[Program to improve care in chronic illnesses: application of the model of care in chronic illness]. / Programa para mejorar la atención de las enfermedades crónicas. Aplicación del Modelo de Cuidados para Enfermedades Crónicas.

INTRODUCTION: Chronic diseases have become more central to Primary Care due to their greater prevalence and the difficulties of monitoring them. This complex problem requires a many-sided solution that affects patients' behaviour, health workers' approach and changes in how the health service is organised. OBJECTIVES: The Chronic Diseases Care Model aims to empower the patient to manage his/her own disease and to encourage doctors to take a proactive approach. PROGRAMME: The model proposed has six interlinked components, focusing on the patient. A personalized care plan, based on the scientific data, is worked out. All patients are followed up, including those not attending for consultations. The model possesses a specific tool for exploring possibilities of improvement and incorporates the P-D-C-A cycles in order to make changes in activities. DISCUSSION: The Health Service's emphasis on resolving acute problems is the biggest barrier to the Model's introduction. Selection of those patients who will most benefit and the visible support of system leaders are key elements for the Model's success.

[Small cell-sarcomatoid carcinoma of the urinary bladder]. / Carcinoma de célula pequeña-sarcomatoide de vejiga urinaria.

OBJECTIVES: Oat cell carcinoma of the urinary bladder is extremely uncommon. To date, 87 cases have been reported in the literature. Histologically, these tumors are similar to oat cell carcinoma of the lung and in slightly more than half of the cases the tumor is associated with another carcinomatous component: urothelial, squamous carcinoma, adenocarcinoma or, more rarely, sarcomatoid carcinoma. A case of sarcomatoid small cell carcinoma is described herein. METHODS/RESULTS: We report a case of sarcomatoid small cell carcinoma of the urinary bladder in a 79-year-old female patient. The tumor was in the advanced stages and was unamenable to resection. The patient was treated with multi-drug systemic chemotherapy, but she died five months after diagnosis. Light microscopy disclosed a carcinomatous component similar to oat cell carcinoma of the lung that stained with epithelial and neuroendocrine markers. The sarcomatoid component was histologically nondescript and showed extensive immunoreactivity to mesenchymal and epithelial markers. CONCLUSIONS: Sarcomatoid small cell carcinoma of the bladder is rare. To our knowledge, only five cases have been previously reported. It is aggressive, metastasizes early and has a poor diagnosis. Surgical resection with adjuvant multidrug systemic chemotherapy is currently the best available treatment.

[Clinico-histological scale for identifying preinvasive lesions of the larynx]. / Escala clínico-histológica en el pronóstico de las lesiones preinvasivas de laringe.

Preinvasive laryngeal lesions progress to infiltrating carcinoma in 7-15% of cases. Clinical manifestations and histological findings are not reliably predictive of progression. Quantitative cytometry improves predictive effectiveness, but is not a routine procedure. A clinico-histological scale consisting of 13 variables which were combined and used prospectively had a predictive value of 0.8 sensitivity and 0.9 specificity for progression of preinvasive laryngeal lesions.

[Primary leiomyosarcoma of the liver]. / Leiomiosarcoma primario de hígado.

We report a case of primary hepatic leiomyosarcoma in a 70 years old woman presenting with hepatomegaly, right upper quadrant pain and impairement of general status. A left hemihepatectomy was undertaken revealing a single tumor of 7 cm in diameter in the left hepatic lobe. An immunohistochemycal study was performed indicating the smooth muscle nature of the tumor. The patient died 6 months later without evidence of active tumoral disease. This is the 28th report on primary leiomyosarcoma of the liver in the world literature.

[Effect of overexpression of P53 protein in colorectal carcinoma on short-term prognosis]. / Influencia en el pronóstico a corto plazo de la sobreexpresión de la proteína P53 en carcinomas colorrectales.

BACKGROUND AND METHODS: p53 protein expression was studied immunohistochemically in 73 colorectal adenocarcinomas, using monoclonal antibody D07 in alcohol fixed, paraffin embedded tissue. RESULTS: Immunoreactivity was found in 49% of specimens, detected in the nuclei of the cancer cells. There was no significant correlation between the expression of p53 and the clinicopathological parameters age, sex, tumor size and site, lymphatic invasion, and lymph node metastasis. However, the p53 overexpression correlated with stage of disease, histologic grade, vascular invasion and with the presence of villous or tubular adenomas in the resected specimens. The p53 positive tumors showed a higher rate of recurrence than the p53 negative tumors; however, the difference was not statistically significant. The short-term survival rate (follow-up 7-48 months, median 30 months) was 90% for 20 patients with p53 negative tumors, and 65% for the patients with p53 positive tumors; a significant difference in the survival between the two groups of patients was found. CONCLUSIONS: These results suggest that in colorectal carcinoma, immunohistochemical detection of p53 protein can be used along with other established indicators to asses prognostic outcome, specially to identify patients with a poor short-term prognosis.

[Well-differentiated liposarcoma of the spermatic cord with dedifferentiation]. / Liposarcoma bien diferenciado de cordón espermático con desdiferenciación.

We report a case of well-differentiated liposarcoma with dedifferentiation of spermatic cord in a 73-year-old-man. Treatment was by orchiectomy without retroperitoneal lymph node dissection or adjuvant therapy. The patient has survived 10 months with no evidence of recurrence. Liposarcoma localized to the spermatic cord is rare; less than 70 cases have been previously reported. The literature is reviewed with special emphasis on the clinical significance of the dedifferentiation phenomenon.

[Follicular adenoma in lingual thyroid: report of a case]. / Adenoma folicular en tiroides lingual: a propósito de un caso.

We present a case of follicular adenoma which has its origin in a unique lingual thyroid. The interest lies in the oddity of this pathology and in the unusual clinical form of dysphagia. In spite of the fact that the thyroid ectopy is a congenital anomaly in the development of the thyroid, the history of previous administration of cervical radiotherapy and the diagnosis in an elderly person makes us suppose, in this case, that there is a different etiopathology.

Thymic carcinosarcoma associated with a spindle cell thymoma: an immunohistochemical study.

A case of thymic carcinosarcoma associated with a spindle cell thymoma in a 71-year-old woman is reported. Histological and immunohistochemical studies of the carcinosarcoma showed two quite different components: the sarcomatous component included cells with myoid differentiation which stained for desmin and muscle specific actin, and some isolated cells which stained positively for low molecular weight cytokeratin, while the carcinomatous component, which formed less than 10% of the tumour, showed an epithelial phenotype, being positive for low and high molecular weight cytokeratin and epithelial membrane antigen. The thymoma cells showed epithelial markers, and a few cells were also positive for desmin and muscle specific actin. The rarity of this tumour and its possible histogenesis are discussed.

Premalignant lesions of the larynx: pathological prognostic factors.

Eighty-seven precancerous lesions of the larynx were studied; 46 showed keratosis, 31 slight dysplasias, five severe dysplasias, and five carcinomas in situ. The average follow-up was 3.8 years per patient, and malignant degeneration was observed in nine of them (10.3%). This arose on a pre-existing dysplasia in eight cases, and in the other on a hyperkeratosis. Dyskeratosis was observed in 12 cases, half of which degenerated, this being the group of worst prognosis.