[The use of evoked potentials in the follow-up and prognosis of patients in coma following severe traumatic brain injury]. / Utilización de potenciales evocados en el seguimiento y pronóstico de pacientes en coma por traumatismo craneoencefálico grave.

INTRODUCTION: When dealing with patients in coma, it can be very useful to have early access to objective tests that provide information about their clinical status and can help to establish a prognosis for survival and functional recovery. The value of evoked potentials (EP) in such cases is already well known, although only techniques that assess the neurological status have been used. AIM: To determine the usefulness of different types of evoked potentials as a means of reaching a short and medium term prognosis for survival and functional recovery in patients in coma as a result of traumatic brain injury (TBI). PATIENTS AND METHODS: Our study involved patients with an admission Glasgow coma score of 8 or below due to severe TBI. During the first 24 hours the following tests were carried out on patients: somatosensory EP (SSEP), brainstem auditory EP, visual EP (VEP) obtained using stimulation goggles and mismatch negativity, as well as an imaging test (computerised axial tomography). The tests were repeated at one week and one month, and each patient was evaluated by means of the Glasgow scale and the Karnofsky scale. RESULTS: We studied 22 patients (mean age: 39.95 years; interval: 15-84 years), 20 of them were males. The highest number of deaths occurred during the first week. There was a strong correlation between survival and the results from the SSEP and VEP. CONCLUSIONS: SSEP and VEP performed on admission were a valuable aid for reaching a short and medium term prognosis for survival of patients in coma due to TBI, although they were not effective in evaluating a prognosis for functional recovery.

Utilización de potenciales evocados en el seguimiento y pronóstico de pacientes en coma por traumatismo craneoencefálico grave / The use of evoked potentials in the follow-up and prognosis of patients in coma following severe traumatic brain injury

Introducción. En los pacientes en coma es útil disponer desde un primer momento de pruebas objetivas que nos informen del estado clínico y nos sirvan de ayuda para establecer un pronóstico vital y funcional. El valor de los potenciales evocados (PE) en estos casos es ya conocido, aunque la mayoría de los estudios se centran sólo en algunos tipos de potenciales, valorando únicamente el estado neurológico en ese momento. Objetivo. Determinar el valor pronóstico vital y funcional a corto y medio plazo de los distintos tipos de potenciales evocados en pacientes en coma secundario a traumatismo craneoencefálico (TCE). Pacientes y métodos. Pacientes con un Glasgow de ingreso igual o inferior a 8 debido a un TCE grave. En las primeras 24 horas se les realizaron PE somatosensitivos (PESS) de nervio mediano, PE auditivos de tronco, PE visuales (PEV) obtenidos con estimulador goggles y mismatch negativity, además de una prueba de imagen (tomografía axial computarizada). Las pruebas se repitieron a la semana y al mes, y se valoró a cada paciente mediante la escala de Glasgow y la escala de Karnofsky. Resultados. Estudiamos 22 pacientes (media: 39,95 años; intervalo: 15-84 años), 20 de ellos varones. Durante la primera semana se produjo el mayor número de fallecimientos. Existió una fuerte correlación entre la supervivencia y los resultados obtenidos con PESS y PEV. Conclusión. Los PESS y PEV realizados al ingreso son de gran utilidad para la valoración pronóstica vital a corto y medio plazo del paciente en coma por TCE, sin llegar a mostrar eficacia en la valoración pronóstica funcional

Introduction. When dealing with patients in coma, it can be very useful to have early access to objective tests that provide information about their clinical status and can help to establish a prognosis for survival and functional recovery. The value of evoked potentials (EP) in such cases is already well known, although only techniques that assess the neurological status have been used. Aim. To determine the usefulness of different types of evoked potentials as a means of reaching a short and medium term prognosis for survival and functional recovery in patients in coma as a result of traumatic brain injury (TBI). Patients and methods. Our study involved patients with an admission Glasgow coma score of 8 or below due to severe TBI. During the first 24 hours the following tests were carried out on patients: somatosensory EP (SSEP), brainstem auditory EP, visual EP (VEP) obtained using stimulation goggles and mismatch negativity, as well as an imaging test (computerised axial tomography). The tests were repeated at one week and one month, and each patient was evaluated by means of the Glasgow scale and the Karnofsky scale. Results.We studied 22 patients (mean age: 39.95 years; interval: 15-84 years), 20 of them were males. The highest number of deaths occurred during the first week. There was a strong correlation between survival and the results from the SSEP and VEP. Conclusions. SSEP and VEP performed on admission were a valuable aid for reaching a short and medium term prognosis for survival of patients in coma due to TBI, although they were not effective in evaluating a prognosis for functional recovery

Expression of type I interferon receptor in renal cell carcinoma.

Immunohistochemical analysis of INF-R was performed on 110 renal tumors, 25 peritumoral kidney tissues and 10 lymph node metastases. Pathological material was previously studied and classified according to predominant cell type, stage and grade. A statistical analysis was made in order to determine to what extent the immunoexpression of INF-R differed in relation to the histological variables studied. All peritumoral kidney sections, 89/110 tumors and 9/10 metastases proved positive. Membranous expression was related to clear cell carcinomas. Type I INF-R is expressed in RCC, independent of tumor stage and grade, as well as sex, age and survival. INF-R is widely expressed in RCC in any tumoral type, and its expression is preserved in metastatic disease, which may help to target those patients who could benefit from INF therapy.

[The development of lipid and anthropometric parameters in the treatment of pre-pubertal obese patients]. / Evolución de parámetros lipídicos y antropométricos en el tratamiento de pacientes obesos prepúberes.

OBJECTIVE: Relationships have been found between obesity and changes in serum lipid levels which may lead to antherogenic lipid profiles. There are few studies treating obesity and showing the possibility of improving lipid abnormalities in prepubertal obese patients. PATIENTS AND METHODS: One hundred and three obese patients ranging from 5.3 to 9.9 years old have been studied. Anthropometric (height, weight, body mass index-BMI-, and subscapular and triceps skinfolds) and lipid (total and lipoprotein cholesterol, triglycerides, apoprotein A1 and B) parameters were measured both at the beginning of the study and after six months of diet treatment. Patients were included in three groups according to their response to treatment: good response (GR), no response (NR) and bad response (BR), if the difference in BMI was less than 1 point (< 1), between -1 and +1 and more than 1 point (> 1), respectively. RESULTS: Forty-one patients (39.8%) were noncompliant. Of the remaining sixty-two, 41 (66%) had a GR, 16 (25.8% NR and 5 (8%) BR. The obese patients showed a significantly lower HDL-C (38.8 +/- 15.6 vs 48.3 +/- 10.2 mg/dl, p < 0.01) in comparison to the control group. GR patients showed a statistically significant increase in HDL-C (48.2 +/- 9.1 vs 54.9 +/- 12.0 mg/dl, p < 0.01) and apoprotein A1 (126.7 +/- 17.3 vs 136.0 +/- 17.4 mg/dl, p < 0.05) levels at the end of the study. There was no statistically significant difference in serum lipid levels in the other two groups. There was no statistically significant correlation between serum lipid levels and anthropometric parameters. The difference between final minus initial value in both lipid and anthropometric parameters were not correlated. Sixteen patients (17.7%) had pathological serum lipid levels, 15 of them showing hypertriglyceridemia, that disappeared in GR patients. CONCLUSIONS: Prepubertal obese patients show alterations in lipid profiles and this is not correlated with anthropometric parameters. The improvement in these anthropometric parameters improve the lipid profile. Initial pathologic serum lipid levels in GR patients become normalized.

[Multidisciplinary treatment of pediatric obesity. Results in 213 patients]. / Tratamiento multidisciplinario de la obesidad pediátrica. Resultados en 213 pacientes.

OBJECTIVE: The objective of this study was to evaluate the results that have been obtained on obese patients with different modalities of treatment. PATIENTS AND METHODS: Two hundred thirteen patients (118 girls and 95 boys) diagnosed with exogenous obesity with an average age of 10.3 +/- 2.4 years (range 5-14 years) have been studied. The patients were classified into four different groups depending on the type of health specialty by which they were treated: a) Nutritionist; b) Nutritionist and dietician; c) Nutritionist and paidopsychiatry and d) Nutritionist, dietician and paidopsychiatry. The duration of the treatment was 1.0 +/- 0.8 years (0.1-4.6 years). RESULTS: Seventy-five patients (35%) abandoned treatment. A decrease of the body mass index > 2 points/year, criterion to be considered as a good response, was accomplished in 78 patients (36.6%). A good response associated with the fulfillment of the diet showed a sensitivity of 86% and a specificity of 62%. The increase of the size between the first and the last check-up was remarkably inferior in those patients who fulfilled the diet in relationship to those who did not (p < 0.003) and in the patients who had good response in relation to the patients who did not (p < 0.03). The control of the patients by different specialists did not improve the response, although there is a tendency for a better response in the patients of group-d with regards to the total of patients in the rest of the groups (41.3% vs 31.8%). A lower number of patients treated by a dietician left the treatment and 73% of these lost weight at some time during the treatment. CONCLUSIONS: Good response to the treatment seems to be associated with the fulfillment of the diet strictly controlled by the dietician, as well as with physical exercise. The lower increase of the height in patients with good fulfillment of the diet shows the necessity of a strict control of these patients.

DNA-ploidy, morphometric-stereological and P-glycoprotein study of superficial bladder carcinomas.

We carried out a DNA-ploidy, morphometric-stereologic and P-glycoprotein study on 40 newly diagnosed superficial bladder cancer patients (G1-G2), correlating the results with histological grade and clinical outcome. Variations in the number of patients who present recurrences, progression or remain tumor-free during the whole follow-up period (at least 5 years) were not significant when related to nuclear size, proliferative diploid index, presence of aneuploidy and expression of P-glycoprotein. It is striking how the majority of disease-free subjects showed a proliferative diploid index higher than 10%. Moreover, 3 of them presented an aneuploid cell population. In our study, only histological grade showed a significant discriminatory level in terms of progression versus no progression in patients with superficial bladder cancer.

Correlation between serum values of prostatic acid phosphatase and morphometric analysis in the cytologic diagnosis of prostatic carcinoma.

We studied 78 men with suspicion of prostatic carcinoma, who underwent transrectal aspiration biopsy, diagnosing 46 adenocarcinoma, 13 chronic prostatitis and 19 benign prostatic hyperplasia. Moreover, we determined prostatic acid phosphatase (PAP) by enzyme immunoanalysis, resulting in 9/78 false-positives and 18/78 false-negatives. Also, we carried out a morphometric analysis of the cytologic samples which showed good correlation with the cytologic diagnosis except in the moderately differentiated carcinomas. We found a good correlation between PAP values, cytologic diagnosis and nuclear size as well as the percentage of the binucleolated cells.

Behavior of epithelial differentiation antigens (carcinoembryonic antigen, epithelial membrane antigen, keratin and cytokeratin) in transitional cell carcinomas of the bladder.

Results of an immunohistochemical study in normal urothelium and transitional cell carcinomas of the bladder are presented. Paraffin-embedded material was confronted with immunoantisera against carcinoembryonic antigen (CEA), keratin (K), cytokeratin (CK) and epithelial membrane antigen (EMA). Immunohistochemical findings confirm the changes in reactivity of dysplastic urothelium and carcinoma in situ for CEA, CK and EMA, in comparison with normal urothelium. Statistically significant differences were also found, depending upon tumor stage, in staining of transitional cell carcinomas for K and CK. Expression of CK correlated with the tumor differentiation grade: normal urothelium and well-differentiated carcinomas showed a specific pattern of immunostaining for the basal cells, this pattern being lost in poorly differentiated carcinomas.

[Evolution value of quantitative performance indicators of a large hospital (La Fe. 1974-1986)]. / Valor evolutivo de los indicadores cuantitativos de rendimiento de un gran hospital (La Fe. 1974-1986).

An analytical study has been conducted from a historical-developmental viewpoint for a 13-year period--1974-1986--on the most widely-used quantitative hospital performance indicators for a 2.000-bed Centre composed of four hospitals: General, Children's, Maternity and Traumatology-Rehabilitation. To take a general count of these indicators for the Centre as a whole would present a misleading picture in that the differences in the working of its constituent parts, which are mutually autonomous and adopt different approaches to their own specific areas, would be concealed. Thus while there are areas unable to cope with increasing demand--General and Traumatology-Rehabilitation-, in others-Children's and Maternity-the pressure is not nearly so great. Overall the Centre is seen as overloaded, but not nearly so great. Overall the Centre is seen as overloaded, but not in a uniform way, and this creates imbalances and distortions within the constituent hospitals themselves. It is very probable that the rate of growth in demand for hospital services can be put down in large part to structural and functional deficiencies in primary care.