RESUMEN
PURPOSE: Comorbidity assessment is essential in the triage of care for men with prostate cancer (PC). The aim of this study was to validate the Spanish version of the revised Charlson index (RCI) in PC. MATERIALS AND METHODS: 731 PC patients diagnosed from 1993 to 2008 were referred to our Radiation Oncology Department. The RCI classified patients into four categories RCI 0, RCI 1-2, RCI 3-4, and RCI 5 and higher. The Kaplan-Meier method and Cox proportional hazards modeling were used. We also analyzed the median age of patients who remained alive at the last control and those who died due to non-prostate cancer comorbidities. RESULTS: 636 patients were included median age: 70 years (44-85). The mean follow-up was 153.62 months, (6-288 months). Distribution of the D'Amico risk classification was 21%, 38.2%, and 40.8% for low, intermediate, and high risk, respectively. The RCI distribution categories were: 303 (46.7%) RCI 0, 102 (16%) RCI 1-2, 131 (20.6%) RCI 3-4, and 100 (15.7%) RCI 5 and higher. The probability of non-cause-specific mortality at 5 and 10 years was 2. 4% and 11.25% RCI 0, 3 and 14.1% RCI 1-2, 5.7% and 22.1% RCI 3-4, and 47% and 92% (RCI 5 and higher). The median age in the last control in patients alive or who had died by non-PC causes was 82.81 years (55.27-102). DISCUSSION: The RCI may be used to aid medical decision making in older Spanish men with PC, especially in those with a high RCI 5 and higher.
Asunto(s)
Toma de Decisiones Clínicas , Comorbilidad , Mortalidad , Neoplasias de la Próstata , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte , Humanos , Estimación de Kaplan-Meier , Esperanza de Vida , Masculino , Persona de Mediana Edad , Pronóstico , Modelos de Riesgos Proporcionales , Reproducibilidad de los Resultados , Factores de Riesgo , EspañaRESUMEN
PURPOSE: Adjuvant radiotherapy (ART) for biochemical relapse (BR) after radical prostatectomy (RP) showed increased disease-free survival (DFS) in three previous randomized trials. Retrospective phase II trials evaluated if early salvage RT (ESRT) is equivalent to ART. Our study aims to compare ART and ESRT to salvage RT. MATERIALS AND METHODS: We compared RP plus ART and ESRT versus SRT. Indication for RT was made by PSA determination after RP: ART when PSA ≤ 0.2 ng/ml, ESRT when PSA ≤ 0.3 after PSA rise from 0.0 to SRT PSA ≥ 0.3. The cause of death of each patients was analyzed, DFS, cause-specific survival (CSS) overall survival (OS) and metastasis-free survival (MFS) in relation to RT intention. RESULTS: Between 1993 and 2008, 204 patients with a median age of 65 years (44-75) were treated. The median follow-up was 160 months (28.1-273.3). At diagnosis, 89.7% had localized clinical stages and 90.2% had Gleason (G) ≤ 7. The median PSA was 10 (range 4-101). The postoperative G was ≥ 7 in 66.2%; 56.4% had ≥ 2 positive margins; 29.4% received ART, 20% ESRT and 59.3% SRT. The DFS for ART, ESRT and SRT was 74, 56 and 39% with significant differences between the three groups (p < 0.001). ART + ESRT were combined versus SRT; for the DFS, the significant differences (p < 0.001) remained 67% versus 39%. Positive margins, pT3 and pre-RT PSA were significant factors on multivariate analysis. The CSS in the ART + ESRT group was 92 vs. 78% in the SRT group (p < 0.05). OS was 69% in ART + ESRT vs. 57% in SRT (p < 0.05). MFS was 82.7% in ART + ESRT vs. 67.4% in SRT. CONCLUSIONS: In this study the ART + ESRT presented benefits versus SRT in DFS, CSS, OS and MFS.
Asunto(s)
Neoplasias de la Próstata/radioterapia , Radioterapia Adyuvante/métodos , Terapia Recuperativa/métodos , Adulto , Anciano , Supervivencia sin Enfermedad , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Prostatectomía , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/cirugía , Radioterapia Adyuvante/mortalidad , Estudios Retrospectivos , Terapia Recuperativa/mortalidadRESUMEN
PURPOSE: We compared biochemical control and quality of life with intermittent (6 months) versus continuous (36 months) androgen deprivation therapy (ADT) in a non-inferiority randomized phase 3 trial in patients with biochemical failure (BF) after external beam radical radiotherapy (EBRT). MATERIALS AND METHODS: Patients were stratified according to the Gleason score (GS) and were classified as low risk with a GS < 6 and 7 (3 + 4) and high risk with a GS of 7 (4 + 3) and >7. Patients were followed with PSA determinations and quality-of-life assessments (QLQ C-30 and QLQ PR-25) every 6 months for a period of 3 years. BF after radiation was defined as a PSA level of nadir +2 ng/ml. Disease progression (DP) after ADT was defined as PSA ≥4 ng/ml (BF) and/or metastases. RESULTS: Seventy-seven patients were included in this multicenter phase 3 trial from 2005 to 2009. Thirty-eight and 39 patients were included in the intermittent and continuous groups, respectively. The median follow-up for both groups was 48 months (40-68). DP after ADT in the intermittent group was seen in three patients (distant metastases in one patient) versus 0 in the continuous group. The QLQ-C30 and QLQ PR-25 scores did not show any statistically difference between the two ADT groups. CONCLUSIONS: No significant differences were seen in DP and QLQ between intermittent (6 months) and continuous (36 months) ADT in patients with BF after EBRT.
Asunto(s)
Antagonistas de Andrógenos/uso terapéutico , Braquiterapia , Recurrencia Local de Neoplasia/diagnóstico , Neoplasias de la Próstata/tratamiento farmacológico , Calidad de Vida , Anciano , Terapia Combinada , Estudios de Seguimiento , Humanos , Masculino , Clasificación del Tumor , Recurrencia Local de Neoplasia/sangre , Estadificación de Neoplasias , Pronóstico , Estudios Prospectivos , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/radioterapia , Factores de TiempoRESUMEN
El desconocimiento sobre salud periodontal en las embarazadas, trae como consecuencia resultados fatales tanto a la salud de las futuras madres como al bebé. En el período comprendido entre noviembre de 2015- mayo 2016 se realizó un estudio de intervención educativa, en el Policlínico Docente Fausto Favier con el objetivo de efectuar un conjunto de acciones para mejorar la salud periodontal en las embarazadas. El universo lo constituyeron 30 embarazadas, que se encontraban ingresadas en ese período, se estudiaron las variables, nivel de conocimientos sobre salud periodontal, zona de residencia, nivel de escolaridad, y el estado de salud periodontal. Se obtuvieron las siguientes conclusiones, del total de embarazadas atendidas predominó el grupo de edad de 25 a 29 años, el mayor por ciento reside en zona rural, el nivel de escolaridad que predominó fue el técnico medio, conjuntamente con el nivel de conocimiento, mejoró el estado de salud periodontal(AU)
The lack of knowledge about periodontal health in pregnant women results is fatal results both for the health of future mothers and for the baby. In the period, from November 2015 to May 2016, an educational intervention study was conducted at the Fausto Favier Teaching Polyclinic with the aim of performing a set of actions to improve periodontal health in pregnant women. The universe consisted of 30 pregnant women, who were admitted to the study period. The variables, level of knowledge about periodontal health, area of residence, level of schooling, and periodontal health status were studied. The following conclusions were obtained: the 25 percent to 29 year old group was predominantly pregnant; the highest percentage resided in rural areas; the predominant level of schooling was the average technician, together with the level of knowledge; Periodontal health status.
Asunto(s)
Humanos , Femenino , Embarazo , Enfermedades Periodontales/prevención & control , Medicina Oral/educación , Salud Bucal/educación , Estudios Controlados Antes y Después/métodosRESUMEN
Las fracturas costales son muy frecuentes en los traumatismos torácicos cerrados. La mayoría de estos pacientes tienen un dolor importante con los movimientos y con la tos. Los pacientes politraumatizados con tórax inestable presentan una alta morbimortalidad, el principal enfoque del tratamiento se centra en la terapia del dolor y la ventilación con presión positiva. Actualmente existen estudios que demuestran la mejoría en el tratamiento al utilizar la estabilización quirúrgica. Material y métodos: en el período comprendido entre diciembre de 2010 y diciembre de 2011, en nuestro hospital y en la práctica privada, se realizó la comparación prospectiva, de la evolución de 5 pacientes en los que se fijaron las fracturas costales con osteosíntesis con placa "U", con 8 pacientes a los que no se les realizó fijación quirúrgica de las fracturas costales. La edad promedio de cada grupo fue similar (34 y 39 años respectivamente). Solo se tuvieron en cuenta a aquellos pacientes que sufrieron al menos 2 fracturas en costillas diferentes. La placa en U posee entre 4-6 tornillos, orificios con rosca en la cara profunda de la placa y un puente que separa ambos segmentos estabilizadores. Para la valoración del dolor se utilizó la escala lineal analógica subjetiva asociada a la demanda de analgesia endovenosa en las primeras 24 horas y oral posteriormente. Esquema protocolizado (Diclofenac EV. 2 mg/kg, ibuprofeno 5,33 mg/kg VO., paracetamo 6,33 mg/kg VO). Analgesia adicional: primeras 24 hs se utilizó D-propoxifenos 1,52 mg/kg EV y luego de las 24 hs D-propoxifeno 2,6 mg/kg VO. Resultados: sobre el grupo control se observó que con el tratamiento farmacológico se logró controlar el dolor en el 37,5 % de los casos (3 pacientes), mientras que el 62,5 % restante requirió analgesia adicional. En el grupo con fijación quirúrgica solo un paciente (20%) requirió analgésicos sobre el grupo control. Todos los pacientes con dolor o inestabilidad mostraron mejoría subjetiva ...
Trauma to the chest wall frequently results in fracture of the ribs which provides its stability. As an injury it ranges from one which causes little but discomfort to one which is immediately life threatening. Most of these patients show important pain during movements and with cough. Politraumatized patients with unstable thorax present a high morbimortality, and the mainstay approach of treatment focuses in pain management and ventilation. Fixation of fractured ribs may be indicated if the injured chest wall requires a chest wall fixation with osteosynthesis plates. An initial experience presented by the authors, is discussed
Asunto(s)
Humanos , Adulto , Analgésicos/uso terapéutico , Fijación Interna de Fracturas , Fracturas Cerradas/terapia , Fracturas de las Costillas/cirugía , Ventilación de Alta Frecuencia , Dolor , Traumatismos Torácicos/cirugíaRESUMEN
The HIV epidemic in Argentina is characterized by the high prevalence of infections caused by subtype B and BF variants. In this study, the Nef protein was used as a tool to study the impact of HIV-1 BF variants in the design of future vaccines. DNA and MVA vectors expressing Nef of the CRF12_BF recombinant form of HIV-1 were generated and characterized. After the administration of single DNAprime/MVAboost immunization schedules in Balb/c mice we found that NefBF delivered from these vectors generated a response of high specificity with low cross-reactivity against subtype B. But, when a more potent response was induced after 3 priming DNA doses and a booster with MVA virus, cross-reactivity against NefB was detected, although of lower magnitude than the NefBF specific. These results will be pivotal for vaccines designs in our region, indicating that antigens from these viral variants must be considered for a future vaccine.
Asunto(s)
Vacunas contra el SIDA/inmunología , VIH-1/inmunología , Vacunas de ADN/inmunología , Virus Vaccinia/genética , Productos del Gen nef del Virus de la Inmunodeficiencia Humana/inmunología , Vacunas contra el SIDA/genética , Animales , Anticuerpos Neutralizantes/sangre , Línea Celular , Chlorocebus aethiops , Cricetinae , Reacciones Cruzadas , Vectores Genéticos , Anticuerpos Anti-VIH/sangre , Infecciones por VIH/prevención & control , VIH-1/genética , Inmunización Secundaria/métodos , Interferón gamma/metabolismo , Leucocitos Mononucleares/inmunología , Ratones , Ratones Endogámicos BALB C , Vacunas de ADN/genética , Vacunas de Subunidad/genética , Vacunas de Subunidad/inmunología , Productos del Gen nef del Virus de la Inmunodeficiencia Humana/genéticaRESUMEN
OBJECTIVE: The objective was to compare the short- and long-term impact of 3 different treatment modalities on health-related quality of life (HRQOL) in patients treated for localised prostate cancer at a single centre in Catalonia, Spain. MATERIAL AND METHODS: This was a longitudinal, prospective study of 304 patients from a single centre in Catalonia, Spain. Patients underwent 1 of 3 treatment procedures: radical prostatectomy (114 patients), external beam radiation (134) or interstitial brachytherapy (56). HRQOL was assessed by both general and specific questionnaires, including the SF-36 health survey and the Expanded Prostate Cancer Index Composite (EPIC). Interviews were administered prior to treatment and at months 1, 3, 6, 12 and 24. One-way analysis of variance and generalised estimating equations models were constructed to assess between group differences in HRQOL. RESULTS: After initial deterioration, HRQOL scores partially recovered, although significant differences between treatment groups persisted at two years. Worsening of urinary incontinence was especially marked for the radical prostatectomy group (11.45, p=0.005), while deterioration in the urinary irritative/obstructive domain was worse following brachytherapy treatment (4.76, p=0.025). Decline in sexual function was significantly greater for the radical prostatectomy group than for the brachytherapy group (18.74, p<0.001). No significant between-group differences were observed in bowel domain scores. CONCLUSIONS: Quality of life 2 years after treatment for prostate cancer shows wide variability. Radical prostatectomy had the largest negative impact on the sexual and urinary incontinence domains. Differences between external radiation and brachytherapy were relatively small. Brachytherapy led to a moderate increase in urinary irritation compared to the other 2 groups.
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Braquiterapia/efectos adversos , Prostatectomía/efectos adversos , Neoplasias de la Próstata/terapia , Calidad de Vida , Anciano , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Próstata/patología , Próstata/cirugía , Neoplasias de la Próstata/radioterapia , Neoplasias de la Próstata/cirugía , Resultado del Tratamiento , Incontinencia Urinaria/patologíaAsunto(s)
Humanos , Cateterismo Cardíaco , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/etiología , Estenosis de la Válvula Aórtica/fisiopatología , Diagnóstico Diferencial , Diagnóstico por Imagen/métodos , Diagnóstico por Imagen , Estenosis de la Válvula Aórtica/complicaciones , Espectroscopía de Resonancia Magnética , Signos y SíntomasAsunto(s)
Humanos , Disfunción Ventricular , Infarto del Miocardio , Radioisótopos de Talio , Tomografía Computarizada de Emisión de Fotón Único , Corazón/inervación , Medicina Nuclear/tendencias , Miocardio/metabolismo , Trazadores Radiactivos , Radiofármacos , Radioisótopos , Sensibilidad y EspecificidadRESUMEN
Background: smoking is the main single avoidable cause of death in our country. Little research in the treatment of such disorder has been made. Aim: to report the results of a prospective follow up for one year of outpatients from our Smoker's Clinic at the Department of Psychiatry of the Catholic University. Patients and methods: One hundred twenty seven patients (84 male, aged 21 to 70 years old), with DSM-IV criteria for nicotine dependence, were included in a total of 18 groups. Each group received an intensive treatment program of 10 sessions with cognitive-behavioral relapse prevention techniques and nicotine replacement. Patients with active psychiatric diseases were not included in the program. Results: Eighty seven percent of subjects were abstinent at the first month and 50 percent were still abstinent after twelve months of follow up. We did not find differences in gender, age, previous psychiatric disease, number of cigarettes and breath carbon monoxide level between abstinent and non abstinent patients after 12 months of follow up. Conclusion: This intensive nicotine dependence treatment in seriously dependent patients, proved to be successful, regardless of the previous psychiatric history
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Psicoterapia de Grupo , Tabaquismo/terapia , Terapia Cognitivo-Conductual , Estudios de Seguimiento , Cese del Hábito de Fumar , Nicotina/administración & dosificaciónRESUMEN
Se midió el perímetro de las arcadas dentarias de 539 niños, de los cuales 285 eran niños y 254 niñas de edades comprendidas entre los 6 y los 14 años de edad, realizándose un estudio transversal. El propósito de esta investigación es determinar la evolución del perímetro de las arcadas dentarias en una población española basándonos en la edad cronológica
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Arco Dental/crecimiento & desarrollo , Odontometría , Cronología , Estudios TransversalesRESUMEN
Se midió el perímetro de las arcadas dentarias de 539 niños, de los cuales 285 eran niños y 254 niñas de edades comprendidas entre los 6 y los 14 años de edad, realizándose un estudio transversal. El propósito de esta investigación es determinar la evolución del perímetro de las arcadas dentarias en una población española basándonos en la edad cronológica (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Arco Dental/crecimiento & desarrollo , Odontometría/métodos , Estudios Transversales , CronologíaRESUMEN
Seventy two partial subperiosteal implants were inserted in 52 patients. Thirty six of these implants had a classical design in which the submerged structure had thick primary and secondary connectors. Thirty six implants had a newly designed submerged structure consisting of long and thin primary connectors with grooves along their outer surfaces designed to stop or delay the downgrowth of epithelial mucosa. A six year evaluation revealed a 92.5% success of the newly designed implants and an 84% success for the classical design. A 10 year statistical projection revealed a 50% cumulative success for the classical design and a 92.5% success for the new design.
Asunto(s)
Implantación Dental Subperióstica , Implantes Dentales , Análisis Actuarial , Diseño de Equipo , Estudios de Seguimiento , HumanosRESUMEN
Se ha sometido a tratamiento con apósitos oclusivos de hidrocoloides semisintéticos a tres pacientes con grandes pérdidas de sustancia cutánea, dos e ellos de largo tiempo de evolución, observando con este tipo de tratamiento un precoz desarrollo de tejido de granulación que rellenó el defecto tisular, así como un rápida reepitelización se dichas lesiones.
Asunto(s)
Heridas y Lesiones/tratamiento farmacológico , Lepra/terapiaRESUMEN
Después de consideraciones sobre Ainhum típico se pasa al estudio en la lepra de lesiones parecidas a las que se denominan Pseudoainhum. Sobre un total de 153 enfermos, estas lesiones se han encontrado un en 53'6 por ciento, sobre todo en enfermos entre 40 y 80 años, con mucho tiempo de enfermedad, con preferencia en los lepromatosos (87'81 por ciento) y sin manifestaciones bacteriológicas (89 por ciento). Las lesiones han sido más frecuentes en los pies (95'12 por ciento) que las manos (19'51 por ciento) y se dividen en tres grados siendo el más avanzado el que recuerda más al Ainhum típico. Se relaciona su aparición como consecuencia de las lesiones neutróficas de la enfermedad.