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1.
Arch. Soc. Esp. Oftalmol ; 92(5): 202-209, mayo 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-162623

RESUMO

OBJETIVO: Describir las características de los pacientes con uveítis valorados en una unidad multidisciplinar de referencia del norte de España. MATERIAL Y MÉTODOS: Análisis retrospectivo de los pacientes con uveítis valorados en la Unidad Multidisciplinar del Complejo Hospitalario de Navarra desde enero del 2010 hasta marzo del 2015. Se analizaron las características demográficas, procedencia, tipos de uveítis, lateralidad, etiología y se compararon estas características con las de 2 series de pacientes de Castilla y León y de Barcelona. RESULTADOS: Se analizó a un total de 500 pacientes, 50% mujeres y con una edad media de 47,9±16,4 años. El 65,4% de las uveítis fueron anteriores; el 17,6%, posteriores; el 15,2%, panuveítis y el 1,8%, de localización intermedia. El 31,2% fueron no clasificables, seguidas de la enfermedad sistémica no infecciosa con el 29,2%. La espondilitis anquilopoyética (10,8%), la infección por virus herpes (9,2%) y la toxoplasmosis (7,8%) fueron las 3causas más frecuentes. En comparación con las otras 2series, en la de este estudio se encontró una mayor proporción de uveítis anteriores unilaterales. Además, en Navarra los pacientes presentaron mayor prevalencia de uveítis anterior unilateral y de uveítis idiopáticas en relación con la serie de Barcelona. CONCLUSIONES: Los datos de nuestro estudio demuestran características similares con las uveítis de otras regiones de nuestro país. Las uveítis anteriores unilaterales y las idiopáticas fueron las más frecuentes en nuestra serie


OBJECTIVE: To describe the main characteristics of a cohort of patients with uveitis referred to a multidisciplinary unit in northern Spain. MATERIAL AND METHODS: Retrospective analysis of clinical records of patients evaluated in the Multidisciplinary Unit of the Navarra Hospital Complex from the period January 2010 until March 2015. An analysis was performed on the demographic characteristics, origin, types of uveitis, laterality, and aetiology. The present series was also compared with 2 previous series from Castilla y León and Barcelona. RESULTS: A total of 500 patients were identified, with a mean age of 47.9±16.4 years, with 50% women. The most frequent type of uveitis was anterior uveitis (65.4%), followed by posterior uveitis (17.6%), panuveitis (15.2%), and intermediate uveitis (1.8%). The origin was unclassifiable in 31.2%, followed by non-infectious systemic disease in 29.2%. Ankylosing spondylitis was the most frequent cause in 10.8% of patients, followed by herpes infection in 9.2%, and toxoplasmosis in 7.8%, respectively. Compared with the 2other cohorts, the present cohort showed a higher proportion of unilateral anterior uveitis. Furthermore, the patients from the Navarra series had a higher prevalence of unilateral and idiopathic uveitis compared to the series from Barcelona. CONCLUSIONS: The main characteristics of the present cohort of patients with uveitis are similar to those of patients from other regions of our country. Unilateral anterior uveitis and idiopathic uveitis were the most frequent in our series


Assuntos
Humanos , Uveíte/epidemiologia , Uveíte Intermediária/epidemiologia , Uveíte Posterior/epidemiologia , Uveíte Anterior/epidemiologia , Estudos Retrospectivos , Pan-Uveíte/epidemiologia , Espondilite Anquilosante/epidemiologia , Antígeno HLA-B27/análise
2.
Arch Soc Esp Oftalmol ; 92(5): 202-209, 2017 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27956325

RESUMO

OBJECTIVE: To describe the main characteristics of a cohort of patients with uveitis referred to a multidisciplinary unit in northern Spain. MATERIAL AND METHODS: Retrospective analysis of clinical records of patients evaluated in the Multidisciplinary Unit of the Navarra Hospital Complex from the period January 2010 until March 2015. An analysis was performed on the demographic characteristics, origin, types of uveitis, laterality, and aetiology. The present series was also compared with 2 previous series from Castilla y León and Barcelona. RESULTS: A total of 500 patients were identified, with a mean age of 47.9±16.4 years, with 50% women. The most frequent type of uveitis was anterior uveitis (65.4%), followed by posterior uveitis (17.6%), panuveitis (15.2%), and intermediate uveitis (1.8%). The origin was unclassifiable in 31.2%, followed by non-infectious systemic disease in 29.2%. Ankylosing spondylitis was the most frequent cause in 10.8% of patients, followed by herpes infection in 9.2%, and toxoplasmosis in 7.8%, respectively. Compared with the 2other cohorts, the present cohort showed a higher proportion of unilateral anterior uveitis. Furthermore, the patients from the Navarra series had a higher prevalence of unilateral and idiopathic uveitis compared to the series from Barcelona. CONCLUSIONS: The main characteristics of the present cohort of patients with uveitis are similar to those of patients from other regions of our country. Unilateral anterior uveitis and idiopathic uveitis were the most frequent in our series.


Assuntos
Ambulatório Hospitalar/estatística & dados numéricos , Uveíte/epidemiologia , Adulto , Idoso , Comorbidade , Emigrantes e Imigrantes , Feminino , Antígeno HLA-B27/análise , Infecções por Herpesviridae/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos , Espanha/epidemiologia , Espondilite Anquilosante/epidemiologia , Toxoplasmose Ocular/epidemiologia , Uveíte/diagnóstico , Uveíte/etiologia
3.
Eur J Surg Oncol ; 42(8): 1229-35, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27134189

RESUMO

PURPOSE: To investigate clinical factors influencing the prognosis of patients submitted to hepatectomy for metastases from gastric cancer and their clinical role. METHODS: Retrospective multi-center chart review. We evaluated how survival from surgery was influenced by patient-related, gastric cancer-related, metastasis-related and treatment-related candidate prognostic factors. RESULTS: One hundred and five patients submitted to hepatectomy for metastases from gastric cancer, in the synchronous and metachronous setting of the disease. In 89 cases a R0 resection was achieved, while in 16 a R+ hepatic resection was performed. Adjuvant chemotherapy was administered to 29 patients. Surgical mortality was 1% and morbidity 13.3%. Median disease-free survival was 10 months, median overall survival was 14.6 months. Overall 1, 3, and 5-year survival rates were 58.2%, 20.3%, and 13.1%, respectively. Survival was influenced independently by the factor T of the gastric primary (p < 0.001), by the curativity of surgical procedure (p = 0.001), by the timing of hepatic involvement (p < 0.001) and by adjuvant chemotherapy (p < 0.001). T4 gastric cancer, R+ resection, synchronous metastases, and abstention from adjuvant chemotherapy were associated with a worse prognosis; T4 gastric cancer and R+ resections displayed a cumulative effect (p < 0.001). CONCLUSIONS: Our data show that R0 resection must be pursued whenever possible. Furthermore, in the synchronous setting, the coexistence of T4 gastric primaries and R+ resections suggests prudence and probably abstention from hepatectomy. Finally, a multimodal treatment associating surgery and chemotherapy offers the best survival results.


Assuntos
Hepatectomia , Neoplasias Hepáticas/cirurgia , Metastasectomia , Complicações Pós-Operatórias/epidemiologia , Neoplasias Gástricas/cirurgia , Idoso , Fístula Anastomótica/epidemiologia , Quimioterapia Adjuvante , Intervalo Livre de Doença , Feminino , Gastrectomia , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Hemorragia Pós-Operatória/epidemiologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Taxa de Sobrevida
4.
Lymphology ; 48(1): 6-14, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26333209

RESUMO

Colorectal cancer is one of the most frequent causes of death in Western countries. Most patients develop metastasis traveling through the lymphatic system, and regional lymph node metastasis is considered a marker for dissemination, increased stage, and worse prognosis. Despite rapid advances in tumor biology, the processes that underpin lymphatic invasion and lymph node metastasis remain poorly understood. The aim of this study was to establish an easy protocol for isolation of pure tumor lymphatic endothelial cells derived from lymph nodes to study differences compared with normal endothelial cells of uninvolved tissue from the same patients. Cells were isolated with very high purity via magnetic cell sorting and express the specific lymphatic markers Prox-1 and Lyve-1. They show differences in expression of adhesion molecules, chemokines, and growth factor secretion, and capability to form capillaries when seeded on basal membrane, thereby, revealing important differences between the two cell type. These cultures may provide a promising platform for the comparative analysis of both cell types at the molecular and biological level and to optimize treatment strategies.


Assuntos
Neoplasias Colorretais/patologia , Células Endoteliais/fisiologia , Movimento Celular , Separação Celular , Células Cultivadas , Quimiocina CCL2/análise , Citocinas/metabolismo , Humanos , Molécula 1 de Adesão Intercelular/análise , Linfangiogênese , Metástase Linfática , Fenótipo
5.
Protein Pept Lett ; 22(9): 816-27, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26145564

RESUMO

Phospholipases A2 (PLA2s) are enzymes responsible for inflammatory effects, edema formation, myotoxicity, neurotoxicity and other manifestations from envenoming. In this paper we report the isolation and biochemical characterization of Lmr-PLA2, the first acidic PLA2 found in Lachesis muta rhombeata venom. Furthermore, this study compared biological effects of Lmr-PLA2 and crotoxin B (CB), a PLA2 from Crotalus durissus terrificus venom. Lmr-PLA2 was isolated by molecular exclusion and reversed phase chromatography. The purified enzyme showed a molecular mass of 13,975 Da, pI of 5.46 and its partial amino acid sequence showed a high identity with PLA2s already described in the literature. In addition, this enzyme possesses the residue D49 in its amino acid sequence, indicating that it is a catalytically active PLA2. Lmr-PLA2 presented high phospholipase activity and was able to inhibit platelet aggregation. Studies of biochemical characterization of new PLA2s, as Lmr-PLA2, are relevant since they help to clarify the structure-function relationship of this important class of toxins.


Assuntos
Fosfolipases A2/química , Fosfolipases A2/isolamento & purificação , Proteínas de Répteis/química , Proteínas de Répteis/isolamento & purificação , Venenos de Víboras/química , Sequência de Aminoácidos , Animais , Creatina Quinase/análise , Creatina Quinase/metabolismo , Crotoxina/química , Edema/induzido quimicamente , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Dados de Sequência Molecular , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/patologia , Fragmentos de Peptídeos/análise , Fosfolipases A2/toxicidade , Agregação Plaquetária/efeitos dos fármacos , Proteínas de Répteis/toxicidade , Alinhamento de Sequência , Viperidae
7.
Rev. clín. esp. (Ed. impr.) ; 215(3): 171-181, abr. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-134771

RESUMO

La fibrilación auricular (FA) en el anciano es una entidad compleja debido al elevado número de comorbilidades frecuentemente asociadas, como las enfermedades cardiovasculares y la enfermedad renal, los trastornos cognitivos, las caídas o la polimedicación. Excepto cuanto esté contraindicada, la anticoagulación es necesaria para la prevención de los eventos tromboembólicos en esta población. Tanto los antagonistas de la vitamina K como los anticoagulantes orales de acción directa (dabigatran, rivaroxaban y apixaban) están indicados en este contexto. En este grupo de edad la función renal debe ser estrechamente vigilada cuando se utilizan estos últimos. En los últimos años se han publicado diferentes guías de práctica clínica sobre el paciente con FA. La mayoría de estas guías realizan recomendaciones específicas sobre las características clínicas y el tratamiento en los pacientes ancianos. En esta actualización se revisan los comentarios específicos sobre las recomendaciones referentes al tratamiento antitrombótico en los pacientes ancianos con FA no valvular (AU)


Atrial fibrillation (AF) in the elderly is a complex condition due to the high number of frequently associated comorbidities, such as cardiovascular and kidney disease, cognitive disorders, falls and polypharmacy. Except when contraindicated, anticoagulation is necessary for preventing thromboembolic events in this population. Both vitamin K antagonists and direct oral anticoagulants (dabigatran, rivaroxaban and apixaban) are indicated in this context. Renal function should be closely monitored for this age group when these drugs are used. In recent years, various clinical practice guidelines have been published on patients with AF. The majority of these guidelines make specific recommendations on the clinical characteristics and treatment of elderly patients. In this update, we review the specific comments on the recommendations concerning antithrombotic treatment in elderly patients with nonvalvular AF (AU)


Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Fibrilação Atrial/tratamento farmacológico , Terapia Trombolítica/métodos , Fibrinolíticos/uso terapêutico , Tromboembolia/prevenção & controle , Fatores de Risco , Anticoagulantes/uso terapêutico , Vitamina K/antagonistas & inibidores
8.
Rev Clin Esp ; 215(3): 171-81, 2015 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25618495

RESUMO

Atrial fibrillation (AF) in the elderly is a complex condition due to the high number of frequently associated comorbidities, such as cardiovascular and kidney disease, cognitive disorders, falls and polypharmacy. Except when contraindicated, anticoagulation is necessary for preventing thromboembolic events in this population. Both vitamin K antagonists and direct oral anticoagulants (dabigatran, rivaroxaban and apixaban) are indicated in this context. Renal function should be closely monitored for this age group when these drugs are used. In recent years, various clinical practice guidelines have been published on patients with AF. The majority of these guidelines make specific recommendations on the clinical characteristics and treatment of elderly patients. In this update, we review the specific comments on the recommendations concerning antithrombotic treatment in elderly patients with nonvalvular AF.

9.
J Phys Chem B ; 116(12): 3760-71, 2012 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-22385278

RESUMO

The origin of the alignment with respect to the director observed for solutes in a nematic host remains unclear, and various mechanisms ranging from steric repulsions to dispersive or electrostatic interactions have been invoked. Here we present atomistic molecular dynamics (MD) computer simulations of rigid solutes of small dimensions dissolved in a nematic liquid crystal solvent, 4-n-pentyl-4'cyanobiphenyl (5CB), that aim to quantitatively predict the orientational order. We have validated the results comparing the dipolar couplings obtained by atomistic simulation with their experimental NMR counterparts. To help assess the separate effect of the various types of anisotropic interactions on the orientational order of solutes, we have modeled solute molecules with their partial atomic charges present or absent (switching them to zero), finding that, at least for the cases studied, the alignment mechanism is largely dominated by steric and van der Waals dispersive forces rather than Coulomb ones. We have compared the anisotropic aligning potential with the predictions of the Maier-Saupe and surface tensor models and discussed their performance.

11.
Eur J Surg Oncol ; 37(9): 779-85, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21726975

RESUMO

BACKGROUND: The prognostic value of T subclassification in patients with gastric carcinoma has been just implemented in the new AJCC TNM staging system, which has reclassified T2a and T2b into T2 and T3 tumors, respectively. The aim of the present study was to validate the prognostic significance of the new T categorization within the frame of the latest TNM staging system. METHODS: We retrospectively reviewed the records of 686 T2/T3 patients among 2155 subjects who underwent radical resection for gastric carcinoma at six Italian centers from 1988 through 2006. RESULTS: Upon multivariate analysis, the new T categories, extent of lymph node dissection (D) and patient's age were retained by the survival model as independent prognostic factors. In particular, the death risk for patients with T3 tumors was higher than that of patients with T2 tumors (HR: 1.42, P = 0.005). Among the 686 patients previously classified as having T2 tumors, patients with T2 and T3 disease were 270 (39.4%) and 416 (60.6%), respectively. After a median follow-up of 55 months, the 5-year overall survival rates were 67.3% and 52.3% for patients with T2 and T3 tumors, respectively (P < 0.001). The survival advantage for the T2 as compared to T3 category was maintained even when N0 and N+ patients were separately considered (P = 0.0154 and P < 0.001, respectively). CONCLUSIONS: Our data confirm the prognostic difference between the newly proposed T2 and T3 categories, which should be implemented in the routine clinical practice to improve risk stratification of patients with gastric cancer.


Assuntos
Estadiamento de Neoplasias , Neoplasias Gástricas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Prognóstico , Neoplasias Gástricas/classificação , Neoplasias Gástricas/mortalidade , Análise de Sobrevida
12.
J Prev Med Hyg ; 51(2): 80-6, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21155410

RESUMO

BACKGROUND: A prevalence study aimed to update the epidemiological scenario of Hospital-Acquired Infections (HAI) was performed at the San Martino University Hospital of Genoa, the Regional Reference Adult-care Center in Liguria, Italy, with more than 1300 beds. MATERIALS AND METHODS: The investigation was performed in all the wards, except the Psychiatric Units, between 19th March and 6Ih April, 2007, using a one-day monitoring system for each ward. International standardized criteria and definitions for the surveillance of HAI were used for the collection of data, which were recorded in specific software for subsequent consolidation, analysis and quality control. RESULTS: The hospital infection control staff actively monitored 912 inpatients: a total of 84 HAI among 72 patients were diagnosed, with an overall prevalence of infections and affected cases of 9.2% (95% CI: 7.3-11.1) and 7.9% (95% CI: 6.1-9.7), respectively. Urinary Tract Infections (UTI) (30.9%), Respiratory Tract Infections (RTI) (28.6%) and Blood Stream Infections (BSI) (21.4%) were found to be the most frequent infections. As expected, both specific prevalence and localization of HAI varied considerably between wards, with the highest values recorded in Intensive Care Units (ICU) and in Functional Rehabilitation wards. RTI (26.3%) and BSI (13.2%) were found primarily represented in ICU, while the highest values of UTI (13.3%) were registered in Functional Rehabilitation Units. Enterococcus spp. (16.8%), Candida spp. (14%), Pseudomonas spp. (12.2), Staphylococcus aureus (10.7%), Escherichia coli (10.3%) and Coagulase-negative staphylococci (CNS) (9.3%) were the most frequent pathogens isolated. The overall rate of administration of antibiotics was 55.3% and penicillin (26.7%), cephalosporins (22.8%) and fluoroquinolones (17.9%) were found to be the leading antibacterial administered. CONCLUSION: Results of the present study have been, and are currently, used for orientating surveillance and control hospital policies, planning activities according to a rational and evidence-based approach.


Assuntos
Infecção Hospitalar/epidemiologia , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/epidemiologia , Bactérias Gram-Positivas/isolamento & purificação , Infecções por Bactérias Gram-Positivas/epidemiologia , Controle de Infecções/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/epidemiologia , Criança , Pré-Escolar , Infecção Hospitalar/prevenção & controle , Feminino , Bactérias Gram-Negativas/classificação , Infecções por Bactérias Gram-Negativas/prevenção & controle , Bactérias Gram-Positivas/classificação , Infecções por Bactérias Gram-Positivas/prevenção & controle , Hospitais Públicos/organização & administração , Humanos , Lactente , Recém-Nascido , Itália , Masculino , Pessoa de Meia-Idade , Pneumonia/epidemiologia , Prevalência , Sepse/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Infecções Urinárias/epidemiologia , Adulto Jovem
13.
Rev. clín. esp. (Ed. impr.) ; 210(11): 567-572, dic. 2010. tab
Artigo em Espanhol | IBECS | ID: ibc-82901

RESUMO

Este documento presenta la primera experiencia de la Sociedad Española de Medicina Interna en el desarrollo de un programa de formación médica continuada basado en Internet para los miembros de la sociedad, acreditado por el Ministerio de Sanidad y la Universidad Autónoma de Barcelona, y financiado por el Grupo Menarini SA. Los resultados académicos y el grado de satisfacción de los participantes en este curso han sido muy elevados, tanto por lo que respecta a los contenidos científicos como al entorno virtual de aprendizaje. Esta experiencia demuestra que la formación médica continuada basada en Internet es un campo de gran futuro y con una buena aceptación por parte de los médicos participantes, y que las sociedades científicas, con la colaboración de otras instituciones y empresas, pueden liderar programas de formación médica continuada no presencial especialmente dirigidos y adaptados a sus afiliados(AU)


This paper presents the first experience of the Spanish Society of Internal Medicine in the development of an Internet-based Continuing Medical Education program for Society members, accredited by the Health Ministry and the Autonomous University of Barcelona, and funded by the Menarini Group SA. Academic performance and satisfaction of participants in this course have been very satisfactory, both with respect to scientific content and the virtual learning environment. This experience shows that Internet-based continuing medical education is a field with a great future that is well accepted by participating physicians, and that the scientific societies, with the collaboration of other institutions and companies, can lead Internet-based Continuing Medical Education programs especially designed and tailored to their members(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Internet/instrumentação , Internet , Sociedades Médicas/normas , Sociedades Médicas , Educação Continuada/métodos , Educação Continuada/normas , Educação Médica Continuada/ética , Educação Médica Continuada/métodos , Educação Continuada/organização & administração , Educação Médica Continuada/normas , Aprendizagem , Enquete Socioeconômica , Acreditação
14.
Rev Clin Esp ; 210(11): 567-72, 2010 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-20633875

RESUMO

This paper presents the first experience of the Spanish Society of Internal Medicine in the development of an Internet-based Continuing Medical Education program for Society members, accredited by the Health Ministry and the Autonomous University of Barcelona, and funded by the Menarini Group SA. Academic performance and satisfaction of participants in this course have been very satisfactory, both with respect to scientific content and the virtual learning environment. This experience shows that Internet-based continuing medical education is a field with a great future that is well accepted by participating physicians, and that the scientific societies, with the collaboration of other institutions and companies, can lead Internet-based Continuing Medical Education programs especially designed and tailored to their members.


Assuntos
Educação Médica Continuada/métodos , Medicina Interna/educação , Internet , Sociedades Médicas , Espanha
15.
Eur J Surg Oncol ; 35(5): 486-91, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19171450

RESUMO

BACKGROUND: The treatment of hepatic metastases from gastric cancer is controversial, due to biologic aggressiveness of the disease. OBJECTIVE: To survey the clinical approach to the subset of patients presenting with metachronous hepatic metastases as sole site of recurrence after curative resection of gastric cancer, focusing on the results achieved by different therapies and to investigate the prognostic factors of major clinical relevance. METHODS: Retrospective multi-center chart review evaluating 73 patients, previously submitted to D >or= 2 gastrectomy for gastric cancer, who developed exclusive hepatic recurrence. Prognostic factors related to the patient, to the gastric malignancy and its treatment, and to the metastatic disease and its therapy were evaluated. RESULTS: Forty-five patients received supportive care, 17 were submitted to chemotherapy, and 11 to hepatic resection. Survival was independently influenced by the variables T (p=0.019), N (p=0.05) and G (p=0.018) of the gastric primary and by the therapeutic approach to the metastases (p<0.005). In particular, T4 gastric cancer, presence of lymph-node metastases and G3 tumor displayed a negative prognostic value. Therapeutic approach to the metastases was the principal prognostic variable: 1, 2, and 3 years survival rates were 22.2%, 4.4% and 2.2%, respectively, for patients without specific treatment; 44.9%, 12.8% and 6.4% after chemotherapy (p=0.08) and 80.8%, 30.3% and 20.2% after surgical resection (p<0.001). CONCLUSIONS: Our data suggest some clinical criteria that may facilitate selection of therapy for patients with hepatic recurrence after primary gastric cancer resection. The best survival rates are associated with surgical treatment, which should be chosen whenever possible.


Assuntos
Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Segunda Neoplasia Primária/patologia , Segunda Neoplasia Primária/terapia , Neoplasias Gástricas/patologia , Idoso , Terapia Combinada , Feminino , Gastrectomia/métodos , Humanos , Metástase Linfática , Masculino , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias , Seleção de Pacientes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida
16.
J Thromb Haemost ; 6(2): 251-5, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18021305

RESUMO

INTRODUCTION: Although extensive screening in patients with venous thromboembolism (VTE) may result in early identification of hidden cancer, it is unknown whether the prognosis of these patients may be favorably influenced. PATIENTS AND METHODS: RIETE is an ongoing, prospective registry of consecutive patients with objectively confirmed, symptomatic, acute VTE. We compared the 3-month outcome of patients with hidden cancer with that in patients in whom no symptoms of cancer were noted. RESULTS: Of 17,475 patients with acute VTE, 2852 (16%) had cancer diagnosed before VTE or during admission. Hidden cancer was detected in 178 (1.2%) of the remaining 14,623 patients. The most common sites were lung, prostate, colorectum, or hematologic, and 51% had metastases. As compared with patients in whom no symptoms of cancer were noted, those with hidden cancer had an increased incidence of recurrent VTE (11.4% vs. 2.1%; P < 0.001), major bleeding (5.1% vs. 2.1%; P = 0.007), and mortality (20% vs. 5.4%; P < 0.001). In the multivariate analysis, patients aged 60-75 years [odds ratio 1.8; 95% CI 1.2-2.7], with idiopathic VTE (odds ratio 3.0; 95% CI 2.2-4.2), with bilateral thrombosis (odds ratio 2.3; 95% CI 1.3-4.1) or with anemia (odds ratio 1.9; 95% CI 1.4-2.6) were at an increased risk for hidden cancer. CONCLUSIONS: VTE patients with hidden cancer have an increased incidence of recurrences, major bleeding or death during the first 3 months of therapy. With four simple, easily obtainable variables, it is possible to identify a subgroup of VTE patients with a higher risk for hidden cancer.


Assuntos
Neoplasias Primárias Desconhecidas/sangue , Trombofilia/etiologia , Tromboembolia Venosa/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos de Coortes , Feminino , Transtornos Hemorrágicos/epidemiologia , Transtornos Hemorrágicos/etiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Desconhecidas/diagnóstico , Neoplasias Primárias Desconhecidas/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Recidiva , Sistema de Registros/estatística & dados numéricos , Risco , Espanha/epidemiologia , Análise de Sobrevida , Trombofilia/epidemiologia , Resultado do Tratamento , Tromboembolia Venosa/epidemiologia
17.
An Sist Sanit Navar ; 30 Suppl 2: 143-62, 2007.
Artigo em Espanhol | MEDLINE | ID: mdl-17898834

RESUMO

In spite of the lung being the target organ par excellence of tuberculosis, any other organ and system can be affected. In this article we review the forms of extrapulmonary tuberculosis, with the exception of the pleural form that requires the use of good diagnostic skills. From the dreaded tuberculous meningitis, by way of the insidious affectation of the spondylodiscitis, the so-called ganglionary affectation , the genitourinary affectation, pericarditis, and ending with less frequent forms such as ocular and cutaneous tuberculosis. In each section we will indicate what is most characteristic with the aim of providing a diagnostic and therapeutic orientation.


Assuntos
Tuberculose/diagnóstico , Tuberculose/terapia , Humanos
18.
An. sist. sanit. Navar ; 29(3): 433-437, sept.-dic. 2006. ilus
Artigo em Espanhol | IBECS | ID: ibc-052259

RESUMO

Se presenta el caso de un varón de 46 años con lipomatosis simétrica múltiple (LSM), enfermedad poco frecuente y de etiología desconocida. La LSM se caracteriza por múltiples depósitos de tejido adiposo y se asocia con alcoholismo, trastornos metabólicos y neuropatía. Se describen las características clínico-morfológicas de las lesiones que presenta, los hallazgos exploratorios, TAC cervical, los resultados analíticos y de biopsia subcutánea. Se diagnostica al paciente de LSM tipo I, aplicándose el tratamiento de elección, la lipectomía que le permite obtener una importante mejoría de la enfermedad, tanto física como estéticamente


We present the case of a 46 year-old man with Multiple Symmetric Lipomatosis (MSL), an infrequent disease with an unknown aetiology. MSL is characterized by multiple masses of adipose tissue and it is usually associated with alcoholism, metabolic disorders and neuropathy. We describe the clinical-morphological characteristics of the lesions it presents, the exploratory findings, cervical CAT, the analytical results and the results of subcutaneous biopsy. MSL type I disease was diagnosed. The treatment of choice, the lipectomy, was performed, making it possible to obtain a substantial disease improvement, both physical and aesthetically


Assuntos
Masculino , Pessoa de Meia-Idade , Humanos , Lipomatose Simétrica Múltipla/diagnóstico , Lipectomia/métodos , Lipomatose Simétrica Múltipla/cirurgia
19.
An Sist Sanit Navar ; 29(3): 433-7, 2006.
Artigo em Espanhol | MEDLINE | ID: mdl-17224944

RESUMO

We present the case of a 46 year-old man with Multiple Symmetric Lipomatosis (MSL), an infrequent disease with an unknown aetiology. MSL is characterized by multiple masses of adipose tissue and it is usually associated with alcoholism, metabolic disorders and neuropathy. We describe the clinical-morphological characteristics of the lesions it presents, the exploratory findings, cervical CAT, the analytical results and the results of subcutaneous biopsy. MSL type I disease was diagnosed. The treatment of choice, the lipectomy, was performed, making it possible to obtain a substantial disease improvement, both physical and aesthetically.


Assuntos
Lipomatose Simétrica Múltipla/patologia , Biópsia , Humanos , Lipomatose Simétrica Múltipla/cirurgia , Masculino , Pessoa de Meia-Idade
20.
Hipertensión (Madr., Ed. impr.) ; 22(6): 241-248, ago. 2005. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-040421

RESUMO

Objetivos. Dada la gran utilización del método diagnóstico que es la automedida de presión arterial (AMPA) y existiendo escasa clarificación sobre la variabilidad diurna y sobre el número de determinaciones de PA a realizar mediante AMPA se realizó este estudio. Método. Se seleccionó una muestra de 1.136 personas (población total, 2.084), aleatoria y estratificada por edad y sexo, de 25 a 64 años. Se excluyeron a los diagnosticados de hipertensión arterial (HTA). En la recogida de datos en consulta (C) se determinó la PA tres veces mediante el esfigmomanómetro de mercurio (Hg) en las dos primeras y mediante el aparato automático Omron 705 CP (ap autom) en la tercera. Se registró la frecuencia cardíaca (FC), la talla y el peso. Para la recogida de datos en el domicilio (D) se les instruyó en el manejo del ap autom y se les pidió que obtuviesen 9 mediciones de PA, tres por la mañana (M), tres por la tarde (T) y tres por la noche (N) durante tres días laborables (L) y uno festivo (F). Se aplicó la "t" de Student de medias pareadas y ANOVA monofactorial. Resultados. Las mediciones de PA (mmHg) en C y D se obtuvieron en 734 participantes. De ellos, 185 con una PA en C >= 140/90. Las medias de presión sistólica/presión diastólica (PS/PD) en C con el Hg fueron: 123,5 ± 15,1/76,4 ± 10,3 y 122,4 ± 14,4/75,5 ± 10 y con el ap autom de 123 ± 16,1/73,7 ± 10,3. La media de PS/PD en el D de toda la muestra fue: 115 ± 14,3/69,2 ± 9 y en el grupo con PA en C < 140/90, la media de PS fue 111 ± 12,2 y de PD 66,8 ± 7,6. La media de FC en la C fue de 70,3 ± 10,4 (pulsaciones/minuto). La media de FC en el D de toda la muestra fue 67,9 ± 9,7 y en el grupo con PA < 140/90 en C fue de 67 ± 9,6. Al comparar la PA de la C y del D existieron diferencias significativas entre las determinaciones en C en relación con las del D (M, T o N) en los días L y F (p < 0,05); siendo superior la PA en C. La FC fue también diferente en la C y en el D, siendo superior en C que en el D. Al analizar las tres tomas de la M de cada día se observó que existía una diferencia significativa de la PA tanto en la primera toma que se realizaba por la M, por la T y por la N del primer día en relación con la segunda y la tercera tomas del mismo día (p < 0,05). Respecto a la FC se observaron diferencias significativas entre la primera toma de la M en comparación con la segunda y la tercera tomas de la M del primer día (p < 0,05). Al comparar la PA de la M, la T y la N de los días L se observó que existían diferencias significativas entre las tomas de la M y la N (p < 0,05). Al comparar el día L y el F no existieron diferencias significativas de PS entre las M (p = 0,998) y las T (p = 0,934) del día L y F, pero sí existieron diferencias entre PS de las N (p < 0,05). La PD no presentó diferencias significativas por las T (p = 0,268), pero sí entre las M y las N (p < 0,05). Conclusiones. 1) Se demuestra una gran variabilidad entre las diferentes tomas de PA y se mantiene el ritmo circadiano, y 2) se recomienda realizar tres determinaciones por la M, tres por la T y tres por la N durante tres días, debiendo eliminar sólo la primera determinación del primer día


Objectives. This study was conducted given the great use of the diagnostic method that is the self-measurements of blood pressure (SMBP) and there being scarce clarification on the daytime variability and the number of BP determinations to be conducted by SMBP. Method. A sample of 1,136 persons (total population, 2,084) was chosen. It was randomized and stratified by age and gender, from 25 to 64 years. Those diagnosed of HBP were excluded. PB was determined three times in the consultation (C) data collection. This was done by mercury sphygmomanometer (Hg) in the first two and by automatic Omron 705 CP apparatus (ap autom) in the third. Heart rate (HR), height and weight were recorded. For home (H) data collection, they were instructed in the management of the ap autom and were asked to obtain 9 BP measurements, three in the morning (M), three in the afternoon (A) and three at night (NO) for three work (W) days and one holiday (H). The Student's "t" test of paired means and monofactorial ANOVA were administered. Results. The blood pressure measurements (mmHg) in C and H were obtained in 734 participants. Of them, 185 had a BP C >= 140/90. SP/DP means in the C with the Hg were 123.5 ± 15.1/76.4 ± 10.3 and 122.4 ± 14.4/75.5 ± 10 and with the ap autom, 123 ± 16.1/73.7 ± 10.3. The mean SP /DP at H of all the sample was 115 ± 14.3/69.2 ± 9 and in the group with BP at C < 140/90, the mean SP was 111 ± 12.2 and DP, 66.8 ± 7.6. Mean HR in the C was 70.3 ± 10.4 (beats/minute). Mean HR at H of all the sample was 67.9 ± 9.7 and in the group with BP < 140/90 in C it was 67 ± 9.6. When the BP of the C was compared with that of the H, there were significant differences between the measurements in C in relationship with those in H (M, A or N) on the days of W and H (p < 0.05); the BP being greater in C. The HR was also different in the C and H, it being greater in the C than in the H. When the three measurements of the M of each day were analyzed, it was observed that there was a significant different of BP both in the first done in the M, the A and N of the first day in relationship with the 2nd and 3rd measurements of the same day (p < 0.05). Regarding the HR, significant differences were observed between the 1st measurement of the M in comparison with the 2nd and 3rd measurements of the M of the first day (p < 0.05). When the BP of the M, A and N of the W days were compared, it was observed that there were significant differences between the measurements of the M and N (p < 0.05). When the W and H day were compared, there were no significant differences of SP between M (p = 0.998) and A (p = 0.934) of the W and H day. However, there were differences between SP of the N (p < 0.05). The DP did not have significant differences in the A (p = 0.268), but did between the M and N (p < 0.05). Conclusions. 1) A large variability is shown between the different BP measurements and the circadian rhythm is maintained, and 2) it is recommended to make three measurements in the M, three in the A and three at N for three days, and only the 1st measurement of the first day should be eliminated


Assuntos
Humanos , Determinação da Pressão Arterial/métodos , Hipertensão/diagnóstico , Autoanálise , Manometria , Frequência Cardíaca , Peso Corporal , Estatura , Coleta de Dados/métodos , Variações Dependentes do Observador
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