Sex estimation of the humerus: A geometric morphometric analysis in an adult sample.

Sex estimation is the keystone for positive identification when an unidentified human body is recovered in forensic contexts. However, in complex death scenes such as mass disasters, the remains are often fleshed, mutilated, burned, and/or commingled. In situations such as these where it is not possible to analyze pelvis and/or cranium data, traditional metric and qualitative morphological methods on postcranial bones can yield unsatisfactory results. In such cases, geometric morphometric techniques offer an alternative to the analysis of both shape and size components of morphological variation that can be of great utility for sex estimation in forensic investigations. The study population consisted of 72 well-preserved adult humeri (40 males and 32 females; mean age of 62 years) that were photographed in standardized positions with landmarks located in four two-dimensional views of the humerus (anterior surface of the proximal epiphysis, and anterior, posterior and inferior surface of distal epiphysis). Principal components analysis, canonical variates analysis and discriminant analysis were applied. The data indicated that males and females were classified with low levels of accuracy (54.95-77.92% for males; 56.87-71.78% for females) based on shape variables. However, when the shape variable was combined with the centroid size, the levels of accuracy increased (81.86-94.92% for males; 84.08-94.88% for females). To obtain larger differences between males and females, it is necessary the combination of centroid size with shape variables; the shape of the humerus is insufficient to discriminate sex with accuracy.

Estrongiloidosis en niños: dificultad de diagnóstico y tratamiento / Strongyloidiasis in children: difficulty of diagnostic and treatment

La estrongiloidosis es una enfermedad parasitaria endémica en zonas tropicales, casi siempre asintomática, pero en pacientes inmunodeprimidos puede provocar una hiperinfección y una enfermedad diseminada severa. Presentamos el caso de una niña de 18 meses de edad, procedente de Etiopía, que acude a la consulta por presentar distensión abdominal y diarrea. Se diagnosticó inicialmente como una giardiasis, y se trató sin que se obtuviese mejoría clínica. Ante la aparición de eosinofilia y la persistencia de los síntomas, se repitieron los estudios microbiológicos y se aislaron larvas de Strongyloides stercoralis en heces. Fue tratada con albendazol, con buenos resultados. La estrongiloidosis es una enfermedad que plantea dificultades diagnósticas por su sintomatología, la escasa rentabilidad de las pruebas diagnósticas y su baja incidencia en nuestro medio. El tratamiento en adultos está bien establecido, pero en menores de 2 años hay cierta controversia en cuanto al fármaco de elección(AU)

Strongyloidiasis is a parasitic endemic disease in tropical zones, usually asymptomatic but in immunodepressed patients can induce an hyperinfection and a serious disseminated disease. We report a case of an 18 months old girl from Ethiopia, that comes to consultation with abdominal bloating and diarrhea. Initially was diagnosed and treated as a giardiasis but a clinical improvement was not obtained. Because of the rise of eosinophilia and the persistence of the symptoms, the microbiological studies were repeated and Strongyloides stercoralis larvae were detected in stools. It was treated with albendazole achieving a good result. Strongyloidiasis is a disease that implies diagnostic difficulties, for his symptomatology, for the reliability of the diagnostic tests and for the low incident in our country. The treatment in adults is well established, but in children younger than 2-year-old there is scanty information about the drug of choice(AU)

Metástasis cutáneas zosteriformes de mesotelioma pleural maligno / No disponible

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La salud de los niños adoptados en el extranjero por familias del País Vasco y Navarra (1997-2004) / No disponible

Objetivo: estudiar el estado físico, el desarrollo psicomotor y la adaptación de niñosadoptados internacionalmente entre 1997 y 2004 en el País Vasco y Navarra al llegar y un añodespués.Material y métodos: doble encuesta médica y psicológica bilingüe anónima a todas las familiasadoptantes.Resultados: se enviaron 1.647 encuestas y se recibieron 420 (25,5%). Los niños proveníande China, Latinoamérica y Europa del Este. Media y mediana de edad: 2 años.Malnutrición: 9% índice de masa corporal (IMC) < 2 DE (desviaciones estándar); los valoresdel Z score para el peso, la talla y el IMC evolucionaron de –1 DE al llegar a casi 0 DE un añodespués.Parasitosis intestinal: 18,5%; infección tuberculosa latente: 5,5%; serología de hepatitis Balterada: 4%; una lúes tratada; anemia: 12,2%; alteraciones visuales: 11,4%; y déficit auditivo:1%.Trastorno psicomotor global: 2,5%, retraso área motora: 8%, comportamiento retraído18,2%, conducta hiperactiva 18,6%. Un año después 1,6%, 5%, 7,1% y 13,2% respectivamente.Ninguna alteración espectro autista. Control esfínteres, sueño y alimentación similares anuestra población.Conclusiones: en general, alteraciones físicas poco graves con satisfactoria evolución. Desarrollopsicomotor adecuado para la mayoría. Al año buena evolución excepto los 7 casos graves (4 con información preadoptiva al respecto). Se debe investigar sobre el excesivo númerode niños con comportamiento hiperactivo y sobre el posible retraso del lenguaje.Con respecto a otras publicaciones, encontramos iguales patologías pero con incidenciamenor tanto en datos objetivos (auxología, vacunaciones y estudios complementarios) comoen el lenguaje, la adaptación social o el desarrollo psicomotor. El grado de satisfacción de lospadres es altísimo.Los gobiernos deberían exigir informes preadoptivos fidedignos y completos ya que la patologíaes, sin duda, mayor en estos niños.Los pediatras de Atención Primaria son los indicados para el diagnóstico y el seguimientocoordinado siempre que se mejore la difusión de los protocolos de adopción internacional

Objective: to study physical status, psychomotor development, and social adaptation atarrival and a year after of 420 children (25.5%) adopted internationally in the Basque Countryand Navarra. Most children come from China, Latin America and East Europe. Median and mode:2 years of age.Method: medical and psychological survey administered to each of the adopting familiesto complete with their pediatrician.Results: 9% malnourished (BMI< 2 SD). Z score for weight, height and BMI increased from–1SD to almost 0 SD after one year.Psychomotor retardation from mild to serious 8%. Introspective behaviour 18.6%. Hyperactivebehaviour 18.2. After one year, 7% and 13% respectively.No autistic spectrum disorders. Sphincter control, sleep quality and nutrition behaviour similarto that of the local population.Conclusions: mild physical diseases, the majority of which disappeared or were improvedafter one year. Psychomotor development is good in general, especially after one year, exceptfor the seven severe cases, four of which had bad preadopting reports. There is a substantialpercentage of hyperactive behaviour and also a possible language delay.In respect to other publications, vaccinations, nutrition, height, weight, examinations, socialadaptation and psychomotor development showed better results.Preadopting reports present serious deficits but are not always false. Our governmentsshould struggle to obtain good preadopting reports.First line pediatricians are the appropriate ones to coordinate monitoring as long as the diffusionof the adoption protocols improves

[Climacturia, a symptom to take into account after radical prostatectomy]. / Climacturia, un sintoma a tener en cuenta tras prostatectomía radical.

INTRODUCTION AND OBJECTIVES: Patients after radical prostatectomy describe sexual dysfunctions such as orgasm-associated incontinence also termed climacturia. Our aim is to analyse incidence and data in relation with this symptom. METHODS: 119 phone surveys carried out to patients after radical prostatectomy to Know about climacturia incidence. We are trying to show the relationship between this symptom and the degree and type of incontinence, affectation at bladder neck and apex, and the age. RESULTS: The climacturia incidence came to 20%. The average age of the patients with this symptom was 59 years, the same as for those without it. The patients with both, incontinence and climacturia perform stress incontinence basically but urgency-incontinence to a greater extent (20%) that those with no climacturia (5%). Most patients with climacturia suffer a light leakage (87%) and a 62% always associated to orgasm. Negative effect of the symptom in the patient's and partner's sexual life appeared only in 2 cases (13%). CONCLUSIONS: We suggest the same term in Spanish than in English. Age and affectation of the bladder neck and apex do not have an effect on climacturia. Stress incontinence is more often related to patients with climacturia and the degree of incontinence is higher than in those without it.

Climacturia, un síntoma a tener en cuenta tras prostatectomía radical / Climaturia, a symptom to take into account after radical prostatectomy

Introducción y objetivos: Los pacientes a los que se les ha realizado una prostatectomía radical describen disfunciones sexuales entre las que se encuentra el orgasmo asociado a incontinencia. Pretendemos valorar la incidencia y datos relacionados con este síntoma. Métodos: Realizamos a 119 pacientes a los que se había realizado una prostatectomía radical, una encuesta telefónica dirigida a conocer la incidencia de climacturia. Pretendemos establecer la relación de éste síntoma con el grado y tipo de incontinencia, afectación a nivel de cuello vesical y apex, y la edad. Resultados: La incidencia de climacturia fue del 20%. La edad media de presentación del síntoma fue de 59 años, la misma que para los pacientes sin climacturia. Los pacientes con incontinencia y climacturia presentan fundamentalmente incontinencia de esfuerzo pero urgencia -incontinencia en mayor proporción (20%) que los pacientes sin climacturia (5%). El paciente que tiene climacturia la presenta en forma de unas gotas en un 87% y siempre que llegan al orgasmo en un 62%. La influencia negativa del síntoma en la vida sexual del paciente y de su pareja solo se presentó en 2 casos (13%). Conclusiones: Proponemos el uso del mismo término en lengua castellana que en lengua inglesa. La edad y la afectación en cuello vesical y apex no influyen en la aparición de climacturia. En los pacientes con climacturia se asocia mas frecuentemente incontinencia de esfuerzo y el grado de incontinencia es mayor que en los que no la padecen

Introduction and objectives: Patients after radical prostatectomy describe sexual dysfunctions such as orgasm-associated incontinence also termed climacturia. Our aim is to analyse incidence and data in relation with this symptom. Methods: 119 phone surveys carried out to patients after radical prostatectomy to Know about climacturia incidence. We are trying to show the relationship between this symptom and the degree and type of incontinence, affectation at bladder neck and apex, and the age. Results: The climacturia incidence came to 20%.The average age of the patients with this symptom was 59 years, the same as for those without it. The patients with both, incontinence and climacturia perform stress incontinence basically but urgency-incontinence to a greater extent (20%) that those with no climacturia (5%). Most patients with climacturia suffer a light leakage (87%) and a 62% always associated to orgasm. Negative effect of the symptom in the patient´s and partner´s sexual life appeared only in 2 cases (13%). Conclusions: We suggest the same term in Spanish than in English. Age and affectation of the bladder neck and apex do not have an effect on climacturia. Stress incontinence is more often related to patients with climacturia and the degree of incontinence is higher than in those without it

[Infants aged 3-24 months with fever without source in the emergency room: characteristics, management and outcome]. / Lactante de 3-24 meses con fiebre sin foco en urgencias: características, tratamiento y evolución posterior.

OBJECTIVE: To determine the characteristics of infants aged 3-24 months admitted to a Hospital Pediatric Emergency Room with fever without source, the management of these infants and their subsequent outcome. PATIENTS AND METHOD: We performed a retrospective survey of 733 children aged 3-24 months with fever without source admitted to our Emergency Room between September 1, 2003 and December 31, 2003. Subsequently, the parents of all infants diagnosed with fever without source who were managed as outpatients were telephoned to ascertain their outcome and changes in the final diagnosis. RESULTS: Onset of fever occurred less than 6 hours before arrival at the hospital in 237 episodes (32.2%). The family reported a temperature of > or = 39 degrees C in 436 episodes. Diagnoses in the Emergency Room were the following: fever without source in 677 (92.3%), urinary tract infection in 53 (7.2%) and bacterial meningitis in three (0.4 %). Fifty-five infants with an altered dipstick were excluded and complete blood count (CBC) and blood culture were performed in 66 infants (9.7%). There was a significant negative association between the probability of a request for CBC and blood culture and higher age [6-11 months vs. 3-6 months OR 0.24 (95 % CI: 0.11-0.49); > or = 12 months vs. 3-6 months, OR 0.15 (0.07-0.3)] and a significant positive association with onset more than 12 hours previously [vs. less than 6 hours OR 2.3 (1.2-4.43)] and highest temperature registered at home > 40 degrees C [vs. less than 39 degrees C OR 4.22 (1.5-11.84)]. Follow-up was completed (by telephone or readmission to the Emergency Room) in 574 infants diagnosed with fever without source and managed as outpatients. The final diagnosis differed from that made in the Emergency Room in 158 infants (27.5%), and 70 received antibiotics (12.1%). CONCLUSIONS: A considerable percentage of infants aged 3-24 months with fever without source visits the Emergency Room with very short-term processes. Patient observation is very useful in the management of these infants, since the final diagnosis differed from that made in the emergency room in nearly 30% and 12% were treated with antibiotics.

Lactante de 3-24 meses con fiebre sin foco en urgencias: características, tratamiento y evolución posterior / Infants aged 3-24 months with fever without source inthe emergency room: characteristics, management and outcome

Objetivo: Conocer las características de los lactantes de 3-24 meses que consultaron en una unidad de urgencias pediátrica hospitalaria con fiebre sin focalidad, su tratamiento y evolución posterior. Pacientes y método: Estudio retrospectivo de los 733 episodios correspondientes a los lactantes de 3 a 24 meses que consultaron por fiebre sin focalidad entre el 1 de septiembre y el 31 de diciembre de 2003. Posteriormente se contactó telefónicamente con los diagnosticados de síndrome febril sin focalidad y tratados ambulatoriamente, para conocer su evolución y diagnóstico final. Resultados: El tiempo de evolución de la fiebre hasta la consulta fue inferior a 6 h en 237 episodios (32,2 %). En 436 casos la familia refirió una temperatura mayor o igual a 39 °C. Los diagnósticos fueron: síndrome febril sin focalidad, 677 (92,3 %); infección del tracto urinario, 53 (7,2 %), y meningitis bacteriana, 3 casos (0,4 %). Excluidos los 55 niños con tira reactiva de orina alterada, se practicó analítica sanguínea y hemocultivo a 66 (9,7 %). La probabilidad de solicitar analítica se asoció negativa y significativamente con: mayor edad (6-11 meses frente a 3-6 meses; odds ratio [OR], 0,24; intervalo de confianza [IC] del 95 %, 0,11-0,49; >= 12 meses frente a 3-6 meses; OR, 0,15 [límites, 0,07-0,3]); y positivamente con mayor tiempo de evolución superior a 12 h (frente a < 6 h; OR, 2,3 [límites, 1,2-4,43]); y temperatura máxima registrada en casa superior a 40 °C (frente a < 39 °C; OR, 4,22 [límites, 1,5-11,84]). En 574 niños diagnosticados de síndrome febril sin focalidad que siguieron tratamiento ambulatorio se completó el seguimiento (telefónicamente o por readmisión en urgencias), variando el diagnóstico en 158 (27,5 %), y recibieron antibiótico 70 (12,1 %). Conclusiones: Un porcentaje importante de lactantes de 3-24 meses con fiebre sin focalidad consulta por procesos muy recortados. La observación continuada es un instrumento capital del tratamiento de los lactantes con síndrome febril sin focalidad, ya que alrededor del 30 % reciben un diagnóstico final diferente al inicial y el 12 %, tratamiento antibiótico

Objective: To determine the characteristics of infants aged 3-24 months admitted to a Hospital Pediatric Emergency Room with fever without source, the management of these infants and their subsequent outcome. Patients and method: We performed a retrospective survey of 733 children aged 3-24 months with fever without source admitted to our Emergency Room between September 1, 2003 and December 31, 2003. Subsequently, the parents of all infants diagnosed with fever without source who were managed as outpatients were telephoned to ascertain their outcome and changes in the final diagnosis. Results: Onset of fever occurred less than 6 hours before arrival at the hospital in 237 episodes (32.2 %). The family reported a temperature of >= 39 °C in 436 episodes. Diagnoses in the Emergency Room were the following: fever without source in 677 (92.3 %), urinary tract infection in 53 (7.2%)and bacterial meningitis in three (0.4 %). Fifty-five infants with an altered dipstick were excluded and complete blood count (CBC) and blood culture were performed in 66 infants (9.7 %). There was a significant negative association between the probability of a request for CBC and blood culture and higher age [6-11 months vs. 3-6 months OR 0.24 (95 % CI: 0.11-0.49); >= 12 months vs. 3-6 months, OR 0.15 (0.07-0.3)] and a significant positive association with onset more than 12 hours previously [vs. less than 6 hours OR 2.3 (1.2-4.43)] and highest temperature registered at home > 40 °C [vs. less than 39 °C OR 4.22 (1.5-11.84)]. Follow-up was completed (by telephone or readmission to the Emergency Room) in 574 infants diagnosed with fever without source and managed as outpatients. The final diagnosis differed from that made in the Emergency Room in 158 infants (27.5 %), and 70 received antibiotics (12.1 %). Conclusions: A considerable percentage of infants aged 3-24 months with fever without source visits the Emergency Room with very short-term processes. Patient observation is very useful in the management of these infants, since the final diagnosis differed from that made in the emergency room in nearly 30 % and 12% were treated with antibiotics

Nuestra experiencia en linfomas extranodales del área ORL / Our experience with extranodal lymphomas in ear, nose and throat practice

Los linfomas extranodales de cabeza y cuello son una entidad clínica poco común. El anillo linfático de Waldeyer es la localización más frecuente de estos linfomas, seguida de la cavidad oral y glándulas parótidas. Se ha realizado un estudio retrospectivo de pacientes diagnosticados de linfomas extranodales, entre los años 1991 al 1999 en nuestro Hospital. Se incluyeron en el estudio 23 pacientes, 15 hombres y 9 mujeres. Se empleó la clasificación REAL para su catalogación. Todos lo linfomas fueron linfomas de tipo no-Hodgkin. El cavum fue el lugar más afectado, seguido de amígdalas palatinas y cavidad oral. La mayor parte de los linfomas eran de grado intermedio y se encontraban en estados iniciales. Los síntomas de presentación variaban según la localización. La edad del paciente, estadio y grado histológico fueron importantes para la elección del tratamiento (AU)

No disponible

Aplasia pulmonar: un hallazgo infrecuente en adultos / Pulmonary hypoplasia: an infrecuent disease in adults

No disponible

Screening de infección tuberculosa en inmigrantes recién llegados a Ceuta / Screening of tuberculosis infection in recently arrived immigrants to Ceuta

Las poblaciones inmigrantes procedentes de países subsaharianos y del Magreb constituyen grupos de alto riesgo de infección tuberculosa. Analizamos la prevalencia de infección tuberculosa en un grupo de estos inmigrantes en Ceuta, con el fin de encontrar posibles diferencias en su comportamiento incidental según su país o región geográfica de procedencia y establecer protocolos y necesidad de estudio del estado de salud de dichos inmigrantes. Métodos: Estudio descriptivo transversal sobre una muestra de 2.223 inmigrantes (1.979 varones y 244 mujeres) procedentes de distintos países africanos (Nigeria, Mali, Guinea Bissau, Camerún, Ghana, Sierra Leona, Rep. Dem. Congo y Liberia, principalmente) en el campamento de refugiados de Calamocarro de Ceuta. Se practicó la intradermorreacción según la técnica de Mantoux según protocolo ya establecido, presentando los datos para tres puntos de corte.Resultados: Los inmigrantes procedían de 36 países africanos, el 89 por ciento eran varones y el 11 por ciento mujeres (p<0,001) con una edad media de 24,9 ñ 4,3 y 23,4 ñ 4,1 años, respectivamente. Un 32,6 por ciento presentaron una respuesta al test de Mantoux igual o superior a 10 mm, 33,2 por ciento en varones y 27,9 por ciento en mujeres (p=0,09). Sólo un 1,1 por ciento con induración 5-10 mm de probable origen vacunal. Por zonas geográficas, las tasas más altas se presentaron en inmigrantes procedentes de la R. D. Congo (65,1 por ciento) y Camerún (48,4 por ciento), seguidos a distancia por Nigeria (34, 0 por ciento), Liberia (32,7 por ciento), Mauritania (29,1 por ciento), Sierra Leona (28,8 por ciento), Costa de Marfil (27,8 por ciento), Guinea Bissau (27,4 por ciento), Ghana (26,3 por ciento), Argelia (25,6 por ciento), Mali (24,1 por ciento) y R. Guinea (20,9 por ciento) (p<0,0001). Conclusiones: La población inmigrante procedente de países centroafricanos presenta una alta prevalencia de infección tuberculosa, constituyendo un grupo de riesgo de padecer la enfermedad. Por tanto, es fundamental la implantación de programas específicos de búsqueda activa de infección tuberculosa durante su estancia en nuestra ciudad, aprovechando su concentración a la entrada en nuestro país, antes de su emigración definitiva a localidades penisulares y posterior dilución demográfica en la población de acogida. En dicho destino, el servicio médico supervisará el tratamiento a quién se le haya prescrito por el servicio del Área Funcional de Sanidad, eliminando así posibles futuras fuentes de infección de la enfermedad (AU)

[Prevalence of tuberculosis among the immigrant population in Ceuta, Spain]. / Prevalencia de infección tuberculosa en la población de inmigrantes en Ceuta, España.

BACKGROUND: The immigrant populations from sub-Saharan and Maghreb countries are groups in high risk of contracting tuberculosis. An analysis is made of the prevalence of tuberculosis infection among one group of these immigrants in Ceuta for the purpose of finding possible differences in their incidental behavior according to the country or geographical region from which they came. METHODS: A descriptive cross-sectional study of a sample of 2,223 immigrants (1979 males and 244 females) from different African countries (mainly Nigeria, Mali, Guinea-Bissau, Cameroon, Ghana, Sierra Leona, Democratic Republic of Congo and Liberia) at the Calamocarro refugee camp in Ceuta. A Mantoux intradermic reaction test was performed following the previously-established protocol, the data for three cut-off points being presented. RESULTS: The immigrants came from 36 African countries, 89.0% being males and 11.0% females (p < 0.001), respectively averaging in age from 24.9 +/- 4.3 to 23.4 +/- 4.1. A reaction to the Mantoux text of 10 mm or more was found in 32.6%, that is 33.2% among males and 27.9% among females (p = 0.09). Solely 1.1% showing 5-10 mm hardening of probable vaccination-related cause. By geographical regions, the highest rates were found among immigrants from the Democratic Republic of Congo (65.1%) and Cameroon (48.4%), followed far behind by Nigeria (34.0%), Liberia (32.7%), Mauritania (29.1%), Sierra Leona (28.8%), Ivory Coast (27.8%), Guinea-Bissau (27.4%), Ghana (26.3%), Algeria (25.6%), Mali (24.1%) and the Republic of Guinea (20.9%) (p < 0.0001). CONCLUSIONS: The immigrant population from central African countries shows a higher prevalence of tuberculosis infection, comprising a group at risk of contracting this disease. Therefore, it is of fundamental importance to implement specific programs to actively detect tuberculosis infection during their stay in our city, taking advantage of their being grouped together upon entry into our country, prior to their final emigration to localities throughout the mainland and subsequent mixing among the host country population.

[Bronchiolitis obliterans in a patient previously working as a printer in a textile factory]. / Bronquiolitis obliterante en un paciente trabajador de estampación en una fábrica textil.

We report the case of a 24-year-old man with a diagnosis of bronchiolitis obliterans, a rare clinical condition; the similarity to Ardystil syndrome was striking. Relevant occupational history included work in a textile air-brushing factory. Also noteworthy were lesions observed by CT scan in the form of cystic formations measuring less than 1 cm, a finding not previously described in the context of bronchiolitis obliterans. The patient improved immediately after starting corticoid treatment although scans failed to improve over several months of follow-up.

[The immotile cilia syndrome as a cause of sterility]. / El síndrome del cilio inmóvil como causa de esterilidad.

We investigated the relationship between ciliary dyskinesia--commonly referred to as inmotile cilia syndrome--and sterility. In the past two years, we have accurately diagnosed 6 new cases of a total of 20 suspected as having this condition. To make the diagnosis, complete clinical, radiological, ultrastructural and spermatic work up was performed. All males in the fertile age were found to be sterile with spermatozoides with no motility. Sterility may initially go undetected in these patients due to early intense ORL and respiratory symptoms they present. However, mild forms of this disease entity may be asymptomatic and patients may consult for sterility with a clinical picture of scantily florid chronic bronchitis like that of smokers. Coincidental situs inversus may be useful in making the diagnosis.

[Paratesticular rhabdomyosarcoma]. / Rabdomiosarcoma paratesticular.

We report a case of paratesticular rhabdomyosarcoma in a 5-year-old boy who was submitted to radical orchidectomy via the inguinal approach and high ligation of the spermatic cord. Clinical and retroperitoneal staging classify this case under group I of the Intergroup Rhabdomyoma Study. Adjuvan chemotherapy with 12 courses of VAC have achieved a good clinical course to date (14 months after surgery) and a good outcome is predicted. We review the literature and discuss the features of this mesenchymal tumor.

[Adriamycin versus ftorafur in the prevention of recurrence of superficial carcinoma of the bladder]. / Adriamicina versus ftorafur como profilaxis de recidiva en el carcinoma vesical superficial.

We performed a randomized prospective study in 40 patients with primary superficial carcinoma of the bladder who had been submitted to TUR. These patients were divided into two groups; one received intravesical adriamycin and the other oral ftorafur. We analyzed tumor size, number and grade and determined the recurrence rate (IR), recurrence rate/month (RR) recurrence rate/cystoscopy (RIC), disease-free interval, survival curves, and drug toxicity. After a mean follow-up of 19.7 months for the patient group that received adriamycin and 20.2 months for the group on oral ftorafur, the IR, RR, and RIC for the group on adriamycin were 40, 2.20 and 0.08%, respectively, and 33.3, 1.64 and 0.07% for the patient group on ftorafur (difference: NS). Drug toxicity was practically absent for the group on adriamycin whereas treatment had to be discontinued in two of the patients on ftorafur due to gastric intolerance. Furthermore, ftorafur was shown to cause a transient increase of transaminase levels in 4 patients, cutaneous changes and alterations in fingernails in 1 patient, and intense dermatitis during the last month of treatment in another patient. However, it was not necessary to discontinue treatment.

[Bladder carcinoma in patients under 40 years of age]. / Carcinoma vesical en pacientes menores de cuarenta años.

A retrospective study was undertaken on 147 cases of bladder tumors T1 GI-II that were treated over the period 1984-1987. Of these, 9 (6.1%) were tumors in patients under 40 years of age. All the foregoing 9 cases, and only 97 of the remaining 138 cases could be evaluated and compared. The male to female ratio was 8:1. Both patient groups were similar with respect to tumor grade, number, and size. All patients were treated by TUR and received chemotherapy post-operatively. Of the 9 patients under 40 years of age, 2 (22.2%) patients classed as GII had tumor recurrence and total cystectomy was performed in one (11.1%) due to tumor upgrading; whereas for the remaining patient group tumor recurrence was 37.7% and tumor progression was 6.6%. This finding shows that the choice of treatment or the decision to follow patients more or less closely cannot be based on patient age. Treatment should be based on patient overall condition and tumor grade and stage.