Disfunción tiroidea en mayores de 75 años. Estudio en un colectivo rural no institucionalizado de Guadalajara / Thyroid dysfunction in individuals aged more than 75 years old. Study in a rural, non-institutionalised collective in Guadalajara (Spain)

Objetivos: conocer la prevalencia de distiroidismos en personas muy ancianas de nuestra zona básica de salud y estudiar la utilidad del cribado de esta enfermedad en dicho colectivo. Pacientes y método: estudio descriptivo transversal efectuado en una zona básica de salud semiurbana de la provincia de Guadalajara y en el marco de la atención primaria. Se incluyó una muestra aleatoria de 112 personas > 75 años (n = 490) representativa de este grupo. Tres personas se negaron a participar. En todos los participantes se determinaron las variables antropométricas, el perfil tiroideo (TSH, T4, anticuerpos antitiroideos y antimicrosomales cuando era procedente) , el hemograma y el perfil bioquímico general. Estudiamos la comorbilidad potencialmente relacionada con los distiroidismos. Resultados: la prevalencia de distiroidismos fue del 13,8% (intervalo de confianza del 95%, 7,3-20,3) . El 9,2% era de nuevo diagnóstico y el 4,6% era conocido con anterioridad. En todos los casos se trataba de hipotiroidismos subclínicos. En 8 casos se obtuvieron anticuerpo positivos. Conclusiones: debemos señalar la grandes dificultades para la comparación de las prevalencias con las de otros estudios debido a las enormes diferencias metodológicas. Señalaremos la utilidad del cribado de distiroidismos en este grupo de ancianos

Objectives: to determine the prevalence of thyroid dysfunction in very old people in our Basic Health Area (BCA) and to study the utility of screening for this disease. Patients and method: we performed a descriptive, cross-sectional study in a semiurban BCA in the province of Guadalajara (Spain) . The setting was primary care. A representative sample of 112 persons were selected by random sampling of a population (n = 490) older than 75 years. Three persons refused to participate. In all patients anthropometric variables, thyroid profile (thyroid-stimulating hormone, T4, thyroid antibodies and microsomal antibodies, when necessary) , blood count and general biochemical profile were determined. Comorbidity potentially related to thyroid dysfunction was also analysed. Results: the prevalence of thyroid dysfunction was 13.8% (95% confidence internal 7.3 to 20.3). A total of 9.2% were newly diagnosed and 4.6% were previously diagnosed. All cases of hypothyroidism were was subclinical. Eight patients were antibody positive. Conclusions: comparison with the prevalences reported in other studies is difficult because of wide methodological variability. Screening of thyroid function is useful in persons aged more than 75 years old

[Survival analysis following the addition of temozolomide to surgery and radiotherapy in patients with glioblastoma multiforme]. / Análisis de la supervivencia global al añadir temozolamida al tratamiento quirúrgico y radioterápico en pacientes con glioblastoma multiforme.

OBJECTIVES: To analyze the effect of different therapies -surgery, radiotherapy, and chemotherapy (temozolomide)- on the survival of various groups of patients with glioblastoma multiforme (GBM). METHOD: The overall survival of a total of 85 patients with histopathological diagnosis of GBM was analyzed (descriptive statistics, Kaplan-Meier). Patients were divided into 4 treatment groups: group 1 (n=12), untreated patients (" no treatment" option was chosen by the family); group 2 (n=22), patients undergoing surgery only (retrospective series from the 1980s); group 3 (n=24), patients undergoing surgery + standard radiotherapy (control group, partially effective treatment); group 4 (n=27), patients undergoing surgery + radiotherapy + chemotherapy (temozolomide [TMZ]) (current study group). RESULTS: Mean age (one-way ANOVA) showed no significant difference between the groups. Mean/median survival (weeks) was as follows: group 1, 18/16; group 2, 23/14; group 3, 48/42; group 4, 70/64. The Kaplan-Meier analysis yielded the following 50% survival cutoffs (weeks): group 1, 16.00; group 2, 14.29; group 3, 42.00; group 4, 64.43. This demonstrated a significant difference when radiotherapy (group 3) was added to surgery (group 2) or no treatment (group 1), and a significant difference (p < 0.001) in survival when TMZ (group 4) was added to the so far considered as being the standard treatment (group 3: surgery + radiotherapy). CONCLUSIONS: Surgery alone does not result in a higher survival rate for GBM patients. However, surgery allows to establish a histopathological diagnosis, to improve signs and symptoms which are attributable to intracranial hypertension or tumour topography, and to reduce the number of target cells for adjunctive therapies. Radiotherapy improves survival and TMZ chemotherapy that is given after radiotherapy adds further survival benefit for patients.