Validación externa de las ecuaciones europea y americana para el cálculo del riesgo cardiovascular en población laboral española / Validación externa de las ecuaciones europea y americana para el cálculo del riesgo cardiovascular en población laboral española External validation of the European and American equations for calculating cardiovascular risk in a Spanish working population

Objetivo Validar externamente los modelos europeo y norteamericano de cálculo de riesgo cardiovascular en prevención primaria. Métodos Estudio transversal de una cohorte nacional de población laboralmente activa. Se incluyeron trabajadores sin antecedentes de enfermedad cardiovascular que acudieron a una revisión laboral entre los años 2004 y 2007, y se siguieron hasta 2017. Resultados Participaron 244.236 sujetos. El 24,5% eran mujeres, la edad media se situó en 48,10 años (DE 6,26). El riesgo medio según el modelo europeo SCORE fue de 1,70 (DE 1,81) para hombres y de 0,37 (DE 0,53) para mujeres. Según el modelo norteamericano PCE, el riesgo medio fue de 6,98 (DE 5,66) para hombres y de 1,97 (DE 1,96) para mujeres. Se registró un total de 1.177 eventos (0,51%) considerados en la calculadora SCORE, y un total de 2.330 eventos (1%) considerados según las PCE. El estadístico C de Harrell fue de 0,746 (SCORE) y 0,725 (PCE). La sensibilidad y especificidad para el punto de corte del 5% en SCORE fue del 17,59% (IC95% 15,52-19,87%) y 95,68% (IC95% 95,59-95,76%) y para el punto de corte del 20% de las PCE de 9,06% (IC95% 7,96-10,29%) y 97,55% (IC95% 97,48-97,61%), respectivamente. Conclusiones Las tablas europeas del SCORE y americanas de las PCE sobreestiman el riesgo en nuestra población, manteniendo una discriminación aceptable. SCORE mostró mejores índices de validez que las PCE. El perfil de riesgo de las poblaciones va cambiando, por lo que es necesario ir actualizando las ecuaciones que incluyan información de poblaciones más contemporáneas (AU)

Objective This work aims to externally validate the European and American models for calculating cardiovascular risk in the primary prevention. Methods This is a cross-sectional study of a nation-wide cohort of individuals who are active in the work force. Workers without a medical history cardiovascular disease who attended occupational health check-ups between 2004 and 2007 were included. They were followed-up on until 2017. Results A total of 244,236 subjects participated. Of them, 24.5% were women and the mean age was 48.10 years (SD 6.26). According to the European SCORE risk chart, the mean risk was 1.70 (SD 1.81) for men and 0.37 (SD 0.53) for women. According to the North American PCE model, the mean risk was 6.98 (SD 5.66) for men and 1.97 (SD 1.96) for women. A total of 1,177 events (0.51%) were registered according to the SCORE tool and 2,330 events (1.00%) were registered according to the PCE tool. The Harrell's C-statistic was 0.746 for SCORE and 0.725 for PCE. Sensitivity and specificity for the SCORE'S 5% cut-off point were 17.59% (95%CI 15.52%-19.87%) and 95.68% (95%CI 95.59%-95.76%). Sensitivity and specificity for the PCE's 20% cut-off point were 9.06% (95%CI 7.96%-10.29%) and 97.55% (95%CI 97.48%-97.61%), respectively. Conclusions The European SCORE and North American PCE models overestimate the risk in our population but with an acceptable discrimination. SCORE showed better validity indices than the PCE. The population's risk is continuously changing; therefore, it is important continue updating the equations to include information on current populations (AU)

External validation of the European and American equations for calculating cardiovascular risk in a Spanish working population.

INTRODUCTION AND OBJECTIVE: This work aims to externally validate the European and American models for calculating cardiovascular risk in the primary prevention. METHODS: This is a cross-sectional study of a nation-wide cohort of individuals who are active in the work force. Workers without a medical history cardiovascular disease who attended occupational health check-ups between 2004 and 2007 were included. They were followed-up on until December 2017. RESULTS: A total of 244,236 subjects participated. Of them, 24.5% were women and the mean age was 48.10 years (SD 6.26). According to the European SCORE risk chart, the mean risk was 1.70 (SD 1.81) for men and 0.37 (SD 0.53) for women. According to the North American PCE model, the mean risk was 6.98 (SD 5.66) for men and 1.97 (SD 1.96) for women. A total of 1177 events (0.51%) were registered according to the SCORE tool and 2,330 events (1.00%) were registered according to the PCE tool. The Harrell's C-statistic was 0.746 for SCORE and 0.725 for PCE. Sensitivity and specificity for the SCORE'S 5% cut-off point were 17.59% (95%CI 15.52%-19.87%) and 95.68% (95%CI 95.59%-95.76%). Sensitivity and specificity for the PCE's 20% cut-off point were 9.06% (95%CI 7.96%-10.29%) and 97.55% (95%CI 97.48%-97.61%), respectively. CONCLUSIONS: The European SCORE and North American PCE models overestimate the risk in our population but with an acceptable discrimination. SCORE showed better validity indices than the PCE. The population's risk is continuously changing; therefore, it is important continue updating the equations to include information on current populations.

Latest progress in molecular biology and treatment in genitourinary tumours.

The management of genitourinary cancer, including bladder, prostate, renal and testicular cancer, has evolved dramatically in recent years due to a better understanding of tumour genetic mutations, alterations in molecular pathways, and to the development of new kinds of drugs such as targeted therapies and immunotherapies. In the field of immunotherapy, new drugs focused on stimulating, enhancing and modulating the immune system to detect and destroy cancer, have been recently discovered. Research in oncology moves quickly and new data of great relevance for clinical practice are communicated every year. For this reason, a group of experts, focused exclusively on the treatment of genitourinary tumours and who get together every year in the BestGU conference to assess the latest progress in this field have summarized the most important advances in a single review, along with a critical assessment of whether these results should alter daily clinical practice.

A definition for aggressive disease in patients with HER-2 negative metastatic breast cancer: an expert consensus of the Spanish Society of Medical Oncology (SEOM)

Purpose. To converge on an expert opinion to define aggressive disease in patients with HER2-negative mBC using a modified Delphi methodology. Methods. A panel of 21 breast cancer experts from the Spanish Society of Medical Oncology agreed upon a survey which comprised 47 questions that were grouped into three sections: relevance for defining aggressive disease, aggressive disease criteria and therapeutic goals. Answers were rated using a 9-point Likert scale of relevance or agreement. Results. Among the 88 oncologists that were invited to participate, 81 answered the first round (92%), 70 answered the second round (80%), and 67 answered the third round (76%) of the survey. There was strong agreement regarding the fact that identifying patients with aggressive disease needs to be adequately addressed to help practitioners to decide the best treatment options for patients with HER2-negative mBC. The factors that were considered to be strongly relevant to classifying patients with aggressive HER2-negative mBC were a high tumor burden, a disease-free interval of less than 12-24 months after surgery, the presence of progressive disease during adjuvant or neoadjuvant chemotherapy and having a triple-negative phenotype. The main therapeutic goals were controlling symptoms, improving quality of life and increasing the time to progression and overall survival. Conclusions. High tumor burden, time to recurrence after prior therapy and having a triple-negative phenotype were the prognostic factors for which the greatest consensus was found for identifying patients with aggressive HER2-negative mBC. Identifying patients with aggressive disease leads to different therapeutic approaches (AU)

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A definition for aggressive disease in patients with HER-2 negative metastatic breast cancer: an expert consensus of the Spanish Society of Medical Oncology (SEOM).

PURPOSE: To converge on an expert opinion to define aggressive disease in patients with HER2-negative mBC using a modified Delphi methodology. METHODS: A panel of 21 breast cancer experts from the Spanish Society of Medical Oncology agreed upon a survey which comprised 47 questions that were grouped into three sections: relevance for defining aggressive disease, aggressive disease criteria and therapeutic goals. Answers were rated using a 9-point Likert scale of relevance or agreement. RESULTS: Among the 88 oncologists that were invited to participate, 81 answered the first round (92%), 70 answered the second round (80%), and 67 answered the third round (76%) of the survey. There was strong agreement regarding the fact that identifying patients with aggressive disease needs to be adequately addressed to help practitioners to decide the best treatment options for patients with HER2-negative mBC. The factors that were considered to be strongly relevant to classifying patients with aggressive HER2-negative mBC were a high tumor burden, a disease-free interval of less than 12-24 months after surgery, the presence of progressive disease during adjuvant or neoadjuvant chemotherapy and having a triple-negative phenotype. The main therapeutic goals were controlling symptoms, improving quality of life and increasing the time to progression and overall survival. CONCLUSIONS: High tumor burden, time to recurrence after prior therapy and having a triple-negative phenotype were the prognostic factors for which the greatest consensus was found for identifying patients with aggressive HER2-negative mBC. Identifying patients with aggressive disease leads to different therapeutic approaches.

Adjuvant regimens with trastuzumab administered for small HER2-positive breast cancer in routine clinical practice

Purpose. Trastuzumab has proven to improve the prognosis of HER2-positive breast cancer, but the information available about its administration for small tumors is still limited. Therefore, we assessed the use of adjuvant regimens with trastuzumab for the treatment of small HER2-positive breast cancer in routine clinical practice. Methods. This observational study was conducted in patients with HER2-positive breast adenocarcinoma ≤1.5 cm who received trastuzumab-based adjuvant treatment in clinical practice. Clinical/histopathological data were retrieved from patients’ medical charts. Results. A total of 101 evaluable patients were enrolled (median age [range], 56.7 [49.0–64.8] years; ECOG 0, 98.0 %; ductal carcinoma, 88.1 %; lymph nodes N0, 79.2 %). Only five (5.0 %) patients received neoadjuvant treatment, while all patients underwent tumor surgery. Adjuvant trastuzumab was administered at a mean (±SD) dose of 5.9 ± 1.5 mg/kg/cycle, and mostly in a three-weekly schedule (89 [89.0 %] patients). The most frequent adjuvant therapy used with trastuzumab was chemotherapy (87 [86.1 %] patients), followed by radiotherapy (63 [62.4 %] patients) and hormone therapy (52 [51.5 %] patients). Chemotherapy regimens mainly included doxorubicin, cyclophosphamide and paclitaxel/docetaxel (n = 30), docetaxel and cyclophosphamide (n = 15), docetaxel and carboplatin (n = 13). Hormone therapy mainly included letrozole (n = 17) and tamoxifen (n = 17). Nine (8.9 %) patients reported trastuzumab-related adverse events; only one allergic reaction reached grade 3 toxicity. Conclusion. This study shows that trastuzumab-based adjuvant treatment of small HER2-positive breast cancer is mostly based on chemotherapy—mainly paclitaxel/docetaxel. Adjuvant administration of trastuzumab for small HER2-positive breast cancer seems to be similar to that used for larger tumors (AU)

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Adjuvant regimens with trastuzumab administered for small HER2-positive breast cancer in routine clinical practice.

PURPOSE: Trastuzumab has proven to improve the prognosis of HER2-positive breast cancer, but the information available about its administration for small tumors is still limited. Therefore, we assessed the use of adjuvant regimens with trastuzumab for the treatment of small HER2-positive breast cancer in routine clinical practice. METHODS: This observational study was conducted in patients with HER2-positive breast adenocarcinoma ≤1.5 cm who received trastuzumab-based adjuvant treatment in clinical practice. Clinical/histopathological data were retrieved from patients' medical charts. RESULTS: A total of 101 evaluable patients were enrolled (median age [range], 56.7 [49.0-64.8] years; ECOG 0, 98.0 %; ductal carcinoma, 88.1 %; lymph nodes N0, 79.2 %). Only five (5.0 %) patients received neoadjuvant treatment, while all patients underwent tumor surgery. Adjuvant trastuzumab was administered at a mean (±SD) dose of 5.9 ± 1.5 mg/kg/cycle, and mostly in a three-weekly schedule (89 [89.0 %] patients). The most frequent adjuvant therapy used with trastuzumab was chemotherapy (87 [86.1 %] patients), followed by radiotherapy (63 [62.4 %] patients) and hormone therapy (52 [51.5 %] patients). Chemotherapy regimens mainly included doxorubicin, cyclophosphamide and paclitaxel/docetaxel (n = 30), docetaxel and cyclophosphamide (n = 15), docetaxel and carboplatin (n = 13). Hormone therapy mainly included letrozole (n = 17) and tamoxifen (n = 17). Nine (8.9 %) patients reported trastuzumab-related adverse events; only one allergic reaction reached grade 3 toxicity. CONCLUSION: This study shows that trastuzumab-based adjuvant treatment of small HER2-positive breast cancer is mostly based on chemotherapy-mainly paclitaxel/docetaxel. Adjuvant administration of trastuzumab for small HER2-positive breast cancer seems to be similar to that used for larger tumors.

Perfil de las funciones ejecutivas de niños con TDAH en comparación con población general / Profile of executive functions of children with ADHD compared to general population

INTRODUCCIÓN: Las alteraciones en las funciones ejecutivas se han relacionado con diversos cuadros psicopatológicos y de manera especial con la sintomatología nuclear del trastorno por déficit de atención con hiperactividad. OBJETIVOS: Analizar las diferencias en el perfil de las funciones ejecutivas en niños con trastorno por déficit de atención con hiperactividad y niños con neurodesarrollo típico y de manera secundaria en aquellos niños de ambos grupos que muestren un funcionamiento académico deficiente. Material y metodología. Estudio prospectivo en niños de 6-14 años con trastorno por déficit de atención con hiperactividad procedentes de dos centros de salud mental infanto-juvenil y niños control de un servicio de pediatría habiendo descartado psicopatología a través del Cuestionario de Capacidades y Dificultades (SDQ). El perfil de las funciones ejecutivas se registró a través del Cuestionario BRIEF para padres. RESULTADOS: Se reclutaron 94 sujetos, 25 niños en el grupo con trastorno por déficit de atención con hiperactividad (72% hombres) y 69 en el grupo control (51% hombres). Todas las puntuaciones registradas en el cuestionario respecto a las funciones ejecutivas mostraron diferencias significativas entre ambos grupos (p = 0,001). Niños con deficiente funcionamiento académico, en el grupo trastorno por déficit de atención con hiperactividad un 72%, y grupo control 7,25% (p = 0,001). AAquí hubo diferencias significativas en todas las funciones ejecutivas a excepción de la de Control emocional, iniciativa, orden y supervisión. CONCLUSIÓN: Los niños con trastorno por déficit de atención con hiperactividad muestran una evidente disfunción en las funciones ejecutivas en comparación con población de niños con neurodesarrollo típico, independientemente de si tienen un deficiente funcionamiento académico o no

INTRODUCTION: Impairment of executive functions has been associated with different psychopathological disorders, especially with Attention Deficit Hyperactivity Disorder. OBJECTIVES: Principal: to analyze the differences in the profile of executive functions in children with Attention Deficit Hyperactivity Disorder and children with typical neurodevelopment, and secondarily those children in both groups showing poor academic performance. Material and methodology. Prospective study of children aged 6-14 years with Attention Deficit Hyperactivity Disorder attended in two clinics of child and adolescent mental health, and healthy children of same ages attended in a pediatric office, out-ruling psychiatric pathology with Capabilities and Difficulties Questionnaire SDQ. Primary endpoint: executive functions evaluated by questionnaire BRIEF for parents. RESULTS: 94 subjects were recruited, 25 children in Attention Deficit Hyperactivity Disorder group (72% men), and 69 in control group (51% men). All executive functions showed significant differences between both groups (p = 0.001). Children with poor academic performance, in Attention Deficit Hyperactivity Disorder group 72%, and controls 7.28% (p = 0.001). In this case, all executive functions showed significant differences except Emotional Control, initiate, organization of materials and monitor. CONCLUSION: Children with Attention Deficit Hyperactivity Disorder have obvious dysfunction in executive functions compared to typically developing children, regardless if they had poor academic performance or not. Children without Attention Deficit Hyperactivity Disorder but with poor academic performance have similar difficulties in controlling their emotions as a child with Attention Deficit Hyperactivity Disorder

Breast cancer management in the elderly

The increase in life expectancy in the western world means that we are faced with patients diagnosed with breast cancer in old age with increasing frequency. The management of these cases is a challenge for the oncologist, who must take into account the conditions associated with advanced age and the lack of trials in this population. In this review, we addressed the incorporation of geriatric assessment methods that may be useful in making decisions, the particular biological characteristics of breast cancer in elderly patients and their treatment in both localized and advanced disease. Finally, we collected recommendations based on scientific evidence regarding the monitoring and life-style after finishing treatment (AU)

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Breast cancer management in the elderly.

The increase in life expectancy in the western world means that we are faced with patients diagnosed with breast cancer in old age with increasing frequency. The management of these cases is a challenge for the oncologist, who must take into account the conditions associated with advanced age and the lack of trials in this population. In this review, we addressed the incorporation of geriatric assessment methods that may be useful in making decisions, the particular biological characteristics of breast cancer in elderly patients and their treatment in both localized and advanced disease. Finally, we collected recommendations based on scientific evidence regarding the monitoring and life-style after finishing treatment.

Hábitos de estilo de vida en adolescentes con sobrepeso y obesidad (Estudio Obescat) / Life style habits of overweight and obese adolescents (Obescat study)

Objetivo: evaluar la eficacia de una intervención educativa sobre hábitos de estilo de vida para reducir el índice de masa corporal en adolescentes. Pacientes y métodos: ensayo clínico de un año de seguimiento realizado en 48 centros de Atención Primaria de Cataluña. Participaron 174 adolescentes entre 10 y 14 años con sobrepeso u obesidad; 87 aleatorizados al grupo intervención y 87 al grupo control. La intervención fue de carácter educativo (hábitos alimentarios y de ejercicio físico) y se realizó en la visita inicial, y a los 1, 3, 6, 9 y 12 meses de seguimiento. Variables de resultados: cambios en hábitos alimentarios y ejercicio físico, cambios en el índice de masa corporal (IMC) y en el perímetro abdominal. Resultados: edad media 11,81 años (desviación estándar [DE]: 1,21) y 50% mujeres. Completaron el seguimiento 125 participantes (71,8%). Los Z-scores de IMC disminuyeron en ambos grupos (p < 0,001), de un valor medio inicial de 2,35 (DE: 0,46) a 2,06 (DE: 0,60). Los Z-scores de perímetro abdominal se redujeron en ambos grupos: en el grupo intervención de una media de 2,06 a 1,77, y en el grupo control de 2,06 a 1,82 (p < 0,001). La intervención educativa mejoró los hábitos alimentarios (aumento ingesta de fruta, disminución de dulces y de la ingesta de alimentos cuando se está aburrido). La actividad física disminuyó (p = 0,002). Conclusiones: la intervención educativa fue efectiva para reducir el IMC y el perímetro abdominal en ambos grupos. Hubo mejoría en los hábitos alimentarios, pero no en la práctica de ejercicio (AU)

Objective: to assess lifestyle habits and efficacy of a lifestyle intervention to reduce body mass index (AU)

CD11c decrease in mouse thymic dendritic cells after vanadium inhalation.

Vanadium (V) is a transition metal found in air adsorbed onto suspended particles. As a result, urban populations are often exposed to this element as a constituent of particulate matter (PM). One aspect of the myriad toxicities that might arise from these exposures is altered immune responses. Previous reports from the laboratory reported modifications in splenic architecture - with germinal center hyperplasia and a suppressed humoral immune response - in mice that had been exposed to vanadium agents via inhalation. This paper reports a decrease in the presence of the CD11c surface marker on mouse thymic dendritic cells (DC) as a result of host exposure to vanadium (here, in the form of vanadium pentoxide; V(2)O(5)) over a period of 4 weeks. All results were obtained using immunohistochemistry and flow cytometry. It is surmised that this decrease might induce a dysfunction, including possible negative selection of T-cells, which could increase the presence of autoreactive clones in the exposed host. Such an outcome could, in turn, increase the risk for development of autoimmune reactions in different organs specifically, and of autoimmune diseases in general in these V-exposed hosts.

The effect of guideline-consistent antiemetic therapy on chemotherapy-induced nausea and vomiting (CINV): the Pan European Emesis Registry (PEER).

BACKGROUND: While guidelines for preventing chemotherapy-induced nausea and vomiting (CINV) are widely available, clinical uptake of guidelines remains low. Our objective was to evaluate the effect of guideline-consistent CINV prophylaxis (GCCP) on patient outcomes. PATIENTS AND METHODS: This prospective, observational multicenter study enrolled chemotherapy-naive adults initiating single-day highly or moderately emetogenic chemotherapy (HEC or MEC) for cancer. Patients completed 6-day daily diaries beginning with cycle 1 for up to three chemotherapy cycles. The primary study end point, complete response (no emesis and no use of rescue therapy) during 120 h after cycle 1 chemotherapy, was compared between GCCP and guideline-inconsistent CINV prophylaxis (GICP) cohorts using multivariate logistic regression, adjusting for potential confounding factors. RESULTS: In cycle 1 (N=991), use of GCCP was 55% and 46% during acute and delayed phases, respectively, and 29 % for the overall study period (acute plus delayed phases). Complete response was recorded by 172/287 (59.9%) and 357/704 (50.7%) patients in GCCP and GICP cohorts, respectively (P=0.008). The adjusted odds ratio for complete response was 1.43 (95% confidence interval 1.04-1.97; P=0.027) for patients receiving GCCP versus GICP. CONCLUSION: GCCP reduces the incidence of CINV after single-day HEC and MEC.

Atención primaria y declaración de enfermedades profesionales en España / No disponible

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Comparative study of whole-body MRI and bone scintigraphy for the detection of bone metastases.

AIM: To assess and compare the diagnostic accuracy of whole-body magnetic resonance imaging (MRI) and bone scintigraphy in the detection of metastases to bone. MATERIAL AND METHODS: Forty randomly selected patients with known malignant tumours were prospectively studied using bone scintigraphy and whole-body MRI. Two patients were excluded. Symptoms of bone metastasis were present in 29 (76%) patients and absent in nine (24%). Findings were classified into four categories according to the probability of bone metastasis: (1) negative, (2) probably negative, (3) probably positive, and (4) positive. Diagnostic accuracy was determined according to the area under the receiver operating characteristic (ROC) curve. The definitive diagnosis was reached using other imaging techniques, biopsy, or 12 months clinical follow-up. RESULTS: Metastases were present in 18 patients. The sensitivity, specificity, and diagnostic accuracy were 94, 90, and 92%, respectively, for whole-body MRI and 72, 75, and 74%, respectively, for bone scintigraphy. Diagnostic accuracy measured by the area under the ROC curve was significantly higher for whole-body MRI (96%) than for bone scintigraphy (77%; p<0.05). Interobserver agreement measured by the kappa index was significantly higher for whole-body MRI (0.895) than for bone scintigraphy (0.524; p<0.05). Whole-body MRI detected lesions in tissues other than bone in 17 (45%) patients. CONCLUSIONS: Whole-body MRI is more accurate and more objective than bone scintigraphy for the detection of bone metastases. Whole-body MRI can also detect lesions in tissues other than bone.

Diagnostic value of apparent diffusion coefficients to differentiate benign from malignant vertebral bone marrow lesions.

AIM: The aim of this study is to evaluate the value of the apparent diffusion coefficient (ADC) obtained in diffusion-weighted (DW) MR sequences for the differentiation between malignant and benign bone marrow lesions. METHOD: Forty-five patients with altered signal intensity vertebral bodies on conventional MR sequences were included. The cause of altered signal intensity was benign osteoporotic collapse in 16, acute neoplastic infiltration in 15, and infectious processes in 14; based on plain-film, CT, bone scintigraphy, conventional MR studies, biopsy or follow-up. All patients underwent isotropic DW MR images (multi-shot EPI, b values of 0 and 500 s/mm(2)). Signal intensity at DW MR images was evaluated and ADC values were calculated and compared between malignancy, benign edema and infectious spondylitis. RESULTS: Acute malignant fractures were hyperintense compared to normal vertebral bodies on the diffusion-weighted sequence, except in one patient with sclerotic metastases. Mean ADC value from benign edema (1.9+/-0.39 x 10(-3) mm(2)/s) was significantly (p<0.0001) higher than untreated metastasic lesions (0.9+/-1.3 x 10(-3)mm (2)/s). Mean ADC value of infectious spondilytis (0.96+/-0.49 x 10(-3) mm(2)/s) was not statistically (p>0.05) different from untreated metastasic lesions. ADC value was low (0.75 x 10(-3) mm(2)/s) in one case of subacute benign fracture. CONCLUSIONS: ADC values are a useful complementary tool to characterize bone marrow lesions, in order to distinguish acute benign fractures from malignant or infectious bone lesions. However, ADC values are not valuable in order to differentiate malignancy from infection.

Comparación de la calidad de vida de dos grupos de pacientes oncológicos: pacientes libres de enfermedad a los cinco años y pacientes fallecidos / No disponible

Objetivo: analizar y comparar la evolución de la calidad de vida a lo largo del tratamiento oncológico de un grupo de pacientes libres de enfermedad (GL) y otro de fallecidos (GE). Método: sobre una muestra total de 112 pacientes de nuevo ingreso en el Servicio de Oncología del Hospital de Cabueñes de Gijón (Asturias) en 2001 y a quienes se evaluó su calidad de vida mediante escalas estandarizadas, entrevistas y autoinforme, y en distintos momentos del tratamiento oncológico, se identificaron en junio de 2006 los pacientes libres de enfermedad (n = 38) y los éxitus (n = 45). Se describe y compara (t para muestras independientes) la situación de ambos grupos durante el periodo de tratamiento oncológico en relación a las medidas de calidad de vida, síntomas, alteraciones en la rutina y variables emocionales. Resultados: en el GE se encuentra que el dolor, cansancio, fatiga, falta de apetito, las dificultades para dormir y el estado depresivo es significativamente mayor que en el GL al inicio del tratamiento y en los periodos de seguimiento. Estas diferencias estadísticas desaparecen durante el tratamiento con quimioterapia. Asimismo, durante el tratamiento entre ambos grupos no hay diferencias en relación a las valoraciones que hacen los propios pacientes sobre su estado general, de salud o afectación de su vida y sólo aparecen diferencias en los seguimientos. Este resultado discrepa de la valoración del médico que siempre valora peor el estado de los pacientes. Conclusiones: estos resultados no permiten considerar que el estadio y pronóstico de la enfermedad tengan un valor predictor fiable de la calidad de vida del paciente. Por el contrario, los síntomas, las alteraciones emocionales y los cambios en la rutina tienen un valor diferente y diferencial respecto a la calidad de vida del paciente oncológico paliativo en los distintos momentos del tratamiento oncológico (AU)

Objective: the main goal of this study was to analyze and compare the development of different parameters related to quality of life during oncological treatment. A group of disease-free patients (FG) and a group deceased after treatment (DG) were compared. Method: in 2001 quality of life was evaluated at different times during oncological treatment by means of standardized scales, interviews, and self-reports for 112 new patients at the Oncological Dept., Hospital de Cabueñes (Asturias, Spain). In June 2006 FG (n = 38) and DG (n = 35) data were gathered. Both groups were compared (t-test for independent samples) during the period of oncological treatment regarding quality of life, emotional symptoms, changes in daily life, and emotional variables. Results: pain, fatigue, tiredness, lack of appetite, sleeping difficulties, and depression symptoms were significantly higher in FG during treatment and at follow-up versus DG. These statistical differences disappeared during chemotherapy. Also during treatment, both groups did not differ in the assessment that patients made about their general condition, health, or disease-induced changes in their daily life. In contrast, physician evaluations were always more negative regarding the condition of patients in DG. Conclusions: the results of this study show that the disease stage and prognosis are not appropriate variables to predict patient quality of life. However, symptoms, emotional disturbances, and changes in daily life affect quality of life in cancer patients in a way that is different for each phase of oncological treatment (AU)

[Diffusion-weighted whole-body MRI (virtual PET) in screening for osseous metastases]. / Resonancia magnética de todo el cuerpo con técnica de difusión (PET virtual) para el cribado de las metástasis óseas.

OBJECTIVE: To present our preliminary experience in whole-body MRI with an added diffusion-weighted sequence in screening for osseous metastases. MATERIAL AND METHODS: 24 patients with malignant neoplasms underwent bone scintigraphy and whole-body MRI with the addition of a diffusion-weighted sequence. Whole-body MRI was performed on a 1.5 T unit using a three-station protocol; coronal T1-weighted FSE and STIR sequences and sagittal T1-weighted FSE of the spine were acquired. A diffusion-weighted sequence (b: 600 s/mm2) was added in the axial plane at five different stations and iconographic presentation in coronal-plane reconstructions with contrast inversion was used to obtain an image similar to that provided by PET (virtual PET). The findings at bone scintigraphy (BS) and MRI were compared for the presence of osseous metastases, evaluating the results for each patient both globally and for different osseous regions. Metastatic lesions were confirmed by biopsy or by six to eight months' follow-up. RESULTS: Globally, whole-body MRI with diffusion-weighted sequences was superior to bone scintigraphy, with a sensitivity of 100% (BS 71%), specificity 90% (BS 80%), and reliability 96% (BS 75%). In the evaluation by osseous region, the results of MRI were also better than those of bone scintigraphy: sensitivity 96% (BS 52%). In the diffusion-weighted sequence, lytic metastases were hyperintense in all cases, with an apparent diffusion coefficient (ADC) value higher than normal bone but lower than lesions with acute edema of benign etiology. Whole-body MRI also revealed unknown extraosseous findings related to the tumors and extraosseous metastases in 42% of the patients. CONCLUSIONS: Whole-body MRI with an added diffusion-weighted sequence is an efficacious method of detecting osseous metastases and is more reliable than bone scintigraphy. Moreover, whole-body MRI provides information about extraosseous lesions. Lytic metastases are hyperintense in diffusion-weighted sequences and have a lower ADC than benign edema.

Resonancia magnética de todo el cuerpo con técnica de difusión (PET virtual) para el cribado de las metástasis óseas / Diffusion-weighted whole-body MRI (virtual PET) in screening for osseous metastases

Objetivo. Presentar nuestra experiencia preliminar en resonancia magnética de cuerpo entero (RMCE) en el cribado de metástasis óseas, añadiendo la secuencia de difusión de todo el cuerpo. Material y métodos. Veinticuatro pacientes con neoplasias malignas fueron estudiados con gammagrafía ósea (GO) y RM de cuerpo entero añadiendo secuencia de difusión. La RMCE se realizó con un equipo de 1.5 T en 3 estaciones en el plano coronal FSE T1 y STIR y plano sagital FSE T1 del raquis. Se añadió la secuencia de difusión (b: 600 s/mm2) de RMCE en el plano axial en 5 estaciones diferentes y presentación iconográfica en reconstrucción en el plano coronal con inversión del contraste para obtener una imagen similar a la de la tomografía por emisión de positrones (PET) (PET virtual). Los hallazgos de la GO y la RM fueron comparados para la existencia o no de metástasis óseas, valorando al paciente tanto globalmente como por regiones óseas. Las lesiones metastásicas se confirmaron por biopsia o seguimiento en 6-8 meses Resultados. Globalmente, la RMCE con difusión fue superior a la GO, sensibilidad 100% (GO 71%), especificidad 90% (GO 80%) y fiabilidad 96% (GO 75%). Valorando por regiones óseas, la RM tuvo también unos resultados superiores a la GO: sensibilidad 96% (GO 52%). En difusión las metástasis líticas fueron hiperintensas en todos los casos, con un valor ADC superior al hueso sano pero inferior a las lesiones con edema agudo de etiología benigna. La RMCE mostró, además, hallazgos extraóseos desconocidos relacionados con el tumor y en un 42% de los pacientes metástasis extraóseas. Conclusiones. La RMCE añadiendo la secuencia de difusión es un método eficaz para detectar metástasis óseas con fiabilidad superior a la gammagrafía; aportando además información sobre lesiones extraóseas. Las metástasis líticas se comportan de forma hiperintensa en difusión y tienen un valor ADC inferior al edema benigno (AU)

Objective. To present our preliminary experience in whole-body MRI with an added diffusion-weighted sequence in screening for osseous metastases. Material and methods. 24 patients with malignant neoplasms underwent bone scintigraphy and whole-body MRI with the addition of a diffusion-weighted sequence. Whole-body MRI was performed on a 1.5 T unit using a three-station protocol; coronal T1-weighted FSE and STIR sequences and sagittal T1-weighted FSE of the spine were acquired. A diffusion-weighted sequence (b: 600 s/mm2) was added in the axial plane at five different stations and iconographic presentation in coronal-plane reconstructions with contrast inversion was used to obtain an image similar to that provided by PET (virtual PET). The findings at bone scintigraphy (BS) and MRI were compared for the presence of osseous metastases, evaluating the results for each patient both globally and for different osseous regions. Metastatic lesions were confirmed by biopsy or by six to eight months' follow-up. Results. Globally, whole-body MRI with diffusion-weighted sequences was superior to bone scintigraphy, with a sensitivity of 100% (BS 71%), specificity 90% (BS 80%), and reliability 96% (BS 75%). In the evaluation by osseous region, the results of MRI were also better than those of bone scintigraphy: sensitivity 96% (BS 52%). In the diffusion-weighted sequence, lytic metastases were hyperintense in all cases, with an apparent diffusion coefficient (ADC) value higher than normal bone but lower than lesions with acute edema of benign etiology. Whole-body MRI also revealed unknown extraosseous findings related to the tumors and extraosseous metastases in 42% of the patients. Conclusions. Whole-body MRI with an added diffusion-weighted sequence is an efficacious method of detecting osseous metastases and is more reliable than bone scintigraphy. Moreover, whole-body MRI provides information about extraosseous lesions. Lytic metastases are hyperintense in diffusion-weighted sequences and have a lower ADC than benign edema (AU)