Exploratory Analysis of the Role of Radiomic Features in the Differentiation of Oncocytoma and Chromophobe RCC in the Nephrographic CT Phase.

In diagnostic imaging, distinguishing chromophobe renal cell carcinomas (chRCCs) from renal oncocytomas (ROs) is challenging, since they both present similar radiological characteristics. Radiomics has the potential to help in the differentiation between chRCCs and ROs by extracting quantitative imaging. This is a preliminary study of the role of radiomic features in the differentiation of chRCCs and ROs using machine learning models. In this retrospective work, 38 subjects were involved: 19 diagnosed with chRCCs and 19 with ROs. The CT nephrographic contrast phase was selected in each case. Three-dimensional segmentations of the lesions were performed and the radiomic features were extracted. To assess the reliability of the features, the intraclass correlation coefficient was calculated from the segmentations performed by three radiologists with different degrees of expertise. The selection of features was based on the criteria of excellent intraclass correlation coefficient (ICC), high correlation, and statistical significance. Three machine learning models were elaborated: support vector machine (SVM), random forest (RF), and logistic regression (LR). From 105 extracted features, 41 presented an excellent ICC and 6 were not highly correlated with each other. Only two features showed significant differences according to histological type and machine learning models were developed with them. LR was the better model, in particular, with an 83% precision.

Gynaecological Causes of Acute Pelvic Pain: Common and Not-So-Common Imaging Findings.

In female patients, acute pelvic pain can be caused by gynaecological, gastrointestinal, and urinary tract pathologies. Due to the variety of diagnostic possibilities, the correct assessment of these patients may be challenging. The most frequent gynaecological causes of acute pelvic pain in non-pregnant women are pelvic inflammatory disease, ruptured ovarian cysts, ovarian torsion, and degeneration or torsion of uterine leiomyomas. On the other hand, spontaneous abortion, ectopic pregnancy, and placental disorders are the most frequent gynaecological entities to cause acute pelvic pain in pregnant patients. Ultrasound (US) is usually the first-line diagnostic technique because of its sensitivity across most common aetiologies and its lack of radiation exposure. Computed tomography (CT) may be performed if ultrasound findings are equivocal or if a gynaecologic disease is not initially suspected. Magnetic resonance imaging (MRI) is an extremely useful second-line technique for further characterisation after US or CT. This pictorial review aims to review the spectrum of gynaecological entities that may manifest as acute pelvic pain in the emergency department and to describe the imaging findings of these gynaecological conditions obtained with different imaging techniques.

Pilot Study for the Assessment of the Best Radiomic Features for Bosniak Cyst Classification Using Phantom and Radiologist Inter-Observer Selection.

Since the Bosniak cysts classification is highly reader-dependent, automated tools based on radiomics could help in the diagnosis of the lesion. This study is an initial step in the search for radiomic features that may be good classifiers of benign-malignant Bosniak cysts in machine learning models. A CCR phantom was used through five CT scanners. Registration was performed with ARIA software, while Quibim Precision was used for feature extraction. R software was used for the statistical analysis. Robust radiomic features based on repeatability and reproducibility criteria were chosen. Excellent correlation criteria between different radiologists during lesion segmentation were imposed. With the selected features, their classification ability in benignity-malignity terms was assessed. From the phantom study, 25.3% of the features were robust. For the study of inter-observer correlation (ICC) in the segmentation of cystic masses, 82 subjects were prospectively selected, finding 48.4% of the features as excellent regarding concordance. Comparing both datasets, 12 features were established as repeatable, reproducible, and useful for the classification of Bosniak cysts and could serve as initial candidates for the elaboration of a classification model. With those features, the Linear Discriminant Analysis model classified the Bosniak cysts in terms of benignity or malignancy with 88.2% accuracy.

Renal Angiomyolipoma: A Diagnostic and Therapeutic Challenge.

BACKGROUND: Angiomyolipomas (AML) represent less than 10% of renal tumours. They are most often detected incidentally during imaging tests, but there are several histological variants that pose difficulties in the radiological differential diagnosis. Their identification should allow the loss of renal parenchyma due to embolization or radical surgery to be prevented. METHODS: Retrospective study of patients undergoing kidney surgery with post-surgical pathological diagnosis of AML at the Álvaro Cunqueiro Hospital (2016-2021). Patients with a radiological diagnosis of AML who underwent surgery based on clinical criteria were excluded. RESULTS: 18 patients were registered, allowing for the assessment of 18 renal tumours. All of the cases were diagnosed incidentally. Preoperative radiological diagnosis was: 9 lesions suggestive of renal cell carcinoma (RCC) (50%), 7 cases suggestive of RCC vs. AML (38.9%) and 2 lesions suggestive of AML vs. retroperitoneal liposarcoma (11.1%). Histological variants of AML were found in 61.1% of cases (n = 11). The most widely used surgical technique was partial nephrectomy, in 66.67% of cases. CONCLUSIONS: The radiological differential diagnosis of AML, and particularly its variants, with malignant lesions have important limitations either due to the predominance or scarcity of any of the AML components. Some cases can also pose difficulties at the histological level. This fact highlights the importance of the specialization of uroradiologists and uropathologists and the performance of kidney-sparing therapeutic techniques.

Malformaciones esqueléticas y alteraciones del crecimiento en fetos de ratas con diabetes moderada / Skeletal malformations and growth disturbances in fetuses of mild diabetic rats

Resumen Introducción. En la actualidad, la diabetes mellitus representa una de las condiciones médicas que complica el embarazo con mayor frecuencia, lo que afecta el crecimiento y el desarrollo fetal. Objetivo. Determinar las malformaciones esqueléticas y alteraciones en el crecimiento en fetos de ratas Wistar diabéticas. Materiales y métodos. Se utilizó un modelo de diabetes moderada inducida neonatalmente con estreptozotocina (STZ 100 mg/kg de peso corporal, por vía subcutánea) en ratas Wistar. En la adultez, las ratas sanas y diabéticas se aparearon con machos sanos de la misma edad y cepa. El día 20 de gestación se practicó la cesárea bajo anestesia. Se extrajeron los fetos, se pesaron y clasificaron como pequeños (PAG), adecuados (AEG) o grandes (GEG) para la edad gestacional. Los fetos seleccionados se procesaron para el análisis de anomalías esqueléticas y sitios de osificación. Resultados. En la descendencia de las ratas diabéticas, hubo un mayor porcentaje de fetos clasificados como pequeños o grandes y un menor porcentaje de fetos con peso adecuado; el promedio de peso fetal fue menor y había menos sitios de osificación. Se observaron alteraciones en la osificación de cráneo, esternón, columna vertebral, costillas y extremidades anteriores y posteriores; y también, hubo una correlación directa entre el peso y el grado de osificación fetal. Hubo malformaciones congénitas asociadas con la fusión y bifurcación de las costillas, así como cambios indicativos de hidrocefalia, como la forma de domo del cráneo, una amplia distancia entre los parietales y la anchura de las fontanelas anterior y posterior. Conclusión. La diabetes moderada durante la gestación altera el crecimiento y el desarrollo fetal, que se ve afectado tanto por macrosomía y la restricción del crecimiento intrauterino como por malformaciones esqueléticas.

Abstract Introduction: Currently, diabetes mellitus represents one of the medical conditions that more frequently complicates pregnancy affecting the fetus's growth and development. Objective: To determine the skeletal malformations and growth alterations in fetuses of diabetic Wistar rats. Materials and methods: We used a neonatally streptozotocin-induced mild diabetes model (STZ 100 mg/kg body weight - subcutaneously) in Wistar rats. In adulthood, healthy and diabetic rats were mated with healthy males of the same age and strain. On day 20 of gestation, a cesarean was performed under anesthesia. Fetuses were removed, weighed, and classified as small (SPA), adequate (APA), and large (LPA) for the gestational age. Selected fetuses were processed for skeletal anomaly and ossification sites analysis. Results: In the offspring of diabetic rats, there was a higher percentage of fetuses classified as small or large and a lower percentage of fetuses with adequate weight; the fetal weight mean was lower and there were fewer sites of ossification. Alterations were observed in the ossification of the skull, sternum, spine, ribs and fore and hind limbs; and also, there was a direct correlation between fetal weight and ossification degree There were congenital malformations associated with fusion and bifurcation of the ribs, as well as changes indicative of hydrocephaly, such as the dome shape of the skull, a wide distance between parietals, and the width of the anterior and posterior fontanels. Conclusion: Moderate diabetes during pregnancy alters fetal growth and development with macrosomia and intrauterine growth restriction, as well as skeletal malformations.

Endometrial Cancer MRI staging: Updated Guidelines of the European Society of Urogenital Radiology.

OBJECTIVES: To update the 2009 ESUR endometrial cancer guidelines and propose strategies to standardize image acquisition, interpretation and reporting for endometrial cancer staging with MRI. METHODS: The published evidence-based data and the opinion of experts were combined using the RAND-UCLA Appropriateness Method and formed the basis for these consensus guidelines. The responses of the experts to 81 questions regarding the details of patient preparation, MR imaging protocol, image interpretation and reporting were collected, analysed and classified as "RECOMMENDED" versus "NOT RECOMMENDED" (if at least 80% consensus among experts) or uncertain (if less than 80% consensus among experts). RESULTS: Consensus regarding patient preparation, MR image acquisition, interpretation and reporting was determined using the RAND-UCLA Appropriateness Method. A tailored MR imaging protocol and a standardized report were recommended. CONCLUSIONS: These consensus recommendations should be used as a guide for endometrial cancer staging with MRI. KEY POINTS: • MRI is recommended for initial staging of endometrial cancer. • MR imaging protocol should be tailored based on the risk of lymph node metastases. • Myometrial invasion is best assessed using combined axial-oblique T2WI, DWI and contrast-enhanced imaging. • The mnemonic "Clinical and MRI Critical TEAM" summarizes key elements of the standardized report.

Association of T and NK Cell Phenotype With the Diagnosis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a pathological condition characterized by incapacitating fatigue and a combination of neurologic, immunologic, and endocrine symptoms. At present its diagnosis is based exclusively on clinical criteria. Several studies have described altered immunologic profiles; therefore, we proposed to further examine the more significant differences, particularly T and NK cell subpopulations that could be conditioned by viral infections, to discern their utility in improving the diagnosis and characterization of the patients. The study included 76 patients that fulfilled the revised Canadian Consensus Criteria (CCC 2010) for ME/CFS and 73 healthy controls, matched for age and gender. Immunophenotyping of different T cell and natural killer cell subpopulations in peripheral blood was determined by flow cytometry. ME/CFS patients showed significantly lower values of T regulatory cells (CD4+CD25++(high)FOXP3+) and higher NKT-like cells (CD3+CD16+/-CD56+) than the healthy individuals. Regarding NK phenotypes, NKG2C was significantly lower and NKCD69 and NKCD56 bright were significantly higher in the patients group. A classification model was generated using the more relevant cell phenotype differences (NKG2C and T regulatory cells) that was able to classify the individuals as ME/CFS patients or healthy in a 70% of cases. The observed differences in some of the subpopulations of T and NK cells between patients and healthy controls could define a distinct immunological profile that can help in the diagnostic process of ME/CFS patients, contribute to the recognition of the disease and to the search of more specific treatments. However, more studies are needed to corroborate these findings and to contribute to establish a consensus in diagnosis.

Estrategia educativa dirigida a incrementar la resiliencia en madres de niños con Síndrome de Down / Educational strategy aimed to increase the resilience of mothers with Down syndrome children

Introducción: el nacimiento de un niño con Síndrome de Down puede desencadenar una crisis sin precedente en el seno familiar y ser causa de estrés mantenido, lo cual puede afectar a la familia, en especial a las madres. Es necesario aumentar el conocimiento sobre esta enfermedad genética para fortalecer conductas resilientes en las madres y mejorar su capacidad para sobrellevar con éxito tener un niño diferente. Objetivo: incrementar la resiliencia en las madres de niños con Síndrome de Down a través de una estrategia educativa. Métodos: se diseñó y aplicó una estrategia educativa con diseño ambispectivo (Pre-test y Post-test), sobre algunos aspectos relacionados con la resiliencia en las madres de los niños con Síndrome de Down que asisten a un círculo infantil especial. El estudio se dividió en tres fases: en la fase inicial se aplicó una encuesta, evaluada y avalada por expertos, sobre diferentes aspectos del conocimiento, la salud de los niños y la resiliencia en las madres; en la segunda fase se aplicaron los talleres a todas las madres; y la tercera consistió en la aplicación de la encuesta inicial. Resultados: la mayoría de las madres (54,2 por ciento) tienen 35 años y más, el nivel de escolaridad es alto (70,8 por ciento), el 50 por ciento son trabajadoras, predomina el estado civil casada (37,5 por ciento) y unión estable (33,3 por ciento), el ingreso económico de la familia es regular (41,7 por ciento) y dominan las condiciones constructivas satisfactorias en los hogares (62,5 por ciento). Después de recibir los talleres aumentó significativamente el conocimiento de las madres (91,7 por ciento); el mismo porcentaje tuvo expectativas positivas sobre la inclusión social de sus hijos, 23 (95,2 por ciento) reclamaron una información continuada y se incrementaron en las madres las conductas resilientes (87,5 por ciento). Conclusiones: aumentó el conocimiento y la resiliencia de las madres a partir de la estrategia educativa aplicada a las mismas(AU)

Introduction: the birth of a child with Down syndrome may trigger an unprecedented crisis within the family and be the cause for maintained stress, which may affect the family, specially mothers. It is necessary to increase the knowledge about this genetic disease, to strengthen resilient behavior in mothers and improve their capacity to successfully bear having a different child. Objective: to increase resilience in mothers with Down syndrome children, by means of an educational strategy. Methods: we designed and applied an educational strategy with an ambispective design (pre-test and pro-test) about some of the aspects related with resilience in mothers with Down syndrome children who attend a special kindergarten. The study was divided into three stages: in the initial stage we conducted a survey (assessed and validated by experts) about different aspects of knowledge, children health and mother's resilience; in the second stage we held the workshops with all the mothers; in the third stage we conducted the same initial survey. Results: the majority of the mothers (54.2 percent) were 35 years old or older, schooling is high (70.8 percent), 50 percent of them are workers, status of married (37.5 percent) and stable engagement (33.3 percent) predominated, regular family incomes (41.7 percent) and satisfactory constructive conditions (62.5 percent) prevail in the houses. After attending the workshops, the mother's knowledge increased up to 91.7 percent; the same percentage represented positive expectations about the social inclusion of their children, 23 mothers (95.2 percent) demanded continued information, while their resilient behaviors increased (87.5 percent). Conclusions: the mother's knowledge and resilience increased from the educational strategy applied to them(AU)

Stromal prostatic sarcoma: a rare tumor with rare clinical and imaging presentation.

Adult prostatic stromal sarcoma is a rare malignant tumor. The main presenting symptom is urinary retention secondary to bladder outlet obstruction. Prostatic Specific Antigen level can be normal. Imaging features show a prostate mass with or without pelvic organ invasion depending on the aggressiveness of the tumor. We present a patient with prostatic stromal sarcoma who debuted with urinary obstruction, leukocytosis and neutrophilia, prostate enlargement, and hypodense prostate areas on CT images, simulating prostatitis with abscess formation.

Adult weight gain, fat distribution and mammographic density in Spanish pre- and post-menopausal women (DDM-Spain).

High mammographic density (MD) is a phenotype risk marker for breast cancer. Body mass index (BMI) is inversely associated with MD, with the breast being a fat storage site. We investigated the influence of abdominal fat distribution and adult weight gain on MD, taking age, BMI and other confounders into account. Because visceral adiposity and BMI are associated with breast cancer only after menopause, differences in pre- and post-menopausal women were also explored. We recruited 3,584 women aged 45-68 years within the Spanish breast cancer screening network. Demographic, reproductive, family and personal history data were collected by purpose-trained staff, who measured current weight, height, waist and hip circumferences under the same protocol and with the same tools. MD was assessed in the left craniocaudal view using Boyd's Semiquantitative Scale. Association between waist-to-hip ratio, adult weight gain (difference between current weight and self-reported weight at 18 years) and MD was quantified by ordinal logistic regression, with random center-specific intercepts. Models were adjusted for age, BMI, breast size, time since menopause, parity, family history of breast cancer and hormonal replacement therapy use. Natural splines were used to describe the shape of the relationship between these two variables and MD. Waist-to-hip ratio was inversely associated with MD, and the effect was more pronounced in pre-menopausal (OR = 0.53 per 0.1 units; 95 % CI = 0.42-0.66) than in post-menopausal women (OR = 0.73; 95 % CI = 0.65-0.82) (P of heterogeneity = 0.010). In contrast, adult weight gain displayed a positive association with MD, which was similar in both groups (OR = 1.17 per 6 kg; 95 % CI = 1.11-1.23). Women who had gained more than 24 kg displayed higher MD (OR = 2.05; 95 % CI = 1.53-2.73). MD was also evaluated using Wolfe's and Tabár's classifications, with similar results being obtained. Once BMI, fat distribution and other confounders were considered, our results showed a clear dose-response gradient between the number of kg gained during adulthood and the proportion of dense tissue in the breast.

Desarrollo moral en estudiantes de medicina y enfermeria de la Universidad Centroccidental Lisandro Alvarado (UCLA) - Venezuela / Moral development in medical and nursing students at the Universidad Centroccidental Lisandro Alvarado (UCLA) - Venezuela

Se realizó un estudio no experimental, de campo, de tipo correlacional con el fin de establecer posibles relaciones entre el nivel de desarrollo moral y el nivel de estudios de pregrado alcanzado por estudiantes de medicina y enfermería de la Universidad Centroccidental Lisandro Alvarado (UCLA), Barquisimeto - Venezuela. La muestra se seleccionó de forma probabilística y estratificada quedando conformada por 87 estudiantes de Medicina y 44 de Enfermería. Para evaluar el nivel de desarrollo moral, se utilizó una adaptación del Defining Issues Test (DIT), versión de tres dilemas, traducida, adaptada y validada al contexto venezolano. Los resultados obtenidos muestran que los estudiantes poseen un nivel de desarrollo moral convencional y un índice de moral de principios similar al que obtienen muestras latinoamericanas. No se encontraron diferencias significativas entre el desarrollo moral y el nivel de estudios alcanzado por la muestra. Los resultados permiten justificar y orientar el diseño e implantación de un eje curricular de formación moral-educación en valores dirigido a estudiantes del Decanato de Ciencias de la Salud de la Institución

A non experimental correlational study was conducted for purposes of establishing a possible relationship between moral development and academic level of Health Science students from Universidad Centro-Occidental Lisandro Alvarado (UCLA), Barquisimeto Venezuela. A probabilistic and stratified sample consisting of 131 students, 87 from the Medicine School and 44 from the Nursing School was used. An adapted version of the "Defining Issues Test" (DIT) was run to assess the group moral development. Such test is a version of the three dilemma model which was translated and validated to the Venezuelan context. According to test results, students have a conventional moral development and a moral principles index (Index P) similar to those obtained from Latin-American samples. Non-significant relationship between the moral development and academic level was found. Also, test results set the basis for justifying and designing a new curriculum for the students of the University’s Health Science Faculty based on moral development

Follow-up of aneurysm neck diameter after endovascular repair of abdominal aortic aneurysms.

We assessed aneurysm neck diameter change after endovascular abdominal aortic aneurysm repair (EVAR) and its relationship to stent-graft diameter. Ninety-eight patients with abdominal aortic aneurysm who underwent EVAR were studied with multislice computed tomography following a standardized protocol. A preoperative study and immediate postoperative, 6-month, 1-year, and 2-year follow-up studies were performed. The aneurysm neck was measured from adventitia to adventitia, 6 mm below the lowermost renal artery, in planar images performed perpendicular to the vessel axis (real axial section). Baseline and follow-up neck diameters were compared with stent-graft diameters. For statistical analysis, a one-way analysis of variance with repeated measures was used. Pearson's correlation coefficient was used to examine the correlation between the change in neck diameter and stent-graft diameter. The average neck diameter was 22.38 mm (range 16-32.5) on the preoperative study and 23.35 mm (17-33.9) on the immediate postoperative, 24.35 mm (18.2-34.5) on the 6-month, 24.36 mm (18-34.5) on the 1-year, and 24.39 mm (17.8-35.7) on the 2-year follow-up. The mean device diameter was 24.08 mm (20-32). A significant increase in average neck diameter was found between the preoperative, immediate postoperative control, and 6-month control. There was no significant increase in the average neck diameter between the 6-month, 1-year, and 2-year follow-up. Baseline mean stent-graft oversizing was 1.7 mm, which decreased to -0.31 mm at latest follow-up. Dilation of the neck did not significantly exceed the endograft diameter in 83 cases (87.36%). An enlargement of the infrarenal aneurysm neck occurred during the first 6 months after EVAR. No significant variation in neck diameter occurred between the 6-month and 2-year follow-up visits. In the majority of cases, dilation of the aneurysm neck does not significantly exceed stent-graft diameter and, therefore, is possibly related to the presence of the endograft.

Adenosine diphosphate-induced platelet aggregation correlates with platelet activation identified with the use of flow cytometry.

BACKGROUND: Assessment of the likelihood of platelet activation (i.e. platelet reactivity) identifies patients at high and low risk of subsequent thrombotic events. Turbidometric platelet aggregation has been used to assess platelet function for more than 4 decades. We have developed a method to assess individual components of platelet activation with the use of flow cytometry that is performed in minimally altered whole blood. AIMS: To compare assessment of platelet reactivity determined with the use of aggregometry and flow cytometry. MATERIAL AND METHODS: Twenty adult patients with atherosclerotic vascular disease were included in this study. Blood from each patient was used to determine turbidometric platelet aggregation and to assess platelet activation by flow cytometry. ADP was used as the agonist. Values are means +/- SEM. Comparison was performed with the use of Student's t test and correlation was assessed with the use of Pearson's correlation analysis. RESULTS: Both maximal aggregation and the slope of aggregation correlate with the percentage of platelets that bound fibrinogen in response to 0.2 microM ADP. The best correlation was seen between the slope of aggregation induced by 0.2 or 1 microM ADP and the percentage of platelets that bound fibrinogen in response to 0.2 microM ADP (for 0.2 microM r = 0.62, p = 0.038; for 1 microM r = 0.71, p = 0.025). CONCLUSION: The binding of fibrinogen to activated platelets assessed with the use of flow cytometry correlates best with the slope of turbidometric aggregation and appears to reflect the propensity of platelets to activate.

Efecto de algunos insecticidas sobre la mota blanca del guayabo, Capulinia SP. (Hemiptera: Eriococcidae) / Effects of some insecticides on guava cottony scale, Capulinia SP. (Hemiptera: Eriococcidae)

Durante ene-mar 2004 y jun-jul 2005, dos ensayos fueron realizados para evaluar el efecto de algunos insecticidas sobre Capulinia sp. En el primero, realizado en el laboratorio, los tratamientos incluidos fueron clorpirifos (0,06 por ciento v/v i.a.), imidacloprid (0,06 por ciento p/v i.a.), azadirachtina (0,45 por ciento p/v i.a.), Bauveria bassiana (2x10¹² conidias/100g; 2,5g/l) y un testigo absoluto. A las mezclas de insecticidas les fue añadido un surfactante (Extravón 200 0,5 por ciento v/v). Para el segundo ensayo, realizado fuera del laboratorio, fue incluido un tratamiento adicional consistente en surfactante+agua solamente. Se contó el número de individuos vivos y muertos, previo a la aplicación de tratamientos y a las 48, 72, 96h postaplicaciones, seguido de seis y siete conteos semanales, para el primer y segundo ensayo, respectivamente. El porcentaje de mortalidad fue significativamente superior sobre plantas tratadas con clorpirifós y con imidacloprid, bajo los cuales todas las plantas llegaron al final de los ensayos en buenas condiciones, contrastando con los restantes tratamientos, donde hubo tallos necrosados debido al daño causado por el insecto. A pesar de la efectividad demostrada, el uso de estos dos insecticidas debe ser considerado dentro de la racionalidad del manejo integrado de plagas.

[Local recurrence after radical prostatectomy and salvage radiotherapy]. / Recidiva local después de la prostatectomía radical y radioterapia de rescate.

OBJECTIVE: To evaluate the efficacy of radiotherapy to the prostatic bed in patients with biochemical recurrence prostate cancer after radical prostatectomy. METHODS: We analyse the outcomes of 292 patients who underwent radical prostatectomy for localized prostate cancer T1-T2 between January 1992 and June 2003, with an average follow-up of 36 months (range 6 months to 12 years). We detected biochemical recurrence (PSA > 0.20 ng/ml) in 75 (26%) patients. 75 patients with biochemical recurrence, 9 (12%) were diagnosed of local recurrence by the following criteria: a) First PSA obtained 6 weeks after radical prostatectomy < 0.20 ng/ml. b) Time to biochemical recurrence > 6 months. c) Prostate specific antigen doubling time > 6 months. d) Prostate specific antigen velocity after radical prostatectomy < 0.75 ng/ml/year. e) Prostate specific antigen level after radical prostatectomy < 2.5 ng/ml. The 9 patients diagnosed of local recurrence received an average dose of 56.42 Gy to the prostate bed. RESULTS: Of all 9 patients with local recurrence, 8(88.8%) have complete response with a mean follow-up of 30 months (12-36 months). The time between the radiotherapy and the response, in patients with complete response, was lower than 3 months in 7 patients and 12 months in 1 patient. Significant adverse effects associated to radiotherapy were not observed. CONCLUSIONS: Salvage radiotherapy may be beneficial in selected patients with local recurrence. The characteristics of prostate specific antigen elevation are useful in distinguishing men with local recurrence from those with distant metastases.

Nivel de conocimiento del familiar responsable sobre la enfermedad de Alzheimer y su relación en la atención brindada a su paciente en Lima Metropolitana, Octubre - Enero 1997 / Level of knowledge of the relative responsible on the disease for Alheimer and its relation in the attention offered to its Metropolitan patient in Lima October, January 1997

La enfermedad de Alzheimer es uno de los males más desvastadores que afecta al cerebro humano y enferma muchos individuos alrededor del mundo. En el Perú existen casos de Alzheimer y aunque no se tienen estadísticas nacionales se calcula que hay de 100,000 a 150,000 personas con esta enfermedad. La presente investigación es un estudio descriptivo, analítico prospectivo de corte transversal, que tuvo como finalidad precisar el nivel de conocimiento que tienen los familiares responsables sobre la enfermedad de Alzheimer y su relación con el nivel de conocimiento en la atención a su paciente, quienes estuvieron inscritos en el CIAAL. La muestra estuvo conformada por 89 familiares responsables de pacientes con la enfermedad de Alzheimer, siendo entrevistados en su domicilio. Se utilizó como instrumento el cuestionario de preguntas tipo abierta y cerrada de alternativas múltiples. La recolección de datos fue individual a través de una entrevista a los familiares responsables en los meses de octubre de 1996 a enero de 1997. Para el análisis se utilizó la prueba de Chi cuadrado. Los resultados demuestran que un alto porcentaje de familiares responsables tienen bajó conocimiento sobre la enfermedad (58.43 por ciento) y al mismo conocimiento escaso sobre la atención al paciente con Alzheimer (60.67 por ciento), siendo esto de gran significancia estadística (P<0.05). Se encontró que los familiares responsables tiene conocimientos escasos sobre la atención física, emocional y social brindada a su paciente, siendo de gran significancia P<0.05). No se encontró diferencias significativas respecto al grado de instrucción, edad, ocupación, procedencia y estado civil (P>0.05). Es de gran importancia que los familiares responsables conozcan sobre la enfermedad de Alzheimer y a la vez la forma correcta de atender a su paciente para una mejor calidad de vida.