Afectación ganglionar como factor pronóstico en el carcinoma localmente avanzado de cérvix / Lymph node involvement as a prognostic factor in locally advanced cervix carcinoma

Propósito: Estudiar los resultados del tratamiento con radioterapia y braquiterapia del carcinoma de cérvix avanzado en función de la afectación ganglionar. Material y métodos: Se analizan 68 pacientes en estadio IIB y IIIB, 16 con ganglios pélvicos afectos por TAC o linfografía, 33 sin afectación y 19 sin estudio previo. Se dieron 50 Gy en pelvis con fotones de 10 MV y dos aplicaciones con braquiteropia de baja tasa. Sólo en 6 casos se hizo RT paraaórtica. Resultados: La supervivencia global a 5 años es 57 por ciento. Con ganglios positivos es 43 por ciento, frente a 60 por ciento sin ganglios afectos (p<0,1). En estadios IIB N + es 15 por ciento frente a 76 por ciento (p<0,01). En estadios IIIB no hay diferencias. El control loco-regional a 5 años es de 60 por ciento en ambos estadios. Con ganglios positivos es 44 por ciento frente a 60 por ciento (p<0,1). En estadio IIB N + es 20 por ciento, y en N - 76 por ciento (p<0,01). En estadio IIIB no hay diferencias significativas. Cuando hay N + hay mayor afectación paraaórtica (44 por ciento frente a 18 por ciento), pero no aumentan las metástasis a distancia (25 por ciento y 24 por ciento), que sí aumentan en estadios IIIB respecto a IIB (29 por ciento frente a 18 por ciento)Conclusiones: Cuando hay ganglios pélvicos afectos se recomienda añadir RT paraaórtica. Con enfermedad voluminosa es preferible asociar RT con QT concomitante para intentar mejorar el control locoregional (AU)

[Metabolic improvement of diabetes mellitus through pamphlets on the norms of self-monitoring control measures]. / Mejoría metabólica de la diabetes mellitus mediante el seguimiento de normas escritas de autocontrol.

OBJECTIVE: To assess whether giving a leaflet containing norms of self-control to diabetics receiving insulin treatment results in a metabolic improvement. The HbA1c was established prior and subsequent to giving out the leaflet. The written norms contained in the leaflet were highlighted from the wider range of instructions obtained from diabetes education. DESIGN: A longitudinal intervention study with no random allocation. SETTING: Hospital care in a specialised Endocrinology clinic. PATIENTS AND OTHER PARTICIPANTS: 122 types 1 and 2 diabetics, treated with various insulin diets, who had received prior diabetes education and carried out blood self-controls. Cases of meta-diabetic syndrome, serious illnesses and those without apparent hypoglycaemia symptoms were excluded. INTERVENTIONS: Giving out of a leaflet with written norms of self-control. MEASUREMENTS AND MAIN RESULTS: The averages, standard deviations and 95% confidence intervals of the basal HbA1c and of those at four-monthly check-ups were calculated. Basal 8.07 (CI 7.75 - 8.39); 4th month 6.88 (CI 6.74 - 7.17); 8th month 6.59 CI 6.29 - 6.90); 12th month 6.60 (CI 6.23 - 6.94); 16th month 6.06 (CI 5.63 - 6.49); 20th month 5.40 (CI 3.04 - 7.75). Averages were compared by the Student T test and all values had p < 0.005 against the basal. CONCLUSIONS: Following the written norms produced a clear metabolic improvement, represented by the significant fall of HbA1c. Therefore, though without ignoring the overall context of treatment and diabetes education, it is proposed that the relationship of the most practical features of insulin dosing to written norms of self-control should be emphasised.

[Does goiter constitute basically a surgical process?]. / Constituye el bocio un proceso fundamentalmente quirúrgico?

Goiter is usually a clinical manifestation present almost in all the thyroid processes. The over-simple idea of a thyroid tumoration demanding surgical resection is, unfortunately, deeply implanted in many medical and, above all, surgical environments. We tried to estimate the incidence of goiter in a series of thyroid processes and how many of them required surgery. We reviewed the surgical indications in several thyroid entities. In a series of 377 thyroidopathies, goiter was present in 345 (91.5%), 50 of which underwent surgery (12.26% of the total and 14.49 of goiters). Some of the patients were operated in other hospitals without adjusting to the aforementioned criteria and, in theory, just 36 of then should had undergone surgery (9.54% of the total and 10.43% of goiters). In conclusion, surgery has a very secondary role in the treatment of goiter.

[Palliative interatrial septostomy in severe pulmonary hypertension]. / Septostomía interatrial paliativa en la hipertensión pulmonar severa.

Three patients with severe pulmonary hypertension underwent palliative atrial septostomy by dilating the interatrial septum with valvuloplasty catheter-balloons. In two cases successful dilation improved cardiac index and symptoms of cardiac failure (13 and 11 months follow-up). One patient died immediately post-septotomy due to severe hypoxemia. Severe pulmonary hypertension with low cardiac output and high right ventricular filling pressures has a very poor short-term prognosis. Atrial septostomy is a useful palliative procedure and can serve as a bridge to heart and/or lung transplantation. It is not free of risk and the resultant systemic hypoxemia can lead to dead; that is why we recommend progressive balloon diameters, stopping the procedure when improvement of cardiac index is achieved with the minimal systemic oxygen desaturation.