El suicidio: un reto para la prevención / Suicide: the challenge of prevention

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Tratamiento no farmacológico de la obesidad / No disponible

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Cirugía de alta resolución pediátrica: una serie de 75 casos / Paediatric one-stop surgery: a series of 75 cases

La cirugía de alta resolución (CAR) se define por la realización de la evaluación preoperatoria y la subsiguiente intervención quirúrgica en una única visita hospitalaria. El plan piloto de implantación de CAR se diseñó para la provincia de Bizkaia, y comprende una población de 124.494 niños de 1 a 14 años. El nuevo plan de trabajo permite pasar de 4 visitas hospitalarias en la cirugía ambulatoria habitual, a una única visita. El pediatra de atención primaria (PAP) en el centro de salud realiza el diagnóstico y la evaluación postoperatoria. Durante un período de 10 meses se han operado 75 niños siguiendo este programa. Las intervenciones realizadas fueron cirugía de pared abdominal, cirugía genital y cirugía de piel y partes blandas. Hubo 2 complicaciones menores. La valoración global de la asistencia recibida por parte de los familiares fue excelente en el 32,7% de los casos, muy buena en el 36,2%, buena en el 24,1% y regular en el 3,4% de los casos. La CAR es un avance más de la cirugía ambulatoria. La estrecha relación entre el cirujano y el PAP es esencial. Se consiguen los siguientes objetivos: disminución del número de consultas y tiempo de espera, reducción de los costes de los procesos, disminución de la sobrecarga del trabajo de los facultativos en jornada matinal, mejora de la organización y agilidad de su actividad, y aumento de la calidad percibida por los usuarios (AU)

By one-stop surgery is meant the performing of both the pre-surgery assessment and the surgical procedure on the same day. We report our experience with a pilot study on one-stop surgery in the province of Bizkaia, with a population of 124,494 children aged 1 to 14 years old. Under the new scheme, the patient average of four visits to the hospital outpatient clinics was cut down to only one. Diagnosis and pre-surgery assessments were made by the children's Primary Care Paediatricians at their NHS clinics. Seventy-five children were treated over 10 months. They had abdominal wall, genital or soft tissue surgery. Only two developed minor complications. Families were generally satisfied with the quality of the medical care received as shown by a survey: 32.7% scored it as "excellent", 36.2% "very good", 24.1% "good" and 3.4% "medium". We think that one-stop surgery is a breakthrough in ambulatory surgery. Not only does it dramatically lower the number of visits to hospital outpatient clinics, but also the waiting time for surgery, the costs, and the surgeon's workload, and helps streamline the Public Health Services and the quality of the medical care as perceived by both patients and families. Ensuring a close relationship between Paediatric Surgeons and Primary Care Paediatricians is paramount (AU)

[Paediatric one-stop surgery: a series of 75 cases]. / Cirugía de alta resolución pediátrica: una serie de 75 casos.

By one-stop surgery is meant the performing of both the pre-surgery assessment and the surgical procedure on the same day. We report our experience with a pilot study on one-stop surgery in the province of Bizkaia, with a population of 124,494 children aged 1 to 14 years old. Under the new scheme, the patient average of four visits to the hospital outpatient clinics was cut down to only one. Diagnosis and pre-surgery assessments were made by the children's Primary Care Paediatricians at their NHS clinics. Seventy-five children were treated over 10 months. They had abdominal wall, genital or soft tissue surgery. Only two developed minor complications. Families were generally satisfied with the quality of the medical care received as shown by a survey: 32.7% scored it as "excellent", 36.2% "very good", 24.1% "good" and 3.4% "medium". We think that one-stop surgery is a breakthrough in ambulatory surgery. Not only does it dramatically lower the number of visits to hospital outpatient clinics, but also the waiting time for surgery, the costs, and the surgeon's workload, and helps streamline the Public Health Services and the quality of the medical care as perceived by both patients and families. Ensuring a close relationship between Paediatric Surgeons and Primary Care Paediatricians is paramount.

Anaphylaxis produced by oxaliplatin.

We are discussing two patients, with clinically compatible reactions, who display an immediate hypersensitive mechanism following the administration of oxaliplatin, confirmed by the performance of cutaneous tests.

Análisis retrospectivo multicéntrico del tratamiento adyuvante con quimioradioterapia en pacientes con cáncer gástrico resecado. Resultados preliminares. Grupo Oncológico del Norte (G.O.N) / No disponible

INTRODUCCIÓN. En el carcinoma gástrico (CG), los resultados del estudio IT-0116 pusieron de manifiesto el beneficio del tratamiento con quimioterapia más radioterapia adyuvante después de cirugía radical R0, en un grupo de pacientes en los que la linfadenectomía D0 (inferior a D1) se había realizado en el 53% de los casos. Si los resultados de este estudio son trasladables a nuestros pacientes ha sido un punto de controversia. MATERIAL Y MÉTODOS. Hemos iniciado un análisis retrospectivo multicéntrico de los pacientes con CG que han recibido tratamiento adyuvante según la pauta de IT-0116. Analizamos las características de los pacientes, el tipo de linfadenectomía realizada, el número de ganglios analizados, el tratamiento recibido y la toxicidad. RESULTADOS. Analizamos 31pacientes. Se realizó una linfadenectomía D0 en 8(26%), D1 y entre D1-D2 en 12 (39%) y D2 en 9 (29%). Esplenectomía en 2 (6.5%). La mediana de ganglios analizados fue de 12 (2-38). El 90% presentaba ganglios positivos. De los 23 pacientes evaluables para la tolerancia al tratamiento, 17 pacientes (74%) completaron el tratamiento, 7 (32%) desarrollaron toxicidad hematológica grado 3-4 y 5 (20 %) toxicidad digestiva grado 3. La intensidad de dosis del 5FU fue del 86% (64-108%). CONCLUSIONES. En nuestros hospitales el número de pacientes con linfadenectomías D0 es inferior al del estudio IT-0116. Realizaremos análisis de supervivencia tras mayor tiempo de seguimiento (AU)

BACKGROUND. In gastric cancer, the results of Intergroup 0116 trial showed a benefit for adyuvant chemoradiotherapy after radical surgery. However, in 53% of this group of patients the lymphadenectomy had been D0 (less than D1). Controversy exists as to whether the results of this study can be applied to our patients. MATERIAL AND METHODS. We have conducted a retrospective multicentric analysis including patients with gastric cancer who have received adyuvant treatment with the IT-0116 regimen after complete resection. We analyze patients characteristics, the extent of lymph-node dissection, the number of cycles administered and toxicity. RESULTS. Thirty one patients were analyzed. 26% of the patients underwent a D0 dissection. A D1 lymphadenectomy or a lymphadenectomy between D1 and D2 were performed in 12 patients (39%) and a D2 in 9 patients (29%). 2 patients were splenectomized. The median number of nodes analyzed were 12 (2-38). 90% of the patients had positive-nodes. There were 23 patients evaluables for treatment toxicity. 17 patients (74%) completed treatment as planned. 7 patients (32%) developed hematologic toxicity grade 3-4 and 20% grade 3 diarrhea. The dose-intensity of fluorouracil was 83%(64-100%). CONCLUSIONS. We have less patients with a D0 lymphadenectomy in our hospitals than in the Intergroup trial. We will make a survival analysis after a longer follow-up (AU)

Phase I trial of weekly irinotecan combined with UFT as second-line treatment for advanced colorectal cancer.

The aim of this study was to determine the maximum-tolerated dose (MTD) and dose-limiting toxicity (DLT) of weekly Irinotecan (CPT-11) plus UFT, and to assess the antitumour activity of this combination as second-line chemotherapy in patients with advanced colorectal carcinoma, 31 patients with measurable advanced colorectal carcinoma were treated. Cohorts of 3 patients received increasing dose levels of the combination. Levels 1 to 4 included a fixed dose of oral (p.o.) UFT (250 mg/m(2)/day) for 21 days of a 28-day cycle combined with increasing intravenous (i.v.) doses of CPT-11 (80, 100, 110 and 120 mg/m(2)) on days 1, 8 and 15. Levels 5 and 6 included a higher fixed dose of oral UFT (300 mg/m(2)) combined with increasing i.v. doses of CPT-11 (100 and 110 mg/m(2)) on days 1, 8 and 15. 147 courses were administered. MTD were reached at level 4 (2 cases of grade 4 diarrhoea and 1 grade 3 asthenia), and level 6 (1 grade 4 diarrhoea, 1 grade 3 diarrhoea and 1 grade 3 febrile neutropenia). Responses in 30 evaluable patients were: 3 partial responses (10%), 15 stable disease (50%) and progressive disease in 12 patients (40%). Median time to progression was 4.5 months (95% Confidence Interval (CI): 3.4-6.6 months) and median survival was 11 months (95% CI: 7.9-14.1 months). The recommended doses for phase II trials are: (a) CPT-11 110 mg/m(2) i.v. on days 1, 8 and 15 every 28 days plus UFT 250 mg/m(2) p.o. on days 1 through to 21 or (b) CPT-11 100 mg/m(2) and UFT 300 mg/m(2).

Phase I trial of weekly gemcitabine at 3-h infusion in refractory, heavily pretreated advanced solid tumors.

Gemcitabine (2',2'-difluorodeoxycytidine) is a nucleoside analog with antitumor activity against a variety of malignancies. The critical enzyme cytidine kinase is saturated at plasma concentrations achieved after a 30-min infusion at conventional doses. Prolonged infusion time may yield higher intracellular dFdCTP concentrations. A phase I study was designed to determine the maximum tolerated dose (MTD) of gemcitabine, given by infusion for 3 h, in heavily pretreated patients. Twenty-seven patients (13 head and neck cancer, seven sarcoma, three esophageal cancer, three non-small-cell lung cancer and one ovarian cancer) were enrolled. Twenty patients were defined as refractory at first- or second-line chemotherapy. Four different entry dose levels (300, 400, 450 and 500 mg/m(2)) were evaluated for gemcitabine administered on days 1, 8 and 15 of a 28-day cycle. The MTD was defined as 450 mg/m(2), with granulocytopenia, thrombocytopenia and asthenia being dose limiting. The maximum grade III/IV patient toxicities for hemoglobin, leukocytes, neutrophils and platelets for all doses were 7, 19, 19 and 11%, respectively. Non-hematological toxicities included asthenia, nausea/vomiting and diarrhea. Thus, gemcitabine administered at a fixed 3-h infusion was well tolerated up to 450 mg/m(2) in heavily pretreated patients. Myelosupression and asthenia were dose-limiting toxicities.

Brain metastases from colorectal carcinoma.

AIMS AND BACKGROUND: Brain metastases are an unusual finding in patients with colorectal carcinoma. We wished to determine the clinical presentation, the time interval between the diagnosis of colorectal carcinoma and the appearance of brain metastases, and the overall survival. PATIENT CHARACTERISTICS: The median age of our patients was 61 years. Brain metastases developed subsequently to the diagnosis of colorectal cancer in nine patients. All patients had neurologic symptoms. All patients had progressing systemic disease at the moment of intracranial presentation. Four patients received whole brain radiation therapy. The median survival was 11 weeks. DISCUSSION: The development of brain metastasis is a late event in the course of colorectal carcinoma and occurs most often in patients with extensive systemic disease that contraindicates surgical resection. Radiotherapy can improve the survival of this group of patients whereas the role of chemotherapy is still unclear due to the low frequency of such cases.

Metástasis gingivales de cáncer de mama / Gingival metastases of breast cancer

Propósito: Efectuar una revisión bibliográfica que permita conocer la frecuencia y características de la aparición de lesiones metastásicas en los tejidos blandos de la cavidad oral. Material y métodos: Presentamos el caso de una mujer con cáncer de mama metastásico, la cual, en la última parte de su enfermedad desarrolló metástasis gingivales. Resultados: La aparición de metástasis a este nivel es extremadamente raro, no obstante pueden ser incluso la primera manifestación de un tumor. Conclusiones: En la evaluación de tumores gingivales debe tenerse en cuenta la posibilidad de que se trate de metástasis de neoplasias internas y el paciente deberá ser estudiado en este sentido tras el diagnóstico de neoplasia gingival (AU)

[Complete duplication of the urethra]. / Duplicación completa de uretra.

A case of complete urethral duplication in a child is presented. The malformation consisted of a normal urethra and another epispadial dorsal urethra ending at the dome of the bladder. This is a rare variant of this type of malformation. Incontinence was the surgical indication. The classification, embryology, diagnosis, indications for surgery and treatment of this anomaly are presented.