La edad es un factor predictor independiente para recurrencia tumoral en el cáncer de vejiga no músculo invasor: resultados de una serie local / Age is an independent predictor for tumoral recurrence in non muscle-invasive bladder cancer: results of a local series

Introducción: El cáncer de vejiga es en su mayoría una enfermedad de pacientes de edad avanzada. El objetivo del estudio fue evaluar la edad como factor pronóstico en una cohorte de pacientes chilenos con cáncer de vejiga no músculo invasor. Material y métodos: Se revisaron retrospectivamente los registros clínicos de 107 pacientes tratados por un cáncer no-músculo invasor de vejiga confirmado histológicamente. Se determinaron asociaciones de la edad con parámetros clínicos e histopatológicos, así como con recurrencia y progresión tumoral. Finalmente se realizó un análisis multivariado para identificar factores predictores de los desenlaces mencionados. Resultados: La mediana de edad fue 65 años (rango 29-94). Se observó una significativa asociación de unos pacientes jóvenes con el tabaquismo activo. Por otro lado, los pacientes mayores a 65 años mostraron una asociación significativa con la presencia de recurrencia y progresión tumoral en el análisis univariado. Finalmente, una edad por sobre los 65 años fue el predictor independiente más importante para la recurrencia en el análisis multivariado, por sobre el estadío pT. Conclusiones: Existen varios factores clínicos y psicosociales que contribuyen al significativo poder predictor de una edad > 65 años en el pronóstico de un paciente con un cáncer de vejiga no músculo invasor. Por lo mismo, cada paciente debe ser evaluado en forma integral, tomando en cuenta las distintas dimensiones involucradas. En un escenario de progresivo envejecimiento de la población, el urólogo debe estar preparado para resolver adecuadamente esta situación.

Introduction: Bladder cancer is most frequently a disease of the elderly. The aim of the study was to evaluate the impact of age on prognosis in a cohort of Chilean patients with non muscle-invasive bladder cancer. Methods: The medical records of 107 patients treated for non muscle-invasive bladder cancer at our institution were retrospectively reviewed. Associations of age with clinical and histopathological parameters were assessed, as well as with tumoral recurrence and progression. Finally, a multivariate analysis was performed in order to identify predictive factors for the mentioned outcomes. Results: The median age was 65 years (range 29-94). Younger patients showed a significant association with an active smoking status. On the other hand, a significant association of age > 65 years with tumoral recurrence and progression was observed on univariate analysis. Age was also the most important predictive factor for recurrence on the multivariate analysis, even more than the pT stage. Conclusions: There are several clinical and psychosocial factors related to the significant predictive power of a higher age on the prognosis of patients with non muscle-invasive bladder cancer. Therefore, every patient should be assessed integrally, taking into account all the different dimensions involved. In an era of an aging population, the urologist must be prepared to handle with this situation.

Evidence from in vivo 31-phosphorus magnetic resonance spectroscopy phosphodiesters that exhaled ethane is a biomarker of cerebral n-3 polyunsaturated fatty acid peroxidation in humans.

BACKGROUND: This study tested the hypothesis that exhaled ethane is a biomarker of cerebral n-3 polyunsaturated fatty acid peroxidation in humans. Ethane is released specifically following peroxidation of n-3 polyunsaturated fatty acids. We reasoned that the cerebral source of ethane would be the docosahexaenoic acid component of membrane phospholipids. Breakdown of the latter also releases phosphorylated polar head groups, giving rise to glycerophosphorylcholine and glycerophosphorylethanolamine, which can be measured from the 31-phosphorus neurospectroscopy phosphodiester peak. Schizophrenia patients were chosen because of evidence of increased free radical-mediated damage and cerebral lipid peroxidation in this disorder. METHODS: Samples of alveolar air were obtained from eight patients and ethane was analyzed and quantified by gas chromatography and mass spectrometry (m/z = 30). Cerebral 31-phosphorus spectra were obtained from the same patients at a magnetic field strength of 1.5 T using an image-selected in vivo spectroscopy sequence (TR = 10 s; 64 signal averages localized on a 70 x 70 x 70 mm3 voxel). The quantification of the 31-phosphorus signals using prior knowledge was carried out in the temporal domain after truncating the first 1.92 ms of the signal to remove the broad component present in the 31-phosphorus spectra. RESULTS: The ethane and phosphodiester levels, expressed as a percentage of the total 31-phosphorus signal, were positively and significantly correlated (rs = 0.714, p < 0.05). CONCLUSION: Our results support the hypothesis that the measurement of exhaled ethane levels indexes cerebral n-3 lipid peroxidation. From a practical viewpoint, if human cerebral n-3 polyunsaturated fatty acid catabolism can be measured by ethane in expired breath, this would be more convenient than determining the area of the 31-phosphorus neurospectroscopy phosphodiester peak.

Regional grey matter volumetric changes in forensic schizophrenia patients: an MRI study comparing the brain structure of patients who have seriously and violently offended with that of patients who have not.

BACKGROUND: The aim was to carry out the first voxel-based morphometry study of grey matter changes in the whole brain in schizophrenia associated with a history of seriously and violently offending. METHODS: Structural cerebral magnetic resonance imaging scans of 26 patients with schizophrenia were analyzed using voxel-based morphometry: 13 of the patients had seriously and violently offended directly as a result of schizophrenia prior to admission, the offences consisting of homicide, attempted murder or wounding with intent to cause grievous bodily harm; the other 13 patients did not have a history of violence. There was no history of comorbid psychoactive substance misuse disorder in any of the patients. Voxelwise generalized linear modelling was applied to the processed magnetic resonance data using permutation-based non-parametric testing, forming clusters at t > 2.3 and testing clusters for significance at p < 0.05, corrected for multiple comparisons across space. RESULTS: The two groups of patients were matched with respect to age, gender and duration of illness, but the group with a history of serious violence was on average receiving a higher dose of antipsychotic medication than the group without a history of violence. There were local regions of reduced grey matter volume in the schizophrenia patient group with a history of serious and violent offending, compared with the schizophrenia patient group without such a history. Significant voxels (p < 0.05, corrected for multiple comparisons) were noted bilaterally in the cerebellum and in BA 39 and 40. CONCLUSION: These regions are important in verbal working memory. The cerebellum may integrate inputs from ventrolateral prefrontal cortex and parietal regions, providing a corrective signal that refines the process of rehearing the contents of the phonological store. A strong connection has been hypothesized between the supramarginal region corresponding to BA 39/40 and Broca's area, which may correspond largely to the arcuate fasciculus, with the connectional pattern of the language regions of this model fitting the network of parietotemporal-prefrontal connections that participate in working memory. Therefore our results point to the possibility of an abnormality in neural circuits involved in verbal working memory in this group of patients.

Brain cell membrane motion-restricted phospholipids in patients with schizophrenia who have seriously and dangerously violently offended.

This study directly assessed, for the first time, whether there was a change in brain cell motion-restricted membrane phospholipids in vivo in male forensic patients with schizophrenia who had seriously and violently offended (homicide, attempted murder, or wounding with intent to cause grievous bodily harm) while psychotic, by quantification of the broadband resonance signal from 31-phosphorus neurospectroscopy scans. Cerebral 31-phosphorus magnetic resonance spectroscopy was carried out in 15 such patients, who suffered from positive symptoms of schizophrenia, and in 12 age- and sex-matched normal control subjects. Spectra were obtained from 70 x 70 x 70 mm(3) voxels using an image-selected in vivo spectroscopy pulse sequence. There was no significant difference in the broad resonances between the two groups, with the mean (standard error) percentage broadband signal for the patients being 57.8 (5.6) and that for the control subjects 57.7 (6.0). The phosphomonoesters and phosphodiesters narrow signals also did not differ between the groups. These results suggest that patients with schizophrenia who have predominantly positive symptoms may not show neuroimaging-based signs compatible with the membrane phospholipid hypothesis of schizophrenia.

Carcinoma de células renales: tamaño tumoral como factor pronóstico / Renal cell carcinoma: tumor size like factor prognosis

El objetivo de este trabajo fue analizar nuestra serie y establecer factores pronósticos en el carcinoma de células renales.Se realizó un estudio retrospectivo de todos los casos de carcinoma de células renales operados en el Servicio de Urología del Hospital Militar de Santiago, entre los años 1983 y abril de 2002.Se revisaron las fichas de 157 pacientes con diagnóstico de carcinoma renal. La edad promedio fue de 62,5 años (r 30-91), 64 porciento fueron hombres (101 pac). 42 porciento tuvieron una presentación incidental. En 137 pacientes se efectuó nefrectomía radical, parcial en 15 pac. y en un paciente una ligadura de uréter alto.En 4 ocasiones se realizó, en el mismo tiempo quirúrgico, una nefrectomía radical más nefrectomía parcialen el lado contralateral. El tamaño tumoral promedio fue de 5,9 cm (r 2-14). El 33 porciento tuvo un tamaño tumoral menor o igual a 40 mm.En estadío I se encontraron 90 pacientes, 19 en estadío II, 43 en estadío III y 5 en estadío IV. El seguimiento actuarial promedio fue de 76,2 meses (r 1-212).La sobrevida a 5 años fue: 97 porciento estadío I, 89 porciento estadío II, 79 porciento estadío III y 40 porciento estadío IV. Los pacientes>60 años y los tumores >4 cm presentaron menor sobrevida.Los tumores de bajo estadío, <4 cm, y pacientes menores de 60 años tienen mejor pronóstico en cuanto a la sobrevida global.

Papiloma vesical invertido / Inverted bladder papilloma

Se presenta un caso de papiloma vesical invertido tratado por resección endoscópica, señalándose las características histológicas típicas y el comportamiento clínico benigno de este tipo de patología que mejor pudiera denominarse adeno urotelioma de Von Brunn