El papel pronóstico de la invasión perineural en la biopsia prostática / Prognostic role of perineural invasion in prostate biopsy

Introducción: A pesar de que la diseminación celular tumoral a través del sistema nervioso intraprostático se considera un mecanismo de progresión del cáncer prostático, el significado de la invasión perineural en biopsias de próstata para predecir extensión extraprostática y su utilidad como potencial factor pronóstico es controvertido. Material y métodos: Estudio retrospectivo llevado a cabo en una institución sobre 208 pacientes tratados con prostatectomía radical (enero 2007-julio 2010) en los que se ha determinado la presencia de invasión perineural y el score de gleason en la biopsia preoperatoria, así como el estadio clínico y el PSA prequirúrgico. Clasificamos los pacientes en grupos de riesgo según la clasificación de D’Amico. Realizamos análisis estadístico bivariante y multivariante para establecerla correlación entre las distintas variables. Resultados: Se objetivó IPN en el 18,3% de las biopsias prostáticas. Presentaron extensión extraprostática el 71% de los espécimenes de prostatectomía con invasión perineural en la biopsia previa vs. 23,1% cuando no existía este hallazgo (p < 0,0001) y márgenes positivos el 47,4% de los casos con IPN, frente a 18,3% sin invasión perineural (p < 0,0001). De hecho, en el análisis multivariante la invasión perineural demostró ser un factor de riesgo independiente para presentar extensión extraprostática y márgenes positivos en la pieza de prostatectomía. Conclusiones: La presencia de Invasión perineural es un factor pronóstico útil para la predicción de extensión extraprostática y afectación de márgenes quirúrgicos en la pieza de prostatectomía radical. Consideramos que su determinación puede ser una herramienta útil en la mejora del diagnóstico preoperatorio y en la planificación del tratamiento (AU)

Introduction: Despite tumour cell dissemination through the intraprostatic nervous systembeing considered as a prostate cancer progression mechanism, the significance of perineural invasion in prostate biopsies to predict extraprostatic extension and its use as a potential prognosis factor is controversial. Materials and methods: Retrospective study carried out at an institution on 208 patients treated with radical prostatectomy (January 2007 - July 2010) in which the presence of perineural invasion and the Gleason score in the preoperative biopsy were determined, as well as the clinical stage and the pre-surgery PSA. We classified the patients in risk groups in accordance with the D’Amico classification. We performed bivariate and multivariate statistical analyses to establish the correlations between the different variables. Results: We objectified PNI in 18.3% of the prostate biopsies. 71% of the prostatectomy specimens with perineural invasion presented extraprostatic extension in the previous biopsy against 23.1% when this was not found (p < 0.0001) and 47% of the cases showed positive margins with PNI, against 18.3% without perineural invasion (p < 0.0001). In fact, in the multivariate analysis, perineural invasion proved to be an independent risk factor in the presentation of extraprostatic extension and positive margins in the prostatectomy specimen. Conclusions: The presence of perineural invasion is a useful prognostic factor for predicting extraprostatic extension and the involvement of surgical margin in the radical prostatectomy specimen. We believe that determining it may be a useful tool for improving preoperative diagnosis and planning treatment (AU)

[Prognostic role of perineural invasion in prostate biopsy]. / El papel pronóstico de la invasión perineural en la biopsia prostática.

INTRODUCTION: Despite tumour cell dissemination through the intraprostatic nervous system being considered as a prostate cancer progression mechanism, the significance of perineural invasion in prostate biopsies to predict extraprostatic extension and its use as a potential prognosis factor is controversial. MATERIALS AND METHODS: Retrospective study carried out at an institution on 208 patients treated with radical prostatectomy (January 2007 - July 2010) in which the presence of perineural invasion and the Gleason score in the preoperative biopsy were determined, as well as the clinical stage and the pre-surgery PSA. We classified the patients in risk groups in accordance with the D'Amico classification. We performed bivariate and multivariate statistical analyses to establish the correlations between the different variables. RESULTS: We objectified PNI in 18.3% of the prostate biopsies. 71% of the prostatectomy specimens with perineural invasion presented extraprostatic extension in the previous biopsy against 23.1% when this was not found (p<0.0001) and 47% of the cases showed positive margins with PNI, against 18.3% without perineural invasion (p<0.0001). In fact, in the multivariate analysis, perineural invasion proved to be an independent risk factor in the presentation of extraprostatic extension and positive margins in the prostatectomy specimen. CONCLUSIONS: The presence of perineural invasion is a useful prognostic factor for predicting extraprostatic extension and the involvement of surgical margin in the radical prostatectomy specimen. We believe that determining it may be a useful tool for improving preoperative diagnosis and planning treatment.

Evaluación del patrón de actividad física y estilo de vida en una muestra del personal del Hospital Clínico San Carlos de la UCM / No disponible

La actividad física se relaciona con la salud y la calidad de vida. Conocer los hábitos y estilos de vida de una población permite diseñar estrategias de promoción de salud más acertadas y contribuye a mejorar el perfil de riesgo de ese colectivo. Métodos: Encuestas sobre actividad física adaptada de Contrywide Integrated Noncommunicable diseases intervention programme de la OMS, n=140, de los cuales 58 (41,43%) pertenecen al género masculino, 82 (58,57%) al género femenino. Se obtuvieron medias, desvíos, odds ratio y regresión logística. Resultados: Entre las mujeres el 70,73% conoce este dato, pero en hombres el porcentaje desciende al 55,17%. El 86,43% respondió que su trabajo consiste en estar sentado. El 66,43% refiere no realizar ninguna actividad física durante la pausa en su jornada laboral. El 78,57% de los encuestados respondió que camina de un lugar a otro para trasladarse. Camina el 89,83% de los no fumadores contra un 60,98% de los fumadores, 61,3% hace alguna actividad física de tiempo libre. Conclusiones: El nivel de actividad física general resulta insuficiente para cumplir con las recomendaciones de OMS. El nivel de educativo tiene influencia sobre la actividad física. Los no fumadores caminan más que los fumadores (AU)

No disponible

[Renal angiomyolipoma: presentation, treatment and results of 20 cases]. / Angiomiolipomas renales: presentación, tratamiento y resultado de 20 casos.

INTRODUCTION: Renal angiomyolipoma is a benign tumour, but its spontaneous rupture may become threatening for patient's live. Both surgery and selective arterial embolization are accepted treatments for this lesion. OBJECTIVES: Analyze renal angyolipoma treated in our center, their clinical outcome and treatment purposed in each case. MATERIAL AND METHODS: We retrospectively analyse 20 cases of patients with renal angiomyolipoma treated in our centre from March 1996 to March 2006. We describe tumour characteristics, treatment followed and results obtained. RESULTS: Patients suffering from tuberous sclerosis (20%) showed multiple bilateral tumours, with size similar to the rest of patients. Diagnosis of tuberous sclerosis was the only factor attached to spontaneous rupture of those lesions. Four of 9 emergency embolized patients (44.4%) required from second treatment because of recurrent haemorrhage, and 4 of the 16 embolization episodes (25%) presented post-embolization syndrome, both with no predicting factors attached. Reduction of less than one third of the inicial diameter was observed in 58.4% of embolized tumours, which used to be multiple, bilateral and of size larger to the rest. No significative differences were observed in plasmatic creatinine after and before treatments. CONCLUSIONS: Renal angiomyolipoma may behave in an aggressive way in patients with tuberous sclerosis. No predicting factors of recurrent haemorrhage or post-embolization syndrome were observed. Both surgery and arterial embolization have proved not to compromise renal function in treated patients.

Dystrophin muscle enhancer 1 is implicated in the activation of non-muscle isoforms in the skeletal muscle of patients with X-linked dilated cardiomyopathy.

X-linked dilated cardiomyopathy (XLDC) is a dystrophinopathy characterized by severe cardiomyopathy with no skeletal muscle involvement. Several XLDC patients have been described with mutations that abolish dystrophin muscle (M) isoform expression. The absence of skeletal muscle degeneration normally associated with loss of dystrophin function was shown to be due to increased expression of brain (B) and cerebellar Purkinje (CP) isoforms of the gene exclusively in the skeletal muscle of these patients. This suggested that the B and CP promoters have an inherent capacity to function in skeletal muscle or that they are up-regulated by a skeletal muscle-specific enhancer unaffected by the mutations in these patients. In this work we have analyzed the deletion breakpoints of two XLDC patients with deletions removing the M promoter and exon 1, but not affecting the B and CP promoters. Despite the presence of several muscle-specific regulatory motifs, the B and CP promoters were found to be essentially inactive in muscle cell lines and primary cultures. As dystrophin muscle enhancer 1 (DME1), the only known muscle-specific enhancer within the dystrophin gene, is preserved in these patients, we tested its ability to up-regulate the B and CP promoters in muscle cells. B and CP promoter activity was significantly increased in the presence of DME1, and more importantly, activation was observed exclusively in cells presenting a skeletal muscle phenotype. These results point to a role for DME1 in the induction of B and CP isoform expression in the skeletal muscle of XLDC patients defective for M isoform expression.

The b and delta subunits of the Escherichia coli ATP synthase interact via residues in their C-terminal regions.

An affinity resin for the F1 sector of the Escherichia coli ATP synthase was prepared by coupling the b subunit to a solid support through a unique cysteine residue in the N-terminal leader. b24-156, a form of b lacking the N-terminal transmembrane domain, was able to compete with the affinity resin for binding of F1. Truncated forms of b24-156, in which one or four residues from the C terminus were removed, competed poorly for F1 binding, suggesting that these residues play an important role in b-F1 interactions. Sedimentation velocity analytical ultracentrifugation revealed that removal of these C-terminal residues from b24-156 resulted in a disruption of its association with the purified delta subunit of the enzyme. To determine whether these residues interact directly with delta, cysteine residues were introduced at various C-terminal positions of b and modified with the heterobifunctional cross-linker benzophenone-4-maleimide. Cross-links between b and delta were obtained when the reagent was incorporated at positions 155 and 158 (two residues beyond the normal C terminus) in both the reconstituted b24-156-F1 complex and the membrane-bound F1F0 complex. CNBr digestion followed by peptide sequencing showed the site of cross-linking within the 177-residue delta subunit to be C-terminal to residue 148, possibly at Met-158. These results indicate that the b and delta subunits interact via their C-terminal regions and that this interaction is instrumental in the binding of the F1 sector to the b subunit of F0.

[Uncinariasis in younger infants]. / Uncinariasis en el lactante menor.

In order to determine the main clinical and laboratory manifestations associated with the infestation by an uncinaria during the first year of life, 42 children were studied from a group hospitalized between the years 1980 and 1985 in whom the main diagnosis at their time of leave from the hospital was parasitosis. Over 31 patients (74%) showed some degree of malnutrition, and severe in 24 of them (57% of the total). Clinical manifestations were mainly related to anemia (paleness, lack of air) and active intestinal bleeding (enterorrhagia, melena). Among the laboratory findings, 80% of the patients were shown to have anemia and in 24% of them, their hemoglobin levels were less than 5 g/dL, in more than half the anemia was normocytic normochromic. Also included are particularities concerning uncinariasis in the breast-feeding infant and some differences with the infection in the adult.

Curve of perceptive intellectual deterioration in hemodialysis patients.

In order to optimize the results of kidney transplant, i.e. patient's acceptance and speedy recovery, the available organ resources must be combined with appropriate "preparation" of the patient's mental state. In order to plot the "mental deterioration curve" of patients on a hemodialysis program, the present study was made on 62 patients in a general hospital in Spain. The possible repercussions of treatment of kidney disease on intellectual (Weschler's Adult Intelligence Scale-WAIS test) and perceptive (Benton test) capacity were investigated. Samples were grouped according to whether they had been on dialysis for up to four years (less than 4) or more than four years (greater than 4). The WAIS test for the greater than 4 group indicated a lower I.Q. These results indicated that it was after four years on dialysis that greater negative effects began to be seen in perceptive-intellectual capacity. The Benton test indicated that time on hemodialysis adversely affected the patient's capacities. A sharp decline was seen particularly between two and four years in the less than 4 group, suggesting that patients' mental conditions vary with time on dialysis but that their resources and capacities are still fairly untroubled by the treatment in the first two years. In the light of these findings, the deterioration curve should be taken into account when planning kidney transplant, in order to take advantage of the initial period if possible.

Temas de pediatria

Presenta la mortalidad infantil en el Paraguay, causa metodología para el estudio de la mortalidad infantil. Incluye crecimiento desarrollo del niño, lactancia materna y efermedades que causa la muerte del niño

Serum ferritin in haemodialysis.

A rapid assay for serum ferritin was performed in old and new patients undergoing regular dialysis treatment. The mean values were higher in the patients, especially the older patients, than in the controls. The normal differences in serum ferritin with age and sex were absent in the patients. We attribute these changes to iron loss and multiple transfusions received. Tissue iron was well reflected by serum ferritin concentration even during iron treatment, unless the intravenous route was used. Although an acceptable rise of serum ferritin was obtained, results of the iron administration have been poor.