Análisis del gasto de bolsillo en medicamentos e insumos en Perú en 2007 y 2016 / Out-of-pocket expenditure on medicines and supplies in Peru in 2007 and 2016

INTRODUCCIÓN: El gasto de bolsillo en medicamentos e insumos puede afectar financieramente los hogares. Objetivo: Determinar el gasto de bolsillo en medicamentos e insumos en Perú y las características de la población con mayor gasto de este tipo en los años 2007 y 2016. MÉTODOS: Estudio transversal analítico de la Encuesta Nacional de Hogares sobre Condiciones de Vida y Pobreza 2007 y 2016. Se determinó la media y mediana del gasto de bolsillo en medicamentos e insumos en dólares americanos para la población general, y según la presencia de factores descritos en la literatura como asociados al gasto de bolsillo en medicamentos e insumos. RESULTADOS: Se incluyeron datos de 92 148 encuestados en 2007 y de 130 296 en 2016. En 2007, se encontró una mediana de 3,19 (rango intercuartílico: 0,96 a 7,99) y una media de 8,14 (intervalo de confianza 95%: 7,80 a 8,49) para el gasto de bolsillo en medicamentos. En 2016, la mediana y media de este gasto fueron de 3,55 (rango intercuartílico: 1,48 a 8,88) y 9,68 (intervalo de confianza 95%: 9,37 a 9,99), respectivamente. Para 2016, se encontró un mayor gasto de bolsillo en medicamentos en mujeres, menores de cinco y mayores de 60 años; personas de mayor nivel educativo; tener seguro privado o de las fuerzas armadas; vivir en la región costa y en zona urbana; tener una enfermedad crónica; y ser de los quintiles de gasto per cápita más altos. Entre 2007 y 2016, se incrementó significativamente (p < 0,05) el gasto de bolsillo en medicamentos e insumos en los menores de cinco años (p < 0,001), personas no aseguradas (p < 0,001), asegurados en el Seguro Integral de Salud (p < 0,001) o a las fuerzas armadas, para el área urbana y rural (p < 0,001, ambos), y en personas sin enfermedades crónicas (p < 0,001). CONCLUSIONES: Se obtuvo el gasto de bolsillo en medicamentos e insumos en población peruana en 2007 y 2016, encontrándose un incremento del mismo entre los años de estudio, existiendo grupos poblacionales con mayor gasto y con aumentos significativos. Se requiere profundizar el estudio de factores asociados al gasto de bolsillo en medicamentos en grupos de mayor vulnerabilidad económico frente al gasto directo en salud en Perú.

BACKGROUND: Out-of-pocket spending on medicines and supplies can lead to a heavy financial burden in households. OBJECTIVE: To determine the out-of-pocket spending on medicines and supplies in Peru and the population groups with the highest out-of-pocket spending on medicines and supplies in 2007 and 2016. METHODS: We conducted an analytical cross-sectional study of the Peruvian National Household Survey on Living and Poverty Conditions for the years 2007 and 2016. Mean and median out-of-pocket spending on medicines and supplies are reported in USD for the general population, and according to the presence or not of factors described in the literature as associated with out-of-pocket spending on medicines and supplies. RESULTS: 92 148 and 130 296 participants from 2007 and 2016 were included. In 2007, a median of 3.19 (interquartile range: 0.96 to 7.99) and an average of 8.14 (95% confidence interval: 7.80 to 8.49) were found for the out-of-pocket spending on medicines and supplies. In 2016, the median and mean out-of-pocket spending on medicines and supplies were 3.55 (interquartile range: 1.48 to 8.88) and 9.68 (95% confidence interval: 9.37 to 9.99), respectively. For 2016, higher out-of-pocket spending on medicines and supplies was found in women, children under five and over 60 years of age, people of higher educational level, having private or armed forces insurance, living in the coastal region, and being in one of the highest per capita quintile of expenditure. Between 2007 and 2016, the out-of-pocket spending on medicines and supplies was significantly increased in children under five (p < 0.001), uninsured persons (p < 0.001), insured to the Seguro Integral de Salud (p < 0.001) or the Armed Forces (p = 0.035), for the urban and rural area (both p < 0.001), and in people without chronic diseases (p < 0.001). CONCLUSIONS: An increase in out-of-pocket spending on medicines and supplies was found in the study period. There were population groups with significant increases in out-of-pocket spending on medicines and supplies. It is necessary to explore further the factors associated with out-of-pocket spending on medicines and supplies in groups of greater economic vulnerability regarding direct health spending in Peru.

Infección quirúrgica profunda en cirugía instrumentada de raquis toracolumbar. Diez años de experiencia / Deep surgical site infection following thoracolumbar instrumented spinal surgery. Ten years of experience

Objetivo: Describir las características y la evolución de la infección profunda en cirugía instrumentada de raquis toracolumbar (IPCITL) en nuestro centro en un periodo de 10años. Material y método: Estudio descriptivo retrospectivo. Se analizan datos del paciente (epidemiológicos/salud), datos operatorios, presentación de la infección, gérmenes cultivados, limpiezas quirúrgicas requeridas, extracción de los implantes y complicaciones significativas derivadas de la infección. Resultados: Se revisan 110 pacientes (80mujeres). El seguimiento medio tras el diagnóstico de infección fue de 3,6años. Etiologías más frecuentes: escoliosis idiopática del adolescente, deformidad del adulto y estenosis lumbar degenerativa. El 62% de pacientes presentaban algún dato clínico que les hacía proclives a la infección. La aparición de la infección fue precoz (0-3meses de la cirugía primaria) en el 60,4% de los casos, retardada (3-24meses) en el 11,7% y tardía (más de 24meses) en el 27%. Todos los pacientes fueron tratados mediante limpieza quirúrgica. El 25% necesitaron más de una limpieza. Se extrajeron los implantes en el 46% de los pacientes (en el 71% de ellos en la primera limpieza). Los gérmenes aislados con mayor frecuencia fueron Staphylococcus coagulasa-negativo, Propionibacterium acnes y Enterococcus. Hubo complicaciones significativas derivadas de la IPCITL en el 15% de casos. El 88% de ellas precisaron cirugías complejas para su tratamiento. Conclusiones: Las IPCITL tardías son más frecuentes de lo esperado según la literatura. En IPCITL globalmente predominan gérmenes cutáneos. Las IPCITL provocan una alta tasa de complicaciones, que habitualmente requieren tratamiento mediante cirugías complejas

Objective: To describe thee characteristics and evolution of deep surgical site infection following thoracolumbar instrumented spinal surgery (DSITIS) in our centre over a period of ten years. Material and method: Descriptive retrospective study. Patient data (epidemiological/health status), surgical data, infection characteristics/presentation, isolated microorganisms, required surgical debridements, implant removal and major complications linked to infection were evaluated. Results: We included 110 patients (80 females). Median follow-up after infection diagnosis was 3.6years. Adolescent idiopathic scoliosis, adult deformity and degenerative lumbar stenosis were the most frequent aetiologies. Sixty-two percent of the patients had at least one clinical feature that made them prone to infection. Infection presentation was early (0-3months from first surgery) in 60.4% of the cases, delayed (3-24months) in 11.7%, and late (more than 24months) in 27%. All patients were treated by surgical debridement. Twenty-five percent needed more than one surgical debridement. Implants were removed in 46% of the patients (71% in the first surgical debridement). The most frequent isolated microorganisms were coagulasa-negative Staphylococcus, Propionibacterium acnes and Enterococcus. Major complications appeared in 15% of the patients, and 88% of them required major surgeries. Conclusions: Late DSITIS is more frequent than previously reported. Skin microorganisms predominate among the DSITIS culprits. DSIITS produce a high rate of major complications that usually require major surgery for treatment

Deep surgical site infection following thoracolumbar instrumented spinal surgery. Ten years of experience. / Infección quirúrgica profunda en cirugía instrumentada de raquis toracolumbar. Diez años de experiencia.

OBJECTIVE: To describe the characteristics and evolution of deep surgical site infection following thoracolumbar instrumented spinal surgery (DSITIS) in our centre over a period of ten years. MATERIAL AND METHOD: Descriptive retrospective study. Patient data (epidemiological/health status), surgical data, infection characteristics/presentation, isolated microorganisms, required surgical debridements, implant removal and major complications linked to infection were evaluated. RESULTS: We included 110 patients (80 females). Median follow-up after infection diagnosis was 3.6years. Adolescent idiopathic scoliosis, adult deformity and degenerative lumbar stenosis were the most frequent aetiologies. Sixty-two percent of the patients had at least one clinical feature that made them prone to infection. Infection presentation was early (0-3months from first surgery) in 60.4% of the cases, delayed (3-24months) in 11.7%, and late (more than 24months) in 27%. All patients were treated by surgical debridement. Twenty-five percent needed more than one surgical debridement. Implants were removed in 46% of the patients (71% in the first surgical debridement). The most frequent isolated microorganisms were coagulasa-negative Staphylococcus, Propionibacterium acnes and Enterococcus. Major complications appeared in 15% of the patients, and 88% of them required major surgeries. CONCLUSIONS: Late DSITIS is more frequent than previously reported. Skin microorganisms predominate among the DSITIS culprits. DSIITS produce a high rate of major complications that usually require major surgery for treatment.

Importance of technical aspects in the beginnings of a pancreas transplantation program.

Pancreas and kidney transplantation is the treatment of choice for patients with type 1 diabetes mellitus and terminal renal insufficiency. Herein we have presented a series of 35 patients transplanted between 2002 and 2009 including periods before and after 2007 divided based on introduction of some technical aspects. In the first phase (learning period) we have noted complications related to pancreatic surgery with a morbidity among 12 of 18 patients (66.6%). In the second period (stabilization period), complications appeared in 6 out of 17 patients (35.2%; P < .028). The reoperation rate was 83.3% in the learning period and 23.5% in the stabilization period (P < .03). Seven transplantectomies were performed in the first period (P < .004). Five patients died, all of them in the learning group (P < .019). Changes in the technical aspects of the procedure were responsible for improved outcomes obtained among pancreas and kidney transplantations.

Indications for and results of liver retransplantation.

Liver retransplantation (LReTx) is the therapeutic option for the irreversible failure of a hepatic graft. Our aim was to evaluate the rate of and indications for LReTx and actuarial patient survivals. Among 1260 LTx were 79 LReTx (6.3%). During the first LTx, there were no apparent differences between patients who did or did not required LReTx. The most frequent reasons were hepatic artery thrombosis (31.6%), recurrence of the VHC cirrhosis (30.4%), and primary graft failure (21.5%). The actuarial survivals at 1 and 5 years were 83% and 69% among those without LReTx versus 71% and 61% among early LReTx, and 64% and 34% among late LReTx (P < .001). Although there exists high morbidity and mortality with LReTx, it seems that this therapeutic alternative continues to be valid for patients with early hepatic loss, but not when the graft loss was late. It becomes necessary to define the minimal acceptable results that patient can benefit from LReTx.

Indications for and results of liver retransplantation.

Liver retransplantation (LRT) is the only therapeutic option for the irreversible failure of a hepatic graft. The aim of this study was to evaluate our rate, indications, postoperative morbidity and mortality and patient survival at one and 5 years after LRT. 1,260 liver transplants (LT) were performed between 1991 and 2006, 79 were LRT (6.3%). During the first LT, there were no apparent differences between patients who did or did not require LRT. The most common reasons for LRT were hepatic artery thrombosis (31.6%), recurrence of hepatitis C virus cirrhosis (30.4%) and primary graft non function (21.5%). The actuarial survival rates at one and 5 years were 83% and 69% among those without LRT versus 71% and 61% among those with early LRT, and 64% and 34% among those with late LRT (p < 0.001). Although high morbidity and mortality were associated with LRT, it seems that this therapeutic option is valid for patients with early hepatic loss, although not when the graft loss is late. It becomes necessary to define the minimal acceptable results so that patients can benefit from LRT.

Uso de modelos simuladores como metodología docente para la carrera de medicina / Use of simulator models like educational methodology for the medicine carrer

Introduction: Usefulness of high tech clinical simulators as learning tools, are partially established. Objective: To determine utility of an Emergency Care Simulator (ECS) as a learning tool inmedicine. Methods: Study was conducted in 2007, during the respiratory diseases rotation of third year medical students. Informed consent was required to participants. They were divided in two groups: Study Group (SG) and Control group (CG). Both were submitted to the same regular respiratory diseases learning activities. Only the SG had a session with the ECS. The simulated scenario referred to a young man with severe community pneumonia. At the end of the activities every student from those groups answered a modified essay and a questionnaire about this disease problem (maximum score was 70 points). The SG also responded a list of12 statements to get their opinion on this experience. Results: 63 students participated in the study, 42 in the SG and 21 in the CG. All the SG answered the questionnaire and 31 answeredthe modified essay. All the CG answered the modified essay. The scores in the essay were (mean +/- SD) 44, 3 +/-12,9 and 35,5+/-14,7 for the SG and CG, respectively (p=0,026). 80 percent ofthe SG agreed that the experience was useful to learn; entertaining and allowing the application of previous knowledge. Less than 50 percent felt the simulation real enough. Conclusions: A learning activity about severe community acquired pneumonia with the METI ECS simulator apparently was useful for students learning and well evaluated by them.

Therapeutic effects of the anti-tumor necrosis factor monoclonal antibody, infliximab, in four children with refractory juvenile idiopathic arthritis.

OBJECTIVE: To report the results of treatment with infliximab in patients with refractory juvenile idiopathic arthritis (JIA). PATIENTS AND METHODS: A prospective study of four children with refractory JIA was carried out. Infliximab (100 mg) was administered in weeks 0, 2 and 6. Subsequently, the drug was administered every 8 weeks. The following parameters were assessed at the beginning and at the end of the follow-up period: number of joints with active arthritis, number of joints with a limited range of motion, physician overall assessment of disease activity, parent assessment of the child's overall well-being, pain assessment scores, and erythrocyte sedimentation rate. Improvement was rated according to the definition of the American College of Rheumatology (ACR 30). Paired sample tests were used for statistical analysis. RESULTS: Three girls and one boy aged between 10 and 16 years old with a history of JIA ranging from 1 to 9 years were included. The patients received infliximab for a period of 11 to 33 months (average 22 months). There was a significant decrease in the number of swollen joints (p < 0.05), joints with a limited range of movement (p < 0.04), pain score assessment (p < 0.005), physician overall assessment (p = 0.002), maternal evaluation (p < 0.001), the patient's own evaluation (p < 0.001), and duration of morning stiffness (p < 0.001). Both steroids and methotrexate dosages were reduced and no adverse effects or infections were registered. CONCLUSIONS: Infliximab improved joint inflammatory indexes and clinical assessments. This improvement increased the quality of life of the patients and their families, suggesting that the use of biological therapy is a good option in refractory JIA.

Embryonic and larval development of Jundiá (Rhamdia quelen, Quoy & Gaimard, 1824, Pisces, Teleostei), a South American Catfish

The jundiá (Rhamdia quelen, Quoy & Gaimard) is an endemic South American fish species. Because this species supports cold winters and grows faster during warm months, it has begun to be viewed as an ideal species for fish production in southern South America. In the present study, jundiá oocytes used were obtained by extrusion from females after hormone injection. Soon after hydration, the eggs were transferred to 50 L conic glass incubators, with constant and controlled water influx. Samples of fertilized eggs were transferred to Petri dishes and, examined under a stereoscopic microscope, were spherical, demersal, and non-adhesive with defined perivitelline space and resistant chorion. Cleavage stages occurred during the first 3.5 h. After hatching, larvae were transferred to 200 L glass fiber incubators. First signs of embryo movement were observed 21 h after fertilization; larval eclosion occurred 30.5 h after fertilization. Present findings may provide a basis for studies aimed at determining the complete ontogeny of jundiá and may be useful in eco-toxicological studies.

O jundiá (Rhamdia quelen, Quoy & Gaimard) é uma espécie endêmica da América do Sul. Por ser adaptada ao frio do inverno e ter um crescimento rápido durante os meses quentes, o jundiá é uma espécie adequada para aqüicultura no sul da América do Sul. Muitos aspectos da fisiologia reprodutiva, larvicultura, hematologia, fisiologia da resposta ao estresse, têm sido recentemente estudados. Os ovócitos utilizados neste estudo foram obtidos pela extrusão de fêmeas após indução hormonal. Logo após a hidratação, foram transferidos para incubadoras cônicas de vidro com capacidade para 50 L, com fluxo de água constante e controlado. Amostras de ovos fertilizados foram colocadas em placas de Petri e examinadas através de estereomicroscópio. Os ovos eram esféricos, demersais e não-adesivos, com espaço perivitelino definido e córion resistente. Os estágios de clivagem ocorreram durante as 3,5 primeiras horas. Após a eclosão, as larvas foram transferidas para incubadoras de fibra de vidro de 200 l. Os primeiros sinais de movimento embrionário foram observados 21 h após a fertilização, e a eclosão das larvas ocorreu 30,5 h após a fertilização. Estes resultados podem servir como base para muitos estudos, objetivando o conhecimento da ontogenia completa do jundiá, e para aplicação em estudos ecotoxicológicos.

Embryonic and larval development of jundiá (Rhamdia quelen, Quoy and Gaimard, 1824, Pisces, TeleosteI), a South American catfish.

The jundiá (Rhamdia quelen, Quoy and Gaimard) is an endemic South American fish species. Because this species supports cold winters and grows faster during warm months, it has begun to be viewed as an ideal species for fish production in southern South America. In the present study, jundiá oocytes used were obtained by extrusion from females after hormone injection. Soon after hydration, the eggs were transferred to 50 L conic glass incubators, with constant and controlled water influx. Samples of fertilized eggs were transferred to Petri dishes and, examined under a stereoscopic microscope, were spherical, demersal, and non-adhesive with defined perivitelline space and resistant chorion. Cleavage stages occurred during the first 3.5 h. After hatching, larvae were transferred to 200 L glass fiber incubators. First signs of embryo movement were observed 21 h after fertilization; larval eclosion occurred 30.5 h after fertilization. Present findings may provide a basis for studies aimed at determining the complete ontogeny of jundiá and may be useful in eco-toxicological studies.

Relationship between 3p deletions and telomerase activity in non-small-cell lung cancer: prognostic implications.

3p deletions and telomerase reactivation are two of the most frequent events described in relation to non-small-cell lung cancer (NSCLC) pathogenesis. Moreover, a number of genes that map on 3p have been proposed as candidates to tumour-suppressor genes of importance in the lung cancer process. In this work, we analysed deletions at different 3p loci in relationship to telomerase activity in 66 NSCLCs obtained from patients who had suffered potentially curative surgery. Also, we evaluated prognostic implications. DNA samples were analysed for 3p deletions using five different polymorphic human dinucleotide repeat DNA markers (D3S1619 at 3p22.2, D3S3623 at 3p22.1, D3S1260 at 3p21.33, D3S3697 at 3p14.3, and D3S3722 at 3p21.2). Telomerase activity was investigated by a TRAP-based method. Possible correlations between the different molecular markers and distributions of disease-free survival were estimated. Our data revealed a significant correlation between telomerase activity and losses of heterozygosity (LOH) on D3S3697 (P=0.040), since all of the tumours showing deletion at this locus were positives for telomerase. Moreover, our results revealed clear associations with poor prognosis of patients, in the case of LOH at D3S1260 and D3S3697 (P=0.005 and 0.005, respectively). According to our data, potential repressors for telomerase may be located in chromosome 3p.

Ambulatorio didatico homeopatico: relato de experiencia / Didactal homeopathic ambulatory: experience report

Atraves do relato do acompanhamento de pacientes durante 4 mses no ambulatorio didatico da segunda turma de mestrado profissionalizante em homeopatia...

Ambulatorio didatico homeopatico: relato de experiencia / Didactal homeopathic ambulatory: experience report

Atraves do relato do acompanhamento de pacientes durante 4 mses no ambulatorio didatico da segunda turma de mestrado profissionalizante em homeopatia...(AU)

Tratamiento quirúrgico de las fracturas patológicas metastásicas del fémur proximal / Surgical treatment of metastatic pathological fractures of the proximal femur

Objetivo: El objetivo fue analizar retrospectivamente los resultados del tratamiento quirúrgico de 31 fracturas patológicas del fémur proximal por metástasis óseas, tratadas en el Hospital Universitario de Getafe de Madrid, desde 1991 a 2000. Pacientes y método: El origen primario fue en 12 pacientes un carcinoma de mama, en 7 de pulmón, en 5 de próstata, en 3 de riñón y hubo 4 de otros tipos. Las fracturas se localizaron en el cuello del fémur en 13 pacientes, en la región intertrocantérea en 7 y en la subtrocantérea en 11.Se realizó enclavado intramedular cerrojado en 18 pacientes y artroplastia cementada de cadera en 13 (7 parciales y 6 totales). Se valoró: el dolor residual durante la evolución postoperatoria, la mejoría funcional para la marcha y para los cuidados del paciente, el tiempo de supervivencia a la cirugía y la evolución postoperatoria de la lesión. Resultados: La calidad de vida mejoró en todos los pacientes, al disminuir la intensidad del dolor. Se consiguió la movilización en todos los pacientes y 19 recuperaron la capacidad de marcha. En 20 casos el tamaño de la lesión aumentó. La supervivencia media fue de 6,6 meses, excluyendo 4 pacientes fallecidos en el primer mes postoperatorio. Conclusión: Es posible mejorar la calidad de vida de los pacientes con fracturas patológicas metástasicas del fémur proximal. (AU)

Cirugía profiláctica de las fracturas patológicas pertrocantéreas y diafisarias del fémur / Prophylactic surgery for pathological pertrochanteric and shaft fractures of the femur

Objetivo: Las metástasis óseas aumentan el riesgo de aparición de fractura patológica por disminución de la resistencia mecánica. Se evalúan las indicaciones quirúrgicas para evitar la aparición de fracturas patológicas y los resultados obtenidos en metástasis de la región trocantérea y diafisaria del fémur. Material y métodos: Se trataron 19 lesiones óseas metastásicas en 17 pacientes. Las indicaciones se establecieron según el riesgo de fractura que determinaban los criterios de Mirels (localización, dolor, patrón radiográfico y tamaño de la lesión). En 15 casos se realizaron enclavados intramedulares, en uno placa acodada con cemento, en otro un tornillo-placa y en los otros dos, tallos de Ender. El resultado fue considerado como malo si no se aliviaba el dolor tras la cirugía, fallaba el implante, se aceleraba el desarrollo de la enfermedad alrededor del campo quirúrgico o se producía empeoramiento del estado general o muerte del paciente como consecuencia directa de la cirugía. Resultados: Los pacientes se movilizaron de forma inmediata, el dolor disminuyó; no se produjeron complicaciones sépticas ni tromboembólicas. Todos reiniciaron la marcha excepto dos, uno de ellos por aflojamiento del material (mal resultado) y otro por infiltración adyuvante del nervio ciático. El otro caso de mal resultado fue una diseminación tumoral a lo largo de un clavo intramedular fresado. En ningún caso la supervivencia del paciente se vio influida por la actuación quirúrgica. Discusión: La dificultad de estas intervenciones radica en saber cuándo están realmente indicadas y qué implante utilizar. La no indicación de cirugía profiláctica condiciona frecuentemente la aparición de la fractura patológica, con gran aumento del dolor y pérdida de calidad de vida, que motiva generalmente una osteosíntesis en peores condiciones para el paciente, cuando no está contraindicada por su mal estado general (AU)

Steroid profiles in cultured female jundiá, the Siluridae Rhamdia quelen (Quoy and Gaimard, Pisces Teleostei), during the first reproductive cycle.

The jundiá Rhamdia quelen (Quoy and Gaimard) is a teleost species from the Siluridae family and is an important species for aquaculture in temperate and subtropical climates. Gonad and blood tissue samples were taken from cultured jundiá females between 1998 and 1999. Plasma concentrations of 17beta-estradiol (E(2)), testosterone (T), 11-ketotestosterone (11-KT), 17-hydroxy-4-pregnene-3,20-dione (17-P), 17,20beta-dihydroxy-4-pregnen-3-one (17,20beta-P), and 17,20beta,21-trihydroxy-4-pregnen-3-one (20beta-S) were measured by radioimmunoassay and potential correlations with the stage of oogenesis and sexual maturation examined. During the experimental period two spawning episodes were observed. Plasma concentrations of E(2) increased progressively during oocyte development, simultaneously with the appearance of yolk vesicles and increasing amounts of deposited yolk. In female jundiá, the T peak occurred in October and was coincident with the peak in gonadosomatic index. Two distinct peaks of progestogens were detected, corresponding to the two spawning episodes, suggesting that one or more of these steroids might act as the "maturational-inducing steroid" in jundiá. Unusually large amounts of 11-KT were also measured in the plasma of mature jundiá females. The identity of 11-KT was confirmed by thin-layer chromatography. Although the profiles of the other steroids are compatible with the roles proposed for the action of these hormones in other teleosts, the role of 11-KT, normally found only in males, is unknown.

Loss of heterozygosity at 3p23 is correlated with poor survival in patients with colorectal carcinoma.

BACKGROUND: Loss of heterozygosity (LOH) of chromosome 3p has been observed commonly in carcinomas of various tumor tissues, including colorectal carcinoma (CRC). Because there is no report analyzing 3p deletions in relation to patient prognosis in CRC, the authors investigated the prognostic value of LOH on 3p in 87 patients with sporadic CRC. METHODS: DNA samples from tumor and nontumor tissues were amplified by using polymerase chain reaction (PCR) and were analyzed for LOH on 3p using four different polymorphic human dinucleotide repeat DNA markers that map on this chromosome arm. The correlations with prognosis were established by the Kaplan-Meier method, and the Cox proportional hazards model was used to identify which independent factors jointly had a significant influence on patient survival. RESULTS: Overall, allelic losses were detected in 19.5% of the patients evaluated. Only considering informative tumors, the data indicated that LOH was observed in 17 of 71 (29.4%) informative cases. Results from survival analysis showed a significant correlation between this molecular abnormality and both overall survival and disease free survival (P = 0.02 and P = 0.0005, respectively). The worst prognosis was found for the group of patients with LOH at 3p23: This alteration was an independent prognostic factor according to Cox multivariate analysis. CONCLUSIONS: This study is the first to demonstrate the prognostic significance of LOH at chromosome arm 3p for patients CRC and may help to identify patients who need an intensive postoperative follow-up protocol.

Estudio comparativo entre las técnicas de Bankart y Magnuson-Stack en la luxación recidivante anterior de hombro / Comparative study of the Bankart and Magnuson-Stack techniques in recurrent anterior shoulder dislocation

Se compara el resultado del tratamiento quirúrgico de la luxación recidivante anterior de hombro en 2 grupos de pacientes, unos tratados con la técnica de Bankart abierta (grupo A) y otros con la técnica de Magnuson-Stack modificada (grupo B). Se realizó un estudio retrospectivo con 40 pacientes (20 de cada grupo) con un seguimiento medio de 29 meses en el grupo A y de 34 en el grupo B. El grupo A tuvo un 75 por ciento de buenos resultados y el grupo B un 85 por ciento; 16 pacientes del grupo A y 15 del grupo B, no presentaron signos de inestabilidad en la revisión. En ningún caso hubo recidiva de la luxación ni reintervenciones. La pérdida media de rotación externa no fue significativamente distinta. Diecinueve pacientes del grupo A y 18 del grupo B, no presentaron limitación o muy leve para el trabajo o el deporte y no tuvieron molestias o éstas eran mínimas. Los pacientes del grupo A tuvieron un peor recuerdo del postoperatorio que los del grupo B en cuanto a dolor y dificultad para conseguir el resultado final. Dieciocho pacientes del primer grupo y 19 del segundo estaban satisfechos con el resultado de la cirugía. Se realizó un estudio estadístico no encontrando ninguna diferencia significativa respecto a estabilidad, movimiento o función (AU)