0 (p=0.55). In the multivariate analysis, only lymph node involvement (p=0.02, HR=2.88), tumor differentiation (p=0.02, HR=3.2) and adjuvant therapy (p<0.01; HR=0.21) were found to be factors related to survival. CONCLUSIONS R1 resection is not an independent risk factor. Lymph node involvement, differentiation grade and adjuvant treatment are prognostic factors. The benefit of expanding the resection margins should be demonstrated. More studies are needed to assess the impact of the resection margin.
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Affiliation(s)
- Juan Ocaña
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - Alfonso Sanjuanbenito
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Alba García
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, España
| | - José Manuel Molina
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Eduardo Lisa
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Elena Mendía
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Cristina Saavedra
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Eduardo Lobo
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, España
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Verdú-Rotellar JM, Calero E, Abellana R, Verdú-Soriano J, Vinyoles E, Del Val-García JL, Domingo M, Muñoz MA. Short-term mortality in end-stage heart failure patients. Aten Primaria 2020; 52:477-87. [PMID: 31932015 DOI: 10.1016/j.aprim.2019.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/08/2019] [Accepted: 07/22/2019] [Indexed: 12/21/2022] Open
Abstract
Objectives This study is aimed at analyzing the impact of the main factors contributing to short and long-term mortality in patients at final stages of heart failure (HF). Setting Patients attended at any of the 279 primary health care centers belonging to the Institut Català de la Salut, in Catalonia (Spain). Participants Patients with Advanced HF. Design Multicenter cohort study including 1148 HF patients followed for one-year after reaching New York Heart Association (NYHA) IV. Main measurements The primary outcome was all-cause mortality. Multivariate logistic regression models were performed to assess the outcomes at 1, 3, 6, and 12 months. Results Mean age of patients was 82 (SD 9) years and women represented 61.7%. A total of 135 (11.8%) and 397 (34.6%) patients died three months and one year after inclusion, respectively. Male gender, age, and decreased body mass index were associated with higher mortality at three, six and twelve months. In addition, low systolic blood pressure levels, severe reduction in glomerular filtration, malignancy, and higher doses of loop diuretics were related to higher mortality from 6 to 12 months. The most important risk factor over the whole period was presenting a body mass index lower than 20 kg/m2 (three months OR 3.06, 95% CI: 1.58–5.92; six months OR 4.42, 95% CI: 2.08–9.38; and 12 months OR 3.68, 95% CI: 1.76–7.69). Conclusions We may conclude that male, age, and decreased body mass index determined higher short-term mortality in NYHA IV. In addition, low systolic blood pressure, reduced glomerular filtration, malignancy, and higher doses of loop diuretics contribute to increasing the risk of mortality at medium and long-term. Such variables are easily measurable and can help to decide the best way to face the most advances stages of the disease.
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Lloret-Durá MA, Panach-Navarrete J, Martínez-Jabaloyas JM, Valls-González L, Cózar-Olmo JM, Miñana-López B, Gómez-Veiga F, Rodríguez-Antolín A. Factors related to early castration resistance in metastatic prostate cancer. Results from the National Prostate Cancer Registry in Spain. Actas Urol Esp 2019; 43:562-567. [PMID: 31301868 DOI: 10.1016/j.acuro.2019.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/13/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The objective of the study was to determine the factors independently related with the development of castration resistance (CR) in prostate cancer (PC) in the medium term. MATERIAL AND METHODS 155 patients diagnosed with metastatic PC with a follow-up of up to 39 months. Data taken from the National PC Registry. The evaluated variables were age, PSA, nadir PSA, Gleason, perineural invasion, TNM stages, and ADT type (intermittent/continuous). RESULTS Mean follow-up 26,2±13,4 months. 47.1% developed early CR, with mean time until onset of 12,2±8,7 months. Univariate analysis the mean PSA was correlated with CR (290±905,1 ng/mL in non CR, 519,1±1437,2 ng/mL in CR, P<.001), mean age (73,3±8,3 years in non CR, 69,1±9,3 in CR P=.01), mean PSA nadir (15,5±57,3ng/mL in non CR, 15,9±23,7 ng/mL in CR, p<0,001), Gleason (in ≥8, HR:2,11. 95% CI: 1.22-3.65, p=0.006), and T stage (in T3-T4, HR: 2.85. 95% CI: 1.57-5.19, P<.001). Multivariate analysis the independent variables associated to CR are age (HR: 0.96. 95% CI: 0.94-0.99, P=.01), PSA nadir (HR: 1.65. 95% CI: 1,43-1,91, P<.001), and T3-T4 stage (HR: 2.11. 95% CI: 1.10-4.04, P=.02). CONCLUSIONS PSA nadir and T3-T4 tumor stage at diagnosis are associated to an increased risk of developing CR. In addition, age at diagnosis is shown as a variable that decreases risk. Therefore, an older age would be associated with lower risk probability of CR in the medium term.
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Affiliation(s)
- M A Lloret-Durá
- Servicio de Urología, Hospital Clínico Universitario de Valencia, Facultat de Medicina i Odontologia, Universitat de València, Valencia, España.
| | - J Panach-Navarrete
- Servicio de Urología, Hospital Clínico Universitario de Valencia, Facultat de Medicina i Odontologia, Universitat de València, Valencia, España
| | - J M Martínez-Jabaloyas
- Servicio de Urología, Hospital Clínico Universitario de Valencia, Facultat de Medicina i Odontologia, Universitat de València, Valencia, España
| | - L Valls-González
- Servicio de Urología, Hospital Clínico Universitario de Valencia, Facultat de Medicina i Odontologia, Universitat de València, Valencia, España
| | - J M Cózar-Olmo
- Servicio de Urología, Hospital Virgen de las Nieves, Granada, España
| | - B Miñana-López
- Servicio de Urología, Clínica Universidad de Navarra, Pamplona, España
| | - F Gómez-Veiga
- Servicio de Urología, C.H.U.A.C., Hospital Universitario de Salamanca, Salamanca, España
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Gamboa-Arango A, Duaso E, Formiga F, Marimón P, Sandiumenge M, Salgado MT, Escalante E, Lumbreras C, Tarrida A. Pronostic factors of good functionality at 12 months of a hip fracture. Maluc Anoia study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 64:57-63. [PMID: 31377157 DOI: 10.1016/j.recot.2019.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/24/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Hip fracture usually occurs in frail elderly patients and is associated with an important morbi-mortality in the first year. The objective of the study is to describe the prognostic factors that would allow maintaining functionality at 12 months. METHOD From June 1, 2010 to May 31, 2013, all patients older than 69 years with hip fracture due to bone fragility admitted to the Geriatric Acute Unit of our hospital were included. We define as functional maintenance those patients who have lost between 0-15 points in the Barthel Index with respect to the previous to the fracture. Prospective study of bivariate data analysis for related and multivariate prognostic factors for predictive predictors. RESULTS 271 patients were included, of them, 146 (54.8%), maintained functionality at 12 months and 122 (45.2%) no. Patients who maintain functional status are younger: average age 83.4 vs 85.80 years (P=.002); with better scores in the indexes of: Lawton prior to fracture 4.42 vs 2.40 (P<.001) and Barthel at discharge 34.2 vs. 27.1 (P=.002). There are also differences in the score of the "Geriatric Dementia Scale" 2.59 vs. 3.13 (P=.009), in the score of the "American Society Anesthesiologist"<II 62.2% vs 37.8% (P=0.006) and have presented less delirium during hospitalization 4.7% vs 35.3% (P=.002). In the multivariate analysis they maintained statistical significance, age OR: 1.044 (95% CI: 1.002-1.088) (P=.04) and the Lawton Index OR: 0.869 (95% CI: 0.804-0.940) (P <.001). CONCLUSIONS Prognostic factors of functional maintenance at 12 months are age and the ability to perform instrumental activities of daily life.
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Affiliation(s)
- A Gamboa-Arango
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España.
| | - E Duaso
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - F Formiga
- Programa de Geriatría, Medicina Interna, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, España
| | - P Marimón
- Unidad Geriátrica de Agudos, Servicio de Traumatología y Cirugía Ortopédica, Hospital de Igualada, Igualada, España
| | - M Sandiumenge
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - M T Salgado
- Servicio de Fisioterapia, Fundación Sanitaria San José, Igualada, España
| | - E Escalante
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - C Lumbreras
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - A Tarrida
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
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Del Pozo Jiménez G, Herranz Amo F, Díez Cordero JM, Monzó Gardiner JI, Lledó García E, Subirá Ríos D, Carballido Rodríguez J, Hernández Fernández C. [Prognostic factors of mortality in patients with urothelial bladder tumor treated with radical cistectomy.]. ARCH ESP UROL 2019; 72:451-462. [PMID: 31223123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Radical cystectomy (RC) with pelvic lymphadenectomy is the treatment of choice in patients with muscle invasive bladder cancer (MIBC). OBJECTIVE To identify clinical and pathological variables that influence global mortality (GM) and cancer specific mortality (CSM) in patients with urothelial bladder tumor (UBT) treated with RC. METHODS: Retrospective analysis of 517 patients diagnosed with UBT and treated with RC between 1986 and 2009. Demographic, clinical, surgical and pathological variables, as well as complications and evolution after RC were collected. A comparative analysis was carried out with Chi square and ANOVA test. Survival analysis was performed with the Kaplan-Meier method and the long-rank test. Univariate and multivariate analysis were performed using Cox regression to identify independent predictors of GM and CSM. RESULTS: 91% of the patients were males with a median age of 66 years. The most frequent local pathological stage was pT3 (32.6%), with lymph node involvement in 23.8% of the patients. After a median follow-up of 34 months, 170 patients were alive and 311 had died from any cause (63.5%), being UBT the cause of death in 225 patients (45%). Rates of global survival and cancer specific survival at 5 and 10 years were 45%/34.3% and 52.5%/46.6% respectively. On the multivariate analysis age ( p = 0.004), ASA ( p = 0.000), the existence of hydronephrosis ( p = 0.01), pT ( p = 0.000) and pN ( p = 0.003) were identified as independent predictors of GM, as well as pT ( p = 0.000) and pN ( p = 0.002) for CSM. CONCLUSIONS: Age, anesthetic risk, presence of hydronephrosis, pT and pN stage were identified as independent predictors of GM, as well as pT and pN stage for CSM.
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Affiliation(s)
| | | | | | | | | | - David Subirá Ríos
- Hospital Universitario Puerta de Hierro. Majadahonda. Madrid. España
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León X, Rodriguez C, Rovira C, García J, López M, Quer M. Analysis of specific survival and local control through a recursive partitioning analysis in patients with head and neck carcinoma. Acta Otorrinolaringol Esp (Engl Ed) 2019; 71:131-139. [PMID: 31060733 DOI: 10.1016/j.otorri.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Recursive partitioning analysis (RPA) is a technique that allows prognostic classification in oncological patients. The aim of the present study is to analyse by means of an RPA a cohort of patients with squamous carcinomas of the head and neck (SCHN). METHODS 5,226 SCHN were retrospectively analysed with an RPA, considering the specific survival and local control of the disease as dependent variables. A cohort of patients was used for the creation of the classification model, and another cohort was used to carry out its internal validation. RESULTS Considering specific survival as a dependent variable we obtained a classification tree with 14 terminal nodes that were grouped into 5 categories, including as partition variables the local and regional extent of the tumour, and the location of the tumour. When considering the local control of the disease as a dependent variable we obtained a classification tree with 10 terminal nodes that were grouped into 4 categories, including as partition variables the local extension and location of the tumour, the type of treatment performed, the age of the patient, and if it was a first tumour or a subsequent neoplasm. The validation study confirmed the prognostic capacity of the models developed with the RPA. One of the advantages of the RPA is that it allows the identification of groups of patients with specific behaviour. CONCLUSION RPA is shown to be an effective technique for the prognostic classification of patients with a SCHN.
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Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España.
| | - Camilo Rodriguez
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Carlota Rovira
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Jacinto García
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Montserrat López
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
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Mas MÀ, Miralles R, Renom-Guiteras A, Durán X, Inzitari M. [Hospital-at-home Integrated Care Programme tailored to older patients with disabling acute processes: identification of prognostic factors]. Rev Esp Geriatr Gerontol 2019; 54:136-142. [PMID: 30792139 DOI: 10.1016/j.regg.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/09/2018] [Accepted: 11/19/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Several authors have demonstrated the efficacy of different hospital-at-home strategies in older patients. The identification of prognostic factors is key for improving the targeting process of candidates. METHODS We performed an analysis of a cohort of older patients attended due to disabling health crises (medical, orthopaedics, or stroke) by a hospital-at-home scheme developed in an integrated care institution over a 5-year period. Main outcomes were: health crisis resolution (discharge to Primary Care); functional resolution (relative functional gain ≥35%), and their combined variable. A logistic regression analysis was performed, including clinical variables from Comprehensive Geriatric Assessment at admission to detect factors related to favourable outcomes. RESULTS A total of 484 patients were included. The main characteristics were: age 84.4 (6.7), female gender 69%, baseline Barthel score 74.2 (22.6), family-private caregiver/nursing home 82%/18%, referral from hospital wards/emergency department-community in 55%/45%. The main results (for selected processes medical/orthopaedics/stroke) were: health crisis resolution 71.7/87.5/77.6%; functional resolution 72.1/84.9/73.5%; favourable crisis resolution (health crisis resolution with functional resolution) 67.1/81.6/67.3%. Favourable crisis resolution was associated with [OR (95%CI)]: orthopaedic as main diagnosis [2.00 (1.22-3.29)], Barthel score at admission higher than 40 points [2.00 (1.18-3.38)], and the absence of pressure ulcers at admission [2.80 (1.68-4.65)]. CONCLUSIONS Patients presenting with an orthopaedic diagnosis, not having severe disability at admission, and not having pressure ulcers at admission could obtain better results on favourable crisis resolution. Suffering cognitive impairment or delirium, or being institutionalised, was not found related with less favourable results.
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Affiliation(s)
- Miquel Àngel Mas
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Geriatría y Cuidados Paliativos, Badalona Serveis Assistencials, Badalona, Barcelona, España; RE-FIT BCN Research Group, Vall d'Hebron Institute of Research (VHIR), Barcelona, España.
| | - Ramón Miralles
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Direcció Clínica Territorial de Cronicitat, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, España
| | - Anna Renom-Guiteras
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Geriatría, Parc de Salut Mar, Barcelona, España
| | - Xavier Durán
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, España
| | - Marco Inzitari
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Parc Sanitari Pere Virgili, Barcelona, España
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Queiro R, Laiz A, Seoane-Mato D, Galindez Agirregoikoa E, Montilla C, Park HS, Bethencourt Baute JJ, Bustabad S, Pinto Tasende JA, Tejón P, Joven Ibáñez B, Ramírez J, Cuervo A, Cañete JD, Trenor Larraz P, Ordás C, Alonso S, García-Fernández E, Toniolo E, Moreno Ramos MJ, Beteta MD, Lojo Oliveira L, Navío Marco T, Cebrián L, Barbazán C, Maceiras F, Rodriguez-Moreno J, Steiner M, Muñoz-Fernández S, Nóvoa Medina FJ, León M, Rubio E, Medina Luezas J, Sánchez-González MD, Arévalo M, Gratacós J, Senabre JM, Rosas JC, Santos Soler G, Nieto-González JC, González C, López Robles A, Álvarez Castro C, Ruiz Montesino MD, Torrente-Segarra V, Fernández-Carballido C, Martínez-Vidal MP, Jovani V, Urruticoechea-Arana A, Cabello Fernández Y, Toledo MD, Almodóvar R, Belmonte-Serrano MÁ, Notario Ferreira I, Raya Álvarez E; Grupo de Trabajo del Proyecto REAPSER. Spanish Registry of Recent-onset Psoriatic Arthritis (REAPSER study): Aims and methodology. ACTA ACUST UNITED AC 2019; 15:252-7. [PMID: 30522944 DOI: 10.1016/j.reuma.2018.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/04/2018] [Accepted: 09/10/2018] [Indexed: 12/30/2022]
Abstract
AIMS To describe the methodology of REAPSER (Spanish Registry of Recent-onset Psoriatic Arthritis), its strengths and limitations. The aim of this study is to identify prognostic factors for the clinical and radiographic course in a cohort of patients with psoriatic arthritis (PsA) diagnosed within 2years of symptom evolution. METHODS Multicenter, observational and prospective study (with 2-year follow-up including annual visits). Baseline visit intended to reflect patient situation before the disease course was modified by treatments prescribed in rheumatology departments. Patients were invited to participate consecutively in one of their routine visits to the rheumatologist. 211 patients were included. Following data were collected: sociodemographic variables; employment situation; family history; personal history and comorbidities; anthropometric data; lifestyle; use of healthcare services; clinical situation at the time of PsA diagnosis; joint involvement and spinal pain; pain and overall assessment; enthesitis, dactylitis and uveitis; skin and nail involvement; functional situation and quality of life; radiographic evaluation; analytical determinations; treatment; axial and peripheral flare-ups. CONCLUSIONS The REAPSER study includes a cohort of patients with recent-onset PsA, before the disease course was modified by disease-modifying antirheumatic drugs prescribed in rheumatology departments. Exhaustive information collected in each visit is expected to be an important data source for future analysis.
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Nari G, Mariot D, Góngora-Ortega J, López-Ben S, Albiol M, Figueras J. [Resultados a corto y largo plazo de las rehepatectomías como parte del tratamiento multimodal de las metástasis de origen colorrectal. Un estudio biinstitucional]. CIR CIR 2018; 86:347-354. [PMID: 30067717 DOI: 10.24875/ciru.m18000053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introducción Un alto porcentaje de pacientes que reciben una hepatectomía por metástasis de cáncer colorrectal presentarán recidiva hepática, y en algunas será posible una nueva resección. La utilidad de las hepatectomías repetidas continúa siendo discutida. Objetivo Evaluar los resultados obtenidos a corto y largo plazo. Método Fueron analizadas 68 rehepatectomías de dos instituciones. Se analizaron datos demográficos y características de la enfermedad metastásica y de las resecciones hepáticas. Los tipos de complicaciones y la morbimortalidad también fueron analizados, al igual que la supervivencia y el tiempo libre de enfermedad. Se evaluaron algunos de los factores de mal pronóstico mencionados en la literatura. Resultados El análisis de los datos de corto plazo no mostró diferencias significativas entre los pacientes de primera hepatectomía y de hepatectomías repetidas, a excepción del porcentaje de fístulas biliares posoperatorias (p = 0.001). La supervivencia a 1 año es similar, mientras que a 3 y 5 años mostró diferencias significativas (p = 0.024 y 0.004, respectivamente). Los factores de mal pronóstico referidos en la literatura no fueron representativos en esta serie. Conclusión Los resultados a corto plazo de los pacientes con rehepatectomía son similares a los de aquellos resecados una vez. Los resultados a largo plazo de las rehepatectomías son inferiores a otros publicados. Introduction A high percentage of patients undergoing hepatectomy for metastatic colorectal liver disease will have a recurrence. Of these, some can be subject to a new resection. The usefulness of repeated hepatectomy remains controversial. The aim of this study is to evaluate the results of short and long-term outcomes in repeated hepatectomies. Methods They were re-analyzed 68 repeated hepatectomies from two institutions. Demographics, characteristics of metastatic disease and hepatic resections were analyzed. Types of complications, morbidity and mortality were also analyzed as survival and disease-free time. Some of the factors of poor prognosis mentioned in the literature were evaluated. Results The analysis of short-term data showed no statistically significant differences between patients with first and repeated hepatectomy, except the percentage of postoperative biliary leakage (p = 0.001). The 1-year survival was similar while 3 and 5 years survival showed significant differences (p = 0.024 and 0.004, respectively). The factors of poor prognosis referred in the literature were not representative in this series. Conclusion The short-term results of repeated hepatectomy are similar to those resected once. Long term result are inferior to other published series.
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Affiliation(s)
- Gustavo Nari
- Servicio de Cirugía, Hospital Tránsito Cáceres de Allende, Córdoba, República Argentina
| | - Daniela Mariot
- Servicio de Cirugía, Hospital Tránsito Cáceres de Allende, Córdoba, República Argentina
| | | | - Santiago López-Ben
- Unidad de Cirugía Hepato-bilio-pancreática, Departamento de Cirugía, Hospital Josep Trueta, Girona, España
| | - Maite Albiol
- Unidad de Cirugía Hepato-bilio-pancreática, Departamento de Cirugía, Hospital Josep Trueta, Girona, España
| | - Joan Figueras
- Unidad de Cirugía Hepato-bilio-pancreática, Departamento de Cirugía, Hospital Josep Trueta, Girona, España
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Navarro S. Historical review of our knowledge of acute pancreatitis. Gastroenterol Hepatol 2018; 41:143.e1-143.e10. [PMID: 29249269 DOI: 10.1016/j.gastrohep.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/27/2017] [Accepted: 11/09/2017] [Indexed: 12/29/2022]
Abstract
Acute pancreatitis is one of most common causes of consultation due to abdominal pain in medical emergency units and it requires hospital admission. Although the majority of cases are mild and patients tend to recover quickly, a small percentage of cases is severe, with mortality in the region of 5-10%. This historical review considers how our understanding of this disease has changed since it was first described in 1579 thanks to the contributions of renowned experts such as Nicolaes Tulp, Reginald Fitz, Nicholas Senn and many others who, through their expertise and dedication, have improved the survival of patients with this disease.
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Aragón Chamizo J, Herranz Amo F, Hernández Fernández C, González Enguita C. Prognostic factors for vesical relapse in patients with upper urothelium tumours treated with surgery. Actas Urol Esp 2017; 41:571-576. [PMID: 28258788 DOI: 10.1016/j.acuro.2017.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/13/2017] [Accepted: 01/16/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify the prognostic factors for vesical relapse in patients with tumours of the upper urothelium treated with surgery. MATERIAL AND METHODS We conducted a retrospective analysis of patients with tumours of the upper urothelium who underwent surgery between 1999 and 2011 at our centre (139 patients). We collected demographic, clinical, diagnostic and pathological variables, as well as the treatment, complications and progression. A descriptive analysis was performed using the chi-squared test for categorical variables and the ANOVA test for continuous variables. We also performed a univariate and multivariate analysis using the Cox proportional hazards model. Statistical significance was considered when P<.05. All calculations were performed with SPSS Statistics version 21. RESULTS During the follow-up, 26.6% of the patients (37 cases) showed vesical relapse. Some 19.6% of the patients with no history of bladder tumours showed a bladder tumour relapse compared with 48.6% of the patients with a history of bladder tumours (P<.001). In the multivariate analysis, only the presence of bladder tumours prior to or concomitant with the upper urinary tract tumour diagnosis was identified as an independent predictor of bladder tumour relapse (P=.007). CONCLUSION In our series, only the presence of a prior or synchronous bladder tumour behaved as an independent predictor of bladder tumour relapse in patients with tumours of the upper urothelium treated with surgery.
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Affiliation(s)
- J Aragón Chamizo
- Hospital General Universitario Gregorio Marañón, Madrid, España; Hospital Universitario Fundación Jiménez Díaz, Madrid, España.
| | - F Herranz Amo
- Hospital General Universitario Gregorio Marañón, Madrid, España
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Pareja Sierra T, Bartolomé Martín I, Rodríguez Solís J, Bárcena Goitiandia L, Torralba González de Suso M, Morales Sanz MD, Hornillos Calvo M. Predictive factors of hospital stay, mortality and functional recovery after surgery for hip fracture in elderly patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:427-435. [PMID: 28888685 DOI: 10.1016/j.recot.2017.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/09/2017] [Accepted: 06/21/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Due to its high prevalence and serious consequences it is very important to be well aware of factors that might be related to medical complications, mortality, hospital stay and functional recovery in elderly patients with hip fracture. MATERIAL AND METHODS A prospective study of a group of 130 patients aged over 75 years admitted for osteoporotic hip fracture. Their medical records, physical and cognitive status prior to the fall, fracture type and surgical treatment, medical complications and functional and social evolution after hospitalization were evaluated. RESULTS Patients with greater physical disability, more severe cognitive impairment and those who lived in a nursing home before the fracture had worse functional recovery after surgery. Treatment with intravenous iron to reduce transfusions reduced hospital stay and improved walking ability. Infections and heart failure were the most frequent medical complications and were related to a longer hospital stay. The prescription of nutritional supplements for the patients with real indication improved their physical recovery after the hip fracture CONCLUSIONS: Evaluation of physical, cognitive and social status prior to hip fracture should be the basis of an individual treatment plan because of its great prognostic value. Multidisciplinary teams with continuous monitoring of medical problems should prevent and treat complications as soon as possible. Intravenous iron and specific nutritional supplements can improve functional recovery six months after hip fracture.
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Affiliation(s)
- T Pareja Sierra
- Sección de Geriatría, Hospital Universitario de Guadalajara, SESCAM, Guadalajara, España.
| | - I Bartolomé Martín
- Sección de Geriatría, Hospital Universitario de Guadalajara, SESCAM, Guadalajara, España
| | - J Rodríguez Solís
- Sección de Geriatría, Hospital Universitario de Guadalajara, SESCAM, Guadalajara, España
| | - L Bárcena Goitiandia
- Sección de Geriatría, Hospital Universitario de Guadalajara, SESCAM, Guadalajara, España
| | | | - M D Morales Sanz
- Servicio de Hematología, Hospital Universitario de Guadalajara, SESCAM, Guadalajara, España
| | - M Hornillos Calvo
- Sección de Geriatría, Hospital Universitario de Guadalajara, SESCAM, Guadalajara, España
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da Costa E, Robles MJ, Sánchez-Rodríguez MD, Vázquez-Ibar O, Miralles R. [Prognostic value of assessment tools on elderly patients with chronic advanced disease and end of life, admitted to an intermediate care centre]. Rev Esp Geriatr Gerontol 2017; 53:77-80. [PMID: 28781008 DOI: 10.1016/j.regg.2017.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 06/06/2017] [Accepted: 06/09/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To apply 3advanced chronic disease evaluation tools in elderly patients admitted to an intermediate and long-term care centre, and evaluate its relationship with mortality. METHODS The NECPAL tool, PROFUND prognostic index, and Charlson comorbidity index were applied to 87 patients. RESULTS The NECPAL tool identified 31 patients (35.6%) in need of palliative care, and according to the PROFUND index, 45 (54.7%) had high/very high risk of mortality (≥7 points), and according to Charlson index, 31 (35.6%) had high comorbidity (≥4 points). Of the NECPAL positive patients, 80.5% had a PROFUND index score ≥7, and 48.3% a Charlson index ≥ 4. These percentages were 34.4% and 28.5% in negative NECPAL patients (P<.001 and P≤.06, respectively). Correlations between the 3tools: quantitative (Spearman) number of responses in NECPAL with PROFUND (r=.57; P<.001); with Charlson (r=.214; P<.047) and between PROFUND and Charlson (r=.157; P=.148). Qualitative (kappa) NECPAL (positive/negative) with PROFUND (cut-off 6/7) (0.40; P<.001), and Charlson (cut-off 3/4) (0.19; P=.080) and between PROFUND and Charlson (0.08; P=.399). Mortality prediction (area under the curve): NECPAL 3 months 0.81 (95% CI: 0.62-1.00); 6 months 0.71 (95% CI: 0.53-0.89) and 12 months 0.67 (95% CI: 0.52-0.82). PROFUND 3 months 0.71 (95% CI: 0.50-0.91); 6 months 0.73 (95% CI: 0.58-0.87), and 12 months 0.69 (95% CI: 0.57-0.81). Charlson 3 months 0.72 (95% CI: 0.52-0.91); 6 months 0.62 (95% CI: 0.45-0.80), and 12 months 0.64 (95% CI: 0.50-0.78). CONCLUSIONS The 3tools were significantly associated with high mortality. A low concordance was found between the results of the different tools.
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Affiliation(s)
- Elizabeth da Costa
- Servicio de Geriatría del Parc de Salut Mar, Centro Forum, Hospital de la Esperanza, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, España.
| | - María José Robles
- Servicio de Geriatría del Parc de Salut Mar, Centro Forum, Hospital de la Esperanza, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, España
| | - María Dolores Sánchez-Rodríguez
- Servicio de Geriatría del Parc de Salut Mar, Centro Forum, Hospital de la Esperanza, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, España
| | - Olga Vázquez-Ibar
- Servicio de Geriatría del Parc de Salut Mar, Centro Forum, Hospital de la Esperanza, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, España
| | - Ramón Miralles
- Servicio de Geriatría del Parc de Salut Mar, Centro Forum, Hospital de la Esperanza, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, España
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Lorente D, Trilla E, Meseguer A, Planas J, Placer J, Celma A, Salvador C, Regis L, Morote J. Systematic review of renal carcinoma prognostic factors. Actas Urol Esp 2017; 41:215-225. [PMID: 27659130 DOI: 10.1016/j.acuro.2016.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 11/16/2022]
Abstract
CONTEXT AND OBJECTIVES The natural history of renal cell carcinoma is heterogeneous. Some scenarios can be found in terms of clinical presentation, clinical evolution or type of recurrence (local/metastatic). The aim of this publication is to analyze the most important prognostic factors published in the literature. EVIDENCE ACQUISITION A literature review ob published papers was performed using the Pubmed, from first Motzer's classification published in 1999 to 2015, according to PRISMA declaration. Search was done using the following keywords: kidney neoplasm, kidney cancer, renal cell carcinoma, prognostic factors, mortality, survival and disease progression. Papers were classified according to level of evidence, the number of patients included and the type of study performed. EVIDENCE SYNTHESIS The evolution in the knowledge of molecular pathways related to renal oncogenesis and the new targeted therapies has left to remain obsolete the old prognostic models. It's necessary to perform a continuous review to actualize nomograms and to adapt them to the new scenarios. CONCLUSIONS Is necessary to perform a proper external validation of existing prognostic factors using prospective and multicentric studies to add them into the daily urologist clinical practice.
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Affiliation(s)
- D Lorente
- Servicio de Urología, Hospital de la Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, España
| | - E Trilla
- Servicio de Urología, Hospital de la Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, España.
| | - A Meseguer
- Unidad de fisiología y fisiopatología renal (VHIR), Barcelona, España
| | - J Planas
- Servicio de Urología, Hospital de la Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, España
| | - J Placer
- Servicio de Urología, Hospital de la Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, España
| | - A Celma
- Servicio de Urología, Hospital de la Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, España
| | - C Salvador
- Servicio de Urología, Hospital de la Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, España
| | - L Regis
- Servicio de Urología, Hospital de la Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, España
| | - J Morote
- Servicio de Urología, Hospital de la Vall d'Hebron, Universidad Autonoma de Barcelona, Barcelona, España
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Sanz-Reig J, Salvador Marín J, Pérez Alba JM, Ferrández Martínez J, Orozco Beltrán D, Martínez López JF. Risk factors for in-hospital mortality following hip fracture. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:209-215. [PMID: 28462865 DOI: 10.1016/j.recot.2017.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 02/21/2017] [Accepted: 03/07/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To identify and quantify the risk factors for in-hospital mortality in patients older than 65 years with a hip fracture. MATERIALS AND METHODS Retrospective review of prospectively collected data. We studied a cohort of 331 hip fracture patients older than 65 years of age admitted to our hospital from 2011 to 2014. Patients demographics, type of residence, physical function, mobility, prefracture comorbidities data, cognitive status, anti-aggregant and anticoagulant medication, preoperative haemoglobin value, type of fracture, type of treatment, surgical delay, and complications, were recorded. RESULTS The average age was 83, 73% female, and 57% had sustained a subcapital fracture. In 62.8% pre-fracture baseline co-morbidities were equal or greater than 2. The in-hospital mortality rate was 11.4%. In univariate analysis, age over 90, male gender, haemoglobin ≤ 10g/dl, no antiplatelet agents, orthopaedic treatment, number of co-morbidities≥2, Charlson index≥2, age-adjusted Charlson index≥6, congestive heart failure, asthma, rheumatologic disease, were associated with in-hospital mortality. CONCLUSIONS Preoperative patient-related factors have a strong relationship with in-hospital mortality in a hip fracture patients aged older than 65 years. These factors are non-modifiable; we recommend the development of protocols to reduce in-hospital mortality in this group of patients.
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Affiliation(s)
- J Sanz-Reig
- Servicio de Cirugía Ortopédica, Hospital Universitario Sant Joan d'Alacant, Alicante, España.
| | - J Salvador Marín
- Servicio de Cirugía Ortopédica, Hospital Universitario Sant Joan d'Alacant, Alicante, España
| | - J M Pérez Alba
- Servicio de Cirugía Ortopédica, Hospital Universitario Sant Joan d'Alacant, Alicante, España
| | - J Ferrández Martínez
- Servicio de Cirugía Ortopédica, Hospital Universitario Sant Joan d'Alacant, Alicante, España
| | - D Orozco Beltrán
- Departamento de Medicina, Universidad Miguel Hernández, Elche, España
| | - J F Martínez López
- Servicio de Cirugía Ortopédica, Hospital Universitario Sant Joan d'Alacant, Alicante, España
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Sanz-Reig J, Salvador Marín J, Ferrández Martínez J, Orozco Beltrán D, Martínez López JF. Risk-factors for surgical delay following hip fracture. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:162-169. [PMID: 28373089 DOI: 10.1016/j.recot.2017.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/18/2017] [Accepted: 02/04/2017] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To identify pre-operative risk factors for surgical delay of more than 2 days after admission in patients older than 65 years with a hip fracture. MATERIAL AND METHODS A prospective observational study was conducted on 180 hip fractures in patients older than 65 years of age admitted to our hospital from January 2015 to April 2016. The data recorded included, patient demographics, day of admission, pre-fracture comorbidities, mental state, level of mobility and physical function, type of fracture, antiaggregant and anticoagulant medication, pre-operative haemoglobin value, type of treatment, and surgical delay. RESULTS The mean age of the patients was 83.7 years. The mean Charlson Index was 2.8. The pre-fracture baseline co-morbidities were equal or greater than 2 in 70% of cases. Mean timing of surgery was 3.1 days. At the time of admission, 122 (67.7%) patients were fit for surgery, of which 80 (44.4%) underwent surgery within 2 days. A Charlson index greater than 2, anticoagulant therapy, and admission on Thursday to Saturday, were independently associated with a surgical delay greater than 2 days. CONCLUSIONS The rate of hip fracture patients undergoing surgery within 2 days is low. Risk factors associated to surgical delay are non-modifiable. However, their knowledge should allow the development of protocols that can reduce surgical delay in this group of patients.
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Affiliation(s)
- J Sanz-Reig
- Servicio de Cirugía Ortopédica, Hospital Universitario Sant Joan d' Alacant, Sant Joan d'Alacant, Alicante, España.
| | - J Salvador Marín
- Servicio de Cirugía Ortopédica, Hospital Universitario Sant Joan d' Alacant, Sant Joan d'Alacant, Alicante, España
| | - J Ferrández Martínez
- Servicio de Cirugía Ortopédica, Hospital Universitario Sant Joan d' Alacant, Sant Joan d'Alacant, Alicante, España
| | - D Orozco Beltrán
- Departamento de Medicina, Universidad Miguel Hernández, Elche, Alicante, España
| | - J F Martínez López
- Servicio de Cirugía Ortopédica, Hospital Universitario Sant Joan d' Alacant, Sant Joan d'Alacant, Alicante, España
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Sanchez Santos R, Corcelles R, Vilallonga Puy R, Delgado Rivilla S, Ferrer JV, Foncillas Corvinos J, Masdevall Noguera C, Socas Macias M, Gomes P, Balague Ponz C, de Tomas Palacios J, Ortiz Sebastian S, Sanchez Pernaute A, Puche Pla JJ, Sabench Pereferrer F, Abasolo Vega J, Suñol Sala X, Garcia Navarro A, Duran Escribano C, Cassinello Fernandez N, Perez N, Gracia Solanas JA, Garcia-Moreno Nisa F, Hernández Matias A, Valentí Azcarate V, Perez Folques JE, Navarro Garcia I, Dominguez-Adame Lanuza E, Martinez Cortijo S, González Fernández J. Prognostic factors of weight loss after sleeve gastrectomy: Multi centre study in Spain and Portugal. Cir Esp 2017; 95:135-142. [PMID: 28325497 DOI: 10.1016/j.ciresp.2017.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/31/2017] [Accepted: 02/06/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) has become a technique in its own right although a selective or global indication remains controversial. The weight loss data at 5 years are heterogeneous. The aim of the study is to identify possible prognostic factors of insufficient weight loss after SG. METHODS A SG retrospective multicenter study of more than one year follow-up was performed. Failure is considered if EWL>50%. Univariate and multivariate study of Cox regression were performed to identify prognostic factors of failure of weight loss at 1, 2 and 3 years of follow up. RESULTS A total of 1,565 patients treated in 29 hospitals are included. PSP per year: 70.58±24.7; 3 years 69.39±29.2; 5 years 68.46±23.1. Patients with EWL<50 (considered failure): 17.1% in the first year, 20.1% at 3 years, 20.8% at 5 years. Variables with influence on the weight loss failure in univariate analysis were: BMI>50kg/m2, age>50years, DM2, hypertension, OSA, heart disease, multiple comorbidities, distance to pylorus> 4cm, bougie>40F, treatment with antiplatelet agents. The reinforcement of the suture improved results. In multivariate study DM2 and BMI are independent factors of failure. CONCLUSION The SG associates a satisfactory weight loss in 79% of patients in the first 5 years; however, some variables such as BMI>50, age>50, the presence of several comorbidities, more than 5cm section of the pylorus or bougie>40F can increase the risk of weight loss failure.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pedro Gomes
- Hospital Geral, Centro Hospitalar Univertario Coimbra, Coimbra, Portugal
| | | | | | | | | | | | | | | | | | | | | | | | - Nieves Perez
- Hospital Virgen de los Lirios, Alcoy (Alicante), España
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Requena C, Sendra E, Llombart B, Sanmartín O, Guillén C, Lavernia J, Traves V, Cruz J. Cutaneous Angiosarcoma: Clinical and Pathology Study of 16 Cases. Actas Dermosifiliogr 2017; 108:457-465. [PMID: 28318524 DOI: 10.1016/j.ad.2017.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Primary cutaneous angiosarcoma is one of the most aggressive skin tumors and carries a very poor prognosis. Its initially indolent clinical presentation explains the frequently late diagnosis that, together with its typically multifocal pattern and poor delimitation, often makes surgery difficult. The low incidence of primary cutaneous angiosarcoma means that few large single-center series have been published. We review the clinical and pathologic characteristics of cutaneous angiosarcomas treated in our hospital, looking for prognostic factors and for possible diagnostic traits that could facilitate early diagnosis. MATERIAL AND METHODS This was a retrospective observational study including all patients diagnosed with cutaneous angiosarcoma in Instituto Valenciano de Oncología in Valencia, Spain between January 2000 and December 2015. We recorded 16 clinical parameters, including age, sex, type of angiosarcoma, site, size, and time since diagnosis, and 8 histopathologic parameters. RESULTS We identified 16 patients (11 women and 5 men) with cutaneous angiosarcoma. Their mean age was 67 years (median, 71 years). The most common site was the trunk (10 cases), followed by the head and neck (5 cases). The mean size of the tumor was 10cm (median, 6.5cm). Fourteen patients underwent surgical excision. Six of the 16 patients were alive at the end of the study, after a mean follow-up period of 42.5 months. CONCLUSIONS The major determinants of survival among patients with cutaneous angiosarcoma are tumor size and patient age. Other characteristics associated with a poor prognosis were infiltration of deep planes (muscle), a predominantly solid histologic pattern, and a larger number of mitoses.
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Affiliation(s)
- C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
| | - E Sendra
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Guillén
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - J Lavernia
- Servicio de Oncología, Instituto Valenciano de Oncología, Valencia, España
| | - V Traves
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
| | - J Cruz
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
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Rodríguez-Cabello MA, Laso-García I, Donis-Canet F, Gómez-Dos-Santos V, Varona-Crespo C, Burgos-Revilla FJ. Renal cell carcinoma with vascular invasion: Mortality and prognostic factors. Actas Urol Esp 2017; 41:132-138. [PMID: 27461850 DOI: 10.1016/j.acuro.2016.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/05/2016] [Accepted: 06/06/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Analysis of the results of patients who had been operated of renal cell carcinoma with vascular invasion in our institution, evaluation of prognostic factors and complications. METHODS Retrospective observational study of 37 patients diagnosed of renal cell carcinoma with vascular invasion operated between May 1999 and July 2013. We used the method of Kaplan-Meier survival analysis and the Mantel-Haenszel's test (log rank) and the Cox's proportional hazards analysis test to analyse the risk factors of mortality. RESULTS The median age was 60 years. Mean follow-up period was 42.1 months. The median overall survival and disease-free survival were 53.8and 36.3 months, respectively. There was statistical association between overall survival and ASA (p=0.047), tumor stage (p=0.003), lymph node involvement (p=0.024), presence of metastases (p=0.013), level of tumor thrombus (p=0, 05) and histological type (p=0.001). 14 patients had grade IIIb complications or higher according to the Clavien Dindo classification, the most frequent was bleeding. CONCLUSIONS Renal cell carcinoma with vascular invasion is a disease with high rate of mortality. Surgery is a therapeutic option that can be curative. The number of complications is important. Survival is conditioned by the ASA, tumor stage, the level of tumor thrombus, lymph node involvement, metastasis and histological type.
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Affiliation(s)
| | - I Laso-García
- Servicios de Urología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - F Donis-Canet
- Servicios de Urología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - V Gómez-Dos-Santos
- Servicios de Urología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - C Varona-Crespo
- Servicios de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - F J Burgos-Revilla
- Servicios de Urología, Hospital Universitario Ramón y Cajal, Madrid, España
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Paño Pardo JR, Serrano Villar S, Ramos Ramos JC, Pintado V. Infections caused by carbapenemase-producing Enterobacteriaceae: risk factors, clinical features and prognosis. Enferm Infecc Microbiol Clin 2016; 32 Suppl 4:41-8. [PMID: 25542051 DOI: 10.1016/s0213-005x(14)70173-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Infections caused by carbapenem-producing Enterobacteriaceae (CPE) can present as several infectious syndromes, but they primarily present as respiratory, urinary and blood stream infections (primary or catheter-related) that are usually found as nosocomial or healthcare-associated infections. The risk of CPE infection is influenced by individual factors, such as the length of the hospital stay and their exposure to invasive procedures and/or to antimicrobials. Of note, exposure to several antimicrobials, not only carbapenems, has been linked to CPE colonization; the duration of antibiotic exposure is one of the primary drivers of CPE acquisition. Individual risk factors must be considered jointly with the local epidemiology of these microorganisms in healthcare institutions. Overall, these infections have a high associated mortality. Mortality is influenced by host factors (e.g., age, comorbidity and immune deficiency), infection-related variables (e.g., type and severity of the infection) and treatment-related factors such as the delay in the initiation of appropriate antimicrobial therapy and the use or monotherapy or combined antimicrobial therapy. Gaining knowledge concerning the epidemiology, clinical features and prognostic features of CPE infection could be useful for improving infection prevention and for the management of patients with infections caused by these microorganisms.
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Affiliation(s)
- José Ramón Paño Pardo
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Departamento de Medicina Interna, Hospital Universitario La Paz, IDIPAZ, Madrid, Spain
| | - Sergio Serrano Villar
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Juan Carlos Ramos Ramos
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Departamento de Medicina Interna, Hospital Universitario La Paz, IDIPAZ, Madrid, Spain
| | - Vicente Pintado
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Castro Sousa A, Henriques V, Rodrigues J, Fonseca R. Ossiculoplasty in chronic otitis media: Surgical results and prognostic factors of surgical success. Acta Otorrinolaringol Esp (Engl Ed) 2016; 68:131-137. [PMID: 27663221 DOI: 10.1016/j.otorri.2016.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/01/2016] [Accepted: 06/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES The goal of ossiculoplasty is to improve hearing. Successful ossiculoplasty depends on several factors. This retrospective study was carried out to analyze hearing results of ossiculoplasty in ears with chronic otitis media (COM) and evaluate clinical outcomes and factors predictive of hearing improvement. SUBJECTS AND METHODS We reviewed the results of 153 patients with COM (with cholesteatoma (COMC) and without cholesteatoma (COMWC)) who underwent ossiculoplasty between January of 2002 to December of 2011. Several potential prognostic factors were evaluated: cholesteatoma present vs absent; type of surgical procedure, state of the middle ear mucosa, state of the ossicular chain, type of prosthesis. RESULTS We analyzed 153 ossiculoplasties: 96 patients presented COMWC and 57 patients presented COMC. The ossiculoplasties were performed using autologous ossicles for the most part. All ossiculoplasties were carried out in one-stage surgery. In 38% of cases ossiculoplasty was combined with mastoidectomy; in the remaining 62% of cases, ossiculoplasty was performed without mastoidectomy. Ossiculoplasty was successfully achieved in 113 patients (74%). The presence of the stapes superstructure and normal mucosa were significant predictive factors of surgical success. CONCLUSION The majority of the ossiculoplasties improved hearing status satisfactorily. Multivariate analysis should be performed to investigate prognostic factors of favorable short-term hearing outcomes after ossiculoplasty. Better knowledge of these predictive factors may contribute to the surgeon's judgment and the information given to patients.
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Affiliation(s)
- Ana Castro Sousa
- Head and Neck Surgery Department of Guimarães Hospital, Alto Ave Hospital Center, Guimarães, Portugal.
| | - Vânia Henriques
- Head and Neck Surgery Department of Guimarães Hospital, Alto Ave Hospital Center, Guimarães, Portugal
| | - Jorge Rodrigues
- Head and Neck Surgery Department of Guimarães Hospital, Alto Ave Hospital Center, Guimarães, Portugal
| | - Rui Fonseca
- Head and Neck Surgery Department of Guimarães Hospital, Alto Ave Hospital Center, Guimarães, Portugal
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Manuel Vázquez A, Carabias Hernández A, Carrascosa Mirón T, Valle Rubio A, Mínguez García J, Sanz Muñoz P, Serantes Gómez A, Jover Navalón JM. What to do with an intraductal papilary mucinous pancreatic neoplasm? Our experience. Cir Esp 2016; 94:467-72. [PMID: 27461233 DOI: 10.1016/j.ciresp.2016.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/19/2016] [Accepted: 05/22/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Cystic pancreatic neoplasms are a heterogeneous group of pathology, and intraductal papillary mucinous neoplasia is becoming more common. The aim of this study is to review our series of cystic pancreatic neoplasms that underwent surgery and to evaluate the similarities with Fukuoka recommendations. METHODS Retrospective review of our experience analyzing clinical and radiological data, indication for surgery and pathology study of 11 patients operated on in our centre from july 2011 to july 2015, aiming to evaluate the degree of agreement with the current consensus. RESULTS In our series the majority of cases (7/11) had symptoms at diagnosis. Preoperative diagnosis was achieved in 10 patients using radiology and/or endoscopy. Indications for surgery were the presence of symptoms, radiological data suspicious of malignancy, and secondary branch neoplasia over 30mm. Pathological findings were malignancy in 6/11 cases (2 invasive neoplasia, 4 high grade dysplasia), moderate dysplasia in 2/11, low-grade dysplasia in 2/11 and no dysplasia in one patient. CONCLUSIONS Surgical indication of intraductal mucinous pancreatic neoplasms depends on the associated symptoms, size, location, risk and suspicion of malignancy.
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Affiliation(s)
- Alba Manuel Vázquez
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Getafe, Madrid, España.
| | | | | | - Ainhoa Valle Rubio
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Getafe, Madrid, España
| | - Javier Mínguez García
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Getafe, Madrid, España
| | - Paloma Sanz Muñoz
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Getafe, Madrid, España
| | - Ana Serantes Gómez
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Getafe, Madrid, España
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Fontanals J, Magaldi M, Caballero Á, Fontanals M. [Prognostic factors for in-hospital cardiopulmonary arrests. A review of 760 cases]. Med Clin (Barc) 2016; 147:49-55. [PMID: 27237362 DOI: 10.1016/j.medcli.2016.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 04/04/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study is to analyse in-hospital cardiopulmonary arrests (CA) that took place in conventional wards and evaluate their prognostic factors. PATIENTS AND METHOD Retrospective review of in-hospital CA which occurred in our hospital over a 9-year period. CA that took place in intensive care areas, emergency rooms and operating theatres were excluded from the study. The following data were collected: demographic data, cause and initial rhythm of CA, internal control data, time, place, methods and results after cardiopulmonary resuscitation (CPR) (recovery of spontaneous circulation, [ROSC], and survival at discharge [SAD]) and neurologic performance at discharge. Results were analysed with SPSS(®) v. 20 predictive analytics software. RESULTS Average age was 66.9±17.5 years; 63.5% male. CA team arrived in 1.75±0.74min on average, and the average length of CPR was 25.8±16.10min. First rhythm: a) shockable rhythms=22.1%; b) asystole=66.2%, and c) pulseless electrical activity=11.7%. ROSC=51% and SAD=24.8%. Factors associated with a better prognostic (P<.05): age, reason for hospital admission, patient's previous physical condition, principal cause of CA, number of defibrillations and average length of CPR. CONCLUSIONS Despite having studied several variables as prognostic factors for CA and some of them being statistically significant, early prediction for survival for an in-hospital CA remains uncertain. Our study suggests that applying rational organisational measures, 25% of in-hospital CA could be discharged from hospital in good condition, and therefore, these organisational and educational measures should be extended to large hospitals.
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Affiliation(s)
- Jaume Fontanals
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - Marta Magaldi
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España.
| | - Ángel Caballero
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - Montserrat Fontanals
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
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