[Comparative study between cystoscopy, urinary cytology, NMP-22 and a new method, bladder chek, in the follow-up of superficial bladder cell carcinoma]. / Estudio comparativo entre cistoscopia, citología urinaria, NMP-22 y un nuevo método, bladder chek, en el seguimiento del cáncer vesical superficial.

OBJECTIVE: The goal of this work tries to evaluate the utility of the qualitative determination of NMP-22 in the evaluation of the superficial bladder carcinoma in asymptomatic patients, comparing it with its quantitative determination, the cytology and the cystoscopy. MATERIALS AND METHODS: A simple of urine just voided was taken in 88 asymptomatic patient follow-up for superficial bladder cell carcinoma. This dose was distributed in 3 parts, for performed cytology, for determination of NMP-22, and 4 drops of the third part are added to device bladder chek. Later, we performed cystoscopy and transurethral resection in patients with a suspicion of bladder cancer. RESULTS: 26 patients had tumor relapse and 62 patients were free of disease. The sensitivity for the bladder chek was of 28%, 34.62% for NMP-22, 34.62% for cytology and 100% for cystoscopy. The specificity was of 93.55%, 80.33%, 87.10% and 87.10% respectively. The sensitivity by degree was 25 in G1, 28.57 in G2 and 50 in G3 for Bladder chek; 29.41, 42.86 and 50 for NMP-22; 23.53, 71.43 and 0 for cytology. The sensitivity by stages was 27.7 in Ta-1 and 50 in T2 for Bladder chek; 34.78 and 50 for NMP-22; 39.13 and 0 for the cytology. CONCLUSIONS: The low sensitivity of bladder chek invalidates it like alternative method to the cystoscopy in the follow-up of the superficial asymptomatic bladder cell carcinoma.

Estudio comparativo entre cistoscopia, citología urinaria, NMP-22 y un nuevo método, bladder chek, en el seguimiento del cáncer vesical superficial / Comparative study between cystoscopy, urinary cytologym, NMP-22 and new method, bladder chek, in the follow-up of the superficial bladder cell carcinoma

Objetivo: Evaluar la utilidad de la determinación cualitativa del NMP-22 en el seguimiento del carcinoma vesical superficial en pacientes asintomáticos, comparándolo con su determinación cuantitativa, la citología y la cistoscopia. Material y Métodos: 88 pacientes asintomáticos en seguimiento por carcinoma vesical superficial se les recogió una muestra de orina recién emitida, repartiéndose en 3 alícuotas, para citología, NMP-22 y 4 gotas se añaden al dispositivo Bladder chek, para su lectura en 30 minutos. Posteriormente, cistoscopia y RTU-vesical en sospecha de recidiva. Resultados: 26 pacientes tenían recidiva tumoral y 62 estaban libres de enfermedad. La sensibilidad fue del 28% para el Bladder chek, 34.62% para el NMP-22, 34.62% para la citología y de 100%para la cistoscopia. La especificidad fue de 93.55%, 80.33%, 87.10% y 87.10% respectivamente. La sensibilidad por grado fue: 25 en G1, 28.57 en G2 y 50 para G3 en Bladder chek, de 29.41, 42.86, 50 para NMP-22 respectivamente, 23.53, 71.43, 0 para la citología. Por estadios la sensibilidad fue: 27.27 para Ta-1 y 50 en T2 para Bladder chek, 34.78, 50 para NMP-22 y 39.13, 0 para la citología. Conclusiones: La baja sensibilidad del Bladder chek lo invalida como método alternativo a la cistoscopia en el seguimiento del carcinoma vesical superficial asintomático (AU)

Objective: The goal of this work tries to evaluate the utility of the qualitative determination of NMP-22 in the evaluation of the superficial bladder carcinoma in asymptomatic patients, comparing it with its quantitative determination, the cytology and the cystoscopy. Materials and Methods: A simple of urine just voided was taken in 88 asymptomatic patient follow-up for superficial bladder cell carcinoma. This dose was distributed in 3 parts, for performed cytology, for determination of NMP-22, and 4 drops of the third part are added to device bladder chek. Later, we performered cystoscopy and transurethral resection in patients with a suspicion of bladder cancer. Results: 26 patients had tumor relapse and 62 patients were free of disease. The sensitivity for the bladder chek was of 28%, 34.62% for NMP-22, 34.62% for cytology and 100% for cystoscopy. The specificity was of 93.55%, 80.33%, 87.10% and 87.10% respectively. The sensitivity by degree was 25 in G1, 28.57 in G2 and 50 inG3 for Bladder chek; 29.41, 42.86and 50 for NMP-22; 23.53, 71.43 and 0 for cytology. The sensitivity by stages was 27.7 in Ta-1 and 50 in T2 for Bladder chek; 34.78 and 50 for NMP-22; 39.13 and 0 for the cytology. Conclusions: The low sensitivity of bladder chek invalidates it like alternative method to the cystoscopy in the follow-up of the superficial asymptomatic bladder cell carcinoma (AU)

[Detection of malnutrition on admission to hospital]. / Detección de malnutrición al ingreso en el hospital.

In view of the high prevalence of malnutrition in hospitals as shown by some studies and in the light of its direct impact on the increase in morbidity and mortality among hospitalized patients, it is necessary to ensure the early identification of this condition. This would allow appropriate nutritional treatment to be instituted as soon as possible for patients at risk who require it. The present multi-centric study included the participation of hospitals in the northern region of the country which have a Nutrition Unit, with use of the Overall Subjective Assessment and a few basic parameters. The study analyzed the nutritional status on admission of 620 patients hospitalized in the Internal Medicine and General Surgery areas during the months of December, 1999, January, February and March, 2000. We detected moderate malnutrition or suspected malnutrition in 20% of the patients studied and severe malnutrition in 18.2%, with a greater incidence in Internal Medicine. Malnutrition was mainly evidenced by weight loss of more than 5% and a reduction in subcutaneous fat and muscle mass. In addition, there are functional limitations on performing everyday activities. Changes in dietary intake were present in 40.8% of the patients. The associated gastro-intestinal symptoms included anorexia, which affected 37.7% of the group studied. Malnutrition is most frequently linked with infectious diseases, problems in circulation and with the digestive apparatus. We feel that the Overall Subjective Assessment, together with the measurement of height and weight, should be used systematically with patients on admission, as it is a simple and effective method for the identification of patients with nutritional risk.

NMP 22, BTA stat test and cytology in the diagnosis of bladder cancer: a comparative study.

OBJECTIVE: To evaluate the usefulness of the NMP 22 and BTA stat test in the diagnosis and follow-up of bladder cancer and to compare these tests to cytology and cystoscopy, routine diagnostic methods. METHODS: 150 patients followed up for bladder cancer or symptoms suggestive of bladder cancer underwent cystoscopy after cytology, NMP 22 and BTA stat test using a recently voided urine sample. In suspect cases, TUR and histopathological analysis were performed. RESULTS: Bladder cancer was proven in 76 patients and excluded in 74. For NMP 22 we have used the cutoff value recommended by the manufacturer (10 U/ml) and that obtained by our receiver-operating characteristic curve (6 U/ml). Sensitivity was 84.21% for NMP 22 at the cutoff value of 6 U/ml and 76.32% with 10 U/ml; 72.37% for BTA stat test; 69.74% for cytology, and 100% for cystoscopy. Specificity was 86.49% for NMP 22 at a cutoff value of 6 U/ml and 90.54% at 10 U/ml; 89.19% for the BTA stat test; 93.24% for cytology and 89.19% for cystoscopy. NMP 22 sensitivity for grades 1, 2, and 3 was 68.75, 75.86 and 100%, respectively, at a cutoff value of 6 U/ml, and 50, 68.97 and 96.77%, respectively, at a cutoff level of 10 U/ml; for BTA stat the sensitivity was 56.25% in G1, 62.07% in G2 and 90.32% in G3, and for cytology the sensitivity was 43.75, 62.07 and 90.32%, respectively. The sensitivity of NMP 22 was 68.75% in stage Ta, 84.78% in T1 and 100% in T2-T4 at a cutoff level of 6 U/ml and 50, 80.43 and 92.86%, respectively, at a cutoff level of 10 U/ml; BTA stat sensitivity was 50% in Ta, 73.91% in T1 and 92.86% in T2-T4; and in cytology the results were 37.50, 73.91 and 85.71%, respectively. Using the McNemar test, there was only a significant difference between the sensitivity of NMP 22 at a cutoff level of 6 U/ml and cytology in the overall sample. CONCLUSIONS: The high sensitivity of the NMP 22 and BTA stat test in combination with the data obtained from the parameters used for the evaluation of the test demonstrate their usefulness in the diagnosis and follow-up of bladder cancer. NMP 22 at a cutoff value of 6 U/ml is significantly more sensitive than cytology and consequently a thoroughly valid diagnostic tool in the diagnosis of bladder cancer which may substitute voided urine cytology.

Usefulness of the BTA STAT Test for the diagnosis of bladder cancer.

OBJECTIVES: To evaluate the usefulness of the Bard BTA stat Test in the diagnosis and follow-up of bladder cancer and to compare this test to cytologic analysis and cystoscopy, routine diagnostic methods. METHODS: Three hundred seventy-nine patients being followed up because of bladder cancer or with symptoms suggestive of bladder cancer underwent cystoscopy, cytologic analysis, and the BTA stat Test using a recently voided urine sample. In suspected cases, transurethral resection and histopathologic analysis were performed. RESULTS: Of the 379 patients, 235 proved to have bladder cancer and 144 did not. The sensitivity was 73.62% for the BTA stat, 61.70% for cytologic examination, and 99.57% for cystoscopy. The specificity was 83.33% for the BTA stat, 92.36% for cytologic analysis, and 85.42% for cystoscopy. The BTA stat Test's sensitivity for grades 1, 2, and 3 tumor was 47.27%, 69.15%, and 95.35%, respectively. The sensitivity of cytologic analysis was 30.91%, 55.32%, and 88.37%. The BTA stat Test's sensitivity for stage was 45.65% in Stage Ta, 75.52% in T1, and 95.56% in Stage T2-4; the cytologic results were 28.26%, 65.03%, and 84.44%, respectively. The combination of both tests improved the sensitivity and decreased the specificity slightly. CONCLUSIONS: The high sensitivity of the BTA stat Test, together with the data obtained from the parameters used for the evaluation of the test, demonstrate the better results of the BTA stat Test compared with cytologic analysis, making it a thoroughly valid diagnostic tool in the diagnosis of bladder cancer. In our opinion, the BTA stat Test can replace the use of cytologic analysis in the diagnosis of bladder cancer, but not the use of cystoscopy.

[Intravascular ultrasonographic evaluation of direct stents, implanted without predilatation. Comparison of results according to lesion types]. / Evaluación con ultrasonografía intravascular de stents implantados sin predilatación (stents directos). Comparación de resultados según el tipo de lesión.

INTRODUCTION AND OBJECTIVES: Direct stenting is a safe and feasible technique in selected lesions yielding excellent angiographic results. However, there are no studies providing intravascular ultrasonographic examination after direct stenting. The aim of this study was to evaluate direct stent expansion with ultrasonography and to know whether there are differences in the results based on lesion types. METHODS: Patients with amenable lesions for direct stenting were enrolled; including patients with no occlusion, no calcification, no significant tortuosity or angulation, a length 15 mm and a reference lumen diameter 2.5 mm. Intravascular ultrasonography was performed after stent implantation. The ultrasonographic criteria for optimal expansion were: complete apposition and a minimal intrastent lumen area > 80% of the average reference luminal area and 90% of the distal reference lumen area. RESULTS: We included 40 patients (50 lesions). The final angiographic result was good in all the patients but in one case an additional stent was used due to dissection. The ultrasonographic examination did not show significant differences between type A and B lesions. Optimal expansion was achieved in 14/21 (66%) of type A lesions and 17/29 (58%) of type B lesions (p = 0.5). The balloon/artery ratio was the only factor significantly related to ultrasonographic results. When this ratio was 1.1-1.2 (25 cases), 76% of the stents were optimally expanded and when the ratio was < 1. 1 (25 cases) only in a 48% an optimal result was achieved (p < 0.05). CONCLUSIONS: Direct stenting in selected lesions provides ultrasonographic results comparable to those expected with conventional stenting and these results could be even improved if a balloon artery ratio 1.1-1.2 is used. Taking into consideration the selection criteria the differences observed between lesion types A and B are not significant.

El NMP-22 en el diagnóstico del cáncer vesical / The NMP-22 in the diagnosis of bladder cancer

OBJETIVOS: Evaluar la utilidad del test NMP-22 en el diagnóstico del cáncer vesical; calcular el punto ideal de corte; comparar los resultados con la citología urinaria y cistoscopia. MATERIAL Y MÉTODO: 166 pacientes con sospecha clínica o en seguimiento por cáncer vesical. Se excluyen pacientes con otras enfermedades urológicas, radioterapia en los últimos tres meses, quimioterapia sistémica en el último mes, trauma reciente de vejiga y portadores de sonda vesical. Se recoge una muestra de orina recién emitida y se separa en dos alícuotas, una para citología u otra para NMP-22; posteriormente se hace cistoscopia y RTU si se sospecha tumor vesical. Mediante curva ROC calculamos el valor ideal de corte para NMP-22. Para cada prueba calculamos sensibilidad, especificidad, valor predictivo positivo y negativo. Se comparan los resultados de las diferentes pruebas con el test de McNemar. Todos los resultados se dan con un intervalo de confianza del 95 por ciento. RESULTADOS: El punto ideal de corte fue 6 U/ml; con él se obtiene una sensibilidad del 82,72 por ciento frente al 67,90 por ciento de la citología (p = 0,0118). La especificidad fue del 80 por ciento y 94,12 por ciento respectivamente (p = 0,0018). Por grados la sensibilidad fue 72,22 por ciento en G1, 70,97 por ciento en G2 y 100 por ciento en G3 para el NMP-22 frente a 44,44 por ciento, 58,06 por ciento y 90,62 por ciento de la citología. Por estadios fue 68,42 por ciento Ta, 83,83 por ciento T1 y 100 por ciento T2 o superior con NMP-22 frente a 36,84 por ciento, 75 por ciento y 85,71 por ciento de la citología. La cistoscopia detectó el 100 por ciento de los tumores, su especificidad fue 89,41 por ciento. CONCLUSIONES: El NMP-22 es un test útil en el diagnóstico del cáncer vesical; más sensible y menos específico que la citología, a la que pensamos que puede reemplazar en el protocolo de diagnóstico y seguimiento del cáncer vesical. El punto ideal de corte se sitúa en 6 U/ml (AU)

[Comparative study of BTA stat test, NMP-22, and cytology in the diagnosis of bladder cancer]. / Estudio comparativo entre el BTA stat test, NMP-22 y citología en el diagnóstico del cáncer vesical.

OBJECTIVE: To compare the sensitivity and specificity of the BTA stat test, NMP-22 and voided urine cytology in the diagnosis of bladder cancer. METHODS: The study comprised 100 patients or follow-up or with a suspicion of bladder cancer. A voided urine sample was obtained and alliquoted in three samples for the BTA stat test, NMP-22 and cytology. The patients were subsequently evaluated by cystoscopy and TUR was performed when cancer was suspected. The bladder cancer was classified according to TNM stage and WHO grade. The McNemar test was utilized to compare the results. The cut-off level used for NMP-22 was 10 U/ml. ROC curves were plotted to determine the NMP-22 values for optimal sensitivity and specificity in our seires. RESULTS: Two patients were excluded from the study. The overall sensitivity was 76.47% for cytology, 78.43% for the BTA stat test and 84.31% for NMP-22 (p = n.s.). The specificity was 91.49%, 87.23% and 87.23% respectively (p = n.s.). By grade and stage, NMP-22 showed the best results followed by the BTA stat test and lastly cytology, although the differences were not significant. The ideal cut-off for NMP-22 in our series was 6 U/ml and not the generally recognized 10 U/ml. CONCLUSIONS: NMP-22 is superior to the BTA stat test and cytology in the diagnosis of bladder cancer, although the differences were not significant. The ideal cut-off in our series was 6 U/ml. The BTA stat test has the advantage of being easy to perform and provides the results in 5 minutes. In our view, NMP-22 and BTA stat test can replace cytology in the diagnosis of bladder cancer.

[NMP-22 in the diagnosis of bladder cancer]. / El NMP-22 en el diagnóstico del cáncer vesical.

OBJECTIVE: To evaluate the usefulness of the NMP-22 test in the diagnosis of bladder cancer; to calculate the ideal cutoff and to compare the results among NMP-22, voided urine cytology and cystoscopy. MATERIAL AND METHODS: 166 patients having clinical suspicious of bladder cancer or in follow-up due to a previous one. The exclusions criteria were: other urological conditions, radiotherapy in the last three months, systemic chemotherapy in the last month, recent vesical trauma or indwelling catheter. Prior cystoscopy a recent voided urinary sample was sent to the pathology and biochemistry laboratory to perform cytology and NMP-22. A TUR was performed in patients with bladder tumour. The cutoff was calculated with ROC curves. For each test we calculate sensitivity, specificity, positive and negative predictive value. We use the McNemar test to compare the results, all of which are expressed with a confidence interval of 95%. RESULTS: The ideal cutoff was 6 U/ml. We have a global sensitivity of 82.75% for NMP-22 and 67.9 for cytology (p = 0.0118); the specificity was 80% and 94.12% respectively (p = 0.0018). By grade the sensitivity was 72.22% G1, 70.97% G2 and 100% G3 for NMP-22 and 44.44%, 58.06% and 90.62% for cytology. By stage it was 68.42% Ta, 83.33% T1 and 100 T2 or more for NMP-22 and 36.84%, 75% and 85.71% for cytology. With the cystoscopy we obtained a 100% sensitivity and 89.41% specificity. CONCLUSIONS: The NMP-22 is a useful test for the diagnosis of bladder cancer; is more sensitive and less specific than cytology. We think it can replace the cytology in the diagnosis and follow-up of bladder cancer. The ideal cutoff is 6 U/ml.

[Role of nitric oxide in warm ischemia of the transplanted kidney]. / Estudio del papel del óxido nítrico en la isquemia caliente en el riñón trasplantado.

OBJECTIVE: Nitric oxide (NO) is a gas considered to have two roles: cytoprotective, derived from its vasodilating and anti-platelet aggregation effects, and cytotoxic, due to its free oxygen radical. It is produced by NO synthase; nitrites and nitrates are its end products. We investigated the role of NO in ischemia-perfusion injury. METHODS: For the study, we utilized dogs weighing 15 to 25 kg. Autotransplantation of the left kidney and right nephrectomy were performed. Group I comprised 9 dogs submitted to renal autotransplantation; group II comprised 6 dogs submitted to renal autotransplantation after 24 h cold ischemia; group III comprised 6 dogs submitted to renal autotransplantation after 24 h cold ischemia and subsequent warm ischemia of 30 min; group IV comprised 9 dogs submitted to renal autotransplantation after 24 h cold ischemia and 60 min warm ischemia. RESULTS: A significant fall in nitrite levels was observed in dogs that had some type of surgical injury. Nitrate levels increased significantly in dogs that had warm ischemia. At 30 min reperfusion, a significant increase in the production of constitutive enzyme was observed in all groups. A significant increase in inducible enzyme at 30 min reperfusion was observed in the first three groups and no inducible enzyme was produced in the group that had more injury from ischemia (group IV). CONCLUSION: Nitrites are markers of the injury produced by surgery. Nitrates clearly express the injury to the organs caused by warm ischemia-reperfusion. The cNOS enzyme increases after surgery in response to surgical insult or stress. The iNOS enzyme increases in the kidneys that have suffered ischemia and are viable. Non-viable kidneys express no enzymatic activity (cNOS, iNOS).