[Evaluation of the application of hyaluronic acid in postoperative arthroscopy patients with grade II-III gonarthrosis using the WOMAC scale]. / Evaluación en la aplicación de ácido hialurónico en pacientes postoperados de artroscopía con gonartrosis grado II-III mediante la escala de womac.

INTRODUCTION: gonarthrosis is a degenerative disease, whose loss of cartilage causes changes in the adjacent bone and its response produces deformations and attempts at regeneration. In 1934 Meyer and Palmer isolated bovine vitreous humor, a polysaccharide called hyaluronic acid, which has the property of visco-elasticity. Today, multiple procedures performed in orthopedics are known, in order to limit the degenerative process that this entails. OBJECTIVE: to know the use and efficacy of hyaluronic acid in the patient requiring knee arthroscopy, evaluating the evolution of the patient using the WOMAC scale; as well as the ideal time of application of hyaluronic acid in this study group. MATERIAL AND METHODS: clinical, non-randomized, prospective, analytical trial. 48 patients from 45 to 60 years of age, divided into 3 groups with a diagnosis of gonarthrosis grade II-III, who underwent arthroscopy with subsequent hyaluronic acid application, were evaluated; in the postoperative period (group 1), one month after the postoperative period (group 2) and without application (group 3) in a period from September 2015 to June 2016 at the ISSSTE Hospital "Dr. Darío Fernández Fierro". RESULTS: the treatment showed differences in patients regarding reduction of pain and stiffness; and improvement in functional capacity. CONCLUSION: despite, there are no conclusive results if the treatment is better than the other, certain data suggests that using hyaluronic acid in the postoperative improves rigidity and function, however, it was not statistically significant.

INTRODUCCIÓN: la gonartrosis es una enfermedad degenerativa, cuya pérdida de cartílago origina cambios en el hueso adyacente y su respuesta produce deformaciones e intentos de regeneración. En 1934 Meyer y Palmer aislaron el humor vítreo bovino, polisacárido denominado ácido hialurónico, que tiene la propiedad de visco elasticidad. Hoy en día se conocen múltiples procedimientos realizados en ortopedia, con la finalidad de limitar el proceso degenerativo que este conlleva. OBJETIVO: conocer el uso y la eficacia del ácido hialurónico, en el paciente que requiere artroscopía de rodilla, valorando la evolución del paciente mediante escala de WOMAC; así como el tiempo ideal de aplicación del ácido hialurónico en este grupo de estudio. MATERIAL Y MÉTODOS: ensayo clínico, no aleatorizado longitudinal, prospectivo, analítico. Se valoraron 48 pacientes de 45 a 60 años de edad, divididos en tres grupos con diagnóstico de gonartrosis grado II-III, en quienes se realizaron artroscopía con posterior aplicación ácido hialurónico; en el transquirúrgico (grupo 1), al mes del postquirúrgico (grupo 2) y sin aplicación (grupo 3) en un período de Septiembre de 2015 a Junio de 2016 en el Hospital del ISSSTE "Dr. Darío Fernández Fierro". RESULTADOS: el tratamiento mostró diferencias en los pacientes en cuanto a reducción de dolor y rigidez; y mejoría en capacidad funcional. CONCLUSIÓN: a pesar de que no es concluyente si algún tratamiento es mejor que otro, ciertos datos sugieren que el utilizar ácido hialurónico en el transquirúrgico mejora la rigidez y la función, sin embargo, no logró ser estadísticamente significativo.

Evaluación en la aplicación de ácido hialurónico en pacientes postoperados de artroscopía con gonartrosis grado II-III mediante la escala de WOMAC / Evaluation of the application of hyaluronic acid in postoperative arthroscopy patients with grade II-III gonarthrosis using the WOMAC scale

Resumen: Introducción: la gonartrosis es una enfermedad degenerativa, cuya pérdida de cartílago origina cambios en el hueso adyacente y su respuesta produce deformaciones e intentos de regeneración. En 1934 Meyer y Palmer aislaron el humor vítreo bovino, polisacárido denominado ácido hialurónico, que tiene la propiedad de visco elasticidad. Hoy en día se conocen múltiples procedimientos realizados en ortopedia, con la finalidad de limitar el proceso degenerativo que este conlleva. Objetivo: conocer el uso y la eficacia del ácido hialurónico, en el paciente que requiere artroscopía de rodilla, valorando la evolución del paciente mediante escala de WOMAC; así como el tiempo ideal de aplicación del ácido hialurónico en este grupo de estudio. Material y métodos: ensayo clínico, no aleatorizado longitudinal, prospectivo, analítico. Se valoraron 48 pacientes de 45 a 60 años de edad, divididos en tres grupos con diagnóstico de gonartrosis grado II-III, en quienes se realizaron artroscopía con posterior aplicación ácido hialurónico; en el transquirúrgico (grupo 1), al mes del postquirúrgico (grupo 2) y sin aplicación (grupo 3) en un período de Septiembre de 2015 a Junio de 2016 en el Hospital del ISSSTE «Dr. Darío Fernández Fierro¼. Resultados: el tratamiento mostró diferencias en los pacientes en cuanto a reducción de dolor y rigidez; y mejoría en capacidad funcional. Conclusión: a pesar de que no es concluyente si algún tratamiento es mejor que otro, ciertos datos sugieren que el utilizar ácido hialurónico en el transquirúrgico mejora la rigidez y la función, sin embargo, no logró ser estadísticamente significativo.

Abstract: Introduction: gonarthrosis is a degenerative disease, whose loss of cartilage causes changes in the adjacent bone and its response produces deformations and attempts at regeneration. In 1934 Meyer and Palmer isolated bovine vitreous humor, a polysaccharide called hyaluronic acid, which has the property of visco-elasticity. Today, multiple procedures performed in orthopedics are known, in order to limit the degenerative process that this entails. Objective: to know the use and efficacy of hyaluronic acid in the patient requiring knee arthroscopy, evaluating the evolution of the patient using the WOMAC scale; as well as the ideal time of application of hyaluronic acid in this study group. Material and methods: clinical, non-randomized, prospective, analytical trial. 48 patients from 45 to 60 years of age, divided into 3 groups with a diagnosis of gonarthrosis grade II-III, who underwent arthroscopy with subsequent hyaluronic acid application, were evaluated; in the postoperative period (group 1), one month after the postoperative period (group 2) and without application (group 3) in a period from September 2015 to June 2016 at the ISSSTE Hospital «Dr. Darío Fernández Fierro¼. Results: the treatment showed differences in patients regarding reduction of pain and stiffness; and improvement in functional capacity. Conclusion: despite, there are no conclusive results if the treatment is better than the other, certain data suggests that using hyaluronic acid in the postoperative improves rigidity and function, however, it was not statistically significant.

M1 Macrophage Polarization Prevails in Epstein-Barr Virus-Infected Children in an Immunoregulatory Environment.

Macrophages can be polarized toward a proinflammatory phenotype (M1) (CD68+) or to an anti-inflammatory one (M2) (CD163+). Polarization can be triggered by cytokines such as IFN-γ for M1, or IL-10 and TGF-ß, for M2. In the context of pediatric Epstein Barr virus (EBV) infection, little is known about macrophage polarization in EBV primary or persistent infection. When studying tonsils of patients undergoing primary infection (PI), healthy carrier (HC), reactivation (R), and not infected (NI), M1 profile prevailed in all infection status. However, an increase in M2 cells was observed in those patients with broader expression of latency antigens, in particular EBNA2. Tonsils from primary infected patients showed an increased IL-10 expression, whereas, unexpectedly, TGF-ß expression correlated with M1 marker. Furthermore, an inverse correlation was demonstrated between CD68 and IFN-γ. Therefore, in the context of asymptomatic infection in children, M1 macrophage polarization prevails, even in the presence of IL-10 and TGF-Ꞵ immunomodulatory cytokines, and it might be independent from lymphomagenesis process. Our finding indicates that macrophages may have a significant plasticity in response to different types of extrinsic stimuli, and further studies are required to investigate M1 polarization under anti-inflammatory stimuli. IMPORTANCE Most studies on Epstein Barr virus (EBV) primary infection have been performed in adolescents and young adult populations with Infectious Mononucleosis (IM) in developed countries. Furthermore, studies related to macrophage polarization were assessed in EBV-associated lymphomas, but little is known about macrophage polarization in the context of primary infection at the site of viral entry and replication, the tonsils. Therefore, the aim of this study was to characterize macrophage response in children undergoing EBV primary or persistent infection, in order to enlighten the role of macrophages in viral pathogenesis, in a population with a high incidence of EBV-associated lymphomas in children younger than 10 years old. This study may contribute to explain, at least in part, the asymptomatic viral infection in children from an underdeveloped region, given that M1 polarization pattern prevails, but in a regulatory environment.

Distinctive EBV infection characteristics in children from a developing country.

BACKGROUND: In developing countries, Epstein-Barr virus (EBV) infection is mostly asymptomatic in early childhood. EBV persistence may lead to different malignancies, such as B cell derived lymphomas. In Argentina, most children are seropositive at three years and an increased association between EBV and lymphoma was proved in children under 10 years old by our group. OBJECTIVE: Our aim was to characterize EBV infection at the site of entry and reactivation of viral infection -the tonsils- in order to better understand the mechanism of viral persistence in pediatric patients. METHODS: A cohort of 54 patients was described. We assessed specific antibodies profiles in sera; viral proteins presence by IHC on FFPE samples and EBV type from fresh tissue. RESULTS: EBV type 1 was prevalent, mostly in the youngest patients. Asymptomatic primary infected patients presented higher viral loads and Latency 0/I or II patterns, whereas the Latency III pattern was observed mostly in healthy carriers. There were no differences between groups in the expression of viral lytic antigens. This study discloses new features in patients undergoing primary infection from a developing population. Low viral inoculum and restricted viral antigen expression may be responsible for the lack of symptoms in children from our country.

[Frequency of complications in patients older than 60 years with hip fracture]. / Frecuencia de complicaciones en pacientes mayores de 60 años con fractura de cadera.

INTRODUCTION: According to figures from INEGI 2009, indicate that one in 12 Mexican women and one in 20 men over 65 will suffer a hip fracture. Is expected to reach 110,055 patients in the year 2050. Femoral neck stress fractures are more common in women and consist of 5 to 10%. There is a high number of patients with hip fracture complications, secondary to multiple factors which have been little studied and this limits its prevention. MATERIAL AND METHODS: A retrospective, observational and transversal study in senior citizens between January and December 2016 with hip fracture was conducted. Through collection of demographic data: age, sex, address, as well as type of fracture, type of management, primary diagnosis: ICD 10 S72 fracture of hip, hospital stay, surgery carried out and place of destination subsequent to discharge from the unit. RESULTS: The most affected gender was female. Within the main complications it correlates with delirium considering the average hospital stay of one day thrown outcomes, says that hospital stays are relatively short compared to other types of fractures. As in the international literature, the Transtrochanteric fracture is the main type of fracture; However in terms of surgical management of higher prevalence was hemiarthroplasty type Thompson followed by closed reduction internal fixation with DHS system placement.

INTRODUCCIÓN: Según indican las cifras del INEGI 2009, una de cada 12 mujeres mexicanas y uno de cada 20 hombres mayores de 65 años sufre una fractura de cadera. Se estima que en el año 2050 ésta alcance 110,055 pacientes. Las fracturas por estrés del cuello femoral son más frecuentes en mujeres y comprenden de 5 a 10%. Existe un alto número de pacientes con complicaciones de fractura de cadera secundario a múltiples factores, los cuales poco se han estudiado y esto limita su prevención. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo, observacional y transversal de los pacientes de la tercera edad con fractura de cadera entre Enero y Diciembre de 2016 mediante recopilación de datos sociodemográficos: edad, sexo, dirección, además de tipo de fractura, tipo de manejo, diagnóstico principal: CIE 10 S72 fractura de cadera, procedimiento realizado, días de estancia intrahospitalaria, intervención quirúrgica realizada y lugar de destino posterior al alta de la unidad. RESULTADOS: El género más afectado fue el femenino. Las principales complicaciones se correlacionan con delirium, considerando el promedio de estancia hospitalaria de un día por los resultados arrojados, se afirma que las estancias hospitalarias son relativamente cortas en comparación con otro tipo de fracturas. Al igual que en la literatura internacional, la fractura transtrocantérica es el principal tipo de fractura; sin embargo, en cuanto al manejo quirúrgico el de mayor prevalencia fue la hemiartroplastía tipo Thompson seguido de reducción cerrada y fijación interna con colocación de sistema DHS.

Prevalencia de osteoporosis y osteopenia en pacientes laboralmente activos / Prevalence of osteoporosis and osteopenia in patients occupationally active

Resumen: Antecedentes: La osteoporosis constituye un problema de salud pública a nivel mundial; afecta a más de 200 millones de personas. Se calcula que de 30 a 50% de las mujeres postmenopáusicas la padecen. De acuerdo con la International Osteoporosis Foundation (IOF), la osteoporosis es una enfermedad que se distingue por la disminución de la densidad y calidad de los huesos. El objetivo de este trabajo fue conocer la prevalencia de osteoporosis y osteopenia en trabajadores activos sanos. Métodos: Estudio retrospectivo observacional con trabajadores activos de sexo masculino y femenino en quienes se evaluó la densidad mineral ósea por absorciometría dual de rayos X (DXA) central de cadera y columna. El tiempo de evaluación fue de Junio de 2009 a Junio de 2010. Resultados: Se reclutaron 1,431 pacientes: 258 (18%) hombres y 1,173 (82%) mujeres. De acuerdo con los parámetros internacionales, los diagnósticos de las densitometrías centrales fueron, de manera global: normales, 572 sujetos (40%); con osteopenia, 601 (42%); con osteoporosis, 258 (18%). Discusión: Los resultados demuestran que las alteraciones degenerativas en pacientes con osteoporosis u osteopenia son frecuentes, incluso entre personas jóvenes.

Abstract: Background: Osteoporosis is a public health problem worldwide, affecting more than 200 million people. It is estimated that 30 to 50% of postmenopausal women suffer from it. According to the International Osteoporosis Foundation (IOF), osteoporosis is a disease characterized by a decrease in the density and quality of bones. The objective of this work was to know the prevalence of osteoporosis and osteopenia in healthy active workers. Methods: Retrospective, observational study with active male and female workers in whom bone mineral density was evaluated by dual X-ray absorptiometry (DXA) of the hip and spine. The evaluation time was from June 2009 to June 2010. Results: A total of 1,431 patients were recruited: 258 (18%) men and 1,173 (82%) women. According to the international parameters, the diagnoses of the central densitometries were, overall: 572 normal subjects (40%), 601 (42%) with osteopenia and 258 (18%) with osteoporosis. Discussion: The results show that degenerative alterations in patients with osteoporosis or osteopenia are frequent, even among young people.

Frecuencia de complicaciones en pacientes mayores de 60 años con fractura de cadera / Frequency of complications in patients older than 60 years with hip fracture

Resumen: Introducción: Según indican las cifras del INEGI 2009, una de cada 12 mujeres mexicanas y uno de cada 20 hombres mayores de 65 años sufre una fractura de cadera. Se estima que en el año 2050 ésta alcance 110,055 pacientes. Las fracturas por estrés del cuello femoral son más frecuentes en mujeres y comprenden de 5 a 10%. Existe un alto número de pacientes con complicaciones de fractura de cadera secundario a múltiples factores, los cuales poco se han estudiado y esto limita su prevención. Material y métodos: Se realizó un estudio retrospectivo, observacional y transversal de los pacientes de la tercera edad con fractura de cadera entre Enero y Diciembre de 2016 mediante recopilación de datos sociodemográficos: edad, sexo, dirección, además de tipo de fractura, tipo de manejo, diagnóstico principal: CIE 10 S72 fractura de cadera, procedimiento realizado, días de estancia intrahospitalaria, intervención quirúrgica realizada y lugar de destino posterior al alta de la unidad. Resultados: El género más afectado fue el femenino. Las principales complicaciones se correlacionan con delirium, considerando el promedio de estancia hospitalaria de un día por los resultados arrojados, se afirma que las estancias hospitalarias son relativamente cortas en comparación con otro tipo de fracturas. Al igual que en la literatura internacional, la fractura transtrocantérica es el principal tipo de fractura; sin embargo, en cuanto al manejo quirúrgico el de mayor prevalencia fue la hemiartroplastía tipo Thompson seguido de reducción cerrada y fijación interna con colocación de sistema DHS.

Abstract: Introduction: According to Figures from INEGI 2009, indicate that one in 12 Mexican women and one in 20 men over 65 will suffer a hip fracture. Is expected to reach 110,055 patients in the year 2050. Femoral neck stress fractures are more common in women and consist of 5 to 10%. There is a high number of patients with hip fracture complications, secondary to multiple factors which have been little studied and this limits its prevention. Material and methods: A retrospective, observational and transversal study in senior citizens between January and December 2016 with hip fracture was conducted. Through collection of demographic data: age, sex, address, as well as type of fracture, type of management, primary diagnosis: ICD 10 S72 fracture of hip, hospital stay, surgery carried out and place of destination subsequent to discharge from the unit. Results: The most affected gender was female. Within the main complications it correlates with delirium considering the average hospital stay of one day thrown outcomes, says that hospital stays are relatively short compared to other types of fractures. As in the international literature, the Transtrochanteric fracture is the main type of fracture; However in terms of surgical management of higher prevalence was hemiarthroplasty type Thompson followed by closed reduction internal fixation with DHS system placement.

Care models for polypathological patients. / Modelos de atención al paciente pluripatológico.

Polypathological patients have specific clinical, functional, psychoaffective, social, family and spiritual characteristics. These patients are generally elderly and frail and have frequent decompensations. They frequently use healthcare resources, have significant functional impairment and have a high index of dependence. This results in a significant social impact, high mortality and a high consumption of resources. The current healthcare models have not answered these needs, which causes problems with accessibility to healthcare services, a lack of coordination among these services, a higher probability of adverse events related to polypharmacy and a high consumption of resources. In the past decade, the healthcare models have changed and are characterized by work in multidisciplinary and interlevel teams, patient self-care, the availability of tools for decision making, information and communication systems and prevention. The goal is to have prepared and proactive health teams and an informed and active patient population. The assessment of health results, processes and the costs for these programs is still based on moderate to low evidence. It is therefore not an easy task to determine the type and intensity of interventions or to determine the patient groups that could gain more benefits.

Validation of PROFUND prognostic index over a four-year follow-up period.

BACKGROUND/OBJECTIVES: The PROFUND index stratifies accurately the 12-month mortality risk of polypathological patients (PPs), but its fitness over a longer follow-up period remains unknown. We aimed to explore the calibration and discrimination power of PROFUND index over 4-years, in order to assess its follow-up interval generalizability. DESIGN: Multicenter prospective cohort-study. SETTING: 33 Spanish hospitals. PARTICIPANTS: PPs included after hospital discharge, outpatient clinics, or home hospitalization. MEASUREMENTS: Mortality over a 4-year follow-up period. METHODS: PROFUND index calibration was assessed by risk-quartiles predicted/observed mortality (Hosmer-Lemeshow goodness-of-fit test), and its discrimination power by ROC curves. RESULTS: A total of 768 patients were included (630 [82%] of them completed the 4-year follow-up). Global mortality rate was 63.5%. When assessing individual patient scores, mortality was 52% in the lowest risk group (0-2 points in PROFUND score); 73.5% in the low-intermediate risk group (3-6 points), 85% in the intermediate-high group (7-10 points); and 92% in the highest risk group (≥11 points). Accuracy testing of the PROFUND index showed good calibration (P=.8 in the Hosmer-Lemeshow goodness-of-fit test), and also a good discrimination power (AUC=0.71 [0.67-0.77] in ROC curve). CONCLUSIONS: The PROFUND index maintained its accuracy in predicting mortality of polypathological patients over a 4-year follow-up period. This index may be of potential usefulness in deciding the most appropriate health-care interventions in populations with multimorbidity.

Inappropriate prescribing in elderly people with diabetes admitted to hospital.

AIMS: To assess inappropriate prescribing in older people with diabetes mellitus during the month prior to a hospitalization, using tools on potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) and comparing inappropriate prescribing in patients with without diabetes. METHODS: In an observational, prospective multicentric study, we assessed inappropriate prescribing in 672 patients aged 75 years and older during hospital admission. The Beers, Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert Doctors to Right Treatment (START) criteria and Assessing Care of Vulnerable Elders (ACOVE-3) medicine quality indicators were used. We analysed demographic and clinical factors associated with inappropriate prescribing. RESULTS: Of 672 patients, 249 (mean age 82.4 years, 62.9% female) had a diagnosis of diabetes mellitus. The mean number of prescribing drugs per patient with diabetes was 12.6 (4.5) vs. 9.4 (4.3) in patients without diabetes (P < 0.001). Of those patients with diabetes, 74.2% used 10 or more medications; 54.5% of patients with diabetes had at least one Beers-listed PIM, 68.1% had at least one STOPP-listed PIM, 64.6% had at least one START-listed PPO and 62.8% had at least one ACOVE-3-listed PPO. Except for the Beers criteria, these prevalences were significantly higher in patients with diabetes than in those without. After excluding diabetes-related items from these tools, only STOPP-listed PIMs remained significantly higher among patients with diabetes (P = 0.04). CONCLUSIONS: Polypharmacy is common among older patients with diabetes mellitus. Inappropriate prescribing is higher in older patients with diabetes, even when diabetes-related treatment is excluded from the inappropriate prescribing evaluation.

Reporte de dos casos de miocardiopatía periparto en la Unidad de Terapia Intensiva Obstétrica / Report of two cases of peripartum cardiomyopathy in the Intensive Care Unit Obstetric

La miocardiopatía periparto es una enfermedad poco frecuente de causa desconocida, que se caracteriza por la aparición de insuficiencia cardíaca aguda en embarazadas que cursan el último mes de gestación y en el puerperio. En las poblaciones estudiadas, la frecuencia más alta se observa en Haití, donde se estima 1 caso cada 299 nacidos vivos; Sudáfrica 1 caso cada 1000 nacidos vivos. Las frecuencias más bajas corresponden a los Estados Unidos (1 caso cada 4000 nacidos vivos) y Europa. La tasa de mortalidad hospitalaria estimada es del 1,36% y la tasa global de mortalidad, del 2,05%. Se desconoce su verdadera prevalencia e incidencia en la Argentina, probablemente como consecuencia de subregistros. En nuestra Unidad de Terapia Intensiva Obsté- trica, ingresaron dos casos de miocardiopatía periparto, en un período de dos años, que fueron abordados por el equipo multidisciplinario compuesto por intensivistas, cardiólogos, nefrólogos y obstetras.(AU)

Peripartum cardiomyopathy is an unusual condition of unknown origin that is characterized by an acute heart failure during the last months of pregnancy and the puerperium. Most case studies show that Haiti has the highest rate of peripartum cardiomyopathy, 1 in 299 live births, followed by South Africa with 1 in 1,000 and the lowest rate is observed in United States (1 in 4,000 live births) and Europe. Hospital case mortality rate is 1.36% with a global mortality rate of 2.05%. Its prevalence and incidence in Argentina are unknown, perhaps as a result of underreporting cases. Two cases of peripartum cardiomyopathy were treated in our Obstetric Intensive Care Unit within a period of two years by a multidisciplinary team of intensivists, cardiologists, nephrologists and obstetricians.(AU)

Reference values for the CAVIPRES-30 questionnaire, a global questionnaire on the health-related quality of life of patients with prostate cancer.

OBJECTIVE: Define and establish the reference values of the CAVIPRES-30 Questionnaire, a health related quality of life questionnaire specific for prostate cancer patients. MATERIAL AND METHODS: The CAVIPRES-30 was administered to 2,630 males with prostate cancer included by 238 Urologist belonging to the Spanish National Healthcare System. Descriptive analysis on socio-demographic and clinical data were performed, and multivariate analyses were used to corroborate that stratification variables were statistically significantly and independently associated to the overall score of the questionnaire. RESULTS: The variables Time since diagnosis of the illness, whether the patient had a Stable partner or not, if he was, or not, undergoing Symptomatic treatment were statistically significantly and independently associated (P < .001) to the overall score of the questionnaire. The reference values table of the CAVIPRES-30 questionnaire is made up of different kinds of information of each patient profile: sample size, descriptive statistics with regard to the overall score, Cronbach's alpha value (between .791 and .875) and the questionnaire's values are reported by deciles. CONCLUSIONS: The results of this study contribute new proof as to the suitability and usefulness of the CAVIPRES-30 questionnaire as an instrument for assessing individually the quality of life of prostate cancer.

Maxillofacial metastasis of genitourinary origin. A report of 3 cases and review of the literature.

INTRODUCTION: The maxillofacial region can harbour a wide range of primary tumours, as well as secondary tumours spreading from distant sites. Rare, though nevertheless important among the latter are genitourinary tumours, such as clear cell renal carcinoma and cervical cancer. Diagnosis of the maxillofacial metastasis sometimes precedes that of the original site, though in other cases the metastasis may arise many years after treatment of the primary tumour. CASE REPORT: We present three cases of maxillofacial metastasis of genitourinary tumours, two clear cell renal adenocarcinoma and squamous cell carcinoma of the uterine cervix. The patients were referred our hospital service for diagnosis and treatment, after having been initially evaluated for buccodental symptoms. DISCUSSION: The appearance of a maxillofacial tumour, initially with the aspect of a primary tumour, may sometimes be the consequence of haematogenous dissemination from another site, such as these surprising cases originating in the genitourinary area. If disseminated metastatic disease is suspected, an extensive oncological screening should be done to evaluate the best therapeutic option in each patient.

Development of a new predictive model for polypathological patients. The PROFUND index.

BACKGROUND: There is a concern about the accuracy of the available prognostic indexes when applying them to the emergent population of polypathological patients (PP). METHODS: To develop a 1-year mortality predictive index on PP, we developed a multicenter prospective cohort-study recruiting 1.632 PP after hospital discharge, outpatient clinics, or home hospitalization, from 33 hospitals. Potential risk factors were obtained in the 1.525 PP who completed follow-up. Each factor independently associated with mortality in the derivation cohort (757 PP from western hospitals) was assigned a weight, and risk scores were calculated by adding the points of each factor. Accuracy was assessed in the validation cohort (768 PP from eastern hospitals) by risk quartiles calibration, and discrimination power, by ROC curves. Finally, accuracy of the index was compared with that of the Charlson index. RESULTS: Mortality in the derivation/validation cohorts was 35%/39.5%, respectively. Nine independent mortality predictors were identified to create the index (age ≥85 years, 3 points; No caregiver or caregiver other than spouse, 2 points; active neoplasia, 6 points; dementia, 3 points; III-IV functional class on NYHA and/or MRC, 3 points; delirium during last hospital admission, 3 points; hemoglobinemia <10 g/dl, 3 points; Barthel index <60 points, 4 points; ≥4 hospital admissions in last 12 months, 3 points). Mortality in the derivation/validation cohorts was 12.1%/14.6% for patients with 0-2 points; 21.5%/31.5% for those with 3-6 points; 45%/50% for those with 7-10 points; and 68%/61.3% for those with ≥11 points, respectively. Calibration was good in derivation/validation cohorts, and discrimination power by area under the curve was 0.77/0.7. Calibration of the Charlson index was good, but discrimination power was suboptimal (area under the curve, 0.59). CONCLUSIONS: This prognostic index provides an accurate and transportable method of stratifying 1-year death risk in PP.

A multi-institutional, hospital-based assessment of clinical, functional, sociofamilial and health-care characteristics of polypathological patients (PP).

Little is known about the main features of the emergent population of PP. Our objective was to determine the clinical, care and social characteristics of a multi-institutional population of PP, by means of a cross-sectional study including a reference population of hospital-based PP from 36 hospitals. The main clinical, functional, mental and social features and their associated factors were assessed: 1632 PP (53% males, mean age 77.9±9.8 years) were included. An informal caregiver was required by 52% (78% of caregivers were close female relatives). The mean inclusion criteria (Cat): were 2.7±0.8 (49.5% presented ≥3 Cat). The most frequent inclusion Cat were heart (77.5%), lung (45.6%), neurological (38.2%), and kidney diseases (32.2%), whereas the mean of other comorbidities was 4.5±2.7 per PP. The mean Charlson comorbidity index (CCI) was 4; 47.6%, and 52.4% presented dyspnea ≥3 on the NYHA, and on the MRC, respectively; nearly 19% required home oxygen therapy, 19% had suffered >1 fall in previous year, and 11% suffered an active neoplasia. The mean hospital admissions in last 12/3 months, and chronically prescribed drugs were 2/1, and 8±3, respectively. More than 70% presented obesity, while 60% had hypoalbuminemia. The basal/inclusion Barthel index (BI) score was 69±31/58±34 (BI score<60 was present in 31.5%/44%, respectively); and the mean Pfeiffer score was 2.94±3.2 (43% answered with ≥3 errors). More than half of the subjects were at risk or already had established social problems. This emergent population is considerably homogeneous, highly complex, clinically vulnerable, functionally impaired, dependent on caregivers and socially fragile. They need to receive more attention in clinical research and more support in health interventions based on comprehensive attention and continuity of care.

[CAVIPRES questionnaire as a measurement of quality of life in patients with prostate cancer in Spain: Daily clinical practice application]. / Cuestionario Español de Calidad de Vida en Pacientes con Cáncer de Próstata como medida de la calidad de vida de los pacientes con cáncer de próstata en España: aplicación a la actividad diaria.

INTRODUCTION: Prostate cancer (PC) states as the most frequent tumor in elderly patients. Although no direct involvement in death-related, PC entails an important lost in patient's quality of life. There are several questionnaires adapted to Spanish in order to measure the health-related quality of life (HRQoL) in PC patients. OBJECTIVES: To describe the content and feasibility of the Spanish CAVIPRES questionnaire both in its short version to the clinical daily practice and also in the extended version to be used in the investigational protocols. MATERIALS AND METHODS: A detailed review of the different quality of life-related aspects of PC patients gathered in the questionnaire and a cross-comparison with other adapted HRQoL available is been performed. RESULTS: The HRQoL CAVIPRES questionnaire gathers information regarding social and partner support, psychological conditions of the patients, and also life expectancies against disease outcome together with classical symptomatic parameters as other available and adapted questionnaires. CONCLUSION: The CAVIPRES questionnaire in its short version is an adequate, feasible, valid, reliable and sensitive to change in the measurement of HRQoL in PC patients. The extended version is valid to be used in clinical research of PC patients. Both versions have been donated by Abbott to the Spanish Association of Urology (AEU) and are available at AEU web site (www.eau.es).

["Post micturition residual; urodynamic"]. / <>

OBJECTIVES: To study the possible correlation between the existence of postmicturition residual (PR), both in men as in women, with other urodynamic parameters. MATERIAL AND METHODS: A retrospective study in a series of 121 patients (33 male, 88 female), age X=68.22 and SD=12.904 (16-90 years), with a significative PR had been underwent a videourodynamic study. All cases of neurogenic vesicourethral dysfunctions and post pelvic radiotherapy were excluded. Statistical study was performed between the PR and the presence of urinary symptoms, urodynamic data, and findings of physical examination. The study was conducted, both descriptive and with statistical correlations. We used the Spearman Rho and compared with the median chi-square. RESULTS: We found a positive correlation (men and women), between the PR and bladder capacity (p=0.001) and between the PR free flowmetry and PR test pdet/flow (r=0.450 p=0.001). In women, a positive correlation was found between the PR and the urethral resistance (URA) (p=0.001), and between PR and voiding by abdominal pressure (p<0,05). We found a negative correlation in men between the PR and the parameters of detrusor contraction (W80-W20) (p<0.05). Not found statistically significant correlation between the PR and cystometry, nor with the urodynamic diagnosis of obstruction, associated radiological semiology, hyperactive bladder and emptying symptoms in men. CONCLUSIONS: The PR behaved more as a parameter measurement of detrusor contractility, than a parameter of the lower urinary tract obstruction. The PR was not associated with any clinic or associated radiologic semiology.

Immunomagnetic quantification of circulating tumoral cells in patients with prostate cancer: clinical and pathological correlation.

OBJECTIVES: To detect and enumerate circulating prostatic tumor cells (CTC) in the peripheral blood of patients with prostate cancer (PC) and study the relationship between CTCs and clinical-pathological parameters. METHODS: Prospective three-arm study: 26 patients (p) with localised PC (LPC); 24 P with metastatic PC (MPC) and 30 healthy volunteer controls. A single 7.5 ml sample of peripheral blood was retrieved; CTCs were isolated using an immunomagnetic method based on the CellSearch system (Veridex). CTCs were identified as nucleated cells negative for CD45 (leukocytes) and positive for cytokeratins. (8, 18 y 19) The relationship between CTC numbers and PSA levels, Gleason score and TNM classification was studied. RESULTS: Only 10% of the healthy controls had 1 CTC/7.5 mL, none of the patients with localised PC had more than 3 CTCs (88% < or = 2 CTCs), and patients with MPC had significantly higher CTC levels [m: 29 (1-178)] compared with the other two groups (P: 0.000). A positive correlation was demonstrated between the CTC count and PSA levels, tumor size, and presence or absence of enlarged lymph nodes. Gleason score was the only parameter that did not show any correlation with CTC levels, and although the number of CTCs was higher in patients with visceral metastases [m: 297 (0-416)] compared with bone metastases patients [m: 68 (9.5-168)] , these differences were not significant. CONCLUSIONS: Immunomagnetic analysis permits CTCs to be enumerated in peripheral blood and could be a possible way to correctly stage and make a reasonable prognosis of metastatic disease.

[Spontaneous extraperitoneal bladder perforation in an elderly patient with genitalia prolapse]. / Rotura vesical espontánea en paciente senil con prolapso genital.

There are many etiologic reasons which explain the bladder perforation. Bladder injuries happen most commonly in poli-traumatisms (traffic accident), blunt trauma, penetrating injury and iatrogenic injury (surgery, laparoscopic...). However, there is not always a vigorous, direct, extern and blunt agent causing the rupture. In the case reported the extraperitoneal bladder rupture started after a smooth perineal injury caused when the patient seated down. The patient already suffered from a cystocele III/IV plus uterine prolapse for a long time ago.