1000 trasplantes hepáticos consecutivos. Análisis descriptivo y evolución de un centro

Between 1991 and 2013, 1,000 liver transplantations were performed at Virgen del Rocio Hospital (Seville, Spain). A retrospective study was conducted, analyzing the characteristics of recipients and donors, indications, surgical technique, complications and survival in 2 different stages (1991-2002 vs. 2003-2013) coinciding with the implementation of the MELD scale as a prioritization model. The most frequent indication were of hepatopathy of hepatocellular origin in 48.8%. There was a significant increase in the indications for hepatocarcinoma (8.6% and 24.1% P = 0.03), and the rate of retransplantation (5.9% vs 9.6%, P = 0.04). There was a change in the age of donation, going from 27.7 years in 1990 to 62.9 years in 2012 (P = 0.001). The percentage of patients who did not require blood transfusion doubled (6.16 vs. 14.31%, P = .001). Survival of all patients after one, 5 and 10 years was 77, 63.5 and 51.3%, respectively.     

Complicaciones de la quimioembolización transarterial (QETA) en el tratamiento de los tumores hepáticos

Introduction

Transarterial chemoembolization (TACE) is considered a therapeutic option. It is mostly used in hepatocellular carcinoma or liver colorectal, neuroendocrine or melanoma metastases. Although it is considered a safe procedure, TACE presents complications, such as acute cholecystitis, which is the most common. Other procedure-related complications include pulmonary embolism, hepatic abscess, bile duct injury, gastric mucosa injury and, less frequently, acute pancreatitis. The aim of this study is to review the complications following TACE for liver tumors.

Trasplante hepático con injerto de donante en asistolia tipo 2 con perfusión regional normotérmica y máquina de perfusión normotérmica

Background

The current imbalance between donor supply and patients on the waiting list for liver transplantation (LT) is significant. To resolve this situation, marginal organs, such as those from type 2 donation after cardiac death (DCD2), are being considered.

Predicción de hipocalcemia postiroidectomía mediante determinación de PTH rápida

IntroductionHypocalcemia is the most frequent complication after thyroidectomy. The aim of this work is to identify biochemical risk factors of hypocalcemia using quick perioperative (pre and post-thyroidectomy) intact parathyroid hormone (PTHi) and postoperative calcemias.MethodsIn a consecutive series of 310 total thyroidectomies, samples of quick PTHi at the anaesthetic induction and 10 minutes after surgery, together with serum calcemias every 12 hours were obtained. The sensitivity, specificity, positive and negative predictive value are analyzed and related to hypocalcemia. A control group of hemithyroidectomies is also analyzed to compare the effects of surgery on PTH secretion.ResultsOf the 310 patients, 202 (65.1%) remained normocalcemic and asymptomatic (group A), 108 (34.9%) presented hypocalcemia (Group B), requiring oral calcium (79 symptomatic). After analysis of several cut-off points, combining a PTHr drop gradient of 60% or calcemia inferior to 7.4 mg/dl at 24 hours, a sensitivity of 100% is achieved without leaving false negatives. Compared to the control group, there is a significant difference with respect to the post-operative calcemias and PTHr, p < 0.001.ConclusionsTotal thyroidectomy affects parathyroid function with evident decrease in rPTH and risk of hypocalcemia. The combination of PTHr decrease of 60% or less than 7.4 mg/dl calcemia at 24 hours gives a 100% sensitivity for predicting patients at risk of hypocalcemia.     

La 8.ª edición de la clasificación AJCC-TNM: nuevas aportaciones a la estadificación del cáncer de la unión esofagogástrica

The new 8th edition of the TNM classification system for esophageal and cardia or esophagogastric junction cancer provides important innovations in the TNM stages. Two classifications are presented, updated by stages, clinical (cTNM) and pathological (pTNM) methods, together with another pathological classification applicable to cases receiving neoadjuvant treatment (ypTNM). There is a notable increase in complexity compared to previous versions, but it is still early to determine whether the current modifications will result in a clear improvement in the prognostic discrimination of survival among the patient groups (which is their main objective), although the initial expectations are favorable.     

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.     

Resección robótica del lóbulo hepático caudado: descripción técnica y consideraciones iniciales

Introduction

Firstly described in 2002, the robotic liver surgery has not spread widely due to its high cost and the lack of a standardized training program. Still being considered as a ‘development in progress’ technique, it has however a potential to overcome the traditional limitations of the laparoscopic approach in liver interventions.

Predicción de resultados de cistoscopias en la práctica

ObjectiveOur objective was to elaborate a predictive model of bladder cancer, in an unselected clinical population submitted to cystoscopy.Materials and methodsWe recruited consecutive patients that underwent cystoscopy due to suspicion of bladder cancer or surveillance of a previously diagnosed bladder cancer. Urine cytology and a BTA-stat® (BTA) test were carried out for all patients. To avoid an assessment bias, the BTA-tests, cytologies and cystoscopies were conducted in a blinded fashion. We used logistic regression to predict cystoscopy results from cytology, BTA-test and clinical variables.ResultsFrom August 2011 to July 2012, we recruited 244 patients and 237 were valid for analysis. Newly diagnosed and surveillance cases were 13% and 87% respectively. Cytology and BTA-test sensitivities were 57.9% (CI 95: 42.2-72.1) and 63.2% (CI 95: 47.3-76.6) with specificities of 84.4% (CI 95: 78.7-88.8) and 82.9% (CI 95: 77.1-87.5). The predictive model included the BTA-test, cytology, time since previous tumour, and treatment with mitomicin or BGC during the last three months. The model predictive accuracy (AUC) was .85 (.78-.92), and dropped to 0.79 when excluding the BTA-test (P = .026). For the surveillance of bladder cancer, a 10% threshold on the model predicted probabilities resulted in an overall negative predictive value of 95.7%, and 95.0% in low grade tumours.ConclusionIn a cost containment environment, our prediction model could be used to space out cystoscopies in patients with previous, low grade tumours, resulting in a more efficient use of resources in the healthcare system.     

Patrón de presentación del cáncer de próstata avanzado en pacientes menores de cincuenta años

ObjectiveTo identify the clinical features, diagnostic approach, and treatment of metastatic prostate cancer in young adult patients.MethodsA retrospective review was made of the clinical histories of patients under 50 years of age diagnosed with prostate cancer at the urology department of the National Institute for Neoplastic Diseases from 1952 to 2005. Demographic characteristics and data on history, symptoms, diagnostic procedures, treatment, and disease course were collected. Data were statistically analyzed and compared to information obtained from a literature search.ResultsThere were 69 patients aged less than 50 years who had been diagnosed with prostate cancer, 60% of whom had metastatic tumors. Mean patient age was 45.5 years, with a lower range of 29. All patients reported bone pain, associated to other signs and symptoms such as spinal cord compression (19.5%), lower limb edema (17%), peripheral adenopathies (36.5%), and abdominal tumor (2.4%). All patients had bone metastases, of which 14.6% were in solid organs (lung and liver), 48.7% in retroperitoneum, and 7.3% in mediastinum. Initially, three patients were diagnosed a lymphoproliferative syndrome, one patient a retroperitoneal tumor of unknown etiology, and four patients a metastasis from an unknown primary tumor. Mean prostate-specific antigen (PSA) level was 795 ng/mL (3–6500). All pathologies were reported as poorly differentiated or undifferentiated. Mean survival was 16.1 months (1–84), and all patients died due to disease progression.ConclusionsAdvanced prostate cancer is an uncommon condition in young adults. Its clinical presentation is atypical, as metastases may mimic other diseases. The course of disease is indolent, and prognosis is poor. In patients with risk factors, PSA testing should be started before 50 years of age.     

Terapia de privación de andrógenos en el cáncer de próstata localizado. Situación actual y tendencias futuras

IntroductionProstate cancer (PCa) has been recognized as an androgen-sensitive disease since the investigations from Huggins and Hodges in 1941. Thanks to these findings, they received the Nobel Prize in 1966. This was the beginning of the development of androgen deprivation therapy (ADT) as treatment for patients with PCa.ObjectiveTo summarize the current indications of ADT in localized PCa.Evidence acquisitionWe conducted a comprehensive English and Spanish language literature research, focused on the main indications for ADT in localized PCa.Evidence synthesisNowadays, the indications for ADT as monotherapy in localized PCa have been limited to specific situations, to patients unwilling or unable to receive any form of local treatment if they have a PSA-DT < 12 months, and either a PSA > 50 ng/mL, a poorly differentiated tumor, or troublesome local disease-related symptoms. ADT can be used in combination with local treatment in different scenarios. Although neoadjuvant treatment with ADT prior to surgery with curative intent has no clear oncological impact, as a future sight, PCa is a heterogeneous disease, and there could be a group of patients with high-risk localized disease that could benefit.ConclusionsWe need to optimize the treatment with ADT in localized PCa, selecting the patients accordingly to their disease characteristics. Given that the therapeutic armamentarium evolves day by day, there is a need for the development of new clinical trials, as well as a molecular studies of patients to identify those who might benefit from an early multimodal treatment.