Responsabilidad profesional médica en embarazo posvasectomía / Medical professional responsibility for postvasectomy pregnancy

Introducción: El seguimiento de los pacientes posvasectomía queda frecuentemente limitado a un seminograma a los 3 meses si se objetiva azoospermia. Este trabajo evalúa una serie de casos de reclamaciones por embarazo posvasectomía, con el objetivo de establecer recomendaciones de seguimiento que aumenten la seguridad clínica y disminuyan el riesgo de reclamaciones. Material y métodos: Se revisó la base de datos del Servicio de Responsabilidad Profesional del Consejo del Colegio de Médicos de Cataluña, localizándose 28 reclamaciones por embarazo posvasectomía entre 1992 y 2011. Se analizaron las variables clínicas y jurídicas de los casos. Resultados: Se registraron 13 reclamaciones extrajudiciales (46,43%), 13 demandas civiles (46,43%) y 2 penales (7,14%). Únicamente en 10 casos constaba la firma de un documento de consentimiento informado específico para vasectomías. En 26 casos se dispuso de los datos correspondientes al espermiograma. En 20 casos (76,92%) se realizó un único espermiograma, en 4 se realizaron 2 (15,38%) y en 2 casos no se realizó ninguno (7,69%). Cuando solo se llevó a cabo un único espermiograma, en 9 casos (45%) este se realizó antes de los 3 meses. En 17 casos (65,38%) el resultado del último espermiograma fue de azoospermia, 3 casos de oligospermia (11,54%), hubo 2 fallos de interpretación del espermiograma (7,69%), 2 de normospermia (7,69%) y en 2 casos no se realizó espermiograma (7,69%). El embarazo se produjo entre los 4 y los 50 meses de la intervención. En 12 casos (42,86%) se consideró que existía responsabilidad profesional. Discusión: Se recomienda enfatizar en la información al paciente la posibilidad de la recanalización espontánea y solicitar 2 espermiogramas con resultado de azoospermia, resultando de riesgo su realización antes de los 3 meses o basar el tiempo de espera en un número de eyaculaciones

Background: The follow-up of patients postvasectomy is frequently limited to a seminogram at 3 months if azoospermia is observed. This study evaluates a series of cases of complaints for postvasectomy pregnancy to establish follow-up recommendations that increase the clinical safety and reduce the risk of complaints. Material and methods: We reviewed the database of the Department of Professional Responsibility of the Council of the College of Physicians of Catalonia, finding 28 complaints for postvasectomy pregnancy between 1992 and 2011. We analysed the clinical and legal variables of the cases. Results: A total of 13 extrajudicial complaints (46.43%), 13 civil lawsuits (46.43%) and 2 criminal lawsuits (7.14%) were recorded. Only 10 cases had a signed document of informed consent specific to vasectomy. In 26 cases, the data from the spermogram was available. A single spermogram was conducted in 20 cases (76.92%), 2 spermograms were conducted in 4 cases (15.38%) and none were performed in 2 cases (7.69%). For 9 of the cases (45%) where only a single spermogram was performed, the test was performed before 3 months postvasectomy. In 17 cases (65.38%), the result of the last spermogram was azoospermia, and 3 cases had oligospermia (11.54%). There were 2 failures of interpretation of the spermogram (7.69%) and 2 of normospermia (7.69%). In 2 cases, a spermogram was not performed (7.69%). Pregnancy occurred between 4 and 50 months after the intervention. In 12 cases (42.86%), it was considered that the practitioner was responsible. Discussion: It is recommended that physicians emphasise (during the patient information stage) the possibility of spontaneous recanalisation and to request 2 spermograms, whose result should be azoospermia. Performing the test in the 3 months after vasectomy is risky, as is basing the waiting time on the number of ejaculations

Medical professional responsibility for postvasectomy pregnancy. / Responsabilidad profesional médica en embarazo posvasectomía.

BACKGROUND: The follow-up of patients postvasectomy is frequently limited to a seminogram at 3months if azoospermia is observed. This study evaluates a series of cases of complaints for postvasectomy pregnancy to establish follow-up recommendations that increase the clinical safety and reduce the risk of complaints. MATERIAL AND METHODS: We reviewed the database of the Department of Professional Responsibility of the Council of the College of Physicians of Catalonia, finding 28 complaints for postvasectomy pregnancy between 1992 and 2011. We analysed the clinical and legal variables of the cases. RESULTS: A total of 13 extrajudicial complaints (46.43%), 13 civil lawsuits (46.43%) and 2 criminal lawsuits (7.14%) were recorded. Only 10 cases had a signed document of informed consent specific to vasectomy. In 26 cases, the data from the spermogram was available. A single spermogram was conducted in 20 cases (76.92%), 2 spermograms were conducted in 4 cases (15.38%) and none were performed in 2 cases (7.69%). For 9 of the cases (45%) where only a single spermogram was performed, the test was performed before 3months postvasectomy. In 17 cases (65.38%), the result of the last spermogram was azoospermia, and 3 cases had oligospermia (11.54%). There were 2 failures of interpretation of the spermogram (7.69%) and 2 of normospermia (7.69%). In 2 cases, a spermogram was not performed (7.69%). Pregnancy occurred between 4 and 50 months after the intervention. In 12 cases (42.86%), it was considered that the practitioner was responsible. DISCUSSION: It is recommended that physicians emphasise (during the patient information stage) the possibility of spontaneous recanalisation and to request 2 spermograms, whose result should be azoospermia. Performing the test in the 3months after vasectomy is risky, as is basing the waiting time on the number of ejaculations.

[Immunohistochemical expression of p53, p21, p16, and cyclin D1 in superficial bladder cancer. A tissue microarray study]. / Expresión inmunohistoquímica de p53, p21, p16 y ciclina D1 en el cáncer de vejiga superficial. Estudio en un soporte de tissue microarray.

INTRODUCTION AND OBJECTIVES: To retrospectively assess the relationship between immunohistochemical expression of p53, p21, p16, and cyclin D1, with recurrence, progression and survival in superficial bladder cancer. METHODS: 163 patients undergoing transurethral resection for superficial bladder cancer between February 1995 and March 2004. Tumor samples were included in a tissue microarray support that was serially sectioned for immunohistochemical staining. Grade and stage associations for each marker were evaluated by the Chi-square test. Assessment of the relationship with recurrence, progression, and survival Kaplan-Meier curves and log-rank test were used. RESULTS: There were no statistically significant differences in marker expression depending on tumor grade and stage, with the exception of Cyclin D1, that was significantly different depending on tumor stage (p=0.030). p21 expression was related to tumor recurrence (p=0.035), progression (p=0.008) and survival (p=0.034). p16 expression was also related to recurrence (p=0.048) and survival (p=0.047), but not to tumor progression (p=0.116). p53 and Cyclin D1 were not statistically associated with tumor recurrence, progression or survival. CONCLUSIONS: In our experience, only p16 and p21 may be useful in the management of superficial bladder tumors, as they are predictors of recurrence and survival in Ta and T1 patients.

Expresión inmunohistoquímica de p53, p21, p16 y Ciclina D1 en el cáncer de vejiga superficial. Estudio en un soporte de tissue microarray / Immunohistochemical expression of P53, P21, P16, and cyclin D1 in superficial Bladder cancer. A tissue microarray study

Introducción y objetivos: Evaluar, de forma retrospectiva, la relación entre la expresión inmunohistoquímica de p53, p21, p16 y ciclina D1, con la recurrencia, progresión tumoral y supervivencia en los carcinomas vesicales superficiales. Métodos: 163 pacientes sometidos a resección transuretral de tumor vesical superficial entre febrero de 1995 y marzo de 2004. Las muestras tumorales evaluadas estaban contenidas en un soporte de tissue microarray, al que se le realizaron varias secciones consecutivas para tinción inmunohistoquímica. La asociación del grado y estadio tumoral con los marcadores se valoró según el test de Chi-cuadrado y para valorar la relación con la recurrencia, progresión y supervivencia se utilizaron las curvas de Kaplan-Meier y se compararon con el log-rank test. Resultados: No se observaron diferencias estadísticamente significativas en la expresión de los marcadores según el grado y estadio tumoral a excepción de la Ciclina D1, que sí mostraba diferencias significativas según el estadio tumoral (p=0,030). La expresión de p21 se relacionó con la recurrencia tumoral (p=0,035), progresión (p=0,008) y supervivencia (p=0,034). La expresión de p16 también se relacionó con la recurrencia (p=0,048) y supervivencia (p=0,047), pero no con la progresión tumoral (p=0,116). La expresión de p53 y ciclina D1 no mostraron asociación estadísticamente significativa con la recurrencia y progresión tumoral ni con la supervivencia. Conclusiones: En nuestra experiencia, sólo los marcadores p16 y p21 pueden ser útiles en el manejo de los tumores vesicales superficiales por ser predictores de recurrencia y supervivencia en pacientes con estadios Ta y T1

Introduction and objectives: To retrospectively assess the relationship between immunohistochemical expression of p53, p21, p16, and cyclin D1, with recurrence, progression and survival in superficial bladder cancer. Methods: 163 patients undergoing transurethral resection for superficial bladder cancer between February 1995 and March 2004. Tumor samples were included in a tissue microarray support that was serially sectioned for immunohistochemical staining. Grade and stage associations for each marker were evaluated by the Chi-square test. Assessment of the relationship with recurrence, progression, and survival Kaplan-Meier curves and log-rank test were used. Results: There were no statistically significant differences in marker expression depending on tumor grade and stage, with the exception of Cyclin D1, that was significantly different depending on tumor stage (p=0.030). p21 expression was related to tumor recurrence (p=0.035), progression (p=0.008) and survival (p=0.034). p16 expression was also related to recurrence (p=0.048) and survival (p=0.047), but not to tumor progression (p=0.116). p53 and Cyclin D1 were not statistically associated with tumor recurrence, progression or survival. Conclusions: In our experience, only p16 and p21 may be useful in the management of superficial bladder tumors, as they are predictors of recurrence and survival in Ta and T1 patients

[Histopathologic validation of the tissue-microarray technology of urothelial cancer. Our experience]. / Validación histopatológica de la tecnología tissue-microarray de cáncer de urotelio. Nuestra experiencia.

INTRODUCTION: The array technology offers: a big advance to clinic and basic investigator, it provides a variety of technics (immunohistochemistry, FISH, proteomics) to understand the molecular mechanisms of cancer. It offers scale economy in reagents versus the conventional methods. Array most be ratified because the sample is so reduced. MATERIAL AND METHODS: 52 consecutive cases have been chosen from paraffin blocks of bladder and ureteral cancer which are 5-7 years old, a tissue array has been made; disks have been arranged in lines and columns, in an aleatory way, in order to guide it's reading. It has been evaluated by a pathologist with any relation to specimen selection. RESULTS: 87 sheets ha been obtained. Number 1 has been dyed with HE. Has been discrepancy in 27% of sample's stage. Has not been a discrepancy in histopathologic diagnostic. There is no sample's representation in 11 points (17%). DISCUSSION: Our results offer good results in sample's validation. The sample's antigenicity of tissue is conserved. Array sample's represent a 97%, similarly to all unit of conventional sections of the specimen.

Validación histopatológica de la tecnología tissue-microarray de cáncer de urotelio. Nuestra experiencia / Histopatological validation of tissue-microarray technology in uroletial cancer. Our experience

INTRODUCCIÓN: La tecnología array ofrece: gran ventaja a los investigadores clínicos y básicos, facilita aplicar gran cantidad de técnicas (inmunohistoquímica, FISH, proteómica) para comprender los mecanismos moleculares del cáncer, ofrece economía de escala en los reactivos versus los procedimientos convencionales. Dado que la representación de la muestra es muy reducida, es exigible previamente validar el array. MATERIAL Y MÉTODOS: A partir de bloques de parafina de carcinomas de urotelio almacenados, cuya antigüedad oscilaba entre 5-7 años, se han seleccionado 52 casos consecutivos; se ha construido un array de tejido; los discos se colocaron en filas y columnas de manera aletoria, dibujando un topograma para guía de lectura. Se validó por otro patólogo ajeno a la selección de las muestras. RESULTADOS: Se han obtenido 87 laminillas. La número 1 se ha teñido con HE. Ha habido discrepancia en el 27% de las muestras en el estadiaje. No ha existido discrepancia en el diagnóstico histológico. En 11 puntos (17%) no hay representación de la muestra. DISCUSIÓN: Nuestros resultados ofrecen unos buenos resultados en la validación de las muestras. La antigenicidad del tejido está conservada. Las muestras seleccionadas en el array representan alrededor del 97%, similar a todo el conjunto de las secciones convencionales de la muestra problema (AU)

INTRODUCTION: The array technology offers: a big advance to clinic and basic investigator, it provides a variety of technics (immunohystochemistry, FISH, proteomics) to undestand the molecular mechanisms of cancer. It offers scale economy in reagents versus the conventional methods. Array most be ratified because the sample is so reduced. MATERIAL AND METHODS: 52 consecutive cases have been cloosen from paraffin blocks of bladder and ureteral cancer which are 5-7 years old, a tissue array has been made; disks have been arranged in lines and columns, in an aleatory way, in order to guide it’s reading. It has been evaluated by a pathologist with any relation to specimen selection. RESULTS: 87 sheets ha been obtained. Number 1 has been dyed with HE. Has been discrepancy in 27% of sample’s stage. Has not been a discrepancy in hystopathologic diagnostic. There is no sample’s representation in 11 points (17%). DISCUSSION: Our results offer good results in sample’s validation. The sample’s antigenicity of tissue is conserved. Array sample’s represent a 97%, similary to all unit of conventional sections of the specimen (AU)