Uso del antígeno prostático específico en atención primaria (PSA) / Use of prostatic specific antigen in primary care (PSA)

Introducción. En la literatura publicada queda demostrado que el uso del PSA es incorrecto en ocasiones, solicitando este marcador en varones muy jóvenes o muy ancianos, y repitiendo determinaciones en cortos periodos de tiempo. El objetivo principal de este trabajo ha sido describir la utilización del PSA en la práctica diaria por parte de los médicos de atención primaria de nuestra área, tratando aspectos como la importancia de la edad de los pacientes, el valor en el cribado del cáncer de próstata, o las creencias subjetivas sobre su utilidad. Como objetivo secundario se ha comparado el uso y las creencias entre los médicos que dicen conocer bien el PSA y los que no. Pacientes y métodos. Estudio descriptivo y comparativo llevado a cabo mediante cuestionarios que fueron administrados en mano a los médicos de atención primaria de todos los centros de salud de nuestra área. Se realizó un análisis descriptivo y se compararon los porcentajes de respuestas entre los médicos que creían tener suficiente información sobre el PSA y los que no mediante un test Chi-cuadrado. Resultados. Se recibieron cuestionarios de 103 profesionales. Un 83,5% afirmaba tener suficiente conocimiento sobre el PSA. Los profesionales de este último grupo solicitan PSA a edades más tempranas (p=0,029), con una mayor frecuencia (p=0,011) y dudan más sobre su utilidad (p=0,009) que aquellos con menor conocimiento. Un 49,5% decía solicitar al año menos de 50 determinaciones, y un 33% entre 50 y 100. Un 53,4% de los médicos no pediría el primer PSA hasta la década de los 50, y hasta un 49% lo solicita hasta los 80 años. Un 64,1% se ha planteado muchas veces la verdadera utilidad del PSA, y un 29,1% cree que es poco útil para diagnosticar cáncer. Conclusiones. En nuestro estudio, el 64% de los médicos de atención primaria se ha planteado bastantes veces la verdadera utilidad del PSA, y un 29% cree que es poco útil para el diagnóstico del cáncer de próstata. Además, algunos datos apuntan a un uso limitado del mismo, como el hecho de que el 50% realizan menos de 50 peticiones de PSA anuales, o que un 28% de los profesionales no lo solicitarían nunca en un varón sin sintomatología urinaria. En el presente trabajo se ha observado que aquellos profesionales que afirman no tener suficiente información sobre el PSA realizan más peticiones en pacientes con edades tardías y se plantean menos la utilidad o el rendimiento del marcador (AU)

Introduction. In the literature it is shown that the use of PSA is occasionally wrong, by requesting this marker in very young or very old men, and repeated measurements in short periods of time. The main objective of this study was to describe the use of PSA in daily practice by primary care physicians in our area, dealing with aspects such as the importance of patient age, the value in the screening for prostate cancer, or the subjective beliefs about its usefulness. A secondary objective was the comparison of use, and beliefs among doctors who claim to know PSA well, and those who do not. Patients and methods. A descriptive and comparative study was conducted using questionnaires that were handed to primary care doctors in all health centres in our area. A descriptive analysis was performed and response rates among doctors who thought they had enough information about PSA, and those who did not, were compared using the Chi-squared test. Results. A total of 103 questionnaires were received from the physicians, with 83.5% claiming to have sufficient knowledge about the PSA. The professionals in this latter group request PSA at an earlier age (P=.029), with a higher frequency (P=.011) and have more doubts about its usefulness (P=.009) than those with less knowledge. Almost half (49.5%) said they request less than 50 determinations per year, and 33% between 50 and 100. More than half (53.4%) of doctors would not request the first PSA on a patient until their 50s, and up to 49% request it up to 80 years. The true value of PSA has been established many times by 64.1% of requesters, and 29.1% believe it is unhelpful in the diagnosis of cancer. Conclusions. In our study, 64% of primary care physicians have considered the true value of the PSA several times, and 29% believe it to be of little use in the diagnosis of prostate cancer. In addition, some data suggest it has limited use due to the fact that 50% made less than 50 PSA requests per years, and 28% of the professionals would never request it on a male without urinary symptoms. In this study, it has been observed that those professionals who claim not to have enough information about the PSA make more requests in patients of an older age, and consider that it is of limited use as a marker (AU)

[Use of prostatic specific antigen in primary care (PSA)]. / Uso del antígeno prostático específico en atención primaria (PSA).

INTRODUCTION: In the literature it is shown that the use of PSA is occasionally wrong, by requesting this marker in very young or very old men, and repeated measurements in short periods of time. The main objective of this study was to describe the use of PSA in daily practice by primary care physicians in our area, dealing with aspects such as the importance of patient age, the value in the screening for prostate cancer, or the subjective beliefs about its usefulness. A secondary objective was the comparison of use, and beliefs among doctors who claim to know PSA well, and those who do not. PATIENTS AND METHODS: A descriptive and comparative study was conducted using questionnaires that were handed to primary care doctors in all health centres in our area. A descriptive analysis was performed and response rates among doctors who thought they had enough information about PSA, and those who did not, were compared using the Chi-squared test. RESULTS: A total of 103 questionnaires were received from the physicians, with 83.5% claiming to have sufficient knowledge about the PSA. The professionals in this latter group request PSA at an earlier age (P=.029), with a higher frequency (P=.011) and have more doubts about its usefulness (P=.009) than those with less knowledge. Almost half (49.5%) said they request less than 50 determinations per year, and 33% between 50 and 100. More than half (53.4%) of doctors would not request the first PSA on a patient until their 50s, and up to 49% request it up to 80 years. The true value of PSA has been established many times by 64.1% of requesters, and 29.1% believe it is unhelpful in the diagnosis of cancer. CONCLUSIONS: In our study, 64% of primary care physicians have considered the true value of the PSA several times, and 29% believe it to be of little use in the diagnosis of prostate cancer. In addition, some data suggest it has limited use due to the fact that 50% made less than 50 PSA requests per years, and 28% of the professionals would never request it on a male without urinary symptoms. In this study, it has been observed that those professionals who claim not to have enough information about the PSA make more requests in patients of an older age, and consider that it is of limited use as a marker.

[Retroperitoneal germ cell tumor]. / Tumor de células germinales retroperitoneal.

We report a case of retroperitoneal extragonadal germ-cell tumor in an 17 years old patient who presented with aedema and pain in left inferior extremity asociated with hemopthysis caused by pulmonar metastasis, who was treated with chemotherapy and resection of residual mass and pulmonary nodes. Dyagnosis was stableshed by fine neadle aspiration biopsy of the wass. We comment on the difficult of stableshing differential dyagnosis between retroperitoneal extragonadal germ-cell tumor and metastasis of a testicular tumor. Dyagnosis is stableshed by the finding of a histologically malignant germ-cell tumor with normal testis. We considered physical examination and ecographyc exploration enough for a correct dyagnosis.

[Peptic stenoses of the esophagus]. / Estenosis pépticas del esófago.

The authors present a series of 32 cases of reflux peptic strictures of the esophagus. The mean age of the patients is 54 years, with a 3/1 predominance of males. The etiologic antecedent was hiatal hernia in every case, with a clinical time of evolution of 29 months, dysphagia being the most frequent symptom (100%). Complementary diagnosis was based fundamentally on endoscopy and barium transit, explorations that also allow exclusion of other pathologies. All the patients underwent medical treatment, this being the only treatment in 4 cases. The other 28 cases were treated surgically. The technique used was, in the cases in which the esophagus could be dilated, dilatation associated with an antireflux technique, and when not dilatable, resection with reconstruction using stomach (Sweet) or colonoplasty. The global mortality was two patients (5.2%). Patients were followed-up for a minimum of 2 years and the global results have been good, with recurrence in 3 cases (7.7%). Postoperative dysphagia appeared in 17 cases (44.7%), in all of the transitory.