Análisis de nuestra experiencia en la criopreservación del semen en pacientes oncológicos

ObjectiveTo analyze the characteristics of patients with oncological problems who were users of the sperm bank, as well as use of cryopreserved semen.Materials and methodsA retrospective analysis was made of all cryopreserved semen samples from males diagnosed with cancer from April 1992 to October 2007 at the province of Las Palmas.ResultsOne hundred and one male patients with cancer were referred to the sperm bank before cancer therapy. Eighty percent of them were contacted by telephone. Mean freezing age was 25 years. Forty-one percent of patients had testicular tumors. Thirty-three percent had no prior biological children. Only one patient had known fertility problems before treatment. Sixty-seven percent of patients were warned by the healthcare team about the possibility of infertility at the time of cancer diagnosis. Only 1% of samples were not adequate for cryopreservation. The frozen sample was used by 4% of the patients. When patients were asked about future use of semen, 63% of them wanted to continue with semen cryopreservation, as compared to 17% who had no interest in having offspring in the future.ConclusionThe number of fertile patients who cryopreserve semen is extremely low. It is very important that the healthcare team warns patients of potential infertility after treatment. A high proportion of patients have valid samples for cryopreservation, but semen is used by a low number of patients. A high proportion of patients want to maintain their semen frozen.     

Formación del residente en cirugía laparoscópica en coloproctología: análisis retrospectivo de morbimortalidad y pronóstico oncológico sobre 408 pacientes en nuestro centro

IntroductionColorectal cancer has a growing incidence in our society. However, the performance of laparoscopic interventions in this field is still not included in the National Training Program. Given the lack of references, our objective was to analyze the resident's participation in laparoscopic colorectal surgery and its possible effect on morbidity and mortality and oncological prognosis.MethodsA retrospective longitudinal single-center study that included all laparoscopic colorectal surgical procedures performed by residents (R group) and by attending surgeons (A group) between 01/01/2009 and 12/31/2017, maintaining follow-up until 12/31/2018. Postoperative morbidity and mortality, overall survival (OS) and disease-free survival (DFS), as well as their relationship with the resident involvement as first surgeon were analyzed.Results408 patients were analyzed, of which 138 (33.8%) were operated by a supervised resident and 270 (66.2%) by the attending surgeon. No differences were detected in the rate of postoperative complications between both groups (OR: 1.536; 95% CI: 0.947-2.409; p=0.081). Furthermore, resident participation had no influence on tumor recurrence rate (R Group: 14.2% vs. A Group: 16.9%; p=0.588) or on overall (p = 0.562) or disease-free survival (p = 0.305).ConclusionResident involvement in laparoscopic colorectal surgery had no influence on morbidity and mortality or oncological prognosis in our center. Conducting prospective studies in this regard will provide greater knowledge, enabling a progressive improvement of the training program.     

Valor pronóstico del ratio nodal en el cáncer gástrico: análisis unicéntrico de 199 pacientes

IntroductionIn the gastric cancer the most widely used classification is the AJCC TNM system. However, it presents limitations, such as staging migration in cases with suboptimal lymphadenectomies. The nodal ratio has been proposed as an alternative system, proving to be a good prognostic predictor of survival. The aim was to assess the influence of the nodal ratio measured in tertiles [tNR] as a prognostic factor and compare with the TNM systems (7th ed.) and log odds of positive lymph nodes [LODDS].Material and methodsRetrospective and single-center study on 199 patients operated on with curative intent between 2010 and 2014. For each system an univariate and multivariate analysis was performed and the overall survival rates [OS] were compared by the ROC test.ResultsThe prognostic factors that showed statistical significance in the multivariate analysis were: tNR2 (HR 2.87) and tNR 3 (HR 7.29); LODDS 2 (HR 1.55), LODDS3 (HR 2.6) and LODDS4 (HR 4.9); pN2 (HR 1.84) and pN3 (HR 2.91). The 5-year OS was 75.8, 61.4, 25.8 and 3.84% for tNR0, tNR1, tNR2 and tNR3; 72.4, 60, 29.1 and 13.9% for LODDS1, LODDS2, LODDS3 and LODDS4; and 77.6, 59.4, 28.8 and 25.5% for pN0, pN1, pN2 and pN3, respectively. The three systems behaved as good predictors, with areas under the curve >0.75.ConclusiontNR was an independent prognostic factor for estimating survival in gastric cancer. Furthermore, the ease of its calculation in clinical practice could reduce the effect of staging migration.     

Afectación cerebrovascular isquémico-hemorrágica en pacientes con covid-19

Coronavirus associated severe acute respiratory syndrome (SARS-CoV-2) causes a worldwide syndrome called Covid-19 that has caused 5,940,441 infections and 362,813 deaths until May 2020. In moderate and severe stages of the infection a generalized swelling, cytokine storm and an increment of the heart damage biomarkers occur. In addition, a relation between Covid-19 and neurological symptoms have been suggested. The results of autopsies suggest thrombotic microangiopathy in multiple organs. We present 2 cases of patients infected with severe Covid-19 that were hospitalized in the Reanimation Unit that presented cerebrovascular symptoms and died afterwards. A high dose prophylaxis with antithrombotic medication is recommended in patients affected by moderate to severe Covid-19.     

Tratamiento del dolor irruptivo con fentanilo sublingual en pacientes con úlceras cutáneas crónicas

ObjectiveThe aim of the study was to assess the efficacy and safety of opioids in the management of pain in those patients with chronic cutaneous ulcers and breakthrough/incidental pain.Material and methodAn open-label, multicentre, prospective, uncontrolled study was conducted in the pain and ulcer units of 5 hospitals across the Comunidad Valenciana. Eligibility criteria were baseline pain 4 in the visual analogue scale or breakthrough procedural pain 4. Exclusion criteria were cognitive impairment, opioid intolerance, or patient refusal to provide informed consent. The protocol scheduled 5 controls: baseline (enrolment), 15 days, one month, 2 months, and 3 months. The main outcome measure of the study was the visual analogue scale score during rest, movement and procedures. Opioids were administered for release of the baseline pain, and sublingual fentanyl for breakthrough pain.ResultsA total of 32 patients (86.5%) completed the study. Baseline pain achieved a mean improvement of 3.6 visual analogue scale points (SD 2.3), movement pain improved by 3.9 points (SD 2.5) and procedural pain improved by 4.5 points (SD 2.8), and the mean pain intensity improvement was statistically significant from the first control and at all controls thereafter (P < .001). Nausea was reported by 14 patients (43.8%), drowsiness and constipation by 7 (21.9%), itching by 5 (15.6%), and one (3.1%) reported vomiting.ConclusionsStructured assessment of pain is a key concept in the management of patient with chronic cutaneous ulcers. The results of this study suggest that opioid therapy provides clinically significant pain relief with few adverse effects.     

Quimioterapia con estramustina en el manejo del cáncer de próstata resistente a la castración: metaanálisis de ensayos controlados aleatorizados

ObjectiveEstramustine, an agent with both hormonal and non-hormonal effects in men, is supposed to be effective in treating castration-resistant prostate cancer. However, previous studies have reported conflicting results. We conducted this meta-analysis to evaluate the efficacy and toxicity of additional estramustine to chemotherapy.MethodsData sources including PubMed, Medline, EMBASE, and Cochrane Controlled Trials Register were searched to identify potentially relevant randomized controlled trials. Prostate specific antigen (PSA) response, overall survival, and grade 3 to 4 toxicity were analyzed.ResultsSeven randomized controlled trials, a total of 839 patients, were enrolled. The pooled odds ratio for PSA response was 3.02 (95% CI = 1.69-5.39, P = .0002); the pooled hazard ratio for overall survival was .95 (95% CI = .80-1.14, P = .58); the pooled odds ratio for nausea/vomiting and cardiovascular toxicity were 3.90 (95% CI = 1.05-14.45, P = .04) and 2.22 (95% CI = 1.15-4.30, P = .02). No significant difference was detected for neutropenia, anemia, thrombocytopenia, diarrhea, fatigue, or neuropathy (P > .05).ConclusionsAccording to this meta-analysis, chemotherapy with additional estramustine increased the PSA response rate. However, it increased the risk of grade 3 or 4 adverse effects such as nausea/vomiting and cardiovascular events, and the overall survival was not improved for castration-resistant prostate cancer patients.     

Validación en España del cuestionario de calidad de vida PROSQOLI en pacientes con cáncer de próstata avanzado

ObjectivesValidation of the PROSQOLI questionnaire adapted to Spanish, pursing an instrument to evaluate, in the common clinical practice, the quality of life in patients with locally advanced or disseminated prostate cancer in our country.Material and MethodsA cross-sectional prospective study was designed in 750 patients (150 centers) with disseminated or locally advanced prostate cancer (TNM criterion) who came to the scheduled check-up. Socio-demographic and clinical data of the participants were collected. The subjects filled out the PROSQOLI and EQ-5D questionnaires. The analysis included 561 cases that met the selection criteria. The psychometric characteristics (feasibility, validity and reliability) of the adapted PROSQOLI questionnaire were studied.ResultsMean age was 73.63 (7.59) years. A total of 72.01% of the participants had locally advanced disease. In 28.16%, the primary treatment was radiotherapy, in 12.30% it was prostatectomy. A total of 83.48% received hormone treatment. The mean for each scale of the PROSQOLI questionnaire varied from 68.86 to 74.51. The percentage of no response was less than 3% for each scale. The percentage of subjects with minimum score in any scale was negligible, and the maximum score did not surpass 5%. Mean time to fill out the questionnaire was 109.42 (101.00) seconds. Cronbach's α coefficient was 0.937 and the total item correlation was superior to 0.7 for all the items. Correlations with the EQ-5D questionnaire were moderate. Scores on the questionnaire were associated to all the parameters studied related to the disease.ConclusionsThe adapted questionnaire has adequate psychometric properties for its use in research and in the clinical practice.     

Desarrollo de enfermedades concomitantes en pacientes críticos con COVID-19

It may be necessary a consideration about the best approach to the acute concomitant problems that critical COVID-19 patients can develop. They require a rapid diagnosis and an early treatment by a multidisciplinary team. As a result, we would like to describe two clinical cases a patient with diagnosis of COVID-19 pneumonia with good respiratory evolution that, after extubation suffered an acalculous cholecystitis and a patient with COVID-19 pneumonia that suffered an overinfection with necrotising pneumonia that presented with haemoptysis and was finally treated with arterial embolisation by the interventional radiologist's team.     

Papel del índice neutrófilo/linfocito en pacientes con cáncer de próstata resistente a castración metastásicos tratados en primera línea con abiraterona

IntroductionIn patients with prostate cancer, high NLR seems to be associated with worse survival. Abiraterone acetate (AA) is a new generation hormonal treatment that has shown to increase PFS and OS in mCRPC.Material and methodsRetrospective analysis of patients treated with AA in our center (December 2012-September 2018). We analyzed the association of the NLR (< or ≥ 3) before and after 6 months of treatment with PSA response, PFS, OS, and hormone sensitivity prior to AA (< or > 12 months).ResultsWe have treated 56 patients with a median age of 82 (62-94), of which 22 (39%) had NLR ≥ 3 before treatment.There is a statistically significant association between the NLR prior to treatment < 3 and PSA response, OR = 9,444, P=.001, and there was no association with the NLR at 6 months of treatment.Statistically significant differences were found between the groups of NLR < and > 3 prior to treatment with abiraterone in PFS with 15 months of median vs. 9 and P=.008, and in OS with 20 months vs. 9 with P=.014.With respect to the determination of NLR at 6 months, there are no differences in the survival curves between both groups.There are significant differences between the NLR prior to treatment according to the length of hormone sensitivity (P=.026).ConclusionsOur results suggest that NLR could provide relevant information and could act as an early and accessible prognostic marker in patients with mCRPC in first line treatment with Abiraterone.     

Factores pronósticos del tratamiento endoscópico del reflujo vesicoureteral en pacientes con lesión medular

IntroductionVesicoureteral reflux (VUR) is an important complication in patients with spinal cord injury due to its frequency and morbidity. One of the most extended therapeutic options is endoscopic injection of obliteration substances in the urethral meatus.ObjectiveTo analyze the prognostic factors of VUR treatment using obliterative substances in patients with spinal cord injury.Material and methodsA prospective study was performed in a cohort of 76 patients (age 48.9 ± 14.4 years), of both genders, with spinal cord injuries, who underwent endoscopic treatment of the VUR during the years 2008 to 2011. In all the patients, a clinical history was obtained and a pre-operative videourodynamic study was performed. Another study was carried out at 7.32 months (standard deviation: 6.28 months) of the intervention. Treatment consisted in endoscopic injection of dextranomer/hyaluronic acid copolymer (62 cases) and polydimethylsiloxane (14). The statistical tests applied were the Fisher's exact test and the Student's T test comparing the means. Bilateral significance level was established at 95%.ResultsResolution of VUR was achieved in 46 cases (61%). The statistically significant prognostic factors were age (younger aging cured patients), bilaterality and reflects great (greater grade in bilaterality in the cases with persistence of reflux) and presence of neurogenic detrusor overactivity (greater percentage in the cases of reflux persistence). Stress urinary incontinence (greater percentage in cured patients), contractile potency (lower percentage in cured patients) and urethral resistance (greater percentage in cured patients) were also statistically significant prognostic factors.ConclusionsAmong the prognostic factors that affected the endoscopic treatment results of the VUR in patients with neurogenic lower urinary tract dysfunction (NLUTD), anatomical as well as functional factors were found.     

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).

Intubación en dos pacientes con vía aérea difícil y estenosis traqueal tras traqueostomía en cirugía torácica

Lung isolation in thoracic surgery is a challenge, this is even more complex in the presence of unknown tracheal stenosis (TS). We report two cases of unknown TS and its airway management. TS appears most frequently after long term intubation close to the endotracheal tube cuff or in the stoma of tracheostomy that appears as a consequence of the granulation tissue after the surgical opening of the trachea. Clinical history, physical examination, difficult intubating predictors and imaging tests (CT scans) are crucial, however most of tracheal stenosis may be unnoticed and symptoms depend on the degree of obstruction. In our cases, the patients presented anatomical changes due to surgery and previous tracheostomy that led to a TS without symptoms. There is scarce literature about the intubation in patients with previous tracheostomy in thoracic surgery. In the first case, a Univent^® tube was used using a flexible fiberscope but an acute tracheal hemorrhage occurred. In the second case, after intubation with VivaSight SL^® in an awake patient, the insertion of a bronchial blocker was performed through an endotracheal tube guided by its integrated camera without using flexible fiberscopy.     

Impacto de la prostatectomía radical en los resultados urodinámicos de pacientes con cáncer de próstata tratados con radioterapia de intensidad modulada

Introduction and objectivesTo evaluate the effect of radical prostatectomy and age on urodynamics before and after intensity-modulated radiation therapy administered to prostate cancer patients.Materials and methodsThe sample consisted of 40 prostate cancer patients, 22 of whom had undergone a radical prostatectomy. Urodynamic parameters before and after an average of 4.2 months of radiotherapy were measured and compared. External radiotherapy was administered via Volumetric Modulated Arc Therapy (VMAT), Intensity Modulated Radiation Therapy (IMRT) techniques.ResultsUroflowmetry presented no significant parameters. In the case of Cystomanometry, the data did not show an increase in secondary stress urinary incontinence, although there is 7 percent increase in urge urinary incontinence. There were statistically significant changes in reduced bladder capacity with a strong desire to void, with an urge to void and also in the detrusor pressure with a normal desire to void. Furthermore, pressure/flow analysis revealed a statistically significant reduction of residual urine volume.ConclusionsThe effect of prostatectomy and age varies according to the evolution of urodynamics. There was a significant reduction in terms of residual urine volume and detrusor pressure with a normal desire to void in patients without a prostatectomy and in those under 75 years old. In addition to an increase in urge incontinence, there was also a significant worsening of the bladder filling urodynamics and a decrease in the cystomanometric bladder capacity with a strong desire and an urge to void. None of these were modified by age or prostatectomy.