Nuevas perspectivas en el tratamiento paliativo del glioblastoma multiforme y astrocitoma anaplásico recidivado con implantes de carmustina / New prospects of the paliative treatment of relapsing glioblastoma multiforme and anaplastic astrocytoma with carmustine implants

Analizamos el tratamiento de las recidivas de glioblastoma multiforme y astrocitoma anaplásico con cirugíamás la implantación de polímeros de carmustina (BCNU) en el lecho de la recidiva, con el objetivo de mejorarla calidad de vida, los síntomas neurológicos y generales, y aumentar el control tumoral. Reflejamos la experienciay datos clínicos de 4 pacientes intervenidos.El empleo de carmustina implantes puede realizarse de forma factible sin objetivarse efectos adversos queinterfieran la calidad de vida, además de observar un enlentecimiento en la progresión del deterioro neurológicode los pacientes.La selección de pacientes jóvenes, con un buen performance estatus, en los que se prevea la mejor resecciónde la recidiva posible, garantizará el éxito en el tratamiento paliativo con implantes de carmostina

In recurrent glioblastoma multiforme and anaplastic astrocytoma, surgery and carmustine (NCNU) polymersimplants over the surgical area of the removed recidivation is a promising way to improve the quality of life,the neurologic and general symptoms, and the tumor control. We report our data and experience in fourpatients. The resection was optimized because the patients were young and showed a performance statusbetween 0 and 2

[The elderly at risk in the province of Guadalajara]. / El anciano de riesgo en la provincia de Guadalajara.

OBJECTIVE: To study fragile elderly people in the population, their characteristics and their distribution according to fragility markers. DESIGN: Cross-sectional, descriptive study using a survey. SETTING: Primary care. Elderly people living in Guadalajara in January 2002. PARTICIPANTS: 434 people were interviewed (1.24% of population). There were 157 losses (26.6%). INTERVENTIONS: The questionnaire contained social and demographic variables (age, sex, setting), care variables (medication, pathologies, home care) and evaluative scales (Barthel, Folstein, Yesavage, Diaz-Palacios). MAIN MEASUREMENTS: Fragility markers: 3 or more pathologies, 6 or more drugs, dementia, and/or positive on one of the four scales used. RESULTS: Subjects lived in rural areas more (56.7%; CI, 52-61.3), but there were not more women. Fragile elderly, n=257 (59.2%; CI, 54.6-63.8), were more women (OR=1.8; CI, 1.5-2.2) and over 70 (OR=80-84, 5.2; CI, 3.7-7.5; OR=85-89, 8.2; CI, 5.3-12.8). Prevalence of markers was: 3 or more pathologies, 30.2% (95% CI, 25.8-34.5); cognitive deterioration, 22.6% (95% CI, 18.7-26.5); social risk, 20.8% (95% CI, 16.3-23.8); multi-medication, 18.7% (95% CI, 15-22.3); Barthel incapacity, 11.7 (95% CI, 8.7-14.8); depression, 5.3% (95% CI, 3.2-7.5); and dementia, 3.2% (95% CI, 1.6-4.9). Women suffered cognitive deterioration more. The over-80s suffered cognitive deterioration, social risk and incapacity more. CONCLUSIONS: There was high prevalence of fragility with cognitive deterioration, multi-medication and social risk; and lower presence of dementia. Women and the most elderly people were most affected.

[Prevalence of tuberculosis infection in the school age in Guadalajara, Spain]. / Prevalencia de la infección tuberculosa en el medio escolar de Guadalajara.

OBJECTIVES: To estimate the prevalence of tuberculosis infected children in the first grades of Primary Education and to analyse the distribution of infected people among social class groups and other previous circumstances. METHODS: Cross-sectional study with diagnostic test application and questionnaire survey, in a representative sample of the school population of the province of Guadalajara, Spain (two stages sampling design). Tuberculin skin tests with 2 I.U. of P.P.D. RT-23 and the Sokal method for lecture were used. For occupational classification and social class definition were used the criteria of the last report of Spanish Epidemiology Society. RESULTS: A total of 1,093 children (50.8% males) between 6 and 9-year-old were studied. The overall prevalence of infected children was 1.64 (I.C.:1-2.3). The distribution of infection did not show significant differences between urban/rural population, previous disease, family antecedent, social class, dwelling area and occupational activities of parents. The prevalence increased in the older upper school years and among the older children. Prevalence ranged from 0.4% (CI: 0.01-1.3) in the first year to 3.53% (CI: 2.4-4.6) in the last year. Children born in 1988 had a 3.23% prevalence (CI: 1.2-5,1), while those born in 1989; 1990 and 1991 had a prevalence of 0.73 (CI: 0-1.77), 1.88% (CI: 0.2-3.51) and 0.4% (0-1.2), respectively. CONCLUSIONS: Tuberculosis infection is less prevalent at school ages than other areas of Spain. In spite of the increase prevalence per school year, the low frequency and sample size did not allow to test for other associations.

[Multiple primaries of the upper aerodigestive tract, esophagus, and lung]. / Múltiples primarios en vías aerodigestivas superiores, esófago y pulmón.

The existence of multiple primary tumors of the upper aerodigestive tract, esophagus, and lung (UADT-E-L) is related with a common etiopathogenic factor (alcohol-tobacco association). In a review of 43 patients, 6.75% with a UADT-E-L tumor developed another neoplasm, 3.25% at the same site. Nine percent (8.59%) of the tumors were synchronic and 10.85% were metachronic. The most frequent association was larynx-lung. Another neoplasm was detected by physical examination and/or radiology in 44.18% of cases, with a time lapse of less than 3 years in 50%. The most frequent treatment was surgery with/without complementary radiotherapy. The most common stage was T1-T2 (62.06%) and N0-N1 (68.96%). The survival rate was 31% at 2 years and 25% at 3 years.

Prevalencia de la infección tuberculosa en el medio escolar de Guadalajara / Prevalence of tuberculosis infection in the school age in Guadalajara, Spain

Objetivos: Estimar la prevalencia de infección tuberculosa en los niños escolarizados en los cuatro primeros cursos de Educación Primaria, y analizar su distribución según su clase social y la existencia de antecedentes de enfermedad. Métodos: Se trata de un estudio transversal mediante la aplicación de prueba diagnóstica y autocumplimentación de encuesta en una muestra representativa de la población escolar de la provincia de Guadalajara en 1997-1998 (diseño muestral polietápico). Se aplicó la prueba de la tuberculina utilizando 2 UT del lote PPD-RT 23, según normas de consenso y lectura por el método de Sokal. La clasificación de ocupaciones y la definición de clase social se hizo según la actualización de la Sociedad Española de Epidemiología. Resultados: Se estudiaron 1.093 niños (50,8 por ciento varones) comprendidos entre 6 y 9 años de edad. La prevalencia total de infectados fue de 1,64 por ciento (IC: 1-2,3). La distribución de infectados no mostró diferencias significativas para el estrato urbano-rural, antecedentes familiares, clase social, superficie de la vivienda y tipo de actividad ocupacional desarrollada por los padres. La prevalencia aumentó en los cursos superiores y en los niños de mayor edad, siendo de 0,4 por ciento (IC: 0,01-1,3) en el primer curso y de 3,53 por ciento (IC:2,4-4,6) en el último. En los nacidos en 1988 la prevalencia fue de 3,23 (IC: 1,2-5,1), y de 0,73 (IC: 0-1,7), 1,88 (IC: 0,2-3,51), y 0,4 (IC: 0-1,2) en los nacidos en 1989, 1990 y 1991, respectivamente. Conclusiones: La infección tuberculosa es poco prevalente en nuestro medio escolar en relación a estudios de otras comunidades. Esta baja frecuencia y el tamaño muestral utilizado han impedido la estimación estadística de posibles diferencias en la distribución de infectados en algunos subgrupos estudiados, aunque se puede objetivar una mayor afectación en los más mayores (AU)

[Epidemiology of leprosy through the study of frequency of visits to the Trillo Specialized Hospital in 1943-1995]. / Epidemiología de la lepra a través del estudio de la frecuentación en el hospital especializado de Trillo durante el período 1943-1995.

BACKGROUND: The purpose of this study is to describe the social-demographic and clinical profile of hospitalised leprosy patients and to check whether typology has changed during the history of the centre. METHODS: Descriptive and retrospective study, performed by means of reviewing a sample of the patient records registered at the Centre since it was founded in 1943 until 1995. 366 cases were chosen by means of a systematic random sample and questionnaires completed on social-demographic and clinical variables. RESULTS: Most of the patients were male (71.9%, IC: 67.3-76.4), young (39.6 years of age, IC: 37.9-41.4), single (46.2%, IC: 41-51.3%) with low levels of education (illiteracy: 54.1%, IC: 40-69) with occupations relating to farming (35.5%, IC: 30.6-40.4) from Southern Spanish regions (patients from Andalucía 52.8%, IC: 45.8-54). The disease showed a family background in 31.1% of cases (IC: 26.4-35.9) and serious multibacillary forms (Lepromatose Leprosy 66.1%, IC: 61.2-71), which affected lower limbs in 72.1% of cases, heads in 63.1% and upper limbs in 64.4%. Global mortality of people admitted to hospital was 31.1% (IC: 26.4-35.9). During the surveyed period, patient age increased, and symptoms and mortality decreased. In general, hospital stays were for long periods (7.1 years, IC: 6.1-8.1), although at the end of the surveyed period, stays decreased considerably, in accordance with the duration of treatment (2.2 years). CONCLUSIONS: A Young male, in a precarious financial situation living in the South of Spain appear to be the patient profile which, with severe initial anatomical symptoms and later favourable results may represent the disease in a country with an autocuthonous endemy and characteristic epidemiology, which is in the pre-eradication phase.