Bone mass behavior after 1 year of different treatment strategies in prostate cancer patients subjected to androgen deprivation therapy.

The aim of this study was to evaluate bone mass changes after 1 year of four different types of pharmacological intervention. Ninety-seven prostate cancer patients treated with androgen deprivation therapy, and severe osteopenia or osteoporosis were retrospectively studied. Patients were divided in four groups. Group 1: 28 patients treated with denosumab, Group 2: 24 patients treated with alendronate, Group 3: 24 patients with no antiresorptive treatment and Group 4: 21 patients previously treated with alendronate and switched to denosumab. Dual X-ray absorptiometry was performed at baseline and after 1 year. Bone mass changes at the L2-L4 lumbar spine, femoral neck and total hip were evaluated. No differences were found at baseline. After 1 year, men receiving denosumab or alendronate (Group 1 and 2) showed a significant bone mass increase at the lumbar spine (+2.4 and +5.0 %, respectively), while no significant changes were observed in Group 3 and 4. At the femoral neck, Group 1 and 2 patients showed a significant bone mass increase (+3.7 and +3.6 %, respectively), while no significant changes were observed in Group 3 and 4. At the total hip, we observed a significant bone mass increase in Group 1 (+2.9 %) and a significant bone mass loss in Group 3 patients (-1.9 %). No significant changes were observed in Group 2 and 4. Denosumab increased significantly bone mass in all three dual X-ray absorptiometry standard sites, while alendronate did not at total hip. No benefit was observed in men previously treated with alendronate who switched to denosumab treatment.

Trends in incidence and predictions of cutaneous melanoma across Europe up to 2015.

BACKGROUND: Melanoma is a significant health problem in Caucasian populations. The most recently available data from cancer registries often have a delay of several months up to a few years and they are generally not easily accessible. OBJECTIVES: To assess recent age- and sex-specific trends in melanoma incidence and make predictions for 2010 and 2015. METHODS: A retrospective registry-based analysis was performed with data from 29 European cancer registries. Most of them had data available from 1990 up to 2006/7. World-standardized incidence rates (WSR) and the estimated annual percentage change (EAPC) were computed. Predictions were based on linear projection models. RESULTS: Overall the incidence of melanoma is rapidly rising and will continue to do so. The incidence among women in Europe was generally higher than in men. The highest incidence rates were seen for Northern and north-western countries like the UK, Ireland and the Netherlands. The lowest incidence rates were observed in Portugal and Spain. The incidence overall remained stable in Norway, where, amongst young (25-49 years) Norwegian males rates significantly decreased (EAPC -2.8, 95% CI -3.6; -2.0). Despite a low melanoma incidence among persons above the age of 70, this age group experienced the greatest increase in risk during the study period. CONCLUSIONS: Incidence rates of melanoma are expected to continue rising. These trends are worrying in terms of disease burden, particularly in eastern European countries.

Non-purged voltammetry explored with AGNES.

The reduction of oxygen increases pH in the surroundings of an electrode. A theoretical model estimates the steady-state pH profile from the surface of the electrode up to the bulk solution. A very simple formula predicts that, in non-deaerated solutions, for bulk pH-values between 4.0 and 10.0, the corresponding surface pH could be as high as 10.3, regardless of the thickness of the diffusion layer and composition of the sample (except if it has a buffering capacity). For bulk pH lower than 3.0 or higher than 10, pH increases are negligible. Less steep pH-profiles are obtained using buffers (such as MOPS 0.01 M or MES 0.01 M). The change in surface pH modifies the local speciation and hinders the standard interpretation of voltammetric responses. The electroanalytical technique Absence of Gradients and Nernstian Equilibrium Stripping (AGNES), implemented with Screen Printed Electrodes (SPE), provides experimental insights into this phenomenon. AGNES probes the free metal concentration at the electrode surface, from which the surface pH can be estimated for systems of known composition. These estimations agree with the theoretical model for the assayed systems. Additionally, the quantification of the bulk free Zn(2+) and Cd(2+) concentrations with specific modifications of AGNES for non-purged synthetic solutions is discussed. In general, more accurate determinations of the bulk free metal concentrations in non-purged solutions are expected: (i) when the calibration is performed in a medium where the pH increase induces similar changes in the surface free metal concentration and in the sample solution and (ii) when the system is more buffered.

Effect of false-positives and women's characteristics on long-term adherence to breast cancer screening.

False-positive results may influence adherence to mammography screening. The effectiveness of breast cancer screening is closely related to adequate adherence among the target population. The objective of this study was to evaluate how false-positives and women's characteristics affect the likelihood of reattendance at routine breast cancer screening in a sequence of routine screening invitations. We performed a retrospective cohort study of 1,371,218 women aged 45-69 years, eligible for the next routine screening, who underwent 4,545,346 screening mammograms from 1990 to 2006. We estimated the likelihood of attendance at seven sequential screening mammograms. Multilevel discrete time hazard models were used to estimate the effect of false-positive results on reattendance, and the odds ratios (OR) of non-attendance for the women's personal characteristics studied. The overall reattendance rate at the second screening was 81.7% while at the seventh screening was 95.6%. At the second screening invitation reattendance among women with and without a false-positive mammogram was 79.3 vs. 85.3%, respectively. At the fourth and seventh screenings, these percentages were 86.3 vs. 89.9% and 94.6 vs. 96.0%, respectively. The study variables associated with a higher risk of failing to participate in subsequent screenings were oldest age (OR = 8.48; 95% CI: 8.31-8.65), not attending their first screening invitation (OR = 1.12; 95% CI: 1.11-1.14), and previous invasive procedures (OR = 1.09; 95% CI: 1.07-1.10). The risk of non-attendance was lower in women with a familial history of breast cancer (OR = 0.97; 95% CI: 0.96-0.99), and those using hormone replacement therapy (OR = 0.96; 95% CI: 0.94-0.97). In conclusion, reattendance was lower in women with false-positive mammograms than in those with negative results, although this difference decreased with the number of completed screening participations, suggesting that abnormal results in earlier screenings more strongly influence behavior. These findings may be useful in providing women with accurate information and in improving the effectiveness of screening programs.

Direct determination of free metal concentration by implementing stripping chronopotentiometry as the second stage of AGNES.

The electroanalytical technique Absence of Gradients and Nernstian Equilibrium Stripping (AGNES) has been extended by applying stripping chronopotentiometry (SCP) as the re-oxidation stage in the determination of the free concentration of Zn(2+), Cd(2+) and Pb(2+). This new approach, called AGNES-SCP, has been implemented with screen-printed electrodes (SPE) and the standard Hanging Mercury Drop Electrode (HMDE). Clear advantages of this variant have been shown: (i) the easy resolution of the peaks of different metals present in mixtures and (ii) the sparing of blanks. A rigorous computation of the faradaic charge along the SCP stage takes into account the contribution of other oxidants, which can be efficiently measured at the end of the deposition stage of AGNES. The free Cd concentration determined in an oxalate solution at pH 6 with an HMDE as the working electrode agreed well with values obtained with a Cd Ion Selective Electrode. The free metal concentration measured using an SPE for the system Cd and nitrilotriacetic acid (NTA) at pH = 4.8 also conformed well with Visual MINTEQ results.

Population-based risk assessment of second primary cancers following a first head and neck cancer: patterns of association and difficulties of its analysis.

PURPOSE: The diagnosis of a second primary cancer (SPC) is a major concern in the follow-up of survivors of a primary head and neck cancer (HNC), but the anatomic subsites in the head and neck area are close, making it difficult to distinguish a SPC of a recurrence and therefore register it correctly. METHODS: We performed a retrospective cohort study using data from two population-based cancer registries in Catalonia, Spain: the Tarragona Cancer Registry and the Girona Cancer Registry. All patients diagnosed with HNC during the period 1994-2013 were registered and followed-up to collect cases of SPC. We analysed the standardized incidence ratio (SIR) and the excess absolute risk (EAR) to determine the risk of second malignancies following a prior HNC. RESULTS: 923 SPC were found in a cohort of 5646 patients diagnosed of a first head and neck cancer. Men had an increased risk of a SPC with a SIR of 2.22 and an EAR of 216.76. Women also had an increased risk with a SIR of 2.02 and an EAR of 95.70. We show the risk for different tumour sites and discuss the difficulties of the analysis. CONCLUSION: The risks of a SPC following a prior HNC in Tarragona and Girona are similar to those previously found in other similar cohorts. It would appear to be advisable to make a revision of the international rules of classification of multiple tumours, grouping the sites of head and neck area with new aetiological criteria to better determine and interpret the risks of SPC obtained in these studies.

Population-based cancer registries in Spain and their role in cancer control.

Population-based cancer registries (PBCRs) are a key element for cancer control. They measure cancer incidence and trends, provide indicators for planning and evaluating cancer control activities, and undertake research. The first two PBCRs in Spain were established in Zaragoza in 1960 and Navarre in 1970, but it was from 1980 to 1995 when most of the existing registries went into operation. Today, 26.5% of the Spanish population is served by a cancer registry. All registries' quality-control indicators meet the inclusion criteria for comparability and quality of data required by the International Agency for Research on Cancer, and indeed some fulfil most of the excellence criteria for gold standard certification. After their initiation into recording accurate and complete information targeted at ascertaining cancer incidence in their catchment areas, PBCRs are progressively broadening their scope and becoming increasingly involved in collecting and analysing additional data on patient care, diagnosis, disease stage, treatment and follow-up. Spanish registries have become actively engaged in research projects, domestic and international, at a rate that has risen remarkably in the past decade. The creation of a network of Spanish cancer registries is being considered, with the aim of its becoming a key player in developing standards for cancer registration, providing training and technical assistance, undertaking quality audits and promoting the use of cancer surveillance data to reduce the burden of cancer in Spain.

The moderate decrease in invasive cervical cancer incidence rates in Spain (1980-2004): limited success of opportunistic screening?

BACKGROUND: Despite its low incidence, invasive cervical cancer (ICC) is still a public health concern in Spain, due to its being perceived as an avoidable neoplasm. Social changes in recent decades may have increased the risk of ICC among Spanish females. This study sought to update incidence trends in Spanish registries. PATIENTS AND METHODS: We studied the ICC incidence time trend over the period 1980-2004 using data from 13 Spanish population-based cancer registries, analysing all cases and the two main histological types, i.e. squamous cell carcinoma (SCC) and adenocarcinoma (AC). Change-point Poisson regression models were fitted for all women and for the following three age groups: 25-44, 45-64 and > or =65 years. Age-period-cohort models were used to study cohort and period effect. RESULTS: ICC incidence showed a moderate decrease (annual percentage change: -0.9%; 95% CI -1.3% to -0.5%). Whereas rates among younger women rose sharply by 5.5% until 1990, when they began to descend by 1.2% annually, among women aged > or =45 years they declined by 1.5% per annum. In the last decade of the study period, divergent trends were found for SCC and AC, i.e. downward versus upward, respectively. Risk increased with birth cohort after 1940-45 but the period effect showed opposite trends for the two histological types. CONCLUSION: Cervical cancer incidence rates have decreased moderately in Spain, a trend consistent with the preventive effect of widespread opportunistic screening.

Prostate cancer incidence trends in Spain before and during the prostate-specific antigen era: impact on mortality.

BACKGROUND: Although prostate cancer has recently registered increasing incidence and decreasing mortality in Spain, no analysis has yet been made of these two indicators to ascertain the magnitude of and reasons for these trends. MATERIALS AND METHODS: The time trend in invasive prostate cancer incidence from 1975 to 2004 was studied by combining data from 13 Spanish population-based cancer registries. Change-point Poisson regression models were fitted for all men and for two age groups (45-64 and 65+ years). Age-period-cohort models were used to study cohort and period effects. In addition, we studied the time trend in prostate cancer mortality in Spain for the period 1980-2007. RESULTS: Incidence increased annually by 1.3% from 1975 to 1990 and by 7.3% thereafter. Until 1990, the percentage increase was low and indeed similar for both age groups. While the subsequent increase in the two age groups was greater, this was particularly marked among the youngest men, with a decrease being observed in age groups >85 years in the last quinquennium. Mortality increased by an annual figure of 0.7% until 1998, after which it decreased by 3.6% per annum until 2007. CONCLUSIONS: Despite the dramatic rise in incidence from 1990 onwards, mainly due to opportunistic screening, prostate cancer mortality was only observed to decline slowly from 1998. If prostate-specific antigen screening remains at a similar level in Spain, overdiagnosis may well become an important chronic side-effect and health problem.

Childhood cancer incidence and survival in Spain.

BACKGROUND: This article affords an overview of the patterns and time trends of childhood cancer incidence (1983-2002) and survival (1991-2002) in Spain. PATIENTS AND METHODS: A population-based study was conducted, including 5936 cases for incidence and 3257 for survival analyses. Differences in incidence were tested with the standardised incidence ratio. Trends were analysed for all tumours, and for all malignant, haematological, central nervous system (CNS) (all and only malignant) and other solid tumours. Incidence trends were analysed using Poisson and Bayesian joinpoint models. Observed, relative and age-adjusted survival rates were calculated, and trends were tested using the log-rank test. RESULTS: The incidence pattern in Spain was similar to that in Europe. Rates, both overall and for leukaemias, lymphomas, CNS, soft tissue and, remarkably, for sympathetic nervous system and bone tumours, were high. Upward incidence trends were present for all tumour groups. All groups, except solid tumours (excluding CNS), displayed a change-point centred around 1990-95, after which the trend stopped rising. Five-year survival increased significantly across the period for all groups, except for CNS tumours. Recent survival results were in line with Italy, the UK and the European average. CONCLUSIONS: To confirm these results, ongoing surveillance of incidence and survival trends, and studies targeting specific tumours are called for.

Cancer survival in Spain: estimate for nine major cancers.

BACKGROUND: This study provides estimates of population-based relative survival in Spain for nine major cancers and reports results on cancer survival by region, gender and age group. PATIENTS AND METHODS: Our analysis covered eight Spanish regions, namely, Basque Country, Navarre, Girona, Tarragona, Castellón, Albacete, Murcia and Granada, and included patients with cancer of the colon, rectum, lung, breast, ovary, prostate, testis, melanoma of skin and Hodgkin's lymphoma. Cases diagnosed during the period 1995-99 were followed up until 31 December 2004. For individual records, the maximum likelihood approach was used to estimate 5-year relative survival (5y-RS), with crude and adjusted 5y-RS being calculated. A statistical test was applied to explain significant geographical variations. RESULTS: In the regions studied, the highest 5y-RS ratio was detected for lung cancer (adjusted 5y-RS of 12.4% in Navarre versus 6.1% in Granada) and the lowest for breast cancer (91.3% in Castellón versus 81.2% in Albacete). 5y-RS for the respective cancer types was as follows: colon and rectal, 54.7% and 50.2%, respectively; ovarian, 43% overall, though much lower in the oldest age groups; prostate, 76%, rising to close to 80% in the 45-74 age group, with rates ranging from highest in Girona to lowest in Albacete; testicular, 95%, the type with the best prognosis; and Hodgkin's lymphoma, 85%, rising to 92% among young adults. In the case of melanoma of skin, the sex-related difference in 5y-RS was >10% for women. CONCLUSIONS: Although regional differences were identified for most tumours, these were more marked in lung cancer. Women showed better prognosis. Breast and prostate cancer registered lower survival among young than among middle-aged adults. The worst prognosis was for lung cancer and the best for cutaneous melanoma, with breast, prostate and Hodgkin's lymphoma displaying favourable and colon, rectum and ovary unfavourable prognoses. Identifying regional, gender- and age-related differences affords valuable knowledge for improving cancer care.

Experimental verification of the metal flux enhancement in a mixture of two metal complexes: the Cd/NTA/glycine and Cd/NTA/citric acid systems.

Rigorous computation of the metal flux crossing a limiting surface of a system that contains a mixture of 1 : 1 metal complexes under steady-state planar diffusion in a finite domain and under excess of ligand conditions predicts, for some cases, an enhancement of the metal flux with respect to that expected in a system with independent complexes. Indeed, the coupling of the dissociation kinetics of both complexes can yield higher metal fluxes than expected with important environmental implications. By using the voltammetric techniques AGNES and stripping chronopotentiometry, this paper provides experimental evidence of this enhancement for two systems: Cd/NTA/glycine and Cd/NTA/citric acid. The flux measured in both cases is in good agreement with the flux computed for the global system, exhibiting maximum enhancement ratios above 20%. Theoretical discussion of the flux enhancement factors and of the conditions for this enhancement are also provided.

Rising trends in incidence of cutaneous malignant melanoma and their future projections in Catalonia, Spain: increasing impact or future epidemic?

BACKGROUND: During the past decades, there has been a substantial increase in the incidence of cutaneous malignant melanoma (CMM) among all Caucasian populations. Spain presents one of Europe's lowest incidence and mortality rates. OBJECTIVE: The aim of this study was to analyse the recent trends of CMM incidence and mortality in a region with lower incidence as well as to project their future trends. METHODS: Cutaneous malignant melanoma incidence data were provided by the Tarragona and Girona population-based cancer registries and mortality data were provided by the Mortality Registry of Catalonia. Time trends of incidence and mortality rates by CMM were assessed through the estimated annual percentages of change of the incidence and mortality age-standardized rates to the World Standard Population. Projections were based on a Bayesian age-period-cohort model using second order autoregressive effects on age. RESULTS: During the last 20 years CMM incidence has increased substantially at a faster rate than any other neoplasms in Catalonia, particularly among women and this trend will probably continue for the next several years. Nevertheless, CMM mortality trends have been and probably will remain stable during this period. CONCLUSION: Improvements in preventive activities should be implemented to decrease incidence and mortality from this cancer. Monitoring stage-specific trends in CMM incidence can assess the impact of preventive strategies; for this reason more complete information on diagnostic features of CMM patients in the Spanish population-based cancer registries are necessary.

[Decreased glomerular filtration rate using the Cockckroft-Gault and MDRD formulas does not always predict cardiovascular morbidity and mortality in hypertensive primary care patients]. / El filtrado glomerular reducido según las fórmulas de Cockcroft-Gault y MDRD no siempre predice la morbimortalidad cardiovascular en los pacientes hipertensos atendidos en atención primaria.

BACKGROUND: A decrease in renal function is associated with cardiovascular morbidity and mortality. The aim of this study was to analyse the association of cardiovascular morbidity and mortality with baseline glomerular filtration rate (GFR), calculated according to the Cockcroft-Gault and MDRD formulas, with the incidence of major adverse cardiovascular events (MACEs) in a cohort of hypertensive individuals followed for 12 years. METHOD: We performed a prospective study of a random sample of 223 hypertensive patients free of MACEs, who were followed in an urban Primary Care Centre. GFR was estimated using both formulas. MACEs were considered as the onset of ischaemic heart disease, heart failure, heart attacks, peripheral vascular disease or cardiovascular death. Data were analysed using the life-table method and Cox regression modeling. RESULTS: The median follow-up was 10.7 (interquartile range, 6.5-12.1) years. Follow-up was completed in 191 participants (85.7%). The cumulative survival was 64.7% (95% Confidence Interval (CI), 57.9-71.6). The incidence of MACEs during the follow-up period was 3.6 (95% CI, 2.7-4.4) per 100 subject-years. The final multivariable model showed that the most predictive variables of MACEs in the study population were the presence of diabetes mellitus and the estimation of GFR ≥60 ml/min/1.73 m2 by MDRD equation. CONCLUSIONS: There was a relationship between the occurrence of MACEs and an estimated GFR by MDRD above 60 ml/min/1.73 m2 at study entry, inversely to what was expected. GFR estimated by the C-G formula was not associated with cardiovascular risk.

A population perspective on the use of external beam radiotherapy in Catalonia, Spain.

PURPOSE: To assess the use of external beam radiotherapy in Catalonia (Spain), overall and by health management area. METHODS: We assessed radiotherapy treatments in a cohort of patients diagnosed with cancer from 2009 to 2011, using the population-based cancer registries in Girona and Tarragona. Participants had to have a minimum follow-up of 5 years from the time the cancer registry database was linked to the catalan health service database for financing radiation oncology. Outcomes included the proportion of patients receiving radiotherapy within 1 and 5 years of diagnosis. A log-binomial model was used to assess age-related trends in the use of radiotherapy by tumour site. Finally, we calculated the standardized utilization rate and 95% confidence intervals by health management area covered by the radiation oncology services, using indirect methods. RESULTS: At 1 and 5 years from diagnosis, 21.4 and 24.4% of patients, respectively, had received external beam radiotherapy. Patients aged 40-64 years had the most indications for the treatment, and there was a negative correlation between the patients' age and the use of radiotherapy for most tumour sites (exceptions were cervical, thyroid, and uterine cancers). There were no statistically significant differences in the use of radiotherapy according to th health management area. CONCLUSIONS: Population-based data show that external beam radiotherapy is underutilized in Catalonia. This situation requires a careful analysis to understand the causes, as well as an improvement of the available resources, oriented toward achieving realistic targets for the optimal use of external beam radiotherapy in our country.

A transgenic myogenic cell line lacking ryanodine receptor protein for homologous expression studies: reconstitution of Ry1R protein and function.

CCS embryonic stem (ES) cells possessing two mutant alleles (ry1r-/ry1r-) for the skeletal muscle ryanodine receptor (RyR) have been produced and injected subcutaneously into severely compromised immunodeficient mice to produce teratocarcinomas in which Ry1R expression is absent. Several primary fibroblast cell lines were isolated and subcloned from one of these tumors that contain the knockout mutation in both alleles and exhibit a doubling time of 18-24 h, are not contact growth inhibited, do not exhibit drastic morphological change upon serum reduction, and possess the normal complement of chromosomes. Four of these fibroblast clones were infected with a retrovirus containing the cDNA encoding myoD and a puromycin selection marker. Several (1-2 microg/ml) puromycin-resistant subclones from each initial cell line were expanded and examined for their ability to express myoD and to form multinucleated myotubes that express desmin and myosin upon removal of mitogens. One of these clones (1B5 cells) was selected on this basis for further study. These cells, upon withdrawal of mitogens for 5-7 d, were shown by Western blot analysis to express key triadic proteins, including skeletal triadin, calsequestrin, FK506-binding protein, 12 kD, sarco(endo)plasmic reticulum calcium-ATPase1, and dihydropyridine receptors. Neither RyR isoform protein, Ry1R (skeletal), Ry2R (cardiac), nor Ry3R (brain), were detected in differentiated 1B5 cells. Measurements of intracellular Ca2+ by ratio fluorescence imaging of fura-2-loaded cells revealed that differentiated 1B5 cells exhibited no responses to K+ (40 mM) depolarization, ryanodine (50-500 microM), or caffeine (20-100 mM). Transient transfection of the 1B5 cells with the full-length rabbit Ry1R cDNA restored the expected responses to K+ depolarization, caffeine, and ryanodine. Depolarization-induced Ca2+ release was independent of extracellular Ca2+, consistent with skeletal-type excitation-contraction coupling. Wild-type Ry1R expressed in 1B5 cells were reconstituted into bilayer lipid membranes and found to be indistinguishable from channels reconstituted from rabbit sarcoplasmic reticulum with respect to unitary conductance, open dwell times, and responses to ryanodine and ruthenium red. The 1B5 cell line provides a powerful and easily managed homologous expression system in which to study how Ry1R structure relates to function.

[Acetate-free on-line PHF: how to improve hyperacetatemia and haemodynamic tolerance]. / PHF on-line sin acetato: cómo mejorar la hiperacetatemia y la tolerancia hemodinámica.

SUMMARY BACKGROUND: The small quantity of acetate present in the dialysis fluid exposes patient's blood to an acetate concentration 30-40 times the physiological levels. This amount is even greater in hemodiafiltration on-line. Our purpose was to evaluate the clinical-analytical effects using three different dialysis techniques in the same patient. METHODS: 35 patients on hemodialysis were included. All patients were treated with conventional bicarbonate dialysate for 3 months, after randomization were switched to first be treated with PHF online with standard bicarbonate dialysate for 6 months and then switched to PHF on-line acetate-free dialysate for the other 6 months or to invert the two last periods. Blood samples were drawn monthly throughout the study and clinical data were obtained. RESULTS: Postdialysis blood acetate levels were higher in patients treated with conventional bicarbonate dialysate with respect to the period of PHF with free-acetate dialysate. Moreover, the percentage of patients with postdialysis blood acetate levels in the pathologic range was higher in patients treated with conventional bicarbonate dialysate respect to PHF on-line acetate-free dialysate period (61% vs. 30%). Serum concentrations of chloride postdialysis were higher and serum concentrations of bicarbonate pre and posthemodialysis were lower in the PHF free-acetate period. The incidence of hypotensive episodes was significantly lower in the PHF on-line with conventional dialysate. CONCLUSIONS: PHF on-line with free-acetate dialysate allows that most of patients finished hemodialysis with blood acetate levels in the physiologic ranges. PHF on-line is a predilutional hemodiafiltration treatment with better tolerance than hemodialysis with standard bicarbonate dialysate.

[Hypertension and anesthesia: consensus statement of the Catalan Associations of Anesthesiology and Hypertension]. / Documento de Consenso sobre Hipertensión Arterial y Anestesia de las Sociedades Catalanas de Anestesiología e Hipertensión Arterial.

The prevalence of hypertension is high in the surgical population. Differing practices and the absence of consensus among physicians involved in caring for hypertensive patients has made it one of the most frequent reasons for cancelling scheduled surgery. The aim of this consensus statement is to outline a practical approach to managing the hypertensive surgical patient. Hypertension is associated with increased risk of perioperative complications, particularly those related to systemic effects and notable fluctuations in blood pressure during surgery. Preoperative assessment should center on a search for signs and symptoms of target organ damage. The anesthesiologist should seek to reduce perioperative fluctuations in arterial pressure, particularly guarding against sustained hypotension. After surgery, antihypertensive medication should be resumed as soon as possible.