Is there a relationship between varicocele and testosterone levels?

OBJECTIVES: The goal of this work was to study the relationship between presence of varicocele and testosterone serum levels in adulthood. METHODS: A comparative, cross-sectional study of 387 men who consulted for erectile dysfunction. Age, body mass index (BMI), diabetes (DM), and presence of varicocele were related to testosterone levels through uni- and multi-variate analysis. RESULTS: A total of 248 cases (70.8%) had no varicocele, 46 (13.1%) had grade I varicocele, 36 (10.3%) grade II, and 20 (5.7%) grade III. The mean total testosterone levels were 4.77 ng/mL in the non-varicocele group and 4.34 ng/mL in the varicocele group (p = .91), while free testosterone levels were 69.81 and 73.24 pg/mL (p = .18), respectively. In the multivariate analysis, BMI> = 30 was related to low total testosterone levels (OR: 2.94, p < .001) and low free testosterone (OR: 2.01, p = .01), while advanced age associated with low levels of free testosterone (OR: 1.04, p < .001). CONCLUSIONS: We were not able to establish a relationship between the presence of varicocele and decreased serum testosterone levels. Other factors already described, such as obesity and age, were related to low levels of total and free testosterone.

Intrarenal pseudoaneurysm after percutaneous nephrolithotomy. Renal angiography and selective embolization.

OBJECTIVE: We present a case of intrarrenal pseudoaneuysm after percutaneous nephrolithotomy. The treatment was selective embolization of the pseudoaneurysm. We discuss the role of computerized angiotomography and angiography in these cases. We present a review of the related literature. METHODS: A computerized angiotomography (angio CT) was performed because of suspicion of a delayed vascular lesion after percutaneous nephrolithectomy. Faced with the findings of the angio CT an selective renal artery arteriography and selective embolization was performed. RESULTS: The angiotomography shows an enhanced nodular contrast in the lower third of the left kidney with a scarred area at this level suggestive of hemorrhage due to vascular lesion.Through puncture of the right common femoral artery, arteriography was performed on the left renal artery with, objectifying an amputated artery related to the bleeding situation in the calyx. After localization of the point of hemorrhage, the vessel was embolized with a 3 mm metallic microspiral GCD, 6 cm in length After embolization, the evolution of the patient was satisfactory. CONCLUSIONS: Intrarenal pseudoaneurysm is the most frequent cause of late bleeding after percutaneous nephrolithotomy. The most common symptom is hematuria that can be severe and require active treatment in order to inhibit the hemorrhage. In these cases, computerized angiotomography and angiography take on a very important diagnostic role, the latter offering the possibility to treat the hemorrhage through selective embolization of the pseudoaneurysm.

Oncoxin-Viusid® may improve quality of life and survival in patients with hormone-refractory prostate cancer undergoing onco-specific treatments.

The aim of the present study was to identify the efficacy and safety of Oncoxin-Viusid (OV) as a supportive treatment for patients with prostate cancer (PCA). A prospective, non-randomised, open-label phase II clinical trial, including 25 patients with hormone-refractory PCA (HRPC) was conducted at the Hospital Universitario General Calixto García (Havana, Cuba) between June 2017 and March 2018. Each of the patients received chemotherapy (CTX) and/or radiotherapy (RT) and OV treatment. Patients had a mean age of 73 years, clinical stage IV cancer and a high risk of relapse. Six cycles of CTX were completed by 80% of the patients, adverse reactions decreased and no weight loss was observed. Among the 25 patients, 5 were lost to follow-up and 4 died of disease progression. A total of 16 of these patients survived, of which 15 had an improved quality of life and 10 responded to treatment, with a significant reduction in pain and prostate symptoms and ≥50% reduction in baseline PSA. The progression-free survival (PFS) rate was 59% and the overall survival (OS) rate 64% at 1 year after treatment began. The OV nutritional supplement was effective, leading to a significant improvement in the patients' quality of life, good nutritional status and greater treatment tolerance. A clinical and humoral response was observed, with high survival rates and a delayed appearance of signs of disease progression. The present study was registered in ClinicalTrials.gov PRS with ID #NCT03543670.

Family history of cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium.

Alcohol and tobacco consumption are well-recognized risk factors for head and neck cancer (HNC). Evidence suggests that genetic predisposition may also play a role. Only a few epidemiologic studies, however, have considered the relation between HNC risk and family history of HNC and other cancers. We pooled individual-level data across 12 case-control studies including 8,967 HNC cases and 13,627 controls. We obtained pooled odds ratios (OR) using fixed and random effect models and adjusting for potential confounding factors. All statistical tests were two-sided. A family history of HNC in first-degree relatives increased the risk of HNC (OR=1.7, 95% confidence interval, CI, 1.2-2.3). The risk was higher when the affected relative was a sibling (OR=2.2, 95% CI 1.6-3.1) rather than a parent (OR=1.5, 95% CI 1.1-1.8) and for more distal HNC anatomic sites (hypopharynx and larynx). The risk was also higher, or limited to, in subjects exposed to tobacco. The OR rose to 7.2 (95% CI 5.5-9.5) among subjects with family history, who were alcohol and tobacco users. A weak but significant association (OR=1.1, 95% CI 1.0-1.2) emerged for family history of other tobacco-related neoplasms, particularly with laryngeal cancer (OR=1.3, 95% CI 1.1-1.5). No association was observed for family history of nontobacco-related neoplasms and the risk of HNC (OR=1.0, 95% CI 0.9-1.1). Familial factors play a role in the etiology of HNC. In both subjects with and without family history of HNC, avoidance of tobacco and alcohol exposure may be the best way to avoid HNC.

Type of alcoholic beverage and risk of head and neck cancer--a pooled analysis within the INHANCE Consortium.

The authors pooled data from 15 case-control studies of head and neck cancer (9,107 cases, 14,219 controls) to investigate the independent associations with consumption of beer, wine, and liquor. In particular, they calculated associations with different measures of beverage consumption separately for subjects who drank beer only (858 cases, 986 controls), for liquor-only drinkers (499 cases, 527 controls), and for wine-only drinkers (1,021 cases, 2,460 controls), with alcohol never drinkers (1,124 cases, 3,487 controls) used as a common reference group. The authors observed similar associations with ethanol-standardized consumption frequency for beer-only drinkers (odds ratios (ORs) = 1.6, 1.9, 2.2, and 5.4 for < or =5, 6-15, 16-30, and >30 drinks per week, respectively; P(trend) < 0.0001) and liquor-only drinkers (ORs = 1.6, 1.5, 2.3, and 3.6; P < 0.0001). Among wine-only drinkers, the odds ratios for moderate levels of consumption frequency approached the null, whereas those for higher consumption levels were comparable to those of drinkers of other beverage types (ORs = 1.1, 1.2, 1.9, and 6.3; P < 0.0001). Study findings suggest that the relative risks of head and neck cancer for beer and liquor are comparable. The authors observed weaker associations with moderate wine consumption, although they cannot rule out confounding from diet and other lifestyle factors as an explanation for this finding. Given the presence of heterogeneity in study-specific results, their findings should be interpreted with caution.

Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium.

BACKGROUND: The magnitude of risk conferred by the interaction between tobacco and alcohol use on the risk of head and neck cancers is not clear because studies have used various methods to quantify the excess head and neck cancer burden. METHODS: We analyzed individual-level pooled data from 17 European and American case-control studies (11,221 cases and 16,168 controls) participating in the International Head and Neck Cancer Epidemiology consortium. We estimated the multiplicative interaction parameter (psi) and population attributable risks (PAR). RESULTS: A greater than multiplicative joint effect between ever tobacco and alcohol use was observed for head and neck cancer risk (psi = 2.15; 95% confidence interval, 1.53-3.04). The PAR for tobacco or alcohol was 72% (95% confidence interval, 61-79%) for head and neck cancer, of which 4% was due to alcohol alone, 33% was due to tobacco alone, and 35% was due to tobacco and alcohol combined. The total PAR differed by subsite (64% for oral cavity cancer, 72% for pharyngeal cancer, 89% for laryngeal cancer), by sex (74% for men, 57% for women), by age (33% for cases <45 years, 73% for cases >60 years), and by region (84% in Europe, 51% in North America, 83% in Latin America). CONCLUSIONS: Our results confirm that the joint effect between tobacco and alcohol use is greater than multiplicative on head and neck cancer risk. However, a substantial proportion of head and neck cancers cannot be attributed to tobacco or alcohol use, particularly for oral cavity cancer and for head and neck cancer among women and among young-onset cases.

[Renal lithiasis, can we predict the need for retreatment in retrograde intrarenal surgery (RIRS)?] / Litiasis renales, ?podemos predecir la necesidad de retratamientos en cirugía retrógrada intrarrenal?.

OBJECTIVES: To analyze the predictive factors for retreatment in RIRS to achieve complete lithiasis resolution. METHODS: Retrospective comparative study analyzing 298 cases of RIRS performed in our center over a 3 year period. The cohort was divided in two groups: Resolution in one operation or more than one, evaluating homogeneicity for age and gender. We compared the folowing variables: Hounsfield units, body mass index (BMI), number of stones, size, (on the case of multiple stones, larger stone size), side, location in the kidney and stone biochemistry. Bivariant statistical analysis by Student's t and Chi square tests, and multivariate analysis by binary logistic regression. ROC curves were made to set cutting points for relationship between quantitative variables. RESULTS: The groups were homogeneous for both age and gender (p>0.05). 260 (87.25%) patients required one treatment only and 38 (12.75%) more than one. Among the study variables, the only one that showed differences between the groups wa stone size, being the mean size 18 mm in the single treatment group and 26 mm in the more than one treatment group (Difference between mean values -8.27, 95%CI: -5,91 - -10.63, p<0,001). CONCLUSIONS: RIRS with holmium laser is still an effective technique for the treatment of renal lithiasis. The largest stone size is related with the need of retreatments, so it must be taken into consideration specially over 2 cm. In our series, for every extra millimeter in size the probability of retreatment increased 1.14 times, demonstrating the importance of size in this context.

[Renal hemorrhage after ESWL: From small hematoma to renal blowout]. / Hemorragia renal tras LEOC: del pequeño hematoma al estallido renal.

OBJECTIVE: To report two cases of renal hemorrhage after extracorporeal shock wave lithotripsy (ESWL) and their therapeutic management. METHODS: Description of the clinical cases, together with the diagnosis and therapeutic management of these complications. RESULTS: We present two cases of patients with renal hemorrhage after ESWL, which were performed without immediate complications. One of the cases, after detecting an important laceration of the renal parenchyma, needed two embolization sessions for its short-term resolution; however, the patient finally passed away due to the complications derived from hemorrhage. The other case was solved through conservative management. CONCLUSIONS: Even though hemorrhage is an infrequent complication after ESWL, it should be suspected when the patient presents compatible clinical symptoms, since even though most cases are resolved in a conservative manner, on some occasions specific treatments for the hemorrhage are necessary. Old age and the presence of vascular comorbidities seem to be related to a higher risk of hemorrhage after ESWL.

Childhood cancer incidence in Cuba, 2001 to 2003.

INTRODUCTION: Estimating childhood cancer incidence globally is hampered by lack of reliable data and uniform age limits for classifying and analyzing data reported. In Cuba, cancer data has been systematically gathered and processed by the National Cancer Registry (NCR) since 1964. The International Classification of Childhood Cancer (ICCC) is currently recommended for registering neoplasms in the population aged < or =19 years. Cancer incidence data published by the Cuban Ministry of Public Health, however, uses ICCC diagnostic groups for the population aged <15 years, and topographic sites for the population aged > or =15 years. OBJECTIVE: The objectives of this study are to describe cancer incidence in the Cuban population aged < or =19 years in 2001-2003 using the ICCC, as well as geographic distribution of incidence by sex and by principal diagnostic groups. METHODS: A descriptive study of cancer incidence in the population aged < or =19 years was conducted using NCR data for 2001-2003. ICCC diagnostic groups and subgroups were used, and 5 age groups (<1, 1-4, 5-9, 10-14 and 15-19 years) were analyzed. Total incidence and percentages for each diagnostic group were calculated. Number of cases in each diagnostic group and subgroup was also recorded by age group, and age-specific rates per 100,000 population aged < or =19 years (ASR) and age-adjusted rates to the standard world population aged < or =19 years (AAR) were calculated. AARs for leukemias, lymphomas and central nervous system (CNS) tumors were used to analyze childhood cancer risk by sex and geographical distribution in the country's 14 provinces and Isle of Youth Special Municipality. RESULTS: In 2001-2003, the NCR reported 1285 new cancer cases in the population aged < or =19 years for an overall incidence of 13.9 per 100,000 population aged < or =19 years (AAR). Highest risk was found in children aged <1 year with an ASR of 21.9 per 100,000 population aged < or =19 years. Leukemias, lymphomas and central nervous system tumors comprised 61.1% of new cases, and geographic distribution of these diagnostic groups varied by sex. Childhood cancer risk was highest for males in Ciego de Avila, Villa Clara and the Isle of Youth Special Municipality and highest for females in Sancti Spiritus, Villa Clara and Cienfuegos. CONCLUSIONS: Incidence of childhood cancer in Cuba conforms to rates reported internationally and to the incidence pattern most common in Latin America. Further research is recommended to examine risk factors influencing geographical variations in incidence within Cuba.

FOLFOX-4 Regimen as a First-line Therapy for Cuban Patients with Metastatic Colorectal Cancer.

Introduction In Cuba, colorectal cancer (CRC) is the malignant neoplasm with the fourth-highest incidence and third-highest mortality. Over one-third of CRC patients exhibit metastatic disease at the time of diagnosis. Standard treatment for metastatic CRC is a 5-fluorouracil (5-FU) + Folinic Acid (FA) continuous infusion regimen. International studies have shown, however, that systemic therapy using oxaliplatin combined with 5-FU and FA (FOLFOX-4) improves results in terms of both tumor response and survival in patients with inoperable metastatic CRC. Objective Evaluate the FOLFOX-4 regimen as a first-line therapy for patients with inoperable metastatic CRC in Cuba. Methods FOLFOX-4 therapy was administered to 56 patients with metastatic CRC, in a treatment cycle repeated every 2 weeks for 6-8 cycles. Patients were followed up for a period of 2 years. Results Objective response was attained in 44.6% of patients, and complete response in 12.5%. Median duration of response and of progression-free survival was 9.6 and 8.9 months, respectively. Estimated survival at 2 years was 17% (95% CI: 6.89-26.8). The most frequent adverse events were nausea, vomiting, diarrhea and neutropenia, the majority grade 1-2, according to Common Terminology Criteria for Adverse Events (CTCAE) classification. Conclusions In patients studied, the FOLFOX-4 combination was shown to be an effective and well-tolerated therapeutic option for treating inoperable metastatic colorectal cancer.

Multiple ADH genes are associated with upper aerodigestive cancers.

Alcohol is an important risk factor for upper aerodigestive cancers and is principally metabolized by alcohol dehydrogenase (ADH) enzymes. We have investigated six ADH genetic variants in over 3,800 aerodigestive cancer cases and 5,200 controls from three individual studies. Gene variants rs1229984 (ADH1B) and rs1573496 (ADH7) were significantly protective against aerodigestive cancer in each individual study and overall (P = 10(-10) and 10(-9), respectively). These effects became more apparent with increasing alcohol consumption (P for trend = 0.0002 and 0.065, respectively). Both gene effects were independent of each other, implying that multiple ADH genes may be involved in upper aerodigestive cancer etiology.

[Educational methods in the prevention of smoking, among students of the Department of Herault, France]. / Métodos educativos en la prevención del tabaquismo, en escolares del Departamento del Herault, Francia.

OBJECTIVE: To evaluate the efficacy of two educational strategies to prevent tobacco addiction in schoolchildren living in Herault, France. MATERIAL AND METHODS: A study was conducted to deliver an intervention and make a concurrent comparison, among elementary school, fifth-grade students, during school years 1992 to 1995, in Herault Department, Montpellier, France. Three observation groups were included: Group 1 was subject to a cross-sectional educational intervention; Group 2 was only subject to a single health activity on World Day Against Smoking; and Group 3 or control was not subject to any intervention. RESULTS: The prognostic role of peers and the family setting on tobacco consumption was confirmed; after three years, the Group subject to the sustained cross-sectional intervention showed a prevalence of smokers significantly lower than that of the other two groups. CONCLUSIONS: Even though tobacco consumption seems to begin earlier in boys than in girls, in the former the prevalence increases from 0.7 to 7% after three years. Preventive educational interventions should be maintained and reinforced to be effective on the initiation and cessation of tobacco smoking among children.

Cáncer y transición demográfica en América Latina y el Caribe / Cancer and demographic transition in Latin America and the Caribbean

Las proyecciones de las cifras de incidencia de cáncer indican un incremento futuro de estas cifras en todo el mundo, los cambios más conspicuos en países en vías de desarrollo pueden ser atribuidos en gran parte al envejecimiento de la población. Este envejecimiento es heterogéneo, se está produciendo a un ritmo más rápido que el registrado históricamente en los países desarrollados, ocurre en un contexto caracterizado por una gran incidencia de la pobreza y una persistente y aguda iniquidad social. Mientras que la población de Paraguay es una población aún joven, la de Uruguay está en franco envejecimiento. La transición demográfica hacia el 2020 es más alarmante para Cuba, Puerto Rico y Martinica y Guadalupe, que para el resto de los países, con un incremento porcentual de la población de 65 años y más, superior al 40 %. Los valores de la Razón Estandarizada de Incidencia por cáncer son superiores al 100 % en los países más envejecidos e inferiores al 100 % en los grupos menos envejecidos, lo que es un reflejo de que el riesgo de enfermar de cáncer guarda una estrecha relación con el envejecimiento de la población. La transición demográfica muestra la urgencia de establecer políticas públicas para las personas de 60 y más años en la región. La prevención primaria podría ser la alternativa más plausible para evitar los incrementos futuros en el costo de la salud como consecuencia del incremento de las cifras de cáncer.

Projections of cancer incidence figures point to a future increase of these figures worldwide; the most conspicuous changes in developing countries may be greatly attributed to the population aging. This aging is heterogeneous, occurs at a faster rate than that historically recorded in developed countries, in a context characterized by a high incidence of poverty and persistent acute social inequality. Whereas the Paraguay 's population is still young, the Uruguayan population is undergoing a real aging process. The demographic transition towards the year 2020 is more alarming for Cuba, Porto Rico, Martinique and Guadeloupe than for the rest of the countries, with a percentage increase of 65 years old and over population exceeding 40%. The figures of the Standardized Ratio of Cancer Incidence are higher than 100% in the oldest countries and under 100% in less aged groups, which shows that the risk of getting sick with cancer is closely related with the population aging. The demographic transition demonstrates the urgent need of setting out public policies for people aged 60 years or more in the region. The prevention at primary care could be the most plausible alternative to avoid future increases in the healthcare cost as a result of a rise of cancer incidence figures.

Métodos educativos en la prevención del tabaquismo, en escolares del Departamento del Herault, Francia / x

Objetivo. Evaluar la eficacia de dos estrategias educativas para la prevención del tabaquismo en jóvenes de edad escolar. Material y métodos. Estudio de intervención, de comparación concurrente, con alumnos del quinto grado de primaria durante los cursos de 1992 a 1995, efectuado en el Departamento del Herault, Montpellier, Francia. Se incluyeron tres grupos de observación: grupo I, sometido durante el año escolar a un programa educativo transversal; grupo II, sometido el "Día Mundial sin Fumar" a una acción puntual, y el grupo III, testigo, no sometido a intervención, cuyos resultados se compararon con ji cuadrado y se hizo regresión logística. Resultados. Se confirma el papel pronóstico de sus iguales y del entorno familiar sobre el consumo de tabaco. Transcurridos tres años, el grupo sometido a la intervención transversal sostenida muestra una prevalencia de fumadores significativamente inferior a la de los otros dos grupos. Conclusiones. Aunque el consumo de tabaco parece iniciar más tardíamente en las niñas que en los niños, en este estudio la prevalencia aumenta al cabo de tres años, de 0.7 a 7 por ciento. Deben mantenerse y reforzarse en tiempo y lugar las acciones educativas de prevención para que tengan influencia y eficacia en la iniciación y disminución del consumo de tabaco en los niños.

Abstract Objective. To evaluate the efficacy of two educational strategies to prevent tobacco addiction in schoolchildren living in Herault, France. Material and Methods. A study was conducted to deliver an intervention and make a concurrent comparison, among elementary school, fifth-grade students, during school years 1992 to 1995, in Herault Department, Montpellier, France. Three observation groups were included: Group 1 was subject to a cross-sectional educational intervention; Group 2 was only subject to a single health activity on World Day Against Smoking; and Group 3 or control was not subject to any intervention. Results. The prognostic role of peers and the family setting on tobacco consumption was confirmed; after three years, the Group subject to the sustained cross-sectional intervention showed a prevalence of smokers significantly lower than that of the other two groups. Conclusions. Even though tobacco consumption seems to begin earlier in boys than in girls, in the former the prevalence increases from 0.7 to 7 percent after three years. Preventive educational interventions should be maintained and reinforced to be effective on the initiation and cessation of tobacco smoking among children.

Metodología de la investigación en los trabajos de terminación de residencia / Research methodology in the residence termination papers

En el presente trabajo se presentan los resultados encontrados en un estudio nacional de los Trabajos de Terminación de Residencia (TTR) realizados en el presente quinquenio con el fin de estableder un diagnóstico sobre el uso de la metodología de la investigación en el desarrollo de los mismos. Paralelamente se pretende identificar el grado de rigor metodológico con que se realizan los TTR y establecer la relación que pudiera existir entre el apoyo docente recibido por los estudiantes para esa tarea y el rigor metodológico alcanzado por los mismos. Con ese fin se eligió una muestra equiprobalística de 126 especialístas; sus TTR fueron evaluados y sus autores interrogados. Para el análisis de dos revelan que prevalece una situación que demanda atención priorizada. Entre los más relevantes se halla el bajo nivel de compromiso de los tutores con el TTR, la naturaleza predominante descriptiva y carente de profundidad de los trabajos y la falta de consecuencia en la cadena objetivo-método-conclusiones

Efectos trasplacentarios del condensado del humo de cigarrillos negros sobre el genoma de roedores / Trasplacental effects of condesed smoke from black cigarrettes on the genome of rodents

Estudiamos cigogenéticamente las crías de ratones provenientes de madres expuestas a condesado de humo de cigarrillos, como posible indicador de daño inducido sobre el genoma de estos roedores. Encontramos en la generación F1 aberraciones cromosómicas que presentan diferencias estadísticamente significativas entre las crías de madres tratadas con condensado y las de controles y testigos, así como la aparición de células con 41 cromosomas en las crías F1 tratadas y sólo en ellas. En la generación F2 no se encontraron diferencias estadísticamente significativas de aberraciones cromosómicas