Validación: se necesitan instrumentos fiables. Escala de actitud y encuesta de opinión / Verification: reliable instruments needed. Attitude scale and opinion poll

La utilización del método cientifico, en la investigación en enfermerfa, requiere evitar en todo momento la subjetividad. Recogemos datos a través de los instrumentos, que deben ser operativos, válidos y fiables. Se desarrollan y validan dos instrumentos: una encuesta de opinión de 9 preguntas, mediante tests-retests y con una concordancia de proporciones del 93,40%; y una escala de actitud tipo Likert, aplicando la «t» de Student a 59 proposiciones iniciales, recogiendo la escala definitiva con 7 ftems positivos y 7 negativos con significación estadfstica al nivefde confianza del 95%, para una prueba bilateral y con 22 grados de libertad. El trabajo se llevó a cabo mediante un grupo piloto de 43 enfermeras, como ejercicio práctico del taller sobre investigación en enfermerfa celebrado en el Hospital, organizado por la Dirección de Enfermerfa e impartido por el coordinador del grupo

The use of the scientific method in research and investigation in nursing requires avoiding subjectivity at all times. Professionals obtain data by means of instruments which must be operative, valid and reliable. The authors develop and verify two instruments: a nine question opinion poli which uses tests and retests, having a 93-40% concordance proportion. A Likert type attitude scale, applying the «t» in Student to 59 initial propositions, obtaining a definitive scale having 7 positive items and 7 negative ones which gave a 95% confidence 1evel of statistical meaning for a bilateral test and which had 22 degrees-of liberty. This study took place using a pilot group of 43 nurses; it was a practical shop exercise on research in nursing occurred in the Hospital, organized by the Nursing Administration and taught by the group coordinator

Esófago-diverticulostomía en el tratamiento del divertículo de Zenker / Esophagodiverticulostomy for the treatment of Zenker's diverticulum

No disponible

Fístula broncoesofágica tuberculosa / Tuberculous bronchoesophageal fistula

No disponible

Actinomicosis abdominal pulmonar simulando tumor de colon con metástasis pulmonares y hepáticas / Pulmonary abdominal actinomycosis presenting colon tumor with hepatic and pulmonary metastases

No disponible

Niveles séricos preoperatorios del CEA y pronóstico en el cáncer colorrectal / Preoperative serum levels of the carcinoembrionary antigen (cea) and prognosis in colorectal cancer

Objetivo: Analizar el valor pronóstico de los niveles séricos preoperatorios del antígeno carcinoembrionario (CEA) en el cáncer colorrectal primario. Material y métodos: Se analizaron los niveles séricos preoperatorios del CEA en 275 pacientes con carcinoma colorrectal, que fueron sometidos a un período mínimo de seguimiento clínico de cinco años, o hasta su fallecimiento. Resultados: El porcentaje de positividades para los niveles séricos preoperatorios del CEA (> 6 ng/ml) estuvo positiva y significativamente asociado con el estadio tumoral (A: 10,5 por ciento; B: 38,8 por ciento; C: 32,2 por ciento; y D: 72 por ciento; p < 0,0001). Además, los valores séricos elevados del antígeno estuvieron significativamente asociados, en el análisis univariante, con una supervivencia corta en el conjunto de los pacientes (p < 0,0001). Sin embargo, el análisis multivariante tan solo demostró valor pronóstico independiente del CEA en el subgrupo de pacientes con tumores en estadio C. Conclusiones: Los valores séricos preoperatorios del CEA tienen valor clínico para predecir la extensión de la enfermedad, así como para predecir el pronóstico de pacientes con cáncer colorrectal con estadio tumoral C. (AU)

[Preoperative serum levels of the carcinoembryonic antigen (CEA) and prognosis in colorectal cancer]. / Niveles séricos preoperatorios del CEA y pronóstico en el cáncer colorrectal.

OBJECTIVE: To analyze the prognostic value of the preoperative serum levels of the carcinoembryonic antigen (CEA) in primary colorectal carcinoma. MATERIAL AND METHODS: Preoperative serum levels of CEA were analyzed in 275 colorectal cancer patients, who were followed up for a minimum of 5 years, or until death. RESULTS: The percentage of positivities for the preoperative serum levels of CEA (> 6 ng/ml) was positively and significantly associated with the tumoral stage (A: 10,5%; B: 38,8%; C: 32,2%; y D: 72%; p < 0,0001). In addition, the elevated serum values of the antigen were significantly associated, in the univariate analysis, with short survival in the overall group of patients (p < 0,0001). However, the multivariate analysis only showed an independent prognosis value of the CEA in the subgroup of patients with stage C tumors. CONCLUSIONS: Preoperative serum levels of CEA may be useful to predict tumoral extension, and also for the prognosis regarding stage C colorectal cancer patients.

Prognostic significance of cytosolic pS2 protein content in gastric cancer.

pS2, a 60-amino-acid chain peptide which is the most widespread estrogen-induced RNA messenger in MCF-7 breast cancer cells, is normally detected in the epithelium of gastric mucosa. The aims of this work were to evaluate the cytosolic pS2 content and its clinical significance in gastric carcinomas. Cytosolic pS2 levels were examined by immunoradiometric methods in 108 patients with primary gastric adenocarcinomas. The mean follow-up period was 23.3 months. The cytosolic pS2 levels of the tumors ranged widely, i.e., from 0.1 to 3217 ng/mg protein. There were no significant differences in pS2 content between tumors (mean +/- standard error: 137.2+/-31.4 ng/mg protein) and paired adjacent mucosa samples (n=84; mean +/- standard error: 249.6+/-32.6 ng/mg protein), nor were there any significant differences in tumoral pS2 levels with respect to clinicopathologic parameters such as patient age and sex or tumor location, stage, histologic type or grade. However, the results indicated that high intratumoral pS2 levels were significantly and independently associated with an unfavorable outcome in the overall group of patients (p=0.0266) and in patients with resectable gastric cancer (p=0.003). In conclusion, pS2 may represent a useful biological marker in gastric cancer.

Hyaluronic acid as prognostic marker in resectable colorectal cancer.

BACKGROUND: Hyaluronic acid (HA), an extracellular high molecular mass polysaccharide, is thought to be involved in the growth and progression of malignant tumours. The objective of this work was to evaluate the cytosolic HA content in resectable colorectal cancer, its possible relationship with clinicopathological parameters of tumours and its prognostic significance. METHODS: Cytosolic HA levels were examined by radiometric assay in 120 patients with resectable colorectal cancer. The mean follow-up period was 33.4 months. RESULTS: Cytosolic HA levels of tumours ranged widely, from 30 to 29 412 ng per mg protein. Intratumour HA levels were significantly correlated with Dukes stage (P < 0.005), and were higher in patients with advanced tumours (mean(s.e.m.) 2695(446), 2858(293) and 5274(967) ng per mg protein for stages A, B and C respectively). In addition, Cox multivariate analysis demonstrated that tumour HA levels higher than 2000 ng per mg protein predicted shorter relapse-free survival and overall survival periods (both P < 0.05). CONCLUSION: There is a wide variability in cytosolic HA levels in colorectal carcinomas, which seems to be related to the biological heterogeneity of these tumours. In addition, high tumour cytosolic HA levels were associated with an unfavourable outcome in patients with resectable colorectal cancer. HA may provide additional information to that given by other biochemical markers currently used in colorectal cancer.

Paresia gástrica poscolectomía / Gastric paresis following colectomy

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Tissue-type plasminogen activator (tPA) content in colorectal cancer and in surrounding mucosa: relationship with clinicopathologic parameters and prognostic significance.

The aim of this study was to evaluate the cytosolic tissue-type plasminogen activator (tPA) content in colorectal cancer, its possible relationship with the clinicopathologic parameters of tumors, and its prognostic significance. We have therefore examined by immunoenzymatic assay the cytosolic tPA content in tumors and paired surrounding normal mucosa samples from 162 colorectal cancer patients. Cytosolic tPA levels were significantly higher in surrounding normal mucosa samples than in neoplastic tissues (4.01 +/- 5.07 vs 2.63 +/- 5.82 ng/mg protein; p < 0.0001). By contrast, no significant correlation was found between tPA content and clinicopathologic tumor parameters such as location, Dukes' stage, histologic grade, and DNA content or S-phase fraction. However, the results indicated that a high cytosolic tPA content (> 0.75 ng/mg protein) in tumors predicted for a shorter relapse-free and overall survival (both p < 0.05) in 123 resectable colorectal cancer patients who were prospectively evaluated during a mean follow-up period of 32.2 months. This suggests that tPA may give additional information to that provided by other biochemical markers currently used in colorectal cancer.

Significación clínica de la apariencia mamográfica de los carcinomas mamarios / Clinical significance of the mammographic appearance of breast carcinoma

Objetivo. En este estudio analizamos la relación entre la apariencia mamográfica de los carcinomas mamarios y las características de las pacientes y sus tumores, así como el posible valor pronóstico de los hallazgos mamográficos. Método. Realizamos un estudio retrospectivo sobre 237 pacientes diagnosticadas y tratadas por carcinoma ductal infiltrante de mama entre los años 19841994. El tiempo medio de seguimiento fue de 33,9 meses. Los tumores se clasificaron en cinco grupos diferentes según su apariencia mamográfica: espiculados con o sin microcalcificaciones (tipo A), difuso (tipo B), microcalcificaciones sin una masa evidente (tipo C), clrcunscrito (tipo D) y no visible en mamografía (tipo E). Además, se evaluó independientemente el significado clínico de la existencia de microcalcificaciones. Resultados. La apariencia radiográfica tipo A se detectó en 125 pacientes (52,7 por ciento), el tipo B en 24 (10,1 por ciento), el tipo C en 32 (13,5 por ciento), el tipo D en 49 (20,7 por ciento) y el tipo E en siete pacientes (2,9 por ciento). Por otra parte, un total de 87 tumores (36,7 por ciento) mostró microcalcificaciones. Hubo diferencias significativas en la distribución de estos tipos mamográficos según el estado menopáusico, la afectación ganglionar y el grado histológico de los tumores. Así, el porcentaje de tumores tipo A fue más alto en tumores sin afectación ganglionar y en aquellos bien diferenciados. Por el contrario, el tipo B se detectó en un alto porcentaje de tumores con ganglios positivos y en los pobremente diferenciados. Además, las microcalcificaciones se asociaron significativamente con tumores pequeños y con ganglios negativos. Finalmente, el análisis multivariante demostró que el tipo B y la ausencia de microcalcificaciones se asociaban significativamente a un alto riesgo de recurrencia y fallecimiento. Conclusión. Estos resultados nos inducen a considerar que la apariencia mamográfica de los carcinomas mamarios puede reflejar su comportamiento biológico (AU)

C-erbB-2 oncoprotein content in colorectal cancer and in surrounding mucosa: relationship with clinicopathologic parameters and prognostic significance.

BACKGROUND: c-erbB-2 is a transmembrane signaling molecule closely related in structure to the epidermal-growth-factor receptor (EGFR) but biologically distinct from it. c-erbB-2 has been implicated in cell transformation and tumor pathogenesis, but very little is known about its content and clinical significance in colorectal cancer. AIMS: To evaluate the c-erbB-2 content in colorectal cancer and its possible relationship with clinicopathologic parameters from tumors and prognostic significance. METHODS: Membranous and cytologic c-erbB-2 oncoprotein contents were examined by an immunoenzymatic assay in tumors and paired normal surrounding mucosa samples from 131 colorectal cancer patients. In addition, survival analysis were prospectively performed in a subgroup of 69 consecutive patients with resectable colorectal carcinomas, who underwent a mean follow-up period of 28 months. RESULTS: In the overall group of patients, c-erbB-2 levels were significantly higher in membranous than in cytosolic samples, in neoplastic tissues (5,830.4 +/- 1085.3 vs. 934.2 +/- 107.5 NHU/mg protein; p < 0.0001) and in surrounding normal mucosa samples (5,257.8 +/- 646.3 vs. 837.4 +/- 187.4 NHU/mg protein; p < 0.0001). Nevertheless, a significant positive relation was found between membranous and cytosolic oncoprotein levels in these two paired sets (p < 0.0001, for both). There were no significant differences in membranous or cytosolic c-erbB-2 protein levels between neoplastic tissues and surrounding mucosa samples in this overall group of patients. In addition, the results did not show significant correlations of these oncoprotein contents with clinicopathologic parameters from tumors such as location, stage, histologic grade, and DNA content or S-phase fraction. However, the results indicated that low membranous c-erbB-2 content (< 4,500 NHU/mg protein) in tumors predict shorter relapse-free survival and overall survival (p < 0.05, for both) in resectable colorectal cancer patients. CONCLUSIONS: There are a wide variability of both membranous and cytologic c-erbB-2 contents in colorectal carcinomas, which seems to correspond to the biological heterogeneity of these tumors. In addition, our results also demonstrate that high membranous c-erbB-2 levels are associated with lesions of favorable evolution in resectable colorectal cancer patients.

[Aluminum absorption in the presence of normal kidney function: the effect of the pH]. / Absorción de aluminio en presencia de función renal normal: efecto del pH.

Aluminium is a toxic metal of known importance in patients with chronic renal failure on hemodialysis, with a gastrointestinal absorption modulated by several factors including gastric pH which modifies the solubility of Aluminium hydroxide and can increase its absorption. We studied twenty six patients with normal renal function: control (n = 13); presurgery (n = 8); postsurgery (n = 5) by an aluminium hydroxide absorption test (30 mg/kg); serum and urinary aluminium was determined as well as gastric pH and hematologic parameters at different time periods. It was observed that presurgery ulcer patients (pH mean = 2.09) increased serum and urine aluminium levels as well as aluminium/creatinine ratio in urine after the test, opposite to what occurs in the postsurgery group (pH mean = 5.78) in which such parameters were not significantly modified. No differences were found in hematological parameters between the two groups. Our results indicate that acid gastric pH seems to be a factor capable of increasing gastrointestinal absorption of aluminium hydroxide since its solubility and thus its disponibility is increased, and make a point on the risk of a prolonged administration of antacids containing aluminium in patients with normal renal function.

Evaluation of human breast cysts according to their biochemical and hormonal composition, and cytologic examination.

Breast cyst fluids were aspirated during the mild luteal phase of the menstrual cycle from 88 patients with gross cystic disease. According to intracystic Na+/K+ ratio three categories of cyst were identified: Type I with low Na+/K+ ratio, low levels of chloride, glucose, and pH, and high concentrations of dehydroepiandrosterone-sulphate (DHAS) and apocrine epithelium; Type II with high Na+/K+ ratio presenting levels of chloride, glucose, pH, and DHAS similar to those found in plasma, and flattened epithelium; Type III with intermediate values for the above parameters. The findings suggest that the cysts could correspond to the different functional stages of the epithelium lining the cysts. Cyst classification was evaluated using a discriminant analysis, which allows breast cyst fluids to be assigned within a category defined by the Na+/K+ ratio. The apparent correct rate for each category was more than 87%. The variables that better discriminate among groups of cysts were chloride, glucose, intracystic prolactin, and pH, respectively. These discriminant functions could be used as criteria for an optimal classification of breast cysts, which might help study of the epidemiology of breast cancer and its relationship to gross cystic disease.