Multidisciplinary Approach in Hepatocellular Carcinoma in a Level II Hospital: The First Decade of Hospital Universitario Fundacion Alcorcon.

BACKGROUND/AIMS: Mean survival in hepatocellular carcinoma remains low. Many efforts have been done during the last years through screening, diagnosis and treatment to improve the results. The aim of this work is to present the experience of our hospital multidisciplinary group during the first decade of this century. METHODOLOGY: The patients with hepatocellullar carcinoma presented at the multidisciplinary meeting from 1999 to 2009 were prospectively studied. According to the tumor and functional status they were treated through the current available guidelines by transplant, partial hepatectomy, local/regional procedures, systemic or symptomatic treatment. RESULTS: One hundred and forty two patients were studied. Median tumor size was 3 cm. A single tumor was diagnosed in 64.8% of the patients. Eighteen patients had liver resection (6 transplantation and 12 with partial resection), 53 tumors were not treated due to advanced stage or liver dysfunction, and in the remaining patients radiofrequency, ethanol or embolization treatments were used, single or combined. CONCLUSIONS: a multidisciplinary approach of hepatocellular carcinoma in a second level hospital with trained professionals permits a diagnosis in early tumoral and functional stages in the majority of patients, and a variety of possible treatments with adequate survival outcomes.

An outbreak of adenovirus type 8 keratoconjunctivitis in a nursing home in Madrid.

This work describes and analyses an outbreak of epidemic keratoconjunctivitis which occurred in 2001 and 2002 in a nursing home for the elderly in Leganes (an area of Madrid). This is the first such published case in Spain with these characteristics and this serotype identification. Sociodemographic characteristics, epidemic curve and attack rates are described. Comparisons of the data were carried out using a chi2 test for qualitative variable and t-test for quantitative. Factors associated with the illness are explored by means of contingency tables and logistic regression models. One hundred and two cases were detected, with an attack rate of 36.4% for residents, and 12.9% for workers, not considering spatial or professional differences. The epidemic curve showed an interpersonal transmission pattern. Multivariate analysis identified the following risk factors in the residents: able to wander freely through the building, urinary incontinence and use of shared bathroom. In 34.6% of the conjunctival samples, adenovirus serotype 8 was detected with identical genomic sequence. Establishment of hygienic sanitary guidance adapted for the cleaning of such establishments and contact with residents as well as early diagnosis and good coordination of human and material resources are key factors in the prevention and control of these outbreaks in closed communities.