Melanoma uveal: características clínicas, tratamiento y supervivencia en una serie de 500 pacientes / Uveal melanoma: Clinical characteristics, treatment and survival in a series of 500 patients

Objetivo: Analizar las características clínicas, tratamiento y supervivencia de los pacientes diagnosticados de melanoma uveal en una unidad de referencia de tumores intraoculares en un periodo de 20 años. Metodología: Se realizó un estudio prospectivo de 500 pacientes entre enero de 1992 y diciembre de 2011. Se recogieron las características clínicas del tumor y el tratamiento recibido en una base de datos en Microsoft@ Access@. Las variables numéricas se analizaron con medias de frecuencia y desviación estándar, y las cualitativas con tablas de media de frecuencia. Resultados: La edad media de la muestra fue de 62,19 años, siendo un 51,2% mujeres. Se diagnosticaron por la presencia de síntomas visuales el 64,2% de los casos. Los tumores eran pequeños en el 31,12% de los casos y grandes en el 23,09% según criterios del COMS. El color de iris fue el verde-avellana en el 44,2% de los ojos. El tratamiento inicial fue la braquiterapia epiescleral en el 42,4%. La mortalidad global fue del 17 y 31,3% y la específica por melanoma del 11,6 y 14,8%, a los 5 y 10 años, respectivamente. Conclusiones: En la serie estudiada los melanomas son más frecuentes en mujeres y en iris más oscuros comparados con estudios previos. Los tumores detectados son sintomáticos y en estadios poco avanzados, lo que permite tratamientos conservadores, siendo la braquiterapia el más importante. Se observa una disminución de la mortalidad específica por melanoma comparada con otras series publicadas. Sin embargo, son necesarios más estudios sobre los factores que influyen en la supervivencia (AU)

Objective: To analyse the clinical features, treatment and survival of uveal melanoma patients diagnosed in a referral Intraocular Tumours Unit over a twenty-year period. Methodology: A prospective study was performed including five hundred patients, diagnosed between January 1992 and December 2011. Clinical tumour characteristics and treatment were collected in a database in Microsoft@ Access@. The numeric variables were expressed as means of frequency and standard deviation, and the quantitative variables using frequency tables. Results: The mean age of the sample was 62.19 years, with 51.2% females, and 64.2% presented with symptoms. The tumours were small in 31.12% of cases, and large in 23.09%, according to COMS criteria. Hazel green was the iris colour in 42.2% of the cases. The initial treatment was episcleral brachytherapy in 42.4% of the total. The overall mortality ratewas 17% and 31.3%, and melanoma-related mortality rate was 11.6% and 14.8%, at 5 and10 years, respectively. Conclusions: In the serie studied melanomas were more frequent in women, and a higher proportion of darker irides were observed than in other previous studies. Mostof the tumours were diagnosed when they became symptomatic and in the early or medium stages, allowing conservative therapies to be used, with brachytherapy being the predominant treatment. The melanoma-related mortality appeared to be lower than previously data published. However, further studies are required on the factors influencing survival (AU)

[Uveal melanoma: clinical characteristics, treatment and survival in a series of 500 patients]. / Melanoma uveal: características clínicas, tratamiento y supervivencia en una serie de 500 pacientes.

OBJECTIVE: To analyse the clinical features, treatment and survival of uveal melanoma patients diagnosed in a referral Intraocular Tumours Unit over a twenty-year period. METHODOLOGY: A prospective study was performed including five hundred patients, diagnosed between January 1992 and December 2011. Clinical tumour characteristics and treatment were collected in a database in Microsoft@ Access@. The numeric variables were expressed as means of frequency and standard deviation, and the quantitative variables using frequency tables. RESULTS: The mean age of the sample was 62.19 years, with 51.2% females, and 64.2% presented with symptoms. The tumours were small in 31.12% of cases, and large in 23.09%, according to COMS criteria. Hazel green was the iris colour in 42.2% of the cases. The initial treatment was episcleral brachytherapy in 42.4% of the total. The overall mortality rate was 17% and 31.3%, and melanoma-related mortality rate was 11.6% and 14.8%, at 5 and 10 years, respectively. CONCLUSIONS: In the serie studied melanomas were more frequent in women, and a higher proportion of darker irides were observed than in other previous studies. Most of the tumours were diagnosed when they became symptomatic and in the early or medium stages, allowing conservative therapies to be used, with brachytherapy being the predominant treatment. The melanoma-related mortality appeared to be lower than previously data published. However, further studies are required on the factors influencing survival.

Episcleral brachytherapy for uveal melanoma: analysis of 136 cases

PURPOSE: To assess the results of I-125 episcleral brachytherapy (EB) in uveal melanoma: tumour control, visual acuity (VA), eye preservation and survival. PATIENTS: Prospective and consecutive study of patients with a diagnosis of uveal melanoma at the Ocular Oncology Unit in the Valladolid University Teaching Hospital treated with EB between September 1997 and June 2008. Ocular examination and extraocular and systemic extension data were registered in a database at the time of the diagnosis and during the follow-up. RESULTS: Among a total of 310 patients diagnosed between September 1997 and June 2008, 136 were treated with EB (mean age, 58.3). Mean follow-up was 55.3 months. As for tumour type, 66.9% were nodular and 39% mushroom shaped. With respect to size, 80.9% were medium, 7.4% small and 11.8% large. After 4.6 years of follow-up, tumours were controlled in 97.1%, with a 55.1% reduction in mean height; only 2.9% of patients showed recurrence. VA was maintained in 16.2% of patients and 17.6% showed an increase; 33% had retinopathy and 14.6% optic neuropathy. Only 5.1% of patients underwent enucleation due to complications and there has been 1 melanoma-related death to date. CONCLUSIONS: I-125 EB is effective in tumour control, allowing preservation of the eye and useful visual function for the majority of patients (AU)

Prevalence of ocular and oculodermal melanocytosis in Spanish population with uveal melanoma.

PURPOSE: The aim of this study was to determine the prevalence of ocular and oculodermal melanocytosis (ODM) among patients with uveal melanoma (UM) in a Spanish population. METHODS: Retrospective review of the medical records of patients with ODM among patients with UM. RESULTS: Ten (11 eyes) of 400 patients (2.7%) with UM associated had ODM. The mean age at diagnosis of UM among patients with ODM was 62 years. One patient had bilateral tumours. UM was diagnosed during a routine-examination in two cases. All tumours were medium (7/11) or large (4/11) in size, with a mean maximum base of 13 mm and height of 7 mm. No patient had extraocular extension or metastatic disease at diagnosis. Enucleation was done in five cases and I-125-brachytherapy in six. The mean follow-up was 43 months. One patient died because of metastasis 2 years after enucleation; one patient is currently on treatment of systemic metastasis 11 years after. CONCLUSIONS: ODM is more frequent in spanish population with UM than in American population. Despite the risk of UM in ODM, it is often diagnosed late when a conservative treatment is not indicated.

[Lack of concordance between dry eye syndrome questionnaires and diagnostic tests]. / Falta de concordancia entre los cuestionarios y las pruebas diagnósticas en el síndrome de ojo seco.

PURPOSE: To report the prevalence of dry eye syndrome (DES) in a subset of patients > 50 years old in Valladolid, Spain, calculate internal validity of two DES screening questionnaires, and correlate the results with DES diagnostic tests. METHODS: Patients > 50 years-old were randomly selected from the medical network census in Valladolid; they answered the modified McMonnies questionnaire (Q1) and the Ocular Surface Index questionnaire (Q2) and then underwent an ophthalmic evaluation which included: tear break-up time (TBUT), fluorescein and Rose Bengal staining, and Schirmer with anesthesia were performed. Descriptive analysis, test concordance analysis, and Q1 and Q2 reliability using ROC curves were performed. RESULTS: A total of 270 subjects (58.2% female; 41.8% male) with an average age of 64.5 years (95% CI: 63.3 - 65.7) were enrolled. The prevalence of DES based on the Schirmer-Tear break-up time tests combination was 24.2%. The mean Q1 score was 1.2, and 1.4 for Q2. Grittiness and discomfort in dry environments (28.9%) were the most common symptoms recorded for Q1. For Q2 "grittiness" (99.2%) and "burning sensation" (98.9%)were the most common symptoms. With the Schirmer-TBUT combination, DES prevalence in Valladolid was 24.2%, 45.8% with TBUT, and 45.6% with Schirmer test. Values for the areas under the ROC curve for Q1, Q2, and most objective tests were < 0.5, except for Q2 and TBUT (0.503). Cronbach alpha was > 0.7 for all Q1 and Q2 items. Statistically significant concordance was reported for Schirmer - TBUT (κ=0.14) and TBUT- fluorescein staining (κ=0.09); (P<0.05). CONCLUSIONS: Q1 and Q2 were unreliable for DES diagnosis and showed poor internal consistency. Fluorescein and Rose Bengal staining were the most concordant tests for DES diagnosis. Finally, there was no correlation between either screening questionnaire and objective DES diagnostic tests.

Falta de concordancia entre los cuestionarios y las pruebas diagnósticas en el síndrome de ojo seco / Lack of concordance between dry eye syndrome questionnaires and diagnostic tests

PropósitoReportar la prevalencia del síndrome de ojo seco (SOS) y calcular la validez interna de dos cuestionarios para diagnosticar el síndrome de ojo seco y correlacionarlo con los resultados de varias pruebas diagnósticas.Material y métodoSe seleccionaron pacientes mayores de 50 años del sistema de salud de Castilla y León, en Valladolid. Contestaron los cuestionarios modificados de McMonnies (Q1) y Ocular Surface Index questionnaire (OSDI, Q2) y se les realizó: tiempo de ruptura lagrimal (TBUT), tinciones con fluoresceína y rosa de bengala y Schirmer con anestesia. Se registraron los resultados y se realizó análisis descriptivo, de concordancia y fiabilidad de Q1 y Q2 mediante áreas bajo la curva ROC.ResultadosUn total de 270 sujetos (58,2% mujeres; 41,8% hombres) con edad promedio de 64,5 años (IC 95%: 63,3 - 65,7) se enrolaron. El promedio de Q1 fue de 1,2 y la “sensación de arenillas” y las “molestias en ambientes secos” los síntomas más frecuentes. Para Q2 99,2% fueron “sensación de arenillas” y 98,9% “sensación de ardor”. Con la combinación Schirmer-TBUT, la prevalencia del SOS en Valladolid fue del 24,2%, 45,8% con TBUT y 45,6% con Schirmer. Utilizando Schirmer-TBUT, la prevalencia del SOS fue de 27,6% para mujeres (p<0,15) y 19,6% para hombres. Los valores del área bajo la curva ROC para Q1, Q2 y la mayoría de las pruebas diagnósticas fueron<0,5, excepto para Q2 y TBUT (0,503). Para Schirmer-TBUT, el valor de Q1 fue de 0,49 y 0,45 para Q2. Los valores de Cronbach alfa fue > 0,7 para todos los ítems de Q1 y Q2. Se obtuvieron concordancias estadísticamente significativas (p<0,05) con la combinación Schirmer – TBUT (κ=0,14) y TBUT- tinción fluoresceína (κ=0,09)(AU)

ConclusionesQ1 y Q2 no son fiables para el diagnóstico del SOS y tienen pobre consistencia interna. Las tinciones con fluoresceína y rosa de bengala resultaron ser las más concordantes para el diagnóstico del SOS. No hay correlación entre los cuestionarios y las pruebas diagnósticas objetivas del SOS(AU)

PurposeTo report the prevalence of dry eye syndrome (DES) in a subset of patients > 50 years old in Valladolid, Spain, calculate internal validity of two DES screening questionnaires, and correlate the results with DES diagnostic tests.MethodsPatients > 50 years-old were randomly selected from the medical network census in Valladolid; they answered the modified McMonnies questionnaire (Q1) and the Ocular Surface Index questionnaire (Q2) and then underwent an ophthalmic evaluation which included: tear break-up time (TBUT), fluorescein and Rose Bengal staining, and Schirmer with anesthesia were performed. Descriptive analysis, test concordance analysis, and Q1 and Q2 reliability using ROC curves were performed.ResultsA total of 270 subjects (58.2% female; 41.8% male) with an average age of 64.5 years (95% CI: 63.3 - 65.7) were enrolled. The prevalence of DES based on the Schirmer-Tear break-up time tests combination was 24.2%. The mean Q1 score was 1.2, and 1.4 for Q2. Grittiness and discomfort in dry environments (28.9%) were the most common symptoms recorded for Q1. For Q2 “grittiness” (99.2%) and “burning sensation” (98.9%)were the most common symptoms. With the Schirmer-TBUT combination, DES prevalence in Valladolid was 24.2%, 45.8% with TBUT, and 45.6% with Schirmer test. Values for the areas under the ROC curve for Q1, Q2, and most objective tests were < 0.5, except for Q2 and TBUT (0.503). Cronbach alpha was > 0.7 for all Q1 and Q2 items. Statistically significant concordance was reported for Schirmer – TBUT (κ=0.14) and TBUT- fluorescein staining (κ=0.09); (P<0.05).ConclusionsQ1 and Q2 were unreliable for DES diagnosis and showed poor internal consistency. Fluorescein and Rose Bengal staining were the most concordant tests for DES diagnosis. Finally, there was no correlation between either screening questionnaire and objective DES diagnostic tests(AU)

Evaluación de la calidad de vida en pacientes con síndrome postrombótico / Quality of life after deep venous thrombosis

Introducción. Poco se conoce sobre el impacto del síndrome postrombótico (SPT) en la calidadde vida (CV) de los pacientes.Objetivos. Evaluar la CV a largo plazo en pacientes con trombosis venosa profunda (TVP) de losmiembros inferiores y examinar si ésta se correlaciona con el nivel de gravedad del SPT.Material y métodos. Todos los pacientes incluidos fueron consecutivos, con síntomas unilateralesy primer episodio de TVP. Tras 5 años de seguimiento, el grado de secuela postrombótica fuevalorado mediante la escala de Villalta. Al fi nalizar todos realizaron un cuestionario genérico(EuroQol) y otro específi co de insufi ciencia venosa (CIVIQ). Los resultados fueron analizados demanera ciega.Resultados. De 165 pacientes inicialmente reclutados, tan sólo 100 completaron el seguimientode 5 años y cumplimentaron los cuestionarios. A pesar del uso regular de medias elásticas (75 %),la incidencia de SPT fue del 65 %: 35 pacientes asintomáticos, 41 pacientes con SPT moderado y24 pacientes con SPT grave. La CV media con el EuroQol y el CIVIQ fue, respectivamente, de91,5 % y 89,46 % en SPT ausente; 85,9 % y 74,43 % en SPT moderado; 58,2 % y 49,82 % en SPT grave.El EuroQol tan sólo mostró diferencias signifi cativas cuando el SPT fue grave, mientras queel CIVIQ se reveló muy útil para detectar diferencias entre los distintos subgrupos, mostrando undeterioro progresivo en relación con el nivel de gravedad del SPT (r = 0,601).Conclusiones. Los pacientes con TVP que desarrollan SPT presentan un importante deterioro dela CV, tanto peor cuanto más grave sea la secuela postrombótica(AU)

Introduction. Little is known about the impact of the posthrombotic syndrome (PTS) on thequality of life (QoL) of patients after deep vein thrombosis (DVT).Objective. The aims of this study were to analyze the long-term QoL after DVT and to examinewhether QoL correlates with the severity of PTS.Material and methods. Patients with previous symptomatic, unilateral, and a fi rst episode ofDVT were enrolled in this study. After 5 years of follow-up, the venous disease was related topathological severity of PTS according to the scale of Villalta. All patients then completed ageneric (EuroQol) and a disease-specifi c one for venous insuffi ciency (CIVIQ) questionnaires. Theanalysis of results was blinded to clinical details of the patients.Results. Of the 165 patients initially recruited, 100 patients completed the follow-up andcompleted the QoL assessment at 5 years. Despite the regular use of compression stockings theincidence of PTS was 65 %: 35 asymptomatic, 41 with moderate-PTS, and 24 with severe-PTS.The mean QoL with the EuroQol and the CIVIQ was 91.5 % and 89.46 % in absent-PTS; 85.9 % and74.43 % in moderate-PTS; and 58.2 % and 49.82 % in severe-PTS, respectively. The EuroQol onlyshowed signifi cant differences when the PTS was severe, while the CIVIQ was useful to detectdifferences among the different subgroups. These scores worsened signifi cantly with increasingseverity of PTS (r = 0.601).Conclusions. Patients with DVT in whom PTS develops have a worse QoL than those without PTS.Patient-based QoL measures correlated well with the severity of PTS(AU)

High-dose iodine-125 episcleral brachytherapy for circumscribed choroidal haemangioma.

AIMS: To evaluate episcleral plaque radiotherapy with high-dose (125)I for the treatment of circumscribed choroidal haemangioma (CCH). METHODS: A retrospective review was performed of patients treated for CCH between 1995 and 2007. Brachytherapy was performed with ROPES plaques loaded with (125)I seeds with a target apex dose of 48 Gy. Main outcome measures were regression of CCH, resolution of retinal detachment, visual acuity changes and frequency of radiation-related complications. RESULTS: Eight patients met the inclusion criteria. Mean tumour base was 11.3 (range 7.8-14.3) mm and mean height was 4.4 (range 2.8-6.5) mm. Six patients had an associated retinal detachment and seven macular exudates or oedema. Mean preoperative visual acuity ranged from no light perception to 0.7. Three patients had received prior argon laser treatment. All patients received one radiation treatment, since no new symptoms due to CCH developed during follow-up (mean 83 (range 23-123) months). Tumour regression was found in all cases. Three patients presented radiation retinopathy and one subretinal fibrosis. Visual acuity remained stable in six patients and decreased two or more lines in two patients. CONCLUSIONS: Episcleral brachytherapy led to tumour regression and resolution of non-rhegmatogenous secondary retinal detachments in this case series that included large CCH. Visual stabilisation was achieved in most cases. Given the acceptable rate of side effects detected, (125)I episcleral brachytherapy should be considered in large tumours, in tumours with a subfoveal location or extensive subretinal fluid, and in tumours that have failed to respond to other treatments.

Comparison of two vaccination strategies against hepatitis A and B in patients with chronic hepatitis C.

OBJECTIVE: although the vaccination against hepatitis A (VAH) and hepatitis B (VBH) is recommended in patients with HCV, the most cost-effective strategy has not been established. Our objective was to compare the cost-effectiveness of universal strategy (vaccination all patients) with selective strategy (vaccination only patients against virus they lack immunity to) in patients with HCV. PATIENTS AND METHODS: we compared the direct medical costs of the two vaccination strategies against both viruses in 313 patients with HC. Serological markers for HAV (anti-HAV) and HBV (HbsAg, anti HBs, anti HBc) were determined in the 313 patients and the costs of the vaccines and the blood tests necessary to determinate the immunity state in our care system were considered. RESULTS: the prevalence of anti-HAV was 81,2% and of anti-HBc was 24,6%. The prevalence of anti-HAV increases with age. HAV vaccination with universal strategy has a cost of 19.806,64 euro and with selective one of 9.899,62 euro. HBV vaccination with universal strategy rose to 18.780 euro and to 20.385,57 euro with selective one (employing anti-HBc). Costs were analysed in different groups of age and several hepatitis HBV risk factors. CONCLUSIONS: the selective vaccination strategy against HAV was most cost-effective in our patients with HCV. However, when the prevalence of the anti-HAV decreased to less than 20% universal strategy will be the best option. Difference of cost-effective between the two vaccination strategies against HBV was small, on behalf of universal one, so in groups with higher anti-HBc prevalence, like parenteral drugs users and tattoos, the selective strategy could be the best option.

Upper gastrointestinal findings detected by capsule endoscopy in obscure gastrointestinal bleeding.

OBJECTIVE: We analyzed our experience with the use of capsule endoscopy in areas that can be explored with gastroscopy to justify obscure bleeding, as well as the outcome after a new recommended gastroscopy in order to determine if a second gastroscopy before the capsule study can provide any benefit in the management of this disease. METHODS: We retrospectively studied 82 patients who were explored with capsule endoscopy for obscure gastrointestinal bleeding who had undergone previously only one gastroscopy. Findings in the zones which were accessible by gastroscopy were normal, mild/known and severe/unknown. In the latter cases we recommended a second gastroscopy, and their treatment and outcome were subjected to further study. RESULTS: Capsule endoscopy did not find any unknown esophageal findings. In 63% of cases, no gastric or duodenal lesions were shown; in 20%, lesions were mild or had been previously diagnosed, and in 17%, a new gastroscopy was recommended due to the discovery of an unknown condition which could be the cause of the obscure bleeding. This new information brought about a change in treatment for 78% of patients in this group, all of whom improved from their illness. Capsule endoscopy found significant intercurrent alterations in the small intestine in only 14% of cases. CONCLUSIONS: The performance of a second gastroscopy, previous to capsule endoscopy, in the study of obscure gastrointestinal bleeding can offer benefits in diagnostic terms and may introduce therapeutic changes. A detailed analysis of the upper tract frames in intestinal capsule endoscopy studies is mandatory since it may provide relevant information with clinical impact on the management of these patients.

[Ocular retention in patients with uveal melanoma managed by a multimodality approach]. / Estudio de la conservación del globo ocular con un abordaje multiterapéutico en el melanoma uveal.

OBJECTIVE: to analyze ocular survival in eyes with uveal melanoma treated with conservative therapies, in a centre that applies all treatment modalities. METHODS: Patients diagnosed with uveal melanoma and treated between September 1990 and April 2007 were included in an historical cohorts study. RESULTS: 273 patients were included. 193 were treated with conservative treatments (70.69%) and 80 were enucleated as primary treatment. 14 patients were enucleated after conservative treatment (7.2%). Kaplan-Meier survival analysis showed an 88% survival probability of the eye in the first 5 years after conservative treatment and 83% at 10 years. CONCLUSIONS: Conservative treatments for uveal melanoma, especially brachitherapy, are safe and effective in relation to tumor control and rate of secondary effects.

Comparación de dos estrategias de vacunación frente a la hepatitis A y B en individuos con hepatitis crónica C / Comparison of two vaccination strategies against hepatitis A and B in patients with chronic hepatitis C

Objetivo: aunque se recomienda vacunar frente al virus de la hepatitis A (VHA) y al virus de la hepatitis B (VHB) a los pacientes con infección crónica por el virus de la hepatitis C (VHC), la estrategia de vacunación más costo-efectiva aún no está establecida. Nuestro objetivo fue comparar la vacunación universal (de todos los individuos) con la selectiva (únicamente de los individuos no inmunizados) frente al VHA y al VHB de los pacientes con infección crónica por VHC en nuestro medio. Pacientes y métodos: comparamos los costes directos de las dos estrategias de vacunación frente a ambos virus en 313 individuos con infección crónica por VHC. Determinamos los marcadores serológicos del VHA (anti-VHA) y del VHB (HBsAg, anti-HBs y anti-HBc) y tuvimos en cuenta los costes de vacunas y reactivos en nuestro ámbito. Resultados: la prevalencia de anti-VHA fue del 81,2% y la de anti-HBc del 24,6%. La prevalencia de anti-VHA aumentaba progresivamente con la edad. La inmunización frente al VHA suponía 19.806,64 € con la estrategia universal y 9.899,62 € con la selectiva. La vacunación frente al VHB ascendía a 18.780 € con la inmunización universal y a 20.385,57 € con la selectiva (mediante el anti-HBc). Se analizaron los costes considerando distintos grupos etarios y diversos factores de riesgo. Conclusiones: en nuestros individuos con infección crónica por VHC la vacunación selectiva frente al VHA es la más costoefectiva. Pero cuando el porcentaje de inmunización frente al VHA desciende por debajo del 20% la mejor opción es la universal. La diferencia en la costoefectividad de ambas estrategias de vacunación frente al VHB es pequeña, a favor de la universal, por lo que en subgrupos con elevada prevalencia de anti-HBc, como adictos a drogas y tatuados, la selectiva podría ser la mejor alternativa(AU)

Objective: although the vaccination against hepatitis A (VAH) and hepatitis B (VBH) is recommended in patients with HCV, the most cost-effective strategy has not been established. Our objective was to compare the cost-effectiveness of universal strategy (vaccination all patients) with selective strategy (vaccination only patients against virus they lack immunity to) in patients with HCV. Patients and methods: we compared the direct medical costs of the two vaccination strategies against both viruses in 313 patients with HC. Serological markers for HAV (anti-HAV) and HBV (HbsAg, anti HBs, anti HBc) were determined in the 313 patients and the costs of the vaccines and the blood tests necessary to determinate the immunity state in our care system were considered. Results: the prevalence of anti-HAV was 81,2% and of anti-HBc was 24,6%. The prevalence of anti-HAV increases with age. HAV vaccination with universal strategy has a cost of 19.806,64 € and with selective one of 9.899,62 €. HBV vaccination with universal strategy rose to 18.780 € and to 20.385,57 € with selective one (employing anti-HBc). Costs were analysed in different groups of age and several hepatitis HBV risk factors. Conclusions: the selective vaccination strategy against HAV was most cost-effective in our patients with HCV. However, when the prevalence of the anti-HAV decreased to less than 20% universal strategy will be the best option. Difference of cost-effective between the two vaccination strategies against HBV was small, on behalf of universal one, so in groups with higher anti-HBc prevalence, like parenteral drugs users and tattoos, the selective strategy could be the best option(AU)

Estudio de la conservación del globo ocular con un abordaje multiterapéutico en el melanoma uveal / Ocular retention in patients with uveal melanoma managed by a multimodality approach

Objetivo: Analizar la supervivencia de los globosoculares afectados de melanoma uveal sometidos atratamiento conservador, en un centro que aplicatodas las modalidades de tratamiento.Métodos: Se han incluido en el estudio los pacientesdiagnosticados de melanoma de úvea tratadosentre septiembre de 1990 y abril de 2007 en la unidadde Oncología Ocular del Hospital Clínico Universitariode Valladolid realizándose un estudio decohortes histórico.Resultados: De los 273 pacientes incluidos en elestudio, se trataron 193 pacientes con terapias conservadoras(70,69%), mientras que se enuclearon deforma primaria 80 (29,30%). Se enuclearon de formasecundaria 14 de los sometidos a tratamientoconservador (7,2%) El análisis de supervivencia deKaplan-Meier reveló que tras la aplicación de untratamiento conservador, la probabilidad de conservacióndel globo ocular a los 5 años es del 88% y alos 10 años es del 83%.Conclusiones: El presente estudio pone de manifiestola seguridad de los tratamientos conservadores en el melanoma uveal, especialmente de la braquiterapiaepiescleral, en cuanto a control local dela enfermedad y a tasa de efectos secundarios(AU)

Objective: to analyze ocular survival in eyes withuveal melanoma treated with conservative therapies,in a centre that applies all treatment modalities.Methods: Patients diagnosed with uveal melanomaand treated between September 1990 and April2007 were included in an historical cohorts study.Results: 273 patients were included. 193 were treatedwith conservative treatments (70.69%) and 80were enucleated as primary treatment. 14 patientswere enucleated after conservative treatment(7.2%). Kaplan-Meier survival analysis showed an88% survival probability of the eye in the first 5years after conservative treatment and 83% at 10years.Conclusions: Conservative treatments for uvealmelanoma, especially brachitherapy, are safe andeffective in relation to tumor control and rate ofsecondary effects(AU)

Hallazgos digestivos altos de la cápsula endoscópica en la hemorragia digestiva de origen oscuro / Upper gastrointestinal findings detected by capsule endoscopy in obscure gastrointestinal bleeding

Objetivo: hemos analizado los hallazgos que la cápsula endoscópicaaportó de las zonas accesibles a una gastroscopia que podríanjustificar un sangrado digestivo oscuro, así como la evoluciónde estos enfermos tras la nueva gastroscopia recomendadapara determinar si una segunda gastroscopia previa a la cápsulapodría añadir beneficios en el manejo de esta patología.Métodos: estudiamos de forma retrospectiva 82 pacientes alos que se efectuó cápsula endoscópica como estudio de hemorragiaoscura que contaban con una única gastroscopia.Los hallazgos que la cápsula apreció en tramos altos se dividieronen normales, leves/conocidos y severos-desconocidos que recomendaronuna segunda gastroscopia. Estos últimos casos fueronseguidos.Resultados: la cápsula endoscópica no objetivó hallazgosesofágicos desconocidos. En un 63% no evidenció lesiones gastroduodenales,en un 20% estas eran leves o conocidas y en un17% se recomendó una nueva gastroscopia al encontrar patologíadesconocida y que podría motivar la hemorragia digestiva a estenivel. La información motivó cambios en el tratamiento en un85% de este grupo, con mejoría en el 78%. La cápsula endoscópicaencontró alteraciones intercurrentes llamativas en el intestinodelgado en sólo un 14%.Conclusiones: una segunda gastroscopia previa a una cápsulaendoscópica en el estudio de la hemorragia oscura ofrecería beneficiosen términos diagnósticos y a la hora de introducir cambiosterapéuticos que consiguen buenos resultados clínicos.El análisis detallado de los fotogramas del tracto digestivo altoes obligado, ya que puede aportar información relevante y conimportancia en el manejo de estos pacientes(AU)

Objective: we analyzed our experience with the use of capsule endoscopy in areas that can be explored with gastroscopy to justify obscure bleeding, as well as the outcome after a new recommended gastroscopy in order to determine if a second gastroscopy before the capsule study can provide any benefit in the management of this disease. Methods: we retrospectively studied 82 patients who were explored with capsule endoscopy for obscure gastrointestinal bleeding who had undergone previously only one gastroscopy. Findings in the zones which were accessible by gastroscopy were normal, mild/known and severe/unknown. In the latter cases we recommended a second gastroscopy, and their treatment and outcome were subjected to further study. Results: capsule endoscopy did not find any unknown esophageal findings. In 63% of cases, no gastric or duodenal lesions were shown; in 20%, lesions were mild or had been previously diagnosed, and in 17%, a new gastroscopy was recommended due to the discovery of an unknown condition which could be the cause of the obscure bleeding. This new information brought about a change in treatment for 78% of patients in this group, all of whom improved from their illness. Capsule endoscopy found significant intercurrent alterations in the small intestine in only 14% of cases. Conclusions: the performance of a second gastroscopy, previous to capsule endoscopy, in the study of obscure gastrointestinal bleeding can offer benefits in diagnostic terms and may introduce therapeutic changes. A detailed analysis of the upper tract frames in intestinal capsule endoscopy studies is mandatory since it may provide relevant information with clinical impact on the management of these patients(AU)

Interleucina-18 (IL-18) y otros parámetros inmunológicos como marcadores de gravedad en la pancreatitis aguda / No disponible

Objetivo: se trata de comparar prospectivamente el comportamientodurante la primera semana del ingreso de los niveles de interleucina-18 (IL-18), y otros parámetros inmunológicos entre pacientescon pancreatitis aguda con y sin criterios de gravedad, así comoentre pacientes con y sin desarrollo ulterior de seudoquiste.Pacientes y métodos: se compararon en 36 pacientes conpancreatitis aguda los resultados de sTNF-RI, IL-1Ra, IL-6 e IL-18los días 1, 2, 3 y 7 desde el ingreso entre pancretitis leve, grave y ungrupo control (13 pacientes) con cólico biliar simple, así como entrepacientes con o sin seudoquiste.Resultados: al comparar pancreatitis leve con grave, IL-18 fuesignificativamente superior sólo el primer día en las pancreatitis gravesy los otros parámetros a partir del segundo día de forma mantenida.También en pacientes que desarrollaron seudoquiste, IL-18 estuvosignificativamente elevada el primer día.Conclusiones: IL-18 resultó el marcador más precoz de complicacionesy gravedad de la pancreatitis aguda a nivel sistémico y local(seudoquiste)

Objective: our aim was to prospectively compare the behaviorof interleukin 18 (IL-18) levels and other immunological parametersduring the first week of hospitalization between acute pancreatitispatients with and without severity criteria, as well asbetween patients with and without late pseudocyst development.Patients and methods: in 36 patients with acute pancreatitiswe compared sTNF-RI, IL-1Ra, IL-6, and IL-18 levels at days1, 2, 3 and 7 after hospitalization between mild pancreatitis, severepancreatitis, and a “control” group (13 patients) with uncomplicatedbiliary colic, as well as between patients with and withoutpseudocyst.Results: on comparing mild to severe pancreatitis, IL-18 wassignificantly higher only the first day in severe pancreatitis, whilethe other parameters were steadily higher after the second day. Inpatients developing pseudocyst, IL-18 was also noticeably higherthe first day.Conclusions: IL-18 appears to be the earliest marker of complicationsand severity in acute pancreatitis at both the systemicand local level (pseudocyst)

Comparison of two-step transient evoked otoacoustic emissions (TEOAE) and automated auditory brainstem response (AABR) for universal newborn hearing screening programs.

OBJECTIVE: Both transitory auditory otoemissions (TEOAE) and automated auditory brainstem responses (AABR) are considered adequate methods for universal hearing screening. The goal of this study was to compare the results obtained with each device, applying the same screening procedure. MATERIALS AND METHODS: From 2001 to 2003, all the newborns in our health area (2454 infants) were evaluated with TEOAE (ILO92, otodynamics) and all those born from 2004 to 2006 (3117) were evaluated with AABR (AccuScreen, Fischer-Zoth). The population studied included all well newborns and those admitted to neonatal intensive care units (NICU). The first screening was normally undertaken with well babies during the first 48h of life, before hospital discharge. Infants referred from this first step underwent a second screening after hospital discharge, before they were a month old. RESULTS: The results from each study group were compared and analyzed for significant differences. TEOAE screening yielded 10.2% fail results from the first screening step; AABR gave 2.6%. In the second screening step, 2% of the newborns screened with TEOAE were referred, whereas 0.32% of those screened with AABR were referred. These differences are statistically significant. CONCLUSIONS: Although AABR screening tests involve a slightly higher cost in time and money than TEOAE, the results obtained compensate this difference. AABR gives fewer false positives and a lower referral rate; the percent of infants lost during follow-up is consequently smaller. Therefore, in our environment, universal newborn auditory screening with AABR is more effective than that with TEOAE.

[Interleukin 18 (IL-18) and other immunological parameters as markers of severity in acute pancreatitis]. / Interleucina-18 (IL-18) y otros parámetros inmunológicos como marcadores de gravedad en la pancreatitis aguda.

OBJECTIVE: Our aim was to prospectively compare the behavior of interleukin 18 (IL-18) levels and other immunological parameters during the first week of hospitalization between acute pancreatitis patients with and without severity criteria, as well as between patients with and without late pseudocyst development. PATIENTS AND METHODS: In 36 patients with acute pancreatis we compared sTNF-RI, IL-1Ra, IL-6, and IL-18 levels at days 1, 2, 3 and 7 after hospitalization between mild pancreatitis, severe pancreatitis, and a "control" group (13 patients) with uncomplicated biliary colic, as well as between patients with and without pseudocyst. RESULTS: On comparing mild to severe pancreatitis, IL-18 was significantly higher only the first day in severe pancreatitis, while the other parameters were steadily higher after the second day. In patients developing pseudocyst, IL-18 was also noticeably higher the first day. CONCLUSIONS: IL-18 appears to be the earliest marker of complications and severity in acute pancreatitis at both the systemic and local level (pseudocyst).

Two cases of cystic seroma following mesh incisional hernia repair.

Cystic seromas, or mature fibrous cysts, are rare complications after ventral and incisional hernioplasties employing polypropylene mesh. We analyzed the medical records of patients, whose abdominal-wall hernias were surgically repaired with polypropylene mesh from November 1996 to February 2004 (N=685). Of the 162 patients, who had incisional hernias repaired with the Rives technique (preperitoneal mesh), we detected two patients who developed giant cystic seromas. Both patients underwent surgical resection of the cyst wall. As follow-up care improves for patients undergoing hernioplasties with polypropylene meshes, more cystic seromas are detected, thereby improving our knowledge of the clinical, radiological, and histopathological characteristics of this complication. However, the etiologic factors related to the appearance of this chronic cyst remain uncertain.

[Percutaneous tracheotomy with the Ciaglia Blue Rhino technique: a critical analysis after 1 year]. / Traqueotomía percutánea con la técnica de Ciaglia Blue Rhino: un análisis crítico tras un año de experiencia.

OBJECTIVES: To report our experience during a learning period with the Ciaglia Blue Rhino (William Cook Europe) kit for percutaneous tracheotomy. PATIENTS AND METHODS: This prospective, observational study included 38 adult patients who underwent elective placement of a percutaneous tracheostomy tube with the Ciaglia Blue Rhino introducer kit. The study was carried out from April 2002 to May 2003. The main variables analyzed were duration of the procedure, level of difficulty (easy, moderately difficult, difficult), and complications while the procedure was being performed. RESULTS: The mean time of orotracheal intubation was 13.5 days (range, 2-28 days). The mean duration of the procedure was 12 minutes 36 seconds (range, 4 minutes 30 seconds-29 minutes; 95% confidence interval, 10 minutes 30 seconds-14 minutes 36 seconds). The procedure was rated easy in 60.5% of the cases, moderately difficult in 31.6%, and difficult in 7.9%. Some form of complication occurred in 28 patients (73.6%), the most common being puncture of the orotracheal tube (28.9%) and slight bleeding (26.3%). Two patients (5.2%) died, from massive hemorrhage in 1 case and pneumothorax in the other. CONCLUSIONS: The Ciaglia Blue Rhino technique for percutaneous tracheotomy is useful, rapid, and easy but not free of risk. There is a learning curve that calls for caution and an experienced physician to perform the maneuvers, given that potentially fatal complications can occur.

Traqueotomía percutánea con la técnica de Ciaglia Blue Rhino®: un análisis crítico tras un año de experiencia / Percutaneous tracheotomy with the Ciaglia Blue Rhino® technique: a critical analysis after 1 year

OBJETIVOS: Presentar nuestra experiencia con el set Ciaglia Blue Rhino® para traqueotomía percutánea durante el periodo de aprendizaje de la técnica. PACIENTES Y MÉTODOS: Se ha realizado un estudio observacional prospectivo en 38 pacientes adultos a los que se les realizó una traqueotomía percutánea electiva con el equipo introductor Ciaglia Blue Rhino® (William Cook Europe). El estudio se realizó entre los meses de abril de 2002 y mayo de 2003. Las variables primarias analizadas fueron la duración del procedimiento, la graduación del nivel de dificultad (fácil, dificultad media, difícil), así como las complicaciones durante la realización de la técnica. RESULTADOS: El tiempo medio de intubación orotraqueal previo a la traqueotomía fue de 13,5 días (rango: 2-28 días). El procedimiento se realizó en un tiempo medio de 12 min 36 s (rango: 4 min 30 s-29 min; Intervalo de Confianza (IC) 95%: 10 min 30 s-14 min 36 s). El 60,5% de los casos fueron fáciles, el 31,6%, de dificultad media y sólo 3 se consideraron difíciles (7,9%). Existió algún tipo de complicación en 28 pacientes (73,6%), siendo las más frecuentes la punción del tubo orotraqueal (28,9%) y la aparición de hemorragia leve (26,3%). Hubo dos fallecimientos (5,2%). Las causas de estas muertes fueron una hemorragia incoercible y un neumotórax a tensión. CONCLUSIONES: Es una técnica útil, fácil y rápida, pero no está exenta de riesgos. Hay una curva de aprendizaje que demanda precaución y experiencia por parte del médico que está ejecutando la técnica, ya que las complicaciones potencialmente fatales pueden ocurrir

OBJECTIVES: To report our experience during a learning period with the Ciaglia Blue Rhino® (William Cook Europe) kit for percutaneous tracheotomy. PATIENTS AND METHODS: This prospective, observational study included 38 adult patients who underwent elective placement of a percutaneous tracheostomy tube with the Ciaglia Blue Rhino® introducer kit. The study was carried out from April 2002 to May 2003. The main variables analyzed were duration of the procedure, level of difficulty (easy, moderately difficult, difficult), and complications while the procedure was being performed. RESULTS: The mean time of orotracheal intubation was 13.5 days (range, 2–28 days). The mean duration of the procedure was 12 minutes 36 seconds (range, 4 minutes 30 seconds–29 minutes; 95% confidence interval, 10 minutes 30 seconds–14 minutes 36 seconds). The procedure was rated easy in 60.5% of the cases, moderately difficult in 31.6%, and difficult in 7.9%. Some form of complication occurred in 28 patients (73.6%), the most common being puncture of the orotracheal tube (28.9%) and slight bleeding (26.3%). Two patients (5.2%) died, from massive hemorrhage in 1 case and pneumothorax in the other. CONCLUSIONS: The Ciaglia Blue Rhino® technique for percutaneous tracheotomy is useful, rapid, and easy but not free of risk. There is a learning curve that calls for caution and an experienced physician to perform the maneuvers, given that potentially fatal complications can occur