[Detection of malnutrition on admission to hospital]. / Detección de malnutrición al ingreso en el hospital.

In view of the high prevalence of malnutrition in hospitals as shown by some studies and in the light of its direct impact on the increase in morbidity and mortality among hospitalized patients, it is necessary to ensure the early identification of this condition. This would allow appropriate nutritional treatment to be instituted as soon as possible for patients at risk who require it. The present multi-centric study included the participation of hospitals in the northern region of the country which have a Nutrition Unit, with use of the Overall Subjective Assessment and a few basic parameters. The study analyzed the nutritional status on admission of 620 patients hospitalized in the Internal Medicine and General Surgery areas during the months of December, 1999, January, February and March, 2000. We detected moderate malnutrition or suspected malnutrition in 20% of the patients studied and severe malnutrition in 18.2%, with a greater incidence in Internal Medicine. Malnutrition was mainly evidenced by weight loss of more than 5% and a reduction in subcutaneous fat and muscle mass. In addition, there are functional limitations on performing everyday activities. Changes in dietary intake were present in 40.8% of the patients. The associated gastro-intestinal symptoms included anorexia, which affected 37.7% of the group studied. Malnutrition is most frequently linked with infectious diseases, problems in circulation and with the digestive apparatus. We feel that the Overall Subjective Assessment, together with the measurement of height and weight, should be used systematically with patients on admission, as it is a simple and effective method for the identification of patients with nutritional risk.

NMP 22, BTA stat test and cytology in the diagnosis of bladder cancer: a comparative study.

OBJECTIVE: To evaluate the usefulness of the NMP 22 and BTA stat test in the diagnosis and follow-up of bladder cancer and to compare these tests to cytology and cystoscopy, routine diagnostic methods. METHODS: 150 patients followed up for bladder cancer or symptoms suggestive of bladder cancer underwent cystoscopy after cytology, NMP 22 and BTA stat test using a recently voided urine sample. In suspect cases, TUR and histopathological analysis were performed. RESULTS: Bladder cancer was proven in 76 patients and excluded in 74. For NMP 22 we have used the cutoff value recommended by the manufacturer (10 U/ml) and that obtained by our receiver-operating characteristic curve (6 U/ml). Sensitivity was 84.21% for NMP 22 at the cutoff value of 6 U/ml and 76.32% with 10 U/ml; 72.37% for BTA stat test; 69.74% for cytology, and 100% for cystoscopy. Specificity was 86.49% for NMP 22 at a cutoff value of 6 U/ml and 90.54% at 10 U/ml; 89.19% for the BTA stat test; 93.24% for cytology and 89.19% for cystoscopy. NMP 22 sensitivity for grades 1, 2, and 3 was 68.75, 75.86 and 100%, respectively, at a cutoff value of 6 U/ml, and 50, 68.97 and 96.77%, respectively, at a cutoff level of 10 U/ml; for BTA stat the sensitivity was 56.25% in G1, 62.07% in G2 and 90.32% in G3, and for cytology the sensitivity was 43.75, 62.07 and 90.32%, respectively. The sensitivity of NMP 22 was 68.75% in stage Ta, 84.78% in T1 and 100% in T2-T4 at a cutoff level of 6 U/ml and 50, 80.43 and 92.86%, respectively, at a cutoff level of 10 U/ml; BTA stat sensitivity was 50% in Ta, 73.91% in T1 and 92.86% in T2-T4; and in cytology the results were 37.50, 73.91 and 85.71%, respectively. Using the McNemar test, there was only a significant difference between the sensitivity of NMP 22 at a cutoff level of 6 U/ml and cytology in the overall sample. CONCLUSIONS: The high sensitivity of the NMP 22 and BTA stat test in combination with the data obtained from the parameters used for the evaluation of the test demonstrate their usefulness in the diagnosis and follow-up of bladder cancer. NMP 22 at a cutoff value of 6 U/ml is significantly more sensitive than cytology and consequently a thoroughly valid diagnostic tool in the diagnosis of bladder cancer which may substitute voided urine cytology.

Usefulness of the BTA STAT Test for the diagnosis of bladder cancer.

OBJECTIVES: To evaluate the usefulness of the Bard BTA stat Test in the diagnosis and follow-up of bladder cancer and to compare this test to cytologic analysis and cystoscopy, routine diagnostic methods. METHODS: Three hundred seventy-nine patients being followed up because of bladder cancer or with symptoms suggestive of bladder cancer underwent cystoscopy, cytologic analysis, and the BTA stat Test using a recently voided urine sample. In suspected cases, transurethral resection and histopathologic analysis were performed. RESULTS: Of the 379 patients, 235 proved to have bladder cancer and 144 did not. The sensitivity was 73.62% for the BTA stat, 61.70% for cytologic examination, and 99.57% for cystoscopy. The specificity was 83.33% for the BTA stat, 92.36% for cytologic analysis, and 85.42% for cystoscopy. The BTA stat Test's sensitivity for grades 1, 2, and 3 tumor was 47.27%, 69.15%, and 95.35%, respectively. The sensitivity of cytologic analysis was 30.91%, 55.32%, and 88.37%. The BTA stat Test's sensitivity for stage was 45.65% in Stage Ta, 75.52% in T1, and 95.56% in Stage T2-4; the cytologic results were 28.26%, 65.03%, and 84.44%, respectively. The combination of both tests improved the sensitivity and decreased the specificity slightly. CONCLUSIONS: The high sensitivity of the BTA stat Test, together with the data obtained from the parameters used for the evaluation of the test, demonstrate the better results of the BTA stat Test compared with cytologic analysis, making it a thoroughly valid diagnostic tool in the diagnosis of bladder cancer. In our opinion, the BTA stat Test can replace the use of cytologic analysis in the diagnosis of bladder cancer, but not the use of cystoscopy.

[Intravascular ultrasonographic evaluation of direct stents, implanted without predilatation. Comparison of results according to lesion types]. / Evaluación con ultrasonografía intravascular de stents implantados sin predilatación (stents directos). Comparación de resultados según el tipo de lesión.

INTRODUCTION AND OBJECTIVES: Direct stenting is a safe and feasible technique in selected lesions yielding excellent angiographic results. However, there are no studies providing intravascular ultrasonographic examination after direct stenting. The aim of this study was to evaluate direct stent expansion with ultrasonography and to know whether there are differences in the results based on lesion types. METHODS: Patients with amenable lesions for direct stenting were enrolled; including patients with no occlusion, no calcification, no significant tortuosity or angulation, a length 15 mm and a reference lumen diameter 2.5 mm. Intravascular ultrasonography was performed after stent implantation. The ultrasonographic criteria for optimal expansion were: complete apposition and a minimal intrastent lumen area > 80% of the average reference luminal area and 90% of the distal reference lumen area. RESULTS: We included 40 patients (50 lesions). The final angiographic result was good in all the patients but in one case an additional stent was used due to dissection. The ultrasonographic examination did not show significant differences between type A and B lesions. Optimal expansion was achieved in 14/21 (66%) of type A lesions and 17/29 (58%) of type B lesions (p = 0.5). The balloon/artery ratio was the only factor significantly related to ultrasonographic results. When this ratio was 1.1-1.2 (25 cases), 76% of the stents were optimally expanded and when the ratio was < 1. 1 (25 cases) only in a 48% an optimal result was achieved (p < 0.05). CONCLUSIONS: Direct stenting in selected lesions provides ultrasonographic results comparable to those expected with conventional stenting and these results could be even improved if a balloon artery ratio 1.1-1.2 is used. Taking into consideration the selection criteria the differences observed between lesion types A and B are not significant.