Remando contracorriente: facilitadores y barreras para compaginar el deporte y los estudios / Remando contracorrente: facilitadores e barreiras para combinar esportes e osestudos / Paddling upstream: facilitators and barriers to combine sport and studies

Objetivo. El objetivo del presente estudio fue analizar los facilitadores y barreras que influyen en la compaginación de los aspectos académicos y deportivos en remeros de alto rendimiento. Método. Participaron 11 remeros (n = 5 chicos y n = 6 chicas). Este estudio se desarrolló desde un enfoque cualitativo, enmarcado en el modelo holístico de desarrollo de la carrera deportiva, a través de entrevistas semiestructuradas. Se realizó un análisis del contenido de las entrevistas y se presentaron cinco niveles procedentes del modelo teórico utilizado: nivel deportivo, nivel psicológico, nivel psicosocial, nivel académico/vocacional y nivel financiero. Estos niveles se analizaron en función de dos criterios: facilitadores y barreras. Resultados. Se muestran los facilitadores y barreras en los niveles deportivo, psicológico, psicosocial, académico y financiero. Los facilitadores son: motivación intrínseca, reducción de la presión diaria, flexibilidad del profesorado, beca (académica y deportiva) y el apoyo de grupos sociales. Como barreras: largas concentraciones, coincidencia de los entrenamientos con las clases, estrés, cansancio, poco tiempo para el ocio, distancia del centro educativo al lugar de entrenamiento y la no compensación económica como deportista. Conclusiones. Conociendo los beneficios de compatibilizar la formación educativa con la carrera deportiva desde el desarrollo personal, social, salud, financiero-laboral y anticipando la retirada deportiva, es fundamental que el psicólogo del deporte proporcione a los remeros, directa o indirectamente (a través del entrenador), recursos básicos de gestión del tiempo, así como estrategias para que sean autosuficientes en su carrera dual (AU)

Objetivo. O objetivo do presente estudo foi analisar os facilitadores e barreiras que influenciam a disposição dos aspectos acadêmicos e desportivos em remadores de alta performance. Método. Participaram 11 remadores (n = 5 homens e n = 6 mulheres). O estudo foi realizado a partir de uma abordagem qualitativa, emoldurado em um modelo de desenvolvimento de holístico, através de entrevistas semi-estruturadas. A análise do conteúdo das entrevistas foi realizada em cinco níveis a partir do modelo teórico utilizado: nível atlético, nível psicológico, nível psicossocial, nível acadêmico/profissional e nível financeiro. Estas categorias foram analisadas de acordo com dos critérios: facilitadores e barreiras. Resultados. Facilitadores e barreiras nos níveis desportivos, psicológicos, psicossociais, acadêmicos e níveis financeiros são mostrados. Os facilitadores são: motivação intrínseca, redução da pressão diária, flexibilidade do corpo docente, bolsas de estudos e de esportes, e apoio dos grupos sociais. Como barreiras: concentrações longas, coincidência dos treinamentos com as aulas, estresse, fadiga, pouco tempo para o lazer, a distância da escola para o local de treinamento e baixa compensação econômica como um atleta. Conclusões. Conhecendo os benefícios de compatibilizar a formação educacional com a carreira desportiva desde o desenvolvimento pessoal, social, saúde, financeiro-laboral e antecipando a retirada esportiva, é fundamental que o psicólogo do esporte proporcione aos remadores direta ou indiretamente (através treinador), recursos e estratégias básicas de gestão de tempo para ser autossuficientes em sua dupla carreira (AU)

Objective. The aim of this study is to analyze the facilitators and barriers in the arrangement of academic and athletic aspects in high performance rowers. Method. Participated 11 rowers (n = 5 boys and n = 6 girls). The research conducted from a qualitative approach, framed holistic career development model, by means of semi-structured interviews. A content analysis of the interviews was conducted in five levels from the theoretical model used: athletic level, psychological level, psychological level, academic/vocational level and financial level. These categories were analyzed in terms of two others: facilitators and barriers. Results. Facilitators and barriers in sports, psychological, psychosocial, academic and financial levels are shown. Facilitators are: Intrinsic motivation, reducing daily pressure, flexibility teacher, academic scholarship and sports and support of social groups. As barriers: Long concentrations coincidence workouts/classes, stress, fatigue, little time for leisure, distance from the school to the training and non-economic compensation as an athlete. Conclusions. Knowing the benefits of educational training compatible with career from the personal, social development, health, financial and labor and anticipating sports withdrawal, it is essential that the sport psychologist provide, directly or indirectly (through rowers coach), basic time management resources and strategies to become self-sufficient in his dual career (AU)

Geriatric oncology in Spain: survey results and analysis of the current situation.

INTRODUCTION: Geriatric oncology (GO) is a discipline that focuses on the management of elderly patients with cancer. The Spanish Society of Medical Oncology (SEOM) created a Working group dedicated to geriatric oncology in February 2016. OBJECTIVES: The main goal of this study was to describe the current situation in Spain regarding the management of elderly cancer patients through an online survey of medical oncologists. METHODS: A descriptive survey was sent to several hospitals by means of the SEOM website. A personal e-mail was also sent to SEOM members. RESULTS: Between March 2016 and April 2017, 154 answers were collected. Only 74 centers (48%) had a geriatrics department and a mere 21 (14%) medical oncology departments had a person dedicated to GO. The vast majority (n = 135; 88%) had the perception that the number of elderly patients with cancer seen in clinical practice had increased. Eighteen (12%) oncologists had specific protocols and geriatric scales were used at 55 (31%) centers. Almost all (92%) claimed to apply special management practices using specific tools. There was agreement that GO afforded certain potential advantages. Finally, 99% of the oncologists surveyed believed it and that training in GO had to be improved. CONCLUSIONS: From the nationwide survey promoted by the Spanish Geriatric Oncology Working Group on behalf of SEOM, we conclude that there is currently no defined care structure for elderly cancer patients. There is an increasing perception of the need for training in GO. This survey reflects a reality in which specific needs are perceived.

Selection and monitoring of patients with metastatic castration-resistant prostate cancer for treatment with radium-223.

Despite the improvement provided by androgenic suppression in the treatment of prostate cancer, most of tumors develop resistance to castration. However, new therapies have demonstrated an increase in patient survival such as radium-223 (Ra-223), an alpha emitter and calcium mimetic with the capability of targeting osteoblastic metastatic lesions. According to results of the ALSYMPCA phase III trial, Ra-223 has demonstrated its activity by improving symptoms and survival of patients with metastatic castration-resistant prostate cancer (mCRPC), symptomatic bone metastases, and no known visceral metastatic disease, without interfering with subsequent treatments. This review examines the key evidence to establish the best patient selection criteria to use Ra-223, how to assess the response to treatment, treatment-related toxicity, and follow-up, but also current research regarding imaging techniques and biomarkers to assess the efficacy of Ra-223. Finally, we briefly describe the clinical trials that are currently ongoing with Ra-223.

Insatisfacción corporal, conductas de riesgo para trastornos de la conducta alimentaria en universitarios / Body dissatisfaction, risk behaviors eating disorders in university students

Resumen: La insatisfacción corporal supone la presencia de juicios valorativos sobre el cuerpo que usualmente no coinciden con las características reales del individuo. Uno de los principales métodos para el control del peso y de la figura corporal suele ser la realización de conductas alimentarias de riesgo, una amplia variedad de comportamientos negativos y perjudiciales para el individuo. Ambos constituyen factores clave en el origen y desarrollo de trastornos de la conducta alimentaria (TCA). El objetivo del estudio es analizar las diferencias en una serie de variables psicológicas vinculadas con los TCA respecto a la satisfacción o insatisfacción corporal y las conductas de riesgo adoptadas en una muestra de adultos universitarios. Mediante la aplicación del Inventario de trastornos de la conducta alimentaria (EDI-3) de Garner, los resultados indican un mayor riesgo de TCA (obsesión por la delgadez, bulimia, insatisfacción corporal) de los sujetos con insatisfacción corporal, y mayores puntuaciones en baja autoestima, alienación personal, inseguridad interpersonal, déficits introceptivos, desajuste emocional, ascetismo y miedo a la madurez. Respecto a las conductas de riesgo, los individuos que presentan mayor número de conductas de riesgo muestran igualmente mayor riesgo de TCA, baja autoestima, déficits introceptivos, desajuste emocional, perfeccionismo y ascetismo.

Abstract: Body dissatisfaction implies appreciatory body judgments that are different from real characteristics of individuals' body. One of the most important method to control weight and body shape is to be involved in eating risk behaviours, which includes a great amount of negative and damaging behaviours for the individual. Both factors (body dissatisfaction and eating risk behaviours) constitute key elements in the beginning and development of Eating Disorders (ED). The aim of the present study was to analyse differences in some psychological variables attending to body dissatisfaction and eating risk behaviours informed by a sample of university adults. Using Garner's Eating Disorder Inventory-3 (EDI-3) results point out a higher risk of ED (drive for thinness, body dissatisfaction and bulimia) in those individuals with body dissatisfaction, and also higher scores of low self-esteem, personal alienation, interpersonal insecurity, interoceptive deficits, emotional dysregulation, asceticism and maturity fears. Attending to eating risk behaviours, individuals who informed more risk behaviours showed more risk of ED, low self-esteem, interoceptive deficits, emotional dysregulation, perfectionism and asceticism.

Vernakalant en fibrilación auricular: experiencia en un servicio de urgencias / Vernakalant for atrial fibrilation in an emergency department

No disponible

Interfacial pattern selection in miscible liquids under vibration.

We explore the peculiar behaviour of an interface between two miscible liquids of similar (but non-identical) viscosities and densities under horizontal vibration with a frequency less than 25 Hz. Significant differences in the structure of the formed patterns were found between microgravity and ground experiments. In a gravity field, a spatially periodic saw-tooth frozen structure is generated in the interface which dissipates at long times. By contrast, under the low gravity conditions of a parabolic flight, the long lived pattern consists of a series of vertical columns of alternating liquids.

Predictive models for all-cause and cardiovascular mortality in type 2 diabetic inpatients. A cohort study.

BACKGROUND: Many authors have analysed premature mortality in cohorts of type 2 diabetic patients, but no analyses have assessed mortality in hospitalised diabetic patients. AIM: To construct predictive models to estimate the likelihood of all-cause mortality and cardiovascular mortality in type 2 diabetic inpatients. DESIGN: Cohort study with follow-up from 2010 to 2014. METHODS: We evaluated mortality in a randomly selected cohort of 112 type 2 diabetic inpatients at the Hospital of Elda (Spain) in 2010-2012. OUTCOMES: all-cause mortality and cardiovascular mortality during the follow-up. Other variables: gender, age, depression, asthma/chronic obstructive pulmonary disease, hypertension, dyslipidemia, insulin, pills, smoking, walking, baseline blood glucose and creatinine. Predictive tables with risk groups were constructed to estimate the likelihood of all-cause mortality and cardiovascular mortality. Calculations were made of the area under the ROC curve (AUC). RESULTS: During the follow-up, 52 inpatients died (46.4%, 95% CI, confidence interval: 37.2-55.7%), 22 because of cardiovascular causes (19.6%, 95% CI: 12.3-27.0%). The mean follow-up time was 2.7 ± 1.5 years. The AUC for the all-cause mortality model was 0.84 (95% CI: 0.77-0.92, p < 0.001). Associated parameters: pills, smoking, walking, gender, insulin and age. The AUC for the cardiovascular mortality model was 0.79 (95% CI: 0.67-0.91, p < 0.001). Associated parameters: age, pills, walking, smoking, depression and insulin. CONCLUSIONS: This study provides tools to predict premature mortality in type 2 diabetic inpatients. However, before their general application they require joint validation by the internal medicine unit, emergency department, primary healthcare unit and endocrinology service to enable better prediction of the prognosis and more adequate decision-taking.

Smoking habits in elderly lung cancer patients: still no changes in epidemiology? A single-center experience

PURPOSE: Our goal was to describe the clinical, histological, and epidemiological characteristics of lung cancer diagnoses in people ≥70 years of age. MATERIALS AND METHODS: Information on patients diagnosed with lung cancer from January 2006 to February 2008 was prospectively collected from the outpatient oncology department at a regional hospital. A total of 83 patients (97.6% men; mean age 77 years) were studied. There was a higher ratio of men to women than that reported in younger populations. Mean age was higher than that reported for randomized studies: 65.1% were ≥75 years old. Patients >80 years constituted 28.9% of the study population. Most patients (96.4%) had a history of smoking; they were predominantly former smokers (72.5% vs. 27.5%). RESULTS: The most common histological types were squamous cell (61.3%) and small cell (14.5%) carcinoma. Metastasis was present in 36.1% of patients. Stage was significantly associated with survival (logrank p < 0.001). There was no association between age and survival. Squamous cell lung cancer was associated with a better survival (p = 0.003). CONCLUSIONS: Elderly lung cancer patients who attended clinical practice were older than those included in prospective studies. The predominance of men and squamous cell carcinoma is associated with a smoking history. The epidemiological and histological patterns of younger patients have changed, possibly in relation to changes in smoking habits. The translation of these changes to elderly patients will be evidenced in the future. Only prospective epidemiologic studies will determine whether smoking habits are changing epidemiology in elderly lung cancer patients (AU)

Efectos de un programa de entrenamiento en estilos de comunicación en entrenadores de baloncesto / No disponible

El entrenador es considerado la figura clave en la iniciación deportiva y en el deporte en edad escolar. Los comportamientos y actitudes del entrenador constituyen un modelo que imitan muchos de sus jugadores no sólo en el aspecto deportivo sino también en otros aspectos de su vida (Smoll y Smith, 2009) (AU)

Assessment of functional status, symptoms and comorbidity in elderly patients with advanced non-small-cell lung cancer (NSCLC) treated with gemcitabine and vinorelbine.

BACKGROUND: The incidence and prevalence of comorbid conditions in lung cancer patients increase with age. The aim of the study was to determine response and tolerability with the biweekly combination gemcitabine-vinorelbine in elderly non-small-cell lung cancer (NSCLC) patients. In order to characterise the population included in the study well and assess the results achieved properly, an evaluation of the functional status, comorbidity and survival was performed. PATIENTS AND METHOD: Between June 2001, and December 2003, 59 untreated advanced NSCLC patients over the age of 70 years entered the study. Treatment consisted of gemcitabine 1750 mg/m(2) and vinorelbine 30 mg/m(2) on day 1 every two weeks. The response was evaluated every f ive cycles (RECIST guidelines). Comorbidity was evaluated according to the Charlson and Kaplan Feinstein scales. To measure functional status, activities of daily living (ADL) and instrumental ADL (IADL) were considered. RESULTS: Median age was 74; ECOG performance status was >2 in 59.3%; no dependence in ADL or IADL was found in 24.8% and 42.4% of patients, respectively. A total of 381 courses were administered. Grade 3-4 neutropenia was present in 6.8% of these courses and correlated with IADL. Objective response was 22% (95% CI 12-32). Mean global survival and cause-specific survival were 29 weeks (95% CI 19.9-38.1) and 32 weeks (95% CI 23.4-40.8) respectively. Comorbidity displayed no close correlation with functional status, but comorbidity according to the Kaplan Feinstein index correlated with IADL. Performance status, ADL, IADL and weight loss were significantly related to survival in multivariate analysis. CONCLUSIONS: This biweekly combination is feasible in elderly lung cancer patients with a high burden of comorbidity and dependence. Toxicity is acceptable, whereas response rate and survival fall in the range of active regimens. ADL and IADL indices allow the identification of elderly patients with a worse prognosis.

Assessment of functional status, symptoms and comorbidity in elderly patients with advanced non-small-cell lung cancer (NSCLC) treated with gemcitabine and vinorelbine

BACKGROUND: The incidence and prevalence of comorbid conditions in lung cancer patients increase with age. The aim of the study was to determine response and tolerability with the biweekly combination gemcitabine-vinorelbine in elderly non-small-cell lung cancer (NSCLC) patients. In order to characterise the population included in the study well and assess the results achieved properly, an evaluation of the functional status, comorbidity and survival was performed. PATIENTS AND METHOD: Between June 2001, and December 2003, 59 untreated advanced NSCLC patients over the age of 70 years entered the study. Treatment consisted of gemcitabine 1750 mg/m(2) and vinorelbine 30 mg/m(2) on day 1 every two weeks. The response was evaluated every f ive cycles (RECIST guidelines). Comorbidity was evaluated according to the Charlson and Kaplan Feinstein scales. To measure functional status, activities of daily living (ADL) and instrumental ADL (IADL) were considered. RESULTS: Median age was 74; ECOG performance status was >2 in 59.3%; no dependence in ADL or IADL was found in 24.8% and 42.4% of patients, respectively. A total of 381 courses were administered. Grade 3-4 neutropenia was present in 6.8% of these courses and correlated with IADL. Objective response was 22% (95% CI 12-32). Mean global survival and cause-specific survival were 29 weeks (95% CI 19.9-38.1) and 32 weeks (95% CI 23.4-40.8) respectively. Comorbidity displayed no close correlation with functional status, but comorbidity according to the Kaplan Feinstein index correlated with IADL. Performance status, ADL, IADL and weight loss were significantly related to survival in multivariate analysis. CONCLUSIONS: This biweekly combination is feasible in elderly lung cancer patients with a high burden of comorbidity and dependence. Toxicity is acceptable, whereas response rate and survival fall in the range of active regimens. ADL and IADL indices allow the identification of elderly patients with a worse prognosis (AU)

Determinantes del tiempo de espera en urgencias hospitalarias y su relación con la satisfacción del usuario / Determinants of the waiting period at the Hospital Emergency Services and its relation to user satisfaction

Objetivo: Describir los tiempos del proceso de asistencia en Urgencia y contrastar la influencia de los tiempos reales y percibidos en la satisfacción expresada por el paciente. Analizar las variables que pueden influir en los tiempos de espera. Métodos: Estudio epidemiológico transversal descriptivo. Se seleccionaron, de forma sistemática, los pacientes que acudieron al Servicio de Urgencias del Hospital de Elda. Sobre una muestra total de 325 sujetos, y a través de un cuestionario, se obtuvieron datos relativos a descripción sociodemográfica de la población, relación de los tiempos con diferentes variables (información, dolor, gravedad, etc.) y con la satisfacción del paciente. Se estimaron medias, desviación estándar y sucesivos análisis bivariantes mediante SPSS 10.0. Resultados: Se determinó una relación estadísticamente significativa entre la satisfacción del paciente y el tiempo percibido por el mismo con F: 4,84, p<0,029. No hubo una relación significativa entre la información dada al paciente (t:-1,76, p:0,08) o a la familia (t: -0,35, p: 0,73) con la percepción del tiempo transcurrido en Urgencias. Conclusión: Los factores que se relacionaron con un mayor tiempo en Urgencias fueron: mayor edad, mayor gravedad, permanecer en cama, venir acompañado y el tiempo que transcurrió antes de ser valorado por algún sanitario. Se comprobó una relación significativa entre el tiempo total percibido y la satisfacción del mismo que no se observó con el tiempo total real (AU)

Aims: To describe the time periods of the assistential process in the Emergency Service and establish the influence of real and perceived times on patient-expressed satisfaction. To analyse the variables that might influence the waiting period. Methods: Descriptive cross-sectional epidemiologic study. Patients attending the Emergency Service at the Elda Hospital were systematically selected. On a total sample of 325 subjects, and with the help of a questionnarie, data were recorded regarding the socio-demographic description of the population, the relationship between the time periods and a number of variables (information, pain, severity, etc.), and patient satisfaction. The means and standard deviations were calculated, and successive bivariate analyses performed using the SPSS 10.0 software package. Results: A statistically significant correlation was observed between patient satisfaction and patient-perceived time (F: 4.84; p<0.029). There was no significant correlation between the information given to the patient (t: -1.76, P: 0.08) or to the patient’s family (t: -0.35, P: 0.73) and the perception of time elapsed at the Emergency Service. Conclusion: The factors related to a longer waiting time at the Emergency Service were greater age, greater severity, being bedridden, presence of accompanying persons, and time elapsed prior to assessment by health care personnel. There was a significant correlation between the total time perceived and patient satisfaction, by not between the later and the true elapsed time (AU)

La técnica cualitativa en la mejora de la satisfacción en urgencias / The qualitative technique in the improvement of satisfaction at the emergency clinic

Objetivo: Conocer las necesidades de salud que influyen en la satisfacción de los usuarios del Servicio de Urgencias Hospitalario (SUH) del Hospital de Elda. Métodos: El estudio se ha desarrollado mediante la técnica cualitativa de grupo focal. El análisis de la información obtenida en las dinámicas de grupo se realizó en base a dos variables: espontaneidad y coincidencia. Resultados: La mayor coincidencia de los grupos (100 por ciento) está en la importancia de un trato amable y cortés, una atención rápida inicial y la carencia de "especialistas" en Urgencias. Los usuarios pretenden recibir una atención sanitaria idónea y, a la vez, evitar las interminables listas de espera en los centros de especialidades. Las razones argumentadas para acudir, ante un proceso urgente, directamente al SUH fueron: fiabilidad en el diagnóstico de Urgencias, acceso a más medios técnicos y el hecho de que casi siempre les envien al hospital. Conclusiones: Se ha puesto de manifiesto que las expectativas, en general, son comunes a todos los grupos (pacientes, familiares y población general), pero que el orden o prioridad en que éstas se manifiestan es distinto según el grado de implicación en el proceso de enfermar y la posición del usuario dentro del sistema. Mientras que en el grupo de pacientes se mencionaba como principal necesidad el trato amable, cordial y humano, seguido de la información a familiares, las expectativas de la población general fueron ser atendido por especialistas, un cuidado de la intimidad y una rápida atención (AU)

Evaluación de la calidad de la asistencia en el servicio de urgencias hospitalario a través de la revisión de informes clínicos / Assessment of assistance quality at the in-Hospital Emergency Service through a review of the clinical reports

Objetivos: Realizar una evaluación externa de la calidad de la actuación de los médicos de Urgencia Hospitalaria de Elda reflejada en los informes de asistencia en Urgencias, teniendo en cuenta: la necesidad de acudir al Servicio de Urgencias Hospitalario (SUH), necesidad de observación, la necesidad de ingreso, la adecuación del diagnóstico y del tratamiento. Metodología: Estudio transversal, descriptivo. Desarrollo de análisis bivariantes, respetando los supuestos en los que se basan las técnicas estadísticas. Algunas de las variables estudiadas fueron: gravedad, pruebas realizadas, sociodemográficas, necesidad de acudir a Urgencias, de observación, de ingreso, adecuación del diagnóstico y tratamiento. Resultados: El acuerdo entre revisores de los informes de asistencia en Urgencias osciló entre un 82,5 por ciento en la variable adecuación del tratamiento, hasta el 100 por ciento en la necesidad de ingreso. A criterio de los observadores externos encargados de la revisión de los informes clínicos (relectores), en el 51,7 por ciento de los casos no existía necesidad de acudir a Urgencias. Tampoco se apreció necesidad de observación en un 82,2 por ciento, ni de ingreso en un 82,5 por ciento de los casos (X2: -4,95; 84 gl; p= 0,0004).Conclusiones: Se comprobó un alto grado de acuerdo entre las actuaciones realizadas por los médicos de Urgencias Hospitalarias y los relectores. La mejor orientación, diagnóstico y tratamiento se relacionó con la gravedad del caso y con la responsabilidad que implica dar de alta a un paciente. Es evidente que las actuaciones realizadas a nivel del SUH no son tan distantes a las que realizarían otros especialistas que estuvieran en la misma situación. La evaluación periódica externa del Servicio de Urgencias puede favorecer la detección de debilidades y oportunidades de mejora sobre las que actuar, además de poner en evidencia la correcta actuación del Servicio (AU)

Gemcitabine and low dose carboplatin in the treatment of elderly patients with advanced non-small cell lung cancer.

BACKGROUND: Fifty percent of lung cancers arise in patients over 65 years old and 30% in those over 70. The aim of this study was to evaluate response, survival and tolerability of the combination carboplatin-gemcitabine in elderly patients with advanced non-small cell lung cancer (NSCLC). METHODS: Between May 1998 and December 2000, 88 patients were included. Median age was 74 (range 65-83). Treatment consisted of gemcitabine 1250 mg/m(2) (1000 mg/m(2) in the first six patients) on days 1 and 8, and carboplatin AUC=4 on day 1, every 21 days. Prognostic factors for survival were analysed. Performance status (PS) and symptoms were evaluated before and after three and six courses. RESULTS: A total of 400 cycles were administered (median of four per patient). WHO grades 3-4 toxicities were: neutropenia in 13% of the cycles, thrombocytopenia and anaemia in 4.5 and 14.7% of patients in any cycle. There was one treatment-related death. According to the intent-to-treat analysis, 33 patients achieved objective response, 33 had stable disease, and 22 had treatment failure (progression in 18 patients). Median and 1 year survival were 9 months and 34%, respectively. Median time to progression was 8 months. Only disease stage and PS showed independent prognostic value. Comorbidity and PS displayed no close correlation. Symptom improvement was seen as follows: pain (61.7%), dyspnea (50%), haemoptysis (80%), anorexia (62.5%) and asthenia (61.5%). CONCLUSIONS: The combination carboplatin-gemcitabine at these doses is feasible in elderly patients with advanced non-small cell lung cancer. Tolerability and toxicity are acceptable. Response rate and survival stand in the range of the most active regimens. Comorbidity and PS showed prognostic independence.

Role of Doppler echocardiography in the assessment of portopulmonary hypertension in liver transplantation candidates.

BACKGROUND: Portopulmonary hypertension is a severe complication of liver cirrhosis that carries a high risk for posttransplantation mortality. We aimed at evaluating the utility of Doppler echocardiography in screening for portopulmonary hypertension in liver transplantation candidates. METHODS: One hundred seven cirrhotic patients candidates for liver transplantation were studied by Doppler echocardiography and subsequently, by cardiac catheterization at transplantation. Two parameters were estimated by Doppler: systolic pulmonary arterial pressure (SPAP) derived from tricuspid regurgitation and the pulmonary acceleration time. Portpulmonary hypertension was suspected when SPAP was > or = 40 mm Hg and/or pulmonary acceleration time < 100 ms. RESULTS: Portpulmonary hypertension was suspected by Doppler study in 17 patients (15%). However, portopulmonary hypertension (mean pulmonary arterial pressure > or = 25 mm Hg and pulmonary vascular resistance > 120 dynes.s/cm5) was confirmed by the hemodynamic study in five patients (4.7%). Sensitivity and specificity of Doppler echocardiography for detecting portopulmonary hypertension was 100 and 88%, respectively, with a positive predictive value of 30%. The diagnostic accuracy of pulmonary acceleration time alone (96%) was better than pulmonary arterial pressure alone (90%). CONCLUSIONS: Doppler echocardiography, and especially the determination of pulmonary acceleration time, is a useful screening method for portopulmonary hypertension in patients with liver cirrhosis who are candidates for liver transplantation.

Nitric oxide may contribute to nocturnal hemodynamic changes in cirrhotic patients.

OBJECTIVE: Patients with liver cirrhosis have a nocturnal worsening of hemodynamic parameters that has been associated with an increased risk of variceal bleeding at nighttime. The aim of this study was to investigate whether nitric oxide and cytokines are implicated in these hemodynamic changes. METHODS: Ten cirrhotic patients and eight controls were studied. Mean blood pressure, heart rate, plasma norepinephrine, tumor necrosis factor alpha and interleukin-6 levels, and serum nitrite + nitrate levels were determined at 0800, 1600, and 2400 h. All determinations were performed in supine rest and at least 4 h after meals. In a second study, nitrite + nitrate levels were assessed in 10 cirrhotic patients before and after eating a standard meal. RESULTS: Mean arterial pressure levels that were always lower in the patient group showed a nocturnal decrease in both groups of subjects. Heart rate values that were always higher in cirrhotic patients showed a nocturnal fall in controls, whereas cirrhotics maintained elevated values at nighttime. Norepinephrine levels were higher in cirrhotics and maintained similar values during the study, whereas controls had a significant nocturnal decrease. Nitrite + nitrate levels that were higher in cirrhotic patients showed a significant mean increase of 40% from morning (0800 h) to night (2400 h) in the patient group, whereas in controls no change was observed (p < 0.05). Tumor necrosis factor alpha and interleukin-6 levels did not change either in patients or controls during the entire period. Cirrhotic patients with or without ascites maintained a pattern of hemodynamic and biochemical changes similar to the pattern observed in the entire group of patients. Finally, no changes in serum nitrite + nitrate levels were observed in patients before and after eating the standard meal. CONCLUSION: An increased nocturnal nitric oxide production might contribute to the hemodynamic changes observed in cirrhotic patients during nighttime.

Consulta de adolescentes / Consultation of adolescents

Se hace un estudio de todos los adolescentes en la consulta creada al efecto en la especialidad de endocrinología del Hospital Provincial Clínico Quirúrgico Docente "Dr. Gustavo Aldereguía Lima" de Cienfuegos en un año de trabajo. Se manifiesta que las causas mas frecuentes fueron la baja talla el ratardo puberal y el bocio puberal. Siendo la primera mas frecuente en el sexo masculino y la última en el femenino. Se concluye que es una necesidad que estos pacientes dentro de un programa de atención específico, donde no solo sean valorados clinicamente sino que se orienten científicamente en cuanto a todas las dudas que ésta edad produce (AU)