Endarterectomy, Stenting, or Medical Treatment for Symptomatic Carotid Near-Occlusion: Results from CAOS, a Multicenter Registry Study.

BACKGROUND AND PURPOSE: The treatment of symptomatic carotid near-occlusion is controversial. Our aim was to analyze the results of carotid endarterectomy and carotid artery stent placement in patients with symptomatic carotid near-occlusion and to identify factors related to technical failure, periprocedural complications, and restenosis. MATERIALS AND METHODS: We conducted a multicenter, prospective nonrandomized study. Patients with angiography-confirmed carotid near-occlusion were included. We assessed the revascularization rate and periprocedural stroke or death. Twenty-four-month clinical and carotid imaging follow-up was performed, and rates of carotid restenosis or occlusion, ipsilateral stroke, and mortality were analyzed. Carotid artery stent placement, carotid endarterectomy, and medical treatment were compared. RESULTS: One hundred forty-one patients were included. Forty-four carotid artery stent placement and 23 carotid endarterectomy procedures were performed within 6 months after the event. Complete revascularization was achieved in 83.6%, 81.8% in the carotid artery stent placement group and 87% with carotid endarterectomy (P = .360). Periprocedural stroke or death occurred in 6% (carotid artery stent placement = 2.3%; carotid endarterectomy = 13%; P = .077) and was not related to revascularization failure. The carotid restenosis or occlusion rate was 8.3% (5% restenosis, 3.3% occlusion); with carotid artery stent placement it was 10.5%; and with carotid endarterectomy it was 4.5% (P = .419). The 24-month cumulative rate of ipsilateral stroke was 4.8% in the carotid artery stent placement group, 17.4% for carotid endarterectomy, and 13.1% for medical treatment (P = .223). Mortality was 12%, 4.5%, and 5.6%, respectively (P = .422). Revascularization failure and restenosis occurred more frequently in patients with full collapse compared with patients without full collapse (33.3% versus 5.6%, P = .009; 21.4% versus 2.9%, P = .032, respectively). CONCLUSIONS: Carotid artery stent placement and carotid endarterectomy are associated with high rates of failure and periprocedural stroke. Carotid near-occlusion with full collapse appears to be associated with an increased risk of technical failure and restenosis. Carotid near-occlusion revascularization does not seem to reduce the risk of stroke at follow-up compared with medical treatment.

Ultrasonographic and hemodynamic characteristics of patients with symptomatic carotid near-occlusion: results from a multicenter registry study.

PURPOSE: The ultrasonographic and hemodynamic features of patients with carotid near-occlusion (CNO) are still not well known. Our aim was to describe the ultrasonographic and hemodynamic characteristics of a cohort of patients with CNO. METHODS: A prospective, observational, nationwide, and multicenter study was conducted from January/2010 to May/2016. Patients with digital subtraction angiography (DSA)-confirmed CNO were included. We collected information on clinical and demographic characteristics, carotid and transcranial ultrasonography and DSA findings, presence of full-collapse, collateral circulation, and cerebrovascular reactivity (CVR). RESULTS: One hundred thirty-five patients were analyzed. Ultrasonographic and DSA diagnosis of CNO were concordant in only 44%. This disagreement was related to the presence/absence of full-collapse: 45% of patients with CNO with full-collapse were classified as a complete carotid occlusion, and 40% with a CNO without full-collapse were interpreted as severe stenosis (p < 0.001). Mean velocities (mV) and pulsatility indexes (PIs) were significantly lower in the ipsilateral middle cerebral artery compared with the contralateral (43 cm/s vs 58 cm/s, p < 0.001; 0.80 vs 1.00, p < 0.001). Collateral circulation was identified in 92% of patients, with the anterior communicating artery (73%) being the most frequent. CVR was decreased or exhausted in 66% of cases and was more frequent in patients with a poor or absent collateral network compared with patients with ≥ 2 collateral arteries (82% vs 56%, p = 0.051). CONCLUSION: The accuracy of carotid ultrasonography in the diagnosis of CNO seems to be limited, with significant discrepancies with DSA. Decreased ipsilateral mV, PI, and CVR suggest a hemodynamic compromise in patients with CNO.

Resultados de la rama española del Estudio Randomizado Europeo de Screening del Cáncer de Próstata (ERSPC). Actualización tras 21 años de seguimiento / Results of the spanish section of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Update after 21 years of follow-up

INTRODUCCIÓN Y OBJETIVO: El Estudio Randomizado Europeo de Screening del Cáncer de Próstata (ERSPC) tiene como objetivo probar si el cribado del cáncer de próstata (CaP) reduce la mortalidad por esta enfermedad. Este estudio multicéntrico (ocho países europeos) ha reclutado más de 180.000 varones asintomáticos. Tras un tiempo de seguimiento de 16 años se ha demostrado que el cribado con PSA reduce la mortalidad por CaP un 20%, sin efecto sobre la mortalidad global (por cualquier causa). En este artículo se ofrece una actualización de los resultados de la rama española del ERSPC tras 21 años de seguimiento. MATERIALES Y MÉTODOS: Como centro participante en el ERSPC se invitó a participar en el estudio a 18.612 varones entre los 45 y 70 años de edad de los municipios de Getafe y Parla (Madrid). Randomización en brazo intervención (determinación de PSA sérico), y en brazo control (seguimiento sin realizar pruebas). Se registraron los diagnósticos de CaP, así como la mortalidad por CaP y por todas las causas, realizando comparación entre ambos brazos del estudio de las curvas de supervivencia, y análisis pormenorizado de las causas de muerte. RESULTADOS: El estudio se llevó a cabo finalmente con 4.276 varones (2.415 brazo intervención, 1.861 brazo control). Las medianas de edad, PSA sérico y tiempo de seguimiento fueron 57 años, 0,9 ng/ml y 21,1 años respectivamente. Se diagnosticaron 285 CaP, 188 (7,8%) brazo intervención, 97 (5,2%) brazo control (p < 0,001). Un total de 216 (75,8%) debutaron en estadio clínico organoconfinado. Se registraron 994 fallecimientos, 544 (22,5%) en el brazo intervención y 450 (24,2%) en el brazo control. No se detectaron diferencias significativas entre los brazos del estudio en términos de mortalidad cáncer-específica (p = 0,768) o por todas las causas (p = 0,192). La principal causa de muerte fueron los tumores malignos (492 pacientes, 49,5% del total de muertes), siendo los sitios primarios más frecuentes pulmón y bronquios (29,5%), colon y recto (14,8%), y hematológicos (9,8%). Solo 20 pacientes (0,4% de los varones reclutados) fallecieron por CaP, sin diferencia significativa entre brazos del estudio. CONCLUSIONES: En esta actualización de los resultados de la rama española del estudio ERSPC tras 21 años de seguimiento, no hemos detectado un beneficio del cribado del CaP en términos de supervivencia global, ni cáncer específica

INTRODUCTION AND OBJECTIVE: The objective of the European Randomized Study of Screening for Prostate Cancer (ERSPC) is to assess whether prostate cancer (PCa) screening leads to an improvement of cancer-specific survival. This multicenter study (eight European countries) has recruited more than 180,000 asymptomatic men. After a follow-up period of 16 years, it has been shown that PSA screening reduces PCa mortality by 20%, and that it does not affect all-cause mortality. This article provides updated the results of the Spanish arm of the ERSPC after 21 years of follow-up. MATERIALS AND METHODS: The study invited 18,612 men (aged 45 - 70) of the Spanish section (Getafe and Parla, Madrid) to participate. They were randomly assigned to the intervention arm (serum PSA-based screening) and to the control arm (follow-up without intervention). The diagnoses of PCa were recorded, as well as the PCa-specific and all-cause mortality rates. A comparison between the survival curves of both arms of the study and detailed analysis of the causes of death were performed. RESULTS: The study finally included 4,276 men (2,415 intervention arm, 1,861 control arm). The median age, serum PSA and follow-up time were 57 years, 0.9 ng/ml and 21.1 years, respectively. There were 285 cases with PCa diagnosis, 188 (7.8%) from the intervention arm and 97 (5.2%) from the control arm (p < ,001). A total of 216 (75.8%) presented organ-confined disease. There were 994 deaths were recorded; 544 (22.5%) in the intervention arm and 450 (24.2%) in the control arm. No significant differences were detected between the arms of the study in terms of cancer-specific (p = .768) or all-cause (p = .192) mortality rates. The main cause of death was malignant tumors (492 patients, 49.5% of overall mortality), and the most frequent sites were lung and bronchus (29.5%), colon and rectum (14.8%), and hematologic (9.8%). Only 20 patients (0.4% of the patients recruited) died from PCa, with no significant difference between study arms. CONCLUSIONS: In this update of the results of the Spanish section of the ERSPC study after 21 years of follow-up, we have not detected a benefit of PCa screening in terms of overall and cancer-specific survival

Results of the spanish section of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Update after 21 years of follow-up. / Resultados de la rama española del Estudio Randomizado Europeo de Screening del Cáncer de Próstata (ERSPC). Actualización tras 21 años de seguimiento.

INTRODUCTION AND OBJECTIVE: The objective of the European Randomized Study of Screening for Prostate Cancer (ERSPC) is to assess whether prostate cancer (PCa) screening leads to an improvement of cancer-specific survival. This multicenter study (eight European countries) has recruited more than 180,000 asymptomatic men. After a follow-up period of 16 years, it has been shown that PSA screening reduces PCa mortality by 20%, and that it does not affect all-cause mortality. This article provides updated the results of the Spanish arm of the ERSPC after 21 years of follow-up. MATERIALS AND METHODS: The study invited 18,612 men (aged 45 - 70) of the Spanish section (Getafe and Parla, Madrid) to participate. They were randomly assigned to the intervention arm (serum PSA-based screening) and to the control arm (follow-up without intervention). The diagnoses of PCa were recorded, as well as the PCa-specific and all-cause mortality rates. A comparison between the survival curves of both arms of the study and detailed analysis of the causes of death were performed. RESULTS: The study finally included 4,276 men (2,415 intervention arm, 1,861 control arm). The median age, serum PSA and follow-up time were 57 years, 0.9 ng/ml and 21.1 years, respectively. There were 285 cases with PCa diagnosis, 188 (7.8%) from the intervention arm and 97 (5.2%) from the control arm (p<,001). A total of 216 (75.8%) presented organ-confined disease. There were 994 deaths were recorded; 544 (22.5%) in the intervention arm and 450 (24.2%) in the control arm. No significant differences were detected between the arms of the study in terms of cancer-specific (p=.768) or all-cause (p=.192) mortality rates. The main cause of death was malignant tumors (492 patients, 49.5% of overall mortality), and the most frequent sites were lung and bronchus (29.5%), colon and rectum (14.8%), and hematologic (9.8%). Only 20 patients (0.4% of the patients recruited) died from PCa, with no significant difference between study arms. CONCLUSIONS: In this update of the results of the Spanish section of the ERSPC study after 21 years of follow-up, we have not detected a benefit of PCa screening in terms of overall and cancer-specific survival.

The risk of recurrent stroke at 24 months in patients with symptomatic carotid near-occlusion: results from CAOS, a multicentre registry study.

BACKGROUND AND PURPOSE: The risk of recurrent stroke amongst patients with symptomatic carotid near-occlusion (SCNO) has not been clearly established, and its management remains controversial. The aim was to define the 24-month risk of recurrent stroke and to analyse the effect of the different treatment modalities (medical treatment and revascularization) in a population of patients with SCNO. METHODS: A multicentre, nationwide, prospective study from January 2010 to May 2016 was performed. Patients with angiography-confirmed SCNO were included. The primary end-point was ipsilateral ischaemic stroke including periprocedural events within 24 months following the presenting event. Revascularization results and periprocedural complications, ipsilateral transient ischaemic attack, disabling or fatal stroke, and mortality were also noted. RESULTS: The study population comprised 141 patients from 17 Spanish centres. Seventy patients (49.6%) were treated by revascularization (carotid stenting in 47, endarterectomy in 23). Complete revascularization was achieved in 58 patients (83%). Periprocedural stroke or death occurred in 5.7%. The 24-month cumulative incidence of the primary end-point was 11.1% (95% confidence interval 5.8-16.4; n = 15), 12% in the medical treatment group and 10.2% in the revascularization group, log-rank P = 0.817. The cumulative rates of ipsilateral ischaemic stroke or transient ischaemic attack, disabling or fatal stroke, and mortality, were 17%, 4.5% and 7.5%, respectively. CONCLUSIONS: The rate of ipsilateral ischaemic stroke in patients with SCNO seems to be lower than the known rate associated with severe carotid stenosis without near-occlusion. The potential benefit of revascularization in the prevention of stroke in patients with SCNO may be influenced by the effectiveness and safety of the procedure.

THE ROMANIAN VERSION OF THE THYROID-RELATED PATIENT-REPORTED OUTCOMES THYPRO AND THYPRO-39. TRANSLATION AND ASSESSMENT OF RELIABILITY AND CROSS-CULTURAL VALIDITY.

BACKGROUND: ThyPRO is a recently developed thyroid-specific quality of life (QoL) questionnaire applicable to patients with benign thyroid disorders(BTD). The aim of the present study was to translate ThyPRO and ThyPRO-39 into Romanian, and to evaluate reliability and cross-cultural validity. METHODS: Standard methodology for translation and linguistic validation of patient-reported outcomes (PRO) was applied. The questionnaire was completed by 130 patients with benign thyroid diseases seen at Department of Endocrinology in the Emergency County Hospital, Tîrgu Mures, Romania, between October 2015 and March 2016. Internal reliability of the Romanian version of the ThyPRO (ThyPROro) scales was assessed for multi-item scales using Cronbach's alpha coefficient. An efficient method for testing cross-cultural validity is analysis of differential item functioning (DIF). Uniform DIF between the Romanian and the original Danish sample was investigated using ordinal logistic regression. The translation process proceeded without difficulties, and any disagreements were revised by one of the developers and the language coordinator. RESULTS: Internal reliability for ThyPRO was satisfactory. Cronbach`s alpha coefficients for the 13 scales ranged from 0.78 to 0.93 for the ThyPROro and 0.78 to 0.87 for the ThyPROro-39. In the 85-item ThyPRO, nine instances of DIF were found. Most were minor, explaining <3% of the variation in scale score, but DIF in positively worded items were larger, with explained variance (R2's) around 10-15%. CONCLUSION: The ThyPROro questionnaire is ready for assessment of health-related quality of life in Romanian patients with benign thyroid diseases.

[Acute symmetrical lesions in the basal ganglia within the context of uremia]. / Lesiones agudas simetricas de ganglios basales en el contexto de una uremia.

TITLE: Lesiones agudas simetricas de ganglios basales en el contexto de una uremia.

[Relation between preoperative prognostic Onodera's Index and postsurgery complications in the R0 gastric carcinoma resection]. / Relación entre el índice de Onodera pre-operatorio y las complicaciones post-cirugía R0 en el cáncer de estómago.

BACKGROUND: It has been postulated in the Asian literature that a low prognostic nutritional index (OI) could be associated with a higher rate of complications following radical gastric cancer surgery, but there is a lack of data concerning western countries. The aim is to analyze the relationship between a low preoperative OI and the frequency and severity of surgical complications in R0 gastric cancer resection. PATIENTS AND METHODS: In the present article, 124 cases of gastric cancer with R0 resection were reviewed. An OI <45 was considered pathologically low. The complication rate was compared between both groups: OI <45 vs OI =45. A multivariate analysis was performed adjusting for: age > 68 years, ASA score, preoperative hemoglobin level <12 g/dL, pTNM stage, administration of neoadyuvant therapy and type of gastrectomy. The relationship between a PNI<45 and the severity of complications graded according to the Clavien-Dindo classification was determined. RESULTS: We registered mild complications in 11.3% of cases, severe complications in 9.7% and a mortality rate of 2.4%. Patients with a OI <45 showed a higher complication rate: 37.7% versus 12.7% [odds ratio (OR) = 4.17; CI95% = (1.71 - 10.20 p = 0.001)], confirmed by multivariate analysis: [OR = 4.17; CI95% = (1.54 - 11.30); p = 0.005]. Patients with OI <45 had more severe complication-exitus: 20.8% versus 5.6% [OR = 4.39; CI95% = (1.31 - 14.68); p = 0.011]. CONCLUSIONS: We confirmed that patients with a low preoperative OI show a higher independent risk of complications after a R0 gastric cancer resection in a western country as well. Complications, in these cases with OI <45, registered a significantly higher severity grade.

Relación entre el índice de Onodera pre-operatorio y las complicaciones post-cirugía R0 en el cáncer de estómago / Relation between preoperative prognostic Onodera’s Index and postsurgery complications in the R0 gastric carcinoma resection

Fundamento: En publicaciones asiáticas se postula que un Índice de Onodera (IO) bajo puede asociarse con una mayor frecuencia de complicaciones post-resección radical del cáncer gástrico, careciendo de resultados en áreas occidentales. En el presente trabajo se analiza la relación entre un IO pre-operatorio bajo con la frecuencia y la gravedad de las complicaciones post-cirugía R0 en el cáncer gástrico. Pacientes y métodos: Se revisaron 124 tumores gástricos con resección R0. Considerando patológicamente bajo un IO <45, estudiamos la frecuencia de complicaciones entre los grupos con IO menor y ≥45. En el análisis multivariante incluimos como variables de ajuste la edad mayor de 68 años, puntuación ASA, hemoglobina pre-operatoria menor de 12 g/dL, estadio pTNM, infiltración serosa, invasión ganglionar y tipo de gastrectomía realizada. Determinamos la relación entre IO <45 y la frecuencia y gravedad de las complicaciones, según la clasificación de Clavien-Dindo modificada. Resultados: Se registraron complicaciones leves en un 11,3%; graves 9,7% y exitus 2,4%. Los pacientes con IO <45 presentaron mayor frecuencia de complicaciones: 37,7% versus 12,7% [ odds ratio (OR) = 4,17; IC 95% = (1,71-10,20); p = 0,001], confirmada en el análisis multivariante: [OR = 4,17; IC 95% = (1,54-11,30); p = 0,005]. Los pacientes con IO <45 tuvieron más complicaciones graves-exitus: 20,8% versus 5,6% [OR = 4,39; IC 95% = (1,31-14,68); p = 0,011]. Conclusiones: También en un país occidental, los pacientes con IO pre-operatorio bajo (<45) muestran un mayor riesgo independiente de presentar complicaciones tras la resección R0 del carcinoma gástrico. Adicionalmente, las complicaciones registradas en los casos con IO <45, muestran una significativa mayor gravedad (AU)

Background: It has been postulated in the Asian literature that a low prognostic nutritional index (OI) could be associated with a higher rate of complications following radical gastric cancer surgery, but there is a lack of data concerning western countries. The aim is to analyze the relationship between a low preoperative OI and the frequency and severity of surgical complications in R0 gastric cancer resection. Patients and methods: In the present article, 124 cases of gastric cancer with R0 resection were reviewed. An OI <45 was considered pathologically low. The complication rate was compared between both groups: OI <45 vs OI ≥45. A multivariate analysis was performed adjusting for: age > 68 years, ASA score, preoperative hemoglobin level <12 g/dL, pTNM stage, administration of neoadyuvant therapy and type of gastrectomy. The relationship between a PNI<45 and the severity of complications graded according to the Clavien-Dindo classification was determined. Results: We registered mild complications in 11.3% of cases, severe complications in 9.7% and a mortality rate of 2.4%. Patients with a OI <45 showed a higher complication rate: 37.7% versus 12.7% [odds ratio (OR) = 4.17; CI95% = (1.71 - 10.20 p = 0.001)], confirmed by multivariate analysis: [OR = 4.17; CI95% = (1.54 - 11.30); p = 0.005]. Patients with OI <45 had more severe complication-exitus: 20.8% versus 5.6% [OR = 4.39; CI95% = (1.31 - 14.68); p = 0.011]. Conclusions: We confirmed that patients with a low preoperative OI show a higher independent risk of complications after a R0 gastric cancer resection in a western country as well. Complications, in these cases with OI <45, registered a significantly higher severity grade (AU)

EXPRESSION OF MENIN IN THE HUMAN THYROID GLAND.

INTRODUCTION: The expression of menin in the thyroid gland has long been debated. Animal models with targeted inactivation of menin in the thyroid gland have shown that its inactivation might play a role in the progression to a more aggressive type of cancer. Human studies are conflicting, some have identified mutations in the MEN1 gene in a sub-type of oncocytic thyroid carcinomas, while others have not identified a higher prevalence of thyroid cancer in MEN1 patients. OBJECTIVE: To analyze the immunohistochemical expression of menin in different types of thyroid carcinomas. MATERIALS AND METHODS: 48 thyroid tumours (12 papillary thyroid carcinomas (PTC), 6 anaplastic thyroid carcinomas (ATC), 12 poorly differentiated thyroid carcinomas (PDTC), 5 medullary thyroid carcinomas (MTC), 5 oncocytic follicular carcinomas (OC), 3 oncocytic adenomas (OA) and 5 goiters (G)) were tested for nuclear expression of menin using an anti-menin antibody. The expression was considered positive, negative or decreased. RESULTS: The expression of menin was positive, identical to normal tissue, in 39 cases (81.25%). The expression was decreased (n=8) or absent (n=1) in 9 tumours (18.75% - 2 PTC, 5 PDTC, 2 OC) accounting for 42% (5/12) of the PDTC and 40% (2/5) of the OC. CONCLUSIONS: Our results show that the expression of menin is generally preserved in human thyroid carcinomas, but it can be decreased or absent in certain types of thyroid cancer. Further molecular studies are needed to evaluate to potential of menin protein in tumorigenesis.

Factores predictivos de recidiva de estenosis uretral tras uretrotomía endoscópica / Predictors of urethral stricture recurrence after endoscopic urethrotomy

Objetivo: El objetivo del trabajo fue analizar las variables clínico-demográficas de la serie y los factores predictores de recidiva de estenosis uretral tras uretrotomía endoscópica. Material y métodos: Se analizó retrospectivamente a 67 pacientes tratados mediante uretrotomía endoscópica tipo Sachse entre junio de 2006 y septiembre de 2014. Se excluyó a los intervenidos previamente de uretrotomía endoscópica o uretroplastia y se incluyó al resto de los pacientes que presentaban estenosis uretral. Se analizó edad, peso, hábito tabáquico, factores de riesgo cardiovascular, número, localización, longitud y etiología de la estenosis, uretrotomía previa, tiempo de sonda vesical y dilataciones posquirúrgicas. Se realizó un análisis univariado y multivariado mediante el test de chi-cuadrado o de Fisher y regresión logística para identificar las variables relacionadas con la recidiva. Resultados: El 37% recidivaron. La mayoría eran > 60 años (56,7%), obesos (74,6%), no fumadores (88%) y sin factores cardiovasculares (56,7%). La mayoría de las estenosis fueron únicas (94%), < 1 cm (82%), de uretra bulbar (64,2%), iatrogénicas (67,2%) y sin uretrotomía previa (89,6%). La mayoría llevaron sonda vesical durante < 15 días (85,1%) y no realizaron dilataciones posquirúrgicas (65,7%). Solamente la longitud de la estenosis resultó factor de riesgo independiente de recidiva (p = 0,025) con un riesgo relativo de 5,7 para un IC 95% (1,21-26,41). Conclusiones: En el tratamiento de la estenosis uretral mediante uretrotomía endoscópica, la longitud de la estenosis > 1 cm es el único factor que predice un incremento del riesgo de recidiva. No se encontró factores clínicos ni demográficos que condicionaran un incremento en la incidencia de recidiva. Del mismo modo, factores técnicos como incrementar el tiempo de sondaje vesical o las dilataciones uretrales no alteran el curso de la enfermedad, por lo que su uso rutinario es innecesario

Objective: The aim of the study was to analyse the clinical-demographic variables of the series and the predictors of urethral stricture recurrence after endoscopic urethrotomy. Material and methods: We retrospectively analysed 67 patients who underwent Sachse endoscopic urethrotomy between June 2006 and September 2014. Those patients who had previously undergone endoscopic urethrotomy or urethroplasty were excluded. The other patients who presented urethral stricture were included. We analysed age, weight, smoking habit, and cardiovascular risk factors, as well as the number, location, length and aetiology of the strictures, previous urethrotomies, vesical catheter duration and postsurgical dilatations. A univariate and multivariate analysis was conducted using the chi-squared test or Fisher's test and logistic regression to identify the variables related to recurrence. Results: Thirty-seven percent of the patients had a relapse. The majority of the patients were older than 60 years (56.7%), obese (74.6%), nonsmokers (88%) and had no cardiovascular factors (56.7%). The majority of the strictures were single (94%), < 1 cm (82%), bulbar urethral (64.2%), iatrogenic (67.2%) and with no prior urethrotomy (89.6%). The majority of the patients carried a vesical catheter for < 15 days (85.1%) and did not undergo postsurgical dilatation (65.7%). Only the length of the stricture was an independent risk factor for recurrence (P = .025; relative risk, 5.7; 95% CI 1.21-26.41). Conclusions: In the treatment of urethral strictures through endoscopic urethrotomy, a stricture length > 1 cm is the only factor that predicts an increase in the risk of recurrence. We found no clinical or demographic factors that caused an increase in the incidence of recurrence. Similarly, technical factors such as increasing the bladder catheterisation time and urethral dilatations did not change the course of the disease. Their routine use is therefore unnecessary

[Predictive pre-treatment value of the Prognostic Nutritional Index on survival in gastric carcinoma]. / Valor predictivo pre-tratamiento del Índice Pronóstico Nutricional sobre la supervivencia del carcinoma gástrico.

BACKGROUND: The Prognostic Nutritional Index (PNI) combines the values of circulating lymphocytes and serum albumin and, in the Asian literature; it has been related with the prognosis following R0 resection of gastric cancer. No results are available in Western countries. We study the possible independent prognostic value, at the moment of the tumour's diagnosis, of PNI on survival. PATIENTS AND METHODS: We review 234 consecutive gastric carcinomas, calculating global survival and tumour-specific survival. We considered pre-treatment PNI values of < 40 to be pathological. We carried out a univariate and multivariate analysis of cases of survival according to PNI, including the following adjustment variables: age > 70 years, ASA anaesthetic at the time of diagnosis, size of the neoplasia > 5cm, macroscopic type, undifferentiated degree and TNM clinical stage through echoendoscopy and/or CAT. RESULTS: The univariate analysis registered greater global and specific survival in cases with PNI ≥ 40 versus PNI < 40: [HR = 2.28; CI 95% = (1.60-3.26); p< 0.001] and [HR = 2.35; CI 95% = (1.63-3.39); p< 0.001], respectively. The multivariate analysis confirmed a better independent prognosis in cases with OI ≥ 40: global survival: [HR = 1.48; CI 95% = (1.02-2.16); p = 0.040], specific survival: [HR = 1.51; CI 95% = (1.03-2.23); p = 0.036]. CONCLUSIONS: At the moment of diagnosis of gastric cancer and including all registered cases, a PNI ≥ 40 is accompanied by a signifi-cantly greater global and tumour-specific survival. In our series, this better prognosis is independent of the patient's age group, his/her ASA classification, the size and degree of differentiation of the neoplasia and its TNM clinical stage.

Valor predictivo pre-tratamiento del Índice Pronóstico Nutricional sobre la supervivencia del carcinoma gástrico / Predictive pre-treatment value of the Prognostic Nutritional Index on survival in gastric carcinoma

Fundamento: El Índice Pronóstico nutricional (IPN) combina los valores de los linfocitos circulantes y la albúmina sérica y, en la literatura asiática, se le ha relacionado con el pronóstico tras la resección R0 del cáncer gástrico, sin disponer de resultados en países occidentales. Estudiamos, en el momento del diagnóstico del tumor, el posible valor pronóstico independiente del IPN, sobre la supervivencia. Pacientes y Métodos: Revisamos 234 carcinomas gástricos consecutivos, determinando la supervivencia global y la específica por el tumor. Consideramos patológicos los valores del IPN pre-tratamiento < 40. Realizamos un análisis univariante y multivariante de las supervivencias según el IPN, incluyendo las siguientes variables de ajuste: edad > 70 años, ASA anestésico al diagnóstico, tamaño de la neoplasia > 5 cm, tipo macroscópico infiltrante, grado indiferenciado y estadificación clínica TNM mediante ecoendoscopia y/o TAC. Resultados: El análisis univariante registró una mayor supervivencia global y específica en los casos con IPN ≥ 40 versus IPN < 40: [HR = 2,28; IC 95% = (1,60-3,26); p< 0,001] y [HR = 2,35; IC 95% = (1,63-3,39); p< 0,001], respectivamente. El análisis multivariante confirmó un mejor pronóstico independiente en los casos con IO ≥ 40: supervivencia global: [HR = 1,48; IC 95% = (1,02-2,16); p = 0,040], supervivencia específica: [HR = 1,51; IC 95% = (1,03-2,23); p = 0,036]. Conclusiones: En el momento del diagnóstico del cáncer gástrico e incluyendo la totalidad de los casos registrados, un IPN ≥ 40 se acompaña de una supervivencia global y específica por el tumor significativamente mayor. En nuestra serie, este mejor pronóstico es independiente del grupo de edad del paciente, de su clasificación ASA, del tamaño y grado de diferenciación de la neoplasia y de su estadificación clínica TN (AU)

Background: The Prognostic Nutritional Index (PNI) combines the values of circulating lymphocytes and serum albumin and, in the Asian literature; it has been related with the prognosis following R0 resection of gastric cancer. No results are available in Western countries. We study the possible independent prognostic value, at the moment of the tumour's diagnosis, of PNI on survival. Patients and methods: We review 234 consecutive gastric carcinomas, calculating global survival and tumour-specific survival. We considered pre-treatment PNI values of < 40 to be pathological. We carried out a univariate and multivariate analysis of cases of survival according to PNI, including the following adjustment variables: age > 70 years, ASA anaesthetic at the time of diagnosis, size of the neoplasia > 5cm, macroscopic type, undifferentiated degree and TNM clinical stage through echoendoscopy and/or CAT. Results: The univariate analysis registered greater global and specific survival in cases with PNI ≥ 40 versus PNI < 40: [HR = 2.28; CI 95% = (1.60-3.26); p< 0.001] and [HR = 2.35; CI 95% = (1.63-3.39); p< 0.001], respectively. The multivariate analysis confirmed a better independent prognosis in cases with OI ≥ 40: global survival: [HR = 1.48; CI 95% = (1.02-2.16); p = 0.040], specific survival: [HR = 1.51; CI 95% = (1.03-2.23); p = 0.036]. Conclusions: At the moment of diagnosis of gastric cancer and including all registered cases, a PNI ≥ 40 is accompanied by a significantly greater global and tumour-specific survival. In our series, this better prognosis is independent of the patient's age group, his/her ASA classification, the size and degree of differentiation of the neoplasia and its TNM clinical stage (AU)

Cavernoplastia con injerto de mucosa oral para el tratamiento quirúrgico de la enfermedad de La Peyronie / Cavernoplasty with oral mucosa graft for the surgical treatment of Peyronie's disease

Introducción: La enfermedad de La Peyronie es un trastorno de la albugínea que condiciona incurvación peneana, y que precisa corrección quirúrgica cuando la deformidad dificulta la penetración. Material y métodos: Análisis retrospectivo de los resultados a corto plazo (longitud del pene, ángulo de incurvación y función eréctil) del tratamiento de la enfermedad de La Peyronie en 10 pacientes mediante cavernoplastia con injerto de mucosa oral. En esencia, el tratamiento incluyó la incisión de la placa fibrótica con bisturí eléctrico y el posterior recubrimiento del defecto cavernoso mediante un parche de mucosa oral. Al sexto mes medimos la longitud e incurvación peneanas, y recogimos la función eréctil mediante el cuestionario IIEF-5. Finalmente, se planteó a los pacientes la pregunta «¿volvería a repetir la misma intervención?». Resultados: La edad media fue de 53,4 años. El seguimiento promedio fue de 22,7 meses y la mediana de 24. La incurvación media preoperatoria fue de 68,5° (50-90°); la longitud media del pene de 11,2 cm (9-15) y el IIEF-5 medio de 16,1 (8-25). La longitud peneana media postoperatoria fue de 10,7 cm y el IIEF-5 medio de 18,9. Las diferencias entre los registros pre- y postoperatorios no alcanzaron significación estadística (p = ns). Un paciente desarrolló disfunción eréctil. En todos los casos la incurvación residual fue < 20°. Nueve pacientes (90%) aseguraron que repetirían la misma intervención. Conclusiones: Los resultados a corto plazo señalan que la cavernoplastia con injerto de mucosa oral puede ser una alternativa a los injertos tradicionales para la corrección quirúrgica de la enfermedad de La Peyronie

Background: Peyronie's disease is a disorder of the tunica albuginea and causes penile curvature, requiring surgical correction when the deformity impedes penetration. Material and methods: Retrospective analysis of the short-term results (penile length, angle of curvature and erectile function) of treating Peyronie's disease in 10 patients through cavernoplasty with oral mucosa graft. Essentially, the treatment included the incision of the fibrotic plaque with electrical scalpel and the subsequent coating of the cavernous defect using a patch of oral mucosa. At month 6, we measured the penile length and curvature and recorded the erectile function using the International Index of Erectile Function-5 (IIEF-5) questionnaire. Finally, the patients were asked 'Would you undergo the same operation again?'. Results: The mean age was 53.4 years. The average and median follow-up was 22.7 months and 24 months, respectively. The mean preoperative curvature was 68.5° (50°-90°), the mean penile length was 11.2 cm (9-15) and the mean IIEF-5 score was 16.1 (8-25). The mean postoperative penile length was 10.7 cm, and the mean IIEF-5 score was 18.9. The differences between the preoperative and postoperative values were not statistically significant (P=ns). One patient developed erectile dysfunction. In all cases, the residual curvature was <20°. Nine patients (90%) stated that they would undergo the same operation. Conclusions: The short-term results suggest that cavernoplasty with oral mucosa graft can be an alternative to traditional grafts for surgically correcting Peyronie's disease

Predictors of urethral stricture recurrence after endoscopic urethrotomy. / Factores predictivos de recidiva de estenosis uretral tras uretrotomía endoscópica.

OBJECTIVE: The aim of the study was to analyse the clinical-demographic variables of the series and the predictors of urethral stricture recurrence after endoscopic urethrotomy. MATERIAL AND METHODS: We retrospectively analysed 67 patients who underwent Sachse endoscopic urethrotomy between June 2006 and September 2014. Those patients who had previously undergone endoscopic urethrotomy or urethroplasty were excluded. The other patients who presented urethral stricture were included. We analysed age, weight, smoking habit, and cardiovascular risk factors, as well as the number, location, length and aetiology of the strictures, previous urethrotomies, vesical catheter duration and postsurgical dilatations. A univariate and multivariate analysis was conducted using the chi-squared test or Fisher's test and logistic regression to identify the variables related to recurrence. RESULTS: Thirty-seven percent of the patients had a relapse. The majority of the patients were older than 60 years (56.7%), obese (74.6%), nonsmokers (88%) and had no cardiovascular factors (56.7%). The majority of the strictures were single (94%), <1cm (82%), bulbar urethral (64.2%), iatrogenic (67.2%) and with no prior urethrotomy (89.6%). The majority of the patients carried a vesical catheter for <15 days (85.1%) and did not undergo postsurgical dilatation (65.7%). Only the length of the stricture was an independent risk factor for recurrence (P=.025; relative risk, 5.7; 95% CI 1.21-26.41). CONCLUSIONS: In the treatment of urethral strictures through endoscopic urethrotomy, a stricture length >1cm is the only factor that predicts an increase in the risk of recurrence. We found no clinical or demographic factors that caused an increase in the incidence of recurrence. Similarly, technical factors such as increasing the bladder catheterisation time and urethral dilatations did not change the course of the disease. Their routine use is therefore unnecessary.

Cavernoplasty with oral mucosa graft for the surgical treatment of Peyronie's disease. / Cavernoplastia con injerto de mucosa oral para el tratamiento quirúrgico de la enfermedad de La Peyronie.

BACKGROUND: Peyronie's disease is a disorder of the tunica albuginea and causes penile curvature, requiring surgical correction when the deformity impedes penetration. MATERIAL AND METHODS: Retrospective analysis of the short-term results (penile length, angle of curvature and erectile function) of treating Peyronie's disease in 10 patients through cavernoplasty with oral mucosa graft. Essentially, the treatment included the incision of the fibrotic plaque with electrical scalpel and the subsequent coating of the cavernous defect using a patch of oral mucosa. At month 6, we measured the penile length and curvature and recorded the erectile function using the International Index of Erectile Function-5 (IIEF-5) questionnaire. Finally, the patients were asked "Would you undergo the same operation again?". RESULTS: The mean age was 53.4 years. The average and median follow-up was 22.7 months and 24 months, respectively. The mean preoperative curvature was 68.5° (50°-90°), the mean penile length was 11.2cm (9-15) and the mean IIEF-5 score was 16.1 (8-25). The mean postoperative penile length was 10.7cm, and the mean IIEF-5 score was 18.9. The differences between the preoperative and postoperative values were not statistically significant (P=ns). One patient developed erectile dysfunction. In all cases, the residual curvature was <20°. Nine patients (90%) stated that they would undergo the same operation. CONCLUSIONS: The short-term results suggest that cavernoplasty with oral mucosa graft can be an alternative to traditional grafts for surgically correcting Peyronie's disease.

Rotación de los cuerpos cavernosos para el tratamiento de la incurvación peneana congénita / Rotation of the corpora cavernosa for the treatment of congenital penile curvature

Introducción: La incurvación peneana congénita (IPC) está originada por una alteración en el desarrollo embrionario de la uretra y los cuerpos cavernosos. Condiciona dificultad para la penetración, precisando corrección quirúrgica cuando imposibilita el coito. Material y métodos: Presentamos 2 varones en la 4.ª década de la vida que presentan incurvación ventral superior a 60° de 2 años de evolución con erecciones mantenidas. Los pacientes fueron sometidos a cirugía de rotación de los cuerpos cavernosos. Tras la denudación completa del pene se realiza la liberación atérmica del paquete vasculonorvioso del pene desde la cara ventral hasta la dorsal. Una vez evidenciada la incurvación mediante una erección artificial se realiza una incisión en la albugínea de ambos cuerpos cavernosos, suturando de forma continua con monofilamento reabsorbible ambos bordes internos y externos. Posteriormente se comprueba la rectificación de la incurvación y se reconstruye el plano mucocutáneo. Resultados: El tiempo quirúrgico fue de 120 min, no existiendo complicaciones intraoperatorias. Ambos pacientes fueron dados de alta a las 24 h de la intervención. A la semana presentaban erecciones nocturnas espontáneas, pudiendo mantener relaciones sexuales al mes de la intervención. A los 6 meses la incurvación residual era inferior a 20°, el acortamiento peneano inferior al centímetro y el IIEF-5 de 25 en ambos casos. Conclusiones: La cirugía de rotación de los cuerpos cavernosos permite corregir la IPC sin acortamiento peneano significativo ni disfunción eréctil. En nuestra opinión constituye un tratamiento adecuado en pacientes con IPC, necesitándose estudios con seguimientos a largo plazo para considerarla la técnica de elección

Introduction: Congenital penile curvature (CPC) is caused by a disorder in the embryonic development of the urethra and corpora cavernosa. The condition causes difficulty for penetration, requiring surgical correction when it prevents intercourse. Material and methods: We present the cases of 2 men in their 40s who had ventral curvature greater than 60° of 2 years of evolution, with maintained erections. The patients underwent surgery for rotation of the corpora cavernosa. After the complete denudation of the penis, athermal release of the neurovascular bundle of the penis from the ventral side to the dorsal was performed. Once the curvature was verified using artificial erection, an incision was performed in the tunica albuginea of both corpora cavernosa, continuously suturing both internal and external margins with resorbable monofilament. The rectification of the curvature was then checked, and the mucocutaneous plane was reconstructed. Results: The surgical time was 120 minutes and there were no intraoperative complications. Both patients were discharged 24 h after the surgery. At 1 week, the patients experienced spontaneous night-time erections and were able to maintain sexual relations 1 month after the surgery. At 6 months, the residual curvature was less than 20°, the penile shortening was less than 1 centimeter and the International Index of Erectile Function-5 was 25 for both cases. Conclusions: Surgery for rotation of the corpora cavernosa helps correct CPC without significant penile shortening or erectile dysfunction. In our opinion, the procedure is an appropriate treatment for patients with CPC but requires studies with long-term follow-up in order to consider it the technique of choice

Rotation of the corpora cavernosa for the treatment of congenital penile curvature.

INTRODUCTION: Congenital penile curvature (CPC) is caused by a disorder in the embryonic development of the urethra and corpora cavernosa. The condition causes difficulty for penetration, requiring surgical correction when it prevents intercourse. MATERIAL AND METHODS: We present the cases of 2 men in their 40s who had ventral curvature greater than 60° of 2 years of evolution, with maintained erections. The patients underwent surgery for rotation of the corpora cavernosa. After the complete denudation of the penis, athermal release of the neurovascular bundle of the penis from the ventral side to the dorsal was performed. Once the curvature was verified using artificial erection, an incision was performed in the tunica albuginea of both corpora cavernosa, continuously suturing both internal and external margins with resorbable monofilament. The rectification of the curvature was then checked, and the mucocutaneous plane was reconstructed. RESULTS: The surgical time was 120minutes and there were no intraoperative complications. Both patients were discharged 24h after the surgery. At 1 week, the patients experienced spontaneous night-time erections and were able to maintain sexual relations 1 month after the surgery. At 6 months, the residual curvature was less than 20°, the penile shortening was less than 1 centimeter and the International Index of Erectile Function-5 was 25 for both cases. CONCLUSIONS: Surgery for rotation of the corpora cavernosa helps correct CPC without significant penile shortening or erectile dysfunction. In our opinion, the procedure is an appropriate treatment for patients with CPC but requires studies with long-term follow-up in order to consider it the technique of choice.

Reanastomosis uretro vesical por extraccion accidental de sonda vesical tras prostatectomia radical / Urethrovesical redo anastomosis after accidental removal of the urethral catheter after radical prostatectomy

No disponible

[Prognostic value of Onodera's index in colorectal cancer survival]. / Valor pronóstico del índice de Onodera en la supervivencia del cáncer colorrectal.

BACKGROUND: Onodera's prognostic nutritional index (OPNI), which is calculated using total lymphocyte count and serum albumin level, has been used as a marker of nutritional status, with its potential prognostic value in colorectal cancer having recently been postulated in Japan and China. There is still no data on the predictive value of OPNI in a Western population. PATIENTS AND METHODS: A consecutive case series of 207 patients scheduled for colorectal cancer resection with curative intent was reviewed. Pre-treatment OPNI was calculated using the formula: [10 x serum albumin (g/dl) + 0.005 x lymphocytes/mm²]. OPNI values under 40 were considered low. Univariate and multivariate analysis were performed on survival curves, comparing cases with OPNI values less than, equal to or greater than 40 (Cox model, stepwise), in the overall series and in pTNM stage II. RESULTS: The median for clinical follow-up was 81 months (interquartile range 60-96). Twenty-six patients (12.6%) had a low OPNI (≤ 40). In the multivariate analysis, patients with low OPNI showed less favourable survival curves, both in the overall series: [p <0.001; HR = 3.16; 95% CI = 1.67-5.94] and in the 78 cases in pTNM stage II: [p <0.004; HR = 4.36; 95% CI = 1.61-11.76]. CONCLUSIONS: A low pre-treatment OPNI (<40) has an independent, unfavourable predictive value on survival in European patients with resected colorectal cancer, both in the overall series and in pTNM stage II.