The impact of time from biopsy to radical prostatectomy on Gleason score undergrading and other related factors. / Impacto del tiempo desde la biopsia a la prostatectomía radical en la infragradación del grado de Gleason y análisis de factores relacionados.

INTRODUCTION: Gleason score biopsy undergrading (GSBU) can have an impact on the management and prognosis of patients with prostate cancer. We analyze the possible impact of time and other clinical and analytical factors in the appearance of GSBU in our series. PATIENTS AND METHOD: Ambispective, multicenter study of 1955 patients with localized prostate cancer undergoing radical prostatectomy between 2005 and 2018. Descriptive statistics and hypothesis testing are reported by univariate and multivariate analyses. RESULTS: Mean age 63.69 (44-80) years, median PSA 8.70 ng / ml (1.23-99). GSBU was observed in 34.7% of the entire cohort. In 72.8% of the cases, the GSBU occurred in one consecutive Gleason score, with the progression from 3 + 3 to 3 + 4 being the most frequent (289 patients, 47.6%). Performing radical prostatectomy 90-180 days before or after the biopsy does not have an impact on its undergrading in any of the groups. In the univariate and multivariate analysis, the presence of tumor or pathological rectal examination in both lobes, the tumor load ≥50% of cylinders and a DPSA ≥0.20, showed independent discriminative capacity to select patients who presented GSBU. CONCLUSIONS: The time from biopsy to radical prostatectomy did not show impact on GSBU. The number of affected cylinders, bilateral tumor and DPSA are easily accessible parameters that can help us select patients with greater probability of presenting GSBU.

Actual incidence of prostate cancer in healthcare areas of the autonomous community of Castilla-Leon during 2014. CAPCYL registry data. / Incidencia real de cáncer de próstata en las áreas sanitarias de la comunidad autónoma de Castilla y León durante el año 2014. Datos del registro CAPCYL.

OBJECTIVE: To determine the actual incidence of prostate cancer (PC) in the healthcare areas of Castilla-Leon in 2014. MATERIAL AND METHODS: A multicentre study was conducted with the participation of 7 of the 9 healthcare areas of Castilla-Leon. We collected retrospective data that included 87.8% of the target population (men diagnosed with PC with histopathological confirmation in 2014). We calculated the raw and age-adjusted incidence rates based on the direct method and consulted the community and national epidemiological data in the Spanish National Institute of Statistics. RESULTS: A total of 1198 new cases of PC were diagnosed, with a raw incidence rate in the community of 109.54 cases per 100,000 men. The adjusted rates for the Spanish and European populations were 115.41 and 110.07, respectively. The age group with the highest diagnostic concentration was the 60-70-year group, with 41.97% of the diagnoses. The group with the highest incidence was the 70-80-year group, with 438.87 cases per 100,000 inhabitants. There were differences in the raw and age-adjusted incidence rates and in the age at diagnosis among the various included healthcare areas. CONCLUSIONS: The community raw incidence rate was higher than most existing data. We observed significant differences among the various geographical areas, which could be explained mainly by the age distribution and the opportunistic screening policies for each area.

[Patients over-using a primary care centre: their social, demographic and clinical characteristics, and their use of health service facilities]. / Pacientes hiperfrecuentadores de un centro de atención primaria: características sociodemográficas, clínicas y de utilización de los servicios sanitarios.

OBJECTIVES: To find the social and clinical characteristics of patients over-using (OUP) our centre. To find how much these patients use the health services. DESIGN: Observational, descriptive study. SETTING: Urban primary care centre (36 408 inhabitants). PARTICIPANTS: Patients over 15 seen at the centre during the year 2000, who exceeded in their number of attendances the mean plus two standard deviations for their age group. MAIN MEASUREMENTS: The records of OUPS were reviewed to analyse their social and demographic characteristics, kinds of attendance, reasons for consultation, further tests, medication, referrals, and time off work this year. RESULTS: The sample was of 954 OUPs, 50.9% of whom were male with an average age of 50.54 (SD, 19.68). 86.3% had some risk factor recorded (34% hypertension, 32.4% mental health, 27.7% obesity, 25.7% tobacco dependency, 17.7% diabetes mellitus). They generated a mean of 9.6 visits to the doctor per year, with 95% CI (8.09-11.19), with the most common reason for attendance the monitoring of acute pathology (19.29%), followed by monitoring of chronic pathology (14.32%). There was an average of 1 analysis per OUP per year, and 0.68 image tests per OUP per year (48.38% were simple x-rays). 46.8% of the medication prescribed were analgesics. Average time off work was 0.5 periods off per OUP per year, with a mean period of 49.4 days off (SD, 113.69). They engendered an average of 4.15 nursing visits per OUP per year, 95% CI (2.60-5.70), with monitoring of chronic pathology the most common reason for consultation. 30.3% of OUP had a visit to hospital casualty recorded, with osteo-muscular pathology the most common reason for consultation (34.29%). Mean referrals were 0.88 OUP per year, with traumatology being the department to which most referrals were made (13.92%). CONCLUSIONS: OUP are middle-aged, have associated chronic pathology and use programmed appointments a lot. The additional tests conducted matched the centre's procedures for monitoring chronic pathologies. The most common reason for attendance at casualty was traumatology, as was the specialist clinic to which most referrals were made.

Aneurysm of the anterior leaflet of the mitral valve secondary to aortic valve endocarditis.

Aneurysm of the anterior mitral leaflet is a rare complication of infective aortic valve endocarditis, the natural evolution of which is generally its rupture, with subsequent acute and severe mitral regurgitation. Its presence cannot be recognized with transthoracic echocardiography and even in surgery. We describe a 78-year-old man with aortic valve endocarditis, in whom transesophageal echocardiography was essential for the diagnosis of this complication, its therapeutic management, and the postoperative follow-up after simple valve repair. In addition, the most appropriate surgical approach is discussed.

[Factors related to the appearance of peripheral vascular complications after taneous cardiovascular interventions]. / Factores relacionados con la aparición de complicaciones vasculares periféricas tras procedimientos intervencionistas cardiovasculares percutáneos.

BACKGROUND: Percutaneous diagnostic and therapeutic cardiac catheterization procedures carries some risks, most of them related to the appearance of peripheral vascular complications. These complications imply additional treatments for the patient including vascular surgery, longer hospital stays and increased costs. Some clinical and procedural variables have been pointed out as independent predictors of appearance of vascular complications. Nevertheless, no information have been reported concerning to the influence of the experience of the cardiologist who performs the procedure or provides the local hemostasia and the rate of vascular complications. OBJECTIVE: To characterise the type and incidence of peripheral vascular complications in patients undergoing a percutaneous cardiac procedure, to identify the predictors and to determine the influence of the professional experience and the complexity of the technique in the complications rate. METHODS AND RESULTS: Within 1-year (1994 to 1995) period, 1,008 consecutive patients undergoing a percutaneous cardiovascular procedure (750 diagnostic and 258 therapeutic) were prospectively included. Seventy percent were male. Mean age was 63 +/- 2 years. A total of 55 vascular complications were demonstrated (5.6%): 36 (3.6%) hematomas, 14 (1.4%) pseudoaneurysms, 2 (0.2%) arteriovenous fistula, 2 (0.2%) episodes of limb ischemia and 1 (0.1%) retroperitoneal hematoma. Only 28 (2.8%) were severe complications. By multivariate analysis, only experience to perform hemostasis (OR: 3.36; 95% CI: 1.37-8.22), previous treatment with aspirin (OR: 2.69; 95% IC: 1.31-5.52), left femoral artery puncture (OR: 2.53; 95% IC: 1-1.02), sheath removal later than 60 minutes (OR: 1.02; 95% IC: 1.01-1.04) and hemostasis which lasted > 30 minutes (OR: 1.01; 95% IC: 1-1.02), were independent predictors of vascular complications. CONCLUSIONS: Vascular complications rate after percutaneous cardiovascular procedures was low. Most of them associated to procedural variables and potentially avoidable, with promotion of a well planned policy of training in order to modify the factors involved.

[Triple ureter with inverted ureteral branch in "y" with ectopic ending and calculi inside]. / Triple uréter con rama ureteral en "y" invertida con desembocadura ectópica y litiasis en su interior.

OBJECTIVE: To report an uncommon case of ureteral duplication with a single intramural trajectory and a third ureter arising from the medial ureter, corresponding to the inferior pyelon, opening at the level of the bladder neck and containing a calculus measuring 10 mm along its longest axis, lodged in a saccular dilatation. The etiopathogenesis of this rare anomaly is briefly reviewed and discussed. METHODS/RESULTS: Diagnosis was established endoscopically and pyelographically. Endoscopic resolution was not possible, but stone removal was successfully achieved by conventional surgery using the least invasive approach possible. The patient is asymptomatic 24 months postoperatively. CONCLUSION: Although infrequent, this condition should be suspected in those "unclear' cases seen in day-to-day urological practice. Symptoms of the associated pathology are more common than those arising from the anomaly. Treatment should be specific to each case, as least invasive as possible and should aim at symptomatic resolution.

Endothelial changes in phakic eyes with anterior chamber intraocular lenses to correct high myopia.

PURPOSE: To evaluate the long-term endothelial cell loss after implantation of Worst-Fechner and Baikoff ZB5M anterior chamber intraocular lenses. SETTING: Jiménez-Díaz Foundation and San Carlos University Hospital, Madrid, Spain. METHODS: Preoperative and serial postoperative specular microscopy was performed on 30 eyes that had a Worst-Fechner lens and on 28 eyes that had a Baikoff ZB5M lens to correct high myopia. A video specular microscope adapted to an image analysis system was used to analyze the endothelium for cell density. Follow-up was 24 months. RESULTS: In the Worst-Fechner lens group, postoperative endothelial cell density was significantly lower than preoperative density at all times (P < .001). Endothelial cell loss was 7.26% at 3 months, 10.64% at 6 months, 13.00% at 12 months, and 17.60% at 24 months. In the Baikoff ZB5M lens group, postoperative cell density was also significantly lower than preoperative density at all times (P < .001). It was 7.50% at 3 months, 10.94% at 6 months, 12.33% at 12 months, and 12.30% at 24 months. Cell loss did not stabilize between 1 and 2 years after surgery in the Worst-Fechner group (P = .047). However, no additional cell loss was noted during this period in the Baikoff ZB5M group (P = .968). Endothelial cell densities in the two groups did not differ during the first year. However, 2 years after surgery, cell density in the Worst-Fechner group was significantly lower than it was in the ZB5M group (P = .048). CONCLUSIONS: Endothelial cell loss during the first year was similar in eyes with Worst-Fechner and Baikoff ZB5M lenses; however, at 2 years after surgery, endothelial cell loss was higher in eyes with Worst-Fechner lenses than it was in eyes with Baikoff ZB5M lenses.

Chronic subclinical inflammation in phakic eyes with intraocular lenses to correct myopia.

PURPOSE: To evaluate whether either of two anterior chamber intraocular lenses (IOLs) implanted in myopic, phakic eyes induced an inflammatory response that was measurable with a laser flare-cell meter but that could not be measured by other methods. SETTING: Jiménez-Díaz Foundation and San Carlos University Hospital, Madrid, Spain. METHODS: Thirty eyes with a Worst-Fechner IOL and 30 eyes with a Baikoff ZB5M IOL were evaluated using the flare mode of a laser flare-cell meter. Patients in each group were divided into three subgroups of 10 eyes each according to when the postoperative flare measurements were done: 12 months, 18 months, and 24 months. Thirteen phakic eyes with myopia greater than -6.00 diopters were used as controls. RESULTS: Postoperative flare in the Worst-Fechner group was 27.05 +/- 19 photons per millisecond (photons/ms) (mean +/- SD) at 12 months, 18.09 +/- 17.38 photons/ms at 18 months, and 31.03 +/- 28.8 photons/ms at 24 months. Postoperative flare in the Baikoff group was 21.1 +/- 5.9 photons/ms at 12 months, 16.13 +/- 8.3 photons/ms at 18 months, and 21.05 +/- 23.5 photons/ms at 24 months. Flare in the control group was 4.24 +/- 2.8 photons/ms. Postoperative flare values were significantly higher in both IOL groups than in the control group at all follow-ups (Mann-Whitney test, P < .05). Postoperative flare values in the Worst-Fechner group were higher than in the Baikoff group at 12, 18, and 24 months, although the difference was not significant (Mann-Whitney test, P > .05). CONCLUSIONS: Our study shows chronic subclinical inflammation between 1 and 2 years after implantation of both IOL types.

[Right ventricular myxoma. A rare case of pulmonary stenosis]. / Mixoma ventricular derecho. Un caso raro de estenosis pulmonar.

We discuss a case of a fourteen year old girl in whom, clinical signs of right ventricular outflow obstruction were discovered following a syncopal attack. A right ventricular tumor was observed by echocardiography. Histology confirmed the diagnosis of myxoma.

12-year followup study of epidemic Spanish toxic oil syndrome.

OBJECTIVE: To determine the longterm clinical and functional outcome among a large group of patients with toxic oil syndrome (TOS). METHODS: One hundred individuals with onset in 1981 were randomly selected for followup in 1993 from a national TOS database. Clinical and laboratory data for 1981 were collected by retrospective chart review. Ninety-one survivors were reevaluated in 1993 by direct interview, examination, the Health Assessment Questionnaire (HAQ), and the visual analog scale (VAS) for pain. A semiquantitative Total Clinical Score (TCS) was created to assess relative global outcome in 1993, for comparison with the HAQ, and for developing a predictive model based on disease manifestations at onset. RESULTS: Fifty-eight percent continue to have symptoms consisting predominantly of muscle cramping (60%), fatigue (55%), arthralgias (43%), subjective cognitive impairment (44%), psychiatric disease (27%), and soft tissue tenderness (22.5%). Severe neuromuscular sequelae, sclerodermatous skin disease, or pulmonary hypertension were not detected. The most notable laboratory findings at followup were hypercholesterolemia (55%) and hyperglycemia (14.5%). A good correlation was demonstrated between both the HAQ and the VAS for pain with the TCS. A statistical model indicated that alopecia, Raynaud's phenomenon, and sensory neuropathy were predictive of outcome. CONCLUSION: TOS is commonly associated with longterm neuromuscular and articular disease. Multiple factors implicated in the adaptation to chronic disease may contribute to this morbidity.

Ischemic optic neuropathy after intraocular lens implantation to correct high myopia in a phakic patient.

A 33-year-old patient had uncomplicated anterior chamber intraocular lens implantation (Worst-Fechner biconcave myopia lens) to correct high myopia. Immediately after surgery, she developed anterior ischemic optic neuropathy likely associated with increased intraocular pressure and systemic hypotension. To our knowledge, this is the first documented case of anterior ischemic optic neuropathy after anterior chamber intraocular lens implantation to correct high myopia in a phakic eye.

Macular edema and vitreous detachment.

To determine if vitreous changes play a role in macular edema, 197 eyes were selected, 113 with macular edema (68 diffuse and 45 cystoid) associated with different pathologies. We studied the vitreoretinal relationship in all cases. Photocoagulation was done in 21 eyes and vitreous examination before and after treatment. The difference between complete and incomplete posterior vitreous detachment (PVD) between the control and pathologic groups was statistically significant (P less than .0005). This shows that incomplete PVD is related to macular edema. The difference between complete and incomplete PVD and diffuse or cystoid macular edema was not statistically significant. It was significant between incomplete PVD without collapse and with contraction and diffuse and cystoid macular edema (P less than .0005). That is cystoid macular edema is associated with incomplete PVD with vitreous contraction. The vitreous usually collapses with laser treatment. Complete PVD before treatment seems to be associated with a good prognosis after photocoagulation. Cases with incomplete PVD and cystoid macular edema show worsening of the visual field after laser treatment.