Epidemiology, Treatment Patterns and Survival in Canadian Patients With Chronic Hepatitis B-Related Hepatocellular Carcinoma.

Chronic hepatitis B (CHB) is the leading cause of hepatocellular carcinoma (HCC) globally. We described and evaluated the outcomes of patients with CHB-HCC in Canada. In this retrospective cross-sectional cohort study, data were analysed from CHB mono-infected subjects seen between 1 January 2012 and 31 December 2022, and entered the Canadian Hepatitis B Network Registry. Descriptive analysis and chi-squared modelling were used to compare cohorts, followed by multivariable survival analysis regarding survival post-diagnosis. Statistical analyses were completed in R version 2.2. Of the 6711 patients with CHB who met inclusion criteria, 232 (3.5%) developed HCC. Compared with the CHB cohort, the majority of CHB-HCC cohort were male, SEA and HBeAg negative and born in endemic area (80% vs. 56%, 73% vs. 55%, 84% vs. 54%, 64% vs. 40% and all p < 0001). Overall, median HBV DNA level was log 2.54 (IQR: 0-4.04). Advanced liver disease, defined as minimum Fibrosis stage F3, was seen in 9.4% of overall cohort, but 92% of HCC cohort. At diagnosis, median tumour size was 2.5 cm (IQR: 1.7-4.0) and mean tumour number was 1.33 (SD: 1.33), with 81% of patients BCLC 0-A. Fifty-three per cent of patients were diagnosed with HCC as part of surveillance protocols. The survival rate after HCC diagnosis was 78.7%, during the median follow-up of 52.9 months (IQR: 17-90). In multivariable analysis, survival was significantly correlated with diagnosis through the screening programme. In this large cohort of patients with CHB-HCC, the majority of patients were detected with early-stage HCC and received treatment with curative intent, resulting in strong survival rates.

Therapeutic applications of germline testing for cancer predisposition genes in Asia in the real world.

BACKGROUND: Germline genetic testing is traditionally carried out in patients suspected with hereditary cancer syndrome for enhanced cancer surveillance and/or preventive strategies, but is increasingly carried out for therapeutic indications. MATERIALS AND METHODS: We conducted a retrospective review of patients who underwent germline genetic testing at our centre to determine the prevalence of actionable pathogenic germline variants (PGV) and their clinical utility. RESULTS: From 2000 to 2022, 1154 cancer patients underwent germline testing, with the majority (945/1154) tested with multi-gene panels. Four hundred and eleven (35.6%) patients harboured a PGV and 334 (81%) were clinically actionable. BRCA1/2 accounted for 62.3% of actionable mutations, followed by mismatch repair (18%), and other homologous recombination repair (HRR) genes (19.7%). One hundred and fifty-two germline-positive patients have advanced cancers, and 79 received germline-directed therapies (poly ADP ribose polymerase inhibitors = 75; immunotherapy = 4). Median duration of immunotherapy and poly ADP ribose polymerase were 20.5 months (range 5-40 months) and 8 months (range 1-76 months), respectively. Among BRCA/HRR mutation carriers who received platinum-based chemotherapy, pathological complete response rate in the neoadjuvant setting was 53% (n = 17 breast cancers) and objective response rate was >80% in the advanced setting (n = 71). CONCLUSIONS: One-third of cancer patients tested carried a PGV and ∼80% were clinically actionable. Three-quarters of germline-positive advanced cancer patients received germline-directed therapies in the real world, underscoring the practical utility of germline testing to guide cancer therapeutics.

Do athletic ECG changes predict athletic performance in Gurkha recruits?

INTRODUCTION: ECG changes are associated with regular long-term intensive exercise due to electrical manifestations of increased vagal tone, increased ventricular wall thickness and enlarged chamber size. The aim of this study was to further understand the relationship of athletic ECG changes and athletic performance in an athletic population. METHODS: A retrospective cohort study was performed in 195 Nepali civilian males undergoing selection to the Gurkhas. V̇O2max (maximal oxygen consumption) was estimated from a 1.5-mile run time using Cooper's formula and correlated with athletic ECG adaptations. Variables were explored with univariable and multivariable linear regression. RESULTS: The median number of athletic changes on ECG was 2 (IQR 1-2). There was no significant correlation (p=0.46) between the number of ECG adaptations and the degree of cardiovascular fitness by estimated V̇O2max (estV̇O2max). We found a negligible but significant correlation between the presence of inferior T wave inversion (TWI) and estV̇O2max (R2=0.03, p=0.02). The multivariable-fitted regression model was: estV̇O2max~Intercept+presence of RVH (right ventricular hypertrophy) voltage criteria+absence of sinus arrhythmia+T wave axis+inferior TWI. The overall regression was statistically significant: R2=0.10, F(df=4, df=189)=[5.4], p=0.0004). All variables in the multivariable model significantly predicted estV̇O2max (p<0.04). CONCLUSION: ECG changes of athleticism negligibly predict and differentiate athletic performance in our athletic population. The most predictive ECG markers being voltage criteria for left ventricular hypertrophy and RVH. Markers of increased vagal tone were not predictive. TWI, being a marker for disease, was also a marker for athletic performance in this cohort. The number of athletic ECG adaptations did not predict increased athletic performance.

The primary prevention of pancreatic fistula using a vascularised rectus abdominis muscle flap - A porcine model.

Background: A pancreatic fistula is one of the most devastating complications following a Whipple's procedure. Fistula rates remain high despite various modifications to surgical techniques. We propose the use of a vascularised muscle flap in the primary prevention of pancreatic fistulas. Method: A distal pancreatectomy was performed on 5 pigs in our porcine model. A pancreaticojejunal (PJ) anastomotic leak was simulated. The pigs were divided into treatment (4 pigs) and control groups (1 pig). A left pedicled rectus abdominis flap was wrapped around the PJ anastomosis for the treatment group and omitted for the control group. Serum and drain amylase levels were recorded. The PJ-rectus abdominis flap complex was evaluated histologically. Results: There was no biochemical evidence of anastomotic leak in the treatment group. The drain-serum amylase ratio was less than 1.5 in the treatment group (p=0.006). Microscopically, the muscle adjacent to the anastomotic leak showed mild necrotic changes with an affected muscle depth of less than 10%. Conclusion: The vascularised rectus abdominis muscle is a durable flap to withstand proteolytic pancreatic enzymes. It is able to provide a water-tight seal around the PJ anastomosis and mitigate intraperitoneal haemorrhage and infection caused by erosion from the pancreatic fistula.

Evaluation and 1-year follow-up of patients presenting at a Lyme borreliosis expertise centre: a prospective cohort study with validated questionnaires.

OBJECTIVES: To describe the course of symptoms reported by patients with symptoms attributed to Lyme borreliosis (LB) without being subsequently diagnosed with LB. METHODS: We performed a prospective cohort study with patients presenting at the outpatient clinic of two clinical LB centres. The primary outcome was the prevalence of persistent symptoms, which were defined as clinically relevant fatigue (CIS, subscale fatigue), pain (SF-36, subscale bodily pain), and cognitive impairment (CFQ) for ≥ 6 months and onset < 6 months over the first year of follow-up. Outcomes were compared with a longitudinal cohort of confirmed LB patients and a general population cohort. Prevalences were standardised to the distribution of pre-defined confounders in the confirmed LB cohort. RESULTS: Participants (n = 123) reported mostly fatigue, arthralgia, myalgia, and paraesthesia as symptoms. The primary outcome could be determined for 74.8% (92/123) of participants. The standardised prevalence of persistent symptoms in our participants was 58.6%, which was higher than in patients with confirmed LB at baseline (27.2%, p < 0.0001) and the population cohort (21.2%, p < 0.0001). Participants reported overall improvement of fatigue (p < 0.0001) and pain (p < 0.0001) but not for cognitive impairment (p = 0.062) during the follow-up, though symptom severity at the end of follow-up remained greater compared to confirmed LB patients (various comparisons p < 0.05). CONCLUSION: Patients with symptoms attributed to LB who present at clinical LB centres without physician-confirmed LB more often report persistent symptoms and report more severe symptoms compared to confirmed LB patients and a population cohort.

The role for intra-arterial chemotherapy for refractory retinoblastoma: a systematic review

Background Intra-arterial chemotherapy is a new retinoblastoma treatment associated with high rates of globe salvage that has been widely adopted for primary treatment of retinoblastoma but is less frequently used as secondary treatment for refractory retinoblastoma. This systematic review aims to summarize the reported outcomes of intra-arterial chemotherapy for refractory retinoblastoma. Methods We conducted a systematic review of studies published on PubMed, Medline, and Embase from 2011 to 2021 reporting globe salvage rates following intra-arterial chemotherapy for secondary treatment of refractory retinoblastoma. Results Our search yielded 316 studies, and 24 met inclusion criteria. The 24 included studies were comprised of 1366 patients and 1757 eyes. Among these, 1184 (67%) eyes received secondary indication treatment, and globe salvage was achieved for 776 of these 1184 eyes (64%). Sixteen studies reported cannulation success rates from 71.8 to 100%. Pooled analysis of subjects revealed 21 patients (2.6%) with metastatic disease and 26 deaths (3%) during study follow-up periods (7–74 months). The most common ocular complications were vitreous hemorrhage (13.2%), loss of eyelashes (12.7%), and periocular edema (10.5%). The most common systemic complications were nausea/vomiting (20.5%), neutropenia (14.1%), fever (8.2%), and bronchospasm (6.2%). Conclusions Intra-arterial chemotherapy is associated with high rates of globe salvage and low rates of serious complications in patients with refractory retinoblastoma. Unfortunately, current literature is predominantly comprised of retrospective case studies, and further high-quality evidence is necessary to inform clinical practice (AU)

Cáncer de próstata: ventajas e inconvenientes del cribado diagnóstico / Prostate cancer: Advantages and disadvantages of diagnostic screening

El cáncer de próstata (CaP) es la segunda neoplasia mas diagnosticada. En España corresponde a la tercera causa de cáncer en hombres (excluyendo los tumores de piel no melanoma). Aun así, la evidencia actual ha llevado a organismos internacionales a contraindicar su cribado por el poco beneficio que se puede generar en cuanto a mortalidad sopesando los riesgos que conlleva el diagnóstico y el tratamiento. El objetivo de este trabajo es una revisión bibliográfica sobre las potenciales ventajas e inconvenientes del cribado con PSA a partir del consenso basado en la evidencia científica publicada en la literatura. Para ello se realiza una revisión de la literatura examinando las recomendaciones del cribado con PSA de los diferentes organismos urológicos americano y europeo, evaluando los ensayos clínicos aleatorizados y no aleatorizados en los que se basan sus recomendaciones. Se examinaron los posibles beneficios en cuando a mortalidad, los riesgos y prejuicios condicionados al cribado y el tratamiento del cáncer de próstata. Estipulamos nuestra recomendación basada en la evidencia actual (AU)

Prostate cancer is the second most frequently diagnosed cancer. In Spain only is the third leading cause of cancer deaths, yet evidence has addressed some international associations to stand against PSA screening declaring that screening´s harms outweigh the benefits of such procedure. The objetive of this paper is searched the literature about potential benefits and harms that PSA screening can generate. We also stipulated a consensus based on the scientiphic evidence. We reviewed guideline publications from the European and American urological institutions about PSA screening recommendations. We examined both, randomized controlled and non-randomized trials in which its recommendations are based. We reviewed the possible advantages and benefits related to PSA screening and prostate cancer treatment stipulating our consensus based on the evidence (AU)

Divertículo vesical adquirido. Caso clínico / Acquired bladder diverticulum. A clinical case

El divertículo vesical (DV) puede ser congénito o adquirido. Consiste en una herniación de la mucosa vesical. Los adquiridos se deben a un mecanismo de hiperpresión endovesical generalmente en pacientes con obstrucción infravesical secundaria a hiperplasia benigna de próstata (HBP), patología del cuello vesical o uretral. Cuando los DV son sintomáticos o producen complicaciones se debe plantear tratamiento quirúrgico. En los últimos años la diverticulectomía laparoscópica ha presentado muy buenos resultados aunque la cirugía abierta está indicada en algunos casos más complejos. En DV adquiridos de tamaño pequeño y mediano está indicado el tratamiento transuretral. Se presenta un caso clínico y una revisión de diferentes aspectos diagnósticos y quirúrgicos del DV (AU)

The bladder diverticulum (DV) can be congenital or acquired. It consists of a herniation of the bladder mucosa. The acquired is due to a mechanism of intravesical hyperpressure usually in patients with bladder outlet obstruction secondary to BPH, cervical or urethral pathology. When DV are symptomatic or produce complications surgical treatment should be considered. In recent years laparoscopic diverticulectomy has shown very good results although open surgery is indicated in some more complex cases. In small and medium acquired DV transurethral treatment is indicated. One clinical case and a review of various diagnostic and surgical aspects of DV are presented (AU)

Principios físicos y aplicaciones quirúrgicas y urológicas del láser / Physical principles and surgical and urological applications of laser

El láser es una tecnología que se basa en la estimulación de fotones. Se consigue un haz de luz de gran potencia y alta precisión capaz de cortar y coagular, así como de destruir lesiones de todo tipo, incluidos los cálculos. Cada especialidad tiene sus indicaciones. En urología se utilizan para la ablación de la próstata con hiperplasia benigna (HBP) y de tumores de urotelio (superficiales) así como para destruir cálculos urinarios (litiasis). Se realiza una breve revisión de los principios del láser y su aplicación en algunas especialidades quirúrgicas (AU)

The laser is a technology based on the stimulation of photons, getting a beam of high power and high accuracy can cut and coagulate and destroy all kinds of tissues and stone. Each specialty has its indications. In urology is used to ablate benign hyperplasic prostate (BPH) and urothelial tumours (surface) as well as to destroy urinary calculi (stones). It is a brief review of the principles of the laser and its applications in some surgical specialties, particularly urology (AU)

Retención de orina en el embarazo y el postparto / Retention of urine in pregnancy and postpartum

La retención aguda de orina (RAO) durante el embarazo es un hecho poco frecuente que se observa en la práctica clínica habitual, por ello se comentan cinco casos documentados en nuestra Institución, revisando las características clínicas y actitud terapéutica empleada en cada uno de ellos, con la finalidad de establecer un protocolo de actuación frente a esta patología. Casos clínicos: Se describen cinco gestantes que presentaron retención aguda de orina en el periodo 2006-2012, cuya edad se encontraba entre los 27-38 años. En cuatro de ellos se presentó la retención de orina entre la décima tercera y décima quinta semana de gestación y en un caso la retención de orina se presentó en el puerperio. Discusión: La retención de orina en el embarazo y el puerperio se encuentra asociada a los cambios fisiopatológicos que se dan durante el mismo, siendo el útero en retroversión el factor mecánico más importante para el desarrollo de esta patología durante la gestación, mientras que en el puerperio, además de los cambios, el parto distócico parece ser el factor más importante para el desarrollo de la retención de orina. El manejo general consiste en la aplicación de maniobras descompresivas y cambios de hábito que permitan el vaciado adecuado vesical. En caso de fallar, el drenaje de orina mediante sondaje vesical intermitente o a permanencia son opciones factibles que pueden ser aplicadas conjuntamente con estudios y seguimiento urológico y ginecológico (AU)

Acute urinary retention of urine during pregnancy is a rare occurrence observed in clinical practice, discusses why five cases documented in our institution, reviewing the clinical and therapeutic approach used in each, in order to establish a protocol against this disease. Case reports: We describe five pregnant women who had acute retention of urine in the period 2006-2012, whose age was between 27-38 years old. In four of these patients developed urinary retention between the thirteenth and fifteenth week of gestation and in one case of urinary retention occurred in the postpartum period. Discussion: The retention of urine in pregnancy and the postpartum period is associated with pathophysiological changes that occur during the same, being retroverted uterus the most important mechanical factor for developing this disease during pregnancy, while the puerperium pathophysiological changes besides the dystocia seems to be the most important factor for the development of urine retention. The general operation involves the application of maneuvers allowing adequate bladder emptying. In case of failure, the urine drainage by intermittent catheterization or permanence is feasible options that can be applied in conjunction with a study and urological and gynecological follow (AU)

Coluria y pigmenturia / Choluria and pigmenturia

Orina oscura no siempre significa hematuria. Diversas situaciones clínicas y pigmentos orgánicos e inorgánicos pueden modificar el color amarillento pajizo de la orina normal. Conviene diferenciar a simple vista las diversas tonalidades cromáticas de la orina para no confundir las distintas situaciones clínicas que la provocan. La tirilla reactiva es la prueba inicial más eficaz para discriminar la hematuria de la hemoglobinuria/mioglobinuria, la bilirrubinuria y la coluria. En este trabajo se repasan las principales causas de orina oscura, coluria y pigmenturia (AU)

Dark urine does not always mean hematuria. Various clinical and organic and inorganic pigments can dye urine modifying the straw yellow color of normal urine. Should distinguish at a glance the various chromatic tones of urine in order not to confuse the different clinical situations that cause it. The dipstick test is the most effective initial test to discriminate hematuria and hemoglobinuria/myoglobinuria. This paper reviews the main causes of dark urine, choluria and pigmenturia (AU)

Insuficiencia renal tras nefroureterectomía por carcinoma urotelial del tracto urinario superior / Renal failure after nephroureterectomy due to urothelial carcinoma of the upper urinary tract

La posibilidad de desarrollar una insuficiencia renal crónica tras la nefroureterectomía por carcinoma urotelial del tracto urinario superior tiene algunos aspectos pendientes de estudio. A pesar de que el uso de quimioterapia adyuvante tras la nefroureterectomía no ha mostrado todavía un beneficio significativo, una de las contraindicaciones para su uso óptimo es la insuficiencia renal. El objetivo de este trabajo es identificar factores clínicos predictivos de insuficiencia renal crónica tras nefroureterectomía por carcinoma urotelial del tracto urinario superior (AU)

Possibility of developing chronic kidney insufficiency after nephroureterectomy for carcioma upper urinary tract urothelial has some aspects under study. Despite the uncertain value of adjuvant chemotherapy after radical nephroureterectomy, it is clear that impaired renal function represents a contraindication to its administration. The objective of this study was to identify predictive clinical factors for impaired renal function following RNU in patients with upper urinary tract urothelial cell carcinoma (AU)

Lesión en el colon como complicación de la nefrolitotomía percutánea / Injury to the colon as a complication of percutaneous nephrolithotomy

La cirugía percutánea es una opción quirúrgica efectiva y segura para el tratamiento de cálculos renales, tumores del sistema colector y para realizar endopielotomía anterógrada por síndrome de la unión pieloureteral. La lesión colónica yatrogénica es poco frecuente, pero puede tener consecuencias graves. El diagnóstico de la misma es habitualmente difícil, y las estrategias de tratamiento son controvertidas. Se presenta un caso de lesión de colon descendente durante una nefrolitotomía percutánea tratado con éxito aplicando medidas conservadoras (AU)

Percutaneous endoscopic renal surgery is usually a safe and effective treatment for patients with complex renal calculi, tumors of the collecting system, and ureteropelvic junction obstruction. A unique set of complications, however, can occur with this surgical approach that may involve the targeted kidney and surrounding structures. Iatrogenic colon injury is an uncommon but serious complication. Diagnosis is sometimes delayed, and treatment strategies are still controversial. We report a case of descending colon injury during percutaneous nefrolithotomy successfully treated using conservative measures (AU)

Fistula uretrorectal post prostatectomia radical: reparación vía perineal con interposición del músculo gracilis. Caso clinico / Post radical prostatectomy fistula: perineal repair with gracilis muscle interposition. Clinical case

Existen diversas técnicas quirúrgicas para la solución de las fístulas uretrorectales debidasa cirugía prostática. La plastia con interposición de músculo gracilis vía perineal es una técnica eficaz. Se presenta un caso clínico de fístula uretrorectal post prostatectomía radical y su resolución por vía perineal con músculo gracilis (AU)

There are several surgical techniques for the solution of uretrorectales fistulas due to prostate surgery. Plasty with gracilis muscle interposition perineal approach is an effective technique. We report a case of fistula uretrorectal post radical prostatectomy and perineal resolution with gracilis muscle (AU)

Quiluria. Presentación de un caso y revisión de la literatura / Chyluria. Case report and literature review

La quiluria, se deriva del paso anómalo de linfa al sistema urinario por fistulización. Su principal causa es la filariasis, una infección parasitaria causada en el 90% por el nemátodo Wuchereria bancrofti, aunque paralelamente existen diversas etiologías como enfermedades granulomatosas, infecciones, tumores o yatrogenia postquirúrgica. Su diagnóstico es clínico al observar la orina densa de color blanco y su confirmación se realiza al encontrar triglicéridos, quilomicrones y proteínas elevadas en orina. El tratamiento se realiza de manera individualizada y varía desde un manejo conservador con medidas higiénico dietéticas, esclerosis de las fístulas con instilaciones piélicas de povidona yodada, N-butil 2- cianoacrilato o nitrato de plata hasta procedimientos quirúrgicos de diversa índole. Se presenta el caso deuna paciente mujer de 60 años que inicia quiluria tras someterse a una cirugía pélvica (AU)

Chyluria, is the clinical manifestation of a fistulous process between the lymphatic and urinary systems. It is often due to parasitic infections, principally filarial roundworms of the genera Wuchereria bancrofti. Although other causes such as granulomatous diseases, urinary tract infections, tumors or iatrogenic can be present. Diagnosis is made by clinical evidence of chyluria and detection of elevated triglyceride and proteins levels in urine samples. Treatment options are individualized and can vary from medical management, sclerotherapy with povidone iodine, silver nitrate or N-butyl-2-cyanoacrylate, to surgical approaches. We present a case of a 60 years old women ho presented chyluria after pelvic surgery (AU)

Esquistosomiasis vesical y en la población pediátrica. Reporte de un caso y revisión de la literatura / Bladder schistosomiasis in the pediatric population. Case report and literatur review

La esquistosomiasis es una enfermedad que afecta a más de 200 millones de personas a nivel mundial. Es poco frecuente en nuestro medio, estando sobre todo distribuida a lo largo de África, en algunas áreas del Oriente Medio, en el oeste de Asia y ciertas zonas de América Latina. Se estima que 88 millones de los infectados son menores de 15 años. La hematuria es el síntoma cardinal, y se debe sospechar en los pacientes provenientes de las áreas de riesgo (sobre todo África subsahariana). Presentamos el caso de un niño de 11 años, originario de Mali, que consultó por presentar durante un año macrohematuria monosintomática; se siguió nuestro método diagnóstico, evidenciando la enfermedad causante del proceso, estableciéndose tras ello la terapéutica pertinente. Se realiza a partir de ahí una revisión de la literatura de la patología que nos ocupa (AU)

Schistosomiasis is a prevalent disease affecting more than 200 million people world wide. Even though is an infrequent disease in our environment, it is endemic trough Africa, some Middle East areas, Western Asia and certain South American areas. There are approximately 88 million children, 15 years old or less, affected. Hematuria is the paramount symptom, and we should suspect this infection in patients who come from this risky area. We report an 11 year old boy, originally from Mali, who complaint about having approximately a year of gross hematuria, discussing the pertinent assessment and treatment. Performing a literature review of the causative pathology (AU)

Esfínter urinario artificial: consideraciones radiológicas sobre sus características morfológicas, ubicación y complicaciones / Artificial urinary sphincter: radiologic considerations about its morphological characteristics, location and complications

La incidencia de incontinencia urinaria en hombres se estima que se encuentra globalmente, en alrededor de un 1-39%. El origen en la mayoría de casos es la realización previa de prostatectomía radical. El EUA es un dispositivo activación manual, cuyo mecanismo impide la pérdida involuntaria de orina y esta indicado en pacientes con incontinencia de esfuerzo moderada a severa con deterioro de la calidad de vida. Las complicaciones pueden ser mecánicas (fallo mecánico, fuga del medio liquido, problemas de llenado del reservorio) y no mecánicas (atrofia o erosión uretral, infección, hematoma, retención aguda de orina, recidiva de la incontinencia, migración). Se realizó una revisión de la literatura, en la que se pretende dar un bosquejo inicial de la valoración del EUA con las diferentes pruebas imagen (AU)

Urinary incontinence in men has a global prevalence of 1-39%. Of those patients, there is a group that develop secondary stress incontinence as an adverse outcome of radical prostatectomy. The artificial urinary sphincter is a mechanical device that allows a urethral occlusion preventing urinary leakage. It is the gold standard treatment for patients that developed stress incontinence after radical prostatectomy. Complications from urinary artificial sphincter are mechanic (mechanical failure, leakage of contrast fluid, problems of reservoir filling) and no mechanic (atrophy or urethral erosion, infection, hematoma, urinary retention, recurrent incontinence, migration). This review show an overview of the artificial urinary sphincter assessment with conventional imaging (AU)

Asistencia integral al enfermo oncológico: detección y abordaje precoz de los factores psicológicos / Comprehensive care to cancer patients: detection and early approach of psychological factors

A pesar de los actuales avances en el abordaje de la enfermedad oncológica en urología, el diagnóstico de cáncer conlleva una amenaza de muerte que provoca un sufrimiento psíquico importante, que puede desestabilizar el equilibrio emocional del paciente y su familia, interfiriendo en la adherencia al tratamiento y en el curso de la enfermedad. MATERIAL Y MÉTODOS: a partir de un caso clínico, se discute la importancia de la detección precoz por parte de los facultativos del malestar psicológico en los pacientes uro-oncológicos, y se discute sobre las formas de intervención psicológica. RESULTADOS: destaca la necesidad de realizar un abordaje asistencial integral del enfermo uro-oncológico desde una perspectiva bio-psico-social, contemplando las diferentes variables que caracterizan a cada individuo y su modo singular de responder ante la enfermedad. CONCLUSIONES: se enfatiza que sea el propio equipo asistencial el que desde la primera línea de atención detecte síntomas de malestar psicológico para poder ofrecer esta asistencia integral de manera precoz (AU)

Despite medical progress addressing urological oncology, the diagnosis of cancer carries a death threat that causes significant psychological stress. This can cause a major emotional disturbance to the patient and their relatives, interfering with treatment adherence and the healing process.MATERIAL AND METHODS: From a single case, we discuss the importance of the early detection of emotional stress in oncological patients, and the methods of psychological intervention. RESULTS: It’s necessary to have a comprehensive approach of these patients from a bio-psycho- social perspective, considering the different variables characterizing each individual and their unique way of responding to the disease. CONCLUSIONS: Each medical team has to be aware for the early detection of psychological distress symptoms and therefore provide and adequate and prompt integral assistance (AU)

Gastritis necrotizante: caso clínico / Necrotizing gastritis: case report

Necrotizing gastritis is an infrequent severe pathology. The rich vascular supply and intramural arterial anastomosis protects stomach from vascular disease and embolism. Gastric infarction and necrosis presents as an acute abdominal emergency that requires rapid resolution, which in general includes surgery. Other important etiologies reported are chemical agents, mechanical distention, postoperative, bulimia and infectious diseases. In this article, we report a case of necrotizing gastritis in a 29 years-old male patient, with chronic consumption of NSAIDs for low back pain. He was admitted in the emergency room due to acute abdominal pain that appeared, after alcohol and raw fish consumption. Antral wall thickening was observed in the abdominal computed tomography. Upper gastric endoscopy showed necrosis of antral mucosa and biopsies confirmed necrotizing gastritis. He received medical therapy with antibiotics and proton pump inhibitors with an excellent response with clinical and endoscopic resolution in one month.

La gastritis necrotizante es una patología infrecuente muy grave. Esto se debe en parte a la rica irrigación y a las anastomosis arteriales intramurales que protegen al estómago de enfermedades vasculares y embolias. El infarto gástrico se presenta como una urgencia abdominal, que requiere resolución precoz, frecuentemente quirúrgica. Otras etiología importantes reportadas incluyen agentes químicos, factores mecánicos, bulimia e infecciones. En este artículo se presenta el caso de un paciente de 29 años, sexo masculino, con antecedentes de uso crónico de anti-inflamatorios no esteroidales (AINES), que ingresa a urgencia con dolor abdominal agudo, posterior al consumo de alcohol y pescado crudo. Destaca un engrosamiento antral marcado, sin neumatosis en la tomografía computada de abdomen. En la endoscopia digestiva alta se observa extensa necrosis de la mucosa antral y se confirma el diagnóstico de gastritis necrotizante por biopsias. El paciente tuvo una excelente respuesta a tratamiento con reposo intestinal, antibióticos e inhibidores de bomba de protones. Luego de 1 mes, presentó recuperación completa clínica y endoscopía.