[Prevalence of atrial fibrillation and relationed factors in a population in the centre Madrid]. / Prevalencia de fibrilación auricular y factores relacionados en una población del centro de Madrid.

INTRODUCTION: Atrial fibrillation is the most common arrhythmia on clinical practice and an important risk factor for ictus. The aim of this study was to know the prevalence of this arrythmia in a central district of Madrid. MATERIAL AND METHODS: A retrospective study was done analysing medical records of 13,945 patients belonging to a primary care centre of Madrid. Time of study: recruitment of data from September 2000 to May 2001; analysis of data: from September 2001 to May 2002. RESULTS: We obtained a total of 425 atrial fibrillations, 348 non-valvular and 77 valvular. Global prevalence of atrial fibrillation in patients over 40 years in our area was 2.52%. (2.47% male, 2.55% female). Risk factors for atrial fibrillation more frequently found in non-valvular were high blood pressure (HBP), diabetes, ischaemic heart disease and left ventricular dysfunction. Among valvulars we found HBP, left atrial size over 45 mm and left ventricular dysfunction. CONCLUSIONS: Atrial fibrillation shows a prevalence and distribution in the studied area similar to that found in other European countries.

Prevalencia de fibrilación auricular y factores relacionados en una población del centro de Madrid / Prevalence of atrial fibrillation and relationed factors in a population in the centre Madrid

Introducción: La fibrilación auricular es la arritmia más frecuente en la práctica clínica y un importante factor de riesgo para ictus. El objetivo de nuestro estudio es conocer su prevalencia en un distrito central de Madrid. Material y métodos: Se trata de un estudio retrospectivo, analizando historias clínicas procedentes de 13.945 pacientes del centro de atención primaria. A partir de éstas, se cumplimentó un protocolo clínico-epidemiológico. Tiempo de recogida de los datos: de septiembre de 2000 a mayo de 2001; tiempo de análisis: de septiembre de 2001 a mayo de 2002. Resultados: Se obtuvieron un total de 425 fibrilaciones auriculares, 348 no valvulares y 77 valvulares. La prevalencia global de fibrilación auricular en pacientes mayores de 40 años fue de 2,52 por ciento. Por sexos, fue de 2,47 por ciento en varones y 2,55 por ciento en mujeres. Los factores de riesgo más frecuentemente asociados a fibrilación auricular no valvular fueron la HTA, diabetes, cardiopatía isquémica y disfunción ventricular. En la valvular la HTA, el crecimiento auricular mayor de 45 mm y la disfunción ventricular. Conclusiones: La fibrilación auricular presenta en la zona estudiada una prevalencia y distribución similar a la encontrada en otros países europeos (AU)

[Spread channels of anterior commissure cancer: clinico-pathological study and surgical implications]. / Vías de diseminación del cáncer de comisura anterior: estudio clínico-patológico e implicaciones quirúrgicas.

UNLABELLED: The aim of the present study is to describe the spread channels of the anterior commisure cancer, its clinical significance and its surgical implications. PATIENTS AND METHODS: A prospective study was performed at the ENT Department of the Complutense University in about 31 patients with anterior commisure carcinoma wo underwent surgery between 1994/97. Specimens were processes with Whole-Organ Serial Sections. RESULTS: Patients were differenciated into two groups: 1) Patients with glottic tumors, with a good cord mobility and no invasive tumor in commisure region (18 patients); In these patients, conservative surgery was possible; 2) Another group (13 patients) with aggressive lesions (80% with cartilage involvement), vocal cord fixation and transglottic lesions. In these group, conservative surgery was contraindicated. CONCLUSIONS: This report emphasizes the importance of laryngoscopy in surgical technique of anterior commisure cancer.

Vías de diseminación del cáncer de comisura anterior: estudio clínico-patológico e implicaciones quirúrgicas / Spread channels of the anterior commisure cancer: a clinical and pathological study with surgical implications

El objetivo del estudio será la descripción de las vías de diseminación del cáncer de la comisura anterior y su implicación quirúrgica. Material y métodos: se realizó estudio histopatológico de 31 piezas de laringuectomía intervenidas entre 1994/97 mediante técnica de secciones seriadas de órgano completo. Resulta dos: los 31 pacientes con afectación de la región comisural anterior fueron divididos en dos grupos: 1) Un primer grupo de 18 pacientes en los que el tumor no invadía en profundidad la región comisural anterior que presentaban por laringoscopia tumores estrictamente del plano glótico con movilidad cordal conservada, en los que era posible realizar cirugía funcional; 2) Un segundo grupo de peor pronóstico, formado por 13 pacientes con invasión en profundidad de la región comisural anterior (83 por ciento con invasión del esqueleto cartilaginoso), todos ellos con invasión de más de un piso laríngeo y fijación cordal, en los que estaba contraindicada cualquier tipo de cirugía conservadora. Conclusiones: la imagen laringoscópica en el cáncer de la comisura anterior resulta fundamental para plantear cualquier intento de cirugía conservadora. (AU)

The aim of the present study is to describe the spread channels of the anterior commisure cancer, its clinical significance and its surgical implications. PATIENTS AND METHODS: A prospective study was performed at the ENT Department of the Complutense University in about 31 patients with anterior commisure carcinoma wo underwent surgery between 1994/97. Specimens were processes with Whole-Organ Serial Sections. RESULTS: Patients were differenciated into two groups: 1) Patients with glottic tumors, with a good cord mobility and no invasive tumor in commisure region (18 patients); In these patients, conservative surgery was possible; 2) Another group (13 patients) with aggressive lesions (80% with cartilage involvement), vocal cord fixation and transglottic lesions. In these group, conservative surgery was contraindicated. CONCLUSIONS: This report emphasizes the importance of laryngoscopy in surgical technique of anterior commisure cancer (AU)

Rotura capsular en el cáncer avanzado de laringe / Extracapsular spread in advanced laryngeal cancer

La rotura capsular del ganglio metastásico es un signo de muy mal pronóstico en los pacientes con cáncer de laringe. La identificación de esta rotura de la cápsula del ganglio por el tumor es difícil en el estudio prequirúrgico del paciente, incluso con las modernas técnicas de imagen. El objetivo de este trabajo será establecer parámetros histopatológicos predictivos de diseminación extracapsular en los ganglios metastásicos. Para ello hemos estudiado 11variables patológicas (tumorales -estadio T, localización tumoral, diámetro tumoral, invasión laríngea en profundidad, grado de diferenciación, invasión perineural, invasión cartilaginosa- y de las adenopatías cervicales- número de ganglios afectados, diámetro de los ganglios, bilateralidad de las metástasis cervicales, estadio N-) que podrían ser predictivas de rotura capsular en 47 pacientes con metástasis cervicales intervenidos quirúrgicamente en la Cátedra de ORL de la Universidad Complutense de Madrid entre los años 94/97. Todas las piezas quirúrgicas fueron estudiadas mediante Secciones Seriadas de Órgano Completo. Las variables que aumentaron el riesgo de rotura capsular en el presente estudio fueron la localización del tumor, el diámetro tumoral mayor de 2 cm, las presencia de 2-3 ganglios metastásicos y el estadio N (AU)

The aim of the present study is to evaluate histopathological features of extracapsular spread detected in patients with laryngeal cancer. PATIENTS AND METHODS: Specimens of 47 patients with laryngeal cancer were processed as Whole-Organ Serial Sections at the ENT Department of the Complutense University of Madrid between 1994/97. RESULTS: Extracapsular metastases were found in 21 patients. The risk for extracapsular spread was higher in those patients with: supraglottic or piriform sinus cancer, more than 2-3 neck metastatic nodes, tumor diameter of more than 2 cm and N2 stage (AU)

[Extracapsular spread in advanced laryngeal cancer]. / Rotura capsular en el cáncer avanzado de laringe.

UNLABELLED: The aim of the present study is to evaluate histopathological features of extracapsular spread detected in patients with laryngeal cancer. PATIENTS AND METHODS: Specimens of 47 patients with laryngeal cancer were processed as Whole-Organ Serial Sections at the ENT Department of the Complutense University of Madrid between 1994/97. RESULTS: Extracapsular metastases were found in 21 patients. The risk for extracapsular spread was higher in those patients with: supraglottic or piriform sinus cancer, more than 2-3 neck metastatic nodes, tumor diameter of more than 2 cm and N2 stage.

[Early prognosis in chronic subdural hematomas. Multivariate analysis of 137 cases]. / Pronóstico precoz en hematomas subdurales crónicos. Análisis multivariante de 137 casos.

INTRODUCTION: In the literature there is evidence relating different factors such as age and preoperative clinical condition with prognosis in patients treated surgically for chronic subdural haematoma. OBJECTIVE: To clarify and quantify the magnitude of the factors which determine early prognosis (during hospital admission) of these patients. PATIENTS AND METHODS: We made a prospective study of 137 patients who had been operated on in our centre and found the relationship between different clinical and therapeutic variables with the clinical course and morbidity-mortality by means of multivariate and survival analysis. RESULTS: A high Markwalder functional score (3-4) is an independent factor of poor prognosis (OR = 13.15; CI 95% 6.1-28.4; p = 0.01), as is the presence of a coexisting coagulopathy (OR = 27.2; CI 95% 9.3-79.5; p = 0.01). Advanced age tended to increase the risk (OR = 1.104) but did not reach statistical significance (p = 0.0654). A multivariate logistic model, which included the functional score and presence of coagulopathy, correctly classified 94.7% of the cases studied. Analysis of survival showed two groups with different early mortality as a function of the Markwalder score (high: 3-4 and low: 0-1-2), which could be differentiated statistically (Log-Rank chi squared test: 3.95; p = 0.0468). CONCLUSIONS: The preoperative clinical state classified by functional scores and the presence of underlying coagulopathy are the main prognostic factors in chronic subdural haematoma during hospital admission. Advanced age is probably not in itself an independent factor for bad prognosis.

Pronóstico precoz en hematomas subdurales crónicos. Análisis multivariante de 137 casos / Early prognosis in chronic subdural haematomas multivariante analysis of 137 cases

Introduction. In the literature there is evidence relating different factors such as age and preoperative clinical condition with prognosis in patients treated surgically for chronic subdural haematoma. Objective. To clarify and quantify the magnitude of the factors which determine early prognosis (during hospital admission) of these patients. Patients and methods. We made a prospective study of 137 patients who had been operated on in our centre and found the relationship between different clinical and therapeutic variables with the clinical course and morbidity-mortality by means of multivariate and survival analysis. Results. A high Markwalder functional score (3-4) is an independent factor of poor prognosis (OR= 13.15; CI 95% 6.1-28.4; p= 0.01), as is the presence of a coexisting coagulopathy (OR= 27.2; CI 95% 9.3-79.5; p= 0.01). Advanced age tended to increase the risk (OR= 1.104) but did not reach statistical significance (p= 0.0654). A multivariate logistic model, which included the functional score and presence of coagulopathy, correctly classified 94.7% of the cases studied. Analysis of survival showed two groups with different early mortality as a function of the Markwalder score (high: 3-4 and low: 0-1-2), which could be differentiated statistically (Log-Rank chi squared test: 3.95; p= 0.0468). Conclusions. The preoperative clinical state classified by functional scores and the presence of underlying coagulopathy are the main prognostic factors in chronic subdural haematoma during hospital admission. Advanced age is probably not in itself an independent factor for bad prognosis (AU)

Introducción. Existen evidencias en la literatura que relacionan diversos factores, como la edad o el estado clínico preoperatorio, con el pronóstico del paciente intervenido quirúrgicamente porhematoma subdural crónico. Objetivo. Clarificar y cuantificar lamagnitud de aquellos factores que determinan el pronóstico precoz (durante el ingreso hospitalario) de dichos pacientes. Pacientes y métodos. Se estudiaron prospectivamente 137 pacientes intervenidosen nuestro centro y se relacionaron diversas variables clínicas y terapéuticas con la evolución clínica y morbimortalidad, mediante análisis multivariantes y de supervivencia. Resultados. Un grado funcional alto de Markwalder (3-4) es factor independiente de mal pronóstico (OR= 13,15; IC 95% 6,1-28,4; p= 0,01), así como la presencia decoagulopatía de base (OR= 27,2; IC 95%: 9,3-79,5; p= 0,01). La edad avanzada tiende a incrementar el riesgo (OR= 1,104), aunque sin significación estadística (p= 0,0654) El modelo logístico multivariante, que incluye el grado funcional y la presencia de coagulopatía, clasifica correctamente al 94,7% de los casos estudiados. El análisis de supervivencia extrajo dos grupos con distinta mortalidad precoz en función del grado de Markwalder (alto: 3-4, y bajo: 0-1-2), y estadísticamente diferenciables (χ2 del test de Log-Rank: 3,95; p= 0,0468). Conclusiones. El estado clínico prequirúrgico clasificado en grados funcionales y la presencia de coagulopatía de base son los principales factores pronósticos del hematoma subdural crónico durante el ingreso hospitalario. La edad avanzada per se probablemente no constituya un factor de mal pronóstico independiente (AU)