Population-based risk assessment of second primary cancers following a first head and neck cancer: patterns of association and difficulties of its analysis.

PURPOSE: The diagnosis of a second primary cancer (SPC) is a major concern in the follow-up of survivors of a primary head and neck cancer (HNC), but the anatomic subsites in the head and neck area are close, making it difficult to distinguish a SPC of a recurrence and therefore register it correctly. METHODS: We performed a retrospective cohort study using data from two population-based cancer registries in Catalonia, Spain: the Tarragona Cancer Registry and the Girona Cancer Registry. All patients diagnosed with HNC during the period 1994-2013 were registered and followed-up to collect cases of SPC. We analysed the standardized incidence ratio (SIR) and the excess absolute risk (EAR) to determine the risk of second malignancies following a prior HNC. RESULTS: 923 SPC were found in a cohort of 5646 patients diagnosed of a first head and neck cancer. Men had an increased risk of a SPC with a SIR of 2.22 and an EAR of 216.76. Women also had an increased risk with a SIR of 2.02 and an EAR of 95.70. We show the risk for different tumour sites and discuss the difficulties of the analysis. CONCLUSION: The risks of a SPC following a prior HNC in Tarragona and Girona are similar to those previously found in other similar cohorts. It would appear to be advisable to make a revision of the international rules of classification of multiple tumours, grouping the sites of head and neck area with new aetiological criteria to better determine and interpret the risks of SPC obtained in these studies.

HDL-c levels predict the presence of pleural effusion and the clinical outcome of community-acquired pneumonia.

OBJECTIVES: To investigate if HDL cholesterol (HDL-c) could be a biomarker of the degree of severity according to prognostic prediction scores in community-acquired pneumonia (CAP) or the development of clinical complications such as pleural effusion. METHODS: We included in a retrospective study 107 patients admitted to the hospital that fulfilled diagnostic criteria for CAP between the 30th October 2011 and 1st September 2012. HDL-c levels at admission, CAP prognosis scores (PSI and CURB65) and clinical outcomes were recorded for the study. RESULTS: Basal HDL-c levels were not statistically different according to prognostics scores neither PSI nor CURB-65. Significantly lower levels of HDL-c were also associated to the development of septic shock and admission to the intensive care unit. HDL-c were inversely correlated with acute phase reactants CRP (r = -0.585, P < 0.001), ESR (r = -0.477, P < 0.001), and leukocytes cell count (r = -0.254, P < 0.009). Patients with pleural effusion showed significant lower levels of HDL-c [28.9 (15.5) mg/dl vs. 44.6 (21.1) mg/dl]; P = 0.007. HDL-c is a good predictor of the presence of pleural effusion in multivariate analyses and using ROC analyses [AUC = 0.712 (0.591-0.834), P = 0.006]. HDL-c levels of 10 mg/dl showed a sensitivity of 97.6 % and a specificity of 82.4 % for the presence of pleural effusion. CONCLUSION: Monitoring HDL-c in CAP is an useful serum marker of acute phase response, clinical outcome and the presence of pleural effusion.

[A glucose tolerance study in the 12 months postpartum in patients with gestational diabetes]. / Estudio de la tolerancia a la glucosa en los 12 meses posparto en pacientes con diabetes gestacional.

BACKGROUND: It has been reported that patients with gestational diabetes have a considerable long term risk of developing diabetes mellitus. METHOD: Glucose tolerance was studied in the 12 months following birth in 155 patients diagnosed by the authors as having gestational diabetes and followed during pregnancy. RESULTS: It was observed that in 48% of the patients alterations persisted (33% glucose intolerance and 15% diabetes mellitus). Glucose tolerance during gestation and the perinatal results were retrospectively analyzed with a relation with the postpartum reclassification being observed. CONCLUSIONS: It was estimated that the percentage of alterations in glucose tolerance persisting postpartum is extremely high, suggesting the need for this test with a double objective: the reclassification of gestational diabetes and the early detection of glucose intolerance and diabetes mellitus.

Temporal trends of incidence and survival of sarcoma of digestive tract including Gastrointestinal Stromal Tumours (GIST) in two areas of the north-east of Spain in the period 1981-2005: a population-based study.

INTRODUCTION: The diagnostic approach of Gastrointestinal Stromal Tumours (GIST) was established in 2002. Before this, GIST had been classified with a wide range of histological terms. This fact and the consideration of potential malignity of all these tumours led to a false perception of an increasing incidence. PURPOSE: This study aimed at evaluating the accuracy in registration of sarcoma of digestive tract and GIST and to elucidate the trends of incidence and survival of those. MATERIALS AND METHODS: We used data from two population-based cancer registries in Spain. In the Girona's Cancer Registry we previously reclassified all sarcoma of digestive tract performing c-kit to confirm GIST and analysed the time period 1994-2005. In Tarragona's Cancer Registry, where we analysed the time period 1981-2005, this reclassification was not done. RESULTS: We obtained a significant increasing trend in incidence of all sarcoma of digestive tract in the Tarragona Cancer Registry database, with an annual per cent of change of 3.87 but a non-statistically significant trend in incidence in the Girona Cancer Registry database. The incidence of GIST in Girona Cancer Registry was 1.24 cases/100,000 inhabitants/year. Survival rates did not change in time and was high in less aggressive GIST. The 5-year relative survival for low, intermediate and high risk of malignant behaviour GIST groups were, respectively, 80.5, 85.6 and 64.6 %. CONCLUSIONS: The increase in the incidence of GIST could be explained by the improvement in their diagnosis and registration. The survival of low and intermediate risk of malignant behaviour is high and close to normal population survival.

[Clinical aspects of stasis hepatomegaly]. / Aspectos clínicos de la hepatomegalia de estasis.

The clinical characteristics of 100 patients diagnosed of congestive hepatomegaly have been reviewed in order to analyze some of the clinical and analytical parameters. The protocol for the study consisted of ten variables: sex, age, quality and size of the hepatomegaly, presence of hepatojugular reflux, jugular engorgement, ankle edema, abdominal ultrasonography, laboratory data and any other pertinent exploration. The mean age of the patients was 69 (31%). 65% of the cases had ankle edema. Prothrombin time was abnormal in 12% of the total series and in 27.9% of those with abnormal laboratory data. The most common ECG finding was atrial fibrillation (26%). The second most common was complete bundle block (21%).