PREVALENCE OF FATIGUE AND IMPACT ON QUALITY OF LIFE IN CASTRATION-RESISTANT PROSTATE CANCER PATIENTS: the VITAL study.

BACKGROUND: Fatigue is one of the most prevalent symptoms among cancer patients. Specifically, in metastatic castration-resistant prostate cancer (mCRPC) patients, fatigue is the most common adverse event associated with current treatments. The purpose of this study is to describe the prevalence of fatigue and its impact on quality of life (QoL) in patients with CRPC in routine clinical practice. METHODS: This was a cross-sectional, multicentre study. Male chemo-naïve adults with high-risk non-metastatic (M0) CRPC and metastatic (M1) CRPC (mCRPC) were eligible. Fatigue was measured using the Brief Fatigue Inventory (BFI) and QoL was assessed using the Functional Assessment of Cancer Therapy questionnaire for patients with prostate cancer (FACT-P) and the FACT-General (FACT-G) questionnaire. Data were analysed using Mann-Whitney or Kruskal-Wallis tests (non-parametric distribution), a T-test or an ANOVA (parametric distribution) and the Fisher or chi-squared tests (categorical variables). RESULTS: A total of 235 eligible patients were included in the study (74 [31.5%] with M0; and 161 [68.5%] with M1). Fatigue was present in 74%, with 38.5% of patients reporting moderate-to-severe fatigue. Mean FACT-G and FACT-P overall scores were 77.6 ± 16.3 and 108.7 ± 21.4, respectively, with no differences between the CRPC M0 and CRPC M1 subgroups. Fatigue intensity was associated with decreased FACT-G/P scores, with no differences between groups. Among 151 mCRPC patients with available treatment data, those treated with abiraterone-prednisone ≥3 months showed a significant reduction in fatigue intensity (p = 0.043) and interference (p = 0.04) compared to those on traditional hormone therapy (HT). Patients on abiraterone-prednisone ≥3 months showed significantly better FACT-G/P scores than patients on HT (p = 0.046 and 0.018, respectively). CONCLUSION: Our data show a high prevalence and intensity of fatigue and its impact on QoL in chemo-naïve CRPC patients. There is an association between greater fatigue and less QoL, irrespective of the presence or absence of metastasis. Chemo-naïve mCRPC patients receiving more than 3 months of abiraterone acetate plus prednisone showed an improvement of fatigue and QoL when compared to those on traditional HT. TRIAL REGISTRATION: Not applicable since it is not an interventional study.

Management of patients with localized prostate cancer and biochemical recurrence in Spain: A medical survey.

INTRODUCTION: The management of patients with prostate cancer (PCa) is established in clinical practice guidelines, which are based on randomized studies according to the level of evidence. In Spain, the degree of compliance with these guidelines in clinical practice is unknown. OBJECTIVES: To describe the profiles of PCa patients at the time of diagnosis and the management of patients with localized PCa and those with BCR in Spain. MATERIALS & METHODS: A medical survey was conducted in specialized care (85 urologists [UROs], 64 radiation oncologists [ROs], and 21 medical oncologists [MOs]). Three questionnaires were developed for this study with 22 (UROs and ROs) or 21 questions (MOs). RESULTS: The annual incidence of PCa was 24,057 in participating hospitals (N = 131). The extrapolated annual incidence in Spain is 40,531 cases. The estimated prevalence of PCa in Spain is 221,689. Of note, 79% and 80% of patients seen by UROs and ROs, respectively had localized PCa at diagnosis. Biopsy was the most used diagnostic test among the three specialties, followed by abdominopelvic computer tomography. More than 90% of patients with BCR underwent standard tests. Next generation imaging tests and PET-choline/PSMA are still used residually. Most patients with localized PCa are currently treated with either surgery or radiotherapy, while for BCR patients, UROs and ROs prefer radiotherapy and MOs androgen deprivation therapy alone or in combination. CONCLUSION: This study describes patient profiles at the time of diagnosis and provides an overview of the current therapeutic management of localized PCa and BCR in clinical practice in Spain.

Clinical drivers for imaging testing in non-metastatic castration-resistant prostate cancer in clinical practice: Results of the IDENTIFICA study. / Factores clínicos determinantes para la realización de pruebas de imagen en cáncer de próstata resistente a la castración no metastásico en la práctica clínica: resultados del estudio IDENTIFICA.

INTRODUCTION: The aim of the study was to describe the clinical drivers that lead physicians to perform imaging tests in search of metastasis in non-metastasic castration prostate resistant cancer (nmCRPC) patients. METHODS: Observational, cross-sectional study conducted at the Departments of Urology of 38 Spanish hospitals. The study included 188 patients diagnosed with nmCRPC who underwent an imaging test for the assessment of metástasis. In one study visit, physicians were requested to specify the clinical factors that led them to perform these tests. The results of the imaging tests and the clinical characteristics of the patients since the time of prostate cancer (PC) diagnosis, were reported. Regression analyses were used to determine predictors of imaging test results. RESULTS: Prostate-specific antigen (PSA) level was the most important driver to order imaging tests (57.1%), followed by regular follow-up (16.5%) and PSA doubling time (PSADT) (12.0%). Although these drivers were not associated to detection of metastasis, patients with PSA levels ≥20 ng/mL had a greater risk of metastasis than patients with PSA levels <4ng/mL (P=.004) and CRPC patients diagnosed with metastasis (mCRPC) had higher median PSA levels (20.9; interquartile range [IQR]: 6.7-38.6) than nmCRPC (9.1; IQR: 5.0-18.0) (P=.005). Sixty-six percent of the patients did not undergo any imaging test after CRPC diagnosis until the study visit (10.6, IQR: 4.0-19.5 months). Curative-intent treatment at PC diagnosis and Gleason score predicted longer time from PC to CRPC diagnosis. CONCLUSIONS: Physicians based their decisions to order imaging tests for metastasis detection in nmCRPC patients mainly on PSA and PSA kinetics, including the regular follow-up stated by guideline recommendations.

Unnecessary overuse. Study of "inadvisable practices" for patients with atrial fibrillation. / Sobreutilización innecesaria. Estudio de los «no hacer¼ en pacientes con fibrilación auricular.

OBJECTIVE: To identify overuse (diagnostic, therapeutic and self-care practices that represent risks that outweigh the potential benefits) in patients with atrial fibrillation. METHOD: The study was based on qualitative research techniques. Using the "Metaplan" technique, we identified and ordered potentially inappropriate, ineffective and inefficient practices. By means of a consensus conference, we then established a number of "inadvisable practice" measures (relatively common practices that should be eliminated based on the scientific evidence or clinical experience). Professionals from the specialties of cardiology, haematology, neurology, internal medicine, family medicine and nursing participated in the consensus. RESULTS: We developed a catalogue of 19 "inadvisable practices" related to the diagnosis, treatment and care of anticoagulated patients that were inappropriate, had questionable effectiveness or were ineffective, as well as 13 beliefs or behaviours for anticoagulated patients that could result in injury or were useless or inefficient. CONCLUSION: The "inadvisable practices" approach helps identify practices that represent greater risks than benefits for patients. It seems appropriate to include algorithms in the clinical decision-making support systems that consider this information for the diagnosis, treatment and for home care. For this last case, recommendations have also been prepared that define specific contents for the healthcare education of these patients.

Management of pediatric acute hypoxemic respiratory insufficiency with bilevel positive pressure (BiPAP) nasal mask ventilation.

OBJECTIVES: To evaluate the efficacy and complications of noninvasive nasal mask bilevel continuous positive airway pressure ventilation in pediatric patients with hypoxemic respiratory insufficiency. DESIGN: Retrospective chart review. SETTING: Intensive care unit, university affiliated tertiary care children's hospital. PATIENTS AND METHODS: The study reviewed all patients admitted to the pediatric ICU with acute hypoxemic respiratory insufficiency who received bilevel noninvasive continuous nasal mask positive airway pressure delivered by a bilevel positive airway pressure system (BiPAP; Respironics Inc; Murrysville, Pa). RESULTS: Bilevel nasal mask positive pressure ventilation was utilized in 28 patients. Median patient age was 8 years (range, 4 to 204 months). The most common primary diagnosis was pneumonia. Nine patients demonstrated severe underlying neurologic disease or immunocompromise. Median duration of nasal mask ventilation was 72 h (range, 20 to 840 h). Clinical and laboratory variables immediately prior to bilevel nasal mask positive airway pressure and approximately 1 h after institution were evaluated. Respiratory rate decreased significantly with nasal mask ventilation (45 +/- 18 breaths per minute to 33 +/- 11, mean +/- SD, p < 0.001). Arterial blood gas PaO2 (71 +/- 13 mm Hg to 115 +/- 55), PaCO2, pulse oximetry saturation, and pH all improved significantly (p < 0.01). Using standard estimates for inspired oxygen, calculated alveolar-arterial gradients (271 +/- 157 to 117 +/- 65, p = 0.001), and PaO2/FIo2 ratios (141 +/- 54 to 280 +/- 146, p < 0.001), both improved significantly with nasal mask ventilation. Only 3 of 28 patients required intubation or reintubation. CONCLUSIONS: We conclude that noninvasive nasal positive pressure mask ventilation can be safely and effectively used in pediatric patients to improve oxygenation in mild to moderate hypoxemic respiratory insufficiency. It may be particularly useful in patients whose underlying condition warrants avoidance of intubation.

Cluster of five children with acute encephalopathy associated with cat-scratch disease in south Florida.

Between August 12 and September 27, 1994, five children in South Florida were hospitalized at a single hospital because of encephalopathy, presenting as status epilepticus, associated with cat-scratch disease (CSD). Diagnoses were confirmed by using an indirect fluorescent antibody test to detect antibody to Bartonella henselae, the causative agent of CSD. These cases represent the first cluster of CSD encephalopathy cases to be recognized in the United States. The patients lived within 7 miles of each other and all reported contact with pet or stray cats before developing regional lymphadenopathy and encephalopathy. All recovered fully. A high proportion of 124 cats from the local area were seropositive (62%) or bacteremic (22%). This study suggests that B. henselae can be associated with geographically focal clusters of CSD encephalitis and should be considered in the evaluation of children with acute encephalopathy.

Cerebrovascular regulation and neonatal brain injury.

Neuropathology occurring as a result of hemodynamic injury occurs in up to 25% of preterm newborns of less than 1,500 gm birth weight and in a much smaller, but nonetheless meaningful, proportion of more mature infants. Abnormalities in cerebrovascular regulation have been proposed as major contributing factors to both ischemic and hemorrhagic injuries in the newborn brain. In this review we explore several factors that play a role in cerebrovascular regulation in the immature brain and relate them to what is known about vascular regulation in the mature brain and to the types of pathology that occur in the newborn brain. One goal in this "decade of the brain" should be to increase our basic and clinical knowledge about the cerebrovasculature of the newborn in order to enhance our ability to predict and prevent perinatal brain injury.

[Clinical and electronystagmographic manifestations in the elderly with vertigo]. / Manifestaciones clínicas y electronistagmográficas de los vértigos seniles.

The goal of the present work is to realize a review over the difference aspects of the alterations of the equilibrium and the vestibular system in the elderly patient. We also present a statistics about the symptomatology, the results of the vestibular tests and the diagnose, in a range of patients complaining of vertigo, aged over 65, studied in our ENT-Department.

[Herpetic pseudotumor laryngitis]. / Laringitis herpética pseudotumoral.

The goal of this paper is to report an interesting case of laryngeal involvement by herpes virus, showing a morphological aspect very alike to an extense neoplasm of this region. Laryngeal involvement of herpes virus is a clinical infrequent entity, but as its wide onset forms range from a banal laryngitis until a severe airway obstruction, hoarseness or dysphagia, it seems mandatory an accurate differential diagnose to settle a treatment and the effective follow-up.

[Tumoral collision: cancer metastases within a second neoplasm]. / Colisión tumoral. (Metástasis de cáncer en una segunda neoplasia).

A case report of epithelial carcinoma of the inferior lip which spread in cervical lymph nodes previously affected by a chronic lymphocitic leukaemia, is presented. The coexistence of both histological findings in some of the nodes (collision tumor) is remarked. We have made a review of the scanty literature about metastases on second tumors and compared and commented those features.

[Warthin's tumor and epidermoid carcinoma of the larynx. Apropos of a case]. / Tumor de Warthin y carcinoma epidermoide de laringe. A propósito de un caso.

The general belief is that primitive multiple growths either in the aero-digestive pathways or elsewhere are increasing events. In the paper is presented a clinical case of Carcinoma of the larynx with an homolateral submaxillary lump which was firstly taken as a metastatic adenopathy. At examination both macro- and microscopically show to be a lymphomatous papillary. Cystadenoma (Warthin's tumor). Comments about the sitting of those multiple tumors as well as the features of the Warthin's tumor.

[Bone metastasis as the first manifestation of follicular carcinoma of the thyroid gland. Apropos of 1 case]. / Metástasis ósea como primera manifestación de carcinoma folicular dtiroides. A propósito de un caso.

The first symptom in this case was an spastic paraplegia following a compressive metastasis of the spine sitting in the D8-9 after a follicular Carcinoma of the thyroid gland.

[Perilymph gush. A complication of stapedectomy]. / Chorro de perilinfa. Complicación de la estapedectomía.

Report of an unusual complication of stapes surgery, called "perilymph gush", resolved with improved hearing and no vertigo.

[Pneumocephalus as a complication of mastoid surgery]. / Neumoencéfalo como complicación de cirugía de la mastoides.

Non-traumatic otologic diseases are a rare cause of Pneumocephalus. Among them few reports have been published whereas it presented following oto-surgery. The AA. communicate one of those events in a patient who presented with CSF-otorrhea, headache and disorientation after recent radical mastoidectomy. The definitive diagnosis was done by CT-scan imaging. Survey of the scarce literature on the subject, description of the clinical and diagnostic features, its possible physiopathology and surgical management.

[Pleomorphic adenoma of the palate]. / Adenoma pleomorfo del velo del paladar.

Furthermore major salivary glands salivary tissue is localized in minor salivary glands. The AA. present a case of pleomorphic adenoma arising in soft palate.

[Otolaryngological complaints in tongue amyloidosis: a case report]. / Manifestaciones otorrinolaringológicas de la amiloidosis. A propósito de un caso de localización lingual.

We present a case of Amyloidosis of the oral cavity associated to multiple mieloma, with otolaryngological symptom. Review of structural characterization of the disease, its pathogenesis and clinical disorders when displayed in thyroid, oral cavity and upper respiratory tract.

[Symptomatic malformations of the first branchial arch]. / Malformación del primer arco branquial sintomática.

Congenital malformations of the branchial arches are not infrequent. Among them first branchial cleft anomalies are common and they are to remain asymptomatic. The case reported is one of symptomatic fistula auris, which at the beginning led us to the initial diagnosis of an orbital cellulitis, secondary to ethmoidal sinusitis. We have made a review of the literature dealing with these anomalies and we expose in the paper an update perusal of the clinical features and the management of this rare complication.

[Brown tumor of the maxilla as initial manifestation of primary hyperparathyroidism]. / Tumor pardo del maxilar como manifestacion inicial de hiperparatiroidismo primario.

The paper reports the case of a maxillary brown tumor as early sign of primary hyperparathyroidism. Brown tumors are very unusual growths in daily ENT practice and an odd start of primary hyperparathyroidism. The AA. emphasize the importance of a correct differential diagnosis, especially with those tumors showing multinucleated giant cells (osteoclast type)--such as true giant cells tumor and central giant granuloma--prior to its management. They also comment on the interesting contribution to diagnosis by imagery brought by CT scan, magnetic resonance (MR), ultrasonography (echography) and digital subtraction gammagraphy to attain the topographic site of the parathyroid tumor.

[Oropharyngeal vascular lesions]. / Lesiones vasculares orofaríngeas.

In this paper a case report of a tonsillar cavernous Hemangioma is presented. A review of the literature about oropharyngeal vascular lesions is done and their diagnosis, classification and its treatment is discussed.