[Translated article] Preoperative assessment and surgical indications: Separation surgery.

Neurological compression occurs in 10%-20% of patients who develop spinal metastases. In the last decade, the evolution of oncological diagnostic and medical techniques, the change from conventional external radiation to radiosurgery and the new surgical instruments have meant that the treatment of these patients must be indicated in a personalized manner and by consensus, multidisciplinary way, in specific commissions. Today, the biological state of the patient, the presence of mechanical instability, the neurological assessment and degree of epidural compression, as well as the best prognostic categorization of the tumor, are established as decision factors prior to the indication of surgical treatment, treatment that has passed from a cytoreductive concept to that of a spinal cord release from tumor in order to ensure safe radiosurgery.

Preoperative assessment and surgical indications: Separation surgery. / Valoración e indicaciones quirúrgicas: cirugía separación.

Neurological compression occurs in 10%-20% of patients who develop spinal metastases. In the last decade, the evolution of oncological diagnostic and medical techniques, the change from conventional external radiation to radiosurgery and the new surgical instruments have meant that the treatment of these patients must be indicated in a personalized manner and by consensus, multidisciplinary way, in specific commissions. Today, the biological state of the patient, the presence of mechanical instability, the neurological assessment and degree of epidural compression, as well as the best prognostic categorization of the tumor, are established as decision factors prior to the indication of surgical treatment, treatment that has passed from a cytoreductive concept to that of a spinal cord release from tumor in order to ensure safe radiosurgery.

Las plantas medicinales, patrimonio natural y cultural de la Reserva Hídrica Natural y Recreativa Bamba, La Calera, Córdoba, Argentina / Medicinal plants, natural and cultural heritage of the Bamba Natural and Recreational Water Reserve, La Calera, Córdoba, Argentina

Herbal medicine has played a leading role in the health systems of many traditional societies. The main objective is to characterize an aspect of the natural and cultural heritage of a protected area of the town of La Calera, through the documentation of medicinal plants of the Bamba Water and Recreational Nature Reserve (RNHRB), in the province of Córdoba, Argentina. Methodologies of social and natural sciences, typical of ethnoecological approaches, were combined, complementing with qualitative and quantitative analyzes. A total of 221 uses corresponding to 137 medicinal species were documented. The most relevant families in terms of quantity of species and uses are Asteraceae, Fabaceae and Lamiaceae. In all cases the native / wild status predominates. Applications associated with gastrointestinal conditions are the most frequent, followed by dermatological, pneumonological, infectological and nephrological. It is concluded that herbal medicine in protected areas provides valuable information and efforts for the conservation of biocultural heritage in intangible rural areas with urbanized spaces, as well as for the potencial knowledge and use of resources by small local producers.

La medicina herbaria ha desempeñado un papel de liderazgo en los sistemas de salud de muchas sociedades tradicionales. El objetivo principal es caracterizar un aspecto del patrimonio natural y cultural de un área protegida de la localidad de La Calera, a través de la documentación de plantas medicinales de la Reserva Natural Acuática y Recreativa de Bamba (RNHRB), en la provincia de Córdoba, Argentina. Se combinaron metodologías de las ciencias sociales y naturales, propias de los enfoques etnoecológicos, complementando con análisis cualitativos y cuantitativos. Se documentaron un total de 221 usos correspondientes a 137 especies medicinales. Las familias más relevantes en cuanto a cantidad de especies y usos son Asteraceae, Fabaceae y Lamiaceae. En todos los casos predomina el estado nativo/salvaje. Las aplicaciones asociadas a afecciones gastrointestinales son las más frecuentes, seguidas de las dermatológicas, neumonológicas, infecciosas y nefrológicas. Se concluye que la fitoterapia en áreas protegidas brinda valiosa información y esfuerzos para la conservación del patrimonio biocultural en áreas rurales intangibles con espacios urbanizados, así como para el potencial conocimiento y uso de recursos por parte de pequeños productores locales.

Biopsia renal. Descripción clinicopatológica, complicaciones y evolución en un hospital general del Perú / Kidney Biopsy. Clinicopathological Description, Complications And Evolution In A General Hospital In Peru

Introducción: La biopsia renal es uno de los exámenes esenciales para la caracterización de la enfermedad renal crónica (ERC). Objetivo: Determinar las glomerulonefritis primarias y secundarias más frecuentes, las complicaciones de la biopsia renal y el número de pacientes en hemodiálisis al ser sometidos a biopsia renal. Métodos: Estudio observacional, descriptivo, de serie de casos, retrospectivo y transversal, realizado en el hospital nacional E. Rebagliati Matins-Perú. Se revisaron las historias clínicas de pacientes mayores de 15 años de edad sometidos a biopsia renal entre 2008-2016. Los datos fueron procesados en Stata 16.1 Resultados: De 2278 historias clínicas, correspondieron a mujeres 1234 y a hombres 1044. Las glomerulonefritis primarias y secundarias más frecuentes fueron glomeruloesclerosis focal y segmentaria (GEFyS) 683 (29,98%) y lupus eritematoso sistémico (LES) 434 (19,04%) respectivamente. De 1644 pacientes biopsiados, 36 (2,19%) y 241 (14,66%), tuvieron complicaciones mayores y menores respectivamente. Las complicaciones mayores fueron más frecuentes cuando el procedimiento lo realizó radiología con guía ecográfica en relación al realizado por el nefrólogo sin guía ecográfica (p = 0,03694). En 1324 pacientes, 329 fueron sometidos a biopsia renal estando en hemodiálisis; de ellos 43 (13,07%) lograron salir de esta terapia y 144 (51,99%) tuvieron complicaciones mayores o menores. Conclusiones: La GEFyS y LES fueron las glomerulonefritis primarias y secundarias más frecuentes, respectivamente. En 1644 pacientes las complicaciones mayores y menores fueron 36 (2,19%) y 241 (14,66%) respectivamente. En 1324 pacientes, 329 (24,8%) fueron biopsiados estando en hemodiálisis y de ellos 144 (51,99%) tuvieron complicaciones mayores o menores.

Introduction: Kidney biopsy is one of the essential tests for the characterization of chronic kidney disease (CKD). Objective: To determine the most frequent primary and secondary glomerulonephritis, complications of renal biopsy and the number of patients on hemodialysis when undergoing renal biopsy. Methods: Observational, descriptive, case series, retrospective and cross-sectional study, carried out at the E. Rebagliati Matins-Peru national hospital. The medical records of patients older than 15 years of age who underwent kidney biopsy between 2008-2016 were reviewed. The data were processed in Stata 16.1 Results: Of 2278 medical records, they corresponded to 1234 women and 1044 men. The most frequent primary and secondary glomerulonephritis were focal and segmental glomerulosclerosis (FSGS) 683 (29.98%) and systemic lupus erythematosus (SLE). ) 434 (19.04%) respectively. Of 1644 biopsied patients, 36 (2.19%) and 241 (14.66%) had major and minor complications respectively. Major complications were more frequent when the procedure was performed by radiology with ultrasound guidance compared to that performed by the nephrologist without ultrasound guidance (p = 0.03694). In 1,324 patients, 329 underwent kidney biopsy while on hemodialysis; of them 43 (13.07%) managed to get out of this therapy and 144 (51.99%) had major or minor complications. Conclusions: GEFyS and SLE were the most frequent primary and secondary glomerulonephritis, respectively. In 1644 patients the major and minor complications were 36 (2.19%) and 241 (14.66%) respectively. In 1,324 patients, 329 (24.8%) were biopsied while on hemodialysis and 144 (51.99%) of them had major or minor complications.

Etnobotánica médica urbana y periurbana de la ciudad de Córdoba (Argentina) / Urban and peri-urban medical ethnobotany in the city of Córdoba (Argentina)

Following is submitted an ethnobotanic study on knowledge and practices on usage, role and meaning of plants and relatives used by practitioners of non-official medicine in urban and peri-urban places of the city of Córdoba, Argentina. In this study area, it can be observed a cultural structure of knowledge as well as local and foreign practices, which are typical of modern cultures. Diverse social actors perform as cultural connectors between urban and rural scenarios, which match traditional components with those of biomedicine as well as those that belong to a large chain of medical herbs marketing. Quantitative and qualitative methods were resorted to, through classical ethnobotanic techniques. An amount of 768 therapeutical usages were registered which correspond to 262 native and foreign medical taxons. These taxons belong to 95 family plants marketed within urban and peri-urban areas. It is also remarkable an urban pharmacopeia highly diverse as regards species and usages with a top level of exotic species (60%) as well as complementary alternative and global medicines in theses contexts.

Se presenta un estudio etnobotánico de los conocimientos y prácticas referidos al uso, rol y significado de los vegetales usados por practicantes de la medicina no oficial en poblaciones urbanas y periurbanas de la ciudad de Córdoba, Argentina. En este ámbito de estudio, se conforma un complejo cultural de saberes y prácticas locales y foráneas, típicas de culturas modernas. Se destaca el protagonismo de diversos actores sociales los que actúan como conectores culturales entre escenarios urbanos y rurales, los que combinan elementos tradicionales con los de la biomedicina, como así también los que forman parte de una larga cadena de comercialización de hierbas medicinales. Se recurrió a métodos cualitativos y cuantitativos mediante técnicas clásicas etnobotánicas. Se documentaron un total de 768 usos terapéuticos correspondientes a 262 taxones medicinales de estatus autóctonos y exóticos que pertenecen a 95 familias de plantas comercializadas en el ámbito urbano y periurbano. Se advierte una farmacopea urbana altamente diversificada en especies y aplicaciones con un predominio de especies exóticas (60%) como así también la presencia influyente de las medicinas alternativas complementarias y de medicinas globales en estos contextos.

Endoscopic Treatment for Vesicoureteral Reflux in Recurrent Urinary Tract Infections in Kidney Transplant: Experience of One Center.

Vesicoureteral reflux (VUR) after renal transplantation in adult patients has been reported. In renal transplant recipients, symptomatic urinary tract infection can cause high morbidity despite improved immunosuppressive and antibiotic treatment. In our country there have been few reported cases about use of copolymer of dextranomer and hyaluronic acid (DX-HA) injection in a renal transplant. We present 3 cases of recurrent or complicated infections with evidence of high-grade VUR, which were treated with DX-HA. Only 1 case had a partial remission; however, there were no episodes of urinary tract infection in 12 months of follow-up. Suburethral injection is an endoscopic treatment modality with low morbidity in our country.

Long-term prostate-specific antigen contamination in the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC).

OBJECTIVES: Recently, the European Randomized Study of Screening for Prostate Cancer achieved a reduction in prostate cancer mortality by measuring serum prostate-specific antigen (PSA) levels. These results were not reproduced in the Spanish arm of European Randomized Study of Screening for Prostate Cancer. PSA contamination (opportunistic measurements outside the study) could decrease the study's contrasting power if performed in the control arm. We have calculated the long-term rate of PSA contamination and its effect on performing prostate biopsy and detecting cancer. MATERIAL AND METHODS: A total of 4,276 men were randomised (2,415 to the screening arm, 1,861 to the control arm) in the Spanish section of the European Randomized Study of Screening for Prostate Cancer. PSA measurements were not scheduled in the control arm. Sextant prostate biopsy was indicated if PSA levels were ≥3 ng/mL. All PSA readings performed outside the study were labelled as "PSA contamination". We calculated the rates of PSA contamination, biopsy implementation and cancer detection. RESULTS: The median age and follow-up time were 57 and 15.1 years, respectively. A total of 2,511 men underwent at least one PSA reading outside the study. PSA contamination at 5, 10 and 15 years was 22.0%, 47.1% and 66.3% in the screening arm, respectively, and 20.8%, 43.2% and 58.6% in the control arm, respectively (P<.0001). The biopsy rate at 5, 10 and 15 years was 19.3%, 22.6% and 24.1% (screening), respectively, and 1.0%, 3.6% and 7.1% (control), respectively (P<.0001). The PC detection rate was 6.7% (screening) and 4.3% (control; P=.0006). CONCLUSIONS: Although the cumulative PSA contamination was pronounced in the 2 study arms, the rate of prostate biopsies was low in the control arm. We therefore believe that the effect of PSA contamination on the study's statistical power should be limited.

Baseline PSA in a Spanish male population aged 40-49 years anticipates detection of prostate cancer.

INTRODUCTION: We researched the usefulness of optimizing prostate cancer (PC) screening in our community using baseline PSA readings in men between 40-49 years of age. MATERIAL AND METHOD: A retrospective study was performed that analyzed baseline PSA in the fifth decade of life and its ability to predict the development of PC in a population of Madrid (Spain). An ROC curve was created and a cutoff was proposed. We compared the evolution of PSA from baseline in patients with consecutive readings using the Friedman test. We established baseline PSA ranges with different risks of developing cancer and assessed the diagnostic utility of the annual PSA velocity (PSAV) in this population. RESULTS: Some 4,304 men aged 40-49 years underwent opportunistic screening over the course of 17 years, with at least one serum PSA reading (6,001 readings) and a mean follow-up of 57.1±36.8 months. Of these, 768 underwent biopsy of some organ, and 104 underwent prostate biopsy. Fourteen patients (.33%) were diagnosed with prostate cancer. The median baseline PSA was .74 (.01-58.5) ng/mL for patients without PC and 4.21 (.76-47.4) ng/mL for those with PC. The median time from the reading to diagnosis was 26.8 (1.5-143.8) months. The optimal cutoff for detecting PC was 1.9ng/mL (sensitivity, 92.86%; specificity, 92.54%; PPV, 3.9%; NPV, 99.97%), and the area under the curve was 92.8%. In terms of the repeated reading, the evolution of the PSA showed no statistically significant differences between the patients without cancer (p=.56) and those with cancer (P=.64). However, a PSAV value >.3ng/mL/year revealed high specificity for detecting cancer in this population. CONCLUSIONS: A baseline PSA level ≥1.9ng/mL in Spanish men aged 40-49 years predicted the development of PC. This value could therefore be of use for opportunistic screening at an early age. An appropriate follow-up adapted to the risk of this population needs to be defined, but an annual PSAV ≥.3ng/mL/year appears of use for reaching an early diagnosis.

Update of the results of the Spanish branch of the European Randomized Study on Screening for Prostate Cancer (ERSPC).

OBJECTIVE: The role of prostate cancer (PC) screening is currently being questioned. The objective of the European Randomized Study of Screening for Prostate Cancer (ERSPC) was to demonstrate whether PC screening reduced mortality from this disease. The results from the Spanish branch of this study are presented: all-cause and cancer-specific mortality, the characteristics of the detected tumors, primary treatments and progression to advanced disease. MATERIAL AND METHODS: A total of 18,612 men, between the ages of 45 and 70, were invited to participate in the study, excluding those with a life expectancy of less than 10 years. The men were randomized to the screening arm (serum prostate-specific antigen [PSA] reading) or the control arm (no diagnostic tests). Randomized transrectal ultrasound-guided sextant prostate biopsies were indicated for the men in the screening arm with PSA levels ≥3ng/ml. The detected PCs were identified (stage and primary treatment), as well as the deaths that occurred (date and cause of death). RESULTS: The study was performed with 4276 men (2415 in the screening arm and 1861 in the control arm). The median age and serum PSA level were 57 years and 0.90ng/mL, respectively. The median follow-up time was 15.8 years. A total of 242 PCs were diagnosed, 162 (6.7%) in the screening arm and 80 (4.3%) in the control arm (P<.001). Of these, 214 (88.4%) had an organ-confined clinical stage at onset (91.4% in the screening arm vs. 82.5% in the control arm; P=.024). A total of 112 patients (46.3%) underwent radical prostatectomy, 53 (21.9%) underwent prostate radiation therapy, 24 (9.9%) underwent hormone therapy and 47 (19.4%) were kept under observation. A total of 18 PCs progressed to advanced disease (M+ or PSA levels >100ng/mL), with no differences between the study arms (P=.938). A total of 618 (14.5%) patients died during follow-up: 340 (14.1%) in the screening arm and 278 (14.9%) in the control arm, with no differences between the arms in terms of cancer-specific (P=.907) or all-cause (P=.399) mortality. The main causes of death were neoplasia (54.0%), cardiovascular (17.6%), respiratory (8.7%) and gastrointestinal (4.0%), with no difference between study arms. Of the 334 patients who died from neoplasia, only 12 (3.6%) died from PC. CONCLUSIONS: PC screening results in a shifting of the diagnosis towards earlier stages. Nevertheless, we have not demonstrated a benefit in terms of overall or cancer-specific survival after more than 15 years of follow-up. The low mortality from this disease in our community could be one of the main factors that explain these results.

Prostate cancer incidence and mortality in the Spanish section of the European Randomized Study of Screening for Prostate Cancer (ERSPC).

BACKGROUND: To present the long-term results of a prostate cancer (PC) screening trial conducted in a Mediterranean setting. METHODS: A total of 4276 men aged 45-70 years were randomized to screening arm (PSA test performed) and control arm (no tests). Transrectal ultrasonography-guided sextant prostate biopsy was conducted when PSA > or = 3 ng ml(-1). Date and cause of death were retrieved from death certificates. PC incidence, and disease-specific and overall mortality curves were plotted and comparison between arms was made. Analysis of causes of death was also performed. RESULTS: Median age at randomization was 57.0 years. Median follow-up time was 15.2 years. A total of 241 men were diagnosed with PC, 161 (6.7%) in the screening arm and 80 (4.3%) in the control arm (P<0.01). Eventually, 554 men (13%) died. No difference in all-cause mortality was found between arms (P=0.34). Only 10 men (10/4276, 0.23%) died from PC, no differences between arms (P=0.67). Overall, the main causes of death were malignancy (54.2%), cardiovascular (17.9%) and respiratory (9.2%) diseases. Main cancer causes of death were lung and bronchus cancer (37.2%), colorectum (15.0%) and stomach (9.0%) cancer. PC only accounted for 3.0% of all malignant causes of death (ranked 10th). CONCLUSIONS: Our study failed to demonstrate benefits of PC screening in terms of all-cause and PC-specific mortality after a median follow-up of 15 years. The limited sample size and the low long-term PC mortality observed in our setting were probably the most important factors to explain these results.

Acoplamiento cibernético paciente-máquina-enfermera / Coupling Cybernetic Machine-Patient-Nursing

El presente estudio cualitativo tuvo como objetivos describir y analizar los estilos de cuidar/cuidado que realizan las enfermeras para el paciente adulto con ventilación mecánica asistida en un Hospital Regional Mexicano. Maturana y Varela, Figueiredo y Boff fueron los autores que dieron soporte teórico-filosófico al estudio desde la perspectiva del pensamiento complejo. Participaron diez enfermeras (os) asistenciales de la Unidad de Cuidados Intensivos adultos, del Hospital General Dr. Agustín O'Horán de Mérida Yucatán, México. Los datos fueron obtenidos a través de la entrevista a profundidad y observación participante. La categoría temática principal del estudio fue: Acoplamientoª cibernético paciente-máquina-enfermería con las subcategorias, acoplamiento paciente-máquina, acoplamiento paciente-enfermera(o) y acoplamiento familiar al sistema hospitalario. Se destaca cómo el cuidar-cuidado de enfermería se hace imprescindible para que dicho acoplamiento se pueda llevar a cabo. Los resultados obtenidos permiten contribuir en la construcción de un cuerpo de conocimientos científicos específicos sobre el cuidar/cuidado de enfermería para pacientes ventilados a partir de la práctica. Este estudio subraya la importancia del cuidado que proveen cotidianamente las enfermeras en la unidad de cuidados intensivos para que pueda desarrollarse un acoplamiento cibernético exitoso entre las máquinas vivientes y las máquinas mecánicas.

This qualitative study aimed to describe and analyze the styles of care/caring given by nurses to adult patients under assisted mechanical ventilation in a Mexican regional hospital The works from the approach of Complex Thought by Maturana and Varela, and Figueiredo and Boff, provide its theoretical and philosophical foundations. A total of ten nurses from the adult intensive care unit of the Dr. Agustin O'Horán General Hospital in Merida Yucatan, Mexico participated in the study. Data were obtained through in-depth interviews and participant observation. The main subject of the study was; Coupling cybernetic machine-patient-nursing with subcategories, coupling patient-machine, coupling patient-nurse, and coupling family the hospital system. Highlighting the essential role of nurses care/caring in this coupling, the results obtained contribute to the construction of a specific body of scientific knowledge on nursing care/caring for patients under assisted mechanical ventilation. This study underlines the importance of nurses' daily care in the intensive care units for a successful cybernetic coupling between living and mechanical machines can take place.

[Mortality due to prostate cancer in the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Results after a 15-year follow-up]. / Mortalidad por cáncer de próstata en la rama española del European Randomized Study of Screening for Prostate Cancer (ERSPC). Resultados tras 15 años de seguimiento.

OBJECTIVE: To address if prostate cancer (PCa) screening decreases PCa mortality in the asymptomatic population, within the setting of the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). MATERIAL AND METHODS: From 1996 to 1999, 4,278 men aged 45-70 years were recruited and randomized to the screening arm (PSA every 4 years, prostate biopsy when PSA ≥3 ng/ml) and control arm (no tests). Dates and causes of death were collected on an annual basis. A Kaplan-Meier analysis was used to calculate overall and cancer-specific survival. RESULTS: A total of 2,416 men were recruited in the screening arm and 1,862 in the control arm. Mean age was 57.8 years, median follow-up was 13.3 years. At the end of the follow-up period, 427 deaths (9 from PCa) were observed. Survival analysis did not show any difference between the study arms with respect to overall and cancer-specific survival (p=0.939 and p=0.544 respectively). Most relevant causes of death were malignant tumors (52.9%), cardiovascular disease (17.3%) and respiratory (8.9%). Only 2.1% of deaths (0.2% of all recruited men) were due to PCa (2.5% screening, 1.6% control). CONCLUSIONS: The Spanish arm of ERSPC failed to reproduce the long-term results shown in the whole study. No differences in mortality (overall or cancer-specific) were observed after 15 years of follow-up. PCa mortality was infrequent (less than 1%). These results suggest limited yield of PCa screening in our setting.

Development of morphologically dominant follicles is associated with fewer metabolic disturbances in amenorrheic women with polycystic ovary syndrome: a pilot study.

OBJECTIVES: To determine if amenorrheic women with polycystic ovary syndrome (PCOS) demonstrate ultrasonographically detectable changes in follicle population. METHODS: Sixteen women with PCOS reporting the absence of menses for more than 3 months were enrolled in the study. Subjects had a physical examination, fasting blood tests and two transvaginal ultrasound scans spaced 1 month apart. In cases where evidence of a morphologically dominant follicle (≥ 10 mm in diameter) occurred, subsequent ultrasound scans were performed to determine the fate of the dominant follicle. Differences in total follicle population, maximum follicle diameter and clinical, hormonal and metabolic features were determined. RESULTS: Forty-four percent of subjects showed changes in follicle population of 6-10 follicles and 37% showed changes in follicle population of > 10. Maximum follicle diameters ranged between 5.4 and 33.0 mm. Four subjects demonstrated follicle diameters ≥ 10 mm. Of those who developed dominant follicles, two subjects ovulated, one subject developed a persistent anovulatory follicle and the dominant follicle regressed in the remaining subject. Diagnostic criteria for PCOS were similar among women that did or did not develop dominant follicles (menstrual cycle length, P = 0.880; hirsutism score, P = 0.809; free androgen index, P = 0.991; total follicle count, P = 0.199). However, lower glycosylated hemoglobin (P = 0.047) and insulin levels (P = 0.049) and better insulin sensitivity (P = 0.048) were noted in women who attained dominant follicles. CONCLUSION: Amenorrheic women with PCOS demonstrate changes in follicle population that are consistent with active follicle growth and regression despite prolonged periods of anovulation. Morphologic selection occurs in amenorrheic women and attainment of dominant follicles is associated with improved metabolic status.

Endoscopic pneumatic balloon dilation in primary achalasia: predictive factors, complications, and long-term follow-up.

Pneumatic dilation (PD) has been widely used in the treatment of idiopathic achalasia with a 70-90% response. The aim of this study was to evaluate the effectiveness of PD and its predictive factors by means of clinical assessment. In addition, we evaluated its safety and the need for subsequent surgical intervention. Fifty-six patients were treated with a Witzel dilator. The response was evaluated at medium (1-5 years) and long term (>5 years). Diverse possible predictive factors to response were analyzed. After the first PD, 85.7% of the 56 patients improved and passed from clinical stage II-III to clinical stage 0-I (P < 0.005). After the second dilation, 84.6% of the patients (13) passed to clinical stage 0-I (P < 0.05). Only patients who were not young (>40 years) avoided a second dilation and/or surgery (P < 0.001). During the first 5 years of follow-up, 80% of patients maintained their response; this percentage decreased to 58% after 10 years. PD therapy of achalasia is a safe technique, with few adverse effects (4% perforations and 10% gastroesophageal reflux). It offers a medium-term response of 80% and long-term response of around 60%. Age was the only predictive response factor.

Quantitative real-time reverse transcription: polymerase chain reaction of prostate-specific antigen (PSA) for detection of circulating prostatic cells in patients with clinically localized prostate cancer.

OBJECTIVE: To evaluate the clinical utility of using the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) to quantify prostate-specific antigen (PSA) mRNA in peripheral blood samples from patients with prostate cancer as a predictor of extraprostatic extension of the disease and to assess any correlations with known predictive markers of this condition. METHODS: Immediately before radical prostatectomy, peripheral blood samples were taken from 42 men with clinically localized prostate cancer and analysed for PSA and 18S ribosomal (endogenous control) genes using real-time RT-PCR (with gene expression assays and the comparative CT-cycle threshold-method for quantifying). A total of 30 healthy male blood donors aged <50 y was taken as a control group. The relationships between PSA mRNA values, pathological and clinical features were analysed. PSA mRNA value, PSA level and biopsy Gleason score were then compared as predictors of extraprostatic extension. RESULTS: PSA gene expression was 3.73 times significantly higher in patients with clinically localized prostate cancer than in healthy men (P<0.05). There was no relationship between PSA real-time RT-PCR values and pathological stage pT2 or pT3 (P=0.5), and no association between PSA mRNA value and serum PSA level (P=0.9) or the Gleason score of the preoperative biopsy (P=0.9). CONCLUSION: There was no significant advantage in using the real-time RT-PCR assay of PSA mRNA before surgery to stage prostate cancer and to discriminate between organ-confined and extraprostatic extension.

Prostate cancer detection and tumor characteristics in men with multiple biopsy sessions.

PURPOSES: To address prostate cancer (PCa) detection with respect to the number of biopsy sessions performed, to identify risk factors for detection after a negative biopsy, and to analyze the clinical characteristics of the detected tumors. SCOPE: Only biopsied men (sextant) were included. A total of 1011 biopsy sessions were carried out in 770 men; 172 underwent a second prostate biopsy and 51 a third biopsy. During the first biopsy round, 111 cancers were found (14.4%), 27 in the second (15.7%), and five during the third round (9.8%), P=0.156. Only high-grade PIN or atypia were identified as independent predictors or PCa detection in subsequent biopsies (P=0.008). A nonsignificant increase of clinically localized tumors, and a decrease of metastatic and poorly differentiated cases were found when more biopsy sessions were needed for detection. CONCLUSIONS: A nonsignificant trend to lower cancer detection rates and less clinical relevance of the tumors detected can be observed when more biopsy rounds are needed for detection.

Prostate apoptosis after doxazosin treatment in the spontaneous hypertensive rat model.

OBJECTIVE: To validate the spontaneous hypertensive rat (SHR) model for basic research into benign prostate hyperplasia (BPH), and to assess doxazosin-induced changes in prostatic structure and apoptotic status. MATERIALS AND METHODS: Four groups of rats were assessed: group 1, 15 SHRs treated with doxazosin; group 2, 14 SHRs with unilateral excision of the major pelvic ganglion; group 3, 14 untreated SHRs; and group 4, 16 intact Wistar-Kyoto (WKY) rats. The doxazosin mesylate (0.03 mg daily) was given compacted in rat food for 3 months. The prostatic ventral lobe (VL) was excised and weighed. Stereological light microscopy, multiplex reverse transcription-polymerase chain reaction of prostate caspases, and caspase-3 activity (cellular enzymatic assay) were assessed. RESULTS: There was more development of the glandular epithelium (P < 0.001) in SHR rats than in controls, which was even greater after doxazosin exposure (P = 0.027). SHR animals had higher caspase expression (P < 0.05) and activity (P = 0.008) than WKY rats, but both were reduced after doxazosin therapy (P < 0.01 and 0.028, respectively). CONCLUSIONS: This study confirmed prostate hyperplasia in the SHR model. Doxazosin exposure did not reduce the volume of glandular epithelium and contributed to protecting against caspase-induced apoptosis. The SHR model may be not a valid option to study doxazosin-induced apoptosis in BPH.

The Spanish contribution to the European Randomized Study of Screening for Prostate Cancer.

OBJECTIVE: To summarize the experience of the Spanish participation in the European Randomized Study of Screening for Prostate Cancer (ERSPC). METHODS: In this study men aged 45-70 years were randomized (1:1) and allocated to one of two arms: screening, with an indication for transrectal ultrasonography (TRUS) and sextant prostate biopsy when the serum prostate-specific antigen (PSA) level was >4 ng/mL (until May 1998) and from then when the PSA was >2.9 ng/mL; and a control group (no diagnostic tests). The findings from a digital rectal examination were not considered as a criterion for biopsy. When the serum PSA was above the threshold levels, biopsy-negative men were invited again after a year ('early recall'). The next (second) screening round was programmed for the rest of participants after a 4-year interval. Cancer-specific mortality was recorded and compared in both groups. RESULTS: In all, 4278 men were recruited (2416 in the screening group and 1862 in the control group). The recruitment phase was closed in June 1999. During the first screening round 40 cancers were detected; the detection rate was then 1.7% and 4.15 biopsies were needed to detect each cancer. The clinical stage was localized in 88.6% and regional or metastatic in 11.4%. Within the first round, 17 more cancers were detected at early recall attendance. During the second screening round 14 cancers were found, giving a detection rate of 1.9%; 17 more cancers were also diagnosed outside the screening programme (contamination), seven in the screening group and 10 in the control group. Until February 2003, 85 participants had died (53 screened and 32 control) but none from prostate cancer. CONCLUSIONS: Cancer detection rates can be increased with further early recalls; the clinical stage was localized in an important proportion of cancers detected.

Four-year prostate-specific antigen progression in the non-cancer population of the European Randomized Study of Screening for Prostate Cancer.

OBJECTIVE: To determine the rate of conversion of prostate-specific antigen (PSA) to values of > 4 ng/mL in a normal male population. PATIENTS AND METHODS: In men with an initial PSA level of < 4 ng/mL the probability of having a PSA of > or = 4 ng/mL and its relationship with the age at first PSA test, baseline PSA level and time to the determination was evaluated. Statistical methods were used to correct for the within-subject variability across many PSA determinations. RESULTS: In all, 45433 PSA tests in 21169 men with an initial PSA of < 4 ng/mL were available. Overall, in 960 men (4.5%) the PSA level changed to > or = 4 ng/mL. The lowest chance was for men aged < 55 years with an initial PSA of < 1 ng/mL and a new PSA determination during the first 18 months (0.952 conversions per 1000 men) while the highest was for men aged < 55 years with an initial PSA level of > 2.5 ng/mL (395 conversions per 1000 men). There was a significant and independent relationship between conversion and the interval between determinations, with conversion being 3.33 times more frequent during 18-42 months than with the reference category (< 18 months) and 5.23 times more frequent during > 42 months. The probability of conversion independently increased by 3 lambda for every additional year of age. Every unit of basal PSA multiplied by 6.48 the probability of conversion. CONCLUSIONS: The risk for conversion to a PSA of > or = 4 ng/mL can be anticipated from the patient's age and initial PSA level. Re-screening before 4 years after the first round can be useless for men with an initial PSA of < 1 ng/mL. Four-year intervals could be inadequate for men with an initial PSA of > 2.5 ng/mL if conversion to > 4 ng/mL is to be avoided.