Endoftalmitis endógenas bacterianas. A propósito de 2 casos / Endogenous bacterial endophthalmitis. A report of 2 cases

Casos clínicos: Presentamos 2 casos clínicos de endoftalmitis endógena bacteriana. El primero causado por Streptococcus bovis tras la realización de una colonoscopia, con mala evolución que acabó en evisceración. El segundo debido a un Staphylococcus aureus meticilin resistente procedente de un absceso paraespinal que complicaba una artrodesis, con excelente recuperación visual. Discusión: La endoftalmitis endógena bacteriana es una enfermedad poco frecuente y grave en la que bacterias procedentes de un foco primario llegan por vía sanguínea hasta el ojo. El diagnóstico de sospecha ha de ser lo más precoz posible, basado en la clínica y los antecedentes del paciente. Un tratamiento adecuado y específico con antibióticos intravenosos e intravítreos puede evitar el mal pronóstico visual en algunos casos (AU)

Clinical cases: The cases are presented on 2 patients with bacterial endogenous endophthalmitis. The first one was caused by Streptococcus bovis, developed after colonoscopy, which had a poor outcome and resulted in evisceration. The second case was caused by a methicillin resistant Staphylococcus aureus from an arthrodesis complicated with a para-spinal abscess. It had an excellent visual outcome. Discussion: Bacterial endogenous endophthalmitis is a rare, but serious ocular disease that occurs when bacteria reach the eye via the bloodstream. It requires a very early diagnosis based on the clinical symptoms and patient history. A suitable and specific treatment with intravenous and intravitreal antibiotics may prevent a bad visual prognosis in some cases (AU)

Endogenous bacterial endophthalmitis. A report of 2cases. / Endoftalmitis endógenas bacterianas. A propósito de 2casos.

CLINICAL CASES: The cases are presented on 2patients with bacterial endogenous endophthalmitis. The first one was caused by Streptococcus bovis, developed after colonoscopy, which had a poor outcome and resulted in evisceration. The second case was caused by a methicillin resistant Staphylococcus aureus from an arthrodesis complicated with a para-spinal abscess. It had an excellent visual outcome. DISCUSSION: Bacterial endogenous endophthalmitis is a rare, but serious ocular disease that occurs when bacteria reach the eye via the bloodstream. It requires a very early diagnosis based on the clinical symptoms and patient history. A suitable and specific treatment with intravenous and intravitreal antibiotics may prevent a bad visual prognosis in some cases.

[Obstructive symptoms in young woman by left hydrosalpinx]. / Sintomatología obstructiva en mujer joven por hidrosalpinx izquierdo.

We describe the case of a 43 years old woman with obstructive and irritative symptoms after having an hysterectomy. Bladder outlet obstruction was observed in an urodinamyc study. She was later diagnosed with left hidrosalpinx. Salpingectomy was performed, as a result all symptoms have disap-

[Prognostic factors for disease progression in patients with renal cell carcinoma]. / Análisis de los factores pronósticos de progresión tumoral en el adenocarcinoma renal.

INTRODUCTION: More than 40% of patients with renal cell carcinoma present with disease progression after surgery. The objective of the current study was to identify a clinically useful set of prognostic factors that would correlate significantly with the capacity of progression. MATERIAL AND METHODS: The authors studied 252 patients with renal cell carcinoma who underwent radical nephrectomy. Followup ranged from 12-246 months (median 36 months). Several morphologic parameters of the tumors were considered. DNA content was analyzed by flow cytometry and tumor size was determined from the surgical specimen. A Cox proportional hazards regression model was used to identify significant independent prognostic factors for disease progression. RESULTS: A total of 224 out of 252 were available for suitable histograms. Of the 224 patients, 95 (42.4%) were aneuploid tumors, 106 (47.2%) were organ-confined renal cell carcinoma and 87 (39.74%) presented disease progression. At 5 and 10 years of followup, disease free survival was found to be 66.31% and 62.23%, respectively. Univariate analysis revealed that DNA ploidy, Furhman grade and stage (TNM) had a statistically significant predictive value for disease progression. Survival univariate analysis found a worse probability of survival for aneuploid tumors, grade III-IV tumors, non organ-confined tumors and conventional and undiferentiated tumors. Using multivariate survival analyses, Furhman grade, stage (TNM) and DNA ploidy were the only independent prognostic factors. So, the probability of death for aneuploid tumor was 1.7 times higher than for diploid tumors. CONCLUSIONS: Stage, DNA content and Furhman grade were the only significant independent predictors of disease progression. Tumoral size and histological type did not provide more additional information.

Análisis de los factores pronósticos de progresión tumoral en el adenocarcinoma renal / Prognostic factors for disease progression in patients with renal cell carcinoma

Introducción: Aproximadamente el 40% de los pacientes con adenocarcinoma renal (AR) fallecen por progresión tumoral a pesar del tratamiento. El 30-40% de los pacientes que progresan, presentan una enfermedad quirúrgicamente resecable en el momento del diagnóstico. Objetivo: El objetivo de este estudio ha sido evaluar que factores muestran un valor pronóstico independiente de supervivencia libre de progresión en el AR. Material y métodos: Estudio retrospectivo de 252 tumores renales intervenidos quirúrgicamente entre 1969-2001. La mediana de seguimiento fue de 36,47 meses (12-246). Las variables evaluadas fueron la edad, el TNM (TNM 2002), grado nuclear de Furhman, tipo histológico, tamaño (diámetro mayor de la pieza quirúrgica) y ploidia del ADN (para un mínimo de 3 muestras en fresco de cada tumor). El contenido de ADN se obtuvo mediante citometría de flujo. La progresión biológica fue definida como recurrencia local, regional y/o presencia de metástasis a distancia. Se utilizaron métodos estadísticos comparativos tanto univariantes (Chi- cuadrado, método de Kaplan-Meyer con el log-rank test) como multivariantes (regresión múltiple de riesgos proporcionales de Cox). Resultados: De los 252 pacientes, 43 se desestimaron para el análisis por un estudio de la ploidia del ADN no válido (coeficiente de variación superior a 8). De los 224 válidos, progresaron 89 (39,74%). La mediana del tiempo libre de progresión fue de 9,55 meses (0-133), de tal forma que el 70,9% de los que recidivaron lo hicieron en los dos primeros años del seguimiento. De los pacientes que progresaron, el 89,5% lo hicieron de forma locorregional, el 9,4% lo hicieron a distancia y 2 pacientes (1,2%) en el riñón contralateral. El 83,1% de los que recidivaron fallecieron por la enfermedad. Al analizar la asociación de las variables con la progresión tumoral, los tumores de alto grado, no organoconfinados y aneuploides presentaban una probabilidad significativamente mayor de progresión. En el análisis univariante de supervivencia el estadio III-IV, el grado nuclear III-IV, los tipos histológicos indiferenciado y convencional, así como los tumores aneuploides mostraron peor probabilidad de supervivencia. El análisis multivariante mediante regresión de Cox, utilizando como variables explicativas los factores pronósticos evaluados en el univariante, seleccionó al TNM, grado nuclear y ploidia del ADN como factores pronósticos independientes de supervivencia libre de progresión. Conclusiones: Los resultados de este estudio indican que el TNM 2002, el grado nuclear y la ploidia del ADN tienen un valor pronóstico independiente de supervivencia libre de progresión. Ni el tipo histológico, ni el tamaño tumoral aportaron información adicional en la predicción pronóstica

Introduction: More than 40% of patients with renal cell carcinoma present with disease progression after surgery. The objective of the current study was to identify a clinically useful set of prognostic factors that would correlate significantly with the capacity of progression. Material and methods: The authors studied 252 patients with renal cell carcinoma who underwent radical nephrectomy. Followup ranged from 12-246 months (median 36 months). Several morphologic parameters of the tumors were considered. DNA content was analyzed by flow cytometry and tumor size was determined from the surgical specimen. A Cox proportional hazards regression model was used to identify significant independent prognostic factors for disease progression. Results: A total of 224 out of 252 were available for suitable histograms. Of the 224 patients, 95 (42,4%) were aneuploid tumors, 106 (47,2%) were organ-confined renal cell carcinoma and 87 (39,74%) presented disease progression. At 5 and 10 years of followup, disease free survival was found to be 66,31% and 62,23%, respectively. Univariate analysis revealed that DNA ploidy, Furhman grade and stage (TNM) had a statistically significant predictive value for disease progression. Survival univariate analysis found a worse probability of survival for aneuploid tumors, grade III-IV tumors, non organ-confined tumors and conventional and undiferentiated tumors. Using multivariate survival analyses, Furhman grade, stage (TNM) and DNA ploidy were the only independent prognostic factors. So, the probability of death for aneuploid tumor was 1,7 times higher than for diploid tumors. Conclusions: Stage, DNA content and Furhman grade were the only significant independent predictors of disease progression. Tumoral size and histological type did not provide more additional information

Development and validation of an inventory for measuring job satisfaction among family physicians.

The aim was to develop and validate a measure of job satisfaction among family physicians. The construct of job satisfaction was developed theoretically, then the semantic network technique was used for the construction of the items. 80 semantic differential items in a random order were related by nine physicians. Four dimensions integrated the construct: "job satisfaction," "health institutions where I work," "my patients," and "myself as a doctor." The average Cronbach alpha was .81. In the factor analysis, four factors were obtained in each dimension except that of "my patients," for which two were obtained. These factors accounted for at least 44% of the construct developed. The semantic network technique may be useful.