[What do MRI and CT scan provide us in patients with vertigo and dizziness? A cost-utility analysis]. / Que aporta la neuroimagen en pacientes con vertigo y mareo? Analisis coste-utilidad.

INTRODUCTION: Vertigo and dizziness are symptoms with a significant burden in the hospital and involve several specialties. There are few guidelines of radiological tests for these symptoms. AIMS: To know which profile of patients with vertigo and dizziness has neuroimaging tests, quantify and describe the radiological findings. To analyze the cost-utility of CT and MRI in the study of these patients. PATIENTS AND METHODS: Descriptive study, we selected patients referred to the hospital for vertigo and dizziness. We analyze demographic and clinical characteristics and quantify the neuroimaging tests requested. We describe the radiological findings, assess their relevance in the diagnosis and detail the cost-benefit. RESULTS: We identified 493 patients, those with neuroimaging test (60%) are older, depressed and frequented the emergency department because of vertigo. The most requested test was the cranial CT scan (5% identifies the cause of the symptom). MRI of the inner ear and cerebellopontine angle was the test that presented the most significant findings (17.7%). The 286 image tests requested for vertigo cost 56,741 euros. The cost for a positive test was 1,576 euros. CONCLUSIONS: A large number of head CT and MRI are made in patients with vertigo and dizziness. A clinical suspicion is recommended from the anamnesis and exploration to make a good selection of test to request. In more than 90% of cases, radiological findings are not shown in relation to vertigo.

TITLE: Que aporta la neuroimagen en pacientes con vertigo y mareo? Analisis coste-utilidad.Introduccion. Vertigo y mareo son sintomas que suponen una carga significativa en el hospital e involucran a varias especialidades. Existen pocas guias sobre la solicitud de pruebas radiologicas ante estos sintomas. Objetivos. Conocer que perfil de pacientes con vertigo y mareo tiene realizadas pruebas de neuroimagen, cuantificar y describir los hallazgos radiologicos, y analizar el coste-utilidad de la tomografia computarizada (TC) y la resonancia magnetica (RM) en pacientes con estos sintomas. Pacientes y metodos. Estudio descriptivo en el que se seleccionan pacientes remitidos al hospital por vertigo y mareo. Se analizan caracteristicas demograficas y clinicas y se cuantifican las pruebas de neuroimagen solicitadas. Se describen los hallazgos radiologicos, se valora su relevancia en el diagnostico y se detalla el coste. Resultados. Se identifica a 493 pacientes, el 60% tiene realizada una prueba de neuroimagen; son pacientes de mas edad, depresivos y que han acudido a urgencias por vertigo. La prueba mas realizada fue la TC de craneo sin contraste (el 5% identifica la causa del sintoma). La que presento mas hallazgos significativos fue la RM de la base del craneo (17,7%). Las 286 pruebas de imagen solicitadas por vertigo costaron 56.741 euros. El gasto para obtener un diagnostico radiologico fue de 1.576 euros. Conclusiones. Se realiza un gran numero de TC y RM de cabeza en pacientes con vertigo y mareo. Es recomendable tener un diagnostico de sospecha previo a partir de la anamnesis y la exploracion para hacer una buena seleccion de las pruebas que hay que solicitar. En mas del 90% de los casos no se muestran hallazgos radiologicos en relacion con el vertigo.

Vitamin D and cutaneous lupus erythematosus: effect of vitamin D replacement on disease severity.

BACKGROUND: The main vitamin D source is exposure to ultraviolet radiation, which aggravates cutaneous lupus erythematosus (CLE). OBJECTIVES: The aims of this study were to identify variables associated with lower serum 25-hydroxyvitamin D [25(OH)D] levels in CLE patients and assess the effect of vitamin D restoration on disease severity. METHODS: Vitamin D status in 60 CLE patients and 117 apparently healthy subjects was compared. We recommended oral vitamin D3 to 27 CLE patients. After one year of treatment, changes in disease severity were assessed and compared to 25 untreated CLE patients. Disease severity was measured by the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI), number of exacerbations, duration of active lesions and patient assessment. RESULTS: Presence of CLE raised the odds of having vitamin D deficiency (OR 3.47, 95% CI 1.79-6.69). Increasing age and disease duration were associated with higher odds of having vitamin D deficiency. After a one-year follow-up, disease activity improved in the treatment group (CLASI A 2.7 ± 2.9 vs. 0.9 ± 1.4) (p = 0.003), as confirmed by the patient assessment (p = 0.01). CONCLUSIONS: Vitamin D inadequacy is more prevalent in CLE participants than in healthy controls. Treating vitamin D insufficiency is associated with improved disease severity according to physician and patient assessments.

Estudio retrospectivo de pacientes diagnosticados de síndrome de Sweet en el área de un hospital terciario de la Comunidad Valenciana / Retrospective Study of Patients Diagnosed With Sweet Syndrome in the Health Area of a Tertiary Hospital in the Autonomous Community of Valencia

El síndrome de Sweet (SS) es la más característica de todas las dermatosis neutrofílicas. Para definir el perfil de los pacientes diagnosticados de SS en nuestro Departamento y evaluar las diferencias clínico-epidemiológicas entre subgrupos, hemos realizado un estudio retrospectivo desde 2001 a 2009, ambos inclusive. Han sido incluidos 24 pacientes (13 mujeres y 11 hombres). La distribución por edades es similar en todos los grupos con dos picos: entre los 30-39 y los 70-79 años. Respecto a la etiología predomina el grupo que incluye los casos infecciosos e inflamatorios, seguido del grupo de etiología idiopática. De los 4 casos paraneoplásicos dos correspondían a neoplasias de órganos sólidos. Hay un caso asociado a la administración de infliximab. En cuanto a la evolución existe una mayor duración de la sintomatología en los casos paraneoplásicos e idiopáticos (AU)

Sweet syndrome is the most characteristic of the neutrophilic dermatoses. We performed a retrospective study of patients with Sweet syndrome seen in our department between 2001 and 2009, inclusive; the aims were to define the patient profile and to evaluate the clinical and epidemiological differences between subgroups. There were 24 patients (13 women and 11 men). The age distribution was similar in both sexes and showed 2 peaks, one in the fourth decade and the other in the eighth decade. The etiology was predominantly infectious or inflammatory, followed by the idiopathic form. There were 4 cases of paraneoplastic disease, 2 of which involved solid-organ tumors. One case was associated with the administration of infliximab. Symptoms persisted longer in cases that were idiopathic or that developed in the context of neoplastic disease (AU)

[Retrospective study of patients diagnosed with Sweet syndrome in the health area of a tertiary hospital in the autonomous community of Valencia]. / Estudio retrospectivo de pacientes diagnosticados de síndrome de Sweet en el área de un hospital terciario de la Comunidad Valenciana.

Sweet syndrome is the most characteristic of the neutrophilic dermatoses. We performed a retrospective study of patients with Sweet syndrome seen in our department between 2001 and 2009, inclusive; the aims were to define the patient profile and to evaluate the clinical and epidemiological differences between subgroups. There were 24 patients (13 women and 11 men). The age distribution was similar in both sexes and showed 2 peaks, one in the fourth decade and the other in the eighth decade. The etiology was predominantly infectious or inflammatory, followed by the idiopathic form. There were 4 cases of paraneoplastic disease, 2 of which involved solid-organ tumors. One case was associated with the administration of infliximab. Symptoms persisted longer in cases that were idiopathic or that developed in the context of neoplastic disease.

[Sentinel lymph node biopsy in patients with melanoma]. / La técnica del ganglio centinela en pacientes con melanoma.

INTRODUCTION AND OBJECTIVES: The incidence of melanoma is currently increasing worldwide. One of the factors influencing disease prognosis is the presence of regional lymph node metastases. Sentinel lymph node biopsy attempts to identify subclinical lymph node metastasis as a prognostic factor in the disease. The aim of this study was to analyze differences between patients with melanoma for whom positive or negative results were obtained in sentinel lymph node biopsy and to assess the impact of the technique on disease prognosis. MATERIAL AND METHODS: Sentinel lymph node biopsy was carried out in patients with melanoma of the following characteristics: Breslow thickness > or =1mm, Breslow thickness <1mm with ulceration, Clark level IV-V, or regression. Lymphadenectomy was performed in patients with positive sentinel node biopsy. Data were also collected on the following variables: sex, age, skin phototype, site and type of melanoma, Breslow depth, Clark level, ulceration, regression, cancer stage at diagnosis, TNM classification, change in cancer stage during follow-up, and death due to melanoma. RESULTS: Positive sentinel node biopsies were recorded in 19.44% of patients. Positive results were associated with the following variables: nodular melanoma (crude odds ratio [ORc] compared with superficial spreading melanoma, 3.44; 95% confidence interval [CI], 1.33-8.90); Breslow thickness >2.0, for a thickness of 2.1-4.0 (ORc, 21.12; 95% CI, 2.60-172.03) and for a thickness >4.0 (ORc, 23.25; 95% CI, 2.44-221.73); Clark level IV (ORc, 8.73; 95% CI, 1.03-74.12); ulceration (ORc, 4.86; 95% CI, 1.58-14.90); T3 (ORc, 4.20; 95% CI, 1.52-11.63) and T4 (ORc, 4.67; 95% CI, 1.27-17.15) in the TNM classification; change in cancer stage during follow-up (ORc, 7.20; 95% CI, 2.25-22.99); and death due to melanoma (ORc, 8.67; 95% CI, 3.62-96.15). CONCLUSIONS: These results confirm the prognostic importance of sentinel lymph node biopsy, which facilitates identification of patients with a greater tendency towards disease progression and death due to melanoma.

La técnica del ganglio centinela en pacientes con melanoma / Sentinel Lymph Node Biopsy in Patients With Melanoma

Material y métodos: Se realizó biopsia del ganglio centinela a los pacientes con melanomas de espesor Breslow ≥1mm o con Breslow <1mm y ulceración, nivel de Clark IV–V o regresión. Aquellos con biopsia positiva fueron sometidos a linfadenectomía.Material y métodos: Además, se recogieron las siguientes variables: sexo, edad, fototipo, localización y tipo de melanoma, niveles Breslow y Clark, ulceración, regresión, estadio inicial, TNM, cambio de estadio y fallecimiento por melanoma. Resultados: El 19,44% de los pacientes presentó ganglios positivos. Esta positividad se presentó asociada con el melanoma nodular (odds ratio cruda [ORc]: 3,44; intervalo de confianza al 95% [IC 95%]: 1,33–8,90) con respecto al melanoma de extensión superficial Breslow superior a 2,0 (nivel 2,1–4,0: ORc: 21,14; IC 95%: 2,60–172,03, nivel >4,0: ORc: 23,25; IC 95%: 2,44–221,73), nivel Clark IV (ORc: 8,73; IC 95% 1,03–74,12), ulceración (ORc: 4,86; IC 95%: 1,58–14,90), estadios T3 y T4 (T3: ORc: 4,20; IC 95%: 1,52–11,63; T4: ORc: 4,67; IC 95% 1,27–17,15), cambio de estadio (ORc: 7,20; IC 95%: 2,25–22,99) y fallecimiento por melanoma (ORc: 8,67; IC 95%: 3,62–96,15). Conclusiones: Estos resultados confirman la importancia pronóstica de la biopsia del ganglio centinela, que permite identificar a los pacientes con mayor tendencia a la progresión de la enfermedad y fallecimiento por melanoma (AU)

Introduction and objectives: The incidence of melanoma is currently increasing worldwide. One of the factors influencing disease prognosis is the presence of regional lymph node metastases. Sentinel lymph node biopsy attempts to identify subclinical lymph node metastasis as a prognostic factor in the disease. The aim of this study was to analyze differences between patients with melanoma for whom positive or negative results were obtained in sentinel lymph node biopsy and to assess the impact of the technique on disease prognosis. Material and methods: Sentinel lymph node biopsy was carried out in patients with melanoma of the following characteristics: Breslow thickness ≥1mm, Breslow thickness <1mm with ulceration, Clark level IV–V, or regression. Lymphadenectomy was performed in patients with positive sentinel node biopsy. Data were also collected on the following variables: sex, age, skin phototype, site and type of melanoma, Breslow depth, Clark level, ulceration, regression, cancer stage at diagnosis, TNM classification, change in cancer stage during follow-up, and death due to melanoma. Results: Positive sentinel node biopsies were recorded in 19.44% of patients. Positive results were associated with the following variables: nodular melanoma (crude odds ratio [ORc] compared with superficial spreading melanoma, 3.44; 95% confidence interval [CI], 1.33–8.90); Breslow thickness >2.0, for a thickness of 2.1–4.0 (ORc, 21.12; 95% CI, 2.60–172.03) and for a thickness >4.0 (ORc, 23.25; 95% CI, 2.44–221.73); Clark level IV (ORc, 8.73; 95% CI, 1.03–74.12); ulceration (ORc, 4.86; 95% CI, 1.58–14.90); T3 (ORc, 4.20; 95% CI, 1.52–11.63) and T4 (ORc, 4.67; 95% CI, 1.27–17.15) in the TNM classification; change in cancer stage during follow-up (ORc, 7.20; 95% CI, 2.25–22.99); and death due to melanoma (ORc, 8.67; 95% CI, 3.62–96.15). Conclusions: These results confirm the prognostic importance of sentinel lymph node biopsy (AU)

Bispectral index changes in carotid surgery.

BACKGROUND: Intraoperative monitoring of cerebral ischemia with shunting during carotid endarterectomy (CEA) remains controversial. Our objective was to evaluate the sensitivity and specificity of BIS changes during carotid clamping in relation to shunted patients in awake CEA. METHODS: Eighty CEAs under cervical block were included. There were two patient groups: with clinical signs of cerebral ischemia (shunted patients) and without signs of cerebral ischemia (nonshunted patients). Data were based on bispectral index (BIS) values and neurological monitoring at different surgery time points, with special attention paid during carotid clamping. BIS values were compared between shunted and nonshunted patients. Sensitivity and specificity, along with positive and negative predictive values of a percentage BIS value decrease during carotid clamping from baseline BIS values, were calculated in both patient groups. RESULTS: Shunting was performed in 11 patients with cerebral ischemia at carotid clamping. Mean BIS values were 82.82+/-11.98 in shunted patients and 92.31+/-5.42 in nonshunted patients at carotid clamping (p<0.001). Relative decreased BIS values in relation to basal BIS values were 13.57% in shunted patients and 3.68% in nonshunted patients (p<0.05). The percentage decrease in BIS was 14%, sensitivity was 81.8% (95% CI 49.9-96.8), and specificity was 89.7% (95% CI 79.3-95.4). CONCLUSION: BIS monitoring during carotid clamping is an easy, noninvasive method which correlates with cerebral ischemia in patients undergoing CEA. A decrease>or=14% from the basal BIS value presents a high negative predictive value, and ischemia is unlikely without a decrease. Nonetheless, a decrease may not always indicate cerebral ischemia with a low positive predictive value.

Características de los recién nacidos tras fecundación in vitro / Birth characteristics due to in vitro fertilization (IVF) techniques

Objetivo: determinar en una unidad neonatal de nivel II la frecuencia de nacimientos tras fecundación in vitro (FIV) incluyendo FIV-ICSI (intracytoplasmic sperm injection) y comparar sus características con los de fecundación natural (FN), según sean gemelares o únicos. Pacientes y método: estudio prospectivo mediante revisiones fetales desde la semana 12 de gestación tras FIV, al nacer y al año de vida. Del 1 de enero de 2004 al 31 de marzo de 2007 nacieron 7.008 recién nacidos (RN), 113 tras FIV y 6.895 por FN. Resultados: la gemelaridad es del 2,4% en FN y el 56,6% en FIV (p<0,001). La edad materna media en únicos es 28±9 años en FN y 36±4 en FIV (p<0,05); en gemelares es 29±10 años en FN y 35±4 en FIV (p<0,05). La edad gestacional media en únicos es 38±4 semanas en FN y 39±2 en FIV y 36±1 semanas en gemelares FN y FIV. La tasa de prematuridad (<37 semanas) y la de bajo peso (<2.500g) no difiere estadísticamente entre únicos y gemelares FN y FIV. El 23,13% de los únicos FN y el 51,02% de los únicos FIV nacieron por cesárea (p<0,001), pero la diferencia entre gemelares FN (71,42%) y FIV (79,69%) no es estadísticamente significativa. El 5,3% de los RN vivos FIV y el 1,1% de los FN nacieron con defectos congénitos (p<0,002). El riesgo relativo (RR) de defectos congénitos de los FIV frente a los FN es 4,83 (intervalo de confianza del 95%, 2,14-10,83). Conclusiones: si se comparan según número de fetos, los FIV suponen el 1,61% de los RN, difieren de los FN en edad materna, gemelaridad, cesáreas (únicos) y defectos congénitos, pero no en prematuridad ni bajo peso (AU)

Objective: To determine the number of deliveries after 31 weeks gestation (w), from in vitro fertilization (IVF), including Intracytoplasmic Sperm Injection (ICSI), and to compare characteristics with those achieved by natural fertilization (NF). We analyse twin and singleton pregnancies separately. Patients and method: This descriptive and prospective study monitors children from foetus, from 12 weeks after IVF, to 12 months of age, including the newborn period. There were 7008 newborns between 1st January 2004 and 31st March 2007 of which there were 113 from IVF and 6895 from NF. Results: Twin-pregnancies in NF is 2.4%, whereas in IVF it is 56.6%, (p<0.001). Mean mother age is 28±9 years (y) in NF and 36±4y in IVF singletons (p<0.05), and 29±10 y in NF and 35±4 y in IVF twins (p<0.05). Mean gestational age is 38±4 w and 39±2w in NF and IVF singletons and 36±1 w in NF and IVF twins. No statistically significant differences were found in prematurity rate (<37 w) and low birth weight (< 2500g) between singletons and twins from IVF or NF. Caesarean sections were 23.13% and 51.02% from singleton NF and IVF (p<0.001). No statistically differences were found between twins NF (71.42%) and IVF (79.69%). Malformations at birth were observed in 5.3% of IVF and in 1.1% of NF newborns (p<0.002). Relative risk of malformations (RR) IVF versus NF is 4.83 (95% CI, 2.14-10.83). Conclusions: Only 1.61% of newborns comes from IVF techniques. There are significant differences in age of mother, twin- pregnancies, caesarean sections (singletons) and congenital defects between them and NF newborns. There were no differences found in prematurity and low birth weight between them and NF newborns, when compared by number of foetus (AU)

[Birth characteristics due to in vitro fertilization (IVF) techniques]. / Características de los recién nacidos tras fecundación in vitro.

OBJECTIVE: To determine the number of deliveries after 31 weeks gestation (w), from in vitro fertilization (IVF), including Intracytoplasmic Sperm Injection (ICSI), and to compare characteristics with those achieved by natural fertilization (NF). We analyse twin and singleton pregnancies separately. PATIENTS AND METHOD: This descriptive and prospective study monitors children from foetus, from 12 weeks after IVF, to 12 months of age, including the newborn period. There were 7008 newborns between 1st January 2004 and 31st March 2007 of which there were 113 from IVF and 6895 from NF. RESULTS: Twin-pregnancies in NF is 2.4%, whereas in IVF it is 56.6%, (p<0.001). Mean mother age is 28+/-9 years (y) in NF and 36+/-4y in IVF singletons (p<0.05), and 29+/-10 y in NF and 35+/-4 y in IVF twins (p<0.05). Mean gestational age is 38+/-4 w and 39+/-2w in NF and IVF singletons and 36+/-1 w in NF and IVF twins. No statistically significant differences were found in prematurity rate (<37 w) and low birth weight (< 2500g) between singletons and twins from IVF or NF. Caesarean sections were 23.13% and 51.02% from singleton NF and IVF (p<0.001). No statistically differences were found between twins NF (71.42%) and IVF (79.69%). Malformations at birth were observed in 5.3% of IVF and in 1.1% of NF newborns (p<0.002). Relative risk of malformations (RR) IVF versus NF is 4.83 (95% CI, 2.14-10.83). CONCLUSIONS: Only 1.61% of newborns comes from IVF techniques. There are significant differences in age of mother, twin- pregnancies, caesarean sections (singletons) and congenital defects between them and NF newborns. There were no differences found in prematurity and low birth weight between them and NF newborns, when compared by number of foetus.

[Study of the obsesity and overweight as a risk factor for asthma and severity of the asthma in children of Valencia (Spain)]. / Estudio de la obesidad y del sobrepeso como factores de riesgo de la prevalencia y severidad del asma en niños de Valencia.

BACKGROUND: Obesity and overweight have been described as factors associated with asthma. Our aim was to evaluate the role obesity plays on asthma in children. SCOPE AND SUBJECTs: A study carried out on children and teenagers between 8 and 15 years of age, chosen for a cluster-type random sampling from children who studied in 80 schools, which represents 30% of the schools in the city of Valencia. MATERIAL AND METHODS: The analysed data was organized into two groups, obese (from the Body Mass Index (Kg/m2)), showing children with a percentile over 85% of the measuring reference for the Spanish population) and non obese, when they did not fulfil this condition. The prevalence of the different parameters studied was calculated by an Interval of Confidence of 95%. The risk was calculated (Relative Risk) from those symptoms compatible with asthma among obese children compared to non obese children. RESULTS: No significant relative risk (RR) was seen for obesity with regards to asthma in those percentiles of obesity over 85. Otherwise, an increase in the relative risk (RR) regarding the severity of asthma was seen in relation to obesity, mainly in the 85th percentile (RR = 1.51 of suffering between 4-12 wheezing attacks and RR = 1.86 of suffering more than 12 attacks in obese children as opposed to non obese children). CONCLUSIONS: In this study, we did not identify a higher risk of asthma among obese children than among non obese children, although we did find there was a higher risk of severity of asthmatic symptoms. As far as the severity of the asthma is concerned, we saw a higher risk of wheezing and whistling attacks among obese children with the 85th and the 95th percentiles according to the Body Mass Index.

Adenocarcinoma colorrectal: factores pronósticos de supervivencia en el tratamiento adyuvante con 5-Fluorouracilo-Levamisol (5FU-Lev) / Colorectal adenocarcinoma: survical prognostic factors of the adjuvant treatment with 5-fluorouracil-levamisole (5FU-LEV)

- Propósito: Valoración de la supervivencia global (SG) y libre de enfermedad (SLE) a 5 años y estudio de los factores pronósticos de los pacientes operados, con finalidad curativa, de adenocarcinoma colorrectal estadios II y III, que recibieron tratamiento adyuvante con 5FU-LEV.- Material y métodos: ciento veintiséis pacientes tratados con esquema 5FU-LEV durante 12 meses, entre septiembre de 1990 y noviembre de 1997.- Resultados: La SG a los 5 años es de 68.3 por ciento y la SLE de 54 por ciento. El número de ganglios afectos por el tumor y la afectación vásculo-linfática y perineural, han resultado factores pronósticos significativos tanto en la SLE como en SG a los 5 años. La existencia de obstrucción intestinal tan sólo resulta factor pronóstico significativo en la SLE a los 5 años.- Conclusiones: los resultados que presentamos son semejantes a otras grandes series conocidas, tanto en supervivencia global y libre de enfermedad como en el estudio univariante de los factores pronósticos. La afectación ganglionar continúa presentando significación pronóstica con el análisis multivariante (AU)

Socioeconomic factors and cervical cancer mortality in Spain during the period 1989-1997.

METHODS: A study was made of cervical cancer (CC) mortality trends in Spain during the period 1989-1997 at National, Autonomous Community and Provincial levels, in relation to different socioeconomic factors. Data were obtained from the Spanish National Institute of Statistics (Instituto Nacional de Estadística, INE). The crude mortality rates were age-adjusted using the indirect method and Gross Domestic Product (GDP) as socioeconomic status (SES) indicator. RESULTS: National CC age-adjusted mortality rates have increasing slightly, varying from 3.09 deaths/100000 women in 1989 to 3.42 in 1996. The highest age-adjusted mortality rates corresponded to Seville, Palencia and Orense, with 4.13, 4.06 and 3.98 cases/100000 women, respectively. The lowest mortality rates were found in Las Palmas, Cantabria and Alicante with 2.63, 2.77 and 2.80 deaths/100000 women, respectively. A relative risk (RR) of 1.14 (95%CI: 0.98-1.32) ( P=0.048) was observed between the provinces with the lowest SES and highest mortality rate, and those with the highest SES and lowest mortality rate. CONCLUSION: The results of our study show a slight increasing trend in CC mortality rates in Spain during the period 1989-1997, and suggest that the variations among provinces and Autonomous Communities could be due to CC risk factors (SES related to human papillomavirus, parity, diet, etc.) and differences in early diagnosis.

La mortalidad por cáncer de mama entre provincias en relación con factores socioeconómicos, tasa de natalidad y edad del primer embarazo a término (1989-97) / Breast cancer mortality between Spanish provinces and its relation with socioeconomic factors, birthrate and age of the first at term pregnancy

- Propósito: En este estudio tratamos de conocer el papel del nivel socioeconómico (NSE), en la evolución de la mortalidad por cáncer de mama (CM) en España y por provincias durante el período 1989-97, teniendo en cuenta la tasa de natalidad y la edad del primer embarazo a término.- Material y métodos: La información de la mortalidad por CM a nivel nacional y por provincias se obtuvo del INE. Defunciones según la causa de muerte (IX Revisión de la Clasificación Internacional de Enfermedades). La información sobre el NSE, la tasa de natalidad y la edad a la maternidad se obtuvieron del INE. Contabilidad regional de España e INE. Indicadores demográficos básicos para el período 1989-97. Calculándose el coeficiente de correlación de Pearson y realizándose un análisis multivariante.- Resultados: Se observaron las tasas de mortalidad por CM más elevadas en las provincias de NSE más elevado, Barcelona, Gerona, Valencia, Alicante y Murcia, aunque no se obtuvo significación estadísticamente significativa. Los coeficientes de correlación de Pearson entre las tasas de mortalidad por CM, con la tasa de natalidad y la edad del primer embarazo a término fueron (-0.421) y 0.240, obteniéndose significación estadística (p<0.05). En el análisis multivariante de regresión lineal se obtuvo una asociación estadísticamente significativa entre el descenso de la tasa de natalidad y el aumento de la mortalidad por CM.- Conclusiones: Nuestros resultados muestran cómo la baja tasa de natalidad, edad tardía de la mujer en el primer embarazo a término y alto NSE, se presentan con una mayor mortalidad por cáncer de mama (AU)

Evolución de la mortalidad y morbilidad del cáncer de mama por provincias y comunidades autónomas en el período 1989-97 / Evolution of mortality and morbidity due to breast cancer according to provinces and autonomous communities in spain 1989-97

El objetivo de este estudio fue analizar la evolución de la mortalidad y morbilidad por cáncer de mama (CM) por provincias y Comunidades Autónomas para el período 1989-1997.Los datos se obtuvieron del Instituto Nacional de Estadística. Las tasas brutas de mortalidad y morbilidad se ajustaron por el método directo e indirecto. Se obtuvieron el coeficiente de correlación de Pearson y las razones de mortalidad y morbilidad. La tasa de mortalidad estandarizada más elevada por provincias se observó en Huesca y Lérida con 37,60 y 37,11 casos/100.000 mujeres, respectivamente. La tasa más baja se encontró en Navarra y Jaén con 14,11 y 18,21 casos/100.000 mujeres, respectivamente. Por Comunidades Autónomas, las tasas de mortalidad más elevadas correspondieron a Aragón, Baleares y Cataluña con 34,31, 32,90 y 32,31 casos/100.000 mujeres. Se observa un aumento de las tasas de mortalidad y morbilidad por CM tanto por provincias como por comunidades autónomas en el período 1989-1997, principalmente en áreas de nivel socioeconómico más elevado (AU)

[Spontaneous pneumothorax and atmospheric pressure]. / Neumotórax espontáneo y presión atmosférica.

In order to assess factors associated with spontaneous pneumothorax (SP), mainly climatic changes, a prospective study was undertaken of 62 SP episodes among patients admitted to our hospital during a two-year period, from January 1994 to January 1996. Atmospheric pressure (AP) changes were analyzed, with daily recording of the number of unusual changes in AP (increases above 95th percentile and decreases below 5th percentile) and how many of these changes were followed by some episode of spontaneous pneumothorax during the following five days. To measure the degree of this association between the emergence of pneumothorax and exposure to unusual changes I AP, the relative risk (RR) was calculated. A total of 77 unusual AP changes were observed, 17 of which concurred with the emergence of 8 episodes of SP during the following five days, with a RR of 2.7 (1.6-4.4). Although the etiology of SP is unknown and probably of multifactorial origin, these data suggest that unusual changes in AP may play a relevant role in triggering this condition.

Neumotórax espontáneo y presión atmosférica / Spontaneous pneumothorax and atmospheric pressure

Con el fin de valorar los factores asociados al neumotórax espontáneo (NE), fundamentalmente climáticos, se realizó un estudio prospectivo de 62 episodios de NE ingresados en nuestro hospital durante un período de 2 años, desde enero de 1994 a enero de 1996. Para ello se analizaron las variaciones de la presión atmosférica (PA), determinándose diariamente el número de cambios no usuales de la PA (aumentos por encima del percentil 95 y caídas por debajo del percentil 5) y cuántos de estos cambios fueron seguidos de algún episodio de neumotórax en los 5 días siguientes. Para medir la fuerza de asociación entre la aparición del neumotórax y la exposición a cambios no usuales de la PA se calculó el riesgo relativo (RR). Se observaron 77 cambios no usuales de PA y 17 de ellos coincidieron con la aparición de 8 episodios de NE en los 5 días siguientes, obteniéndose un RR de 2,7 (1,6-4,4). Estos datos sugieren que aunque la etiología del NE es desconocida y, probablemente multifactorial, los cambios no usuales de la PA pueden desempeñar un papel importante en el desencadenamiento del mismo (AU)

[Malnutrition prevalence in institutionalized elderly people in Valencia Community, Spain]. / Prevalencia de malnutrición entre ancianos institucionalizados en la Comunidad Valenciana.

BACKGROUND: The goal of this study was to know the prevalence of malnutrition in an institutionalized elderly population according to age and sex. PATIENTS AND METHOD: We studied 615 institutionalized patients, with a mean age (SD) of 79.33 (9.07) years. Anthropometric parameters included weight, height, knee-heel length, tricipital and subescapular skin folds, arm perimeter and fat mass. Biochemical parameters included: total cholesterol, triglycerides, albumin, prealbumin, transferrin,retinol-binding protein, C3 and lymphocyte count. Malnutrition prevalence was 26.87% (CI 95%, 23.15-30.86), 29.08% (CI 95%, 22.82-35.97) in men and 25.59% (CI 95%, 25.01-30.61) in women. Anthropometric parameters were found to be decreased in all malnourished patients. Significant decreases in albumin and retinol-binding protein concentrations were observed in some age groups of malnourished patients. We also found a decrease in the total cholesterol level in parallel to an age increase in both sexes, regardless of the nutritional status. Triglyceride levels were significantly decreased in both males and females with malnutrition. CONCLUSIONS: We detected a high prevalence of malnutrition, yet lower than reported in other studies with similar age groups.

Are alcohol intake and smoking associated with mycosis fungoides? A European multicentre case-control study.

The incidence of mycosis fungoides (MF) is low, and the aetiology of the disease is unknown. The aim of this study was to investigate whether wine consumption protects against the disease and whether smoking constitutes a risk factor. This paper is part of the European Rare Cancers Study that tries to determine the risk factors for seven selective rare cancers, including mycosis fungoides, involved in the development of cancer. A multicentre case-control study was conducted in six European countries. Only incident cases with confirmed histology were included in the analysis which include a total of 76 cases of MF and 2899 controls. Wine intake had no protective effect; on the contrary the consumption of more than 24 g of alcohol per day was associated with a high risk of MF (odds ratio (OR)=3.02, 95% confidence interval (CI), 1.34-6.79), after adjusting for centre, country, age, sex and education. There was a dose-dependent increase in the risk of MF with increased smoking habits, albeit the observed trend was not statistically significant. A combined exposure to high tobacco and alcohol use yielded a significantly increased risk factor for MF (P=0.0073). Alcohol intake was associated with MF.