Declaración de Sant Joan d’Alacant en defensa del acceso abierto a las publicaciones científicas, del Grupo de Editores de Revistas Españolas sobre Ciencias de la Salud (GERECS) / Declaration of Sant Joan d'Alacant in defense of open access to the scientific publications, from the publishers of Spanish journals group on (GERECS) health sciences

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Supervivencia del cáncer de pulmón en pacientes tratados en un hospital de referencia en Zaragoza (España) / Survival of lung cancer patients treated at a referral hospital in Zaragoza (Spain)

Objetivo. El presente trabajo tuvo como objetivo estudiar la supervivencia en el cáncer de pulmón de pacientes tratados en un hospital de referencia de Zaragoza. Material y métodos. La supervivencia observada fue calculada por el método de Kaplan-Meier. Para calcular la supervivencia relativa se utilizó el cálculo automatizado del Instituto Catalán de Oncología. Resultados. El tiempo medio de supervivencia fue de 25,74 meses. No hubo diferencia al comparar los grupos de edad (p=0,151), el sexo (p=0,369) y el tipo histológico del tumor (p=0,086); la supervivencia por estadio de la enfermedad en el momento del diagnóstico reveló diferencias estadísticamente significativas (p<0,001). La supervivencia relativa a los 5 años del diagnóstico para el grupo de individuos analizados fue del 14%. La supervivencia fue mayor para los varones (15,5%), las personas menores de 60 años (16,7%) y los tumores de tipo escamoso (18,7%). La supervivencia según el estadio tumoral estaba de acuerdo con la referencia TNM Staging System for Lung Cancer. Conclusiones. Los resultados evidencian que la tasa de supervivencia global para el cáncer de pulmón en Zaragoza sigue siendo muy baja a largo plazo y que depende del estadio de la enfermedad en el momento del diagnóstico (AU)

Objective. The aim of this work is to study the survival of lung cancer patients treated at a referral hospital in Zaragoza (Spain). Material and method. The Kaplan-Meier test was used to calculate observed survival. The automatic calculation of the Catalan Institute of Oncology was used to analyse relative survival. Results. Mean survival time was 25.74 months. There was no difference when comparing age groups (P=.151), gender (P=.369), and histological type of tumour (P=.086). Survival by stage of the disease at diagnosis revealed statistically significant differences (P<.001). Relative survival 5 years after diagnosis for the group analysed was 14%. Survival was higher for men (15.5%), in patients under 60 (16.7%) and squamous tumours (18.7%). Conclusions. Survival by tumour stage was in line with the TNM Staging System for Lung Cancer. These results suggest that overall survival rate for lung cancer in Zaragoza remains very low in the long term, and this depends on the stage of the disease at diagnosis (AU)

PITASOR epidemiological study: prevalence, incidence and treatment of anaemia in radiation therapy oncology departments in Spain

INTRODUCTION: Anemia is the most common haematological complication in cancer patients. OBJECTIVE: Analysis of the incidence, prevalence and treatment of anemia in oncologic patients treated in Radiation Oncology Departments in Spain (ROD) and monitoring of the existing recommendations for the treatment of anemia. MATERIAL AND METHODS: Observational, prospective, multicenter study which involved 19 Spanish ROD. The study was approved by the CEIC Central Defense Hospital. 477 patients with solid tumors, subsidiary of RT with radical intent referred to such centers within a period of one month (5/5/09 to 5/6/09) and gave their consent to participate in the study. We gathered the main characteristics of patients and their oncologic disease. All patients underwent a determination of Hb levels before RT, upon reaching 25-35 Gy and at the end treatment. In patients with anemia we assessed the existence of related symptoms and its treatment. RESULTS: Basal situation: The prevalence of anemia was 34.8% (166 patients). Mean Hb in patients with anemia was 11.17 ± 1.07 g/dl. Anemia-related symptoms were present in 34% of the patients. Anemia predisposing factors were: stage of the disease, previously received chemotherapy, and hormonal therapy. 39% (66 patients) received anemia treatment, with a mean Hb of 10.43 ± 1.04 g/dl. During RT: The prevalence of anemia was 38.9% (182 patients) with a mean Hb of 11.24 ± 1.21 g/dl. Predisposing factors for anemia during RT treatment were: age, male sex, chemotherapy prior to RT, basal anemia and chemotherapy during RT. 36.3% (66 patients) had anemia-related symptoms. 34.6% (63 patients) with a mean Hb of 10.5 ± 1.37 g/dl received treatment for anemia. The prevalence of anemia at the end of the RT was 38.1% (177 patients) with a mean Hb of 11.19 ± 1.18 g/dl. The predisposing factors for the appearance of anemia at the end of RT were: male sex, anemia at basal situation and during treatment and chemotherapy during RT. 34% (61 patients) had anemia-related symptoms and 73 patients (41.2%) with a mean Hb of 10.5 ± 1.22 g/dl received treatment for anemia. The presence of anemia-related symptoms was significantly correlated with the beginning of treatment for anemia. The incidence of anemia (new cases) during radiotherapy was 17.5%. CONCLUSION: The prevalence of anemia in basal situation, during RT and at the end of RT is 34.8%, 38.9% and 38.1%. During RT the incidence of anemia is 17.5%. 39.8%-41.2% of patients with anemia and 64.2%-68% of patients with anemia-related symptoms received treatment. Treatment of anemia starts with Hb<11 g/dl and the goal is to achieve Hb 12 g/dl. In our Radiotherapy Oncology Departments, the treatment of anemia complies with the current recommendations and guidelines in use (AU)

[Diagnostic errors and temporal stability in bipolar disorder]. / Errores de diagnóstico y estabilidad temporal en el trastorno bipolar.

INTRODUCTION: The diagnosis of bipolar disorder is frequently modified during the course of the illness. MATERIAL AND METHODS: Diagnostic changes and associated errors are described for 1,153 patients diagnosed as bipolar disorder, aged over 18 years and with at least ten follow-up visits. Data was extracted from a clinical registry of out-patient care specialized in Psychiatry and psychiatric hospitalizations of 25,152 patients representative of an urban area of 240,000 inhabitants. Limit for diagnostic stability was established as the maintenance of the bipolar disorder diagnosis in at least 75% of the visits. RESULTS: A total of 158 (46.1 %) out of 342 patients diagnosed as having a bipolar disorders in the first visit kept this diagnostic constant in subsequent evaluations. Infradiagnostic initial error was committed with 108 stable patients who were not diagnosed in the first visit. 184 patients diagnosed in the first visit with bipolar disorder had less than 75 % concordant diagnosis along the follow-up and could be considered as initial overdiagnosis. Two hundred and nine out of the 443 patients who were diagnosed as bipolar disorder in their last visit did not keep stability criteria in their follow-up and could be considered therefore as final overdiagnosis. Thirty two stable patients not diagnosed in their last visit could be considered as infradiagnosis final error. Diagnosis from schizophrenia spectrum (F2) appears in one of every four psychiatric visits of the patients included in this study. Overlap was seen in three other categories: anxiety disorders (F4), personality disorders (F6) and substance abuse disorders. CONCLUSION: Initial course of bipolar disorder causes difficulties in the diagnosis.

Causas de asma de control difícil (ACD). Factores que pueden agravar el asma / No disponible

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Comportamiento del CA 19.9 y de la fracción HDL-colesterol en una muestra de pacientes con carcinoma colorrectal esporádico / CA 19.9 and HDL-cholesterol behaviour in a sporadic colorectal carcinoma sample

Fundamento y objetivo: Hemos realizado un estudio comparativo del valor de predicción diagnóstica en el carcinoma colorrectal esporádico (CCRE) de los diferentes lípidos plasmáticos y de los marcadores tumorales utilizados comúnmente para esta neoplasia (antígeno cárcinoembrionario, CA 19.9 y ácido siálico). Pacientes y métodos: Estudio transversal hospitalario de casos y controles no pareados. Se recogieron un total de 53 casos incidentes de CCRE (90 por ciento de ellos en estadío A y B de Dukes) y 40 controles con patología no neoplásica en el mismo servicio. Realizamos un análisis con regresión logística no condicionada (RL) multivariante. Los intervalos de confianza (IC) estimados fueron del 95 por ciento. La sensibilidad (S) y la especificidad (E) del modelo final se calcularon con un punto de corte del 50 por ciento. Realizamos también un estudio de posibles interacciones. Resultados: Los tres marcadores tumorales utilizados estuvieron elevados en los casos con respecto a los controles (p<0,01). El modelo multivariante ajustado mediante RL incluía las siguientes variables: colesterol total (CT) (OR = 0,69; IC: 0,50 - 0,96), fracción de lipoproteína de alta densidad (HDL) (OR = 0,30; IC: 0,11 - 0,83 ) fracción de lipoproteína de muy baja densidad (VLDL) (OR = 2,21; IC: 1,07 - 4,55) edad en años (OR = 1,11; IC: 0,98 - 1,26 ) CA 19.9 (OR = 1,20; IC: 1,02 - 1,42) y fosfatasa alcalina (FA) (OR = 1,09; IC = 1,01 - 1,19). No se detectaron interacciones. La sensibilidad de este modelo fuel 96,23 por ciento y la especificidad del 92,50 por ciento. Conclusiones: La HDL se expresó en esta muestra con una fuerza de predicción diagnóstica semejante a la del marcador tumoral CA 19.9 pero con una OR inversa. El modelo multivariante sobre el que se basa esta afirmación está pendiente de ser validado (AU)

Estudio clínico descriptivo de 40 pacientes con carcinoma de nasofaringe en estadio avanzado en avanzado en un área de bajo riesgo epidemiológico / Clinical descriptive study in 40 patients with carcinoma of the nasopharynx in advanced stages seing in an area of low epidemic risk

El carcinoma de nasofaringe en España, que es considerada una zona geográfica de escasa incidencia, es un tumor raro. Ello es una de las causas de que existan muy pocos trabajos sobre este tema en nuestro país. Hemos realizado un estudio descriptivo muestral, es decir, seleccionado de entre todos los pacientes diagnosticados de carcinoma de nasofaringe a un amplio grupo que por haber sido tratado de manera multidisciplinar con poliquimioterapia de inducción seguida de radioterapia con o sin cirugía posterior presentaba historias clínicas completas en los Servicios de O.R.L., Oncología y Radioterapia, lo que nos permitió contrastar todos los datos recogidos y aumentó, sin duda, la fiabilidad de los mismos. Los resultados obtenidos son coincidentes con los recogidos en la literatura. El carcinoma de nasofaringe es un tumor que afecta a pacientes jóvenes, de ambos sexos, sin consumo previo de alcohol y tabaco, que son diagnosticados en estadios avanzados, en los que la clínica rinológica es la más frecuente pero las adenopatías cervicales son el motivo de consulta habitual, con un amplio intervalo diagnóstico. Predominan los tumores indiferenciados en el estudio histológico (AU)

The nasopharyngeal carcinoma in Spain, low risk geographical area, is a rare tumor. This is the cause why there few papers about it in our country. We have carried out a muestral descriptive statistical study. We have selected among all the patients diagnosed of nasopharyngeal carcinoma a big group who, have been treated with induction chemotherapy followed by radiotherapy with or without surgery, they presented very complete clinical histories in the Departments of E.N.T., Oncology and Radiotherapy that allowed us to compare all the picked up data and this increased, without doubt, the reliability of them. The results obtained in the different examined variables of our patients are the same that those we found in literature. The nasopharyngeal carcinoma is a tumor that usually affects young patients, of both sexes, without previous consumption of alcohol and tobacco and they are diagnosed in advanced stages. The rhinologic symptoms are the most frequent ones but the cervical nodes are the usual cause for consulting a doctor with a long diagnostic interval. There is a prevalence in the undifferentiated tumors showed by histology (AU)

Nuestra Técnica de Aumento Mamario con Descenso Asimétrico del Surco Submamario / Personal Technique in Augmentative Mammoplasty with Assimetric Lowering of the Inframammary Fold

Presentamos en este trabajo nuestra experiencia en la cirugía de aumento mamario a través de un protocolo en el que intentamos definir los parámetros anatómico-estéticos que pensamos son imprescindibles conocer si queremos crear unas mamas estéticas empleando implantes de silicona para aumentar su volumen. Basamos nuestros resultados en la importancia de una correcta disección submuscular para crear un "macrobolsillo" que, rebasando ampliamente los límites de inserción del músculo pectoral mayor, se extienda también bajo otros músculos sobre los que se asienta la glándula mamaria, y en el apropiado descenso del surco inframamario para mantener la posición centrada del complejo pezón-areola como punto focal de la mama. Explicamos también nuestra sistemática de cuidados en el postoperatorio, que nos ayudarán a mantener la amplitud del macrobolsillo submuscular y a evitar la aparición de contractura capsular (AU)