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INTRODUCTION: The association of ipsilateral tibia fractures has a low incidence, being up to 3.2% of total tibia fractures. Currently there is no gold standard regarding the ideal surgical treatment. The objective of this study is to analyze the surgical treatment and the radiographic and functional results, as well as the associated complication rate of ipsilateral bifocal tibia fractures. MATERIAL AND METHODS: Retrospective observational study in our hospital from 2010 to 2022 of 24 patients who underwent bifocal fracture of the ipsilateral tibia. Demographic and surgical data and complications during follow-up were included. RESULTS: The 24 patients were classified into group 1 when they presented a fracture of the plateau and distal tibia (25%), group 2 with a fracture of the plateau and diaphysis (33%) and group 3 with a fracture of the diaphysis and distal tibia (42%). 3 patients underwent surgery with 1 implant and 21 patients with 2 implants. The average follow-up time in outpatient clinics was 2 and a half years. At one year, 22 patients (92%) had full weight bearing and 2 patients had partial weight bearing (8%) due to the sequelae of the fractures. The average time for consolidation of the diaphysis was 7.75±2 months, with no significant differences observed between group 2 and group 3 (p=0.06). The average time for consolidation of the metaphysis was 3.50±1.5 months, with no significant differences observed between group 1 and group 2 (p=0.065). 7 patients (30%) had complications during follow-up. CONCLUSIONS: Bifocal tibia fractures can be treated using a combination of intramedullary nailing and plate osteosynthesis with good long-term results, obtaining an optimal union rate and low complications. In addition, it facilitates the reduction of the fracture, thus facilitating the patient's recovery and obtaining good long-term functional results.
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INTRODUCTION: In 2017, the Spanish Academy of Dermatology and Venereology Psoriasis Working Group (PWG) designed the Minimal Disease Activity (MDA) criteria to determine the level of disease activity. We hereby present the results of an observational, cross-sectional, multicenter study of the nationwide application of these criteria. MATERIAL AND METHODS: We conducted a non-randomized sampling, stratified to achieve autonomic and provincial representation of consecutive patients with psoriasis (Ps) vulgaris without active arthritis. A total of 830 patients were included: 493 men (59.5%), with a mean age of 51.4 years (SD, 14.2), from all autonomous regions of Spain (except for Ceuta and Melilla) and 44 (88%) out of the 50 provinces. A questionnaire was obtained with demographic data, DLQI, subjective assessment-on a scale from 0 to 10-of itching, erythema, desquamation, visibility, and the patients' PASI and BSA. RESULTS: More than 50% failed to meet the MDA criteria (491; 59.2%), with significant differences being reported by region, sex, and age. Additionally, significant differences were reported based on the therapy used (P<.001). The use of biological therapies was associated with higher MDA compliance compared to other therapies (59.4% vs 23.3%). No differences were reported among various biological therapies. CONCLUSIONS: The overall rate of MDA compliance is low, with differences being based on geographic location, sex, age, and drug used, yet none of these factors separately justify them.
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Several studies suggest that patients with psoriasis have a higher incidence of neoplasms, especially of the skin, which could be associated with the use of therapies to treat psoriasis. Furthermore, the evidence available on the safety profile of some treatments in this context, and the management of these patients is scarce, which is why clinical practice guidelines with recommendations on the management of psoriasis in cancer patients are ambiguous. This study provides recommendations on the management and use of the therapies currently available for these patients. They are the result of a Delphi consensus reached by 45 dermatologists of the Spanish Academy of Dermatology and Venereology Psoriasis Working Group, whose goal is to help specialists in the field in their decision-making processes.
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Neoplasias , Psoriasis , Humanos , Psoriasis/terapia , Psoriasis/tratamiento farmacológico , Neoplasias/terapia , Neoplasias/complicaciones , Técnica Delphi , España , Dermatología/normas , ComorbilidadRESUMEN
BACKGROUND AND OBJECTIVE: Psoriasis often precedes the onset of psoriatic arthritis (PsA), so dermatologists often face the challenge of early identifying signs of PsA in patients with psoriasis. Our aim was to validate the Spanish version of the PURE-4 questionnaire as a screening tool for PsA, evaluate its performance in terms of sensitivity, specificity, feasibility, reliability, and build validity. METHODS: This was a cross-sectional, observational, multicenter trial of adult patients with psoriasis. Initially, patients were assessed by a dermatologist and completed 2 self-administered versions (in print and online) of the PURE-4 questionnaire. Afterwards, the rheumatologist, blinded to the PURE-4 results, assessed the presence/absence of PsA, being the reference to determine the performance of the PURE-4 questionnaire. RESULTS: A total of 268 patients were included (115 [42.9%] women; mean age, 47.1±12.6). The prevalence of PsA according to rheumatologist diagnosis was 12.7% (34 patients). The mean PURE-4 score for patients with psoriasis diagnosed with PsA was 2.3±1.1, and 1.3±1.3 for patients without PsA (P<.001). The cutoff value ≥2 demonstrated the best performance for detecting PsA, with a negative predictive value of 95.1% (95% confidence interval, 90.3-97.6). CONCLUSIONS: The PURE-4 questionnaire demonstrated good performance in detecting PsA, with an optimal cutoff point ≥2. This simple tool could facilitate early referral of patients to the rheumatology unit.
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Artritis Psoriásica , Diagnóstico Precoz , Humanos , Artritis Psoriásica/diagnóstico , Femenino , Estudios Transversales , Masculino , Persona de Mediana Edad , Adulto , Encuestas y Cuestionarios , Psoriasis/diagnóstico , Psoriasis/complicaciones , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , España , Traducciones , Estudios de FactibilidadAsunto(s)
Asma , Hipersensibilidad , Pólipos Nasales , Rinitis , Humanos , Asma/epidemiología , Sistema de Registros , Enfermedad CrónicaAsunto(s)
Humanos , Asma , Registros , Pólipos Nasales , Terapéutica , Sistema Respiratorio , EspañaRESUMEN
In response to the COVID-19 pandemic, universities made face masks mandatory during face-to-face classes and/or switched to virtual classes. Such situations pose a challenge for students with hearing loss as they generate listening conditions that make speech comprehension difficult. This study aimed to explore the listening difficulties perceived by Italian university students with hearing loss (HL) and typical hearing (TH) as well as their adoption of self-advocacy strategies . We measured listening difficulties as a function of teaching modality (face-to-face and virtual classes) and the type of face mask (opaque and transparent) worn by the lecturer. In face-to-face classes, the most challenging situations for HL students involved speech comprehension when groups of students were working simultaneously and lecturers talked and moved at the same time during their lessons. The use of transparent masks, compared to opaque one, by the lecturer did not reduce the perceived listening difficulties . In virtual classes, the greatest listening difficulties for HL students occurred when the lecturer's face was not visible or she/he did not use a microphone, while subtitles and sign language interpreters were speech comprehension facilitators. The TH group perceived the same situations as most challenging both in face-to-face and virtual classes, albeit to a lesser extent than the HL respondents. Despite most students demonstrated proactive self-advocacy strategies to improve speech comprehension, in some listening contexts inactive behaviors still persisted. To reduce the listening difficulties posed by pandemic measures, training to improve students' self-advocacy strategies and educators' hearing loss awareness behaviors, as well as the development of interventions aimed at reducing noise in classes, are essential to improve speech perception among HL students.
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Sordera , Pérdida Auditiva , Percepción del Habla , Femenino , Humanos , Máscaras , Universidades , Pandemias , Percepción del Habla/fisiología , Estudiantes , Encuestas y Cuestionarios , ItaliaRESUMEN
Air pollution has been linked to adverse neonatal outcomes, mainly in the case of prolonged exposures. This study focuses on the short-term effects on maternal health. We conducted a retrospective ecological time-series study in the Madrid Region covering the period 2013-2018. The independent variables were mean daily concentrations of tropospheric ozone (O3), particulate matter (PM10/PM2.5) and nitrogen dioxide (NO2), as well as noise levels. The dependent variables were daily emergency hospital admissions due to complications in pregnancy, childbirth and the puerperium. Poisson generalised linear regression models were fitted to quantify the relative and attributable risks, controlling for trend, seasonality, the autoregressive nature of the series, and a number of meteorological factors. There were 318 069 emergency hospital admissions due to obstetric complications across the 2191 days of study. Of this total: 13 164 (95%CI: 9930-16 398) admissions were attributable to exposure to O3, the only pollutant to show a statistically significant (p < 0.05) association with admissions due to hypertensive disorders; and 10 575 (95%CI: 3573-17 566) admissions were attributable to daytime noise levels, while admissions due to hyperemesis gravidarum and vomiting were related to exposure to night noise. Other pollutants which also displayed statistically significant associations were: NO2 concentrations, with admissions due to vomiting and preterm labour; PM10 concentrations, with premature rupture of membranes: and PM2.5 concentrations, with total complications. Exposure to a range of air pollutants, and ozone in particular, is associated with a higher number of emergency hospital admissions due to gestational complications. Hence, surveillance of environmental effects on maternal health should be intensified, and plans and strategies to minimise these should be drawn up.
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Contaminantes Atmosféricos , Contaminación del Aire , Contaminantes Ambientales , Ozono , Recién Nacido , Embarazo , Femenino , Humanos , Ozono/análisis , Dióxido de Nitrógeno/análisis , Estudios Retrospectivos , Contaminación del Aire/efectos adversos , Contaminación del Aire/análisis , Contaminantes Atmosféricos/análisis , Material Particulado/análisis , Contaminantes Ambientales/análisisRESUMEN
Introducción: La hemorragia exanguinante es la primera causa de muerte prevenible del combatiente en los conflictos armados, convirtiendo así la posibilidad de transfundir hemocomponentes de manera precoz en una prestación absolutamente fundamental durante la asistencia sanitaria a las bajas generadas en las operaciones militares. A lo largo de los numerosos conflictos acontecidos durante el pasado siglo, se han producido importantes cambios en el tratamiento hemoterápico a las bajas junto con una evolución de la doctrina sanitaria respecto a este tema. En algunos protocolos de transfusión masiva se ha empleado la técnica diagnóstica de la tromboelastometría (TE). La TE es una prueba que muestra las propiedades viscoelásticas de la sangre desde la formación del coágulo hasta su fibrinólisis, evalúa la función plaquetaria y se correlaciona con el proceso fisiológico de la hemostasia de una forma rápida. El objetivo principal de este estudio es evaluar in vitro la capacidad hemostática de los diversos concentrados de plaquetas frías, congeladas y frescas mediante pruebas de coagulación estandarizadas y tromboelastometría, esclareciendo si se mejora significativamente la contribución al coágulo con los pool de plaquetas frías (conservadas a 4ºC), en comparación con las plaquetas frescas y congeladas. También se pretende determinar qué ventajas supondría la incorporación de las plaquetas frías en la medicina transfusional realizada en el medio militar. Material y método: Se diseñó un estudio experimental para comparar in vitro plaquetas frías (refrigeradas), congeladas y frescas (convencionales), analizando su rendimiento y efectividad mediante análisis sistemático de sangre, mecanismos de laboratorio de coagulación rutinarios (Tiempo de Protrombina, Actividad de Protrombina, Tiempo de Cefalina y Fibrinógeno) y Tromboelastometría rotacional (ROTEM)...(AU)
Introduction: Exsanguinating hemorrhage is the first preventable cause of death for combatants in armed conflicts, thus making the possibility of transfusing blood components early an absolutely essential benefit during health care for casualties generated in military operations. Throughout the numerous conflicts that have occurred during the past century, there have been important changes in the hemotherapy treatment of casualties along with an evolution of the health doctrine regarding this issue. In some massive transfusion protocols, the diagnostic technique of thromboelastometry (TE) has been used. TE is a test that shows the viscoelastic properties of blood from clot formation to fibrinolysis, evaluates platelet function and correlates quickly with the physiological process of hemostasis. The main objective of this study is the evaluation in vitro of the hemostatic capacity of the various cold, frozen and fresh platelet concentrates through standardized coagulation tests and thromboelastometry, clarifying whether the contribution to the clot is significantly improved with cold platelet pools (preserved at 4ºC), compared to fresh and frozen platelets. It is also intended to determine what advantages would be the incorporation of cold platelets in transfusion medicine performed in the military environment. Material and methods: An experimental study was designed to compare cold (refrigerated), frozen and fresh (conventional) platelets in vitro, analyzing their performance and effectiveness through systematic blood analysis, routine laboratory coagulation mechanisms (Prothrombin Time, Prothrombin Activity, Cephalin and Fibrinogen) and Rotational Thromboelastometry (ROTEM).A sample of 20 healthy patients was recruited, after informing them in writing and obtaining the mandatory informed consent, they donated 6 tubes with 10 ml citrate. of blood per patient...(AU)
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Humanos , Plaquetas , Hemorragia , Conflictos Armados , Transfusión de Plaquetas , Medicina Militar , Enfermería MilitarRESUMEN
Background: Video-endoscopic inguinal lymphadenectomy (VEIL) is a minimally invasive approach that is increasingly indicated in oncological settings, with mounting evidence for its long-term oncological safety. Objectives: To present our single-center experience of treating penile and urethral cancer with VEIL, as well as its more recent application in melanoma patients. Methods: We prospectively recorded our experiences with VEIL from September 2010 to July 2018, registering the patient primary indication, surgical details, complications, and follow-up. Results: Twenty-nine patients were operated in one (24) or both (5) groins; 18 had penile cancer, 1 had urethral cancer, and 10 had melanoma. A mean 8.62 ± 4.45 lymph nodes were removed using VEIL and of these, an average of 1.00 ± 2.87 were metastatic; 16 patients developed lymphocele and 10 presented some degree of lymphedema; there were no skin or other major complications. The median follow-up was 19.35 months; there were 3 penile cancer patient recurrences in the VEIL-operated side. None of the melanoma patients presented a lymphatic inguinal recurrence. Conclusions: VEIL is a minimally invasive technique which appears to be oncologically safe showing fewer complications than open surgery. However, complications such as lymphorrhea, lymphocele, or lymphedema were not diminished by using VEIL.
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Resumen La adenopatía dermatopática es una entidad histopatológica que consiste en un aumento del tamaño ganglionar en respuesta a enfermedades cutáneas crónicas. En el análisis histopatológico se observa una hiperplasia paracortical con presencia de células dendríticas, células de Langerhans e histiocitos. La presentación clínica más habitual es la aparición de adenopatías de características benignas con o sin prurito en pacientes con antecedentes de enfermedad cutánea. La aparición de masas laterocervicales es un motivo de consulta frecuente en otorrinolaringología. Presentamos el caso de un paciente exfumador de 41 años que consultó por aparición brusca de una masa cervical quística, sugestiva de quiste braquial o de una adenopatía quística. Una vez descartada malignidad, se procedió a realizar exéresis de la lesión mediante cervicotomía para diagnóstico patológico. El estudio de la muestra confirmó el diagnóstico de adenopatía dermatopática en un paciente sin antecedente de enfermedad cutánea previa.
Abstract Dermatopathic lymphadenopathy is a histopathologic entity which consists on reactive lymphadenopathy in the setting of chronic cutaneous diseases. The histologic examination is characterized by paracortical hyperplasia with presence of dendritic cells, Langerhans cells and histiocytes. The most common clinical presentation is the presence of lymphadenopathy with benign characteristics with or without pruritus in patients with prior history of cutaneous disease. The appearance of laterocervical masses is a frequent reason for consultation in otorhinolaryngology. We present the case of a 41-year-old ex-smoker who consulted due to the sudden appearance of a cystic cervical mass, suggestive of a brachial cyst or cystic adenopathy. Once malignancy had been ruled out, excision of the lesion within cervicotomy was performed in order to reach a pathological diagnosis. The histologic study confirmed the diagnosis of dermatopathic adenopathy in a patient with no history of previous skin disease.
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Humanos , Masculino , Adulto , Branquioma/diagnóstico , Linfadenopatía/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Enfermedades de la Piel/complicaciones , Diagnóstico Diferencial , Linfadenopatía/patologíaRESUMEN
INTRODUCTION AND OBJECTIVE: Proximal humerus fractures with metaphysodiaphyseal extension represent a challenge for the orthopedic surgeon due to their reduced incidence and the difficulty in the treatment decision. These can be treated with an intramedullary nail or using the MIPO technique, associating different advantages and complications depending on the procedure. The objective of this study was to compare metaphyseal-diaphyseal fractures of the humerus treated with antegrade intramedullary nailing and those operated using the MIPO technique to see if there were significant differences in terms of functional, clinical, and radiological results. MATERIAL AND METHODS: retrospective, analytical and unicentric review of 29 patients with proximal fracture with metaphyseal-diaphyseal extension treated by MIPO technique and 33 patients surgically treated by antegrade intramedullary nailing (IMN) in our hospital from 2014 to 2020. Demographic, functional, radiographic and clinical data were obtained.. RESULTS: No significant differences were observed between both groups in terms of fracture mechanism (p=0.34), fracture type (p=0.13) or Maresca classification (p=0.32). Surgical time was significantly shorter in the IMN group compared to the MIPO technique (p=0.014). No significant difference was observed regarding the need for blood transfusion (p=0.32). The mean consolidation in the MIPO group was 21 weeks compared to 21 weeks in the IMN, with no significant differences between both groups (p= 0.88). No significant differences were observed between CONSTANT test at one year in the MIPO group versus the IMN group (p=0.79), nor in radial nerve palsies (p=0.28). CONCLUSIONS: Proximal fractures with metaphyseal-diaphyseal extension are a challenge for the orthopedic surgeon due to the infrequency, the complexity of these fractures and the fact that there is no established consensus on the ideal treatment for this type of injury. Both the MIPO technique with the Philos plate and the intramedullary nail are valid options for the treatment of these fractures, with no differences observed in terms of fracture consolidation time or in terms of functional results.
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Fijación Intramedular de Fracturas , Fracturas del Húmero , Placas Óseas , Fijación Interna de Fracturas/métodos , Fijación Intramedular de Fracturas/métodos , Humanos , Fracturas del Húmero/diagnóstico por imagen , Fracturas del Húmero/etiología , Fracturas del Húmero/cirugía , Húmero , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Resumen La patología del sistema nervioso central, habitualmente, no provoca síntomas auditivos unilaterales, ya que la vía auditiva central está formada por una red de conexiones cruzadas entre los diferentes núcleos que la forman. Además, hay que considerar que una lesión pequeña puede extenderse a más de una estructura provocando varios déficits neurológicos debido a la proximidad de los tractos y núcleos nerviosos. Las lesiones unilaterales circunscritas en el colículo inferior son infrecuentes. No obstante, se han descrito casos en los que lesiones unilaterales de diversas etiologías en esta localización causaban síntomas auditivos. Ya que la vía auditiva central es cruzada, síntomas auditivos detectados con más frecuencia afectaban concretamente a la capacidad de localización del sonido o la comprensión verbal. Presentamos el caso de un hombre de 44 años con acúfeno unilateral derecho de larga evolución, sin otra clínica asociada quien fue diagnosticado de un tumor en el colículo inferior derecho mediante resonancia magnética cerebral. Se exponen los hallazgos clínicos y radiológicos del caso.
Abstract Central nervous system diseases usually do not cause auditory symptoms because the central auditory pathway consists on a network of crossed connections between the different nuclei that form it. In addition, we must consider that a small lesion might extend to more than one structure producing many neurologic symptoms due to the proximity of tracts and nuclei in the midbrain. Unilateral circumscribed lesions at inferior colliculus are rare. Nevertheless, lesions at this location causing auditory symptoms have been described. Because of the crossed central auditory pathway, the most commonly detected auditory symptoms specifically affected the ability to locate sound or verbal comprehension. We present the case of a 44-year-old man with a long-term monoaural right-sided tinnitus without other complaints who was diagnosed of a tumour at right inferior colliculus by neuroimaging. Clinical and radiological findings of this case are discussed.
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Humanos , Masculino , Adulto , Acúfeno/complicaciones , Colículos Inferiores/patología , Espectroscopía de Resonancia Magnética , Enfermedades del Sistema Nervioso Central , NeoplasiasRESUMEN
PURPOSE: Whistle deformity is a sequela of primary surgical repair of the bilateral cleft lip that leads to a vertical tissue deficiency and a nonfunctional orbicularis oris muscle in the medial portion of the upper lip. This sequel is significantly limiting functionally and esthetically. We propose a complete labial revision with a secondary cheiloplasty of Mulliken and a submucosal inferiorly based flap in the central tubercle to increase the volume at this usually deficient area. METHODS: We present our series of 9 patients with whistle deformity who underwent our modified technique. Width and length lip measurements were analyzed pre- and postoperatively. RESULTS: There was a significant decrease in the width of the philtrum (mean 18.7% and 37% measured at the columella base and Cupid's apexes, respectively), an increase in the labial length (mean 11.2%), and improvement of the shape and volume of the vermilion in its middle third. All patients reported a very good to excellent improvement in the function and shape of their lips. CONCLUSIONS: The addition to a complete revision cheiloplasty of our inferiorly based submucosal flap technique solved in a single operation the function of the orbicularis oris and the normal labial anatomy with good functional outcomes in all cases and improved esthetic results.
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Labio Leporino , Procedimientos de Cirugía Plástica , Labio Leporino/cirugía , Estética Dental , Humanos , Procedimientos de Cirugía Plástica/métodos , Reoperación , Colgajos Quirúrgicos/cirugíaRESUMEN
Snyder-Robinson syndrome is an extremely rare genetic disorder, caused by mutations of the spermine synthase gene. We report a novel case of Snyder-Robinson syndrome, caused by a de novo mutation and first misdiagnosed with osteogenesis imperfecta. Clinical features, course, and genetic analysis are presented. The patient was treated with bisphosphonates for a decade, until developing an atypical femoral fracture. Teriparatide was then administered for 2 years and then changed to denosumab every 6 months, improving his bone density mass and preventing further fractures.
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Discapacidad Intelectual Ligada al Cromosoma X , Osteogénesis Imperfecta , Espermina Sintasa , Diagnóstico Diferencial , Humanos , Discapacidad Intelectual Ligada al Cromosoma X/diagnóstico , Discapacidad Intelectual Ligada al Cromosoma X/genética , Osteogénesis Imperfecta/diagnóstico , Osteogénesis Imperfecta/tratamiento farmacológico , Osteogénesis Imperfecta/genética , Espermina Sintasa/genéticaRESUMEN
OBJECTIVE: Determine whether our institution´s active surveillance (AS) protocol is a suitable strategy to minimise prostate cancer overtreatment. MATERIAL AND METHODS: Retrospective analysis of 516 patients on AS after prostate cancer diagnosis. Population divided into "per-protocol" vs "induced" AS depending on fulfilment of protocol´s inclusion criteria. Radical prostatectomies after AS were selected and stratified based on: reclassification, progression or patient anxiety. Clinicopathological features and biochemical relapse-free survival were studied. Primary endpoint was overtreatment ratio based on the presence of insignificant prostate cancer and adverse pathological features in the surgical specimen. Kaplan-Meier curves were used to estimate the biochemical relapse-free survival and compared with log-rank test. RESULTS: 304 patients fulfilled inclusion criteria; 100 proceeded to radical prostatectomy (31% "induced", 69% "per-protocol" AS). Surgery indications were reclassification, progression and anxiety in 66%, 18% and 16% of patients respectively. Rate of positive lymph nodes was higher in the progression group (11%) compared to reclassification and anxiety (5% and 0% respectively, P = .002). Positive surgical margins were more frequently reported in the progression cohort compared to reclassification (28% vs 20%). Median follow-up from diagnosis until last radical prostatectomy was 48.3 months (32.4-70). 3 year biochemical relapse-free survival in the salvage radical prostatectomy was 85.4% (95 CI 78.3-93.2). Insignificant cancer was noticed in 7% of patients (Epstein´s vs 24% Wolters´ criteria). Rate of patients with adverse pathological features was 36%. CONCLUSIONS: The majority of patients who underwent salvage surgery after AS were not overtreated. Radical prostatectomy should be considered a safe rescue treatment.
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Neoplasias de la Próstata , Espera Vigilante , Humanos , Masculino , Uso Excesivo de los Servicios de Salud , Prostatectomía , Neoplasias de la Próstata/cirugía , Estudios RetrospectivosRESUMEN
Objetivo: Determinar si el protocolo de vigilancia activa (VA) de nuestra institución es una estrategia adecuada para minimizar el sobretratamiento del cáncer de próstata.Material y métodosAnálisis retrospectivo de 516 pacientes en VA tras el diagnóstico de cáncer de próstata. La población se dividió en «VA por protocolo» vs. «VA inducida», dependiendo del cumplimiento de los criterios de inclusión del protocolo. Las prostatectomías radicales después de la VA fueron seleccionadas y estratificadas en base a reclasificación, progresión o ansiedad del paciente. Se estudiaron las características clinicopatológicas y la supervivencia libre de recidiva bioquímica. La variable principal del estudio fue el porcentaje de sobretratamiento con relación a la presencia de un cáncer de próstata insignificante y de características patológicas adversas en la pieza quirúrgica. Se utilizaron las curvas de Kaplan-Meier para estimar la supervivencia libre de recidiva bioquímica y se compararon con la prueba log-rank.ResultadosUn total de 304 pacientes cumplieron los criterios de inclusión; 100 procedieron a una prostatectomía radical (31% «VA inducida», 69% «VA por protocolo»). Las indicaciones para la cirugía fueron la reclasificación, la progresión y la ansiedad de los pacientes (66, 18 y 16%, respectivamente). (AU)
Objective: Determine whether our institution's active surveillance (AS) protocol is a suitable strategy to minimise prostate cancer overtreatment.Material and methodsRetrospective analysis of 516 patients on AS after prostate cancer diagnosis. Population divided into «per-protocol» vs «induced» AS depending on fulfilment of protocol's inclusion criteria. Radical prostatectomies after AS were selected and stratified based on reclassification, progression or patient anxiety. Clinicopathological features and biochemical relapse-free survival were studied. Primary endpoint was overtreatment ratio based on the presence of insignificant prostate cancer and adverse pathological features in the surgical specimen. Kaplan-Meier curves were used to estimate the biochemical relapse-free survival and compared with log-rank test.Results304 patients fulfilled inclusion criteria; 100 proceeded to radical prostatectomy (31% «induced», 69% «per-protocol» AS). Surgery indications were reclassification, progression and anxiety in 66%, 18% and 16% of patients, respectively. Rate of positive lymph nodes was higher in the progression group (11%) compared to reclassification and anxiety (5% and 0%, respectively; P=.002). Positive surgical margins were more frequently reported in the progression cohort compared to reclassification (28% vs 20%). Median follow-up from diagnosis until last radical prostatectomy was 48.3months (32.4-70). Three year biochemical relapse-free survival in the salvage radical prostatectomy was 85.4% (95%CI: 78.3-93.2). Insignificant cancer was noticed in 7% of patients (Epstein's vs 24% Wolters criteria). Rate of patients with adverse pathological features was 36%. (AU)
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Humanos , Prostatectomía , Neoplasias de la Próstata/cirugía , Espera Vigilante , Estudios RetrospectivosRESUMEN
Lattice structures are periodic porous bodies which are becoming popular since they are a good compromise between rigidity and weight and can be built by additive manufacturing techniques. Their optimization has recently attracted some attention, based on the homogenization method, mostly for compliance minimization. The goal of our two-part work is to extend lattice optimization to stress minimization problems two-dimensionally. The present first part is devoted to the choice of a parametrized periodicity cell that will be used for structural optimization in the second part of our work. In order to avoid stress concentration, we propose a square cell microstructure with a super-ellipsoidal hole instead of the standard rectangular hole often used for compliance minimization. This type of cell is parametrized two-dimensionally by one orientation angle, two semi-axis and a corner smoothing parameter. We first analyse their influence on the stress amplification factor by performing some numerical experiments. Second, we compute the optimal corner smoothing parameter for each possible microstructure and macroscopic stress. Then, we average (with specific weights) the optimal smoothing exponent with respect to the macroscopic stress. Finally, to validate the results, we compare our optimal super-ellipsoidal hole with the Vigdergauz microstructure which is known to be optimal for stress minimization in some special cases. This article is part of the theme issue 'Topics in mathematical design of complex materials'.