Diagnóstico prenatal complejo

Figura 1 – Imagen de la ecografía prenatal en la que se observa la silueta renal de grandes dimensiones; en la parte más caudal se observa el aspecto hiperecogénico del seno renal rodeado de parénquima normal, y en la parte más superior se observa imagen anecoica compatible con ectasia rodeada de parénquima.Figura 2 – CUMS: reflujo vesicoureteral grado ii en el lado izquierdo, en el pielón inferior.

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Rendimiento del sistema Bethesda en el diagnóstico citopatológico del nódulo tiroideo

Introduction

Fine-needle aspiration biopsies are a key tool for preoperative assessment of thyroid nodules, and the Bethesda system is the preferred method to report cytological analysis. The purpose of this study is to assess the efficiency of the Bethesda system to identify the malignancy risk of thyroid nodules.

Uro-TAC en el diagnóstico de pequeñas litiasis

Figura 1 – Paciente de 37 años con clínica sugestiva de cólico renal izq. con dilatación del sistema pielocalicial y de la vía excretora, sin causa objetivada en la urografía intravenosa.Figura 2 – Solicitamos estudio mediante Uro-TAC visualizando una litiasis de 1,2 mm en uréter distal izq. que es la causa de la obstrucción de la vía excretora.

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Evolución y pronóstico a medio y largo plazo de los tumores vesicales superficiales

ObjetivesTo evaluate the outcome of 551 patients with superficial transitional cell carcinomas of the bladder. To determine prognostic factors in these patients by means of the log-rank analysis of the Kaplan-Meier curves and a multivariate analysis with Cox regression model for the disease free survival (DFS), time to progression to infiltrating lesions (TTP) and overall survival (OS)Material and methodsBetween 1983 and 1998 we have seen 551 patients with superficial transitional cell carcinomas of the bladder in our Hospital. Fifteen patients included in this series had been diagnosed in other hospitals before 1983. The clinical records were actualized between 1998 and 2000 and only 21 patients were lost to follow-up (3,8%). The mean follow-up time was 6,2 years (median time: 5,3). One hundred and eleven patients (20%) died with a mean of 4,5 years (median time 3,4). Four hundred and forty patients were still alive on completion of the study with a mean follow-up time of 6,6 years (range 2-24 years; median 5,7)ResultsFour hundred and fifty-nine patients were men (83%) with a mean age of 64 years and 92 were women (17%) with a mean age of 70 years. In 347 patients there was only one tumour (63%). The tumours were stage Ta in 79 cases (14%), T 1 in 431 (78%) and Tis in 41 (7%). The histological grade was G 1 in 406 cases (74%), G 2 in 96 (17%) and G 3 in 33 (6%)There were recurrences in 253 patients (46%) with a mean time of 2.2 years. The DFS was 55% at 5 years, 44% at 10 years and 38% at 15 years. The multivariate analysis has shown a negative prognostic influence on DFS of the presence of multiple tumours (RR 1.4 CI 1.19-1.69), increasing age (analysed as a continuous variable) and the sex (being worse for females; RR 1.2 CI 0.98-1.52)In 40 patients (7.3%) the tumour became infiltrative in a mean of 3.3 years. The TTP was 93% at 5 years, 91% at 10 years and 90% at 15 years. The negative prognosticators in the multivariate analysis were G 3 tumour (RR: 5.1 CI 2.7-9.6), the group of tumours Ta-T 1 G 3 or multiple T 1 G 2 or Tis (RR 4.6 CI 2.6-7.9) and the age>70 years (RR 2.14 CI 1.2-3.7)Thirthy-one patients (5.6%) died of the tumour in a mean time of 4.6 years. The OS was 95% at 5 years, 93% at 10 years and 91% at 15 years. Significant prognosticators in the multivariate analysis for OS were the group of risk tumours Ta-T 1 G 3 and multiple Tis or T 1 G 2 (RR 5 CI 2.7-9) and age>70 years (RR 4.56 CI 2.2-8.8)ConclusionsThe recurrence rate is very high in all the patients, but the risk is highest when the tumours are multiple. The risk of progression is low, but still exits even in patients with tumours of low malignant potential. The highest risk is associated with Ta-T 1 G 3 of Tis or multiple T 1 G 2     

La leucocitosis extrema puede inducir a un diagnóstico erróneo de hipoxemia severa. Descripción de un caso

The diagnosis and treatment of respiratory failure is a part of the anaesthesist's daily practice, as well as the hypoxaemia that is one of its physiological and analytical consequences. Patients with an extreme leucocytosis secondary to leukaemia can suffer an incorrect diagnosis of hypoxemia, called “pseudohypoxaemia”. This is basically due to the rapid in vitro oxygen consumption, and is characterized by a low partial pressure of oxygen in arterial blood (PaO₂) despite a normal oxygen saturation (SpO₂) measured by pulse oximetry. Pseudohypoxaemia appears in patients with thrombocytosis or hyper-leucocytosis occurring during blastic crisis of a leukaemia. It must be suspected in patients with a discrepancy between the SpO₂ measured by oximetry and the PaO₂. In this context, pulse oximetry is the most accurate way to establish the diagnosis and to avoid unnecessary actions. We report the case of a patient with chronic myeloid leukaemia and extreme leucocytosis requiring emergency surgery, and diagnosed with pseudohypoxaemia during the perioperative period that led to a delay in the extubation of the patient.     

Impacto de la resección no planificada y la reintervención de sarcomas de partes blandas en su pronóstico

IntroductionUp to 40% of all initial operations for soft tissue sarcoma (STS) are unplanned, which would leave residual macroscopic tumor in more than 50% of the cases. The effect this has on local recurrence rate, metastases rate and survival has never been fully established, due to the lack of randomized studies.MethodsRetrospective review of patients with STS treated in our unit between January 2001-January 2016. We classified them whether they had been treated by initial planned or unplanned operation. Outcomes were compared in both groups globally and stage-matched. Endpoints were local recurrence and distant metastases.ResultsTwenty-three patients of STS underwent a planned excision and 16 an unplanned excision, 13 of them underwent further re-excision. 40% of patients with planned excision had an advanced stage in regard to the unplanned excision group which presented earlier stages. 77% of patients with unplanned excision had residual tumor identified after surgical re-excision. Local recurrence rate in the unplanned excision group was considerably higher 73,5% vs. 43,8%. Metastases rate was lower in planned excision group, 45,5% vs 56,3% (P > .05). The recurrence pattern in the unplanned excision group was unstable, with worse outcomes in earlier stages.ConclusionThe unplanned excision of a soft tissue sarcoma may compromise disease local control, with higher rates of local recurrence and metastases, and worse functional out- comes, despite further oncological treatment. We need to recognize the clinical features for malignancy risk in soft tissue lumps for a safe diagnosis to avoid inadequate resections.     

Diagnóstico intraoperatorio de red de Chiari basado en ecocardiografía

We report a case of a Chiari network as a possible cause of intraoperative supraventricular tachycardia with potential cardiac flow obstruction and hemodynamic collapse. The intraoperative diagnostic analysis considered detects cardiac abnormalities associated to this congenital remnant and discard common intraoperative causes of hemodynamic alterations.     

Marcadores inflamatorios como factor pronóstico en el cáncer de próstata resistente a la castración metastásico

IntroductionInflammatory markers have prognostic value in various tumors due to the role of inflammatory phenomena at different stages of tumor development. The aim of this study is to demonstrate the prognostic value of these markers, as well as other clinical and analytical variables in patients with metastatic castration-resistant prostate cancer (mCRPC).Material and methodsProspective cohort study carried out on 80 patients diagnosed with mCRPC. Clinical and analytical data were collected, and the following inflammatory markers were estimated: Absolute Neutrophil Count (ANC), Neutrophil-Lymphocyte Ratio (NLR), Total Platelet Count (TPC), Platelet-Lymphocyte Ratio (PLR), Lymphocyte-Monocyte Ratio (LMR) and Systemic Inflammation Index (SII). The values of albumin, hemoglobin (Hb), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were also determined.ResultsPatients with ANC>7500, NLR>3, PLR>150, LMR>3 and/or SII>535,000, presented significantly lower median survival time than the remaining patients, and TPC was the only marker which did not show a significant association. Moreover, NLR, PLR and SII were inversely correlated with survival time. Patients with hypoalbuminemia, anemia, and elevated LDH values had significantly lower median survival time. Albumin and hemoglobin were directly correlated to overall survival time. The need for analgesia was also associated with shorter survival.ConclusionThe values of certain inflammatory markers are associated with shorter survival time in patients with mCRPC, and their use in clinical practice can be considered to evaluate the prognosis and estimate survival.     

Valor pronóstico de la ploidía del adn en el cáncer de próstata

ObjetiveTo asses the prognostic value of deoxyribonucleic acid (DNA) ploidy in a group of patients with prostate cancer treated with adrogenic blockadeMaterial and methodA retrospective study on 136 patients with prostatic cancer having undergone androgenic blockade was carried out. The prognostic influence of age, T and M categories, Gleason score and flow cytometry-determined DNA ploidy from survival analyses. Univariate survival analysis was carried out following Kaplan-Meier’s method, while for multivariate survival analysis Cox’s proportional hazard model was usedResultsThe univariante analysis showed that T and M categories, Gleason score and DNA ploidy have prognostic value. The Cox’s regression analysis identified DNA ploidy, metastasis and Gleason score as independent variables having prognostic potentialConclusionsDNA ploidy has independent prognostic value in prostate cancer treated with androgenic blockade and improves the predictive potential of classical prognostic factors     

Colitis isquémica. ¿La localización en el colon derecho tiene peor pronóstico?

IntroductionMost patients with ischemic colitis have a favourable evolution; nevertheless, the location in the right colon has been associated with a worse prognosis. The purpose of this study is to compare the clinical presentation and results of right colon ischemic colitis (CICD) with ischemic colitis of other colonic segments (non-CIDC).MethodsRetrospective, observational study of patients admitted to our hospital with ischemic colitis between 1993 and 2014, identified through a computerized search of the ICD9 codes. They were divided into 2 groups: CICD and non-CICD. Comorbidities, clinical presentation, need for surgery, and mortality were compared. Multivariate analysis was performed using logistic regression adjusting for age and sex. Statistical significance was established at a value of P < 0.05.ResultsA total of 204 patients were identified, 61 (30%) with CICD; 61% of CICD patients required surgery compared to 22% of non-CICD patients (P < 0.001). Post-surgical mortality (32 vs. 55%) and overall mortality (20 vs. 15%) differences were not statistically significant. CICD patients had more commonly unfavourable outcomes than non-CICD patients (61 vs. 25%, P < 0.001). The odds ratio (OR) for surgery was 5.28 and 4.47 for unfavourable outcomes for patients with CICD.ConclusionsCICD patients have a worse prognosis than non-CICD patients, 5 times more likely to need surgery and 4 times more likely to have unfavourable outcomes.     

Pronóstico y predictores de mortalidad de los pacientes ancianos críticos

Objectives

to evaluate mortality of patients ≥ 80 years admitted to the Surgical Intensive Care Unit (SICU), global hospital mortality and factors related to it.

Diagnóstico,manejo y tratamiento de las lesiones cervicales traumáticas

Trauma injuries to the neck account for 5-10% of all trauma injuries and carry a high rate of morbidity and mortality, as several vital structures can be damaged. Currently, there are several treatment approaches based on initial management by zones, initial management not based on zones and conservative management of selected patients. The objective of this systematic review is to describe the management of neck trauma.     

Unidades Hounsfield: una herramienta no invasiva prometedora para el diagnóstico de la hiperplasia benigna de próstata

ObjectiveThe clinical symptoms in benign prostatic hyperplasia (BPH) are directly proportional to prostate volume. We aimed to show whom and when to intervene in a noninvasive way, correlating the patient's subjective symptoms with objective diagnostic tools.Material and methodInternational Prostate Symptom Score (IPSS) was evaluated in patients who consulted the urology outpatient clinic for the first time with lower urinary tract symptoms (LUTS). Subsequently, PSA, urea, creatinine, complete urinalysis, uroflowmetry, urinary tract ultrasound and non-contrast lower abdominal computed tomography (CT) examinations were requested. Prostate central (transitional zone) zone and peripheral zone HU scores, prostatic urethral length and bladder wall Hounsfield units (HU) scores were recorded by using computed tomography (CT). The ellipsoid formula was used for ultrasonographic and tomographic measurements of prostate size (anteroposterior diameter × transverse diameter × longitudinal diameter × 0.52).ResultsA statistically significant negative correlation was found between the prostate peripheral zone/central zone HU ratio and the maximum flow rate measured in the uroflowmetry test.ConclusionThis is the first study in the literature to evaluate the correlation between voiding parameters such as Qmax, Qave and IPSS scores, and prostate and bladder wall HU scores obtained by computed tomography examination in BPH patients. A significant relationship has been detected between the peripheral zone/central zone HU ratio and Q max. Additional studies with larger patient populations could better clarify the contribution of HU in the diagnosis of BPH and treatment decision making of these patients.     

Evaluación del test PCA3 para el diagnóstico de cáncer de próstata: revisión sistemática y metanálisis

ObjectiveTo assess the efficacy of diagnostic techniques based on PCA3 gene for early detection of prostate cancer. We carried out a systematic review of scientific literature and subsequent meta-analysis.Material and methodsA literature search (2000–09) in MEDLINE, EMBASE, Cochrane Library, CRD, ECRI, Hayes databases and journals of Cancer and Urology. MESH terms used were "Prostatic Neoplasms", Prostate-Specific Antigen", "Antigens, Neoplasm", "Sensitivity and Specificity", "Predictive Value of Tests", and free terms "upm3", "PCA3", "dd3", "aptima PCA3" and "prostate cancer antigen 3". Patients were adults. The intervention was to determine the PCA3 gene, from urine samples for diagnosis of prostate cancer. The quality of the studies was checked according to QUADAS criteria. We calculated diagnostic accuracy rates and developed a meta-analysis to synthesize results.Results14 studies of diagnostic tests were selected, with moderate-high quality. The sensitivity was between 46.9% and 82.3%, specificity ranged from 56.3% to 89%, positive predictive value had a range of 59.4–97.4% and negative predictive value 87.8–98%. The meta-analysis detected the existence of a threshold effect and heterogeneity between studies. Global sensitivity values was 0.85 [CI 0.84–0.87], specificity 0.96 [CI 0.96–0.97], positive likelihood ratio 22.21 [CI 15.12–32.63], and negative of 0.15 [CI 0.13–0.18].ConclusionsDetection techniques have acceptable diagnostic accuracy rates for using in the diagnosis of prostate cancer.     

Complicaciones intraoperatorias y postoperatorias de la cirugía de prótesis de pene. Diagnóstico y tratamiento

We describe the most frequent complications associated with penile implant surgery, paying special attention to their practical management. We have analyzed preoperative complications and postoperative complications separately. The intraoperative include perforation of the corpora cavernosa during dilation, cylinder cross-over or cross-placement and urethral injury during implantation. The most frequent postoperative complications are mechanical failure, cylinder erosion and prosthesis infection. We emphasize on rescue surgery and reimplantation techniques in cavernous tissue fibrosis.