Monophasic synovial sarcoma of the greater omentum: case report and review of literature.

Synovial sarcoma is a malignant spindle cell neoplasm normally arising from tissues around joints, bursa and tendon sheaths. Several reports involving the gastrointestinal tract, mainly the oesophagus and stomach, have been documented; however, the omentum remains an extremely unusual location. Monophasic type is composed exclusively of spindle cells arranged in fascicles. Establishing the correct diagnosis of these tumours could be challenging because of the similarities with gastrointestinal stromal tumours and other mesenchymal tumours with similar histology.

[Abdominal traumatic evisceration: reconstruction abdominal wall with biologic mesh and negative pressure therapy]. / Evisceración abdominal traumática: reconstrucción de pared abdominal con malla biológica y terapia de presión negativa.

INTRODUCTION: Abdominal traumatic evisceration as a result of high energy trauma is uncommon. Once repaired the possible internal damage, an abdominal wall defect of high complexity may exist, whose reconstruction represents a surgical challenge. CASE REPORT: Politraumatized male with important abdominal muculocutaneous avulsion and evisceration. After initial repair, the patient developed a big eventration in which we use a porcine dermis-derived mesh (PermacolTM), a safe and effective alternative in abdominal wall repair, thanks to its seamless integration with other tissues, even when exposed. Negative pressure therapy has been used for the management of wound complications after surgical implantation of PermacolTM mesh. We describe our experience with the use of PermacolTM mesh and negative pressure therapy to aid the wound closure after skin necrosis and exposed mesh.

INTRODUCCION: La evisceración abdominal traumática como consecuencia de un traumatismo de alta energía es poco frecuente. Una vez reparado el posible daño interno, puede existir un gran defecto en la pared abdominal, de alta complejidad, cuya reconstrucción representa un desafío para el cirujano. CASO CLINICO: Varón politraumatizado que presenta una importante avulsión músculocutánea abdominal con evisceración. Tras la reconstrucción inicial, desarrolló una gran eventración para cuya corrección utilizamos una malla biológica de dermis porcina (PermacolTM), una alternativa segura y efectiva en la reparación, gracias a su perfecta integración con el resto de tejidos, incluso cuando queda expuesta. La terapia de presión negativa ha sido utilizada para el manejo de complicaciones después de la colocación de la malla. Presentamos nuestra experiencia en el uso de la malla de PermacolTM y la terapia de presión negativa para conseguir el cierre de la herida tras la necrosis cutánea que ocasionó la exposición de la malla.

[Lung cancer in Avila province, Spain. Incidence rates, epidemiolgy of the year 2012 and trends in the last 20 years]. / Cáncer de pulmón en la provincia de Ávila. Tasas de incidencia, epidemiología del año 2012 y tendencias en los últimos 20 años.

BACKGROUND AND OBJECTIVES: To determine the extent of lung cancer in Alvila. Its incidence rates and significant epidemiological aspects of the year 2012 were recorded, and the results of each 5-year period (up to 20 years) were compared with those of known studies conducted using the same methodology. PATIENTS AND METHODS: A prospective study was conducted on all patients diagnosed with lung cancer in the Province of Avila throughout the year 2012. RESULTS: A total of 81 patients were diagnosed, of whom 70 were males and 11 females, with a mean age of 72.1 years (range: 44-91), and was higher than that found in previous studies. This gave gross, and adjusted to the standard world population, incidence rates in 2012 of 80.99 and 31.23 per 100,000, respectively, in males, and 12.97 and 5.68 per 100,000, respectively in females. These rates are lower in both sexes than those found in Alvila in 2002. In 2012, 80.25% had been smokers (90% of males and 18.18% of the women), although, on diagnosis, 68.75% had quit smoking. A clinical-radiological diagnosis was made in 9 (11.1%), with a histocytological diagnosis in 72 (88.9%). The histological types were: adenocarcinomas in 37.5%; squamous in 33.3%; microcytic in 13.8%; undifferentiated non-small cell in 11.1%; large cell in 2.77%, and carcinoid in 1.38%. The most frequent treatments were chemotherapy (50.6%), symptomatic (23.4%), and surgery (12.3%). CONCLUSIONS: The incidence of lung cancer in Avila has decreased in both sexes in the last 10 years. In 2012, the patients have been older, the majority with adenocarcinoma histology, and receiving chemotherapy.

Influence of age in the duration of the stay and mortality of patients who remain in an Intensive Care Unit for a prolonged time.

BACKGROUNDS AND OBJECTIVE: The true role of the age in the prognosis of patients admitted in the ICU is not known. This work analyzes the influence of age on the duration of the stay and mortality of patients who remain in an Intensive Care Unit (ICU) for a long period of time. PATIENTS AND METHOD: A retrospective, observational study was performed with patients hospitalized ≥14 days in the ICU. Three age groups were established: <50, 50-70 and >70 years. The influence of different factors on the relationship existing between stay and age was studied. In addition, stay and survival in the ICU, hospital and at one year were analyzed based on the groups. RESULTS: A total of 707 patients were included. Significant differences in hospital stay (P=.183) were not found among the three groups. The older group, which showed greater severity on admission, was the group undergoing the most tracheostomies (74.7%) and extrarenal purification (HDF) (10.8%). When the influence of factors such as APACHE II, pre-ICU stay, origin, tracheostomy or hemodiafiltration (HDF) were analyzed, no relation was found between stay and age of patient. Survival decreased as age increased. CONCLUSIONS: No differences were found in stay based on age, although a difference was found in mortality.

[Cost and management of asthma exacerbations in Spanish hospitals (COAX study in hospital services)]. / Coste y manejo de una crisis asmática en el ámbito hospitalario de nuestro medio (estudio COAX en servicios hospitalarios).

OBJECTIVE: The prevalence and associated health cost of asthma have been increasing in developed countries, and 70% of the overall disease cost is due to exacerbations. The primary objective of this study was to determine the hospital cost of an asthma exacerbation in Spain. The secondary objective was to determine what maintenance treatments patients were using to control asthma before the exacerbation and how the exacerbation was treated. The study formed part of a broader study (COAX II), with the same objectives in each of the 8 participating European countries. PATIENTS AND METHODS: Prospective observational study that enrolled 126 patients with an asthma exacerbation treated in the usual way in 6 Spanish hospitals over a 3-month period (from January 1 to March 31, 2000). RESULTS: According to the criteria of the Global Initiative for Asthma, 33.3% of the exacerbations were mild, 38.9% moderate, 26.2% severe, and 1.6% were associated with risk of imminent respiratory arrest. Use of corticosteroids was widespread among patients with moderate and severe asthma, but only 68% of the patients with severe asthma used long-acting beta2 agonists. The mean cost was 1555.70 Euros (95% confidence interval [CI], 1237.60 Euros-1907.00 Euros), of which 93.8% (1460.60 Euros; 95% CI, 1152.50 Euros-1779.40 Euros) was due to direct costs, and 6.2% (95.10 Euros; 95% CI, 35.50 Euros-177.00 Euros) to indirect costs. Cost rose with increasing severity of the exacerbation--292.60 Euros for a mild exacerbation, 1230.50 Euros for a moderate exacerbation, and 3543.10 Euros for a severe exacerbation. CONCLUSIONS: The mean cost was 1555.70 Euros. The costs of moderate and severe exacerbations were 4 and 12 times that of a mild exacerbation, respectively. Long-acting beta2 agonists were less widely used than recommended by the guidelines for treatment of moderate and severe persistent asthma leading to asthma exacerbations.

Lung cancer incidence in the province of Avila, Spain in 2002 and decade-long trends.

OBJECTIVES: To determine lung cancer incidence in the province of Avila, Spain, in the year 2002 and compare it with incidences reported in 2 previous studies (for 1992-1993 and 1997). PATIENTS AND METHODS: Patients diagnosed in 2002 were evaluated prospectively by the method used in the previous studies. The reference population was obtained from the municipal records for 2001. RESULTS: In 2002, 87 patients (74 men and 13 women) were diagnosed with lung cancer. The crude incidence rate was 53.09 cases per 100 000 population (men: 89.92/100 000; women: 15.93/100 000). Of these, 87.3% had been smokers. Squamous cell carcinomas were the most frequent type overall (38.1%) and in men (42.4%). Adenocarcinomas were the most frequent type in women (60%). The most frequent treatment was chemotherapy (35.6%). Between the 1992-1993 study and our 2002 study, significant increases were found in crude incidence rates of lung cancer and the use of chemotherapy, as well as significant decreases both in squamous cell carcinomas and the use of radiotherapy alone. CONCLUSIONS: Between 1992 and 2002 the lung cancer incidence in men and women in the province of Avila increased significantly.

Clinical utility of hyaluronic acid values in serum and bronchoalveolar lavage fluid as tumor marker for bronchogenic carcinoma.

Various authors have proposed the use of hyaluronic acid (HA) as a tumor marker. In order to analyze its usefulness as a marker in bronchogenic carcinoma, the most common carcinoma in men, we determined the HA values in serum and bronchoalveolar lavage fluid (BAL). We performed prospective studies on two groups of patients: 81 diagnosed as having bronchial carcinoma and 34 with benign respiratory diseases. HA values were higher in patients with cancer than in those with benign diseases (serum: 79.8 ng/ml vs 63.7 ng/ml; BAL: 927 ng/mg vs 522 ng/mg). Also, the percentage of patients with levels exceeding the established cutoff was greater in the group with cancer than in the group with benign disease (serum: 24.6 vs 17.6; BAL: 25.3 vs 3). Statistically significant differences in these percentages were found in BAL (p<0.01). Patients with extended small cell carcinoma had higher HA values (p =0.04) than those with limited disease, and the percentage of patients with abnormal HA values was larger in the group with extended disease than in the group with limited disease (p = 0.004). The serial determinations of HA values in serum reflected the clinical evolution after treatment in 73% of the small cell carcinomas. Most of the patients with benign diseases whose HA values exceeded the cutoff level suffered from acute infectious dis-eases. Once these cases were excluded, the specificity of HA value determination in the diagnosis of carcinoma was very high (serum 96%, BAL 100%). The determination of HA levels in serum or BAL did not have any prognostic value in this study. We conclude that the HA levels in serum and BAL could be of interest as a tumor marker, especially in patients with small cell carcinoma.

[Spontaneous pneumothorax as the only initial manifestation of bronchogenic carcinoma]. / Neumotórax espontáneo como única manifestación inicial del carcinoma broncogénico.

We present the case of a patient with spontaneous pneumothorax associated to pulmonary epidermoid carcinoma, which was not radiologically visible after pulmonary reexpansion. Neither it was macroscopically detected in the first thoracotomy performed for the treatment of the pneumothorax, being diagnosed after the histological study of the resected blisters. The association between pneumothorax and lung cancer is very rare, especially in the absence of other radiological disorders suggesting neoplasia after the pulmonary reexpansion. In these cases, the diagnosis is extremely difficult and it must be always suspected in patients with spontaneous pneumothorax and risk factors for pulmonary cancer.