[CD64 index as a marker of infection in patients with postoperative fever]. / El índice CD64 como marcador de infección en pacientes con fiebre postoperatoria.

OBJECTIVE: To evaluate the utility of the granulocyte CD64 index as a marker of infection in patients with postoperative fever. METHODS: Prospective observational study of a cohort of patients with postoperative fever (2nd-21st day after the intervention) collected during 14 months. Obtaining blood samples during the first 24 hours after the febrile peak to determine the CD64 index (ratio of fluorescence intensity, measured, in the granulocytes of the patient with respect to healthy controls), procalcitonin and C-reactive protein (CRP). RESULTS: During the study period, 50 patients were included, 28 patients (56%) with infection and 22 patients (44%) without evidence of infection. The PCR, procalcitonin and the CD64 index showed significantly higher values in the group of patients who suffered infection. The CD64 index showed a sensitivity of 88.9%, with a specificity of 65.2%. The positive predictive value (PPV) was 75% and the negative predictive value (NPV) was 83.3%, with an area under the curve (AUC) of 0.805 (95% CI 0.68-0.93). Procalcitonin presented a sensitivity of 53.9% and specificity of 86.4%, with NPV and PPV of 82.4% and 61.3% respectively, with AUC of 0.752 (95% CI 0.61-0.89). Regarding the PCR, it showed a sensitivity of 100%, with specificity of 4.4% with an area under the curve of 0.676 (95% CI 0.52-0.83). CONCLUSIONS: The quantification of the CD64 index in patients who develop fever in the early postoperative period is useful to distinguish post-surgical inflammatory phenomena from episodes of established infection.

Valoración de la idoneidad de los criterios STOPP/START en el ámbito de atención primaria en España por el método RAND / Assessment of the appropriateness of STOPP/START criteria in primary health care in Spain by the RAND method

Introducción. Pretendemos valorar la idoneidad de los criterios STOPP/START para su utilización en el ámbito de atención primaria (AP) en España. Material y método. Estudio observacional transversal con metodología RAND a 2 rondas realizado en la Gerencia de AP de Vigo con 582.968 habitantes (24% ≥>= 65 años). El grupo de expertos fue constituido por la comisión de farmacia del área, con 12 miembros de diversas especialidades. En una primera ronda, se proporciona a la comisión bibliografía relevante y un cuestionario con los criterios STOPP/START para puntuar la idoneidad en AP con una escala Likert del 1-9 (mínimo, máximo). Cada criterio se clasifica en función de la mediana de las puntuaciones obtenidas y su grado de acuerdo. En una segunda ronda, los expertos debaten los criterios dudosos y las sugerencias aportadas. Resultados. La mayoría de los criterios se consideran apropiados, proponiendo una nueva versión AP2012 con las siguientes diferencias: eliminar START E2 «Bifosfonatos en pacientes que reciben corticoesteroides orales a dosis de mantenimiento»; eliminar START F3 «Antiagregantes plaquetarios en la diabetes mellitus si coexisten uno o más factores mayores de riesgo cardiovascular»; modificar STOPP A9, A15, A16, A17 y E5 y START A1 y A2, por referirse solo a la warfarina y se añade acenocumarol, habitual en nuestro medio, e introducir STOPP C6 «Uso de inhibidores de la bomba de protones (IBP) fuera de sus indicaciones autorizadas». Conclusiones. Los criterios STOPP/START son adecuados para su uso en el ámbito de AP pero es necesaria su adaptación y actualización periódica (AU)

Introduction: A new screenings tool called STOPP/START has been formulated to identify potentially inappropriate prescribing in older people. This study aimed to assess the appropriateness of STOPP/START criteria in primary health care (PHC) in Spain. Material and method: The RAND Appropriateness Method was used to obtain agreement on STOPP/START criteria with two rounds in Vigo PHC with 582.968 inhabitants (24% >=65 years). The pharmacotherapy committee of Vigo PHC area was identified as expert panel, with 12 members from different specialties. In the first round, the committee was provided with relevant literature and a questionnaire with STOPP/START criteria to rate their applicability in PHC with a 9-point Likert scale. Then, each of the criteria was classified according to the median scores and the degree of agreement. In the second round, the experts discussed the undecided criteria and suggestions. Results: Most of the criteria were appropriate. We present a new version with the following differences: to remove START E2 «Biphosphonates in patients taking maintenance oral corticosteroid therapy»; to remove START F3 «Antiplatelet therapy in diabetes mellitus with coexisting major cardiovascular risk factors»; to modify STOPP A9, A15, A16, A17 and E5; and START A1 and A2, adding acenocoumarol to all of them because acenocoumarol is the most used anticoagulant in our country and they only refer to warfarin, and to introduce STOPP C6: «Use of proton pump inhibitors without authorized indication». Conclusions: Criteria STOPP/START are suitable for use PHC but it is necessary to adapt and update them periodically (AU)

[Assessment of the appropriateness of STOPP/START criteria in primary health care in Spain by the RAND method]. / Valoración de la idoneidad de los criterios STOPP/START en el ámbito de atención primaria en España por el método RAND.

INTRODUCTION: A new screenings tool called STOPP/START has been formulated to identify potentially inappropriate prescribing in older people. This study aimed to assess the appropriateness of STOPP/START criteria in primary health care (PHC) in Spain. MATERIAL AND METHOD: The RAND Appropriateness Method was used to obtain agreement on STOPP/START criteria with two rounds in Vigo PHC with 582.968 inhabitants (24% ≥ 65 years). The pharmacotherapy committee of Vigo PHC area was identified as expert panel, with 12 members from different specialties. In the first round, the committee was provided with relevant literature and a questionnaire with STOPP/START criteria to rate their applicability in PHC with a 9-point Likert scale. Then, each of the criteria was classified according to the median scores and the degree of agreement. In the second round, the experts discussed the undecided criteria and suggestions. RESULTS: Most of the criteria were appropriate. We present a new version with the following differences: to remove START E2 «Biphosphonates in patients taking maintenance oral corticosteroid therapy¼; to remove START F3 «Antiplatelet therapy in diabetes mellitus with coexisting major cardiovascular risk factors¼; to modify STOPP A9, A15, A16, A17 and E5; and START A1 and A2, adding acenocoumarol to all of them because acenocoumarol is the most used anticoagulant in our country and they only refer to warfarin, and to introduce STOPP C6: «Use of proton pump inhibitors without authorized indication¼. CONCLUSIONS: Criteria STOPP/START are suitable for use PHC but it is necessary to adapt and update them periodically.

Nuevos retos en el abordaje de las adicciones a cocaína y alcohol / No disponible

No disponible

Prevalencia del tabaquismo y sintomatología asociada en estudiantes de Medicina de la Universidad Juárez Autónoma de Tabasco (México) / No disponible

Objetivo: Investigar la prevalencia, características y sintomatología relacionada al consumo de tabaco en estudiantes de medicina de la Universidad Juárez Autónoma de Tabasco (UJAT), México. Métodos: Se trata de un estudio observacional, transversal y descriptivo realizado en una muestra aleatoria, a la cual se le aplicó un cuestionario que contenía variables relacionadas con el hábito de fumar y los síntomas y signos manifestados. Resultados 58,4% de los estudiantes encuestados refirieron haber fumado al menos una vez en su vida; de éstos, el 27,1% refirió continuar fumando. Los fumadores que consumían más de 10 cigarrillos al día presentaron mayor riesgo de manchas en los dientes, OR de 9,38 (IC95% 1,42, 6,07). Conclusiones. La prevalencia del hábito de fumar en los estudiantes de medicina de la UJAT es menor que la reportada por otra universidad de México, pero mayor que la del estudio realizado en estudiantes argentinos (AU)

Objective: To investigate the prevalence, characteristics and symptomatology related to the tobacco consumption in medicine students of the Universidad Juárez Autónoma de Tabasco. (UJAT), Mexico. Methods: We made an observational, cross-sectional and descriptive study, developed in a random sample; to which a questionnaire was applied. Wich contained variables related to the smoking habit and the symptoms and signs showed. Results: 58,4% of the students declared to have smoked at least once in their life, of these the 27,1% referred to continue smoking. The smokers who consumed more than 10 cigarettes a day, showed greater risk of spots in teeth OR of 9,38 (IC 95% 1,42, 62,07). Conclusions. The prevalence of the smoking habit in medicine students of the UJAT is lower than the one reported by another university of Mexico, but higher than the one of a study made in Argentine students (AU)

[Relationship between memory tests and volumetry and relaxometry of the hippocampus]. / Relación entre los tests de memoria y la volumetría y relaxometría del hipocampo.

INTRODUCTION AND AIMS: Interdisciplinary research made by neuropsychologist, neurologists and radiologists is making possible descriptions of the anatomic bases of memory. The hippocampus is one of the main structures related to memory processing. The aim of the present study was to study the relationship between verbal and visual memory, and the volumetry and relaxometry of the. PATIENTS AND METHODS: 36 patients with temporal lobe epilepsy and mesial temporal sclerosis (MTS). Fist, a neuropsychological assessment of was made the verbal and visual memory. Second, hippocampal structure were studied by magnetic resonance image (hippocampal volumetry and relaxometry). RESULTS AND CONCLUSIONS: Reactive gliosis measured by T2 relaxation time predicted poorer visual memory in patients with right or left MTS. These results indicate that structural damage in right hippocampus implies worse performance in visual memory. Moreover, MTS was found to have negative effects on contralateral memory (poorer verbal memory in right MTS, and poorer visual memory in left MTS). These results could be due to memory compensation. Thus, the memory function associated with the sclerotic hippocampus is adopted by the contralateral structure. Therefore, the more damage there is to the latter, the poorer is the memory functioning.

Relación entre los tests de memoria y la volumetría y relaxometría del hipocampo / Relationship between memory tests and volumetry and relaxometry of the hippocampus

Introducción y objetivos. Los trabajos interdisplinares realizados desde la neuropsicología, la neurología y la radiología permiten describir las bases anatómicas de la memoria. El hipocampo es una de las principales estructuras relacionadas con el procesamiento de la memoria. El objetivo del presente trabajo es estudiar la relación de distintas tareas de memoria verbal y visual con dos técnicas de diagnóstico por imagen de resonancia magnética, como la volumetría y la relaxometría hipocampal. Pacientes y métodos. Se estudiaron 36 pacientes con crisis parciales complejas de origen temporal asociadas a esclerosis temporal mesial (ETM) unilateral. Se evaluó neuropsicológicamente el funcionamiento de la memoria verbal y visual, y se realizaron estudios de resonancia magnética, volumetría y relaxometría de ambos hipocampos. Resultados y conclusiones. La gliosis reactiva medida por el tiempo de relajación en T2 predice una peor ejecución en memoria visual, tanto en los pacientes con esclerosis temporal derecha como izquierda. Por tanto, los resultados muestran que la alteración estructural del hipocampo derecho implica una peor ejecución en memoria visual. Por otro lado, se ha encontrado que la memoria verbal en la ETM derecha y la memoria visual en la ETM izquierda, empeoran cuanto mayor era la afectación del hipocampo esclerótico. Estos datos podrían ser resultado de la compensación de funciones, al asumir el hipocampo menos dañado parte de las funciones del esclerótico, porque al verse dañado el primero se afectarían negativamente tanto la memoria verbal como la visual

Introduction and aims. Interdisciplinary research made by neuropsychologist, neurologists and radiologists is making possible descriptions of the anatomic bases of memory. The hippocampus is one of the main structures related to memory processing. The aim of the present study was to study the relationship between verbal and visual memory, and the volumetry and relaxometry of the. Patients and methods. 36 patients with temporal lobe epilepsy and mesial temporal sclerosis (MTS). Fist, a neuropsychological assessment of was made the verbal and visual memory. Second, hippocampal structure were studied by magnetic resonance image (hippocampal volumetry and relaxometry). Results and conclusions. Reactive gliosis measured by T2 relaxation time predicted poorer visual memory in patients with right or left MTS. These results indicate that structural damage in right hippocampus implies worse performance in visual memory. Moreover, MTS was found to have negative effects on contralateral memory (poorer verbal memory in right MTS, and poorer visual memory in left MTS). These results could be due to memory compensation. Thus, the memory function associated with the sclerotic hippocampus is adopted by the contralateral structure. Therefore, the more damage there is to the latter, the poorer is the memory functioning

[Guidelines for the scientific and professional development of forensic neuropsychology]. / Pautas para el desarrollo científico y profesional de la neuropsicología forense.

AIMS: The principal aims of this review are: (a) to offer a perspective of the principal challenges that forensic neuropsychology handles in its scientific and professional development, and the empirical advances that have been developed to deal with these challenges; and (b) analyze the potential effects of these advances on the application of the discipline in the Spanish legal system. DEVELOPMENT: With the purpose of reaching these challenges, a series of methodological strategies and instruments, along with specific recommendations about the use of currently available procedures and the development of new procedures, have been generated within the context of forensic neuropsychology. In this paper, we will review: the advances carried out in the different issues of interest that currently handles the development of the discipline, including: the estimation of premorbid functioning, the development of base rates and norms for forensic populations, the detection of malingerers, the ecological validity of instruments, and the creation of professional practices; we will analyze the potential application of these advances to the assessment of the Spanish forensic population; and we will study the principal application areas of forensic neuropsychology within the Spanish legal context. CONCLUSIONS: Forensic neuropsychology is an emergent discipline that is placed in a key moment of its scientific and professional development. This development should be anchored in the application of specific scientific, professional, and academic strategies.

[The impact exerted by the severity of recreational drug abuse on the different components of the executive function]. / Impacto de la gravedad del consumo de drogas de abuso sobre distintos componentes de la función ejecutiva.

INTRODUCTION: A number of neuropsychological studies have shown the relationship between severity of drug abuse and the executive functioning of substance abusers, along with its negative impact on treatment results. AIM: The aim of this study is to examine the relationship between severity of consumption of alcohol, cannabis, cocaine, heroin, amphetamines and ecstasy on the executive processes of fluency, working memory, response inhibition, concept formation and decision-making. PATIENTS AND METHODS: Forty poly-substance abusers participated in this study. In a series of setwise regression analyses we introduced the standardized scores of a severity index as predictor variables, and the raw scores of five indexes sensitive to executive functioning as dependent variables: the Ruff Figural Fluency Test (RFFT), the Letter Number Sequencing subtest (LyN), the 5 Digit Test (5DT), the Category Test (TC) and the Gambling Task (GT). Best subsets of predictors for each dependent variable were included in multiple regression models. RESULTS AND CONCLUSIONS: We obtained significant relationships between severity of heroin and ecstasy abuse and RFFT performance; between severity of alcohol, cocaine, heroin and amphetamines and LyN performance; between severity of alcohol, cannabis, cocaine, heroin and ecstasy and 5DT performance; and between severity of heroin and amphetamines and TC performance. These results show the significant influence of severity of drug abuse on executive impairment, which may have a negative impact on treatment results.

Pautas para el desarrollo científico y profesional de la neuropsicología forense / Guidelines for the scientific and professional development of forensic neuropsychology

Objetivos. Los principales objetivos de esta revisión son: 1. ofrecer una visión acerca de los principales retos que la neuropsicología forense afronta en su desarrollo científico y profesional, así como de los avances empíricos que para afrontar estos retos se han generado o se están generando, y 2. analizar las potenciales repercusiones de dichos avances sobre la aplicación de esta disciplina en el sistema legal español. Desarrollo. Con el objetivo de alcanzar estos retos se han desarrollado una serie de estrategias metodológicas e instrumentos, así como una serie de recomendaciones específicas para la aplicación de los procedimientos disponibles y para el desarrollo de nuevos procedimientos dentro del ámbito de la neuropsicología forense. En este artículo repasaremos los avances que se han realizado en los distintos focos de atención que actualmente afronta el desarrollo de esta disciplina, incluyendo la estimación del funcionamiento premórbido, el desarrollo de porcentajes de base y baremos para poblaciones forenses, la detección de simuladores, la capacidad de predicción ecológica de los instrumentos y el desarrollo de prácticas profesionales. Analizaremos la potencial aplicación de estos avances a la evaluación de la población forense española, y estudiaremos los principales ámbitos de aplicación de la neuropsicología forense dentro del contexto legal español. Conclusiones. La neuropsicología forense es una disciplina emergente que se halla en un momento clave de su desarrollo científico y profesional. Este desarrollo debería anclarse en la aplicación de estrategias científicas, profesionales y académicas específicas (AU)

Aims. The principal aims of this review are: (a) to offer a perspective of the principal challenges that forensic neuropsychology handles in its scientific and professional development, and the empirical advances that have been developed to deal with these challenges; and (b) analyze the potential effects of these advances on the application of the discipline in the Spanish legal system. Development. With the purpose of reaching these challenges, a series of methodological strategies and instruments, along with specific recommendations about the use of currently available procedures and the development of new procedures, have been generated within the context of forensic neuropsychology. In this paper, we will review: the advances carried out in the different issues of interest that currently handles the development of the discipline, including: the estimation of premorbid functioning, the development of base rates and norms for forensic populations, the detection of malingerers, the ecological validity of instruments, and the creation of professional practices; we will analyze the potential application of these advances to the assessment of the Spanish forensic population; and we will study the principal application areas of forensic neuropsychology within the Spanish legal context. Conclusions. Forensic neuropsychology is an emergent discipline that is placed in a key moment of its scientific and professional development. This development should be anchored in the application of specific scientific, professional, and academic strategies (AU)

[Alterations in the decision making processes linked to the ventromedial prefrontal cortex in drug-abusing patients]. / Alteraciones de los procesos de toma de decisiones vinculados al cortex prefrontal ventromedial en pacientes drogodependientes.

INTRODUCTION: The somatic marker hypothesis proposes that somatic signals guide the decision making processes in an adaptive sense for the organism. The processing of these somatic signals is linked to the ventromedial prefrontal cortex activity. The influence of somatic markers on decision making processes has been studied by means of the 'gambling task' (GT). Several studies using the GT in substance abusers have showed the existence of decision making impairments in these patients. AIMS: To examine the performance in the GT of a Spanish sample of substance abusers; and to study the influence of clinically relevant variables: type of substance, years of abuse and abstinence period on GT performance. PATIENTS AND METHODS: 106 substance abusers patients during the dishabituation phase participated in the study. We administered a computerized version of the GT in a single individual session. We used descriptive analyses to study the patients' performance in the GT. Next we carried out multiple regression analyses to study the influence of the clinical variables on the GT performance. RESULTS: A 76.4% of the sample patients showed impairments in the decision making processes measured by the GT. None of the clinical variables significantly predicted performance in the task. CONCLUSIONS: These results suggest the existence of decision making impairments in substance abusers that may be related to pre morbid alterations, or to a neurotoxic effect of drugs of abuse on the activity of the ventromedial prefrontal cortex.

Alteraciones de los procesos de toma de decisiones vinculados al córtex prefrontal ventromedial en pacientes drogodependientes / Alterations to the decision-making processes linked to the ventromedial prefrontal cortex in drug-abusing patients

Introducción. La hipótesis del marcador somático propone que existen señales corporales que guían los procesos de toma de decisiones en un sentido adaptativo para el organismo. El procesamiento de estas señales se asocia al funcionamiento del córtex prefrontal ventromedial. La influencia de estos marcadores somáticos en la toma de decisiones se ha medido mediante la gambling task (GT). Varios estudios realizados con la GT en drogodependientes han mostrado un deterioro de los procesos de toma de decisiones de estos pacientes. Objetivo. Examinar el rendimiento de una muestra española de drogodependientes en la GT y analizar la influencia de variables de interés clínico -tipo de sustancia, tiempo de consumo y abstinencia- sobre el rendimiento en la tarea. Pacientes y métodos. Participaron 106 pacientes drogodependientes en fase de deshabituación. Se administró una versión computarizada de la GT en una única sesión individual. Se realizaron análisis descriptivos para examinar la ejecución de los pacientes en la tarea y análisis de regresión múltiple para estudiar la influencia de las variables clínicas sobre el rendimiento en la GT. Resultados. El 76,4 por ciento de los pacientes de la muestra presentaba deterioro en los procesos de toma de decisiones medidos con la GT. Ninguna de las variables examinadas se relacionaba significativamente con el rendimiento en la GT. Conclusiones. Estos resultados sugieren la existencia de alteraciones en los procesos de toma de decisiones de los pacientes drogodependientes, que pueden relacionarse con alteraciones premórbidas, o bien con el efecto neurotóxico de las drogas, en el funcionamiento del córtex ventromedial (AU)

Introduction. The somatic marker hypothesis proposes that somatic signals guide the decision-making processes in an adaptive sense for the organism. The processing of these somatic signals is linked to the ventromedial prefrontal cortex activity. The influence of somatic markers on decision-making processes has been studied by means of the ‘gambling task’ (GT). Several studies using the GT in substance abusers have shown the existence of decision-making impairments in these patients. Aims. To examine the performance in the GT of a Spanish sample of substance abusers; and to study the influence of clinically relevant variables: type of substance, years of abuse and abstinence period on GT performance. Patients and methods. 106 substance abusers patients during the dishabituation phase participated in the study. We administered a computerized version of the GT in a single individual session. We used descriptive analyses to study the patients´ performance in the GT. Next we carried out multiple regression analyses to study the influence of the clinical variables on the GT performance. Results. A 76.4% of the sample patients showed impairments in the decision-making processes measured by the GT. None of the clinical variables significantly predicted performance in the task. Conclusions. These results suggest the existence of decisionmaking impairments in substance abusers that may be related to pre-morbid alterations, or to a neurotoxic effect of drugs of abuse on the activity of the ventromedial prefrontal cortex (AU)

[Retroperitoneal pathology]. / Patología retroperitoneal.

The retroperitoneum is one of the most complex regions of human anatomy as it contains a variety organs and structures from different systems, in particular those belonging to the urinary and digestive tracts and the vascular systems. The emergence of different diagnostic imaging techniques has made easier to study the retroperitoneum. Thanks to ultrasonography, computerised tomography and magnetic resonance the assessment of retroperitoneal conditions has taken a great leap forwards permitting the anatomical connections and characteristics of the structures in this region to be reliably established. Owing to the location in the retroperitoneal space of the different organs of the digestive tract and the vascular system, a multidisciplinary approach is required involving the different surgical specialties. The urologist performs a large proportion of his surgical activity in this region and must, therefore, have a good knowledge of the different retroperitoneal organs belonging to the urinary tract and also the connections between these and other organs and structures of the retroperitoneal region.

Patología retroperitoneal / Retroperitoneal pathology

El retroperitoneo es una de las áreas más complejas de la anatomía humana, al situarse en este espacio una gran variedad de órganos y estructuras pertenecientes a diferentes sistemas, especialmente al aparato urinario, digestivo y vascular. La incorporación de distintas técnicas diagnósticas de imagen nos han permitido estudiar el retroperitoneo, por lo que gracias a la ecografía, la tomografía computarizada y la resonancia magnética, que han supuesto un decisivo avance en la valoración de las distintas patologías retroperitoneales, se ha podido establecer de forma fiable las características y relaciones anatómicas de las estructuras implicadas en estas. La localización en el espacio retroperitoneal de diferentes órganos del aparato digestivo y del sistema vascular hace necesario un abordaje multidisciplinario por parte de diferentes especialidades quirúrgicas, sin olvidar que el urólogo desarrolla en este espacio una gran parte de su actividad quirúrgica, por lo que ha de estar familiarizado tanto con los diferentes órganos retroperitoneales del aparato urinario como con las relaciones que estos establecen con los demás órganos y estructuras propios del espacio retroperitoneal (AU)

[Descriptive study of bladder tumors in the district of Levante-Alto Almanzora]. / Estudio descriptivo de los tumores vesicales en la comarca del Levante-Alto Almanzora.

We present our series of operater bladder cancers in this District and the annual incidence in the period 1996 at 1998, as web as they are distributed by sex, age and smoking in the population; neoplasic stage and relapse were also studied. 61 patients were treated and un found global half incidence of 19.8 for 10(5) inhabitant-year (h-a), while for sexes it was of 4.22 for 10(5) h-y for women and of 15.58 for 10(5) h-y males. 78.69% was male with a masculinity rate of 3.69. The most frequent age group was starting from the seventh decade with 50.81% of our series. There was 36% of intervened patients that they were smoking, while 29.5% had relationship with other factors of risk like hydrocarbons and pesticidas. The superficial tumors were the most frequent with 86.88% of the cases, on the other hand the undifferentiated neoplastics was not very frequent with 13.21%, increasing these neoplastics with the age. In the follow up there were relapses in 36% of the people, being bigger in the T1 of our series. The occupational factors in this district can explain the high frequency in the female sex, although analytic studies are needed to check it.

Estudio descriptivo de los tumores vesicales en la Comarca del Levante-Alto Almanzora / Descriptive study ob bladder cancer in District the Levant-High Alamanzora

Se presentan los tumores vesicales intervenidos en esta Comarca y la incidencia anual en el periodo 1996 a 1998, así como se distribuyen por sexo, edad y hábito tabáquico en la población; también se estudiaron el estadio tumoral y la recidiva. Se han tratado 61 pacientes con una incidencia media global de 19,8 por 10 5 habitantes-año (h-a), mientras que por sexos fue de 4,22 por 10 5 h-a para mujeres y de 15,58 por 10 5 h-a para varones. El 78,69 por ciento fue-ron varones, con una razón de masculinidad de 3,69. El grupo de edad más frecuente fue a partir de la séptima década con un 50,81 por ciento de nuestra serie. Hubo un 36 por ciento de pacientes intervenidos que eran fumadores, mientras que un 29,5 por ciento habían estado expuestos a otros factores de riesgo como hidrocarburos y pesticidas. Los tumores superficiales fueron los más frecuentes con el 86,88 por ciento de los casos, por el contrario aquellos con histología indiferenciada fueron poco frecuentes con el 13,21 por ciento, aumentando estas neoplasias con la edad. En el seguimiento hubo recidivas en el 36 por ciento de los sujetos, siendo mayor en los T1 de nuestra serie. Los factores ocupacionales en esta zona pueden explicar la elevada frecuencia en el sexo femenino, aunque se necesitan estudios analíticos para comprobarlo (AU)

[Effect of potassium citrate in the prophylaxis of urinary lithiasis]. / Efecto del citrato potásico en la profilaxis de la litiasis urinaria.

OBJECTIVE: The physiologic effects of potassium citrate on urinary solubility have led to their use to facilitate stone passage after lithotripsy. The aim of our study is to evaluate the foregoing effects and the efficacy of long-term treatment with potassium citrate to prevent stone recurrence in patients undergoing extracorporeal shock wave lithotripsy. METHODS: A prospective study was conducted on 100 patients with calcium oxalate or calcium phosphate nephrolithiasis that had undergone treatment by extracorporeal shock wave lithotripsy (ESWL). The patients were divided into 4 groups: patients that were stone-free treated with potassium phosphate (25 cases) or fluid diet (25 cases) and patients with persistent residual lithiasis treated with potassium citrate (25 cases) or fluid diet (25 cases). Calculi were classified according to the changes observed during the study compared with the pre-study status as stable (no changes from the pre-study status, with or without residual stone), increased (increase in number or size of the residual stone or recurrence), and decreased (decrease in number or size or passage of the residual stone). RESULTS: Of the 50 patients treated with potassium citrate, 35 (70%) remained stable, 10 cases (20%) showed a decrease and 5 (10%) showed an increase. Of the 50 patients on fluid diet, 19 (38%) remained stable throughout the study, 4 (8%) showed a decrease and 27 (54%) showed an increase in stone size or number. The number of stone recurrence throughout the study in the 100 patients was 25 (25%); of these, 8 were in patients treated with potassium citrate and 17 of those that did not receive potassium citrate. CONCLUSIONS: Potassium citrate therapy has been found to be statistically significantly effective in the control of post-lithotripsy residual stone and stone recurrence.

[Renal cell carcinoma in patient with situs inversus and Kartagener syndrome]. / Carcinoma de células renales en paciente con situs inversus y síndrome de Kartagener.

A case of a adenocarcinoma renal in a patient with situs inversus complete to which was associated bronchiectasis and chronic sinusitis (kartagener's syndrome) is reported. It is the third case described in the international literature of a renal cells carcinoma in a patient with situs inversus totalis and the first in patient the one which has the triada classic of the kartagener's syndrome plus sterility. The tumor was discovered in a way incidental upon accomplishing a TAC toracoabdominal and was solved through nefrectomia for lumbotomy approach.