Renal function at admission as a prognostic marker for patients hospitalised for a first episode of heart failure. Results of the PREDICE study. / Función renal al ingreso como marcador pronóstico en pacientes hospitalizados por un primer episodio de insuficiencia cardíaca. Resultados del estudio PREDICE.

BACKGROUND AND OBJECTIVE: Heart failure (HF) is a frequent condition that deteriorates quality of life and results in high morbidity and mortality. A considerable number of studies have been implemented in recent years to determine the factors that affect the prognosis of HF; however, few studies have assessed the prognosis of patients hospitalised for their first episode of HF. The aim of our study was to analyse the prognostic impact of renal function on patients hospitalised for a first episode of HF. MATERIAL AND METHODS: We recruited 600 patients hospitalised for a first episode of HF in 3 tertiary Spanish hospitals. We analysed the mortality risk during the first year of follow-up according to renal function at the time of admission. RESULTS: The patients with the highest degree of kidney failure at admission were older (P<.001), were more often women (p=.01) and presented a higher degree of dependence (P<.05), as well as a higher prevalence of arterial hypertension (P<.001), chronic renal failure (P<.001) and anaemia (P<.001). In the multivariate analysis, the degree of kidney failure at admission remained an independent predictor of increased mortality risk during the first year of follow-up. CONCLUSIONS: The presence of kidney failure at admission was a marker of poor prognosis in our cohort of patients hospitalised for a first episode of HF.

Primary extragastrointestinal stromal tumors in the omentum and mesentery: a clinicopathological and immunohistochemical study.

BACKGROUND/AIMS: This study aimed to describe the clinical, histological and immunohistochemical characteristics of primary extragastrointestinal stromal tumors (EGISTs) of the omentum and mesentery diagnosed in the Hospital 12 de Octubre, in Madrid, Spain, from 1993-2005. METHODOLOGY: The clinical data and histological and immunohistochemical findings of primary mesenchymal neoplasias were revised using the Department of Pathological Anatomy databases. RESULTS: Six EGISTs were identified. Three were primarily of the omentum and 3 mesenteric. They were found in 4 males and 2 females with an average age of 65.16 years. All were c-KIT positive, and the majority CD34 positive, while 3 were positive for muscle-specific actin. The 3 omentum cases had a mixed spindle/epithelioid pattern and low mitotic rate, while the 3 mesenteric cases had a spindle pattern, with a high mitotic rate in 2 cases, where hepatic metastasis appeared at 6 and 32 months respectively. The 3 omentum cases were alive at the time of writing, and free of disease at 16, 21 and 34 months of follow-up. EGISTs represent 11.9% of GIST cases diagnosed in the hospital over the period 2000-2005. CONCLUSIONS: In this study primary EGISTs of the omentum and mesentery showed clinicopathological and immunohistochemical characteristics similar to those previously in the literature for GISTs of the digestive tract, which supports the hypothesis that these tumors originate from extragastrointestinal c-KIT positive cells. Mesenteric location appears to be associated with a poorer prognosis.

[Hepatocellular carcinoma in the elderly: clinical characteristics, survival analysis, and prognostic indicators in a cohort of Spanish patients older than 75 years]. / Carcinoma hepatocelular en el anciano: características clínicas, análisis de supervivencia y factores pronósticos en una cohorte de pacientes españoles mayores de 75 años.

AIMS: Hepatocellular carcinoma (HCC) remains poorly characterized in elderly patients with comorbid conditions, a fact that limits the clinical management of the disease. This study analyzes the natural history of HCC in patients older than 75, and determines factors that condition their survival. PATIENTS AND METHODS: A retrospective analysis of 235 patients with HCC divided into 2 groups by age at diagnosis: < or = 75 (n = 186) and > 75 (n = 49). After comparing their clinical variables (chi2 and t test), a logistic regression analysis was performed to determine factors associated with receiving locoregional treatment (versus symptomatic treatment). Survival in the 2 groups was compared using a log rank test with subsequent multivariate analysis (Cox proportional hazards model). RESULTS: There were no differences between groups for sex, presence of cirrhosis, etiology, Child-Pugh score, BCLCancer stage, presence of ascites or portal thrombosis, or bilirubin, AST, ALT, gammaGT, LDH or hematocrit values. Patients of advanced age were more frequently diagnosed in the presence of clinical manifestations, and had multifocal, non-localized disease and alpha-fetoprotein levels > 400 ng/mL (all p < 0.05). This group received exclusively symptomatic treatment in 78% of cases (compared to 33% in younger patients), and only 3 of them underwent surgical resection (p < 0.0001). Age older than 75 was a predictive factor for not receiving locoregional therapy (p < 0.0001). Survival in the elderly group (9.8 +/- 1 months) differed substantially from that of younger patients (25.6 +/- 2 months) (p < .00001). Advanced age continued to be a prognostic factor of poor survival in the multivariate analysis (p = 0.025), but lost significance when the analysis was stratified by treatment subgroups (p = 0.344). CONCLUSIONS: The lower survival seen in elderly patients with HCC, beyond differences in tumor extension or liver failure, seems conditioned by the use of suboptimal treatment in this population.

[Hemoperitoenum as presentation of hepatocellular carcinoma: experience in three cases with spontaneous tumoral rupture and review of the literature]. / Hemoperitoneo como forma de presentación del carcinoma hepatocelular: experiencia de tres casos con rotura tumoral espontánea y revisión de la literatura.

Hemoperitoneum due to spontaneous rupture of hepatocellular carcinoma (HCC) constitutes a life-threatening situation if no appropriate therapy is provided. This complication is a well-known form of HCC presentation in countries with high incidence of liver tumours, but is an unusual event in Western countries, where it has been described in 5% or less of cases with HCC. We report three patients admitted to our centre with acute hemoperitoneum secondary to non-traumatic rupture as a first manifestation of not previously diagnosed HCC. A review of the related literature is also performed.

Effect of highly active antiretroviral therapy on the incidence and clinical manifestations of visceral leishmaniasis in human immunodeficiency virus-infected patients.

This study analyzes the effect of highly active antiretroviral therapy (HAART) on visceral leishmaniasis in human immunodeficiency virus-infected individuals. We describe 66 episodes diagnosed in our hospital from 1994 through 2000 (35 episodes in patients who were not receiving HAART and 31 episodes in patients who were receiving HAART). Since HAART became available, the incidence of visceral leishmaniasis has significantly decreased and the number of first episodes has decreased, although the number of relapses is increasing.

[Localized Castleman's disease associated with high-grade lymphoma]. / Enfermedad de Castleman localizada asociada a linfoma de alto grado.

Castleman's disease is a rare entity which is characterized by its histologic features: hyperplasia of lymph nodes and capillary proliferation. Two distinct histological patterns has been described: hyaline vascular type and plasma-cell type. Two different clinical course has been identified. While localized type is usually a benign disease in which surgical resection is curative, multicentric type has a poor prognosis regarded to the appearance of severe infection or neoplasm (Kaposi's sarcoma or malignant lymphoma. We present a rare association of localized Castleman's disease that presents synchronously with a diffuse large-cell lymphoma.

[Therapeutic management of cancer of unknown primary site by pathological types]. / Manejo terapéutico del cáncer de origen desconocido por grupos patológicos.

The term cancer of unknown primary site includes metastatic tumours with different histology and behaviour. Although most of them have a poor short-term prognosis, some patients can benefit from a treatment and will achieve a longer survival. The treatable cases are: metastases of squamous carcinoma in cervical or inguinal adenopathies, metastases of adenocarcinoma in axilar adenopathies in women, malignant ascites due to adenocarcinoma in women, osteoblastic bone metastases in men with elevated serum prostatic specific antigen levels, poorly differentiated tumours with features of a germinal extragonadal tumour, poorly differentiated neuroendocrine carcinomas and patients with a single metastasis. Chemotherapy must be considered in the rest of patients, although the optimum regimen is not well established yet.

[Diagnostic approach to cancer of unknown primary site]. / Aspectos fundamentales del diagnóstico del cáncer de origen desconocido.

Cancer of unknown primary site (CUPS) is a heterogeneous entity defined by the presence of a histologically-proven metastatic neoplasm, in which the original tumor cannot be identified after a targeted study. The current guidelines for CUPS focus is not based on the search for the primary neoplasm but rather on the identification of patients who may benefit from a treatment that will prolong their survival, based on the clinical and histological characteristics of each case. By improving the diagnostic study, we avoid using fruitless tests in patients with limited therapeutic possibilities and poor short-term prognosis.