Impact of age on the use of adjuvant treatments in patients undergoing surgery for colorectal cancer: patients with stage III colon or stage II/III rectal cancer.

BACKGROUND: Many older patients don't receive appropriate oncological treatment. Our aim was to analyse whether there are age differences in the use of adjuvant chemotherapy and preoperative radiotherapy in patients with colorectal cancer. METHODS: A prospective cohort study was conducted in 22 hospitals including 1157 patients with stage III colon or stage II/III rectal cancer who underwent surgery. Primary outcomes were the use of adjuvant chemotherapy for stage III colon cancer and preoperative radiotherapy for stage II/III rectal cancer. Generalised estimating equations were used to adjust for education, living arrangements, area deprivation, comorbidity and clinical tumour characteristics. RESULTS: In colon cancer 92% of patients aged under 65 years, 77% of those aged 65 to 80 years and 27% of those aged over 80 years received adjuvant chemotherapy (χ2trends < 0.001). In rectal cancer preoperative radiotherapy was used in 68% of patients aged under 65 years, 60% of those aged 65 to 80 years, and 42% of those aged over 80 years (χ2trends < 0.001). Adjusting by comorbidity level, tumour characteristics and socioeconomic level, the odds ratio of use of chemotherapy compared with those under age 65, was 0.3 (0.1-0.6) and 0.04 (0.02-0.09) for those aged 65 to 80 and those aged over 80, respectively; similarly, the odds ratio of use of preoperative radiotherapy was 0.9 (0.6-1.4) and 0.5 (0.3-0.8) compared with those under 65 years of age. CONCLUSIONS: The probability of older patients with colorectal cancer receiving adjuvant chemotherapy and preoperative radiotherapy is lower than that of younger patients; many of them are not receiving the treatments recommended by clinical practice guidelines. Differences in comorbidity, tumour characteristics, curative resection, and socioeconomic factors do not explain this lower probability of treatment. Research is needed to identify the role of physical and cognitive functional status, doctors' attitudes, and preferences of patients and their relatives, in the use of adjuvant therapies.

Predictors of 1- and 2-year mortality in patients with rectal cancer.

AIM: Tools are needed to aid in the assessment of the prognosis of patients with rectal cancer regarding the risk of medium-term mortality. The aim of this study was to develop and validate clinical prediction rules for 1- and 2-year mortality in patients undergoing surgery for rectal cancer. METHOD: A prospective cohort study of patients diagnosed with rectal cancer who underwent surgery was carried out. The main outcomes were mortality at 1 and 2 years after surgery. Background, clinical parameters and diagnostic test findings were evaluated as possible predictors. Multivariable survival models were used in the statistical analyses. RESULTS: Predictors of 1-year mortality were being a current smoker [hazard ratio (HR) 4.98], having a Charlson index adjusted by age > 5 (HR 2.61), the presence of vascular, perineural or lymphatic invasion (HR 3.30), the presence of residual tumour at the operation (R-stage) (HR 8.64) and TNM stage (HR for TNM IV 5.10) [concordance index (C-index) 0.799 (95% CI: 0.71-0.89)]. Age greater than 80 years (HR 2.19), being a current smoker (HR 2.20), the pre-intervention haemoglobin level (HR 2.02), need for blood transfusion (HR 2.12), vascular, perineural or lymphatic invasion (HR 2.59), R-stage of the operation (HR 6.13) and TNM stage (HR for TNM IV 4.43) were predictors of 2-year mortality [C-index 0.779 (0.718-0.840)]. Adjuvant chemotherapy was an additional predictor at both outcome durations. CONCLUSION: These clinical parameters show good predictive values and are easy and quick-to-use tools to help in clinical decision making.

Association between social support, functional status, and change in health-related quality of life and changes in anxiety and depression in colorectal cancer patients.

OBJECTIVE: The aim of this study was to explore the association between baseline social support, functional status, and change in health-related quality of life (HRQoL) in colorectal cancer patients and change in anxiety and depression measured by Hospital Anxiety and Depression Scale (HADS) at 1 year after surgery. METHODS: Consecutive patients who were due to undergo therapeutic surgery for the first time for colon or rectal cancer in 9 hospitals in Spain were eligible for the study. Patients completed the following questionnaires before surgery and 12 months afterward: 1 HRQoL instrument, the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire; a social support questionnaire, the Duke-UNC Functional Social Support Questionnaire; the Barthel Index, to assess functional status; the HADS, to assess anxiety and depression; and questions about sociodemographic information. General linear models were built to explore the association between social support, functional status, and change in HRQoL and changes in anxiety and depression 12 months after surgery. RESULTS: A total of 947 colorectal cancer patients took part in the study. Patients' functional status, social support, and change in HRQoL were associated with changes in anxiety and depression. Greater social support and improvements in physical, cognitive, and social functioning and in insomnia resulted in improvements in anxiety and depression. No functionally independent patients were associated with lesser improvements in anxiety and depression. CONCLUSIONS: Colorectal cancer patients who have more social support, are functionally independent and have higher improvements in HRQoL may have better results in anxiety and depression at 1 year after surgery, adjusting for age, gender, location, occupation, and baseline HADS scores.

Total knee replacement: Are there any baseline factors that have influence in patient reported outcomes?

BACKGROUND: There is conflicting evidence about what factors influence outcomes after total knee replacement (TKR). The objective is to identify baseline factors that differentiate patients who achieve both, minimal clinically important difference (MCID) and a patient acceptable symptom state (PASS) in pain and function, measured by WOMAC, after TKR from those who do not attain scores above the cutoff in either of these dimensions. METHODS: One-year prospective multicentre study. Patients completed WOMAC, SF-12, EQ-5D, expectations, other joint problems and sociodemographic data while in the waiting list, and 1-year post-TKR. Dependent variable was a combination of MCID and PASS in both dimensions (yes/no). Univariate analysis was performed to identify variables associated. Exploratory factor analysis (EFA) was performed to study how these variables grouped into different factors. RESULTS: Total sample comprised 492 patients. Mean (SD) age was 71.3 (6.9), and there were a 69.7% of women. Of the total, 106 patients did not attain either MCID or PASS in either dimension, and 230 exceeded both thresholds in both dimensions. In the univariate analysis, 13 variables were associated with belonging to one group or another. These 13 variables were included in EFA; 3 factors were extracted: expectations, mental health, and other joints problems. The percentage of variance explained by the 3 factors was 80.4%. CONCLUSION: We have found 2 modifiable baseline factors, expectations and mental health, that should be properly managed by different specialist. Indication of TKR should take into account these modifiable factors for improving outcomes after TKR.

Association of social support, functional status, and psychological variables with changes in health-related quality of life outcomes in patients with colorectal cancer.

BACKGROUND: The aim of this study was to explore the association of social support received, and functional and psychological status of colorectal cancer patients before surgery with changes in health-related quality of life (HRQoL) outcomes measured by EORTC QLQ-C30 at 1-year post-intervention. METHODS: Consecutive patients that were because of undergo therapeutic surgery for the first time for colon or rectum cancer in nine hospitals in Spain were eligible for the study. Patients completed questionnaires before surgery and 12 months afterwards: one HRQoL instrument, the EORTC QLQ-C30; a social network and social support questionnaire, the Duke-UNC Functional Social Support Questionnaire; the Hospital Anxiety and Depression Scale, to assess anxiety and depression; and the Barthel Index, to assess functional status; as well as questions about sociodemographic information. General linear models were built to explore the association of social support, functional status, and psychological variables with changes in HRQoL 12 months after intervention. RESULTS: A total of 972 patients with colorectal cancer took part in the study. Patients' functional status, social support, and anxiety and depression were associated with changes in at least one HRQoL domain. The higher functional status, and the higher social support, the more they improved in HRQoL domains. Regarding anxiety and depression, the more anxiety and depression patients have at baseline, less they improve in HRQoL domains. CONCLUSIONS: Patients with colorectal cancer who have more social support and no psychological distress may have better results in HRQoL domains at 1 year after surgery. Copyright © 2015 John Wiley & Sons, Ltd.

Factores predictores de respuesta y revisión de la toxicidad cutánea de cetuximab y panitumumab en 116 pacientes / Predictors of Tumor Response to Cetuximab and Panitumumab in 116 Patients and a Review of Approaches to Managing Skin Toxicity

INTRODUCCIÓN Y OBJETIVOS: Cetuximab y panitumumab son anticuerpos anti-factor de crecimiento epidérmico (anti-EGFR) usados para el cáncer colorrectal metastásico. La mayoría de los pacientes desarrollan una erupción papulopustulosa que podría predecir la respuesta tumoral. Además, producen otros efectos adversos cutáneos, por lo que hemos estudiado si estos también podrían ser predictores clínicos de respuesta. Así mismo, hemos realizado una revisión del tratamiento de la erupción papulopustulosa, ya que no existen directrices basadas en la evidencia. MATERIAL Y MÉTODOS: Estudio retrospectivo de 116 pacientes. Se incluyeron pacientes afectos de cáncer colorrectal metastásico en tratamiento con los anticuerpos anti-EGFR, cetuximab o panitumumab, en el Hospital Universitario Donostia. RESULTADOS: El 81,9% de los pacientes desarrolló la erupción papulopustulosa, siendo el riesgo mayor y de mayor intensidad cuantos más ciclos de anti-EGFR se administraban (p = 0,03). Todos los pacientes que obtuvieron una respuesta tumoral completa desarrollaron la erupción. Cuanto peor era la respuesta tumoral, menor era la frecuencia de la erupción (p = 0,03). También se encontró una asociación entre la xerosis y la respuesta tumoral (el 53,4% de los que obtuvieron respuesta tumoral desarrollaron xerosis, p = 0,002). El manejo de la erupción papulopustulosa se llevó a cabo mediante un algoritmo desarrollado por nuestro servicio. CONCLUSIONES: En la práctica clínica la erupción papulopustulosa grave y la xerosis pueden ser predictores clínicos de buena respuesta al tratamiento anti-EGFR. Los pacientes con esta erupción deben tratarse precozmente, ya que el tratamiento subóptimo de estos efectos secundarios puede conllevar un retraso en la dosis o su interrupción

INTRODUCTION AND OBJECTIVES: Cetuximab and panitumumab are monoclonal antibodies that target the epidermal growth factor receptor (EGFR) in the treatment of metastatic colorectal cancer. Most patients develop a papulopustular rash, which may predict tumor response. We studied whether the other adverse cutaneous effects associated with these monoclonal antibodies are also clinical predictors of response. We also reviewed publications describing approaches to treating the papulopustular rash since no evidence-based guidelines have yet been published. MATERIAL AND METHODS: We performed a retrospective study of 116 patients with metastatic colorectal cancer receiving anti-EGRF therapy with cetuximab or panitumumab at Hospital Universitario Donostia. RESULTS: In total, 81.9% of the patients developed a papulopustular rash. Patients who received the most cycles of treatment with the EGFR inhibitor were at the highest risk of developing the rash, and these patients also had the most severe rash reactions (P = .03). All of the patients who exhibited a complete tumor response had the rash, and the incidence of rash was lower in patients with poor tumor response (P = .03). We also observed an association between tumor response and xerosis (53.4% of the patients who developed xerosis also exhibited tumor response, P = .002). The papulopustular rash was managed according to an algorithm developed by our department. CONCLUSIONS: Severe papulopustular rash and xerosis may be clinical predictors of good response to anti-EGFR therapy. Patients who develop a papulopustular rash should be treated promptly because suboptimal treatment of this and other adverse effects can lead to delays in taking the prescribed anti-EGFR dose or to interruption of therapy

Predictors of Tumor Response to Cetuximab and Panitumumab in 116 Patients and a Review of Approaches to Managing Skin Toxicity.

INTRODUCTION AND OBJECTIVES: Cetuximab and panitumumab are monoclonal antibodies that target the epidermal growth factor receptor (EGFR) in the treatment of metastatic colorectal cancer. Most patients develop a papulopustular rash, which may predict tumor response. We studied whether the other adverse cutaneous effects associated with these monoclonal antibodies are also clinical predictors of response. We also reviewed publications describing approaches to treating the papulopustular rash since no evidence-based guidelines have yet been published. MATERIAL AND METHODS: We performed a retrospective study of 116 patients with metastatic colorectal cancer receiving anti-EGRF therapy with cetuximab or panitumumab at Hospital Universitario Donostia. RESULTS: In total, 81.9% of the patients developed a papulopustular rash. Patients who received the most cycles of treatment with the EGFR inhibitor were at the highest risk of developing the rash, and these patients also had the most severe rash reactions (P=.03). All of the patients who exhibited a complete tumor response had the rash, and the incidence of rash was lower in patients with poor tumor response (P=.03). We also observed an association between tumor response and xerosis (53.4% of the patients who developed xerosis also exhibited tumor response, P=.002). The papulopustular rash was managed according to an algorithm developed by our department. CONCLUSIONS: Severe papulopustular rash and xerosis may be clinical predictors of good response to anti-EGFR therapy. Patients who develop a papulopustular rash should be treated promptly because suboptimal treatment of this and other adverse effects can lead to delays in taking the prescribed anti-EGFR dose or to interruption of therapy.

Effect of oral anticoagulants on the outcome of faecal immunochemical test.

BACKGROUND: We aimed to evaluate whether oral anticoagulants (OACs) alter faecal immunochemical test (FIT) performance in average-risk colorectal cancer (CRC) screening. METHODS: Individuals aged 50-69 years were invited to receive one FIT sample (cutoff 75 ng ml(-1)) between November 2008 and June 2011. RESULTS: Faecal immunochemical test was positive in 9.3% (21 out of 224) of users of OAC and 6.2% (365 out of 5821) of non-users (P-trend=0.07). The positive predictive value (PPV) for advanced neoplasia (AN) in non-users was 50.4% vs 47.6% in users (odds ratio, 0.70; 95% CI, 0.3-1.8; P=0.5). The PPV for AN in OAC more antiplatelets (aspirin or clopidogrel) was 75% (odds ratio, 2; 95% CI, 0.4-10.8; P=0.4). CONCLUSIONS: Oral anticoagulant did not significantly modify the PPV for AN in this population-based colorectal screening program. The detection rate of advanced adenoma was higher in the combination OAC more antiplatelets.

Total knee replacement; minimal clinically important differences and responders.

OBJECTIVE: To provide new data on minimally clinical important difference (MCID) and percentages of responders on pain and functional dimensions of Western Ontario and McMaster Osteoarthritis Index (WOMAC) in patients who have undergone total knee replacement (TKR). METHODS: 1-year prospective multicentre study with two different cohorts. Consecutive patients on the waiting list were recruited. There were 415 and 497 patients included. Pain and function were collected by the reverse scoring option of the WOMAC (0-100, worst to best). Transition items (five point scale) were collected at 1-year and MCID was calculated through mean change in patients somewhat better, Receiver Operating Characteristic (ROC) and two other questions about satisfaction. Analysis was performed in the whole sample and by tertiles of baseline severity. Likewise were calculated the percentages of patients who attained cut-off values. RESULTS: Global MCID for pain were about 30 in both cohorts and 32 for. By ROC these values were about 20 and 24 respectively. According to the other two transitional questions these values were for pain 27 and 20 for function. By tertiles the worst the baseline score the higher the cut-off values. Percentage of responders does not change when comparing responders to the global MCID with their own tertile MCID and were about 61% for pain and 50% for function. CONCLUSION: Due to the wide variations, MCID estimates should be calculated and used according to the baseline severity score.

Usefulness of antimicrobial susceptibility in the eradication of Helicobacter pylori.

The rate of eradication of Helicobacter pylori with standard triple therapy using omeprazole, amoxicillin and clarithromycin (OAC) is unacceptable in populations with high rates of clarithromycin resistance (15-20%). The aim of this study was to compare the efficacy of 10-day OAC therapy as the first-line treatment in patients diagnosed by culture with antimicrobial susceptibility or diagnosed by a (13) C-labelled urea breath test (UBT) without antimicrobial susceptibility in an area where the clarithromycin resistance rate was 15-20%. This was a retrospective cohort study of 266 patients, recruited consecutively throughout 2008. A total of 247 H. pylori-infected patients received antibiotic therapy (221 received the 10-day OAC therapy and 26 received other regimens) of which 134 patients were diagnosed by culture of gastric samples followed by antimicrobial susceptibility testing and 113 were diagnosed by UBT. In all patients, the eradication of H. pylori was checked by UBT. The cost of eradication by 10-day OAC treatment was assessed in each patient. The success rate of 10-day OAC therapy in patients diagnosed by culture and by UBT was 88% (103/117) and 49% (51/104), respectively (p <0.0005). The treatment was also more cost-effective in the former of these two groups (€571 versus €666). To perform culture and antimicrobial susceptibility of the H. pylori isolates was a more successful and cost effective strategy than empirical 10-day OAC treatment in populations with high rates of resistance to clarithromycin.

[Primary hip replacement: first year results and predictive factors of poor outcome]. / Artroplastia primaria de cadera: resultados en el primer año y factores predictores de mala evolución.

OBJECTIVE: To evaluate the results of total hip arthroplasty in patients with osteoarthritis and to identify predictors of poor functional outcome. MATERIAL AND METHODS: A prospective observational study in patients operated on in 2006 with total hip arthroplasty in 4 hospitals in Guipúzcoa, followed up for 1 year. OUTCOME VARIABLES: pain, physical function, complications, mortality, quality of life by WOMAC and SF-12 (at 0, 3, 6 and 12 months) and «Poor functional outcome¼ at one year (last quartile of the WOMAC in function area). Logistic regression was performed to examine predictors of poor functional outcome. RESULTS: A total of 166 patients were followed up. The incidence of systemic and local complications was 6.3% and 14.5%, respectively, 4.3% readmissions and no deaths related to surgery. Close to 40 points improvement in pain, stiffness and WOMAC functional limitation, mainly in the first 3 months after surgery. A similar trend was seen, but lower in the physical and mental component of the SF12 (12 and 8 points, respectively). The previous score on the WOMAC function area and the physical component of SF-12, and the existence of any complications, are predictors of poor functional recovery. DISCUSSION: The improvement experienced after the surgery is already very important before the third month. The functional and physical status before surgery and possible complications of surgery are significant determinants of the results.

Artroplastia primaria de cadera: resultados en el primer año y factores predictores de mala evolución / Primary hip replacement: first year results and predictive factors of poor outcome

Objetivo. Evaluar los resultados del primer año en la artroplastia total de cadera de pacientes con osteoartritis e identificar los factores predictores de mala evolución funcional. Material y método. Estudio observacional, prospectivo en pacientes intervenidos en 2006 con artroplastia total de cadera en 4 hospitales de Guipúzcoa, seguidos durante un año. Variables de resultado: dolor, función física, complicaciones, mortalidad, calidad de vida mediante WOMAC y SF-12 (a 0, 3, 6 y 12 meses) y «mal resultado funcional» al año (último cuartil del WOMAC en área de función). Mediante regresión logística se estudiaron los factores predictores de mal resultado funcional. Resultados. Se incluyeron 166 pacientes. La incidencia de complicaciones sistémicas y locales fue de 6,3 y 14,5%, respectivamente, con 4,3% de reingresos y sin fallecimientos relacionados con la cirugía. Mejoría cercana a 40 puntos en dolor, rigidez y limitación funcional del WOMAC, principalmente en los primeros tres meses postintervención. Evolución similar, pero inferior en el componente físico y mental del SF12 (12 y 8 puntos respectivamente). La puntuación previa en el área de función de WOMAC y en el componente físico del SF-12, así como la existencia de alguna complicación, son factores predictores de la mala recuperación funcional. Discusión. La mejoría experimentada tras la intervención es ya muy relevante antes del tercer mes. La situación funcional y física previa a la intervención y las posibles complicaciones de la cirugía son factores determinantes de los resultados (AU)

Objective. To evaluate the results of total hip arthroplasty in patients with osteoarthritis and to identify predictors of poor functional outcome. Material and methods. A prospective observational study in patients operated on in 2006 with total hip arthroplasty in 4 hospitals in Guipúzcoa, followed up for 1 year. Outcome variables: pain, physical function, complications, mortality, quality of life by WOMAC and SF-12 (at 0, 3, 6 and 12 months) and «Poor functional outcome» at one year (last quartile of the WOMAC in function area). Logistic regression was performed to examine predictors of poor functional outcome. Results. A total of 166 patients were followed up. The incidence of systemic and local complications was 6.3% and 14.5%, respectively, 4.3% readmissions and no deaths related to surgery. Close to 40 points improvement in pain, stiffness and WOMAC functional limitation, mainly in the first 3 months after surgery. A similar trend was seen, but lower in the physical and mental component of the SF12 (12 and 8 points, respectively). The previous score on the WOMAC function area and the physical component of SF-12, and the existence of any complications, are predictors of poor functional recovery. Discussion. The improvement experienced after the surgery is already very important before the third month. The functional and physical status before surgery and possible complications of surgery are significant determinants of the results (AU)

Patient acceptable symptom state and OMERACT-OARSI set of responder criteria in joint replacement. Identification of cut-off values.

OBJECTIVE: To identify new cut-off values beyond which patients can be considered as satisfied or as responders through patient acceptable symptom state (PASS) and OMERACT-OARSI (Outcome Measures in Rheumatology-Osteoarthritis Research Society International) set of responder criteria in total joint replacement. METHODS: Secondary analysis of a 1-year prospective multicenter study of 861 patients, 510 with total knee replacement (TKR) and 351 with total hip prosthesis (THR). Pain and function data were collected by the reverse scoring option of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). PASS values were identified with the 25th centile estimation using an anchoring question about satisfaction with actual symptoms. OMERACT-OARSI set of responder criteria was based on a combination of absolute and relative change of pain, function and global patient's assessment. Receiver operating characteristic (ROC) analysis was used as a complementary approach. RESULTS: The values for PASS were about 80 and 69 for pain and function in THR, while these values were 80 and 68 when using OMERACT-OARSI criteria. Regarding TKR, PASS values were about 75 and 67 in pain and function with both criteria. ROC values were slightly lower in all cases. PASS and OMERACT-OARSI values varied moderately across tertiles of baseline severity. CONCLUSION: With the provided data we can establish when a patient can be considered as satisfied/responder in joint replacement. The scores achieved at 1 year were very similar according to both criteria.

Improving anaphylaxis management in a pediatric emergency department.

BACKGROUND: The management of anaphylaxis in pediatric emergency units (PEU) is sometimes deficient in terms of diagnosis, treatment, and subsequent follow-up. The aims of this study were to assess the efficiency of an updated protocol to improve medical performance, and to describe the incidence of anaphylaxis and the safety of epinephrine use in a PEU in a tertiary hospital. METHODS: We performed a before-after comparative study with independent samples through review of the clinical histories of children aged <14 years old diagnosed with anaphylaxis in the PEU according to the criteria of the European Academy of Allergy and Clinical Immunology (EAACI). Two allergists and a pediatrician reviewed the discharge summaries codified according to the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) as urticaria, acute urticaria, angioedema, angioneurotic edema, unspecified allergy, and anaphylactic shock. Patients were divided into two groups according to the date of implantation of the protocol (2008): group A (2006-2007; the period before the introduction of the protocol) and group B (2008-2009; after the introduction of the protocol). We evaluated the incidence of anaphylaxis, epinephrine administration, prescription of self-injecting epinephrine (SIE), other drugs administered, the percentage of admissions and length of stay in the pediatric emergency observation area (PEOA), referrals to the allergy department, and the safety of epinephrine use. RESULTS: During the 4 years of the study, 133,591 children were attended in the PEU, 1673 discharge summaries were reviewed, and 64 cases of anaphylaxis were identified. The incidence of anaphylaxis was 4.8 per 10,000 cases/year. After the introduction of the protocol, significant increases were observed in epinephrine administration (27% in group A and 57.6% in group B) (p = 0.012), in prescription of SIE (6.7% in group A and 54.5% in group B) (p = 0.005) and in the number of admissions to the PEOA (p = 0.003) and their duration (p = 0.005). Reductions were observed in the use of corticosteroid monotherapy (29% in group A, 3% in group B) (p = 0.005), and in patients discharged without follow-up instructions (69% in group A, 22% in group B) (p = 0.001). Thirty-three epinephrine doses were administered. Precordial palpitations were observed in one patient. CONCLUSION: The application of the anaphylaxis protocol substantially improved the physicians' skills to manage this emergency in the PEU. Epinephrine administration showed no significant adverse effects.

Influence of mode of delivery on pelvic organ support 6 months postpartum.

AIMS: The aims of this study were to describe pelvic organ support 6 months postpartum among women who delivered by cesarean section, spontaneous and instrumental vaginal delivery, and to evaluate the differences between the groups. METHODS: This was a cross-sectional study of 382 primigravid women who gave birth at Donostia Hospital during 2007. Pelvic organ support was explored 6 months postpartum using the pelvic organ prolapse quantification (POPQ) system. Joint hypermobility, height and weight were also assessed. RESULTS: POPQ stage ≥II was present in 7.7, 18.1 and 29.0% of women who delivered by cesarean section, spontaneous and instrumental vaginal delivery, respectively. Spontaneous vaginal delivery increased the risk by more than three times (OR 3.19; 95% CI 1.07-9.49) while instrumental vaginal delivery increased it more than fivefold (OR 5.52; 95% CI 1.79-17.30) in comparison with cesarean section. Instrument-assisted delivery did not increase the risk of prolapse in women who delivered vaginally. CONCLUSIONS: Cesarean section is associated with a lower prevalence of pelvic organ prolapse after delivery. Instrument- assisted delivery is not associated with an increased risk of postpartum prolapse among women who delivered vaginally.

Incidence of overactive bladder after vaginal hysterectomy and associated repairs for pelvic organ prolapse.

OBJECTIVE: The aim of this study was to determine the incidence of overactive bladder (OAB) after vaginal hysterectomy for pelvic organ prolapse (POP) and analyze the associated risk factors. STUDY DESIGN: This was a retrospective cohort study of 217 patients who underwent primary POP vaginal surgery between the years 2000 and 2004 in Donostia Hospital and who did not report OAB before surgery. A personal interview was undertaken after surgery for the diagnosis of OAB, taking into account the ICS 2002 definition. Descriptive statistical analyses and multivariate logistic regression were performed to determine the factors associated with the development of OAB after POP surgery. RESULTS: De novo OAB was diagnosed in 43 (19.8%) patients. The median time at onset of OAB symptoms after surgery was 3 months. Urge urinary incontinence was present in 28 patients (12.9%). Those women operated on also for stress urinary incontinence were at an increased risk for de novo OAB. CONCLUSION: Nearly 20% of women operated on for POP develop OAB soon after surgery. Those operated on for POP and stress urinary incontinence are more at risk.

Female breast cancer in Gipuzkoa: prognostic factors and survival.

BACKGROUND: In Gipuzkoa, screening for breast cancer was initiated in 1997 and in this paper we present breast cancer characteristics and survival for women diagnosed during the pre-screening period. METHODS: All cases diagnosed during 1995-1996 were included and the tumour characteristics were analysed. One-, five- and ten-year observed and relative survival (RS) were estimated overall, as well as by age and tumour characteristics. Multiple regression models were used to evaluate the effect of tumour characteristics on ten-year RS. RESULTS: Six hundred and twenty-two cases with a mean age of 60.7+/-15 years were included. The mean follow-up was 7.5 years (max. 10) with a mortality of 40.5%. Ductal carcinoma accounted for 78% of all cases; almost 50% had good or moderate differentiation and 28% were positive for both hormone receptors studied. Nearly 80% of cases were diagnosed in stage I or II and breast-conserving surgery was employed more often than mastectomy. Age-standardised RS was 77% (95% CI 72.1-82.3) and 68% (95% CI 60.4-74.6), five and ten years after diagnosis respectively. The relative excess risk of death was significantly different only for age, stage and degree of differentiation. DISCUSSION: This study shows an increase in survival compared to previous studies in the region. This could be explained by advances in diagnosis and treatment, as demonstrated by younger age and earlier stage at diagnosis and by the therapy profiles. Age and stage were shown to be major predictors of survival in our study and adjustment for the other factors had only limited effects on the risk of death for these two variables.

Female breast cancer in Gipuzkoa: prognostic factors and survival

BACKGROUND: In Gipuzkoa, screening for breast cancer was initiated in 1997 and in this paper we present breast cancer characteristics and survival for women diagnosed during the pre-screening period. METHODS: All cases diagnosed during 1995-1996 were included and the tumour characteristics were analysed. One-, five- and ten-year observed and relative survival (RS) were estimated overall, as well as by age and tumour characteristics. Multiple regression models were used to evaluate the effect of tumour characteristics on ten-year RS. RESULTS: Six hundred and twenty-two cases with a mean age of 60.7+/-15 years were included. The mean follow-up was 7.5 years (max. 10) with a mortality of 40.5%. Ductal carcinoma accounted for 78% of all cases; almost 50% had good or moderate differentiation and 28% were positive for both hormone receptors studied. Nearly 80% of cases were diagnosed in stage I or II and breast-conserving surgery was employed more often than mastectomy. Age-standardised RS was 77% (95% CI 72.1-82.3) and 68% (95% CI 60.4-74.6), five and ten years after diagnosis respectively. The relative excess risk of death was significantly different only for age, stage and degree of differentiation. DISCUSSION: This study shows an increase in survival compared to previous studies in the region. This could be explained by advances in diagnosis and treatment, as demonstrated by younger age and earlier stage at diagnosis and by the therapy profiles. Age and stage were shown to be major predictors of survival in our study and adjustment for the other factors had only limited effects on the risk of death for these two variables (AU)

No disponible

Synovitis-acne-pustulosis-hyperostosis-osteitis syndrome and psoriatic arthritis exhibit a different immunogenetic profile.

BACKGROUND AND OBJECTIVES: Patients with psoriatic arthritis (PsA) as well as those with synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome share some common features, and in fact, for many authors the SAPHO concept fits well into the broader concept of PsA. However, some clinical features are unique to the SAPHO syndrome, and in the other hand, these patients do not show the known association between the HLA-B27 antigen and the spondyloarthropathies. To date, there are no studies comparing the immunogenetic profile of these two conditions, so the main objective of the present report was to analyse whether or not both entities may share the same genetic basis. PATIENTS AND METHODS: All patients with SAPHO syndrome (n=25) seen in a single university hospital from 1985 to 2005 were recruited and followed up in standardised manner in order to study their main characteristics and HLA profile. The HLA-Cw6, DR and B27 antigen distribution of these cases was compared to that of 50 patients with psoriasis vulgaris, 120 with PsA, and 170 healthy blood donors. PsA patients were classified in accordance with their predominant pattern observed in the last 5 years of disease evolution. Odds ratios (OR) values were calculated to measure the strength of the association between HLA antigens and disease, while the statistical significance of the association was assessed with a two-tailed Fisher's exact test. P<0.05 values were considered significant. RESULTS: No association was found between HLA-Cw6, B27, or DR antigens, and SAPHO syndrome. HLA-Cw6 was strongly associated with psoriasis, OR 12 (95% CI: 5.6-26, p<0.0001) and PsA, OR 10 (95% CI: 5.4-19.5, p<0.0001), however this antigen was equally distributed among the three articular categories of PsA. HLA-DR4 was found under-represented in PsA patients compared to controls, OR 0.4 (95% CI: 0.2-0.7, p=0.002). HLA-DR7 correlated well with psoriatic oligoarthritis, OR 9.6 (95% CI: 2.9-28, p<0.0001), HLA-DR8 was found associated with polyarthritis, OR 6.7 (95% CI: 2-25, p=0.002), while HLA-B27 was over-represented in psoriatic spondylitis, OR 10 (95% CI: 3.3-25, p<0.0001). CONCLUSIONS: Psoriasis/PsA and SAP-HO syndrome show a different immunogenetic background, however the genetic basis of SAPHO syndrome remains unknown.

Evolución del tratamiento del cáncer de cérvix en Guipúzcoa, 1998-2002 / No disponible

Propósito: A partir de 1999, la evidencia disponible recomienda un cambio en el enfoque de lostratamientos. Nuestro propósito es describir las características de los tumores de cérvix tratados enGuipúzcoa durante 1998 y analizar las diferencias en los tratamientos entre 1998 y 2002 en los tumoresinvasivos.Material y métodos: La identificación de los casos se realizó a partir de los Registros de TumoresHospitalarios (RTH) y en su defecto de los Archivos del Servicio de Anatomía Patológica yAltas Hospitalarias. La recogida de información fue a partir de los RTH y RCPG (Registro de CáncerPoblacional de Guipúzcoa) y mediante revisión de historias clínicas para las variables no incluídas endichos registros.Resultados: En 1998 en Guipúzcoa se trataron 91 casos. El número de tumores invasivos diagnosticadosen residentes en Guipúzcoa fue de 25 en 1998 y 20 en 2002. En 1998 la clasificación porestadios de la totalidad de tumores tratados en Guipúzcoa fue: estadio 0, 41.8%; estadio I, 17.7%; estadioII, 17,6%; estadio III, 18,7%; y estadio IV, 4.4. La proporción de tumores tratados con radioterapiay quimioterapia con o sin cirugía en estadios II, III y IV aumenta significativamente del año 1998al 2002: 21.4% versus 72.7%; p=0.01.Conclusiones: Entre 1998 y 2002 el tratamiento del cáncer de cérvix invasivo cambia significativamenteadecuándose a la evidencia científica disponible

Purpose: Beginning in 1999, the available evidence recommended a change of focus in thetreatment of cervical cancer. We describe cervical tumours treated in Guipúzcoa during 1998 andanalyse the differences in the treatment of invasive tumours between 1998 and 2002.Material and methods: Cases were identified from the Hospital Tumour Registries (HTR)and, where not available, from the Archives of the Anatomic Pathology Service and HospitalDischarges. Information was collected from the HTR and the Guipúzcoa Population Cancer Registryand by review of clinical records for variables not included in these registries.Results: Ninety-one cases of cervical carcinoma diagnosed and/or treated in Guipúzcoa in 1998were included. The number of invasive tumours diagnosed in residents of Guipúzcoa was 25 in 1998and 20 in 2002. In 1998 the classification by stage of all such tumours treated in Guipúzcoa was: stage0, 41.8%; stage I, 17.7%; stage II, 17.6%; stage III, 18.7%; and stage IV, 4.4%. The proportion oftumours treated with radiation therapy and chemotherapy with or without surgery in stages II, III andIV increased significantly from 1998 to 2002: 21.4% versus 72.7%; p=0.01.Conclusion: Between 1998 and 2002 the treatment of invasive cervical cancer in Guipúzcoa changed significantly, in line with the available scientific evidence (AU)