Cancer diagnosis in Catalonia (Spain) after two years of COVID-19 pandemic: an incomplete recovery.

BACKGROUND: This study aimed to estimate potential undetected cancers over the first 2 years of the COVID-19 pandemic in Catalonia. METHODS: Cancer incidence was compared between pre-pandemic (2019) and pandemic (March 2020-January 2022) periods in the Catalan Pathology Registry (CPR) according to sex, age, and tumor site. The correlation between cancer diagnosis and COVID-19 health care workload was also evaluated by means of the Pearson's correlation coefficient (R). The expected incident cancers (E) during the pandemic were estimated by applying 2019 CPR cancer incidence specific rates by sex and 5-year age groups to the 2020 and 2021 Catalan population pyramids. CPR incident cancers were considered observed (O). Standardized incidence ratios (SIR) and 95% confidence intervals (CIs) were calculated using the O/E ratio. RESULTS: After two pandemic years, cancer diagnosis decreased by 12% (SIR 0.88, 95% CI 0.87-0.89), or ∼7700 undetected cancers (13 000 with nonmelanoma skin cancer). Without nonmelanoma skin cancer, 72% of the cancer underdiagnosis was generated in 2020. Diagnoses decreased more in men (whole pandemic -14%; 2020 -21%; 2021 -8%) than in women (-9%, -19%, -3%, respectively), dropping significantly overall in all pandemic waves but the fifth (first -37%, second -16%, third -8%, fourth -6%, fifth -2%, sixth -6%), and across all adult age groups. In the first wave, CPR cancer diagnosis was inversely correlated with COVID-19 caseload in primary care (R -0.91, 95% CI -0.97 to -0.75) and occupancy in conventional hospital wards (R -0.91, 95% CI -0.99 to -0.48) and intensive care (R -0.91, 95% CI 95% -0.98 to -0.70). CONCLUSIONS: Our study evaluated the overall pandemic impact on cancer diagnosis on a large scale and with minimal selection bias, showing that as of February 2022, cancer detection in Catalonia had not yet recovered to pre-pandemic levels. Pending cancer incidence data from population-based cancer registries, early CPR data could inform the development of Spanish cancer control plans.

Role of boost radiotherapy for local control of pure ductal carcinoma in situ after breast-conserving surgery: a multicenter, retrospective study of 622 patients.

PURPOSE: To evaluate the effect of boost radiotherapy on ipsilateral breast tumor recurrence (IBTR) for ductal carcinoma in situ (DCIS) after breast-conserving surgery and whole breast radiotherapy (WBRT) with or without boost. METHODS AND MATERIALS: Retrospective, multicentre study of 622 patients (624 tumors) diagnosed with pure DCIS from 1993-2011. RESULTS: Most tumors (377/624; 60.4%) received a boost. At a median follow-up of 8.8 years, IBTR occurred in 64 cases (10.3%). A higher percentage of patients with risk factors for IBTR received a boost (p < 0.05). Boost was not associated with lower rates of IBTR than WBRT alone (HR 0.75, 95% CI 0.42-1.35). On the univariate analyses, IBTR was significantly associated with tumor size (11-20 mm, HR 2.32, 95% CI 1.27-4.24; and > 20 mm, HR 2.10, 95% CI 1.14-3.88), re-excision (HR 1.76, 95% CI 1.04-2.96), and tamoxifen (HR 2.03, 95% CI 1.12-3.70). Boost dose > 16 Gy had a protective effect (HR 0.39, 95% CI 0.187-0.824). Multivariate analyses confirmed the independent associations between IBTR and 11-20 mm (p = 0.02) and > 20 mm (p = 0.009) tumours, and re-excision (p = 0.006). On the margin-stratified multivariate analysis, tamoxifen was a poor prognostic factor in the close/positive margin subgroup (HR 4.28 95% CI 1.23-14.88), while the highest boost dose ( > 16 Gy) had a significant positive effect (HR 0.34, 95% CI 0.13-0.86) in the negative margin subgroup. CONCLUSIONS: Radiotherapy boost did not improve the risk of IBTR. Boost radiotherapy was more common in patients with high-risk disease. Tumor size and re-excision were significant independent prognostic factors.

Detection of incident breast and colorectal cancer cases from an administrative healthcare database in Catalonia, Spain.

OBJECTIVE: To validate the Catalan minimum basic data set (MBDS) of hospital discharges as an information source for detecting incident breast (BC) and colorectal cancer (CRC), against the Hospital del Mar Cancer Registry (RTHMar) in Barcelona (Spain) as the gold standard. METHODS: Using ASEDAT software (Analysis, Selection and Extraction of Tumour Data), we identified Catalan public hospital discharge abstracts in patients with a first-time diagnosis of BC and CRC in the years 2005, 2008, and 2011, aggregated by unique patient identifiers and sorted by date. Once merged with the RTHMar database and anonymized, tumour-specific algorithms were validated to extract data on incident cases, tumour stage, surgical treatment, and date of incidence. RESULTS: MBDS had a respective sensitivity and positive predictive value (PPV) of 78.0% (564/723) and 90.5% (564/623) for BC case detection; and 83.9% (387/461) and 94.9% (387/408) for CRC case detection. The staging algorithms overestimated the proportion of local-stage cases and underestimated the regional-stage cases in both cancers. When loco-regional stage and surgery were combined, sensitivity and PPV reached 98.3% and 99.8%, respectively, for BC and 96.4% and 98.4% for CRC. The differences between dates of incidence between RTHMar and MBDS were greater for BC cases without initial surgery, whereas they were generally smaller and homogeneous for CRC cases. CONCLUSIONS: The MBDS is a valid and efficient instrument to improve the completeness of a hospital-based cancer registry (HBCR), particularly in BC and CRC, which require hospitalization and are predominantly surgical.

Reoperations after primary breast conserving surgery in women with invasive breast cancer in Catalonia, Spain: a retrospective study.

BACKGROUND: Although complete tumor resection is accepted as the best means to reduce recurrence, reoperations after lumpectomy are a common problem in breast cancer. The aim of this study was to assess the reoperation rates after primary breast conserving surgery in invasive breast cancer cases diagnosed in Catalonia, Spain, between 2005 and 2011 and to identify variations based on patient and tumour characteristics. METHODS: Women with invasive incident breast cancer identified from the Patient's Hospital Discharge Database [174.0-174.9 codes of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) as the primary diagnosis] and receiving primary breast conserving surgery were included in the study and were followed up to 3 and 12 months by collecting information about repeat breast cancer surgery. RESULTS: Reoperation rates after primary breast conserving surgery decreased from 13.0 % in 2005 to 11.7 % in 2011 at 3 months and from 14.2 % in 2005 to 12.9 % in 2011 at 12 months' follow-up. While breast conservation reoperations saw a slight, non-significant increase in the same period (from 5.7 to 7.3 % at 3 months, and from 6.0 to 7.5 % at 12 months), there was a significant decrease in radical reoperation (from 7.3 to 4.4 % at 3 months and from 8.2 to 5.4 % at 12 months). Overall, additional breast surgeries decreased among younger women. CONCLUSIONS: Despite the rise of breast conserving surgery, reoperation rates following initial lumpectomy in Catalonia decreased by 10 % at 3 and 12 months' follow-up, remaining low and almost unchanged. Ultimately, there was also a significant decrease in mastectomies.

Biogeographical origin and varicella risk in the adult immigration population in Catalonia, Spain (2004-2006).

Immigrants to the European Union may have a higher susceptibility to varicella-zoster virus primo-infection than the indigenous population. There is no evidence as yet that this is caused by genetic or social factors. Therefore, susceptibility could be due to a lesser transmission of the virus in their ecosystems of origin. A multicentre observational study was performed from July 2004 to June 2006 in four primary healthcare centres in Catalonia, Spain, monitoring varicella incidences and comparing standardised incidence rates and standardised rate ratios among different populations classified according to their biogeographical origin (holarctic, Asian paleotropical, African paleotropical or neotropical). Overall, 516 varicella cases were recorded. The standardised incidence rates per 1,000 inhabitants per year were: holarctic: 2.17 (95% confidence interval (CI): 1.95-2.39); autochthonous 2.26 (95% CI: 2.03-2.49); immigrants 3.59 (95% CI: 2.92-4.26); neotropical 4.50 (95% CI: 3.28-5.71); non-holarctic 5.38 (95% CI: 4.27-6.14); Asian paleotropical 7.03 (95% CI: 4.77-9.28); and African paleotropical 7.05 (95% CI: 1.12-23.58). The difference to the autochthonous population was greatest in immigrants of neotropical origin (standardised rate ratio = 2.07 (95% CI: 1.61-2.64) or 4.5 excess cases per 1,000 inhabitants per year) and Asian paleotropical origin (standardised rate ratio = 3.24 (95% CI: 2.47-4.11) or 9.6 excess cases per 1,000 inhabitants per year). Biogeographical origin may therefore account for the vulnerability of certain immigrant populations to varicella, in particular those from Asian paleotropical (Indostan and Southeast Asia) and neotropical (South America and the Caribbean) ecosystems. Vaccination of immigrants at high risk (fertile women, healthcare workers) could be recommendable.

[Seroprevalence of chronic viral hepatitis markers in 791 recent immigrants in Catalonia, Spain. Screening and vaccination against hepatitis B recommendations]. / Seroprevalencia de marcadores de hepatitis crónica vírica en 791 inmigrantes recientes en Cataluña, España. Recomendaciones de cribado y de vacunación contra la hepatitis B*

INTRODUCTION: The prevalence of chronic viral hepatitis in the European Union (EU) will vary because of the immigrants coming from countries having an elevated with a higher endemicity of hepatitis B (HBV) and C virus (HCV). Serologic screening in healthy immigrants is a subject that has been discussed in the areas of feasibility, ethics and cost-effectiveness. The main study aims were: a) to know the prevalence of chronic hepatitis markers and, b) to determine the best cost-effectiveness strategy of vaccination against hepatitis B. POPULATION AND METHOD: An observational, perspective and multicenter study was performed on the Primary Care level in Catalonia (Spain) among healthy immigrants who had lived in the EU for less than 5 years. RESULTS: Data from 791 individuals were analyzed. They presented anti-HBc+ 33% (95% CI 29.6 -36.1), and anti-HBs+ 16.1% (95% CI 11.4 -20.8). HBsAg+ was 5.9% (95% CI 3-8.7), of those were HBeAg+ 15.62% (95% CI 5.3-32.8). The sub-Saharan group presented the higher prevalence of anti-HBc+ (77.3%) and HBsAg+ (18.2%), whereas the Latin American-origin population displayed the lowest one (12.5% and 1.2%, respectively). Determination of antibodies prior to vaccination was found as cost-effective from a seroprevalence anti-HBc+> 48.72%; only overcome by the CI of sub-Saharan population (95% CI 5.3-32.8). The prevalence of anti-HC+ was 6.1% (95% CI 4.3-7.8), especially high among the Eastern European (19.6%) and Indostanic (14.9%) population. The Latin American group had the lowest prevalence (1.4%). CONCLUSIONS: The prevalence of chronic viral hepatitis markers is found to be at an intermediate level between those described by primary and specialized care levels. The prevalences of HBsAg+ and anti-HC+ in the immigrant population, on the whole, are such that it is advisable to screening for them, with the exception of the Latin American community. Previous serologic determination of markers is only cost-effective among the sub-Saharan community.

Seroprevalencia de marcadores de hepatitis crónica vírica en 791 inmigrantes recientes en Cataluña, España. Recomendaciones de cribado y de vacunación contra la hepatitis B* / Seroprevalence of chronic viral hepatitis markers in 791 recent immigrants in Catalonia, Spain. Screening and vaccination against hepatitis B recommendations

Introducción. La prevalencia de las hepatitiscrónicas víricas en la Unión Europea variará debidoa la recepción de inmigrantes procedentes de paísescon elevada endemia de infección crónica por virusde la hepatitis B (VHB) y C (VHC). La inclusión desu cribado en inmigrantes sanos es un temadebatido en los planos de factibilidad, ética y decoste-efectividad.Los objetivos del estudio fueron: a) conocer laprevalencia de marcadores contra la hepatitiscrónica y, b) determinar una estrategia costeefectivade vacunación contra la hepatitis B.Población y método. Estudio observacionalprospectivo y multicéntrico a nivel de AtenciónPrimaria en Cataluña (España), definido sobrela población de inmigrantes sanos con menos de 5años de residencia en la Unión Europea.Resultados. Se estudiaron 791 individuos.Presentaron HBcAc+ 33% (intervalo de confianza[IC] 95% 29,6-36,1) y HBsAc+ 16,1% (IC 95%11,4-20,8). Presentaron antígeno de superficiepositivo (HBsAg+) 5,9% (IC 95% 3-8,7), de loscuales el antígeno soluble positivo (HBeAg+)15,62% (IC 95% 5,3-32,8). La poblaciónsubsahariana presentó la mayor prevalencia deHBcAc+ (77,3%) y de HBsAg+ (18,2%) y la latinoamericana, la menor (12,5% y 1,2%, respectivamente). La determinación serológica prevacunación se mostró coste-efectiva a partir de una seroprevalencia HBcAc+ >48,72%, valor sólo superado por el IC de la población subsahariana (IC 95% 68,6-86). Presentaron anticuerpos contra el virus de la hepatitis C (HCAc+) 6,1% (IC 95%4,3-7,8), especialmente el colectivo de EuropaOriental (19,6%) e Indostán (14,9%). La comunidadcon menor prevalencia fue asimismo lalatinoamericana (1,4%).Discusión. La prevalencia de marcadores dehepatitis crónica vírica se sitúa en un nivelintermedio entre las descritas en los ámbitos deAtención Primaria y especializada. La poblacióninmigrante en su conjunto muestra prevalencias demarcadores HBsAg+ y HCAc+ que hacenrecomendable su cribado excepto para el colectivolatinoamericano. La determinación serológica previaa la vacunación sólo es coste-efectiva en el colectivosubsahariano

Introduction. The prevalence of chronic viralhepatitis in the European Union (EU) will varybecause of the immigrants coming from countrieshaving an elevated with a higher endemicity ofhepatitis B (HBV) and C virus (HCV). Serologicscreening in healthy immigrants is a subject that hasbeen discussed in the areas of feasibility, ethics andcost-effectiveness. The main study aims were: a) toknow the prevalence of chronic hepatitis markersand, b) to determine the best cost-effectivenessstrategy of vaccination against hepatitis B.Population and Method. An observational,perspective and multicenter study was performed onthe Primary Care level in Catalonia (Spain) amonghealthy immigrants who had lived in the EU for lessthan 5 years.Results. Data from 791 individuals were analyzed.They presented anti-HBc+ 33% (95% CI 29.6 -36.1),and anti-HBs+ 16.1% (95% CI 11.4 -20.8). HBsAg+was 5.9% (95% CI 3-8.7), of those were HBeAg+15.62% (95% CI 5.3-32.8). The sub-Saharan grouppresented the higher prevalence of anti-HBc+(77.3%) and HBsAg+ (18.2%), whereas the LatinAmerican-origin population displayed the lowest one(12.5% and 1.2%, respectively). Determination ofantibodies prior to vaccination was found ascost-effective from a seroprevalence anti-HBc+>48.72%; only overcome by the CI of sub-Saharanpopulation (95% CI 5.3-32.8). The prevalence ofanti-HC+ was 6.1% (95% CI 4.3-7.8), especially highamong the Eastern European (19.6%) and Indostanic(14.9%) population. The Latin American group hadthe lowest prevalence (1.4%).Conclusions. The prevalence of chronic viralhepatitis markers is found to be at an intermediatelevel between those described by primary andspecialized care levels. The prevalences of HBsAg+and anti-HC+ in the immigrant population, on thewhole, are such that it is advisable to screening forthem, with the exception of the Latin Americancommunity. Previous serologic determination ofmarkers is only cost-effective among the sub-Saharan community

Previous STI and risk of HIV infection in men.

To determine the prevalence of a previous history of sexually transmitted infection (STI) and its influence as a risk factor for HIV infection among men tested for HIV, data from men having a voluntary HIV test at the STI Unit of Barcelona during a 6-month period of 1998 were analysed. Descriptive and logistic regression analysis were done to examine the prevalence of previous STI and factors associated with HIV infection. Prevalences of HIV were 5.6% in homo/bisexual and 0.5% in heterosexual men (P<0.001). Risk factors for HIV were STI history: odds ratio (OR)=8.7 and homo/bisexual behaviour: OR=6.6; 19.8% of heterosexuals had a history of STI compared with 44.2% of homo/bisexual men (P<0.01). A previous STI was associated with HIV seropositivity in homosexual men.

[HIV infection and other sexually-transmitted infections among immigrants in Barcelona]. / Infección por el virus de la inmunodeficiencia humana y otras infecciones de transmisión sexual en inmigrantes de Barcelona*

BACKGROUND: Immigration is a recent phenomenon in Spain. Certain subgroups of the immigrant population may be vulnerable to acquiring sexually transmitted infections (STI). MATERIAL AND METHODS: Descriptive study of the seroprevalenceof certain STI (HIV, hepatitis B and syphilis) and the general characteristicsn of persons tested for HIV infection in a specialized clinic in Barcelona during the year 2000. RESULTS: Seroprevalence of HIV was similar in immigrants and native residents(1.8% vs. 1.7% respectively). However, the seroprevalences of hepatitis B virus (anti-HBc) (19.5% vs. 8.3%) and syphilis (RPR 1 TPHA) (3.2% vs. 1.1%), as well as other STI and the practice of prostitution, were higher in immigrants. CONCLUSIONS: Several STI, including hepatitis B and syphilis, were found more frequently in immigrants than in the native population, whereas HIV seroprevalence was similar in the two groups.

[Control of blood pressure in a population of patients with hypertension and in a subgroup with hypertension and diabetes: relationship with characteristics of the health care center and the community]. / Control de la presión arterial en la población hipertensa y en el subgrupo de hipertensos y diabéticos: relación con las características del centro y de la comunidad.

AIMS: To evaluate how well blood pressure (BP) is controlled in the population of persons with hypertension alone and with diabetes, and to evaluate the influence of characteristics of the health care center on the degree of control of BP. Design. Descriptive, cross-sectional, multicenter, retrospective study. SETTING: 31 health centers in Catalonia (Northeastern Spain). Participants. Random sample of 2240 clinical records of patients with hypertension who were seen at 31 different primary care centers in Catalonia between January and December 1996. MAIN OUTCOME MEASURES: Audit of clinical records. We recorded the two most recent BP measurements, and annotations regarding screening for and diagnosis of other cardiovascular risk factors. We also recorded health center and physician characteristics. RESULTS: 495 patients (22.1%) had diabetes in addition to hypertension. 61.2% were women. Mean age was 64.9 years (95% CI, 64.4-65.4 years). In 25.7% of the patients, BP was below 140/90 mmHg (95% CI, 23.9-27.5%), but among patients with diabetes only 6.7% had BP below 130/85 mmHg (95% CI, 4.5-8.9%). Mean systolic and diastolic BP at the end of the study period were higher at teaching centers. Diastolic BP was significantly higher at urban centers and in patients younger than 65 years. Diastolic BP was also higher in patients with at least one associated cardiovascular risk factor, and at centers less than 6 years old, although these differences were not statistically significant. We found no differences according to physician characteristics. CONCLUSIONS: Blood pressure was adequately controlled in few patients with hypertension and diabetes in Catalonia. Associated cardiovascular risk factors, age less than 65 years, and being a patient at a teaching center or an urban center, were associated with a worse degree of BP control.

Survival evaluation of treatment modality in squamous cell carcinoma of the oral cavity and oropharynx.

The treatment of squamous cell carcinoma of the mouth and oropharynx continues to change. In this primary report, we compared the results obtained by combined surgery and radiation therapy, or either modality alone. Other methods such as brachytherapy, or hyperfractionated radiotherapy, were not included in our protocols. A statistical analysis of the 3- and 5-year survival rates in relation to location and size of the primary tumour, stage at initial presentation, treatment modality and recurrence, was carried out in 88 patients with squamous cell carcinoma of the oral cavity or oropharynx. The overall survival rate was 73.8% at 3 years and 66.3% at 5 years. Size of tumour and stage at presentation were significant when P value was adjusted by site. Survival was significantly associated with type of treatment (combined approach obtained superior results), location of primary tumour, and recurrence. The type of neck dissection did not show any effect. Therapeutic modality used, stage, and location of primary tumour significantly influenced survival. A more selective combined initial treatment according to site and stage (distribution) is recommended.

Evaluation of the BACTEC MGIT 960 and the MB/BacT systems for recovery of mycobacteria from clinical specimens and for species identification by DNA AccuProbe.

A total of 120 mycobacterial isolates were recovered from 1,068 clinical specimens. Of these, 82.5% were in MGIT 960, 83.3% were in MB/BacT, 80% were in BACTEC 460, and 70% were on Löwenstein-Jensen medium. Mean times to detection of Mycobacterium tuberculosis (n = 96) were significantly shorter with MGIT 960 (12.6 days, P = 0.003) and BACTEC 460 (11.8 days, P < 0.001) than with MB/BacT (15.9 days). Although, MGIT 960 showed the lowest rate of recovery of M. kansasii genotype I (64.3%), the earliest growth was detected with this system (8.9 days). Low and similar rates of contamination were obtained with MGIT 960 (3.3%) and MB/BacT (3%). The AccuProbe test for identification showed excellent sensitivities with MGIT 960 (96. 8%) and MB/BacT (100%) cultures. In addition to being nonradiometric, both MGIT 960 and MB/BacT are accurate, rapid, and labor-saving detection systems which could replace the radiometric method.

Cardiovascular risk factors associated with clinically isolated and diffuse atherosclerosis in Spanish patients with coronary artery disease.

BACKGROUND: Patients with coronary artery disease (CAD) associated with peripheral (PAD) or cerebrovascular disease (CVD), a condition called diffuse atherosclerosis, have a higher risk of death than patients with isolated CAD. The prevalence of diffuse atherosclerosis and the atherogenic risk factors associated with this condition in our geographic area have not been described previously. METHODS: A cohort of 2597 patients (62 +/- 10.8 years, 665 women) consecutively admitted at Bellvitge Hospital because of acute coronary syndromes were studied. CAD patients were divided in two groups with diffuse and located atherosclerosis according to whether they had or they had not an associated PAD or CVD. Baseline history, physical data and lipid profile were recorded in each patient according to a standardized questionnaire. RESULTS: A total of 370 patients (14.2%) had diffuse atherosclerosis. Among them, there were more men and women older than 55 years than among those with isolated CAD. Patients with diffuse atherosclerosis were more frequently hypertensive, diabetic and former smokers than those with isolated CAD (60.5% vs. 49.4%, P < 0.01; 37.4% vs. 24.5%, P < 0.01; and 47% vs. 35.7%, P < 0.01, respectively). There were no significant differences in the mean values of total cholesterol (TC), low-density cholesterol (LDL-C), high-density cholesterol (HDL-C) and triglycerides between both groups of patients, but patients with diffuse atherosclerosis had a lower HDL-C/TC ratio, with borderline statistical significance (0.18 +/- 0.06 vs. 0.19 +/- 0.06, P = 0.06). Using multiple logistic regression analysis, the variables associated with diffuse atherosclerosis in men were age greater than 55 years (OR 1.97, CI 1.33-2.93), hypertension (OR 1.50, CI 1.14-2.20), diabetes (OR 1.78, CI 1.20-2.70), smoking (former smokers) (OR 2.09, CI 1.36-3.24) and HDL-C/TC < 0.20 (OR 1.60, CI 1.18-2.17); and in women hypertension (OR 3.43, CI 1.48-7.94) and diabetes (OR 2.58, CI 1.55-4.80). CONCLUSIONS: Clinically overt diffuse atherosclerosis is a relatively common disease. Older patients and those with hypertension, diabetes or low HDL-C/TC ratio are more likely to have diffuse atherosclerosis than those without these conditions.

Angiogenesis and malignant melanoma. Angiogenesis is related to the development of vertical (tumorigenic) growth phase.

To study angiogenesis in early steps of melanoma progression, 113 cutaneous melanomas 1 mm or less in thickness were stained with Ulex europaeus lectin. Vascular density was determined in the areas of greatest vascularization. To avoid the effect of anatomic location, the quotient between vascular density at the tumor base and in normal skin (vascular ratio) was obtained in each case. Of these melanomas, 46 were immunohistochemically stained for the presence of vascular endothelial growth factor (VEGF). Positivity was scored from 1-4 by comparing staining of melanoma cells with keratinocytes. Vascular ratio values in vertical growth phase melanomas were higher than those in radial growth phase when counting per 200 or 400 magnification (2.29 +/- 1.3 and 2.48 +/- 1.5 for vertical growth phase and 1.34 +/- 0.62 and 1.41 +/- 0.83 for radial growth phase melanomas, respectively). This difference was statistically significant (p < 0.0001 and p < 0.001 at x200 and x400, respectively). Also, VEGF staining was stronger in vertical growth phase melanomas when compared with radial growth phase melanomas (Chi square, p < 0.025). In conclusion, our findings suggest that angiogenesis and VEGF expression are associated with the development of vertical growth phase.

Human papillomavirus DNA and antibodies to human papillomaviruses 16 E2, L2, and E7 peptides as predictors of survival in patients with squamous cell cervical cancer.

PURPOSE: To assess whether human papillomavirus (HPV) DNA detection in cervical cancer specimens, or antibodies to selected HPV 16 peptides are predictors of tumor recurrence and long-term survival in patients with squamous cell invasive cervical cancer. SUBJECTS AND METHODS: Four hundred seventy-one cases included in two population-based case-control studies underwent follow-up evaluation. The survival and cause of death were ascertained for 410 cases (87%), with a median follow-up time of 4.6 years after diagnosis. HPV DNA was assessed using an L1 polymerase chain reaction (PCR)-based system and Southern hybridization (SH) on scraped cytologic specimens or biopsies. HPV 16 antibodies to E2, L2, and E7 peptides were detected with enzyme-linked immunosorbent assay (ELISA). RESULTS: Clinical stage was the only independent prognostic factor for recurrence or survival. Although seropositivity to HPV 16 E7/3 peptide predicted a twofold excess risk of mortality (adjusted hazards ratio [HRa] = 2.0; 95% confidence interval [CI], 1.2 to 3.3), the association was restricted to stage I (HRa = 6.6; 95% CI, 1.2 to 37.6) and II (HRa = 5.9; 95% CI, 2.1 to 16.5) patients. The presence of HPV DNA (HRa = 0.9; 95% CI, 0.5 to 1.5), different estimates of the HPV viral load and the HPV type identified were not predictors of tumor recurrence or survival. CONCLUSION: The presence of antibodies to HPV 16 E7 proteins is of prognostic value in early-stage cervical cancer. Our results provide strong evidence that detection and typing of HPV DNA in cervical cells or tissues is not a prognostic factor for recurrence or survival.

Ketoacidosis at diagnosis is predictive of lower residual beta-cell function and poor metabolic control in type 1 diabetes.

To determine the factors at diagnosis predictive of changes in residual beta-cell function and metabolic control in Type 1 diabetes, 125 patients older than 7 years of age consecutively diagnosed between March 1986 and June 1991 were followed prospectively for two years. The effect of age, gender and the presence of ketoacidosis (DKA) and islet-cell antibodies (ICA) on beta-cell function, metabolic control and insulin requirements were studied by multivariate analysis of variance (repeated measurements over time) in 90 patients who completed follow-up. DKA had an independent negative effect on residual beta-cell function over time (p = 0.001). ICA-positive patients had lower residual beta-cell function at the end of follow-up (p < 0.05), but overall differences were not significant. DKA and younger age had an independent negative influence on metabolic control (p < 0.05) and insulin requirements (p < 0.001) over time. It is concluded that residual beta-cell function in Type 1 diabetic patients two years after diagnosis was independently influenced by DKA and ICA at diagnosis. Moreover, DKA and age influenced metabolic control and could thus be used to predict those patients with rapidly deteriorating metabolic control who might benefit from a more intensive therapeutic approach.

Age at first full-term pregnancy, lactation and parity and risk of breast cancer: a case-control study in Spain.

A case-control study was carried out in Spain to assess associations between parity, lactation and age at first full-term pregnancy and breast cancer. From November 1989 to February 1992, 184 incident breast cancer histologically confirmed cases were interviewed and matched by age and residence to 184 hospitalized patients and 184 community controls selected by random digit dialing. Multiple logistic regression was used to assess the independent influence of each factor on the risk of breast cancer in relation to other factors included in the model. Age at first full-term pregnancy was associated with breast cancer risk with an estimated odds ratio of 3.5 (95% CI 1.41-9.83) for women with their first birth after 30 years in comparison with those whose first birth was before age 21. Breast cancer risk decreased with increasing number of full-term pregnancies, OR 0.3 (95% CI 0.16-0.78) for women who had had more than 3 full-term pregnancies in comparison with nulliparous women. Among parous women, the estimated OR for women with more than 3 children was 0.4 (95% CI 0.13-0.81) after allowance for age at first childbirth and lactation. The estimated OR was 2.6 (95% CI 1.4-4.7) for women with a positive history of breast cancer in first-degree relatives. Breast cancer was not associated with total duration of lactation. The study indicates that parity is an independent risk factor associated to breast cancer and that the women with a late age at first full-term pregnancy constitute a high-risk group.

Prognosis assessment of cirrhotic patients with refractory ascites treated with a peritoneovenous shunt.

OBJECTIVE: The role of peritoneovenous shunt in the management of refractory ascites has not been clearly established. The aim of this study was to determine readily accessible predictive survival factors in cirrhotic patients with refractory ascites treated with a peritoneovenous shunt. METHODS: We studied a cohort of 100 cirrhotic patients with refractory ascites who underwent peritoneovenous-shunt placement in a university-based reference hospital. RESULTS: The estimated median survival of patients after shunt placement was 11 months (95% CI, 7-14 months). Multivariate analysis based on the proportional hazards model disclosed four independent variables associated with poor survival: high Pugh score, nonalcoholic etiology, low ascitic fluid protein concentration, and history of spontaneous bacterial peritonitis. CONCLUSIONS: Mortality of cirrhotic patients treated with a peritoneovenous shunt can be determined by a prognostic index using four easily available variables. Such a prognostic index, once prospectively validated, could be used as an adjunct in planning treatment of cirrhotic patients with refractory ascites.

Risk factors for the development of Haemophilus influenzae pneumonia in hospitalized adults.

Potential risk factors for developing Haemophilus influenzae nosocomial pneumonia have not been sufficiently studied. We wanted to investigate the incidence and risk factors for the development of Haemophilus influenzae pneumonia in the hospital by means of a multivariate analysis. A total of 468 cases of nosocomial pneumonia were observed during the study period, 317 (68%) of which were aetiologically diagnosed by means of highly reliable methods, and H. influenzae was isolated in 57 of them. Fifty of the 57 episodes of H. influenzae pneumonia occurred in mechanically-ventilated patients. Underlying diseases were: medical in 12 cases, surgical in 15 cases, and traumatological in 22. Variables associated with Haemophilus influenzae nosocomial pneumonia in intubated patients after the univariate analysis were: "period between admission and pneumonia 2-7 days" and "no previous antibiotics". A multivariate analysis demonstrated that the variables "no previous antibiotics" and "coma on admission" were risk factors for H. influenzae pneumonia. In nonintubated patients, no risk factors were found for H. influenzae pneumonia compared with other nosocomial pneumonia. We conclude that H. influenzae was involved in 57 out of 317 (18%) of nosocomial pneumonia registered in our institution, and the majority of patients (50 out of 57) were mechanically-ventilated. In this particular subgroup, coma of the patient on admission to hospital and absence of antibiotic treatment prior to developing pneumonia constitute two definite risk factors for developing H. influenzae nosocomial pneumonia.