Incidencia,prevalencia y patrones de tratamiento del cáncer de próstata metastásico hormonosensible en España: Estudio ECHOS

Introduction and objectiveThe management of patients with metastatic hormone-sensitive prostate cancer (mHSPC) has changed in recent years due to the approval of new drugs. The aim of this study was to evaluate the prevalence, incidence, and treatment patterns in mHSPC in Spain.Patients and methodsMulticenter, observational, longitudinal, retrospective study in routine clinical practice of patients diagnosed with mHSPC treated in Spanish hospitals between 2015 and 2019 (ECHOS study). Electronic medical records were extracted from BIG-PAC database, which contains geographically representative Spanish centers.ResultsData from 379 men with mHSPC were included. The prevalence of mHSPC ranged between 12.2-14.6% per year, representing from 671 to 824 annual cases with an increasing trend. The mean incidence along the 4-year period was 2.5%, with annual incidence ranging 2.2-3.0%. New annual cases of de novo and recurrent disease ranged between 7-11 and 77-104, respectively, with no trend being observed. These patients were mostly recurrent (91%) with high-volume disease (68.6%). The most common first-line therapy was ADT combined with docetaxel (53%), followed by ADT alone (23.8%), combination of ADT and abiraterone (11.2%), and radiotherapy (8.6%). In the last 12 months before diagnosis of metastasis, most men had been submitted to radical prostatectomy (84.9%). The remaining patients had received radiotherapy (12%) or no treatment at all (3.8%).ConclusionsThe ECHOS study provides epidemiologic data and current patterns of treatment in clinical practice of patients with mHSPC in Spain. These results emphasize the medical need of targeted treatments in these clinical settings.     

Escleroterapia del hidrocele y quiste de cordón con polidocanol. Estudio de eficiencia

ObjetivesChecking the efficiency (cost/benefit) of the sclerotherapy with polidocanol in our country for the treatment of hydrocele and epididymal cystPatient and methodsWe studies 86 patients with this diagnosis from may of 1995, until april of 2000. We have applied the costs for process according to the indicators of administration-cost our hospital in the year 1999Outputs79 patient completed the protocol. The overall cure rate was 83.87% with sclerotherapy; 42.3% with first one treatment. Only a 4.5% of the patients had significant pain and a 7.4% others complicationsDiscussionThere were necessaries 1,5 sclerotherapies of mean for curation, resulting this treatment 4.78 more cheaper than surgeryConclusionThe sclerotherapy with polidocanol of the hydrocele or epididymal cyst are an effective treatment, sure, simple, reasonably comfortable and fundamentally, economical     

Estudio comparativo del grado de satisfacción del paciente en cateterismo intermitente con el uso de las sondas lofric y las de cloruro de polivinilo

PurposeTo asses the grade of satisfaction in children on intermittent catheterization with the use of LoFric and PVC conventional cathetersMaterial and methodsA total of 40 p with experience in CIC were included in this study. An anonymous questionnaire was sent to all patients after 2-months using the LoFric catheter. Patients were divided in 3 groups (bladder augmentation, artificial sphincter, Mitrofanoff) because of major differences in CIC disfomfort between these groupsResultsThe questionnaire was completed by 87.5% of the patients (35 p). In 86% (30 p) LoFric catheter training was easy or very easy but in 14% (5 p) it was difficult. Four patients had some difficulty during conventional catheter insertion, in 3 (75%) the difficulty disappeared with the use of LoFric catheter. Of the 51% (18 p) who reported some discomfort during the insertion of conventional catheter, 72% said it was eliminated when the LoFric catheter was used. Of 6 p with some discomfort when removing the conventional catheter, 5 (83%) said it disappeared with the new catheter. Th LoFric catheter was favored by 70% of patients because it reduced the discomfort caused by conventional catheters, bladder insertion was easier and smoother, and gel lubrication was not needed. The 17% of patients reported some difficulty dealing with this slippery catheterConclusionsThe use of the LoFric catheter could be justified in patients who report with conventional catheters have some discomfort. It can also be recommended in patients with artificial sphincter, bladder augmentation and Mitrofanoff procedure, in whom any complication related to CIC would have serious consequences     

Valoración del ganglio centinela en el cáncer papilar de tiroides T1-T2. Estudio preliminar

ObjectiveSentinel lymph node biopsy in differentiated thyroid cancer may benefit patients with no clinically affected lymph nodes and can avoid a prophylactic or staging lymphadenectomy.MethodsA prospective study was conducted on 23 consecutive patients with papillary thyroid carcinoma with no clinical or radiological suspicion of lymph involvement. After injecting methylene blue around the tumour during the biopsy of the identified sentinel lymph node, a total thyroidectomy and a via-b ipsilateral lymphadenectomy was performed for the later study with cytokeratin. If the sentinel lymph node was positive, a modified ipsilateral radical lymphadenectomy was perfumed (groups ii to v).ResultsThe sentinel lymph node was clearly identified in 21 of the 23 patients (91.3%). Seven (33%) of the 21 lymph nodes identified were positive in the intra-operative study, of which 3 (42.8%) demonstrated involvement with the lateral compartment. All together, 9 patients (39.1%) showed lymph node involvement group vi, with two more patients being identified with micro-metastases in the later study. Biopsy of the sentinel lymph node had a sensitivity of 87.5%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 93.7%, with 7.1% false negatives. Five patients (21.7%) had transient hypocalcaemia.ConclusionsThe identification of the sentinel lymph node in patients with T1-T2 tumours with no suspicion of lymph node involvement helps in the selection of patients who should be treated with selective lymphadenectomies.     

Contribución del bloqueo del plano transverso abdominal guiado por ultrasonidos a la analgesia postoperatoria tras la cesárea

ObjectiveThe aim of this study was to evaluate the contribution made by ultrasound-guided transversus abdominis plane block (TAP) to the quality of the analgesia with intrathecal opioids obtained in patients undergoing elective caesarean delivery.Material and methodsA prospective, randomized study in patients submitted to elective caesarean section with spinal anaesthesia with 0.5% hyperbaric bupivacaine. The patients were randomized into 3 groups according to the added complementary drug for analgesia: group A morphine 0.1 mg; group B fentanyl 10 μg; group C 10 μg fentanyl + bilateral TAP block. The TAP block with 20 ml of 0.5% levobupivacaine on each side, after surgery. Groups A and B, were injected with 20 ml of saline. Postoperative analgesia was performed with morphine bolus through a system of patient-controlled analgesia (PCA). We studied the pain on a visual analogue scale at 12 and 24 h at rest and movement, the time elapsed to require the first bolus, and morphine bolus in 24 h. Secondary effects such as nausea, vomiting, pruritus, and drowsiness, were also evaluated. The level of patient satisfaction was also recorded.ResultsA total of 90 patients were included. At rest the 12/24 h VAS score was: group A, at 12 h 2.1 ± 1.2, at 24 h 4.7 ± 1.6; group B at 12 h 4.3 ± 2.9, at 24 h 4.8 ± 2; group C at 12 h 1.9 ± 1.09, at 24 h 2.3 ± 1.2 (P<.05). Walking improved analgesia more in group C (P≤.02). The time of asking for the first bolus was lower in group B: group A 9.3 ± 4.9 h (P=.02 compared to group C), in group B 2 ± 1.8 h (P<.001 compared to group C) and group C 13.2 ± 2.1 h. The number of bolus in 24 h in group B was 38 ± 5, in group A 10 ± 2 (P<.05), group C 5 ± 2 (P<.001). Delayed nausea was increased in group B (36.6%) and pruritus was greater in group A (36.6%).ConclusionsUltrasound (US)-guided TAP block improves spinal opioid analgesia, with a decrease in VAS scores in the first 24 h, and reduces opioid requirement and secondary effects after caesarean delivery.     

Conducta transfusional perioperatoria en la cirugía del cáncer gástrico: análisis del registro del grupo español EURECCA de cáncer esófago-gástrico

Introduction

This study evaluated allogenic packed red blood cell (aPRBC) transfusion rates in patients undergoing resection for gastric cancer and the implementation of blood-saving protocols (BSP).

La ratio de grosor diafragmático (inspiratorio/espiratorio) como método diagnóstico de parálisis diafragmática asociada al bloqueo interescálenico

Introduction

Diaphragmatic paralysis is a side-effect associated with interscalene block. Thickness index of the diaphragm muscle (inspiratory thickness/expiratory thickness) obtained by ultrasound has recently been introduced in clinical practice for diagnosis of diaphragm muscle atrophy. Our objective was to evaluate this index for the diagnosis of acute phrenic paresis associated with interscalene block.

Complicaciones postoperatorias y supervivencia del cáncer de esófago: análisis de dos periodos distintos

Introduction

Nowadays, treatment of esophageal cancer requires a multidisciplinary approach, in which esophagectomy remains the mainstay. The aim of this report is to assess whether multimodal treatment and minimally invasive surgery have led to a lower morbidity rate and an improvement in survival rates.

Evaluación del tratamiento del carcinoma epidermoide cutáneo de cabeza y cuello en la edad avanzada. Análisis de la supervivencia

Introduction

It is unknown whether cervical lymphadenectomy as a treatment for cutaneous squamous cell carcinoma of the head and neck (cSCCh&n) increases survival in elderly patients. The aim of this study is to determine whether this procedure has an influence on the survival of these patients, and whether the Short-Form Charlson Comorbidity Index (CCI-SF) can be used as an alternative to age in the surgeon's estimation of elderly patient mortality.

Validación del índice de salud prostática en un modelo predictivo de cáncer de próstata

Objectives

To validate and analyse the clinical usefulness of a predictive model of prostate cancer that incorporates the biomarker «[–2] pro prostate-specific antigen» using the prostate health index (PHI) in decision making for performing prostate biopsies.

Resección anterior ultrabaja con anastomosis mecánica en el tratamiento del cáncer de recto del tercio inferior

Tumors of the lower third of the rectum are a challenge for the surgeon. Among the various techniques of surgical treatment of these lesions, radical surgery and ultra low anterior anastomosis is one of the therapeutic options. This technique is a defy both in the evaluation of the potential patient as in the surgical technique. Such evaluation and treatment processes must be audited in order to keep proper quality indices both in the oncological as in their functional results. This is only possible when both the multidisciplinary and surgical teams have an adequate and ongoing specialized training and a satisfactory volume of patients treated. Details of this technique, its indications and results are reported in this paper.     

Bloqueo del plano del músculo erector de la columna en 4 casos de cirugía torácica videoasistida

Multimodal anaesthesia, combining epidural catheter and general anaesthesia, is a common technique in thoracic surgery, however, epidural catheter placement is not always possible.Recently, erector spinae plane block has been described, which provides analgesia like that of the epidural block, although unilateral, and which has been used in various procedures at thoracic level. At present, there are no studies comparing the efficacy or safety of this block with those commonly used in thoracic surgery. However, its safety profile and contraindications seem different from those of the epidural catheter, since its placement is done under ultrasound view, the needle introduction is done in plane and the ultrasound target, the transverse process, is easily identifiable and is relatively remote from major neural or vascular structures and the pleura. Unlike other blockages made by anatomical references, erector spinae plane block can be done with the patient in different positions.We describe our experience with erector spinae plane block as part of a multimodal anaesthetic approach in thoracic surgery.     

Tratamiento de las arritmias cardíacas refractarias mediante bloqueo del ganglio estrellado en un paciente. Acceso por técnica clásica y ecodirigida

Stellate ganglion block is a technique that is often used by anesthesiologists for the treatment of complex regional pain syndromes of the upper extremity. This technique interrupts cardiac sympathetic innervation and has been proposed as treatment for refractory arrhythmias.We present the case of a patient with arrhythmias that were refractory to pharmacological treatment, and were finally treated by continuous stellate ganglion block. Left stellate ganglion is a lynchpin of cardiac arrhythmias due to being a structure where the majority of postganglion sympathetic fibers responsible for preferentially innervating the atriventricular node, bundle of His and ventricular mass are originated, fundamentals in the origin and maintenance of ventricular arrhythmias.     

Utilidad clínica de la medición del área máxima del trazado del detrusor en el estudio urodinámico en el paciente pediátrico con vejiga neuropática: estudio piloto

IntroductionNeuropathic bladder (NB) is a lower urinary tract dysfunction (LUTD) that may lead to kidney failure. Urodynamic study is the gold standard for its diagnosis and follow-up. A classic prognostic parameter to predict the risk of upper urinary tract damage (UUTD) is the detrusor leak point pressure (DLPP) > = 40cmH2O, although this factor alone may lack prognostic value. The area under the curve (AUC) of the detrusor pressure tracing has been recently described as a prognostic factor.AimTo analyze the clinical utility of the AUC of the detrusor pressure tracing in the pediatric population (<15 years).MethodsRetrospective study of urodynamic recordings in pediatric population with NB from 2011 to 2020. The following variables were evaluated: detrusor leak point pressure > = 40cmH2O, voiding dysfunction, bladder compliance and overactivity. The sample is classified according to clinical-radiological findings at the time of the UD. AUC is calculated using Newton-Cotes rules (trapezium, Simpson's rule) and its indexes are calculated according to bladder capacity (TI: Trapezium Index, SI: Simpson Index). Statistical significance: P<.05.ResultsFifty-five recordings are analyzed. Unfavorable clinical condition was identified in 41.8% (n = 23) patients. Voiding dysfunction, low compliance and both indexes were associated with an unfavorable clinical condition (P<.05). ROC analysis showed the following AUC for the new indexes: TI (0.736, P=.0006), SI (0.755, P=.0001) with a cut-off value of 10,69 and 8 cmH2O s/cc, respectively. We did not find differences in the diagnostic performance between them (P>.05).ConclusionsThe analyzed indexes are useful in the diagnosis of patients with NB and unfavorable clinical condition.