Cirugía endoscópica vs. cirugía abierta en pacientes con neoplasias nasosinusales malignas con invasión cerebral. Estudio de serie de casos / Endoscopic versus open surgery in patients with malignant sinonasal tumors and brain invasion. A case series study

Objetivos: Evaluar la efectividad, la seguridad y los costos perioperatorios del abordaje endonasal endoscópico en pacientes con tumores nasosinusales malignos con invasión cerebral. Pacientes y método: Se realizó un estudio observacional de serie de casos. Se compararon 30 pacientes con tumores nasosinusales malignos e invasión cerebral operados (2015-2017) mediante abordaje endoscópico con una serie histórica de 53 casos operados (2010-2015) mediante cirugía abierta. Se utilizó el método de emparejamiento por puntaje de propensión para controlar el efecto de factores pronósticos. Las variables de respuesta primaria fueron el control local y la supervivencia global a los tres años. Se analizaron variables de costo perioperatorio. Resultados: Después del emparejamiento se identificaron 50 pacientes (25 en cada grupo terapéutico) con edad promedio de 55 años, 62% de sexo masculino. Predominó el carcinoma de células escamosas y la invasión cerebral grado II. El control local de la enfermedad a los tres años, la supervivencia global y libre de progresión fueron superiores en el abordaje endoscópico. El abordaje endoscópico redujo el tiempo quirúrgico en 1 hora y 20 minutos y la estadía hospitalaria en 19 días en comparación con la cirugía abierta. El abordaje endoscópico mejoró la independencia funcional y redujo las complicaciones. El ahorro promedio estimado con el abordaje endoscópico fue de aproximadamente $7.355,18 por paciente. Conclusiones: El abordaje endonasal endoscópico constituye un procedimiento seguro, efectivo y más económico en los pacientes con neoplasias nasosinusales malignas e invasión cerebral (AU)

Objectives: To determine the safety, effectiveness and perioperative costs of endonasal endoscopic approach in brain invasive malignant sinonsal tumors patients. Materials and methods: This was a case series bidirectional study; that included 30 brain invasive malignant sinonsal tumors patients treated by endonasal endoscopic approach (2015-2017) and 53 by open surgery (2010-2015). Propensity score matching was used to compensate the prognostic factors; in a sample of 50 patients (25 per group). Primary response variables was local control and 3-years overall survival. Perioperative cost variables were analyzed. Results: A number of 50 patients were included after matching (25 in each therapeutic group). The age average was 55 years and male proportion was 62%. Squamous cell carcinoma and grade II lesions were the most represented in the sample. Endonasal endoscopic approach reduced surgical time in 1 hour 20 minutes, transfusion needs in 5.5 fold and hospitalization in 19 days; in comparison with open technique. Oncologic control based on surgical free margins, local control, overall survival and progression free survival after three years was higher when the resection was performed endoscopically. Functional status was enhanced and complications diminished by using endoscopic approach. Saving was estimated in $7 355.18 per patient. Conclusions: Endonasal endoscopic approach represents a safe, effective and economic procedure in selected patients with malignant sinonasal tumors and brain invasion (AU)

Actualización del tratamiento multimodal para la metástasis cerebral única. Revisión sistemática cualitativa / Update of multimodal treatment for single brain metastasis. Systematic qualitative review

El tratamiento de la Enfermedad Metastásica Cerebral única es paliativo y multimodal desconociéndose con certeza la modalidad o combinación terapéutica óptima. Se planteó como objetivo determinar las diferencias entre la Radioterapia Holocraneal, Radiocirugía, y Resección Quirúrgica en cuanto a la Sobrevida Global, Sobrevida Con Independencia Funcional, Control Local, Muerte Neurológica y Neurocognición en los pacientes con enfermedad metastásica cerebral única con tumor primario controlado. Se realizó un estudio retrospectivo del tipo revisión sistemática cualitativa. Se incluyeron Ensayos Clínicos Aleatorizados que compararon la Cirugía (con o sin Radioterapia Holocraneal), con la Radiocirugía (con o sin Radioterapia Holocraneal) en la Enfermedad Metastásica Cerebral Única independientemente de la localización del tumor primario. La búsqueda encontró inicialmente 971 artículos, de ellos 19 Ensayos Clínicos Aleatorizados. Al aplicar la herramienta de riesgo de sesgos de Cochrane se derivó una muestra de 14 Ensayos Clínicos que presentaron bajo riesgo de sesgos. La combinación de RQ y RTH ofreció mayor SG que la RTH sola. La combinación de RTH y RC ofreció un mejor CL que la RQ y RTH. La combinación de RTH Y RC ofreció un mejor CL y SG que la RTH sola. No se encontraron diferencias significativas entre la RTH y RC versus RC sola. Los resultados en cuanto a la neurocognición y SIF fueron inconsistentes. El tratamiento óptimo de los pacientes con EMC aún no está bien definido constituyendo aún un tema controvertido.

The treatment of Isolated Cerebral Metastatic Disease is both multimodal and palliative. At present, the optimal treatment protocol is unknown. The objective of the present study was to determine outcome differences between Whole Brain Radiotherapy (WBRT), Radiosurgery (RS), and Surgical Resection (SR) or a combination of them, regarding Global Survival, Functional Independent Survival, Local Control, Neurological Death & Cognitive Status in patients with a unique cerebral metastasis and a controlled primary tumor. A retrospective study with a systematic qualitative literature review was performed. Randomized clinical trials comparing surgery (with or without whole brain radiotherapy), disregarding the localization of the primary tumor, were searched, resulting in 971 studies, only 19 of them being randomized. After applying Cochrane´s Risk of Bias Tool, only 14 studies showed a low risk of bias. The combination of SR & WBRT showed a longer survival, while WBRT & RS showed a better local control when compared with SR & WBRT. No statistical differences where found between WBRT & RS versus RS alone. Results regarding Cognitive Status & Functional Independent Survival were inconsistent. The optimal treatment in Isolated Metastatic Cerebral Disease still remains controversial.

[Periodontal treatment needs in an elderly institutionalized Vizcaya population]. / Necesidades de tratamiento periodontal en la población de la tercera edad institucionalizada de Vizcaya.

The aim of this study is guessing the needs of periodontal treatment of the population of elderly, residents in Publics Institutions and Private ones in the province of Vizcaya. A total of 565 patients have been explored, using the Community Periodontal Index of Needs of Treatment (CPITN). After the evaluation of the obtained data, we observe that the 91.70% needs a kind of periodontal treatment, 62.64% need basic treatment, at least in one sextant. 13.58% need an advanced periodontal treatment. The severity of the Periodontal Disease increase in proportion to the age and it's bigger in men. 53.10% of the total of the sample were edentate.

[Oral hygiene program on the left bank of the Nervion: its effect on gingivitis]. / Programa de higiene oral en la margen izquierda del Nervión: su efecto sobre la gingivitis.

The effect of monthly professional tooth clearing over gingivitis, without instructions of oral hygiene, was evaluated in a group of 69 children whose ages were from 6 to 12, in the left side of Nervión. The plaque index, PI, and gingival index GI, were registered in the initial exam, al 6, 12, 18 and 24 months. For the test group, the value of the plaque index in the initial exam was 1.57 and for the control group was 1.64. In totally 20 sessions, to the groups test were applied professional monthly clearing, followed by the "aplicación tópica de fluoruro sódico". After 6 months the study began, the plaque index for the group text was 1.18 and for the control group 1.30. In the same way, the gingival index turned out to be 0.21 for the text and 0.37 for the control. The final results gave a plaque index for the text group of 1.01 and for the control group 1.32 and the gingival index 0.29 for the test group and 0.71 for the control. This leads to the thinking that it's enough for children a monthly dental plaque removal, to prevent the develop of the gingivitis.

[Dental status and treatment needs in a Vizcaya geriatric institutionalized population]. / Estado dental y necesidad de tratamiento en la población geriátrica institucionalizada de Vizcaya.

We have studied the Dental State and the Need of treatment in a population of ancients in a institucionalized regime in the province of Vizcaya. From the 565 studied individual, 300 of the were edentulate and the rest still had remanent pieces in their oral cavity. The CAOD in men was 27,86 and 29,50 in women. On average 2,83 (d.e. 1,15) teeth were pasturing but only 0,14 (d.e. 0,01) obturated teeth. Concerning to the general patology, people affected by insanity had the highest CAOD (30,45)., followed by those with Rheumatism (25,51). It existed a high level dental illness without treatment in the studied sample. The needs of treatment for dental decay were not high didn't require a complex treatment.

[Results of a survey of an elderly institutionalized population. 3. A group of elderly with remaining teeth and denture wearers]. / Resultados de una encuesta en población institucionalizada de la tercera edad. III. Grupo de ancianos con piezas remanentes y portadores de prótesis.

It has been carried out an inquest in a geriatric group in institutionalised regime, classifying people interviewed depending on dental health in three groups: Group I: Edentate ancients bearers of total prosthesis. Group II: Ancients with remanent pieces. Group III: Ancients with remanent pieces and bearers of prosthesis. In the present work, all findings related to oral health are detailed, referred uniquely to group III: Ancients with remanent pieces and bearers of prosthesis. Obtained data let us get to some conclusions we consider must be of general diffusion for trying to understand and to solve the existing disputable in this segment of the population, so long forgotten and marginal.

[Elderly with remaining teeth without dentures]. / Ancianos con piezas remanentes, sin prótesis.

It has been carried out an inquest in a geriatric group in institutionalised regime, classifying people interviewed depending on dental health in three groups: Group I: Edentate ancients bearers of total prosthesis. Group II: Ancients with remanent pieces. Group III: Ancients with remanent pieces and bearers of prosthesis. In the present work, all findings related to oral health are detailed, referred uniquely to group II: "Ancients with permanent pieces". Obtained data let us get to some conclusions we consider must be of general diffusion for trying to understand and to solve the existing disputable in this segment of the population, so long forgotten and marginal.

[Nutrition and oral health in gerodontology]. / Nutrición y salud oral en gerodontología.

Nutrition has got a great influence on oldness phenomena. That is why people of age need to keep a prudent and equilibrated nutrition, what is achieved by a regulated diet. A bad nutrition increases the risk in certain clinic situations and overfeeding can have terrific effects because it may desequilibrated the metabolism. The food of an ancient person requires a special attention: it must be soft and easily chewed. They do not tolerate abundant meals and radical changes on daily diet must be avoided. In the present work we analize the nutrition on an ancient person, its characteristics and nutritional requirements, as good as the nutritional effects on the edentale patient.

[Dental prevention in the geriatric patient]. / Prevención odontológica en el paciente geriátrico.

Dental health depends on the behavior of the individual in a great measure and of the groups. To achieve a general improvement of the situation at this respect is necessary the application of efficient measures of sanitary education . Many obstacles oppose to the adoption of a positive concept of dental health in gerontology, among them it is to emphasize the belief so widespread that dental problems can not be helped and its prevention turns out to be impossible. The aim of preventive gerontology will be the maintenance of dental health. With this, we will contribute to the attainment of the greatest possible level of physical, social and mental health of the elderly.

[Geriatric assistance: an unresolved health problem]. / Asistencia geriátrica: un problema sanitario aún sin resolver.

Although the number of elderly needing health care is increasing in Spain, geriatric patients do not receive enough attention or support when compared to that given in other countries. When the elderly get sick they present peculiar and special problems which should be attended following their needs. Because in hospitals the elderly are cared for in a progressive fashion, geriatrics plays a perfect role in organizing the hospitals and out-patient centers. For the aforementioned, a broad coordination and efficiency within the health centers, units of community social services and the hospital are needed. Geriatric care should be present in the health care system of the government as well as in the private sector.