Small intestinal strangulation due to a primary internal paracecal hernia.

The discovery of a paracolic hernia is an unusual event, even for an experienced specialist in colorectal surgery. We report a case of a 59-year-old woman with no previous history of abdominal surgery, who presented to the Emergency Department complaining of episodic abdominal pain and distension accompanied by a palpable mass in the right lower quadrant. At laparotomy, a paracecal hernia with small bowel volvulation was found. The prime objective of this report is to draw the clinician's attention to the necessity of making a rapid diagnosis of internal hernias.

[Effect of Lactobacillus casei on the incidence of infectious conditions in children]. / Efecto de Lactobacillus casei sobre la incidencia de procesos infeeciosos en niñios/as.

AIM: To analyse the effect of continuous consumption of Lactobacillus casei (DN-114001) fermented milk on the incidence of the infectious disorders frequent in children. FIELD: Infant and child population SUBJECTS: children from 3 to 12 years from two schools in Barcelona. A total of 251 children from both sexes participated in the study. INTERVENTIONS: A nutritional intervention study was carried out during 20 weeks with a parallel, prospective, double-blind and randomised by pragmatic clusters design. Participants were children from 3 to 12 years from two schools in Barcelona. One of the centres was assigned to receive two daily units of Actimel" and the other to two units of Placebo. From the 251 participants, 109 receiving placebo and 142 receiving Actimel". Basal demographic characteristics and clinical history data were recorded, and the symptoms related to infectious disorders or other illnesses were monitored at weeks 12, 16 and 20. The analysis of the data was carried out on the intention-to-treat (ITT) population, being the principal endpoint the duration of respiratory and gastrointestinal symptoms. RESULTS: A one day difference, but non-significant, was seen in the median of total duration of days with illness through the study (Actimel group: 1 day vs Placebo group: 2 days). The same nonsignificant difference was also seen in the duration of days with respiratory (high and low respiratory tract infections) and with gastrointestinal (diarrhoea, vomiting, stomach pain and constipation) disorders. There was a statistical significantly difference found in favour of Actimel in the duration of the low respiratory tract infections, bronchitis or pneumonia, and in the duration of fatigue. There was also detected a lower incidence of children with low respiratory tract infections (32% vs. 49%) and with fatigue (3% vs. 13%) in the Actimel group compared to placebo. The satisfaction levels with the nutritional intervention were very high, over 80%. CONCLUSIONS: The study shows a tendency to the reduction of duration and incidence of some infectious disorders in those children receiving two daily Actimel during 20 weeks.

Clinical behaviour of prostatic specific antigen and prostatic acid phosphatase: a comparative study.

We assayed prostatic specific antigen (PSA) and prostatic acid phosphatase (PAP) serum levels in 1383 patients using a double antibody radioimmunoassay (RIA) I125. Establishing the upper normal limit in 10 ng/ml PSA and 2.5 ng/ml for PAP, the false positive results were only 1.9 and 5.1 percent in men with non-prostatic benign or malignant pathology and respectively 0 and 2.2 percent in women. We detected false positive levels for these two tumoral markers in 3.5 and 4.7 percent of patients with non-complicated benign prostatic hypertrophy, 64.8 and 19.2 percent in complicated benign prostatic hypertrophy, 24 and 16 percent in acute prostatitis and 3.3 percent in chronic prostatitis. The sensitivity in patients with prostate cancer was 87.2 percent for PSA and 64.1 percent for PAP, and there was a better correlation with PSA than PAP for tumoral spread and histological grading. Finally, clinical efficacy was higher with PSA and was no better when both markers were assayed.

[Complete hormonal blockade vs. monotherapy in the management of metastasizing prostatic cancer]. / Bloqueo hormonal completo versus monoterapia en el tratamiento del cáncer de próstata metastásico.

Evaluation of results obtained in 70 hormone-treated patients with disseminated prostate cancer. Thirty-six of them were treated via orchiectomy and 34 received also flutamide. Initial objective response rates were 47% in the monotherapy group versus 58% for those undergoing complete blockade. Decrease of PSA and PAP was also higher in the group given flutamide. Nonetheless, no significant changes were observed with regard to biological and clinical progression or patients survival.

[Value of prostate-specific antigen as prognostic factor of metastatic cancer of the prostate]. / Valor del antígeno prostático específico como factor pronóstico del cáncer de próstata metástasico.

This paper examines the behaviour of PSA in 70 patients with metastatic prostate cancer. PSA serum concentration, prior to therapy, was directly related to the tumoral mass and inversely related to the histological degree, which does not constitute a prognostic factor with regard to the disease evolution. Within 3 months of therapy, PSA concentration decreased more noticeably in clinically responding patients, down to less than 10 ng/ml in 93% of them. Also, this level represented a prognostic factor with regard to the free-of-progression interval of the disease.

[Medical treatment of benign prostatic hyperplasia in patients with high surgical risk]. / Tratamiento médico de la hiperplasia prostática benigna en pacientes con alto riesgo quirúrgico.

Eight patients with prostate adenoma and high surgical risk were given leuprolide in depot. Prostate volume decreased by 44.7% after 3 months of treatment and by 58.9% at six months. Two of the 7 patients were resident vesical catheter carriers, 28% re-started spontaneous miction.

[PSA in women. Evaluation of its determination with polyclonal and monoclonal immunoassay]. / El PSA en mujeres. Evaluación de su dosificación mediante inmunoanálisis policlonal y monoclonal.

PSA concentrations were measured in 421 women. In a first group comprising 309 subjects, the assay was carried out with kits containing polyclonal antibodies (PPSA). In the second group with 112 women, the assays used kits containing polyclonal antibodies (PPSA) and kits containing monoclonal antibodies (MPSA), and results obtained with both assays were compared. In the first group PSA levels higher than 0.4 ng/ml were detected in 47.9%. In the second group concentrations higher than 0.4 ng/ml were detected in 52.7% when using PPSA versus 16.7% when using MPSA. The rate of PSA detectable levels in healthy women, with benignant and malignant conditions was 36.7, 42.1 and 84.4% for PPSA, and 16.7, 14.0 and 21.9 for MPSA. This study shows that it is possible to detect PSA levels in women, and that this is more frequent when using a polyclonal antibodies assay.

[Does transurethral resection cause metastatic dissemination of hormone treated prostatic cancer?]. / Produce la RTU diseminación metastásica en el cáncer de próstata tratado hormonalmente?

The evolution of non-metastatic prostate cancer treated with hormonal therapy does not appear to be affected by the performance of a transurethral resection (TUR) as a measure to expedite the common urinary tract. Of 82 patients followed for an interval ranging from 6 months to 15 years, 3 of 45 patients (6.7%) undergoing RUT experienced metastatic dissemination, while the same happened in 2 of 37 (5.4%) patients who did not undergo RUT, p being NS. The group of patients requiring RUT, however, experienced higher local progression rates, 22.2% vs 5.4%, a situation not ascribable to the RUT procedure but to the fact that such surgery was selectively indicated in neoplasias with larger tumoral mass.

[Impact of specific prostatic antigen on the rationalization of the use of bone gammagraphies in the follow-up of hormone-treated non- metastatic prostatic cancer]. / Impacto del antígeno prostático específico en la racionalización del consumo de gammagrafías oseas en el seguimiento del cancer de próstata no metástasico tratado hormonalmente.

Analysis of the evolution of 78 patients with hormonally-treated non-metastatic prostate cancer. During an average follow-up of 62.3 months, local clinical and metastatic progression in 14.1% and 7.7% cases, respectively, was observed. Overall, PSA detected progression of disease in 94.1% cases, with an anticipation which range between 4 and 52 months. Evidence of bone metastatic progression was confirmed in 2.1% of the 286 scintigraphies performed. Following analysis of results, by accepting their indication from a PSA level higher than 100 ng/ml, 97.9% would have been avoided, achieving a 100% sensitivity and 94.1% diagnostic efficacy.

[Extragonadal germ-cell tumors located in the mediastinum]. / Tumores de células germinales extragonadales de localización mediastínica.

INTRODUCTION: The extragonadal germ-cell tumors (EGGCT) represent 5% of all germ-cell tumors at presentation. Histologically, they are identical to testis germ cell tumors. They may arise in such sites as the mediastinum, retroperitoneal area, sacrococcygeal area, or pineal area without a primary in the testis. MATERIAL AND METHODS: The medical records of 10 patients with mediastinal EGGCT were reviewed between 1973 and 1996. All patients were males and his mean age was 26.7 years old (21-24). Follow-up was 19 months (3-72). RESULTS: The first symptoms are diverse. The histology results nonseminomatous tumor at 9 patients and seminomatous tumor at the restant. All of the scrotal examination was normal and only five patients presented increased tumoral markers (alpha-FP in 4 and beta-HCG in 1). Previous at 1990 didn't exist a standard treatment, resulting the four patients treated in this period exitus. After 1990 the treatment was cisplatin-based chemotherapy: BEP (bleomicyn, etoposide-VP-16- and cisplatin-CDDP) then we obtained the best results, a patient died after 6 months but the restants five are alive and without evidence of disease during a follow-up between 3 and 72 months.

[Analysis of free PSA percentage predicting potential surgical failure in patients treated with radical prostatectomy]. / Análisis del porcentaje de PSA libre en la predicción del fallo quirúrgico potencial en pacientes sometidos a prostatectomía radical.

OBJECTIVE: To analyze if free PSA percentage can help to predict a potential surgical failure (PSF) in patients undergoing radical prostatectomy. MATERIAL AND METHODS: Analysis of serum PSA concentration and free PSA percentage in 92 patients undergoing retropubic radical prostatectomy. In 38 cases, the carcinoma was organ-confined, 26 had capsule penetration, 20 had positive margins, 6 seminal vesicle invasion and 2 lymph nodes. PSF was demonstrated in 28 patients (30.4%) and in 64 (69.6%) the carcinoma was organ-confined. RESULTS: No significant relationship was found between PSA serum concentration or free PSA percentage to the pathological stage. The logistic regression analysis where the clinical status, Gleason sum, and free PSA percentage were included as predictive variables, showed that the latter was the only factor with capacity for PSF prediction. Over all, the probability of a carcinoma being confined in the surgical specimen when percentage of free PSA was greater than 10 was 83.8% and 60% when it was lower or equal, p < 0.03. However, the distribution was only significant when PSA concentration ranged between 4.1 and 10 ng/mL, p < 0.008. In this range of PSA, the relative risk of PSF was 5.5 (95% CI 1.4-21.8) when free PSA percentage was equal or lower than 10, the probability being 50% versus 9.1% when it was greater than 10. CONCLUSIONS: Free PSA percentage can help to predict PSF. PSA serum concentration lower than 10 ng/mL and free PSA percentage greater than 10 allows to detect a subgroup of patients with good prognosis and with less than 10% probability of having positive margins, seminal vesicles invasion or lymph nodes.