[Collagenase-3 (MMP-13) expression in epithelial cancers of the eyelids]. / Expresión de colagenasa-3 (MMP-13) en carcinomas epiteliales de los párpados.

PURPOSE: To determine, by means of immunohistochemistry, tumoral expression of collagenase-3, a matrix metalloproteinase linked to cancer and to basal cell and squamous cell carcinomas of the eyelid. MATERIAL AND METHOD: Retrospective review of 23 basal cell carcinomas and 25 squamous cell carcinomas of the eyelid treated at different hospitals during the last five years. We evaluated collagenase-3 expression and the possible relationship to patient and tumour characteristics which included age, sex, histological type, tumour location and surgical margins status. RESULTS: 65% of the basal cell carcinomas and 88% of the squamous cell carcinomas of the eyelids stained positively for collagenase-3. In both cases, the immunostaining was localized in the cytoplasm of the malignant cells and, occasionally in the surrounding stromal cells. CONCLUSIONS: Statistical analysis showed no significant association between collagenase-3 immunostaining and patients or tumour characteristics but the expression of this protein was more intense in the epithelial tumoral cells located at the invading front which could explain the aggressive behaviour of this kind of tumours.

Aspectos psicológicos y psiquiátricos relacionados con el cáncer de mama / Psychological and psychiatric aspects related to the breast cancer

Introducción: El cáncer de mama representa la enfermedad maligna diagnosticada más frecuentemente en las mujeres y la segunda causa de muerte relacionada con el cáncer tras la ocasionada por la de pulmón. Aunque la enfermedad ha alcanzado proporciones epidémicas, el pronóstico de la enfermedad sigue siendo variable y la mortalidad no ha descendido como se esperaba. A pesar de que los factores pronósticos mejor conocidos son los que derivan de las propias características tumorales, se está especulando últimamente que las características psico-psiquátricas de las pacientes también influyen en la forma de afrontar la enfermedad por parte de las mujeres que padecen este proceso. Objetivos: Realizar una revisión bibliográfica sobre los trabajos publicados acerca de lo que se conoce sobre los aspectos psiquiátricos y psicológicos relacionados con el cáncer de mama y realizar un estudio de campo para determinar la repercusión psicológica que provoca en las mujeres la realización de un control mamográfico como despistaje de la enfermedad tumoral mamaria. Material y métodos: Para la revisión de los trabajos publicados al respecto se utilizó el sistema Med-Line y para el estudio de campo se seleccionaron a las pacientes que durante 2 meses acudían a la consulta de Cirugía General del Hospital de Jove de Gijón para someterse a la realización de una mamografía. Como escalas validadas se utilizó la escala Hamilton para la depresión y el inventario STAI para la ansiedad. Resultados: La edad media fue de 52,62 años; el 25,9 por ciento de las mujeres tenían antecedentes familiares de cáncer de mama. Un 96,29 por ciento había realizado con anterioridad alguna mamografía. El 51,9 por ciento había presentado en algún momento un trastorno depresivo, y el 44,4 por ciento tomaban en el momento del estudio medicación antidepresiva/ansiolítica. Se encontró una asociación estadísticamente significativa entre la edad de las pacientes y la puntuación obtenida en la escala Hamilton, así como con la parte del inventario STAI que evaluaba la ansiedad como estado. Existió una diferencia estadísticamente significativa entre el número de mamografías realizadas por las pacientes y el resultado que las mujeres esperaban de la prueba (a mayor número de pruebas complementarias realizadas, mejor era el resultado esperado). La puntuación obtenida en el inventario STAI se relaciona de forma estadísticamente significativa con el resultado esperado de la prueba. Existe una relación estadísticamente significativa entre la edad y el haber padecido un episodio depresivo previo. El haber padecido uno de estos episodios influye desfavorablemente en el resultado esperado; de esta forma, las mujeres con antecedentes psiquiátricos previos, esperan un resultado mamográfico malo, o al menos contemplan la posibilidad de que así sea, con respecto a las que nunca habían presentado este tipo de trastornos. Conclusiones: Es necesario un enfoque más global de la enfermedad tumoral mamaria, en el que además de los factores propios de la enfermedad, se tengan en cuenta variables psicológicas y psiquiátricas que influyen de forma directa tanto en el tratamiento, como en el pronóstico y aceptación de la enfermedad por parte de las mujeres que la padecen. Son necesarios más estudios que complementen a este estudio preliminar dada la limitación de la muestra (AU)

Utilidad clínica de los marcadores tumorales séricos / Clinical utility of serous tumoural markers

No disponible

[Expression and clinical significance of collagenase-3 (MMP-13) in gastric cancer]. / Expresión y significación clínica de la MMP-13 (colagenasa-3) en el cáncer gástrico.

BACKGROUND: MMP-13 (collagenase-3) is a metalloproteinase with potent degradative activity against a variety of elements of the extracellular matrix. Its expression has been described in some human carcinomas, where it seems to play a role in tumor progression and metastasis. The objective of this study was to investigate the expression and clinical significance of MMP-13 in gastric carcinomas. PATIENTS AND METHOD: MMP-13 expression was analyzed by immunohistochemistry in resected specimens from 44 patients with gastric adenocarcinoma. The mean ( standard error) follow-up period was 21.4 3.2 months. RESULTS: A total of 14 gastric carcinomas (31.8%) showed positive immunostaining for MMP-13. The percentage of MMP-13-positive tumors was significantly (p = 0.009) higher in stage IV carcinomas (69.2%) than in lower stages (I: 22.2%; II: 12.5%; and III: 14.3%), as well as in nonresectable tumors (R1 and R2) (61.5%) than in resectable carcinomas (R0) (19.4%) (p = 0.017). Likewise, MMP-13 tumor expression was significantly associated with shortened overall survival in both the entire group of patients (p = 0.0006) and in the subgroup of patients with resectable tumors (p = 0.018). CONCLUSIONS: Our results suggest that, in patients harboring gastric adenocarcinoma, MMP-13 tumor expression is associated with higher tumor aggressiveness and a poor prognosis.

Calcificaciones arteriales detectadas en las mamografías

No disponible

[Relationship between medical treatment compliance and the degree of control in patients with high blood pressure, non-insulin dependent diabetes mellitus and dyslipidemia]. / Relación entre el cumplimiento del tratamiento farmacológico y el grado de control en pacientes con hipertensión arterial, diabetes no insulinodependiente y dislipemias.

BACKGROUND: To study the relationship between therapeutic compliance and the control of arterial hypertension, non insulin dependent diabetes mellitus and hyperlipidemia. PATIENTS AND METHODS: Prospective study performed on 174 hypertensive patients, 107 with diabetes and 107 with hyperlipidemia evaluating compliance by counting of tablets in two home visits. RESULTS: 34% hypertensive patients, 20% diabetics and 37% hyperlipidemics that took medication as instructed or more than they should were badly controlled. CONCLUSIONS: The control grade of high blood pressure, non insulin dependent diabetes mellitus and hyperlipidemia not only depends on improving compliance but also in adapting pharmacologic prescriptions.

[Nursing care for myelomeningocele in infancy]. / Mielomeningocele en la infancia (I). Cuidados enfermeros.

After studying the factors which most often lead to the hospitalization, recuperation and treatment facilitating release from hospitalization of newborns affected by myelomeningocele, we present this treatment plan. One commences with an evaluation, after which various problems are detected. Once identified, establish priorities setting objectives to meet and their corresponding dates; continue by drawing up an action plan which lists those activities that help achieve one's objectives. The purpose of this plan is to provide individualized quality treatments as well as to create a relaxed, confidential atmosphere in which parents express their fears while becoming secure in their practice of those treatments their child needs in their home.

[Factors involved in the non-compliance of the pharmacologic treatment of dyslipidemia]. / Factores implicados en el incumplimiento del tratamiento farmacológico en las dislipemias.

OBJECTIVES: To find how much non-compliance with lipid-lowering drug treatment there is, its causes and to describe the profile of non-compliant patients. DESIGN: Prospective study. SETTING: Primary Care Centres in the province of Alicante. PATIENTS: 107 patients under drugs treatment for lipaemic disorders and belonging to live General Medical practices. MEASUREMENTS AND MAIN RESULTS: To evaluate compliance, the method of a surprise count of pills in the patient's home was used. Compliant patients were defined as those with between 80 and 110% compliance. 46.7% were non-compliant (C.I. 37.3-56.2), with 42% under-compliant and 4.7% over. Forgetfulness and unawareness accounted for 68% of the reasons for non-compliance. Associated factors were: moderate to high cardiovascular risk (p = 0.03), stating that the drug treatment was followed badly (p = 0.01), less than a year in regular treatment (p = 0.006), monitoring lipaemia poorly (p = 0.003). CONCLUSIONS: Non-compliance with pharmacological treatment in patients with lipaemia is high. Its causes are known, as are several factors associated to non-compliance which could be used to identify the non-complier.

[Factors involved in noncompliance with pharmacological treatment in arterial hypertension]. / Factores implicados en el incumplimiento del tratamiento farmacológico en la hipertensión arterial.

OBJECTIVES: To find the amount of non-compliance with medical treatment for Hypertension and its causes, and to describe the profile of non-compliant patients. DESIGN: A crossover study performed on two home visits. SETTING: A rural Health Centre at Calpe, Alicante. PATIENTS: The sample was obtained from the census of medically treated hypertense patients. 174 of the 200 patients chosen completed the study. MEASUREMENTS AND MAIN RESULTS: Compliance was evaluated by a surprise count of pills in the patient's home. Patients complying between 80 and 110% were considered compliant. There was 47.7% non-compliance (C.I. 95%: 40.3-55.1), with 31% under-compliers and 16.7% over-compliers. Lack of information (39.8%) and forgetfulness (28.9%) were the most common causes of non-compliance. CONCLUSIONS: A high amount of non-compliance was shown, including an important number of over-compliers. Its causes were defined along with other reasons predicting non-compliance.

[The validity of 6 indirect methods for assessing compliance with pharmacological treatment in dyslipidemias]. / Validez de 6 métodos indirectos para valorar el cumplimiento del tratamiento farmacológico en las dislipemias.

OBJECTIVE: To validate six indirect methods of identifying patients who do not comply with their treatment with hypolipaemiant drugs. DESIGN: A prospective study. SETTING: Primary care centres in the province of Alicante. PATIENTS: 107 lipaemic patients, on the lists of 5 General Medical practices and on drugs treatment. MEASUREMENTS AND MAIN RESULTS: The most accurate way to assess compliance was the surprise counting of pills in patients' homes. Patients who had between 80 and 110% compliance were defined as compliant. The six indirect methods validated were: Communication of self-compliance (CS), Attendance at appointments (AA), Doctor's judgment (DJ), Information about the illness (II), the Morisky-Green test (MG) and the grade of control (GC). AA, DJ and CS were the methods with highest specificity (91.2%-89.5%). GC and II were the most sensitive (88%-82%). GC obtained the greatest negative predictive value (77.7%), and DJ the greatest positive predictive value (73.6%). The concordance index (kappa) ranged from 0.23 for GC and -0.002 for II. CONCLUSIONS: GC, DJ and CS are the methods with the best validity indicators and concordance. They could, therefore, be used together in clinical practice to identify patients not complying with their hypolipemiant treatment.

[The validity of 6 indirect methods for assessing drug treatment compliance in arterial hypertension]. / Validez de 6 métodos indirectos para valorar el cumplimiento del tratamiento farmacológico en la hipertensión arterial.

OBJECTIVE: To validate six indirect methods, which were simple and easy to apply in clinical practice, of identifying patients who did not comply with drugs treatment for hypertension. DESIGN: A prospective study based on two visits to patient's home. SETTING: rural health centre at Calpe, Alicante. PATIENTS: 174 patients (58 men and 116 women) were included. They were chosen at random from the centre's records of hypertense patients. MEASUREMENTS AND MAIN RESULTS: Compliance was assessed by the method of a surprise counting of pills in the patient's home. Patients who had between 80 and 110% compliance were defined as compliant. The six indirect methods validated were: communication of self-compliance (CS), attendance at appointments (AA), doctor's judgment (DJ), information about the illness (II), hypertension control (HC) and the Morisky-Green test (MG). II was the most sensitive (81.9%). CS reached the highest specificity (93.4%), the best positive predictive value (81.8%) and the best concordance index (kappa, 0.26). CONCLUSIONS: II and CS are the indirect methods with the best validity indicators and could be used together to assess compliance with drugs treatment for hypertension.

[Factors involved in noncompliance with drug treatment in non-insulin dependent diabetes mellitus]. / Factores implicados en el incumplimiento del tratamiento farmacológico en la diabetes no insulinodependiente.

OBJECTIVE: To find the level of non-compliance with treatment with oral hypoglycemics, its causes and the profile of non-compliant patients. DESIGN: Prospective study. SETTING: Primary Care Centres in the province of Alicante. PATIENTS: 107 diabetics not dependent on insulin on the lists of five General Medicine practices and all receiving pharmacological treatment. MEASUREMENTS AND MAIN RESULTS: The method used to value compliance was a surprise count of pills in the patient's home. Patients achieving 80-110% compliance were considered compliant. The level of non-compliance was 51.5% (C.I. 42.1%-61%), 36.5% being hypocompliers and 15% hypercompliers. Forgetting (40.7%) and lack of knowledge (29.5%) were the most frequent reasons for non-compliance. The factors associated with non-compliance were: over four years evolution of the disease (p = 0.02), the diet not properly observed (p = 0.03), over a year in regular treatment (p = 0.006), poor control of the disease valued by HbA1C (p = 0.003). CONCLUSIONS: A high level of non-compliance with pharmacological treatment was found for patients with Diabetes Mellitus not dependent on insulin. Its causes were identified and factors associated with poor compliance were profiled.

[The epidemiology of dermatologic diseases in primary care]. / Epidemiología de las enfermedades dermatológicas en atención primaria.

UNLABELLED: With the aim of finding out the prevalence and the origin of the skin disease in primary health care, a prospective study was carried out over the period of May to October of 1989 in an urban health centre, with the support of the dermatologist and using iconographic means. The 395 cases considered made up 4.85% of all the medical examinations. A limited number of diagnoses (11) made up the majority of the medical examinations (70%). 19% were referred to the dermatologist. 23% of those diagnosed were not consulted for the patient, including two malign tumours. CONCLUSIONS: skin disease has a relevant place in primary health care clinics; the dermatological training of the primary health care doctor should be aimed at the most frequent diagnoses in his setting; active detection of skin lesions is very important.

[Aluminum absorption in the presence of normal kidney function: the effect of the pH]. / Absorción de aluminio en presencia de función renal normal: efecto del pH.

Aluminium is a toxic metal of known importance in patients with chronic renal failure on hemodialysis, with a gastrointestinal absorption modulated by several factors including gastric pH which modifies the solubility of Aluminium hydroxide and can increase its absorption. We studied twenty six patients with normal renal function: control (n = 13); presurgery (n = 8); postsurgery (n = 5) by an aluminium hydroxide absorption test (30 mg/kg); serum and urinary aluminium was determined as well as gastric pH and hematologic parameters at different time periods. It was observed that presurgery ulcer patients (pH mean = 2.09) increased serum and urine aluminium levels as well as aluminium/creatinine ratio in urine after the test, opposite to what occurs in the postsurgery group (pH mean = 5.78) in which such parameters were not significantly modified. No differences were found in hematological parameters between the two groups. Our results indicate that acid gastric pH seems to be a factor capable of increasing gastrointestinal absorption of aluminium hydroxide since its solubility and thus its disponibility is increased, and make a point on the risk of a prolonged administration of antacids containing aluminium in patients with normal renal function.

[Survey of smoking habits of the medical personnel at the Hospital San Pedro de Alcántara (Cáceres)]. / Encuesta sobre el hábito tabáquico en el personal médico del Hospital San Pedro de Alcántara (Cáceres).

The prevalence and social and health aspects of smoking habits among physicians of the Hospital San Pedro de Alcántara (Cáceres) were evaluated with the questionnaire used in the course on smoking habits delivered by the INSALUD in 1988. The sample consisted of 123 physicians. 47.1% (+8.7%) declared to be smokers. This prevalence is higher than that in the general population. The rate of female nonsmokers was significantly higher than that of male nonsmokers (p less than 0.05). 51.7% of smokers had not made any attempt to give up smoking. 90% thought that the role of the doctors as a model is important, and that the health system should undertake their treatment. 97.2% declared to lack therapeutic resources. The results disclose the need for specific programs directed to exemplary groups of professionals, such as those devoted to health care, so as to achieve a reduction in the smoking habit.

[Hospital overuse: evaluation and follow-up of endocrine diseases in primary health care]. / Sobreutilización del hospital: valoración y seguimiento de la patología endocrinológica en atención primaria.

On the base of a preestablished protocol, 350 patients from a hospital endocrinological clinic were evaluated to assess the possible role of primary care teams to reduce its possible massification. A comparative evaluation of the causes for consultation was carried out in those patients requiring specialized attention and those which do not need the complexities of hospital organization for their appropriate care and which should be best directed to primary care. It was concluded that there is an overload of hospital clinics, as 34.5% of patients should have been diagnosed and treated in the primary level of care. On the basis of these results, the endocrine diseases requiring primary care would basically be obesity and type II diabetes mellitus, which, in addition, are present in more than 50% of the patients on care.