Chronic obstructive pulmonary disease in severe mental illness: A timely diagnosis to advance the process of quitting smoking.

BACKGROUND: This study has two main objectives: to describe the prevalence of undetected chronic obstructive pulmonary disease (COPD) in a clinical sample of smokers with severe mental illness (SMI), and to assess the value of the Tobacco Intensive Motivational Estimated Risk tool, which informs smokers of their respiratory risk and uses brief text messages to reinforce intervention. METHOD: A multicenter, randomized, open-label, and active-controlled clinical trial, with a 12-month follow-up. Outpatients with schizophrenia (SZ) and bipolar disorder were randomized either to the experimental group-studied by spirometry and informed of their calculated lung age and degree of obstruction (if any)-or to the active control group, who followed the 5 A's intervention. RESULTS: The study sample consisted of 160 patients (71.9% SZ), 78.1% of whom completed the 12-month follow-up. Of the patients who completed the spirometry test, 23.9% showed evidence of COPD (77.8% in moderate or severe stages). TIMER was associated with a significant reduction in tobacco use at week 12 and in the long term, 21.9% of patients reduced consumption and 14.6% at least halved it. At week 48, six patients (7.3%) allocated to the experimental group achieved the seven-day smoking abstinence confirmed by CO (primary outcome in terms of efficacy), compared to three (3.8%) in the control group. CONCLUSION: In this clinical pilot trial, one in four outpatients with an SMI who smoked had undiagnosed COPD. An intensive intervention tool favors the early detection of COPD and maintains its efficacy to quit smoking, compared with the standard 5 A's intervention.

Implicación en Cataluña de los Servicios de Anestesiología y Reanimación en la pandemia por SARS-CoV-2. Una solución real coste-efectiva para una crisis sanitaria sin precedentes / Involvement in Catalonia of the Anaesthesiology and Resuscitation Services in the SARS-CoV-2 pandemic. A real, cost-effective solution to an unprecedented health crisis

No disponible

Células osteogénicas afectadas por los factores solublestumorales contribuyen a la formación del nichopre-metastásico óseo / Osteogenic cells affected by soluble tumor factorscontribute to bone pre-metastatic niche formation

Objetivo: Analizar el efecto de los secretomas de tumores sólidos organotrópicos hacia el hueso en células de linaje osteogénico, de tipo osteoblástico y osteocítico, en la expresión de genes relacionados con el metabolismo óseo. Material y método: Caracterizamos los cambios en expresión génica por PCR cuantitativa a tiempo real del eje OPG/RANKL, así como de otros genes relacionados con la diferenciación osteoblástica como son Runx2 y osteocalcina, inducidos por los medios condicionados de células tumorales prostáticas, mama y melanoma en pre‐osteoblastosMC3T3‐E1 y osteocitos MLO‐Y4 murinos o en osteoblastos humanos, según correspondiese por especie. Resultados: La estimulación de las células osteocíticas con medios condicionados de células de melanoma o adenocarcinoma prostático indujo un incremento en la expresión génica de OPG y también de RANKL, viéndose incrementado la ratio OPG/RANKL. Únicamente el secretoma de las células de adenocarcinoma prostático alteró la expresión de Runx2en osteocitos. Los medios condicionados de células de cáncer de mama modificaron únicamente la expresión de RANKLen células osteoblásticas, viéndose disminuido la ratioOPG/RANKL. Conclusión: Los factores solubles tumorales tienen como diana celular a las células osteocíticas, favoreciendo la inducción de un nicho pre‐metastásico óseo por modificación de la ratio OPG/RANKL en el entorno óseo, y, con ello, la progresión de tumores organotrópicos óseos como son el melanoma y adenocarcinomas prostático

Objective: To analyze the effect of the secrets of solid organotropic tumors towards bone in osteogenic, osteoblastic and osteocytic lineage cells, in the expression of genes related to bone metabolism. Material and method: We characterize the changes in gene expression by quantitative real‐time PCR of the OPG/RANKL axis, as well as other genes related to osteoblastic differentiation such as Runx2 and osteocalcin, induced by the conditioned means of prostate tumor cells, breast and melanoma in pre MC3T3‐E1 osteoblasts and murine MLO‐Y4 osteocytes or in human osteoblasts, as appropriate by species. Results: Stimulation of osteocitic cells with conditioned means of melanoma or prostate adenocarcinoma cells inducedan increase in OPG and RANKL gene expression, with the OPG/RANKL ratio being increased. Only the secretome of prostate adenocarcinoma cells altered the expression of Runx2 in osteocytes. Conditioned media of breast cancer cellsonly modified the expression of RANKL in osteoblast cells, with a decrease in OPG/RANKL ratio. Conclusion: Soluble tumor factors have osteocitic cells as their cellular target, favoring the induction of a pre‐metastatic bone niche by modifying the OPG/RANKL ratio in the bone environment, and, thus, the progression of bone organo‐tropic tumors such as melanoma and prostatic adenocarcinomas

The use of cisplatin plus doxorubicin or paclitaxel in hyperthermic intraperitoneal chemotherapy (HIPEC) for stage IIIC or IV epithelial ovarian cancer: a comparative study.

PURPOSE: Our main aim is to analyze the survival results in women operated on for advanced ovarian cancer with two different HIPEC regimens (cisplatin plus doxorubicin versus paclitaxel). PATIENTS AND METHODS: A prospective cohort of patients with stage IIIC or IV epithelial ovarian cancer operated on with cytoreductive surgery and HIPEC, from October-2008 to February-2016, was retrospectively analyzed. The two drugs used, cisplatin/doxorubicin (Group A) and paclitaxel (Group B), were compared. RESULTS: Forty-one patients were treated with cytoreductive surgery and HIPEC; 19 patients (46%) were in Group A and 22 (54%) were in Group B. The extent of peritoneal disease was comparable between groups (Peritoneal Cancer Index of 10 in Group A versus PCI of 12.5 in Group B). There were no differences in morbidity between groups, with a severe morbidity (Dindo-Clavien III or IV) of 36.8% versus 27.3%, respectively. There was no postoperative mortality. Median follow-up was 39 months. Median overall survival was 79 months. Overall survival at 3 years in Group A was 66% versus 82.9% in Group B (p = 0.248). Incomplete cytoreduction (macroscopic residual tumour after surgery) was identified as the only independent factor that influenced overall survival (HR 12.30, 95% CI 1.28-118.33, p = 0.03). The cytostatic used in HIPEC had no influence in overall survival. CONCLUSION: The cytostatic used in HIPEC did not have a negative effect in the prognosis of patients with advanced ovarian cancer.

Factores secretados por células óseas inducen acumulación de calcio intracelular y AMP cíclico y activación de ERK 1/2 en células de cáncer de próstata; evaluación por técnicas de fluorescencia en células vivas / Factors secreted by bone cells induce intracellular calcium accumulation and cyclic AMP and activation of ERK 1/2 in prostate cancer cells; evaluation by fluorescence techniques in living cells

Objetivos: Analizar en células tumorales de próstata los efectos causados por el secretoma de células óseas sobre la proliferación y sobre vías de señalización intracelular relacionadas con la progresión del cáncer de próstata. Materiales y métodos: Se caracterizaron los efectos de factores secretados presentes en medios condicionados de pre-osteoblastos MC3T3-E1 y osteocitos MLO-Y4 sobre la proliferación de células de adenocarcinoma de próstata metastásicas PC-3 mediante tinción por azul de tripano. Se observó por técnicas de fluorescencia en células vivas los efectos de los medios condicionados por células MC3T3-E1 y MLO-Y4 en moléculas de señalización intracelular implicadas en la progresión tumoral de células de adenocarcinoma de próstata PC-3. Se estudió la acumulación de calcio intracelular utilizando el indicador de calcio fluorescente Fluo-4AM y la generación de AMP cíclico, y la activación de la quinasa ERK 1/2 por Transferencia de Energía de Resonancia Fluorescente (FRET) usando los biosensores EPAC y ERK-NES, respectivamente. Resultados: La estimulación de células PC-3 con medios condicionados de pre-osteoblastos MC3T3-E1 y osteocitos MLO-Y4 indujo aumento en la proliferación de las células de adenocarcinoma PC-3. Los medios condicionados por células óseas causaron también aumento transitorio en la acumulación de calcio intracelular y de la generación de AMP cíclico e incrementaron la activación de la quinasa ERK 1/2. Conclusiones: Las células óseas secretan factores activadores de la proliferación y de vías de señalización que favorecen la progresión tumoral de células de cáncer de próstata, sugiriendo que la comunicación cruzada entre estos tipos celulares puede favorecer el desarrollo de nichos metástasicos de cáncer de próstata en el hueso

Objectives: To analyze in prostate tumor cells the effects caused by the secretome of bone cells on pro- liferation and on intracellular signaling pathways related to the progression of prostate cancer. Materials and methods: The effects of secreted factors present in conditioned media of pre-osteoblasts MC3T3-E1 and osteocytes MLO-Y4 on the proliferation of metastatic prostate adenocarcinoma cells PC-3 were characterized using trypan blue staining. The effects of media conditioned by MC3T3-E1 and MLO- Y4 cells on intracellular signaling molecules involved in the tumor progression of prostate adenocarcinoma cells PC-3 were observed by fluorescence techniques in living cells. The accumulation of intracellular calcium was studied using the fluorescent calcium indicator Fluo-4AM and the generation of cyclic AMP, and ERK 1/2 activation by Fluorescent Resonance Energy Transfer (FRET) using the EPAC and ERKNES biosensors, respectively. Results: The stimulation of PC-3 cells with conditioned media of pre-osteoblasts MC3T3-E1 and osteocytes MLO-Y4 induced an increase in PC-3 adenocarcinoma cell proliferation. Media conditioned by bone cells also caused a transient increase in intracellular calcium accumulation and generation of cyclic AMP and increased ERK 1/2 activation. Conclusions: Bone cells secrete proliferation-activating factors and signaling pathways that favor the tumor progression of prostate cancer cells, suggesting that cross-communication between these cell types may favor the development of metastatic niches of prostate cancer in the bone

Impact of Histological Factors of Hepatocellular Carcinoma on the Outcome of Liver Transplantation.

BACKGROUND: The aim of this study was to identify predictors of overall survival (OS), disease-free survival (DFS), and recurrence in a cohort of 151 patients with hepatocellular carcinoma (HCC) and cirrhosis who were treated by liver transplantation (LT). PATIENTS AND METHODS: A retrospective database of patients undergoing LT for radiologically diagnosed HCC at "12 de Octubre" Hospital, Madrid during 1986-2006 was analyzed. RESULTS: The median follow-up was 67.44 months (SD = 55.7 months). Overall 1-, 3-, 5-, and 10-year survival was 87.5%, 73.7%, 64.1% and 43.4%, respectively. The 5-year OS of patients beyond the Milan criteria was 47.14%, whereas that of patients within the Milan criteria was 70.13% (P = .011). The 5-year OS of patients beyond the Milan criteria and with microvascular invasion (MVI) was 27.27%, whereas that of patients beyond the Milan criteria and without MVI criteria was 57.89% (P = .003). Multivariate analysis of prognostic factors revealed MVI and G3 to be independent and statistically significant factors affecting OS (P < .0001 and P = .045, respectively), DFS (P < .0001 and P = .004, respectively), and recurrence (P = .0002 and P = .028, respectively). Multivariate analysis of prognostic factors also revealed preoperative fine-needle aspiration (FNA) to be an independent negative statistically significant factor affecting recurrence (P = .0022). Multivariate analysis of predictive MVI factors revealed preoperative α-fetoprotein (AFP) levels >200 ng/mL to be an independent positive and statistically significant predictor of MVI (P = .0004). CONCLUSION: MVI and G3 are independent negative factors affecting OS, DFS, and recurrence. The presence of MVI or AFP levels >200 ng/mL represent a contraindication for LT, as long as the patient is beyond the Milan criteria.

Epidemiology of hidradenitis suppurativa and inflammatory bowel disease: are these two disease associated? / Epidemiología de la hidradenitis supurativa y de la enfermedad inflamatoria intestinal: ¿son enfermedades que se asocian?

Hidradenitis suppurativa and inflammatory bowel disease are chronic inflammatory diseases mainly affecting young people. Their aetiology is complex and multifactorial and numerous case series have shown that the two diseases can manifest concurrently, although the strength of this association varies widely among distinct reports. An additional problem is the difficulty of distinguishing between cutaneous Crohn disease and hidradenitis. In the last few years, epidemiological cohort studies have revealed that 1.2%-23% of inflammatory bowel disease patients also have hidradenitis suppurativa. This wide variability is influenced by geographical variables and the biases inherent in the distinct data collection methods, among other factors. There is a clear predominance of Crohn disease over ulcerative colitis. When hidradenitis suppurativa and inflammatory bowel disease manifest concurrently, the bowel disease is more severe and shows a predominance of colon involvement.

Umbilical paracentesis for incarcerated umbilical hernia in patients with end-stage liver disease.

PURPOSE: Patients with cirrhosis and ascites are prone to abdominal wall complications largely predominate by umbilical hernia. Elective surgery is indicated in select patients but a high morbidity and mortality rate occurs if it is performed in emergency conditions. METHODS: We present a clinical case of a patient with advanced alcoholic liver disease who came to the emergency room for an acutely incarcerated umbilical hernia. Due to the high surgical risk, we had to discuss other treatment options. RESULTS: The use of umbilical paracentesis for incarcerated hernia reduction in cirrhotic patients with tense ascites is a safe and reproducible technique. CONCLUSIONS: Umbilical paracentesis could be considered as an alternative to emergency surgery in these high-risk patients.

Cerebral blood flow abnormalities in neurologically asymptomatic patients with primary antiphospholipid syndrome.

OBJECTIVE: To evaluate cerebral blood flow abnormalities in primary antiphospholipid syndrome (PAPS) patients without ongoing neurological manifestations. PATIENTS AND METHODS: We included 28 PAPS patients and 28 healthy controls. Carotid Doppler ultrasound, and echocardiographic evaluation were done. Transcranial Doppler ultrasonography measured mean flow velocity (MFV) in the carotid siphon, middle, anterior, posterior, intracranial vertebral arteries, and basilar artery (11 cerebral arteries). Results were considered abnormal when the MFV was out of the normal range according to age and/or flow asymmetry and/or more than four arterial segments affected. RESULTS: The mean age of patients was 41.4 ± 11.2 and 39.3 ± 8.6 years in controls. Disease duration was 11 ± 2.7 years. A significant increase in MFV in 7/11 cerebral arteries in PAPS patients, mainly in the middle and anterior cerebral arteries was found compared with controls. A significant association between lupus anticoagulant, history of stroke and obesity with a greater number of affected arteries was found. We did not find an association between MFV and abnormal echocardiography, arterial hypertension and carotid intima-media thickness. CONCLUSIONS: Asymptomatic patients with PAPS can have significantly increased MFVs. These alterations may be the consequence of accelerated atherosclerosis, PAPS vasculopathy or both. Whatever the cause, these findings can represent a risk for stroke in PAPS patients that needs the trial of other therapeutic options.

[Acute abdominal pain in elderly patients evaluated in the emergency department at a tertiary level]. / Dolor abdominal agudo en pacientes geriátricos evaluados en el servicio de urgencias en un hospital de tercer nivel.

BACKGROUND: Life expectancy in México has increased in the last decades with a remarkable increase in geriatric population. Acute abdominal pain (AAP) in elderly people compared with young people has different clinical presentation because of the concomitant chronic diseases, the use of medications, history of abdominal surgeries and decrease in perception of pain and immunity. OBJECTIVE: To know the cause and associated mortality of acute abdominal pain in geriatric patients who attend the emergency room. METHODS: Geriatric patients' files with acute abdominal pain admitted from January 2004 to December 2008 were retrospectively reviewed. Age, gender, presence of chronic diseases, use of medications, history of surgical procedures, definitive diagnosis causative of the symptoms and the associated mortality were recorded. RESULTS: 17 524 patients were admitted, of whom 324 (1.8%) were geriatric patients with AAP: 110 were men (36.9) and 214 were women (66%), with a mean age of 78 years (range 60 to 102 years). The most common causes of AAP were acute cholecystitis in 49 patients (15.1%), irritable bowel syndrome in 42 (12.9%), ulcerative syndrome in 40 (12.3%), intestinal obstruction in 35 (10.8%) and diverticulitis in 23 (10.8%). Nine patients died (2.7%). CONCLUSIONS: In our hospital the most common cause of AAP in geriatric patients is related to biliary disease followed by functional gastrointestinal disorder and ulcerative syndrome. Mortality is low.

Hipertensión arterial ¿Mal control? Quizá no tan malo / Hypertension poorly controlled? Perhaps not so poorly

Objetivo. Conocer el grado de control de hipertensos tratados, en consulta de enfermería y con automedidas domiciliarias. Material y métodos. Estudio descriptivo realizado en Atención Primaria. Mediante muestreo aleatorio simple se seleccionó una muestra de 600 hipertensos tratados, citados en consulta programada de enfermería. A los que aceptaron se les hizo 6 medidas consecutivas de presión arterial en consulta de enfermería, en condiciones estandarizadas y con aparato electrónico automático y se les entrenó para que hicieran 24 automedidas domiciliarias durante un día. Se consideró buen control en consulta cuando la presión arterial era < 140/90 mmHg y en domicilio cuando era < 135/85 mmHg. Resultados. Se midió la presión arterial en consulta de enfermería y domicilio a 583 pacientes (54,4 % mujeres) con una edad media de 62,9 (DE: 10,4) años. Los valores medios de presión arterial en consulta de enfermería fueron 139,3 (DE: 17,1) y 81,3 (DE: 9,4) mmHg para la sistólica y diastólica y con medidas domiciliarias 131,4 (DE: 15,7) y 78,7 (DE: 8,8) mmHg. El grado de control fue del 50,9 % en consulta de enfermería y del 55,4 % con medidas domiciliarias. Se observaron grados de control distintos en los diferentes momentos del día en los que se realizó la automedida y el control mejoró, tanto en enfermería como en domicilio, al excluir las dos primeras medidas. Discusión. Las medidas clínicas infraestimaron el grado de control de los hipertensos. Con automedida de la presión arterial domiciliaria el grado de control observado fue más elevado. Sería de interés estandarizar las condiciones de medida para tener una información más exacta del grado de control y hacer comparables los diferentes estudios epidemiológicos

Objective. To estimate the control rate of hypertensive patients who were treated, in the nurse office and with home self-measurements. Material and methods. Descriptive study developed in Primary Health Care. By means of a random sample, 600 hypertensive treated who go to the programmed nurse office, were selected. Those who agreed, their previously trained nurse, made them 6 arterial blood pressure consecutive measurements, in standardized conditions and with an electronic set, and these patients were trained to make 24 home self-measurements, with the same electronic set, in a day. Control office when < 140/90 mmHg and control at home when < 135/85 mmHg. Results. 583 patients (54.4 % women) were measured blood pressure at nurse office and at home being mean age 62.9 (SD: 10.4) years old. Mean blood pressure values at nurse office were 139.3 (SD: 17.1) and 81.3 (SD: 9.4) mmHg for systolic and diastolic and with home self-measurements 131.4 (SD: 15.7) and 78.7 (SD: 8.8) mmHg. The control rate was 50.9 % at nurse office and 55.4 % with home self-measurements. Different control grades were observed during the different moments of the day when home self-measurements were made, and improved, both at nurse office and in home, on excluding the two first blood pressure measurements. Discussion. Clinical measures understimates hypertension control rate. With home self-measurement the control rate is better. It would be interesting to standardize measure conditions to have a more exact control grade information and so make comparable the different epide miological studies

Threonines at position 174 and 235 of the angiotensinogen polypeptide chain are related to familial history of hypertension in a Spanish-Mediterranean population.

This study investigates the association between the allelic distribution of two polymorphisms of the angiotensinogen (AGT) gene (T174M and M235T in the polypeptide chain) and blood pressure (BP) in a Mediterranean population in the south-west of Europe. The sample consists of 1322 participants from urban and rural areas, from the province of Albacete (218,462 inhabitants), located in the south-east of Spain. The subsample of this study, adjusted by age (over 18 years old) and sex, consists of 401 individuals. A case-control study is conducted which analyses 205 individuals from the group with the highest BP (fifth quintile) and 196 from the group with the lowest BP (first quintile). In addition, a comparative and associated analysis of these polymorphisms with BP level and family history of hypertension is carried out. The T174 allele proved to be more common in the fifth quintile group, although not statistically so. When the presence of threonine was analysed in both polymorphism positions (174 and 235), the TTTT genotype was found to be more common in the fifth quintile than in the first quintile. Moreover, the TTTT genotype was significantly more common in individuals with a family history of hypertension, indicating that it could be considered a predisposing factor to high BP in individuals from such families. In addition, the T174M-T235T genotype was more common in the first quintile group, and showed significant association (P=0.05) with the group that had no family history of hypertension.

[Can or should blood pressure be measured at pharmacy offices?]. / ¿Se puede o debe medir la presión arterial en las oficinas de farmacia?

OBJECTIVE: To evaluate concordance between blood-pressure (BP) measurements at the pharmacy office (PhO) and the nurse office (NO) in the health care centre (HCC). DESIGN: Descriptive study. SETTING: Community. METHODS: 36 PhO have voluntarily participated in the province of Albacete, where they have done 3 BP measures, without previous instructions and with their usual measurements devices, for 3-5 subjects, who were referred to their HCC so that they were taken another 3 BP measures in the NO with their Hg sphymomanometer and in their usual measure conditions (blind measures in relation to those taken at the PhO). These subjects were given a stamped envelope to send the BP measurements (taken at the NO), to the Official Pharmacy College. RESULTS: The 6 BP measurements have been completed to 96 subjects with an average of 57.3 years old (women 63%). The differences between PhO and NO were > 5 mmHg in 58 subjects (60.4%) in the case of SBP and in 45 subjects (46.9%) in the case of DBP, and it was more than 15 mmHg in the 17 subjects (17.7%) with SBP and in 9 subjects (9.4%) with DBP. The difference average was 9.5 mmHg (SD, 8.4 mmHg) and 6.4 mmHg (SD, 5.3 mmHg) respectively. The use rate of digit 0 was 22% at the PhO and 46.5% at the NO. In most of PhO, measurement electronic devices have been used for the BP, but not validated for clinical use. CONCLUSIONS: The PhO can be a good place for the hypertension screening, but the chemist must be trained in the BP correct measurement and use validated electronic devices. Standardization measurement conditions and the use of validated electronic devices must be extended to the NO.

¿Se puede o debe medir la presión arterial en las oficinas de farmacia? / Can blood pressure be measured or not in pharmacy offices?

Objetivo. Evaluar la concordancia entre las medidas de la presión arterial (PA) de la oficina de farmacia (OF) y la consulta de enfermería (CE) del centro de salud (CS).Diseño. Estudio descriptivo. Emplazamiento. Marco comunitario. Métodos. De forma voluntaria han participado 36 OF de la provincia de Albacete en las que han realizado 3 medidas de PA, sin instrucciones previas y con sus aparatos de medida habituales, a 3-5 sujetos que posteriormente acudían a sus CS para que en la CE les llevaran a cabo otras 3 mediciones de PA con sus esfigmomanómetros de mercurio y en sus condiciones habituales de medida (medición ciega respecto de las realizadas en la OF). A los sujetos se les entregaba un sobre franqueado para remitir las medidas de PA de la CE al colegio de farmacéuticos. Resultados. Se han completado las 6 medidas de PA a 96 sujetos con una edad media de 57,3 años (63 por ciento mujeres). Las diferencias entre la OF y la CE fueron > 5 mmHg en 58 sujetos (60,4 por ciento) en el caso de la PAS y en 45 sujetos (46,9 por ciento) en el caso de la PAD, y llegaron a ser de más de 15 mmHg en 17 sujetos (17,7 por ciento) en la PAS y en 9 sujetos (9,4 por ciento) en la PAD. La media de las diferencias fue de 9,5 mmHg (DE, 8,4 mmHg) y de 6,4 mmHg (DE, 5,3 mmHg), respectivamente. La proporción de utilización del dígito 0 fue del 22 por ciento en la OF y del 46,5 por ciento en la CE. En la mayoría de las OF se han utilizado dispositivos electrónicos de medida de la PA, pero no validados para uso clínico. Conclusiones. La OF puede ser un buen lugar para el cribado de la HTA, pero el farmacéutico/a debe estar entrenado en la medida correcta de la PA y utilizar aparatos electrónicos validados. La estandarización en las condiciones de medida y el uso de aparatos electrónicos validados se debe hacer extensible a la CE (AU)

Automedidas domiciliarias de presión arterial y su relación con el diagnóstico de la hipertensión arterial y con la afección orgánica: estudio comparativo con monitorización ambulatoria / Home self-measurements of blood pressure and relationship with diagnosis of hypertension and target organ damage: comparative study with ambulatory monitoring

FUNDAMENTO: El diagnóstico de la hipertensión arterial (HTA) requiere una metodología de la medición exacta y precisa. Las técnicas clásicas sobrestiman con frecuencia su prevalencia y no se relacionan bien con la repercusión orgánica. El objetivo de este trabajo es conocer la asociación entre la automedición domiciliaria de la presión arterial y la afección orgánica de la HTA. PACIENTES Y MÉTODO: Estudio descriptivo en el cual se comparaba la asociación de diferentes técnicas de medida de la presión arterial (PA) con el diagnóstico de HTA y su repercusión orgánica. Mediante muestreo de selección de casos consecutivos, se seleccionaron 64 pacientes con HTA no tratados mayores de 18 años. A todos se les realizaron tres mediciones de PA con esfigmomanómetro de mercurio en la consulta y se les adiestró para hacer 20 automedidas por la mañana en la consulta y 20 automedidas por la tarde en su domicilio con un aparato automático Omron 705CP. El mismo día se realizó una monitorización ambulatoria de la PA (MAPA) de 24 h con un dispositivo Takeda TM-2420; además, se realizó visualización del fondo de ojo, determinación de microalbuminuria y ecocardiografía. RESULTADOS: Los valores medios de las presiones clínicas fueron significativamente superiores a los de las automedidas domiciliarias y a los de la MAPA, que tenían una buena correlación y concordancia entre sí. La correlación de las automedidas domiciliarias con el índice de masa ventricular izquierda (IMVI) fue significativamente superior a la de las presiones arteriales clínicas y similar a la de la MAPA, siendo esta correlación independiente de la edad, el sexo y el índice de masa corporal de los sujetos. La mejor correlación de las automedidas domiciliarias de PA con la MAPA y con el IMVI se obtuvo con los valores medios de la segunda a la sexta automedida. CONCLUSIONES: Un programa mínimo de automedidas domiciliarias de PA con aparatos automáticos obtiene un valor pronóstico y de relación con la afección orgánica de la HTA similar al de la MAPA (AU)

Análisis univariante y multivariante de factores pronósticos en cáncer epitelial de ovario / Univariate and multivalent analysis of prognostic factors for epithelial ovarian cancer

Objetivo: Determinar qué variables predicen de modo independiente el pronóstico de las pacientes con cáncer epitelial de ovario en nuestro medio. Material y métodos: Tras seleccionar 217 pacientes con diagnóstico histológico de cáncer epitelial de ovario tratadas entre 1985 y 1995 se revisaron sus preparaciones y se confirmó el diagnóstico por un mismo patólogo. Se revisó la clasificación del tipo histológico, grado arquitectural y nuclear. Finalmente se ha realizado un análisis de las variables que modificaron la supervivencia de modo univariante y multivariante aplicando un modelo de regresión múltiple para conocer las variables independientes. Resultados: La supervivencia actuarial global a los 5 años de nuestras pacientes fue del 54 por ciento y la supervivencia actuarial a los 10 años del 36 por ciento. La supervivencia actuarial libre de enfermedad fue del 48 por ciento y a los 10 años ha sido del 26 por ciento. El análisis multivariante demostró que las variables independientes que modificaron la supervivencia en el estadio I fueron: grado nuclear del tumor, ascitis (×6) y tamaño del tumor (×4). En los estadios avanzados (II-IV) fueron: enfermedad clínica tras quimioterapia (×7) y grado nuclear (×6).Conclusiones: El grado nuclear del tumor valorado por un mismo patólogo y la existencia de enfermedad clínica tras quimioterapia fueron las variables independientes que modificaron la supervivencia de las pacientes con cáncer de ovario tras la aplicación de un análisis multivariante (AU)