[Diagnostic validity of Zung's self-rating depression scale on primary care patients]. / Validez diagnóstica de la Self-Rating Depression Scale de Zung en pacientes de atención primaria.

INTRODUCTION: Although the Spanish version of the Zung's Self-Rating Depression Scale (SDS) is widely used, there are no studies about its validity as a diagnostic test in primary health care patients. METHODS: In a first phase, a sample of 350 consecutive primary care patients was assessed with the SDS. In a second phase, a subsample composed by all the positive test results and 1/3 of the negatives selected at random, was assessed with the modules of current Major Depressive Episode and Dysthymia of the Structured Clinical Interview for DSM-IV. Specific methods to avoid verification bias were used. Prevalence, sensitivity and specificity, predictive values, Receiver Operating Characteristic (ROC) curve, and Stratum Specific Likelihood Ratios (SSLR) were calculated. RESULTS: Prevalence estimations of major depression and dysthymia were 14,7% (IC95%: 10,7-18,7%) and 4,6% (IC95%: 2,4%-6,8%) respectively. Sensitivity and specificity to detect both diagnoses were 0,95 (IC95%: 0.87-1) and 0,74 (IC95%: 0,68-0,79). Area under ROC curve was 0,93. SSLR for scoring < 50 led to a post-test probability of 0.01. In the stratum with scoring > 69 the SSLR generated a post-test probability of 0.96. Less conclusive results were obtained by intermediate strata. CONCLUSIONS: The SDS is effective in primary care patients and shows operating characteristics comparable to other depression assessment scales. SSLR provides practical information to estimate the probability of suffer a depressive disorder in individual patients.

Validez diagnóstica de la Self-Rating Depression Scale de Zung en pacientes de atención primaria / Diagnostic validity of Zung's Self-Rating Depression Scale on primary care patients

Introducción: Aunque la versión española del cuestionario Self-Rating Depression Scale de Zung (SDS) goza de gran difusión, no existen estudios sobre su validez como prueba diagnóstica en pacientes de atención primaria. Metodología: En una primera fase evaluamos una muestra de 350 pacientes consecutivos de atención primaria con el SDS y, en una segunda fase, aplicamos la Structured Clinical Inteview for DSM-IV, en sus apartados de Episodio Depresivo Mayor y Distimia actuales, a una submuestra compuesta por todos los pacientes con resultado positivo en el test y 1/3 aleatorio de los negativos.Utilizamos metodología específica para evitar el sesgo de verificación y calculamos prevalencia, sensibilidad y especificidad, valores predictivos, curva Receiver Operating Characteristic (ROC) y Razones de Verosimilitud Específicas por Estratos (RVEE).Resultados: La prevalencia de depresión mayor fue de 14,7 por ciento (IC95 por ciento: 10,7 por ciento-18,7 por ciento) y la de distimia 4,6 por ciento (IC95 por ciento: 2,4 por ciento-6,8 por ciento). Los resultados de sensibilidad y especificidad para detectar ambos diagnósticos fueron 0,95 (IC95 por ciento: 0,87-1) y 0,74 (IC95 por ciento: 0,68-0,79). El área bajo la curva ROC fue de 0,93. La RVEE para las puntuaciones 69 la RVEE lleva a una probabilidad posttest de 0,96. Los estratos intermedios ofrecieron resultados menos concluyentes. Conclusiones: El SDS es eficaz en pacientes de atención primaria y muestra un comportamiento equiparable a otros cuestionarios de detección de la depresión. La aplicación de las RVEE puede ser muy práctica e informativa para estimar la probabilidad de padecer un trastorno depresivo en los pacientes individuales (AU)

Tumor antigens CA 19.9, CA 125, and CEA in carcinoma of the uterine cervix.

Serum levels of carcinoembryonic antigen (CEA) and cancer antigens CA 125 and CA 19.9 were determined by immunoradiometric assay in 96 patients diagnosed of invasive carcinoma of the uterine cervix and 7 patients of cervical intraepithelial neoplasia. Elevated CEA levels were found in 33%, CA 19.9 in 32%, and CA 125 in 21.5% of invasive carcinoma patients. Specificity for each tumor marker was 98%. Increased CEA and CA 19.9 levels were found in relation to clinical stage. CA 125 and CA 19.9 mean levels were significantly higher in patients with adenocarcinoma compared with squamous cell carcinoma. Detection rate of CA 19.9 in stage III adenocarcinomas was higher than in stage III squamous cell carcinoma (50 vs 21%). Sensitivity of combined antigens was also higher for adenocarcinomas increasing 60% for CA 19.9 and/or CA 125 and to 70% of cases for one of the three tumor antigens. During follow-up of cases with no evidence of disease, antigen levels showed a tendency to decrease, but all cases with progressive disease, recurrence, or metastasis were detected by elevation of one of these three tumor antigens. In conclusion, CEA, CA 125, and CA 19.9 are useful markers for detection of cervical cancer and monitorization of clinical course of disease. CA 19.9 and CA 125 have been shown to be particularly useful in patients with adenocarcinoma.

Squamous cell carcinoma antigen in cervical cancer.

Squamous cell carcinoma (SCC) antigen was described as being associated with malignant disease of the uterine cervix, and was determined by a radioimmunoassay technique. We studied squamous cell carcinoma serum levels in 72 patients from our gynecological clinic. Forty-three were diagnosed as having gynecological malignancies, and 29 as having benign diseases. The malignant disease group included 35 carcinomas of the uterine cervix, 7 endometrial cancers, and 3 vulvar cancers. Gynecological cancers were classified according to the FIGO system. We also determined SCC levels among 69 healthy subjects. Results showed that 97.1% of healthy subjects were below the cut-off point, 2.5 micrograms/l. Patients with benign gynecological diseases had increased SCC levels in 5.9% of cases. Among gynecological cancers, 56% of 23 cases of cervical cancer and one of three vulvar cancer, all of them in the active phase, had increased levels. The nine squamous carcinomas of the cervix with no evidence of disease, as well as seven endometrial adenocarcinomas with active disease were negative. Thirty-three percent of 12 cervical cancers in Stages I and II were high levels, compared to 81% of 11 advanced stages; none of the 2 early stage carcinoma of the vulva, but 1 advanced stage were increased. SCC is clinically applicable to monitor size and tumor volume of carcinomas of the uterine cervix derived from squamous epithelium.

A prospective study of tumor markers CA 125 and CA 19.9 in patients with epithelial ovarian carcinomas.

In a prospective study, CA 125 and CA 19.9 serum levels were measured in 229 patients with ovarian cancer [121 with active disease, 108 in complete remission (CR)], and in 20 patients with other malignancies. Abnormal levels of CA 125 were found in 90% of patients with active ovarian cancer, in 1.8% of those in CR and in 38% of cases with other malignancies. Abnormal CA 19.9 serum levels were found in 36, 9 and 48% of these groups, respectively. Serum levels of both tumor markers were related to tumor stage and histological type. The highest levels of CA 125 were found in serous adenocarcinoma and the lowest in the mucinous type (p < 0.0001). In contrast, significantly higher CA 19.9 values were found in mucinous carcinoma than in other histologies (p < 0.0001). CA 125 and CA 19.9 were useful for monitoring disease activity in 88.3 and 32%, respectively, while one or other tumor marker was useful in 92% of patients. At the time of the second-look operation, abnormal CA 125 serum levels were found in 32% (6/19) of patients with active disease and in none of those with CR (0/38). CA 125 sensitivity was 83% (5/6) in those patients with residual tumor > 2 cm and in 8% (1/13) in those with tumor < 2 cm. CA 19.9 values were abnormally high in 16% of cases with persistent disease and in 11% of CR patients. In conclusion, our results confirm that CA 125 is a useful marker in ovarian carcinoma. CA 19.9 improves the results obtained with CA 125 alone only in mucinous adenocarcinomas.

Total LDH and its isoenzymes in gynecological malignancies and other gynecological conditions.

Total LDH and its five Isoenzymes have been evaluated in 354 patients from a Gynecological Ward. These patients had uterine fibroids, benign ovarian tumors, tubo-ovarian abscesses (T.O.A.), endometrial cancers, cancers of the cervix and ovarian cancers. 90 patients had no gynecological disease and served as controls. A statistical analysis was performed comparing each group of patients with the control group. A significant elevation in total LDH and Iso-IV and a significant decrease in Iso-I was observed in patients with uterine fibroids. Patients with benign ovarian tumors had a significant elevation of total LDH. Patients with T.O.A., Endometrial cancer, cancer of the cervix and cancer of the ovary had a significant elevations of total LDH and Iso-V and a significant decrease in Iso-I. When the group of patients with endometrial cancer, cancer of the cervix and cancer of the ovary were compared with each other, no differences could be found in total LDH and Isoenzyme values. We conclude that total LDH and Isoenzyme serum levels are not useful clinical indicators for the diagnosis and management of gynecological malignancies and particularly of ovarian cancer.