[Recommendations for the clinical evaluation of results in the biomedical literature]. / Recomendaciones para la valoración clínica de los resultados en literatura biomédica.

The assessment and interpretation of the results of a clinical study are a real challenge for the clinicians. In this paper we establish a general basis for a critical and reserved assessment of these, from the fundamental aspects of the design and statistics, as well as the application of the results to our own patients according to risk and benefit criteria. Main errors and the traps that should be avoided are emphasised.

Recomendaciones para la valoración clínica de los resultados en literatura biomédica / Recommendations for the clinical evaluation of results in the biomedical literature

La valoración y la interpretación de los resultados de un estudio clínico son un auténtico reto para el profesional médico. En el presente artículo se ofrecen las bases generales para una valoración crítica y comedida, partiendo de aspectos fundamentales del diseño y de la estadística, así como de la aplicación de los resultados a nuestros propios pacientes según criterios de riesgo y beneficio. Se hace hincapié en los principales errores y en las trampas que se debe evitar (AU)

The assessment and interpretation of the results of a clinical study are a real challenge for the clinicians. In this paper we establish a general basis for a critical and reserved assessment of these, from the fundamental aspects of the design and statistics, as well as the application of the results to our own patients according to risk and benefit criteria. Main errors and the traps that should be avoided are emphasized (AU)

Seudolinfoma mamario / Breast pseudolymphoma

No disponible

[Is there a minimum number of lymph nodes that should be examined after surgical resection of colorectal cancer?]. / ¿Existe un número mínimo de ganglios linfáticos que se debe analizar en la cirugía del cáncer colorrectal?

Metastasis to regional lymph nodes, after distant metastasis, is the most important prognostic factor of colorectal carcinomas. It is also of primary importance in decisions related to the administration of adjuvant treatments. Most scientific associations recommend the examination of at least 12 lymph nodes for the reliable determination of the absence of nodal metastases. We performed a literature review on lymph node recovery in order to determine whether 12 is the minimum and optimal number of lymph nodes to be examined after colorrectal cancer surgery. The differences between authors suggest that an optimal number of lymph nodes to be examined after colorectal cancer surgery probably does not exist and depends on many factors. Thus, recovering as many lymph nodes as possible seems to be a good option.

¿Existe un número mínimo de ganglios linfáticos que se debe analizar en la cirugía del cáncer colorrectal? / Is there a minimum number of lymph nodes that should be examined after surgical resection of colorectal cancer?

La afección ganglionar es, después de la metástasis a distancia, el principal factor pronóstico en los pacientes con cáncer colorrectal. Además, condiciona la necesidad de tratamientos adyuvantes. Para determinar que un paciente se encuentra libre de enfermedad ganglionar, la mayoría de las asociaciones recomiendan analizar, al menos, 12 ganglios linfáticos. Se planteó en este trabajo la revisión de la literatura sobre el tema para valorar si 12 es el número mínimo y óptimo de ganglios que se debe analizar. La disparidad de resultados encontrados en la mayoría de los trabajos científicos orienta a que, probablemente, no haya un número óptimo de ganglios linfáticos que se debe analizar, sino que estará condicionado por múltiples factores. Por ello, obtener la mayor cantidad posible de ganglios parece una buena alternative (AU)

Metastasis to regional lymph nodes, after distant metastasis, is the most important prognostic factor of colorectal carcinomas. It is also of primary importance in decisions related to the administration of adjuvant treatments. Most scientific associations recommend the examination of at least 12 lymph nodes for the reliable determination of the absence of nodal metastases. We performed a literature review on lymph node recovery in order to determine whether 12 is the minimum and optimal number of lymph nodes to be examined after colorrectal cancer surgery. The differences between authors suggest that an optimal number of lymph nodes to be examined after colorectal cancer surgery probably does not exist and depends on many factors. Thus, recovering as many lymph nodes as possible seems to be a good option (AU)

[Usefulness of computed tomography in determining risk of recurrence after a first episode of primary spontaneous pneumothorax: therapeutic implications]. / Utilidad de la tomografía computarizada para determinar el riesgo de recidiva tras un primer episodio de neumotórax espontáneo primario. Implicaciones terapéuticas.

OBJECTIVE: The main cause of primary spontaneous pneumothorax is the rupture of subpleural blebs or bullae. The presence of bullae may also lead to an increased risk of recurrence. The best way to detect them is by means of computed tomography (CT). Our objective in the present study was to determine whether bullae detected by CT represent an increased risk of recurrence after a first episode of primary spontaneous pneumothorax. We also evaluated therapeutic implications. PATIENTS AND METHODS: We carried out a prospective study that included 55 patients (41 men and 14 women) with primary spontaneous pneumothorax. For all patients, the therapeutic recommendations of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) were followed. After resolution of the episode, a chest CT was performed and the presence, location, number, and size of bullae were evaluated. Subsequently, the number of recurrences in each group was evaluated. RESULTS: The mean follow-up period was 30.7 months (95% confidence interval, 24-37 months). Twenty-six patients presented bullae, and 6 of these experienced recurrence. Of the 29 patients without bullae, 7 experienced recurrence. No association was found between the presence or absence of bullae and recurrence (P=.92). Bullae in the right lung led to more frequent recurrence of pneumothorax (P=.03). The number and size of the bullae had no significant influence on recurrence (P=.51). CONCLUSIONS: The present study could not demonstrate that the presence, size, or number of bullae on CT scans has any influence on recurrence rate. We cannot recommend surgery after a first episode of primary spontaneous pneumothorax based on the presence of bullae on the CT scan.

Utilidad de la tomografía computarizada para determinar el riesgo de recidiva tras un primer episodio de neumotórax espontáneo primario. Implicaciones terapéuticas / Usefulness of computed tomography in determining risk of recurrence after a first episode of primary spontaneous pneumothorax: therapeutic implications

Objetivo: La causa fundamental del neumotórax espontáneo primario es la rotura de bullas o blebs subpleurales. Estas bullas podrían también condicionar un mayor riesgo de recidiva. La mejor forma de detectarlas es mediante tomografía axial computarizada (TAC). Nos planteamos aquí si las bullas en la TAC suponen un riesgo mayor de recidivas tras un primer episodio de neumotórax espontáneo primario. Asimismo, se valoran las implicaciones terapéuticas. Pacientes y métodos: Se trata de un estudio prospectivo en el que se incluyó a 55 pacientes (41 varones y 14 mujeres) con neumotórax espontáneo primario. En todos ellos se siguieron las recomendaciones terapéuticas de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Tras la resolución del episodio se efectuó una TAC de tórax y se valoraron la presencia, la localización, el número y el tamaño de bullas. Posteriormente, se evaluó el número de recidivas en cada grupo. Resultados: El tiempo medio de seguimiento fue de 30,7 meses (intervalo de confianza del 95%, 24-37 meses). Presentaron bullas 26 pacientes, de los que en 6 hubo recidiva. De los 29 pacientes sin bullas, 7 presentaron recidiva. No se encontraron diferencias entre la presencia o ausencia de bullas y la recidiva (p = 0,92). Las bullas derechas recidivaron con mayor frecuencia (p = 0,03). El número y el tamaño de las bullas no tuvieron influencia significativa (p = 0,51). Conclusiones: El estudio no ha podido demostrar que la presencia de bullas en la TAC, su tamaño o su número influyan en el índice de recidivas. No se puede recomendar la cirugía tras un primer episodio de neumotórax espontáneo primario por presentar bullas en la TAC

Objective: The main cause of primary spontaneous pneumothorax is the rupture of subpleural blebs or bullae. The presence of bullae may also lead to an increased risk of recurrence. The best way to detect them is by means of computed tomography (CT). Our objective in the present study was to determine whether bullae detected by CT represent an increased risk of recurrence after a first episode of primary spontaneous pneumothorax. We also evaluated therapeutic implications. Patients and methods: We carried out a prospective study that included 55 patients (41 men and 14 women) with primary spontaneous pneumothorax. For all patients, the therapeutic recommendations of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) were followed. After resolution of the episode, a chest CT was performed and the presence, location, number, and size of bullae were evaluated. Subsequently, the number of recurrences in each group was evaluated. Results: The mean follow-up period was 30.7 months (95% confidence interval, 24-37 months). Twenty-six patients presented bullae, and 6 of these experienced recurrence. Of the 29 patients without bullae, 7 experienced recurrence. No association was found between the presence or absence of bullae and recurrence (P=.92). Bullae in the right lung led to more frequent recurrence of pneumothorax (P=.03). The number and size of the bullae had no significant influence on recurrence (P=.51). Conclusions: The present study could not demonstrate that the presence, size, or number of bullae on CT scans has any influence on recurrence rate. We cannot recommend surgery after a first episode of primary spontaneous pneumothorax based on the presence of bullae on the CT scan

[Confidence intervals: why use them?]. / Intervalos de confianza: por qué usarlos.

We analyze the reasons why the use of confidence intervals is highly advisable. Among these reasons, confidence intervals provide an approach to knowledge of the real importance of a result, independently of statistical significance, as well as equivalence assessment between two variables.

Intervalos de confianza: por qué usarlos / Confidence intervals: why use them?

Se analizan las razones por las que el uso de los intervalos de confianza es altamente recomendable. Entre estas razones, destacan la aproximación al conocimiento de la importancia real de un resultado, independientemente de la significación estadística, y la valoración de equivalencia entre dos variables (AU)

We analyze the reasons why the use of confidence intervals is highly advisable. Among these reasons, confidence intervals provide an approach to knowledge of the real importance of a result, independently of statistical significance, as well as equivalence assessment between two variables (AU)

Trombosis venosa profunda como manifestación clínica inicial de un aneurisma de la arteria femoral común / Deep vein thrombosis as the initial clinical symptom of an aneurysm in the common femoral artery

Introducción. Los aneurismas femorales, junto con los de localización poplítea, constituyen el grupo de aneurismas periféricos más frecuentes (80%). La compresión de estructuras vecinas por efecto masa es frecuente, pero rara vez tiene lugar la aparición de una trombosis venosa profunda como manifestación inicial. Caso clínico. Varón de 55 años que ingresó de urgencias por presentar cuadro clínico compatible con trombosis venosa profunda de miembro inferior izquierdo. Como antecedentes personales refería hipertensión arterial y obesidad mórbida. En la exploración física presentaba edema de toda la extremidad, pulsos femoral y poplíteo presentes; los distales eran difíciles de valorar. El estudio eco-Doppler puso de manifiesto la presencia de un aneurisma en la arteria femoral común y la trombosis del sector venoso femoroilíaco. El paciente sufrió un cuadro de isquemia arterial distal aguda, por lo que se le intervino de urgencia; se realizaron una aneurismectomía e interposición de prótesis iliofemoral con anastomosis terminoterminal

INTRODUCTION. Femoral, together with popliteal, aneurysms constitute the most frequent group of peripheral aneurysms (80%). The compression of neighbouring structures due to the mass effect is frequent, but deep vein thrombosis rarely appears as the initial symptom. CASE REPORT. A 55-year-old male who was urgently admitted to hospital with a clinical picture that was compatible with deep vein thrombosis in the left lower limb. His personal history included arterial hypertension and morbid obesity. The physical examination revealed oedema of the entire extremity, femoral and popliteal pulses were present, but the distal pulses were difficult to evaluate. A Doppler ultrasound recording showed the presence of an aneurysm in the common femoral artery and thrombosis of the femoral-iliac vein segment. The patient suffered symptoms of acute distal arterial ischaemia, and had to be submitted to an emergency surgical intervention involving an aneurysmectomy and placement of an iliofemoral graft with end-to-end anastomosis

Heridas por asta de toro en el Hospital General de Castellón. Estudio de 387 pacientes / Bull horn wounds in Castellon General Hospital. A study of 387 patients

Las heridas por asta de toro son frecuentes en el mundo iberoamericano, donde los espectáculos con estos animales son algo habitual. Dichas heridas presentan unas características especiales que las diferencian de cualquier otro tipo de heridas. Material y método: Se realizó un estudio retrospectivo con revisión de las historias clínicas de los pacientes ingresados en nuestro servicio con el diagnóstico de herida por asta de toro entre enero de 1978 y octubre de 2005. Resultados: Se estudiaron 387 ingresos. En 12 ocasiones se trató de reingresos por nuevas cogidas en un mismo paciente. En 27 enfermos se presentaron múltiples heridas. La localización de las heridas principales fue: cabeza y cuello 12 (3,1%), tórax 21 (5,4%), extremidades superiores 19 (4,9%), abdomen 44 (11,3%), periné 41 (10,5%), región lumbar-espalda 6 (1,5%) y extremidades inferiores 244 (63%). Fueron necesarias 31 laparotomías con 23 lesiones viscerales. Aparte del tratamiento específico, se realizó lavado con solución antiséptica, Friedreich y sutura de piel sobre drenajes, tratamiento antibiótico y vacunación antitetánica. Las complicaciones inmediatas más frecuentes fueron la desvitalización de la herida y la infección, con 7 y 6 casos, respectivamente. La complicación tardía más frecuente fue la eventración con 6 casos. Hubo 3 muertes por shock hipovolémico, por shock séptico y por gangrena gaseosa. Conclusión: Las heridas por asta de toro tienen unas características propias que es necesario conocer especialmente en regiones con afición al toreo. Aunque son lesiones graves, su pronóstico es bueno, con escasas complicaciones y una mortalidad menor del 1% (AU)

Bull horn lesions are frequent in the Latin world due to spectacles involving these animals. These wounds have special characteristics that distinguish them from all other lesions. Material and method: A retrospective analysis of the medical records of patients with bull horn lesions admitted to our service between January 1978 and October 2005 was performed. Results: A total of 387 patients with bull horn lesions were admitted to our service. There were 12 readmissions due to a new wound in a previously treated patient. Twenty-seven patients had two or more lesions. The location of the wounds was: head and neck in 12 (3.1%), thorax in 21 (5.4%), upper extremities in 19 (4.9%), abdomen in 44 (11.3%), perineum in 41 (10.5%), back and lumbar region in 6 (1.5%), and lower extremities in 244 (63%). Thirty-one laparotomies were performed and there were 23 visceral lesions. Surgical treatment in addition to specific procedures consisted of irrigation with antiseptic solution, Friedreich, and primary closure over drains. Antibiotic and antitetanus vaccinations were administered in all patients. The most frequent early complications were: wound devitalization (7 patients) and infection (6 patients). The most frequent late complication was incisional hernia. Three patients died as a result of hypovolemic shock, septic shock and gas gangrene. Conclusion: Bull horn wounds have special characteristics. Familiarity with these lesions is important in areas where bullfighting is practiced. Although bull horn wounds are severe, their prognosis is good, with few complications and a mortality rate of less than 1% (AU)

Cáncer gástrico: valoración probabilística ante un estadio ganglionar negativo y sus consecuencias / Gastric cancer: probability assessment after lymph node-negative staging and its consequences

Objetivo. Aproximación al cálculo de la probabilidad de error tras un estadio ganglionar negativo en el cáncer gástrico. Pacientes y método. A partir de los datos retrospectivos de 75 resecciones gástricas por cáncer, se calculan dichas probabilidades de forma general, según el estadio T de la clasificación TNM, 6.a edición, y según el tipo de linfadenectomía realizada. Se utiliza una modificación de un procedimiento basado en el teorema de Bayes. Resultados. De forma general, se precisan al menos 11 ganglios negativos para asegurar un verdadero pN0. Para los tumores T1 se precisan, al menos, 2 ganglios, 11 para los T2, y 14 para los T3. Una linfadenectomía D2 requiere más ganglios que una D1, pero sus estadios pN0 son casi siempre seguros, mientras que en las linfadenectomías D1 se produjo un 24% de estadificaciones inseguras. Conclusiones. Se ha descrito un modelo matemático sencillo y reproducible que puede ayudar al cirujano a conocer la calidad de las estadificaciones ganglionares negativas en un importante grupo de pacientes con cáncer gástrico (AU)

Objective. To provide an approach to calculating the probability of error after lymph node-negative staging in gastric cancer. Patients and method. Retrospective data of 75 gastric resections for cancer were used to calculate the probability of error in general, according to T staging of the TNM classification (6th edition) and according to the type of lymphadenectomy performed. A modification of a procedure based on Bayes' theorem was used. Results. For all tumors, at least 11 negative lymph nodes were required to ensure a true pN0. Two lymph nodes were required for T1 tumors, 11 for T2 tumors, and 14 for T3 tumors. A greater number of lymph nodes were required for a D2 lymphadenectomy than for a D1 lymphadenectomy. However, in D2 lymphadenectomy, pN0 stages were almost always reliable, while in D1 lymphadenectomy 24% of stagings were unreliable. Conclusions. The present study describes a simple and reproducible mathematical model that could help surgeons to determine the accuracy of lymph node-negative stages in a substantial group of patients with gastric cancer (AU)

[Bull horn wounds in Castellon General Hospital. A study of 387 patients]. / Heridas por asta de toro en el Hospital General de Castellón. Estudio de 387 pacientes.

UNLABELLED: Bull horn lesions are frequent in the Latin world due to spectacles involving these animals. These wounds have special characteristics that distinguish them from all other lesions. MATERIAL AND METHOD: A retrospective analysis of the medical records of patients with bull horn lesions admitted to our service between January 1978 and October 2005 was performed. RESULTS: A total of 387 patients with bull horn lesions were admitted to our service. There were 12 readmissions due to a new wound in a previously treated patient. Twenty-seven patients had two or more lesions. The location of the wounds was: head and neck in 12 (3.1%), thorax in 21 (5.4%), upper extremities in 19 (4.9%), abdomen in 44 (11.3%), perineum in 41 (10.5%), back and lumbar region in 6 (1.5%), and lower extremities in 244 (63%). Thirty-one laparotomies were performed and there were 23 visceral lesions. Surgical treatment in addition to specific procedures consisted of irrigation with antiseptic solution, Friedreich, and primary closure over drains. Antibiotic and antitetanus vaccinations were administered in all patients. The most frequent early complications were: wound devitalization (7 patients) and infection (6 patients). The most frequent late complication was incisional hernia. Three patients died as a result of hypovolemic shock, septic shock and gas gangrene. CONCLUSION: Bull horn wounds have special characteristics. Familiarity with these lesions is important in areas where bullfighting is practiced. Although bull horn wounds are severe, their prognosis is good, with few complications and a mortality rate of less than 1%.

[Gastric cancer: probability assessment after lymph node-negative staging and its consequences]. / Cáncer gástrico: valoración probabilística ante un estadio ganglionar negativo y sus consecuencias.

OBJECTIVE: To provide an approach to calculating the probability of error after lymph node-negative staging in gastric cancer. PATIENTS AND METHOD: Retrospective data of 75 gastric resections for cancer were used to calculate the probability of error in general, according to T staging of the TNM classification (6th edition) and according to the type of lymphadenectomy performed. A modification of a procedure based on Bayes' theorem was used. RESULTS: For all tumors, at least 11 negative lymph nodes were required to ensure a true pN0. Two lymph nodes were required for T1 tumors, 11 for T2 tumors, and 14 for T3 tumors. A greater number of lymph nodes were required for a D2 lymphadenectomy than for a D1 lymphadenectomy. However, in D2 lymphadenectomy, pN0 stages were almost always reliable, while in D1 lymphadenectomy 24% of stagings were unreliable. CONCLUSIONS: The present study describes a simple and reproducible mathematical model that could help surgeons to determine the accuracy of lymph node-negative stages in a substantial group of patients with gastric cancer.