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To determine the presence of a group of mutations, and establish the prognostic value for recurrence and progression.Prospective observational study. Intermediate-to-high-risk non-muscle invasive bladder cancer (NMIBC) was evaluated. Data from genetic analyses were included in a database along with clinicopathological variables of interest.Seventy-four patients. Twenty-five (33.8%) recurred and 3 (4.1%) progressed. Median time to recurrence: 8 months (5.7-12.7). Median time to progression: 14 months (P75: 12). Mutation distribution: KRAS codon 12: one patient (1.4%), BAT25: five patients (6.8%), BAT-26: four patients (5.4%), and D2S123: 6 patients (8.1%). Arg72Pro polymorphism: 50 patients (67.6%) exhibited homozygous mutations, 23 (31.1%) were heterozygous, and 1 patient (1.4%) did not present the mutation. We found an association between presence of MSI at BAT26 and female sex (p 0.05) and tumor stage and the TP53 Arg72Pro polymorphism. Recurrence-free survival (RFS) was significantly associated with presence of MSI at D2S123, with a HR of 5.44 for patients presenting the mutation (95% CI 1.83-16.16). On multivariate analysis, we found a statistically significant increase in risk of recurrence among patients with MSI at D2S123 (HR 5.15; p 0.05) and more than 2 previous transurethral bladder resections (TURBs) (HR 5.07; p 0.05) adjusted for tumor stage and grade. Harrell's concordance index revealed an accuracy of 0.74 (p 0.05).An association was found between presence BAT26 MSI and female sex, Arg72Pro polymorphism with tumor stage and D2S123 and more than 2 TUR procedures were associated with RFS adjusted to tumor stage and grade.

Resumen La COVID-19 es una enfermedad con una gran semiologia clinica, bioquimica y radiologica, que tiene una afectacion preferente por el pulmon, probablemente debido a un mayor numero de receptores ECA-2. La infeccion celular activa sustancias proinflamatorias y provoca un dano alveolar difuso, que es la base histopatologica del distres respiratorio del adulto. La fase exudativa explicaria las imagenes “en vidrio deslustrado” y consolidacion, mientras que la tendencia hacia una morfologia mas lineal representa la fase proliferativa. Tanto la tomografia computarizada (TC) como la tomografia por emision de positrones/ tomografia computarizada (PET/TC) apoyan el caracter inflamatorio de las lesiones pulmonares cuando la enfermedad esta en fase inicial o es leve-moderada. Los casos graves muestran una hipoperfusion pulmonar que se explicaria por una alteracion de la ventilacion-perfusion alveolar (V/Q). Por otro lado, un estado protrombotico conlleva mayor probabilidad de enfermedad tromboembolica por la activacion de la via de la coagulacion y plaquetaria, con la produccion de sustancia de degradacion de la fibrina (dimero D) asi como el consumo de plaquetas.

Patients with large incisional hernias have significant morbidity and their management is a challenge for the surgical team because of the large abdominal wall involvement. The choice of surgical technique is still controversial. The purpose of this study is to analyze the predictive factors for recurrence after intraperitoneal mesh repair in patients with large incisional hernias. A retrospective cohort observational study with a prospectively collected database was performed in the Hospital Clinico San Carlos (Madrid, Spain). All consecutive patients operated on from January 2009 to December 2014 with incisional hernia of 10 or more centimeters in its transverse diameter were included. An intraperitoneal repair with a composite mesh fixed with discontinuous absorbable suture and fibrin sealant was performed. Demographic data, comorbidities, and early and long term outcomes were analyzed. The primary outcome was the presence of recurrence. One hundred and twenty patients were included. Mean age was 63.3 years (SD 12.9) and sex ratio was 1.4:1. Seventy-two patients (60%) were ASA III–IV. Forty-five patients (37.5%) had recurrent ventral hernias. Mean defect size was 14.7 cm (SD 3.21) of width. Overall postoperative morbidity rate was 25%. Median hospital stay was 6 days (IQR 4–8). Recurrence rate was 8.3%, after a median follow-up of 16 months (IQR 10–25). Multivariate analysis showed significant association between ASA III–IV, use of Composix Kugel™ mesh, superficial surgical site infection, and the presence of recurrence. The recurrence rate after intraperitoneal mesh repair in patients with large incisional hernias might be associated with ASA III–IV, use of Composix Kugel™ mesh, and superficial surgical site infection.

A case is described of a woman with history of right peribulbar nerve block prior to cataract surgery that, within a few days, presented with a trochlear intraorbital arteriovenous fistula. This was resolved without sequelae after three months by performing intermittent homolateral carotid massages. This is the first case of supratrochlear intraorbital arteriovenous fistula. There are only 8 cases reported of traumatic intraorbital arteriovenous fistula, and only one was with post-peribulbar anaesthesia.

To assess the importance of false-negative and false-positive findings in computed tomography (CT) andThis retrospective study included 113 consecutive patients and 120 resected NSCLCs; 22 patients received neoadjuvant treatment. We compared the findings on preoperativeMetastatic lymph nodes were found in 26 (21.7%) of the 120 tumors and in 41 (7.7%) of the 528 lymph node stations analyzed.In mediastinal lymph node staging in patients with NSCLC

WEB This is a Web exclusive article. assive pulmonary hemorrhage after treatment with antiplatelet drugs is a rare event that can occur in patients with acute coronary syndrome (ACS). The use of medications such as tirofiban (Aggrastat, Merck) and abciximab (ReoPro, Eli Lilly) has been associated with improvement in short-term outcome among patients with ACS who undergo coronary angioplasty [1]. Pulmonary hemorrhage appears as bilateral alveolar infiltrates on chest radiographs and can be easily mistaken for acute pulmonary edema in the context of ACS [2]. When the infiltrates do not resolve with administration of diuretics, the radiologist must be aware of the possibility of pulmonary hemorrhage because early treatment can increase the probability of survival. We report the clinical and radiologic features of a patient with ACS complicated by massive pulmonary hemorrhage due to use of tirofiban.

To assess the validity and reliability of bladder ultrasound imaging for noninvasive estimation of urine volume, residual volume after voiding, volume before anesthetic induction and after surgery, and volume on sensing an urge to void.Study of a prospective series of 47 ASA 1-3 patients aged 18 to 79 years undergoing major outpatient surgical procedures under general anesthesia (n = 24) or regional anesthesia and sedation (n = 23). Urine volume was measured at baseline and on recovery (bladder volume by ultrasound and voided volume in a flask) and at the end of surgery (ultrasound only). The reliability and validity of the ultrasound estimation was calculated.Agreement (intraclass correlation coefficient [ICC]) between 4 ultrasound-image estimations at baseline and the measured amount collected in a flask ranged from 0.70 to 0.86. The inter- and intra-measurement reliability was high, with ICC values greater than 0.80. The median error of estimation by ultrasound, with respect to measurement in the flask, was 23% at baseline and 29% after recovery. The amount in the flask was greater.Ultrasound monitoring of urine in the bladder is reliable and valid, particularly for small volumes. The procedure is tolerated by patients.

To assess the prevalence of low serum levels of HDL cholesterol (HDL-C) and its relationship with the presence of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (DM) and arterial hypertension attended in Internal Medicine and Nephrology offices.Cross-sectional, multicenter study, conducted in diabetic patients with hypertension, aged/= 55 years old. Demographic, clinical and biochemical data were obtained from the patient's hospital records. Low HDL-C was defined as40 mg/dl (men) or46 mg/dl (women). The relationship between low HDL-C and CVD was assessed using logistic regression models.In 2,021 patients (mean age: 68.6 years, 48.9% women, 51.1% with established CVD), the prevalence of low HDL-C was 33.7% (95% CI: 31.5-35.7), it being higher in women (38.0%) than in men (29.6%, p0.001), and higher in patients with previous CVD (37.3% vs. 29.9% in patients without CVD, p=0.001). In the multivariate analysis that included cardiovascular risk factors, an independent relationship between low HDL-C levels and CVD was observed (OR for CVD in patients with low HDL-C: 1.46 [CI 95%: 1.19-1.79, p0.001]), compared to patients with normal HDL-C blood levels. A second model which was also adjusted for left ventricular hypertrophy and renal disease showed a similar association (OR 1.55 [1.21-2.00], p=0.001). This association was stronger in women than in men.One out of three patients with diabetes and hypertension examined in Internal Medicine and Nephrology outpatient offices had low serum levels of HDL-C. Low HDL-C showed an independent relationship with a higher prevalence of CVD.

To evaluate whether there is equivalence between two treatments for grade I ulcers with a base of hyperoxygenated fatty acids, AGHO and Mepentol: AGHO and phytotherapy.A randomized, controlled, triple blind clinical trial was conducted with patients admitted at the Elderly Ward at San Carlos Hospital in Madrid between November 2006 and January 2008. There were two treatment groups: Experimental and control. A theoretical limit of 15% was determined between both groups. We took a random sample of patients admitted to the Elderly Ward, which produced a sample of 151 sores. The control group received treatment with Mepentol and the experimental group received AGHO. The assignment to the group was at random. The output variable was healing of erythema within the first 72h. We calculated the absolute difference in the incidence of healing between both treatments with a level of confidence of 95%.The sample at the end of the study was 148 (72 control and 76 experimental). There was a healing incidence of 55.6% in the control group and 69.7% in the experimental group (p=0.074). The difference in the incidence of healing between both treatments was 14% (95% CI: 29% to -1%). The upper limit of the confidence interval of the difference is outside the margin of equivalence.We cannot conclude that the treatment with AGHO fatty acids is equivalent to Mepentol treatment. With both treatments the healing is clinically significant.

In a population-based study of the incidence of stroke conducted on a broad denominator, it is wise first to carry out a pilot study.To present the results of the pilot phase of the study on stroke incidence in Spain, entitled Iberictus.Population of the study: all cases involving the first episode of acute cerebrovascular disease (stroke or transient ischaemic attack) diagnosed among residents over 17 years of age with their habitual place of abode registered in the areas of study between 15th and 31st October 2005 (total denominator: 1,440,997 inhabitants).prospective, hospital records (basic minimum data set, discharge abstracts) and casualty department registers. Standardised definitions: diagnostic categorisation and pathological, topographical and aetiological classification. Inter-observer agreement analysis among researchers (kappa).A total of 128 cases were identified. Age range, 37-103 years; mean age, 75.7 +/- 13.4 years; 54% were females. In all, 71.1% of the cases were collected by means of a basic minimum data set. There were 91 ischaemic events (29.7% atherothrombotic and 29.7% cardioembolic). Of the 15 haemorrhagic strokes, 40% due to arterial hypertension, six were lobar hemispheric, six were deep basal ganglia, and there were three cerebellar haemorrhages. The incidence of stroke was seen to increase exponentially with age. Inter-observer agreement was good for the classifications that were employed (range of kappa indices, 0.57-0.78). Several problems were detected and corrected in the fieldwork.The Iberictus pilot study yielded data that were consistent with the literature and provided us with the opportunity to detect and correct issues that would hinder us from conducting the main study.

18F-FDG PET has demonstrated its usefulness in detecting recurrences of differentiated thyroid cancer (DTC) with high thyroglobulin (Tg) levels and negative 131I whole-body scan (WBS); however, the number of patients analyzed is low and different studies report disparate results.To estimate the diagnostic accuracy of 18F-FDG PET in this subgroup of patients.Fifty eight patients (64 18F-FDG PET studies) with histologically proven DTC treated with total thyroidectomy followed by at least one session of 131I therapy for the ablation of thyroid remnants were retrospectively analyzed. Results were verified by pathology, clinical follow-up, response to treatment, or by comparison with conventional diagnostic methods. Sensitivity (Se), specificity (Sp), likelihood ratios (LR), diagnostic accuracy (DA), positive and negative predictive values (PPV, NPV), and Tg levels were calculated for patients with positive and negative 18F-FDG PET results.Twenty seven studies were true positives, 1 false positive, 25 true negatives, and 11 false negatives. Se was 71 %, Sp 96 %, PPV 96.4 %; NPV 69.4 %, DA 81.3 %, positive LR 17.75, and negative LR 0.3. The mean Tg level was 202.34 ng/ml in patients with positive 18F-FDG PET and 40.94 ng/ml in those with negative 18F-FDG PET; the difference between the two groups (161.4 ng/ml) was significant at p0.05.18F-FDG PET is a useful for detecting residual or recurrent DTC in patients with elevated Tg and negative 131I WBS.

To establish the prevalence of diabetic retinopathy (DR), types and risk factors in a diabetic population in the city of Badajoz.A cross-sectional study, with prospective data collection, was performed in 2002 on 762 randomly selected diabetic patients belonging to two Primary Care Centers. We evaluated age, gender, type, treatment, duration of diabetes and blood pressure levels. Two color fundus photographs were taken and ophthalmoscopy performed on both eyes. Data were analyzed using SPSS (11.5).The mean age of the patients was 66.2 (DS 11.4) years, 4.7% were type 1 diabetics, 29% were insulin-treated and 52.8% had elevated blood pressure. Prevalence of DR was 29.8%, macular edema 1.4% and proliferative DR 4.8%. Multivariate analysis showed that patients with an evolution of between 5 and 10 years had a frequency 1.13 times higher (ORaj 1.13; IC 95% 0.68-1.88; p=0.648) than those of less than 5 years evolution, while those with more than 15 years evolution had a frequency 3.12 times higher (ORaj 3.12; IC 95% 1.85-5.26; p0.001). Patients receiving treatment with oral antidiabetic agents had an RD prevalence 2.39 times higher (ORaj 2.39; IC 95% 1.21-4.74; p=0,012) than those treated with diet only. Patients treated with insulin had a 10.32 higher frequency (ORaj 10.32; IC 95% 5.07-21.00; p0.001) than those treated with diet.29.8% of the diabetic population in the city of Badajoz is affected by DR. Although this prevalence is lower than that observed in previous studies performed by the same team, further studies should be carried out to detect risk sub-groups to allow us to act to decrease such a high prevalence.

Reported data about the effect of the 4G/5G PAI-1 polymorphism on plasma PAI-1 levels are controversial. This study was designed to determine the relative effect of the 4G/5G PAI-1 polymorphism on high plasma PAI-1 levels after adjustment for metabolic syndrome - related variables, and to test if this effect is modified by the smoking status. Six hundred and thirty one unrelated subjects (292 men; 35-74 years), from a cross-sectional population-based epidemiological survey in the province of Segovia (Spain) were studied. The higher frequency of high PAI-1 levels was found in 4G/4G subjects (5G/5G 19.4%, 4G/5G 21.6%, 4G/4G 33.7%, p = 0.003). A multiple regression model, adjusted for gender, age, BMI, waist circumference, triglycerides, HDL-cholesterol, HOMA IR and leptin, showed this adjOR: 4G/4G vs 5G/5G: 2.22, p = 0.008. When smoking status - 4G/5G PAI-1 interaction was included as an independent variable these results were not modified. Our results indicate that the 4G/4G PAI-1 genotype might be strongly associated with high PAI-1 levels regardless of metabolic syndrome-related variables and smoking status.

Fever in hospitalized patients (FHP) is a difficult problem. We study clinical characteristics and predictive parameters of infection, sepsis and outcome.Prospective study of 204 patients with fever38 degrees C admitted in an Internal Medicine ward. In each patient clinical evaluation, complete blood count (CBC) urinalysis (UA), C-reactive protein (CRP), chest X- ray (CXR), blood and urine cultures were performed.115 patients suffered infection (75.9% nosocomial, 7.4% sepsis), 35 had a non-infectious etiology and 54 an unknown cause. CBC and CRP did not distinguish infection, bacteremia or sepsis. In UA, positive nitrites, leukocytes and bacteriuria were predictive of infection. 18.6% of the patients were diagnosed by CXR. 18% of urine cultures and 13% of blood cultures were positive. 71.6% received antibiotics (deemed unnecessary in 18%). Microbiological results modified 25% of initial treatments. Average hospital stay was 17 days; 16.7% died. Chronic lung disease, fever duration, dysphagia and urinary tract alterations predict infection. Obesity, diabetes mellitus, liver failure, immunocompromised host, central vascular access, fever duration and nosocomial infection predict bacteremia. Sepsis is more prevalent in males, with malignancy and vascular or nosocomial infection. Chronic liver disease, nosocomial infection, severe lung infection and sepsis increase mortality.Clinical diagnosis of FHP is inaccurate. Infection is it s most frequent cause; UA, CXR, and blood and urine cultures are useful. FHP increases mortality and hospital stay. We have established predictable models of infection, bacteremia, sepsis and mortality. However, its sensibility and specificity are low.

To establish the prevalence of diabetic retinopathy (DR), types and risk factors in a diabetic population in Extremadura.A cross-sectional study, with prospective data collection, was performed between 1997 and 2001 on 3,114 randomly selected diabetic patients belonging to 13 Diabetologic Assistance Centers. We evaluated: age, gender, type, treatment, duration of diabetes and blood pressure levels. Two color fundus photographs were taken and ophthalmoscopy was performed on both eyes. Data were analyzed using SPSS (11.5).The mean age of the patients was 63.8 (SD13.4) years, 7.5% were type 1 diabetics, 31.1% were insulin-treated and 46.0% had elevated blood pressure. Prevalence of DR was 35.7%, macular edema: 5.6% and proliferative DR: 5.3%. Multivariate analysis showed that type 1 diabetics have a DR frequency 1.79 times higher than type 2 diabetics (ORaj 1.79; IC 95% 1.22-2.63; p=0.003). Patients who have been diabetic for 5-10 years have a frequency 2 times higher (ORaj 2.00; IC 95% 1.62-2.45; p0.001), patients diabetic for more than 15 years have a frequency 5.48 times higher (ORaj 5.48; IC 95% 4.33-6.93; p0.001) than patients who have been diabetic for less than 5 years. The frequency of DR in patients aged more than 60 years is 23% higher than those under that age. (ORaj 1.23; IC 95% 1.01-1.50; p=0.045).37.5% of the diabetic population in Extremadura is affected by diabetic retinopathy. New analyses are necessary in this population to detect the existence of other high risk subgroups in order to reduce these high prevalence levels.

Since its discovery as a marker for prostate cancer, there have been many attempts to enhance the diagnostic efficacy of the prostate specific antigen (PSA). Among these are the studies that analyze the behavior of different forms of serum PSA bound to different antiproteases, such as alpha-1-antichymotrypsin, which forms the complexed PSA (PSA-c). This study analyzed the utility of PSA-c to enhance specificity without altering sensitivity in comparison to total PSA (PSA-t).From September 1998 to March 1999, blood samples were obtained from 96 patients that had undergone a prostate biopsy due to a suspicion of prostate cancer. PSA-c, PSA-t (Technicon Immunol system, Bayer) and PSA-c/PSA-t ratio were analyzed in these patients.ROC curves were plotted and the optimal cutoffs were found for which the specificity was higher for PSA-c (44.6% [CI 95%, 32-57]) versus PSA-t (35.4% [CI 95%, 25-49]) and the PSA-c/PSA-t ratio (38.5% [CI 95%, 27-51]) while maintaining a similar sensitivity index (90%). PSA-c showed similar results for other values of sensitivity.PSA-c was found to improve specificity in comparison to PSA-t and PSA-c/PSA-t ratio. PSA-c determination could avoid unnecessary biopsies without altering sensitivity; i.e., the same number of prostate cancers will be detected.

Aiming to preserve the bladder in patients with infiltrative carcinoma of the bladder and to offer patients improved quality of life with no detriment for survival, a therapeutical protocol was set up.Between August 1988 and January 1997 63 patients with stage T2 and T3a infiltrative carcinoma of the bladder, with no metastasis or node extension detectable with imaging techniques were treated in our unit. 45 of these patients met all protocol criteria and were given 3 neoadjuvant chemotherapy courses with MVAC (methotrexate, vincristine, adriamycin, cisplatin).age under 75 years, Karnofsky greater than 50%, leucocytes greater than 2,500 cell/mL and platelet greater than 100,000/mL. Following chemotherapy, re-assessment was performed through lab tests, chest X-rays, abdomino-pelvic CT, bone scanning, cystoscopy, multiple randomized biopsies, tumoral bed scar resection and resection of relapsed urothelioma. Patients with complete remission were given radiotherapy. Those showing stabilisation of progression were proposed to undergo cystectomy. Fisher's test or chi 2 test were used for the comparison of qualitative variables. The survival analysis was performed using the Kaplan-Meier method. The curves comparison was done with Breslow's exact test. A Cox's proportional risk method allowed to calculate the relative risks together with their 95% confidence interval.53.7% patients included in this protocol showed complete remission, 41.5% stable disease and 4.9% progression. 62.2% of patients were given radiotherapy versus 17.8% who underwent cystectomy. 20% received other therapies after rejecting both cystectomy or radiotherapy. Median follow-up was 43.38 months. Overall median survival was 96 months. The accumulate probability of survival at 4 years was 79%. 50% patients with complete clinical response relapsed during follow-up. Tumoral stage of those who relapsed was lower than the initial one in 63.7% cases, remained the same in 18.2%, and higher in 18.2%. With regards to grading, 66.7% patients had lower grading at relapse if tumour was initially grade 2. For those with initial tumour grade 3, only 20% had a lower grade.64.4% patients retained their bladder. In 26.7% there was demonstrable metastatic disease. No differences were seen in the distribution or survival time based on the different treatment given after chemotherapy (p = 0.22). Patients with complete remission after chemotherapy have greater actuarial survival which is statistically significant (p = 0.04).

1) To determine p53 expression in urinary wash cytology by immunohistochemistry in patients with superficial transitional cell carcinoma of the bladder and controls; 2) to correlate p53 in urinary wash cytology and anatomopathological characteristics of the bladder tumors analyzed; 3) to determine the utility of p53 expression in urinary wash cytology as a prognostic factor; and 4) to identify a subgroup of patients with superficial tumors of worse prognosis in order to improve control of the evolution of the tumor and treatment.From 1993 to 1998, 141 cases were studied; 32 controls comprised group I and 109 (38 primary and 71 recurrence) patients with transitional cell carcinoma of the urinary bladder comprised group II.In group II, 29.5% were positive for p53 in urinary wash cytology, while no positive cases were found in group I. A total of 104 valid data were analyzed, which showed a higher percentage of p53-positive cases in grade III tumors (44.4%). Statistical analysis showed the percentage of p53-positive cases increased with tumor grade in a linear trend (p = 0.17). The recurrence rate in the p53-positive was 20% greater than in the p53-negative cases. Tumor progression was three times higher in the p53-positive than in the p53-negative patients.The application of biomolecular knowledge to cytology is a useful complement in follow-up of patients with superficial transitional cell carcinoma of the bladder and offers additional parameters to distinguish benign and malignant cells. Immunohistochemical determination of p53 in urinary wash cytology identifies patients with superficial tumors with a worse prognosis.

Renal cancer accounts for 2% of tumors. The most common chromosome abnormality found in renal cancer is the loss of heterozygosity (LOH) on the short arm of chromosome 3 (3p), which suggests that near the gene responsible for von Hippel-Lindau disease, there may be one or more tumor suppressor genes between 3p14 and 3p21 with a relevant role in the development of renal cancer.41 patients with sporadic renal cancer were tested for three microsatellites mapped to the short arm of chromosome 3 (3p14.1-3p14.3, 3p21.2-3p21.3 and 3p25) by polymerase chain reaction. The results were compared with patient habits and tumor features.43.9% of the patients showed LOH on at least one locus. Thirty-four percent showed LOH only on one locus, 4.9% on two loci and 7.3% on the three loci tested. All the patients who showed LOH on 3p21 had a tumor size greater than 25 mm. There is a risk 1.76 times higher of no loss in tumors less than 25 mm in size than in tumors greater than 25 mm (Cl 95% 1.33-2.33).

We propose the inclusion of deaths due to appendicitis, abdominal hernia, cholecystitis and cholelithiasis and complications occurring during pregnancy, delivery and puerperium as causes of death amenable to medical intervention occurring strictly in the hospital setting (MIPSE). We have carried out a descriptive longitudinal study with the yearly mortality series due to MIPSE and no MIPSE caused in the HUSC (1980-1990). The specific mortality rates were of 0.01 per 100 discharges for MIPSE causes and 1.61 per 100 discharges for no MIPSE causes. The difference was statistically significant (p0.005). Both series showed a significantly declining tendency. Once the deaths were arranged under their respective headings, we observed a general decreasing tendency that was only statistically significant for abdominal hernias, whereas there was a rising tendency for deaths due to appendicitis. The knowledge of the evolution of hospital MIPSE is a interesting sign of alarm of malfunctioning health services. We believe that a consensus is necessary to elaborate a list of strictly hospitality causes of MIPSE.