Quality of life as assessed by adults with cerebral palsy.

AIM: We explored the quality of life of adults with cerebral palsy without an intellectual disability and the predictors of quality of life. BACKGROUND: Because cerebral palsy is a disease that manifests in childhood, much of the research into quality of life for those dealing with it focuses on children; there are few studies that evaluate the quality of life of adults with cerebral palsy. Therefore, it is important to consider their perceptions in order to improve their general wellbeing and self-determination. DESIGN: This was a descriptive, cross-sectional study. METHOD: Quality of life was measured using the GENCAT Quality of Life Scale. Demographic and personal variables were also collected and examined. Participants comprised 75 adults (58.7 percent men, mean age = 40.84 years) with cerebral palsy who were members of the National Cerebral Palsy Association of Spain between 2014 and 2015. A linear multivariate model was examined as well. RESULTS: The overall mean score indicator of participants' quality of life was 103.29, which corresponds to the 56.6th percentile on the GENCAT scale. Examining the level of qualification, we found significant differences in the factors "personal development" and "self-determination," and those with a university education obtained higher scores than their less-educated counterparts. Having a partner was related to higher quality of life standard scores. After constructing a linear model, it was observed that maintaining sexual relationships was another factor that increased participants' quality of life. CONCLUSION: This study highlights the importance of social and romantic relationships to achieve a better quality of life in adults with cerebral palsy who do not have an intellectual disability. Social integration and sexuality education programs should be developed to improve their quality of life.

Combined radical prostatectomy and abdominoperineal resection for locally invasive rectal cancer.

INTRODUCTION: An infiltration of urological organs is found in 5-10% of patients with colorectal carcinoma. Total pelvic exenteration is the standard procedure for locally advanced rectal cancer. In selected patients with rectal cancer involving the prostate or seminal vesicles, the bladder can be preserved and en bloc radical prostatectomy with abdominoperineal rectal resection can be performed. We report two patients who treated with this combined approach. PRESENTATION OF CASE: Two patients with symptoms of rectal bleeding and pelvic pain were investigated. Colonoscopy demonstrated a tumor in the lower rectum. Biopsies revealed adenocarcinoma. Both pelvic MRI and endorectal ultrasound showed tumors that invaded the prostate and the seminal vesicles directly but without invasion of the bladder. After neoadjuvant chemoradiation, combined radical prostatectomy and abdominoperineal amputation was performed. None has developed local recurrence, but one of them was operated on for a single lung metastasis. After a follow-up of 28 and 20 months, respectively, the patients are alive without evidence of local recurrence or distant disease. DISCUSSION: This procedure obviates the need for urinary diversion without compromising the local tumor control. Intraoperative and postoperative diagnostic difficulties, and clinical aspects in relation to postoperative anastomotic leak and survival of patients are discussed. CONCLUSION: En bloc radical prostatectomy and proctosigmoidectomy is feasible in selected patients with rectal cancer and invasion limited to the prostate or seminal vesicles because it provides good local tumor control and significantly improves the patient's quality of life in comparison to total pelvic exenteration.

[Risk factors in patients older than 70 years with complicated colorectal carcinoma]. / Factores de riesgo en pacientes mayores de 70 años con carcinoma colorrectal complicado.

OBJECTIVE: The aim of this study was to analyze the outcome of patients over 70 years of age who underwent emergency surgery for complicated colorectal carcinoma, as well as to identify the factors that might have some influence on outcome. PATIENTS AND METHOD: A retrospective study of 54 patients older than 70 years who underwent emergency surgery for complicated colorectal cancer (42 with obstruction and 12 with perforation) between 1991 and 2002 was performed. Morbidity and mortality after surgery were studied. To determine prognostic factors of morbidity and mortality a multivariate logistic regression analysis was also performed. RESULTS: Overall and major morbidity rates were 81.5% and 42.6%, respectively. The mortality rate was 27.8%. Multivariate analysis revealed that perioperative transfusion (p = 0.014) was an independent predictive factor of major complications and that a high APACHE II score (p = 0.031) and the presence of perforation proximal to the tumor (p = 0.042) independently predicted mortality. CONCLUSIONS: Emergency surgery for complicated colorectal carcinoma in elderly patients carries elevated morbidity and mortality. The presence of risk factors should be taken into account when choosing the most suitable surgical technique and evaluating the need for intensive postoperative treatment.

Factores de riesgo en pacientes mayores de 70 años con carcinoma colorrectal complicado / Risk factors in patients older than 70 years with complicated colorectal carcinoma

Objetivo. El fin de este estudio fue analizar la evolución clínica de los pacientes mayores de 70 años operados de urgencia por carcinoma colorrectal complicado y, además, evaluar los factores con posible influencia en la evolución clínica. Pacientes y método. Se han revisado retrospectivamente los datos de 54 pacientes mayores de 70 años intervenidos de urgencia por carcinoma colorrectal complicado (42 con obstrucción y 12 con perforación) durante el período 1991-2002. Se estudió la morbimortalidad tras la cirugía y se realizó un análisis de regresión logística multivariable para determinar los factores pronósticos de morbilidad y de mortalidad. Resultados. Las tasas de morbilidad global y mayor, y de mortalidad fueron del 81,5, 42,6 y 27,8%, respectivamente. El análisis multivariable mostró que la transfusión perioperatoria (p = 0,014) fue un factor predictivo independiente de complicación mayor y que un índice APACHE II alto (p = 0,031) y la presencia de perforación a distancia (p = 0,042) fueron factores relacionados con la mortalidad.Conclusiones. La cirugía urgente por carcinoma colorrectal complicado en pacientes de edad avanzada conlleva una elevada morbimortalidad. La presencia de factores de riesgo debería tenerse en cuenta al elegir la técnica quirúrgica más adecuada y al valorar la necesidad de un tratamiento postoperatorio intensivo (AU)

Objective. The aim of this study was to analyze the outcome of patients over 70 years of age who underwent emergency surgery for complicated colorectal carcinoma, as well as to identify the factors that might have some influence on outcome. Patients and method. A retrospective study of 54 patients older than 70 years who underwent emergency surgery for complicated colorectal cancer (42 with obstruction and 12 with perforation) between 1991 and 2002 was performed. Morbidity and mortality after surgery were studied. To determine prognostic factors of morbidity and mortality a multivariate logistic regression analysis was also performed. Results. Overall and major morbidity rates were 81.5% and 42.6%, respectively. The mortality rate was 27.8%. Multivariate analysis revealed that perioperative transfusion (p = 0.014) was an independent predictive factor of major complications and that a high APACHE II score (p = 0.031) and the presence of perforation proximal to the tumor (p = 0.042) independently predicted mortality. Conclusions. Emergency surgery for complicated colorectal carcinoma in elderly patients carries elevated morbidity and mortality. The presence of risk factors should be taken into account when choosing the most suitable surgical technique and evaluating the need for intensive postoperative treatment (AU)

Abdomen agudo secundario a pica / Acute abdomen due to pica

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Compresas retenidas. Aspectos clínicos y responsabilidad en enfermería / Retained sanitary pads. Clinical aspects and nursing responsability

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