From Lauren's diffuse gastric cancer to WHO's poorly cohesive carcinoma. Clinicopathological and prognostic characteristics.

INTRODUCTION: since Lauren classified gastric cancer into intestinal-type adenocarcinoma and diffuse gastric carcinoma back in 1965, countless categorizations have been published that attempt to elucidate the clinicopathological and prognostic differences between histological subtypes. OBJECTIVE: a retrospective study was performed of gastric cancer cases managed in a third-level site over ten years in order to compare subtypes between the most widely used classifications (Lauren and World Health Organization [WHO]). METHODS: a comparative study of the most relevant clinicopathological characteristics and a multivariate survival analysis were performed. RESULTS: significant differences exist between histological subtypes in terms of age, gender, location, extension, stage and treatment received. A univariate overall survival analysis revealed better survival rates for intestinal-type adenocarcinoma as compared to diffuse carcinoma (hazard ratio [HR]: 1.405 [1.024-1.927]) according to the Lauren's classification. Furthermore, there was a better prognosis of mucinous carcinoma (HR: 0.378 [0.164-0.868]), though failing to prove a poorer prognosis of poorly cohesive (HR: 1.242 [0.878-1.757]) and signet cell (HR: 1.354 [0.792-2.314]) carcinomas, according to the WHO classification. In the multivariate overall survival analysis, the following poor prognosis factors were identified: male gender, local infiltration (T), nodal invasion (N) and received adjuvant therapy. CONCLUSION: although the various histological subtypes show significant clinicopathological differences, further studies are needed to compare them and clarify the prognostic relevance of each one.

Pelvic hemangiopericytoma. An unusual location of a vascular tumor.

BACKGROUND: The hemangiopericytoma is an uncommon vascular tumour. We report a case of interest because of its rarity, size and location. CASE REPORT: We present the case of a 63-year-old woman who consulted for abdominal pain. TAC, MRI and arteriography showed a pelvic mass occupying Douglas' space, displacing the uterus, bladder and sigma, with vascularisation relative to the inferior mesenteric artery and both hypogastric arteries. The vascularity of the tumour itself was selectively embolised before the mass was resected. There were no intra- or postoperative complications. Pathology confirmed the diagnosis of hemangiopericitoma. The patient is being monitored as an outpatient, with no signs of recurrence to date. DISCUSSION: The hemangiopericytoma is a tumour of the pericyte cells so it can occur in any location. The pelvic location is exceptional. The tumour may appear as nonspecific abdominal pain, show signs of compression of adjacent organs or occasionally be associated with paraneoplastic syndromes. The diagnosis is suspected via CT and angiography findings, but confirmation is only made by analysing the surgical specimen. The treatment of choice is surgery, in some cases after preoperative embolisation of the vascularisation of the mass. There is no agreement on chemo/radiotherapy as the primary treatment for hemangiopericytoma, although adjuvant radiation therapy has been found to improve local control and reduce recurrences. The prognosis is good if complete resection is achieved, with five- and 10-year survival rates between 70 and 80%, depending on the series.

[Diagnostics upon hospital release of immigrants in the city of Valencia, Spain (2001-2002)]. / Diagnósticos al alta hospitalaria de las personas inmigrantes en la ciudad de Valencia (2001-2002).

BACKGROUND: Immigration has increased remarkably in Spain over the past ten years. For theoretical reasons, the question has been raised as to whether this population may possibly be responsible for a rise in the incidence and/or transmission of infectious diseases. However, very few studies have been conducted regarding the diseases among this group which would afford the possibility of ascertaining the importance of this statement. This study is aimed at quantifying the hospital care provided to this population in the city of Valencia. METHODS: The hospital release records were obtained from the Admissions Departments of the public hospitals in the city of Valencia. A one-year retrospective observational study was conducted throughout the October 1, 2001-September 30, 2002 period. RESULTS: We retrieved 8,444 hospital admissions identifying 1,577 hospital admissions of immigrants. Similar percentages of immigrants recorded with their documentation in proper order (841; 51.16%) and immigrants supposedly undocumented (803; 48.84%) were found. Females (68.3%) were predominant over males (31.7%), and a mean age of under 30 years of age. The most frequent diagnosis on release was "pregnancy, childbirth and post-partum-related complications", totaling 37.7% of all releases, others involving, "injuries and poisoning" (12.9%), "digestive tract diseases" (7.8%) and "respiratory tract diseases" (5.4%), "Infectious and parasitic diseases" totaled 4.4%. CONCLUSIONS: The percentage of infectious and infectious-contagious diseases found did not contribute to encouraging the opinions disseminated regarding the importing or re-emergence of diseases from the immigrant groups. The en masse immigration which has taken place requires many adaptations of the Healthcare System to afford the possibility of setting out the health profile for this group based on population estimates.

Migración de clip al coledoco tras colecistectomía laparoscópica / Migration of a clip to the common bile duct after laparoscopic cholecystectomy

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Hemangiopericitoma pélvico. Una localización infrecuente de tumor vascular / Pelvic hemangiopericytoma. An unusual location of a vascular tumor

Introducción: el hemangiopericitoma es una neoplasia infrecuente de estirpe vascular. Presentamos un caso clínico de interés dada su escasa frecuencia, tamaño y localización. Caso clínico: se trata de una mujer de 63 años que consultó por dolor abdominal. Se realizaron TAC, RMN abdominal y arteriografía que mostraban una gran masa pélvica que ocupaba el espacio de Douglas y desplazaba útero, vejiga y sigma y presentaba vascularización dependiente de la arteria mesentérica interior y ambas arterias hipogástricas. Se embolizó selectivamente la vascularización propia de la neoplasia y seguidamente se resecó la masa, sin presentarse complicaciones ni intra ni postoperatorias. La anatomía patológica confirmó el diagnóstico de hemangiopericitoma. La paciente sigue controles en consultas externas sin signos de recidiva hasta la fecha. Discusión: el hemangiopericitoma procede de las células del pericito por lo que puede presentarse en cualquier localización. La localización pélvica es excepcional. Puede presentarse como dolor abdominal inespecífico, dar síntomas de compresión de órganos vecinos y, ocasionalmente, asociarse a síndromes paraneoplásicos. El diagnóstico de sospecha es mediante TAC y angiografía aunque la confirmación es histológica tras analizar la pieza de resección. El tratamiento de elección es quirúrgico, precediéndose en algunos casos de embolización preoperatoria de la vascularización de la masa. No hay acuerdo sobre la quimio/radioterapia como tratamiento primario del hemangiopericitoma, aunque se ha descrito la radioterapia adyuvante para mejorar del control local y disminuir las recurrencias. El pronóstico es bueno si se consigue una resección completa, con supervivencias a 5 y 10 años entre el 70 y el 80% según las series (AU)

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Carcinoma escamoso de ano en enfermedad de Crohn perianal severa de larga evolución / Anal squamous cell carcinoma in chronic severe perianal Crohn's disease

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Standardization of discharge reports with the ISO 13606 norm.

The International Organization for Standardization (ISO) has recently approved a new standard for the communication and semantic interoperability of electronic health record extracts. This standard is based on a dual model architecture, where a simple and generic reference model is defined for the representation of data and an archetype model is used for the representation of complex domain concepts of the electronic health record. By using this standard and a tool called LinkEHR-Ed, we have defined different types of hospital discharge reports in the form of archetypes and then we have normalized automatically discharge reports instances in a real environment following those archetype definitions. This work proves that it is possible to standardize legacy data automatically and enrich them with a semantic information layer by using archetypes as an integration and standardization mechanism.

Non-invasive lightweight integration engine for building EHR from autonomous distributed systems.

In this paper we describe Pangea-LE, a message-oriented lightweight data integration engine that allows homogeneous and concurrent access to clinical information from disperse and heterogeneous data sources. The engine extracts the information and passes it to the requesting client applications in a flexible XML format. The XML response message can be formatted on demand by appropriate Extensible Stylesheet Language (XSL) transformations in order to meet the needs of client applications. We also present a real deployment in a hospital where Pangea-LE collects and generates an XML view of all the available patient clinical information. The information is presented to healthcare professionals in an Electronic Health Record (EHR) viewer Web application with patient search and EHR browsing capabilities. Implantation in a real setting has been a success due to the non-invasive nature of Pangea-LE which respects the existing information systems.

Grupos relacionados por el diagnóstico: patrones de comparación intrahospitalaria entre servicios / Diagnosis-related groups: patterns of intrahospital comparisons among SERVICES

Objetivo: Realizar un análisis comparativo de los servicios de medicina interna, geriatría, cardiología, neumología y neurología que tratan una misma patología, utilizando los grupos relacionados con el diagnóstico (GRD), y analizar las diferencias de facturar los costes por estancias o por GRD. Material y método: Seleccionamos algunas patologías que constituyeron una causa importante de morbilidad durante el año 2000.Comparamos la actividad realizada con un estándar, valorando la eficiencia en la gestión de camas, la calidad de los datos, la calidad asistencial y el análisis de los costes. Resultados: El mayor impacto en el consumo excesivo de estancias fue para cardiología, con más del 10 por ciento de casos extremos. La historia clínica fue algo superior al informe de alta en la exhaustividad de la información. En la valoración económica de la actividad asistencial, las ganancias fueron negativas en geriatría para el GRD 15, si la forma de pago era en función del coste por estancia en lugar de por GRD. Conclusiones: El factor impacto es un indicador inadecuado para analizar el funcionamiento de un servicio, ya que no tiene en cuenta las diferencias de casuística. Los casos extremos, por su repercusión negativa en la estancia, en la calidad asistencial y en los costes, son susceptibles de un análisis sistemático de los posibles factores implicados. La mayor exhaustividad de la información de la historia clínica permite expresar mejor la complejidad de la casuística y clasificar los procesos en GRD más adecuados. El modelo de evaluación de costes es vital para la valoración económica de la actividad asistencial (AU)