Evolución de los factores de riesgo cardiovascular entre 2004 y 2009 en la cohorte del estudio del Riesgo de Enfermedad Cardiovascular en Castilla y León (RECCyL) / Trend in cardiovascular risk factors from 2004 to 2009 in the cohort of the Cardiovascular Disease Risk Study in Castilla y León (RECCYL)

INTRODUCCIÓN: Los factores de riesgo cardiovascular (FRCV) se modifican con la edad y las medidas de prevención y control. El objetivo de este estudio es describir la evolución de la hipertensión, diabetes, hipercolesterolemia, obesidad y hábito tabáquico en una cohorte de población de Castilla y León. MATERIAL Y MÉTODOS: En 2004 se inició el estudio RECCyL en personas ≥15 años residentes en Castilla y León con una anamnesis, exploración física y analítica. En 2009 se realizó un nuevo examen de salud a la muestra superviviente. Se calculó la incidencia acumulada en 5 años para cada FRCV en la población libre de ese factor en 2004. RESULTADOS: De la muestra original de 4.013 personas, se estudió en el año 2009 a 2.954. La incidencia de hipertensión en el quinquenio fue de 17,9%, de diabetes 3,9%, de hipercolesterolemia 15,6%, de obesidad 9,1% y de fumadores (nuevos y recaídas) 6,8%. Los nuevos diagnósticos de hipertensión, diabetes y tabaquismo fueron más frecuentes en edades tempranas. La incidencia fue más elevada en hombres para hipertensión, diabetes, hábito tabáquico e hipercolesterolemia (salvo en la cohorte de ≥75). Para la obesidad, la incidencia total fue mayor en las mujeres excepto en cohortes de edad más tempranas. CONCLUSIONES: Las prevalencias de los FRCV (exceptuando el hábito de fumar) han aumentado desde 2004, con desigual intensidad dependiendo del sexo y la edad. Conocer la incidencia y características de los nuevos diagnósticos, principalmente la distribución de la edad de aparición, es extremadamente útil para establecer actividades de prevención y control de los principales FRCV

INTRODUCTION: Cardiovascular risk factors change with age, as well as with the prevention and control measures. The aim of this study is to describe the trend in hypertension, diabetes, hypercholesterolemia, obesity, and smoking in a population cohort from Castilla y León. MATERIAL AND METHODS: In 2004 the RECCyL study began by recordingmedical history, a physical examination, and blood tests in a sample of the population ≥ 15 years old living in the Community of Castilla y León. In 2009 a new health examination was performed on the survivor sample. The cumulative 5-year incidence was calculated for each cardiovascular risk factor in the population that was free of that factor in 2004. RESULTS: From the original sample of 4013 people, 2954 were studied in 2009. Incidence of hypertension in the period was 17.9%, diabetes 3.9%, hypercholesterolemia 15.6%, obesity 9.1%, and smokers (new and relapse) 6.8%. New diagnoses of hypertension, diabetes and smoking were more common in younger ages. The incidence was higher in men for hypertension, diabetes, smoking, and hypercholesterolemia (except in the cohort of ≥75 years). In the case of obesity, the total incidence is higher for women, except in younger age cohorts. CONCLUSIONS: The prevalences of the cardiovascular risk factors (except smoking) have increased since 2004, with variable intensity depending on sex and age. To know the incidence and characteristics of newly diagnosed people, mainly the distribution of age at onset, is very useful to establish prevention and control activities of the principal cardiovascular risk factors

[Factors associated with control of hypertension in the cohort from the study of Cardiovascular Disease Risk in Castilla y León (RECCyL)]. / Factores asociados al control de la presión arterial en la cohorte del estudio del Riesgo de Enfermedad Cardiovascular en Castilla y León (RECCyL).

INTRODUCTION: Cardiovascular diseases and related risk factors suppose a challenge to public health due to the mortality and health costs involved. This study has aimed to assess the blood pressure control in a population cohort and to identify the factors associated with poor control. MATERIAL AND METHODS: A cardiovascular health examination was carried out in a random sample of 4013 individuals aged 15 years and above who were living in Castilla y Leon in 2004. The study included the medical history, physical exam and blood tests. A new health study was performed in 2009, including 2954 people from the initial sample, 1306 of whom were patients with hypertension. Strict blood pressure control was defined as <140/90 mm Hg. Bivariate analysis was performed and odds ratio was calculated by a regression logistic model. RESULTS: Blood pressure levels were above the established levels in 55.9%, without differences between men and women. The regression model showed that diabetes, obesity, smoking habit and previous systolic blood pressure values, with odds ratio of 3.87, 1.58, 1.49 and 1.13 per 5 mm Hg, respectively, are independently associated with uncontrolled blood pressure. Age did not show statistical significance. CONCLUSION: More than half of the patients with hypertension are not well controlled. This study provides information about the characteristics of the patients with poor control of hypertension in Castilla y León, which will allow policy makers to develop new primary and secondary prevention activities.

Factores asociados al control de la presión arterial en la cohorte del estudio del Riesgo de Enfermedad Cardiovascular en Castilla y León (RECCyL) / Factors associated with control of hypertension in the cohort from the study of Cardiovascular Disease Risk in Castilla y León (RECCyL)

Introducción: Las enfermedades cardiovasculares y sus factores de riesgo suponen un reto para la salud pública por la mortalidad y el coste sanitario que conllevan. El objetivo de este estudio es conocer el grado de control de la presión arterial en una cohorte poblacional y determinar los factores asociados al mal control. Material y métodos: En 2004 se llevó a cabo un examen de salud cardiovascular con anamnesis, exploración y analítica básica, en una muestra aleatoria de 4.013 personas ≥15 años residentes en Castilla y León. En 2009 se realizó un nuevo examen de salud a 2.954 personas de la muestra inicial de las que 1.306 tenían hipertensión arterial. Se consideró control estricto si la presión arterial era <140/90. Se realizó análisis bivariante y se calcularon odds ratio en un modelo de regresión logística. Resultados: El 55,9% presentaron valores de presión arterial por encima de los límites establecidos, sin diferencias entre hombres y mujeres. El modelo de regresión mostró que la diabetes, la obesidad, el hábito de fumar y los valores previos de presión arterial sistólica, con odds ratio de 3,87; 1,58; 1,49 y 1,13 por cada 5 mmHg respectivamente, se asociaban de manera independiente con un mal control. La edad no presentaba significación estadística. Conclusión: Más de la mitad de los pacientes con hipertensión arterial no están bien controlados. Este estudio aporta información sobre las características de los pacientes hipertensos de Castilla y León que presentan un mal control, lo que permitirá desarrollar actividades de prevención primaria y secundaria

Introduction: Cardiovascular diseases and related risk factors suppose a challenge to public health due to the mortality and health costs involved. This study has aimed to assess the blood pressure control in a population cohort and to identify the factors associated with poor control. Material and methods: A cardiovascular health examination was carried out in a random sample of 4013 individuals aged 15 years and above who were living in Castilla y Leon in 2004. The study included the medical history, physical exam and blood tests. A new health study was performed in 2009, including 2954 people from the initial sample, 1306 of whom were patients with hypertension. Strict blood pressure control was defined as <140/90 mmHg. Bivariate analysis was performed and odds ratio was calculated by a regression logistic model. Results: Blood pressure levels were above the established levels in 55.9%, without differences between men and women. The regression model showed that diabetes, obesity, smoking habit and previous systolic blood pressure values, with odds ratio of 3.87, 1.58, 1.49 and 1.13 per 5 mmHg, respectively, are independently associated with uncontrolled blood pressure. Age did not show statistical significance. Conclusion: More than half of the patients with hypertension are not well controlled. This study provides information about the characteristics of the patients with poor control of hypertension in Castilla y León, which will allow policy makers to develop new primary and secondary prevention activities

Sentinel node disection in the treatment of early stages of vulvar cancer.

OBJECTIVES: To assess the results of sentinel lymph node (SLN) detection in the initial stages of vulvar cancer and the recurrences that may appear. STUDY DESIGN: 76 patients with vulvar carcinoma, Stage I and II. Between 2000 and 2010, identification of the SLN was performed with a perilesional injection of Tc99m and vital dye. Ninety sentinel lymph nodes were found. They were removed separately, and lymphadenectomy was performed depending on the involved areas. Vulvar tumour was also removed. RESULTS: 76 patients were included in the study; 20 (22.22%) out of 90 SLNs presented metastases and 70 (77.77%) did not. There were no false negatives, and the sensitivity and negative predictive value reached 100%. Thirty-six months after treatment, one patient presented recurrence with a negative SLN, and two with positive SLNs. CONCLUSION: Biopsy of the SLN is a reasonable alternative to lymphadenectomy in patients with vulvar cancer Stage I and II.

[Study of the nutritional status of elders in Cantabria]. / Estudio del estado nutricional de los ancianos de Cantabria.

INTRODUCTION: Population ageing is a main concern under the biosanitary point of view. AIM: To assess the nutritional status of people 65 year-old and older in Cantabria (Spain) METHOD: A total of 1605 persons were studied by means of the MNA (Mini Nutritional Assessment); a) by primary care (59.9% in the unit, and 4.7% at home) and, b) in nursing homes (35.4%). RESULTS: Nutritional score (NS) was 23.4 ± 4.1 for women and 24.4 ± 4 in males (p < 0.001). We emphasize the fact that 22.3% of people studied in the nursing homes were malnourished or at risk of malnutrition, compared with 14.2% of those studied at the unit, and only 3.3% of the home visited elders. The correlation between the value of the NS and the subjective estimation of nutrition status showed a high value (0.65). We emphasize the negative correlation (-0.53) between BNI value and the incidence of skin lesions. CONCLUSION: Our results highlight the importance of identifying malnutrition or its risk in elders in order to prevent the negative consequences of this deficiency.

Estudio del estado nutricional de los ancianos de Cantabria / Study of the nutritional status of elders in Cantabria

Introducción: El envejecimiento de la población representa uno de los retos más importantes desde el punto de vista biosanitario Objetivo: Valorar el estado nutricional de las personas de 65 y más años de Cantabria. Métodos: Un total de 1605 personas fueron evaluadas por medio del MNA; a) en atención primaria (59,9% en la consulta y 4,7% en domicilios) y, b) en residencias de ancianos (35,4%).Resultados: La puntuación nutricional (PN) obtenida de la suma de los ítems del MNA fue 23,4 ± 4,1 para las mujeres y 24,4 ± 4 en los varones (p < 0,001). Destaca el hecho de que el 22,3% de las personas estudiadas en residencias está malnutrida o en riesgo de malnutrición, frente al 14,2% de las que acuden a consulta, y sólo el3,3% de las estudiadas en su domicilio. La correlación entre los valores de la PN y la apreciación subjetiva del estado de nutrición mostró un valor elevado (0,65). Destacamos la correlación negativa (-0,53) entre los valores del IMC y la incidencia de lesiones cutáneas. Conclusiones: Nuestros resultados indican la importancia de la identificación de la desnutrición o su riesgo, en personas mayores, por las consecuencias negativas que presenta este estado carencial (AU)

Introduction: Population ageing is a main concern under the biosanitary point of view. Aim: To assess the nutritional status of people 65 year old and older in Cantabria (Spain) Method: A total of 1605 persons were studied by means of the MNA (Mini Nutritional Assessment); a) by primary care (59.9% in the unit, and 4.7% at home) and, b) in nursing homes (35.4%).Results: Nutritional score (NS) was 23.4 ± 4.1 for women and 24.4 ± 4 in males (p < 0.001). We emphasize the fact that 22.3% of people studied in the nursing homes were malnourished or at risk of malnutrition, compared with 14.2% of those studied at the unit, and only 3.3% of the home visited elders. The correlation between the value of the NS and the subjective estimation of nutrition status showed a high value (0.65).We emphasize the negative correlation (-0.53) between BNI value and the incidence of skin lesions. Conclusion: Our results highlight the importance of identifying malnutrition or its risk in elders in order to prevent the negative consequences of this deficiency (AU)

Prognosis factors in cancer of the vulva.

A series of factors and its possible influence on the prognosis of cancer of the vulva are analyzed. In the present study 71 patients were studied. We have been able to establish that the main prognosis factor of cancer of the vulva is, beyond doubt, the presence of lymph node metastasis, since in absence of lymph node affection due to the cancer, survival was 100%, after five years, in those patients having positive lymph nodes, survival was 92.5% after the first year, 82.5% after three years and 70% after five years.

[Continuous infusion of epidural morphine to relieve postoperative pain. Protocol and results]. / Infusión continua de morfina epidural para alivio del dolor postoperatorio. Protocolo y resultados.

We have evaluated the efficaciousness and side effects of continuous administration of morphine by lumbar epidural route for relieving postoperative pain in major surgery of the abdomen and orthopedic surgery. Lumbar epidural catheters were placed to 25 patients (mean age, 52 years) before induction of general anesthesia. All patients received a 4 mg bolus dose of morphine sulfate 1 hour before finalization of general anesthesia and subsequently they were placed on a continuous infusion of morphine sulfate at 0.3-1 mg/h. All patients achieved analgesia which maintained then pain-free and allowed early ambulation and initiation of active respiratory physiotherapy. Duration of continuous analgesia varied from 3 to 5 days. No patient presented respiratory depression; four presented nausea and eight had urinary retention. We believe that continuous epidural infusion of morphine is efficacious and safe for the treatment of acute postoperative pain in patients undergoing abdomen major surgery and orthopedic surgery.

El cierre del colon con sutura mecánica: uso del instrumento TA 55 / Colonic closure with a mechanical suture using the TA 55 instrument

Se presenta una corta serie de cierre de colostomías laterales y colotomía (13 casos), efectuados con el aparato de sutura lineal TA 55. Los casos corresponden a 10 colostomías transversas y una sigmoide, y a dos colotomías. Las causas de las aberturas colónicas fueron traumatismos, cánceres, enfermedad diverticular y adenomas. Se señala la selección de pacientes en cuanto a colostomías pequeñas y no complicadas. Se describe la técnica empleada. En todos los casos se utilizó el aparato TA 55 que brindó una sutura hermética evertida; no se efectuó segundo plano de sutura. Las complicaciones fueron dos casos con supuración de escasa magnitud. Se comenta la utilidad del método y la limitación de su empleo por el costo actual.

El cierre del colon con sutura mecánica: uso del instrumento TA 55 / Colonic closure with a mechanical suture using the TA 55 instrument

Se presenta una corta serie de cierre de colostomías laterales y colotomía (13 casos), efectuados con el aparato de sutura lineal TA 55. Los casos corresponden a 10 colostomías transversas y una sigmoide, y a dos colotomías. Las causas de las aberturas colónicas fueron traumatismos, cánceres, enfermedad diverticular y adenomas. Se señala la selección de pacientes en cuanto a colostomías pequeñas y no complicadas. Se describe la técnica empleada. En todos los casos se utilizó el aparato TA 55 que brindó una sutura hermética evertida; no se efectuó segundo plano de sutura. Las complicaciones fueron dos casos con supuración de escasa magnitud. Se comenta la utilidad del método y la limitación de su empleo por el costo actual.(AU)

Cáncer de ano / Cancer of the anus

Se presenta nuestra experiencia con 21 casos de cáncer de ano. Se establecen consideraciones anatómicas, histológicas y patológicas de la afección. Se describen la incidencia, localización y tratamiento efectuado y los resultados alejados y sobrevida a 5 años. El cáncer de ano se beneficia con nuevos elementos diagnósticos y terapéuticos, lo que se traduce en un importante incremento de los índices de curación en las estadísticas actuales

Cáncer de ano / Cancer of the anus

Se presenta nuestra experiencia con 21 casos de cáncer de ano. Se establecen consideraciones anatómicas, histológicas y patológicas de la afección. Se describen la incidencia, localización y tratamiento efectuado y los resultados alejados y sobrevida a 5 años. El cáncer de ano se beneficia con nuevos elementos diagnósticos y terapéuticos, lo que se traduce en un importante incremento de los índices de curación en las estadísticas actuales (AU)