ABSTRACT
Objetivo: analizar los registros de sospechas de efectos adversos (EA) de las vacunas frente al SARSCoV-2 administradas a farmacéuticos comunitarios (FC) y personal auxiliar.Métodos. Diseño: estudio observacional transversal, en febrero-abril de 2021. Sujetos: farmacéuticos, técnicos y auxiliares de la provincia de Pontevedra que ejercen en contacto con los pacientes, vacunados con la primera dosis frente al SARS-CoV-2.Variables: número, tipo y frecuencia de EA, características demográficas.Procedimiento: se habilitó un formulario en la web del Colegio de Farmacéuticos de Pontevedra. Se anunció a los FC colegiados de la provincia su existencia y la conveniencia de cumplimentarlo.Resultados: 167 participantes, de los que 153 manifestaron síntomas compatibles con reactividad a la vacuna, 122 (93,1 %) mujeres y 31 (86,1 %) hombres. 146 (95,4 %) habían recibido Vaxzevria®, 116(79,4 %) mujeres y 30 (20,6 %) hombres, y 7 (4,6 %) Comirnaty®, 6 (85,7 %) mujeres y 1 (14,3 %) hombre. Se comunicaron 823 EA, 811 (5,3 DE=2,8 EA, 0-12 por paciente) con Vaxzevria® y 12 (0,9 DE=1,0 EA, 0-3 por paciente) con Comirnaty®. EA más frecuentes: dolor en punto de inyección, 128 (87,7 %); escalofríos, 107 (73,3 %); dolor muscular, 106 (72,6 %). En los tres casos, mayor proporción de mujeres (p<0,01). El número máximo de EA manifestados por un participante fue 12. 132 (86,3 %) vacunados que refirieron EA, 106 (86,9 %) mujeres y 26 (83,9 %) hombres, necesitaron medicamentos para aliviar los síntomas. 77 (46,1 %) no pudieron desarrollar sus actividades diarias y 47 (28,1 %) no pudieron trabajar el día siguiente. Conclusiones: el número de EA comunicados por farmacéuticos y personal auxiliar vacunados fue alto. Aunque no fueron graves, afectaron de manera considerable a su actividad diaria y laboral. (AU)
Subject(s)
Humans , Patients , Severe acute respiratory syndrome-related coronavirus , Coronavirus Infections/epidemiology , Pharmacovigilance , Pharmaceutical Preparations , Vaccines , Spain , PharmacistsABSTRACT
Los quistes óseos aneurismáticos (QOA) son tumores benignos, expansivos, osteolíticos y localmente agresivos que se localizan principalmente en la metáfisis de los huesos largos. Aparecen predominantemente en niños y adultos jóvenes. La eliminación del QOA mediante cirugía conlleva altas tasas de recurrencia por lo que se emplean otras técnicas no quirúrgicas como las inyecciones intralesionales con doxiciclina. Se presenta el caso clínico de un niño de 7 años diagnosticado de quiste óseo aneurismático acetabular que fue tratado exitosamente con una dosis de 200 mg de doxiciclina intralesional previa aspiración de las cavidades para despresurizarlas. El paciente mostró reducción de la lesión y mejoría clínica tras la intervención, sin manifestaciones de recurrencia tras 34 semanas de seguimiento. (AU)
Aneurysmal bone cysts (ABCs) are benign, expansile, osteolytic and locally aggressive tumors. Typically, ABCs arise in metaphysis of long bones. They often appear in children and young adults. Wide en bloc resection is associated with high recurrence rates. Other non-surgical treatment methods include intralesional injections of doxycycline. We present the case of a 7-year-old male with acetabular ABC who was successfully treated with 200 mg of intralesional doxycycline. During surgery, one needle was used for aspiration to lower the injection pressure. At 34 weeks follow up, we observed a lesion volume reduction and the patient presented an improvement of symptoms without recurrence. (AU)
Subject(s)
Humans , Male , Child , Bone Cysts, Aneurysmal/drug therapy , Bone Cysts, Aneurysmal/prevention & control , Bone Cysts, Aneurysmal/therapy , Acetabularia , Neoplasms , Doxycycline , RecurrenceSubject(s)
Hemochromatosis Protein/genetics , Hemochromatosis , Hyperferritinemia , Metabolic Syndrome , Alleles , Gene Frequency , Genotype , Humans , Metabolic Syndrome/genetics , MutationABSTRACT
BACKGROUND: Writing a Bachelor thesis is the last step in obtaining a university degree. The thesis may be job- or research-orientated, but it must demonstrate certain degree-level competences. Rubrics are a useful way of unifying the assessment criteria. OBJECTIVES: To design a system of rubrics for assessing the competences associated with the Bachelor thesis of a nursing degree, to examine the system's reliability and validity and to analyse results in relation to the final thesis mark. DESIGN: Cross-sectional and psychometric study conducted between 2012 and 2014. SETTINGS: Nursing degree at a Spanish university. PARTICIPANTS: Twelve tutors who designed the system of rubrics. Students (nâ¯=â¯76) who wrote their Bachelor thesis during the 2013-2014 academic year. METHODS: After deciding which aspects would be assessed, who would assess them and when, the tutors developed seven rubrics (drafting process, assessment of the written thesis by the supervisor and by a panel, student self-assessment, peer assessment, tutor evaluation of the peer assessment and panel assessment of the viva). We analysed the reliability (inter-rater and internal consistency) and validity (convergent and discriminant) of the rubrics, and also the relationship between the competences assessed and the final thesis mark. RESULTS: All the rubrics had internal consistency coefficients >0.80. The rubric for oral communication skills (viva) yielded inter-rater reliability of 0.95. Factor analysis indicated a unidimensional structure for all but one of the rubrics, the exception being the rubric for peer assessment, which had a two-factor structure. The main competences associated with a good quality Bachelor thesis were written communication skills and the ability to work independently. CONCLUSION: The assessment system based on seven rubrics is shown to be valid and reliable. Writing a Bachelor thesis requires a range of degree-level competences and it offers nursing students the opportunity to develop their evidence-based practice skills.
Subject(s)
Academic Dissertations as Topic , Clinical Competence , Educational Measurement/methods , Psychometrics/methods , Students, Nursing , Cross-Sectional Studies , Education, Nursing, Baccalaureate , Female , Humans , Male , Reproducibility of Results , Spain , Surveys and QuestionnairesABSTRACT
Two new HLA class I alleles, HLA-A*11:01:01:04 and HLA-B*35:330, were characterized in a Spanish patient.
Subject(s)
Alleles , HLA-A11 Antigen/genetics , HLA-B35 Antigen/genetics , Polymorphism, Single Nucleotide , Tissue Donors , Amino Acid Substitution , Base Sequence , Cloning, Molecular , Codon/chemistry , Exons , Gene Expression , Genotype , HLA-A11 Antigen/immunology , HLA-B35 Antigen/immunology , Hematopoietic Stem Cell Transplantation , Heterozygote , Histocompatibility Testing , Humans , Introns , Multiple Myeloma/genetics , Multiple Myeloma/immunology , Multiple Myeloma/pathology , Multiple Myeloma/therapy , Polymerase Chain Reaction , Sequence Alignment , Sequence Analysis, DNA , Siblings , SpainABSTRACT
An important factor affecting the success in the setting of related haploidentical hematopoietic stem cell transplantation (HSCT) is the graft-versus-leukemia effect mediated by natural killer (NK) cells when the donor displays NK alloreactivity versus the recipient. NK cell function is regulated by killer immunoglobulin-like receptors (KIR) and it has been described that donor KIR genotype influences transplantation outcome. This has led to a requirement of laboratories to have a quality assurance program for validation and control of their KIR genotyping methods. The goal of the 1st and 2nd Spanish KIR Genotyping Workshops was to provide an external proficiency testing program in KIR genotyping for Spanish immunology and transplant laboratories. These workshops were conducted during the years 2014-2016 and consisted of 17 participating laboratories typing a set of 20 samples. The presence/absence of 16 mandatory KIR loci (2DL1, 2DL2, 2DL3, 2DL4, 2DL5, 2DS1, 2DS2, 2DS3, 2DS4, 2DS5, 2DP1, 3DL1, 3DL2, 3DL3, 3DS1, and 3DP1) was evaluated per sample. Methods for KIR genotyping included polymerase chain reaction with the use of sequence-specific primers and sequence-specific oligoprobes. Consensus typing was reached in all samples, and the performance of laboratories in external proficiency testing was satisfactory in all cases. The polymorphism detected in the small sample studied in both workshops is indicative of an ample variety of KIR gene profiles in the Spanish population.
Subject(s)
Donor Selection/methods , Hematopoietic Stem Cell Transplantation/methods , Receptors, KIR/genetics , Gene Frequency , Genotype , Humans , Killer Cells, Natural/immunology , Polymerase Chain Reaction/methods , Polymorphism, Genetic , Quality ControlABSTRACT
A cohort study of patients included in the Basque Country colorectal cancer (CRC) screening programme was carried out to assess the risk of adenomatous polyps and CRC (P-CRC) associated with HFE gene mutations, with gender and with iron biomarkers (serum ferritin (SF), iron (Fe) and transferrin saturation index (TSI)). Among 432 included patients (mean age 59.8 years), 263 were men (60.9 %) and 169 women (39.1 %). P-CRC were identified in 221 patients (51.2 %) and no polyps (NP) in 211 patients (48.8 %). HFE mutations were identified in 43.8 % of the patients. C282Y/wt genotypic frequency was 6.8 % in the P-CRC group and 1.4 % in the NP group (p < 0.05). The allelic frequency was 3.8 versus 1.2 % (p < 0.05). For laboratory, all three iron biomarkers showed a statistically significant difference: mean Fe, 91.29 ± 34 for P-CRC and 80.81 ± 30.59 for NP group. Mean TSI for P-CRC was 24.95 ± 8.90 and 22.74 ± 8.79 for NP group. Mean SF 308.09 ± 536.32 for P-CRC and 177.55 ± 159.95 for NP group. In a multivariate logistic regression analysis, only male gender (odds ratio (OR) = 2.04, 1.29-3.22), SF (OR = 1.001, 1.0004-1.003) and Fe (OR = 1.01, 1.004-1.02) were related with the presence of CRC and adenoma. Men gender and raised serum iron biomarkers increase the risk of P-CRC.
Subject(s)
Biomarkers, Tumor/genetics , Colorectal Neoplasms/genetics , Histocompatibility Antigens Class I/genetics , Iron/blood , Membrane Proteins/genetics , Adenomatous Polyps/blood , Adenomatous Polyps/genetics , Adenomatous Polyps/pathology , Aged , Biomarkers, Tumor/blood , Colorectal Neoplasms/blood , Colorectal Neoplasms/pathology , Endoscopy , Female , Ferritins/blood , Hemochromatosis Protein , Humans , Male , Middle Aged , Mutation , Sex CharacteristicsABSTRACT
BACKGROUND: The lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) have been proposed to minimize the stage migration phenomenon. The value of the LODDS and LNR staging systems to predict and discriminate prognosis was assessed and compared to the International Union Against Cancer (UICC) TNM classification (pN). METHODS: Three hundred and twenty-six patients with gastric carcinoma were retrospectively studied. Disease-specific survival rates were calculated for every pN, LNR, and LODDS category. RESULTS: Four LNR categories (0, 1-25, 26-75, and >76 %) and four LODDS categories (-5 to -3, > -3 to -1, > -1 to 3, and >3 to 5) were established. In the multivariate analysis, only the stage pT3-4 versus pT1-2 (HR 1.88, 95 % CI 1.11-3.20, p=0.02) and LODDS as continuous variable (HR 1.40, 95 % CI 1.21-1.61, p<0.001) remained as independent prognostic factors. In patients with <16 lymph nodes retrieved, only the LODDS system could discriminate different disease-specific survival curves for every category. LODDS categories were able to discriminate subgroups with different prognoses in pN stages and LNR categories. CONCLUSIONS: The LODDS staging system was superior to the pN classification and LNR system to discriminate risk prognosis especially in patients with an insufficient number of retrieved lymph nodes.
Subject(s)
Lymph Nodes/pathology , Neoplasm Staging , Stomach Neoplasms/diagnosis , Adult , Aged , Aged, 80 and over , Female , Gastrectomy , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Stomach Neoplasms/surgery , Survival RateABSTRACT
Introducción. Las personas con demencia progresiva evolucionan hacia un estado donde los tests neuropsicológicos tradicionales dejan de ser eficaces. La batería de evaluación del deterioro grave, en su forma completa (SIB) y abreviada (SIB-s), se desarrolló para evaluar el estado cognitivo de pacientes con demencia avanzada. Objetivo. Evaluar los atributos psicométricos de la SIB-s en población española. Pacientes y métodos. Estudio transversal de 127 pacientes con demencia (86,6%, mujeres; edad media: 82,6 ± 7,5 años) evaluados con la SIB-s y las siguientes medidas: escala de deterioro global, miniexamen cognitivo (MEC), miniexamen del estado mental grave (sMMSE), índice de Barthel y escala del estado funcional. Resultados. La puntuación media total de la SIB-s fue de 19,1 ± 15,34 (rango: 0-48). Efectos suelo y techo < 20%. El análisis factorial identificó un único factor que explica el 68% de la varianza total de la escala. La consistencia interna fue alta (α de Cronbach: 0,96). La correlación ítem-total corregida osciló entre 0,27 y 0,83, y la homogeneidad de los ítems fue de 0,43. La fiabilidad test-retest e interevaluador fue satisfactoria (coeficiente de correlación intraclase: 0,96 y 0,95, respectivamente), así como la validez de constructo convergente con otras medidas cognitivas (MEC: 0,83; sMMSE: 0,9). La SIB-s mostró una correlación moderada con escalas cognitivas de dependencia funcional (índice de Barthel: 0,48; FAST: 0,74). El error estándar de la medida fue de 3,07 para el total de la escala. Conclusiones. La SIB-s es un instrumento fiable y válido, relativamente breve, para evaluar a pacientes con demencia avanzada en la población española (AU)
Introduction. People with progressive dementia evolve into a state where traditional neuropsychological tests are not effective. Severe Impairment Battery (SIB) and short form (SIB-s) were developed for evaluating the cognitive status in patients with severe dementia. Aim. To evaluate the psychometric attributes of the SIB-s in patients with severe dementia. Patients and methods. 127 institutionalized patients (female: 86.6%; mean age: 82.6 ± 7.5 years-old) with dementia were assessed with the SIB-s, the Global Deterioration Scale (GDS), Mini-Mental State Examination (MMSE), Severe Mini- Mental State Examination (sMMSE), Barthel Index and FAST. Results. SIB-s acceptability, reliability, validity and precision were analyzed. The mean total score for scale was 19.1 ± 15.34 (range: 0-48). Floor effect was 18.1%, only marginally higher than the desirable 15%. Factor analysis identified a single factor explaining 68% of the total variance of the scale. Cronbachs α coefficient was 0.96 and the item-total corrected correlation ranged from 0.27 to 0.83. The item homogeneity value was 0.43. Test-retest and inter-rater reliability for the total score was satisfactory (ICC: 0.96 and 0.95, respectively). The SIB-s showed moderate correlation with functional dependency scales (Barthel Index: 0.48, FAST: 0.74). Standard error of measurement was 3.07 for the total score. Conclusions. The SIB-s is a reliable and valid instrument for evaluating patients with severe dementia in the Spanish population of relatively brief instruments (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Alzheimer Disease/epidemiology , Alzheimer Disease/prevention & control , Dementia/epidemiology , Dementia/prevention & control , Neuropsychological Tests/standards , Psychometrics/methods , Psychometrics/standards , Psychometrics/trends , Research Report/standards , Reproducibility of Results , Reproducibility of Results/methods , Dementia/complications , Dementia/diagnosis , Cross-Sectional Studies/methods , Cross-Sectional Studies , Repertory, Barthel , Cognitive Dissonance , Spain/epidemiologyABSTRACT
INTRODUCTION: People with progressive dementia evolve into a state where traditional neuropsychological tests are not effective. Severe Impairment Battery (SIB) and short form (SIB-s) were developed for evaluating the cognitive status in patients with severe dementia. AIM: To evaluate the psychometric attributes of the SIB-s in patients with severe dementia. PATIENTS AND METHODS: 127 institutionalized patients (female: 86.6%; mean age: 82.6 ± 7.5 years-old) with dementia were assessed with the SIB-s, the Global Deterioration Scale (GDS), Mini-Mental State Examination (MMSE), Severe Mini-Mental State Examination (sMMSE), Barthel Index and FAST. RESULTS: SIB-s acceptability, reliability, validity and precision were analyzed. The mean total score for scale was 19.1 ± 15.34 (range: 0-48). Floor effect was 18.1%, only marginally higher than the desirable 15%. Factor analysis identified a single factor explaining 68% of the total variance of the scale. Cronbach's alpha coefficient was 0.96 and the item-total corrected correlation ranged from 0.27 to 0.83. The item homogeneity value was 0.43. Test-retest and inter-rater reliability for the total score was satisfactory (ICC: 0.96 and 0.95, respectively). The SIB-s showed moderate correlation with functional dependency scales (Barthel Index: 0.48, FAST: -0.74). Standard error of measurement was 3.07 for the total score. CONCLUSIONS: The SIB-s is a reliable and valid instrument for evaluating patients with severe dementia in the Spanish population of relatively brief instruments.
TITLE: Fiabilidad y validez de la bateria de evaluacion del deterioro grave, version abreviada (SIB-s), en pacientes con demencia en España.Introduccion. Las personas con demencia progresiva evolucionan hacia un estado donde los tests neuropsicologicos tradicionales dejan de ser eficaces. La bateria de evaluacion del deterioro grave, en su forma completa (SIB) y abreviada (SIB-s), se desarrollo para evaluar el estado cognitivo de pacientes con demencia avanzada. Objetivo. Evaluar los atributos psicometricos de la SIB-s en poblacion española. Pacientes y metodos. Estudio transversal de 127 pacientes con demencia (86,6%, mujeres; edad media: 82,6 ± 7,5 años) evaluados con la SIB-s y las siguientes medidas: escala de deterioro global, miniexamen cognitivo (MEC), miniexamen del estado mental grave (sMMSE), indice de Barthel y escala del estado funcional. Resultados. La puntuacion media total de la SIB-s fue de 19,1 ± 15,34 (rango: 0-48). Efectos suelo y techo < 20%. El analisis factorial identifico un unico factor que explica el 68% de la varianza total de la escala. La consistencia interna fue alta (alfa de Cronbach: 0,96). La correlacion item-total corregida oscilo entre 0,27 y 0,83, y la homogeneidad de los items fue de 0,43. La fiabilidad test-retest e interevaluador fue satisfactoria (coeficiente de correlacion intraclase: 0,96 y 0,95, respectivamente), asi como la validez de constructo convergente con otras medidas cognitivas (MEC: 0,83; sMMSE: 0,9). La SIB-s mostro una correlacion moderada con escalas cognitivas de dependencia funcional (indice de Barthel: 0,48; FAST: 0,74). El error estandar de la medida fue de 3,07 para el total de la escala. Conclusiones. La SIB-s es un instrumento fiable y valido, relativamente breve, para evaluar a pacientes con demencia avanzada en la poblacion española.
Subject(s)
Dementia/diagnosis , Severity of Illness Index , Aged , Aged, 80 and over , Cross-Sectional Studies , Dementia/psychology , Educational Status , Female , Humans , Language , Male , Observer Variation , Psychometrics , Reproducibility of Results , SpainABSTRACT
BACKGROUND: The optimal system for lymph node (LN) staging in gastric cancer is still a subject of debate. The aim of our study was to analyse the probability of error in negative LN (pN0) gastric carcinomas when a low number of LNs were harvested using a probabilistic model. METHODS: Patients with gastric carcinoma who underwent R0 resection at three university hospitals between 2004 and 2009 were retrospectively included. A Bayesian model was used to analyse the probability of error for negative LNs (pN0) gastric carcinomas. Kaplan-Meier survival curves and the log-rank test were used to compare the overall and specific mortality of prognosis groups. RESULTS: Of the 291 patients included, 123 were classified as pN0 (42%). A significant correlation was found between the extent of the LN dissection performed and the number of the LNs retrieved. According to the Bayesian model the carcinomas with 9 or fewer negative lymph nodes were considered to have a high risk (HR) of misclassification, whereas patients with 10-25 LNs analysed and those with more than 26 negative lymph nodes were considered to have a moderate risk (MR) and low risk (LR), respectively. The log-rank test showed a significant improvement in the disease-specific survival for the MR pN0 (p < 0.001) and LR pN0 (p < 0.04) but not for the HR pN0 patients compared to pN1 patients. CONCLUSIONS: The proposed probabilistic model is clinically useful for differentiating the prognosis in pN0 gastric carcinomas when an insufficient number of negative lymph nodes are retrieved.
Subject(s)
Adenocarcinoma/mortality , Adenocarcinoma/secondary , Lymph Nodes/pathology , Stomach Neoplasms/mortality , Stomach Neoplasms/pathology , Adenocarcinoma/surgery , Adult , Aged , Aged, 80 and over , Bayes Theorem , Cohort Studies , Disease-Free Survival , Female , Gastrectomy/methods , Gastrectomy/mortality , Humans , Kaplan-Meier Estimate , Lymph Node Excision/methods , Lymph Nodes/surgery , Lymphatic Metastasis , Male , Middle Aged , Multivariate Analysis , Neoplasm Invasiveness/pathology , Neoplasm Staging , Prognosis , Retrospective Studies , Risk Assessment , Spain , Statistics, Nonparametric , Stomach Neoplasms/surgery , Survival Analysis , Treatment OutcomeABSTRACT
BACKGROUND: Carotid blow-out syndrome is one of the most devastating complications of head and neck carcinoma. It usually occurs as a post-operative complication or when the tumour compromises the vascular axis. METHODS AND RESULTS: We report two patients who suffered carotid blow-out syndrome but who did not have the usual predisposing factors. Both patients had a pharyngolaryngeal carcinoma that was treated with chemoradiotherapy. Residual non-tumoural ulceration was seen along the lateral wall of the hypopharynx in both cases. This ulceration eventually reached the vascular axis, precipitating carotid rupture and death. CONCLUSION: Residual non-tumoural ulceration of the lateral wall of the hypopharynx after chemoradiotherapy should be considered with the utmost caution. Once persistence of the tumour is excluded, surgery is indicated to protect the vascular axis, in order to prevent carotid blow-out syndrome.
Subject(s)
Carcinoma, Squamous Cell/therapy , Carotid Artery Diseases/etiology , Chemoradiotherapy/adverse effects , Head and Neck Neoplasms/therapy , Laryngeal Neoplasms/complications , Pharyngeal Neoplasms/complications , Carcinoma, Squamous Cell/pathology , Carotid Artery Diseases/pathology , Head and Neck Neoplasms/pathology , Humans , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/therapy , Male , Middle Aged , Pharyngeal Neoplasms/pathology , Pharyngeal Neoplasms/therapy , Squamous Cell Carcinoma of Head and Neck , SyndromeABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Aged, 80 and over , Vitamin D Deficiency/complications , Vitamin D Deficiency/diagnosis , Renal Insufficiency/complications , Hypertension/complications , Vitamin D/therapeutic use , Calcium/therapeutic use , Cholecalciferol/therapeutic use , Vitamin D Deficiency/diet therapy , Vitamin D Deficiency/physiopathologyABSTRACT
We present the case of a 46-year-old woman diagnosed with a primary oesophageal melanoma (PEM), who was treated with radical surgery followed by combined chemoimmunotherapy (interferon, carboplatin, dacarbazine and external radiotherapy) and who achieved a complete response after this treatment. PEMs are rare malignancies, with less than 300 cases described in the literature. The main differential diagnosis is with metastases of skin or ocular malignant melanomas. They are usually diagnosed at advanced stages and prognosis is typically poor. The main treatment modality should be radical surgery. The role of adjuvant treatment is uncertain, although some long responses have been seen with the use of chemotherapy or immunotherapy alongside surgery.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Esophageal Neoplasms/pathology , Esophageal Neoplasms/therapy , Melanoma/pathology , Melanoma/therapy , Adenocarcinoma, Follicular/pathology , Adenocarcinoma, Follicular/surgery , Carboplatin/administration & dosage , Chemotherapy, Adjuvant , Combined Modality Therapy , Dacarbazine/administration & dosage , Esophagectomy , Female , Humans , Hypertension/complications , Immunotherapy/methods , Interferons/administration & dosage , Middle Aged , Neoplasms, Second Primary/pathology , Neoplasms, Second Primary/therapy , Radiotherapy, Adjuvant , Thyroid Neoplasms/pathology , Thyroid Neoplasms/surgeryABSTRACT
Liver retransplantation (LReTx) is the therapeutic option for the irreversible failure of a hepatic graft. Our aim was to evaluate the rate of and indications for LReTx and actuarial patient survivals. Among 1260 LTx were 79 LReTx (6.3%). During the first LTx, there were no apparent differences between patients who did or did not required LReTx. The most frequent reasons were hepatic artery thrombosis (31.6%), recurrence of the VHC cirrhosis (30.4%), and primary graft failure (21.5%). The actuarial survivals at 1 and 5 years were 83% and 69% among those without LReTx versus 71% and 61% among early LReTx, and 64% and 34% among late LReTx (P < .001). Although there exists high morbidity and mortality with LReTx, it seems that this therapeutic alternative continues to be valid for patients with early hepatic loss, but not when the graft loss was late. It becomes necessary to define the minimal acceptable results that patient can benefit from LReTx.
Subject(s)
Liver Transplantation/statistics & numerical data , Reoperation/statistics & numerical data , Thrombosis/surgery , Cohort Studies , Follow-Up Studies , Hepatic Artery/pathology , Hepatitis C/complications , Hepatitis C/surgery , Humans , Kaplan-Meier Estimate , Liver Cirrhosis/mortality , Liver Cirrhosis/surgery , Liver Cirrhosis/virology , Liver Transplantation/mortality , Patient Selection , Recurrence , Survival Analysis , Survivors , Thrombosis/mortality , Time Factors , Treatment FailureABSTRACT
Liver retransplantation (LRT) is the only therapeutic option for the irreversible failure of a hepatic graft. The aim of this study was to evaluate our rate, indications, postoperative morbidity and mortality and patient survival at one and 5 years after LRT. 1,260 liver transplants (LT) were performed between 1991 and 2006, 79 were LRT (6.3%). During the first LT, there were no apparent differences between patients who did or did not require LRT. The most common reasons for LRT were hepatic artery thrombosis (31.6%), recurrence of hepatitis C virus cirrhosis (30.4%) and primary graft non function (21.5%). The actuarial survival rates at one and 5 years were 83% and 69% among those without LRT versus 71% and 61% among those with early LRT, and 64% and 34% among those with late LRT (p < 0.001). Although high morbidity and mortality were associated with LRT, it seems that this therapeutic option is valid for patients with early hepatic loss, although not when the graft loss is late. It becomes necessary to define the minimal acceptable results so that patients can benefit from LRT.
Subject(s)
Liver Transplantation/statistics & numerical data , Reoperation/statistics & numerical data , Adult , Aged , Cadaver , Cause of Death , Cohort Studies , Female , Humans , Liver Transplantation/mortality , Male , Middle Aged , Postoperative Complications/classification , Postoperative Complications/mortality , Reoperation/mortality , Spain , Tissue Donors/statistics & numerical dataABSTRACT
BACKGROUND AND PURPOSE: We performed an observational study that compared baseline and subsequent blood pressure (BP) measurements and its association with haematoma enlargement (HE) in patients with intracerebral haemorrhage (ICH). METHODS: We prospectively studied consecutive patients with supratentorial spontaneous ICH within the first 6 h after the onset of symptoms. HE was defined as an increase >or=33% in the volume of haematoma on the CT obtained 24-48 h after the onset of symptoms as compared with the CT at admission. We recorded systolic BP (SBP), diastolic BP (DBP) and mean BP (MBP) at admission and at 6, 12, 18 and 24 h after onset; the maximum SBP, DBP and MBP during the study period; the maximum SBP and DBP within intervals; the mean of all BP readings; administration of antihypertensive agents. RESULTS: We studied 60 patients whose mean age was 72.1 +/- 11.3 years. HE was observed in 27 (45%) patients. No statistically significant differences were observed in any of the analyses that compared BP parameters between the HE and non-HE groups (two-way anova). CONCLUSIONS: In an exploratory analysis, we did not find an association between BP and HE within the first 24 h after an acute ICH.
Subject(s)
Blood Pressure/physiology , Cerebral Hemorrhage/physiopathology , Cerebrovascular Circulation/physiology , Hematoma/physiopathology , Acute Disease , Aged , Aged, 80 and over , Antihypertensive Agents/therapeutic use , Cerebral Hemorrhage/complications , Cerebral Hemorrhage/diagnostic imaging , Disease Progression , Female , Hematoma/diagnostic imaging , Hematoma/etiology , Homeostasis , Humans , Hypertension/complications , Hypertension/physiopathology , Male , Middle Aged , Prospective Studies , Tomography, X-Ray ComputedABSTRACT
AIM: To study the frequency of HFE gene mutations (C282Y, H63D, S65C) in a group of 54 sporadic PCT patients and in a group of healthy controls (blood donors) from Guipúzcoa, Spain. We studied the association of PCT with HCV, HBV, alcohol abuse, and other established risk factors. METHODS: The analysis of mutations was made by PCR. Allelic and genotypic frequencies were compared. Probability was determined and a Chi-squared test was performed. RESULTS: No association was observed between C282Y mutation and PCT (5.76 vs. 5% in controls). A high H63D mutation frequency was observed in PCT (34.25%) but was not statistically significant (controls 29.31%) because of the high prevalence of this mutation in the Basque general population. The S65C mutation was lower in PCT than in controls. There is a similar presence for H63D heterozygosis in PCT (38.8 vs. 38.8%). HCV association was observed in 35.18% of patients with PCT. HBV infected 7.4% of patients. Heavy alcohol intake (> 60 g/day) was present in 55.55% of patients. No HIV-infected patients were detected. The study of other risk factors revealed only one of the five women with PCT taking estrogens. CONCLUSION: Our results found no relevant role for C282Y and H63D mutations. External factors such as HCV and alcohol could be determinant in the development of PCT in the Basque population.
Subject(s)
Alcoholism/complications , Hepatitis, Viral, Human/complications , Histocompatibility Antigens Class I/genetics , Membrane Proteins/genetics , Porphyria Cutanea Tarda/etiology , Adult , Aged , Female , Hemochromatosis Protein , Humans , Male , Middle Aged , Mutation , Porphyria Cutanea Tarda/genetics , Retrospective Studies , Risk Factors , Spain , Young AdultABSTRACT
INTRODUCTION: Progressive anarthria is defined as a clinical entity with a degenerative origin consisting in progressive difficulty in articulating while grammatical, semantic and graphic aspects of language are preserved. It is included within the group of processes affecting restricted areas of the brain although its exact nosological location is not clear. We report two cases that progressed clinically towards frontotemporal dementia and corticobasal degeneration, respectively. CASE REPORTS: Case 1: a male who, at the age of 72, began with speech difficulties while comprehension and reading/writing skills were preserved. Three years later he developed apathy, bulimia, sexual indiscretions and aggressiveness, with preservation of visual memory, visual-constructional capacity and elementary writing skills. Case 2: a male who, at the age of 70, began with speech disorders, which were associated two years later to generalised slowness with Hoehn and Yahr stage II akinetic-rigid symptoms; another two years later, he developed a dystonic attitude and melokinetic apraxia in the left upper limb. CONCLUSIONS: The two cases, which were initially compatible with progressive anarthria, progressed clinically towards frontotemporal dementia and corticobasal degeneration, which are entities that are included in 'Pick complex'. This is a concept that we believe to be useful from a clinical point of view, given the variability that exists in the histology of the entities that have been proposed as members of this syndrome group, together with the progression of the cases described in the literature and the ones we have reported in this work.
