Predicción mediante radiología simple y tomografía axial computarizada de la energía necesaria para fragmentar litiasis de distinta composición empleando litotricia extracorpórea por ondas de choque / Prediction of the energy required for extracorporeal shock wave lithotripsy of certain stones composition using simple radiology and computerized axial tomography

Objetivo: Demostrar que las litiasis urinarias necesitan, según su composición, una determinada energía para ser fracturadas mediante litotricia extracorpórea por ondas de choque (LEOC), pudiendo ser estimada antes del tratamiento mediante radiografía simple y TAC. Material y método: Estudio experimental, prospectivo y ciego, con 308 cálculos urinarios de 4 hospitales. No cumplieron criterios de inclusión 115: litiasis intactas, mayores de 0,5 cm y de composición pura (> 75%) de oxalato cálcico monohidrato (OCM), úrico o carboapatita, o mixta oxalocálcica mono y dihidratada (OCMix). Las 193 restantes fueron sometidas a radiografía simple y a tomografía (TAC), valorando digitalmente el gris máximo (Gmax) y el gris mediano (Gmda) presentado mediante Adobe Photoshop(R) CS5, y la atenuación en unidades Hounsfield (UH). Posteriormente se les administró LEOC a una frecuencia fija de 1 Hz hasta alcanzar una conminución preestablecida, registrándose así la dosis de energía (Edose) y la Edose ajustada a superficie litiásica (EdAJ). Resultados: La composición OCM resultó la más dura, precisando una Edose de 119.624 mJ/cm3 y una EdAJ de 36.983 mJ/cm3, seguida de OCMix (75.501/36.983), carboapatita (22.734/21.186) y úrico (22.580/6.837) (p < 0,05). Gmax y Gmda se correlacionaron con Edose (r = 0,434 y r = 0,420) y EdAJ (r = 0,599 y r = 0,545) (p < 0,01). Las UH se correlacionaron, tanto en ventana de tejido blando como óseo, con Edose/cm3 (r = 0,478 y r = 0,539) y EdAJ/cm3 (r = 0,745 y r = 0,758) (p < 0,01). Conclusiones: Las litiasis precisan, por las características propias de su composición, una determinada cantidad de energía para su rotura con LEOC en fragmentos de diámetro menor de 2 mm, que es predecible empleando la atenuación en UH en TAC, o escala de grises en la radiografía simple

Objective: To demonstrate that urinary lithiasis have a specific susceptibility to fracture through extracorporeal shock wave lithotripsy (ESWL), which is common for all calculi with the same composition and which can be estimated before treatment using CT or plain X-ray. Material and method: We present an in vitro, prospective, randomized, blind and multi-center study involving 308 urinary calculi. 193 of these met the inclusion criteria: whole calculi composed purely of calcium oxalate monohydrate (COM), uric acid (UA) or carbonate apatite (CA), or a mix of oxalate (COMix) and of a size greater than 0.5 cm. The samples were broken using lithotripsy until reaching a pre-established level of comminution. The variables employed were energy dose (Edose) per cm3 of lithiasis and Edose adjusted to lithiasic surface (EdAJ) per cm3. Results: COM was the hardest, requiring an Edose of 119,624 mJ/cm3 and an EdAJ of 36,983 mJ/cm3, followed by COMix (75,501/36,983), CA (22,734/21,186) and UA (22,580/6837) (p < 0.05). Gmax and Gmda were correlated with Edose (r = 0.434/r = 0.420) and EdAJ (r = 0.599/r = 0.545) (p < 0.01). UH were correlated, in bone window and soft tissue window, with Edose/cm3 (r = 0.478/r = 0.539) y EdAJ/cm3 (r = 0.745/r = 0.758) (p < 0.01). Conclusions: In our in vitro research lithiasis require, due to the specific nature of their composition, a given amount of energy in order to be broken by ESWL, which is inherent to all those sharing the same composition, and can be predicted using CT or plain X-ray

Prediction of the energy required for extracorporeal shock wave lithotripsy of certain stones composition using simple radiology and computerized axial tomography.

OBJECTIVE: To demonstrate that urinary lithiasis have a specific susceptibility to fracture through extracorporeal shock wave lithotripsy (ESWL), which is common for all calculi with the same composition and which can be estimated before treatment using CT or plain x-ray. MATERIAL AND METHOD: We present an in vitro, prospective, randomized, blind and multi-centre study involving 308 urinary calculi. 193 of these met the inclusion criteria: whole calculi composed purely of calcium oxalate monohydrate (COM), uric acid (UA) or carbonate apatite (CA), or a mix of oxalate (COMix) and of a size greater than 0.5 cm. The samples were broken using lithotripsy until reaching a pre-established level of comminution. The variables employed were energy dose (Edose) per cm(3) of lithiasis and Edose adjusted to lithiasic surface (EdAJ) per cm(3). RESULTS: COM was the hardest, requiring an Edose of 119,624 mJ/cm(3) and an EdAJ of 36,983 mJ/cm(3), followed by COMix (75,501/36,983), CA (22,734/21,186) and UA (22,580/6,837) (P < .05). Gmax y Gmda were correlated with Edose (r = 0.434/r = 0.420) and EdAJ (r = 0.599/r = 0.545) (P < .01). UH were correlated, in bone window and soft tissue window, with Edose/cm(3) (r = 0.478/r = 0.539) y EdAJ/cm(3) (r = 0.745/r = 0.758) (P < .01). CONCLUSIONS: In our in vitro research lithiasis require, due to the specific nature of their composition, a given amount of energy in order to be broken by ESWL, which is inherent to all those sharing the same composition, and can be predicted using CT or plain x-ray.

[Renal oncocytoma. Review of our 22 patients]. / Oncocitoma renal. Revisión de nuestra serie de 22 pacientes.

UNLABELLED: Renal oncocytoma (OR) is a benign tumor. It may represent up to 3-7% of solid kidney masses, and shows specifics cellular and evolutive characteristics. Metacronicity, multifocality and bilateralism has been reported. MATERIALS AND METHODS: Between 1986 and 2005, 478 kidney tumors have been surgically treated at our institution. We report the frequency and characteristics of OR in our patients, compared with renal cell carcinomas (RCC). We try to find out the rate of multifocality, bilateralism and other tumor association, and the number of neoplasms originally diagnosed as OR before surgery. Mean and median follow up: 36.86 and 13 months (1-193). Specific survival rate 100%. RESULTS: We found 24 OR in 10 men and 12 women with a mean age of 59 years (34-84). 12 in the left kidney and 12 in the right one, one patient presenting oncocytomatosis. Tumor mean size was 4.64 cm (1-12.5 cm). Tumors were discovered incidentally in 17 cases. Presentation symptoms in the rest of patients were gross hematuria. CONCLUSIONS: The rate of OR found in our sample population of renal tumors undergoing surgery matches other series already published. Two synchronic OR, but not metacronous, bilateral or metastatic tumors were found. All cases presented a benign evolution.

Oncocitoma renal. Revisión de nuestra serie de 22 pacientes / Renal oncocytoma. Review of our 22 patients

Introducción: El oncocitoma renal es un tumor benigno cuya frecuencia de presentación oscila entre el 3- 7% de las masas renales sólidas. Muestra especiales características celulares y evolutivas, con posibilidad de metacronicidad, bilateralidad y multifocalidad, además de un difícil diagnóstico diferencial con neoplasias malignas. Material y Método: Revisamos retrospectivamente en 428 tumores renales intervenidos desde Enero de 1986 hasta Abril de 05 la proporción de oncocitomas diagnosticados, analizando sus características anatomopatológicas y comportamiento clínico, comparándolas con las presentadas por los carcinomas de células renales. Observamos su posible bilateralidad, multifocalidad y asociación con otros tumores. Determinamos en cuántos casos los métodos diagnósticos de imagen permitieron sospechar la naturaleza tumoral benigna previamente a la intervención. Seguimiento medio y mediano 13 y 36,86 meses respectivamente (1-193). Resultados: Hemos encontrado 24 oncocitomas (5,67%), en 10 hombres y 12 mujeres con una edad media de 59 años (34-84). 12 de ellos en riñón izquierdo y 12 en derecho, además de una oncocitomatosis renal. Tamaño medio de 4,64 cm (1-12,5). En 17 pacientes el diagnóstico ha sido incidental. En los 5 restantes el síntoma de debut fue hematuria. Supervivencia específica 100%. Se sospechó la naturaleza tumoral benigna o específicamente oncocitomatosa previamente a la cirugía en 22,73% (5/22) y 9,9% (2/22) respectivamente. Conclusiones: En nuestra serie de tumores renales intervenidos el porcentaje de oncocitomas coincide con lo publicado en la literatura. Hemos encontrado dos casos de tumor sincrónico, pero ninguno metacrónico, bilateral ni metastásico. Todos han presentado un comportamiento benigno

Renal oncocytoma (OR) is a benign tumor. It may represent up to 3-7% of solid kidney masses, and shows specifics cellular and evolutive characteristics. Metacronicity, multifocality and bilateralism has been reported. Materials and methods: Between 1986 and 2005, 478 kidney tumors have been surgically treated at our institution. We report the frequency and characteristics of OR in our patients, compared with renal cell carcinomas (RCC). We try to find out the rate of multifocality, bilateralism and other tumor association, and the number of neoplasms originally diagnosed as OR before surgery. Mean and median follow up: 36.86 and 13 months (1-193). Specific survival rate 100%. Results: We found 24 OR in 10 men and 12 women with a mean age of 59 years (34-84). 12 in the left kidney and 12 in the right one, one patient presenting oncocytomatosis. Tumor mean size was 4.64cm (1-12.5 cm). Tumors were discovered incidentally in 17 cases. Presentation symptoms in the rest of patients were gross hematuria. Conclusions: The rate of OR found in our sample population of renal tumors undergoing surgery matches other series already published. Two synchronic OR, but not metacronous, bilateral or metastatic tumors were found. All cases presented a benign evolution

[Xanthogranulomatous pyelonephritis in childhood. A case report]. / Pielonefritis xantogranulomatosa en la infancia. A propósito de un caso.

Xanthogranulomatous pyelonephritis is an uncommon chronic inflammatory renal disorder. Most cases have been described in middle aged women and it is extremely rare in children. We report a case of a 4 year old girl who suffered from recurrent urinary tract infection and antibiotic therapy resistance. She had low growth-rate and palpable left renal mass on examination and was confirmed by radiological findings. We performed left kidney partial resection and then histological examination showed focal xanthogranulomatous pyelonephritis. The focal form of the disease may respond to antibiotic treatment although usually an enucleation or partial resection must be performed. In conclusion xanthogranulomatous pyelonephritis should be considered in the differential diagnosis of a renal mass and recurrent urinary tract infection in childhood.

Pielonefritis xantogranulomatosa en la infancia. A propósito de un caso / Xanthogranulomatous pyelonephritis in childhood. A case report

La pielonefritis xantogranulomatosa es una rara inflamación crónica del parénquima renal. Predomina en mujeres de edad media y es extremadamente rara en niños. Presentamos el caso de una niña de 4 años de edad, con infecciones del tracto urinario de repetición y mala respuesta a tratamiento médico. La paciente tenía retraso pondo-estatural y una masa en hemiabdomen izquierdo a la exploración y en las pruebas de imagen. Se realizó heminefrectomía superior izquierda, con posterior confirmación histopatológica de pielonefritis xantogranulomatosa focal. El tratamiento más frecuente de la forma focal es la nefrectomía parcial, aunque a veces responde a tratamiento antibiótico. Como conclusión la pielonefritis xantogranulomatosa debe ser considerada dentro de un diagnóstico diferencial de un niño con un riñón aumentado de tamaño e infecciones recurrentes (AU)

Xanthogranulomatous pyelonephritis is an uncommon chronic inflammatory renal disorder. Most cases have been described in middle aged women and it is extremely rare in children. We report a case of a 4 years old girl who suffered from recurrent urinary tract infection and antibiotic therapy resistance. She had low growth-rate and palpable left renal mass on examination and was confirmed by radiological findings. We performed left kidney partial resection and then histological examination showed focal xanthogranulomatous pyelonephritis. The focal form of the disease may respond to antibiotic treatment although usually an enucleation or partial resection must be performed. In conclusion xanthogranulomatous pyelonephritis should be considered in the differential diagnosis of a renal mass and recurrent urinary tract infection in childhood (AU)

[Cystic ureteritis in a kidney transplantation candidate]. / Ureteritis quística en paciente candidata a trasplante renal.

Cystic ureteritis is a very uncommon pathology, whose pathogenesis is not well established. It is usually asociated with chronic infectious factors. It presents unspecific symptoms but characteristic radiologic findings. There is not an especific treatment for this disease. Kidney transplant is the final pathway for patients with chronic renal failure. We report a case of cystic ureteritis diagnosed during pre-transplant study.

Ureteritis quística en paciente candidata a trasplante renal / Cystic ureteritis in a kidney trasplantation candidate

La ureteritis quística es una patología muy infrecuente, sin que hasta el momento se haya establecido su patogénesis exacta. Se presenta con sintomatología inespecífica, pero sin embargo los hallazgos radiológicos son bastante orientativos. No hay un tratamiento específico para estos pacientes, siendo el trasplante renal el paso final para los que desarrollen insuficiencia renal crónica terminal (IRCT).Presentamos un caso de ureteritis crónica diagnosticado durante el estudio pretrasplante de una paciente con IRCT (AU)

Cystic ureteritis is a very uncommon pathology, whose pathogenesis is not well established. It is usually asociated with chronic infectious factors. It presents unspecific symptoms but characteristic radiologic findings. There is not an especific treatment for this disease. Kidney trasplant is the final pathway for patients with chronic renal failure. We report a case of cystic ureteritis diagnosed during pre-trasplant study (AU)

Hematoma suprarrenal por rotura de mielolipoma. A propósito de un caso / Adrenal gland hematoma due to rupture of myelolipoma. A case report

El mielolipoma es un tumor benigno de la corteza suprarrenal, no funcionante y normalmente asintomático, que suele diagnosticarse de forma incidental en pruebas de imagen. La rotura y sangrado del mielolipoma es una complicación poco habitual, que puede concluir en la organización de un hematoma o, raramente, ocasionar hemorragia retroperitoneal masiva. La compresión de estructuras adyacentes por hematomas retroperitoneales (HR) de origen adrenal, es un evento poco frecuente. La indicación quirúrgica del HR continúa siendo, hoy día, una decisión difícil y controvertida, pues suele resolverse con tratamiento conservador y actitud expectante. Presentamos el caso de un varón de 69 años de edad, que acudió a Urgencias por dolor abdominal de 7 días de evolución, cuyo inicio coincidió con traumatismo leve. Las pruebas de imagen revelaron la existencia de hematoma retroperitoneal derecho de 16 cm de posible origen adrenal, con signos de sangrado activo, que colapsaba y desplazaba vena cava. Tan sólo hemos encontrado 1 caso descrito en la literatura de compresión de vena cava secundario a hematoma dependiente de glándula suprarrenal. En nuestro caso fue necesaria laparotomía urgente, suprarrenalectomía derecha y exéresis del hematoma

The myelolipoma is a benign tumour of the adrenal cortex, non functioning and normally asymptomatic, which can be diagnosed by chance in imaging test. Rupture and bleeding of the myelolipoma is an infrequent complication, which can conclude with the formation of a haematoma or, less usually, result in a massive retroperitoneal haemorrhage. The compression of adjacent structures by retroperitoneal haematomas with adrenal origin is a possible but not frequent eventuality. ;;Indications for surgery of haematoma retroperitoneal continue to be, nowadays, a difficult and controversial decision, because the problem is normally resolved with conservative treatment and a watchful approach. ;;We are presented with a 69 year old male who came to casualty with abdominal pain of 7 days duration, whose origin coincided with a light blow. The image test revealed the existence of a retroperitoneal haematoma with adrenal gland origin of 16 cm, with active bleeding, which was displaced and compressed the cava vein. We have only found one case, in the literature, of compression of the cava vein coused by adrenal gland haematoma. In the case under our observation, urgent surgery was needed

[Kidney pelvis hemangioma as a cause of hematuria]. / Angiomatosis pélvica como causa de hematuria.

UNLABELLED: Kidney hemangiomas are congenital vascular anomalies with an unknown ethiology. They are considered as benign tumours with a poor clinic expression (hematuria or ureteric colic, which is associated to the drop of clots in the urinary tract). OBJECTIVE: To expound a case of unilateral severe hematuria in a young woman with a restless past medical history, due to a pelvic left kidney hemangioma. MATERIALS AND METHODS: Clinic case of a sixteen years old woman, no relevant past medical history, presented with an anaemizing gross hematuria and passing vermiform clots. As diagnostic techniques we used ultrasonography, excretory urography, cystourethroscopy, CT, angiography and nuclear imaging. Surgery (flank nephectomy) was needed for treatment. RESULTS: Pathology report: submucosal vascular proliferative process in kidney pelvis composed by blood vessels, suggesting haemangioma.

Angiomatosis pélvica como causa de hematuria / Kidney pelvis hemangioma as a cause of hematuria

Los angiomas renales (también llamados hemangiomas) son malformaciones vasculares congénitas (consideradas como tumores benignos), de etiología no conocida y de escasa traducción clínica (hematuria y cólico ureteral asociado al paso de coágulos por la vía urinaria). OBJETIVO: Presentar un caso de hematuria unilateral severa en mujer joven sin antecedentes destacables, secundaria a hemangioma renal pélvico izquierdo. MATERIAL Y MÉTODOS: Caso clínico de mujer de 16 años, sin antecedentes personales de interés, que presenta hematuria anemizante con coágulos de dos meses de evolución. Como técnicas diagnósticas se utilizaron ecografía, urografía intravenosa, cistoscopia, TAC, angiografía, y gammagrafía. Para su tratamiento precisó de intervención quirúrgica (nefrectomía lumbar). RESULTADO: Anatomía patológica de riñón con proceso proliferativo de tipo vascular submucoso en pelvis renal, compuesto de vasos venosos y compatible con hemangiona

Kidney hemangiomas are congenital vascular anomalies with an unknown ethiology. They are considered as benign tumours with a poor clinic expression (hematuria or ureteric colic, which is associated to the drop of clots in the urinary tract. OBJECTIVE: To expound a case of unilateral severe hematuria in a young woman with a restless past medical history, due to a pelvic left kidney hemangioma. MATERIALS AND METHODS: Clinic case of a sixteen years old woman, no relevant past medical history, presented with an anaemizing gross hematuria and passing vermiform clots. As diagnostic techniques we used ultrasonography, excretory urography, cystourethroscopy, CT, angiography and nuclear imaging. Surgery (flank nephectomy) was needed for treatment. RESULTS: Pathology report: submucosal vascular proliferative process in kidney pelvis composed by blood vessels, suggesting haemangioma

Peripheral afferent nerve stimulation for treatment of lower urinary tract irritative symptoms.

OBJECTIVES: To assess the efficacy of posterior tibial nerve stimulation for treatment of lower urinary tract irritative symptoms (urgency, frequency, urge incontinence and pelvic pain). PATIENTS AND METHODS: 51 female patients with a mean age of 55 years were enrolled in the study. The patients presented with the following symptoms: Frequency/urgency 26 patients (50.98%), urge incontinence 22 (43.13%) and interstitial cystitis 3 patients (5.88%). The technique consists in administering low voltage electric stimulation via a 3-5cm needle placed above the tibial malleolus. Patients received weekly stimulations of 30 minutes for a 10-week period. Quality of life questionnaires and voiding diaries before and after treatment were completed. Moreover, the results were evaluated by patients. The variables analysed include: daytime and nighttime voiding frequency, daytime and nighttime voiding volume, daytime and nighttime leakage episodes and hypogastric pain. RESULTS: A statistically significant improvement was seen in all variables, especially remarkable in relation to frequency/urgency, impact on women quality of life and hypogastric pain, being less marked in relation to leakage episodes and voiding volume. CONCLUSIONS: Afferent nerve stimulation offers an alternative treatment for managing lower urinary tract irritative symptoms. However, it would be advisable to confirm the results obtained by means of long-term randomized, follow-up studies.

[Adrenal gland hematoma due to rupture of myelolipoma. A case report]. / Hematoma suprarrenal por rotura de mielolipoma. A propósito de un caso.

The myelolipoma is a benign tumour of the adrenal cortex, non functioning and normally asymptomatic, which can be diagnosed by chance in imaging test. Rupture and bleeding of the myelolipoma is an infrequent complication, which can conclude with the formation of a haematoma or, less usually, result in a massive retroperitoneal haemorrhage. The compression of adjacent structures by retroperitoneal haematomas with adrenal origin is a possible but not frequent eventuality. Indications for surgery of haematoma retroperitoneal continue to be, nowadays, a difficult and controversial decision, because the problem is normally resolved with conservative treatment and a watchful approach. We are presented with a 69 year old male who came to casualty with abdominal pain of 7 days duration, whose origin coincided with a light blow. The image test revealed the existence of a retroperitoneal haematoma with adrenal gland origin of 16 cm, with active bleeding, which was displaced and compressed the cava vein. We have only found one case, in the literature, of compression of the cava vein coused by adrenal gland haematoma. In the case under our observation, urgent surgery was needed.

[Validation of ESCAP-CD as an instrument of measure for the evaluation of the quality of life in prostatic cancer. Part 2a]. / Validación del ESCAP-CDV como instrumento de medida para la valoración de la calidad de vida en el cáncer de próstata. 2a Parte.

UNLABELLED: In order to make a measure of quality of life related to health (QLRH) useful in the investigation, it must fulfill the psychometric properties (validity, reliability and sensibility). The selection of an instrument is a job for the clinic that must choose the most effective for each proposed objective. We set out the objectives to validate the ESCAP-CDV in a multicentric study in Andalusia. We studied 88 patients who were submitted to the instrument presented to validation and two more tests recognized already: the QLQ-C30 from EORTC gold standard in Europe in the valuation of the neoplastic patients' quality of life and the KARNOFSKY the most clinic utility index in neoplastic patients, used to correlate the items. RESULTS: Questionnaire acceptance analysis: The difficulty of understanding was greater for QLQ C30 items (6.81%) than ESCAP items (1.98%). The lapse of time needed to carry out the test was shorter in the ESCAP test (9.84 min) than in the QLQ C30 (13.13), test. Structural analysis or internal validity analysis: The homogeneity index of the items is high (alfa of Cronbach = 0.93). The dimensionality proposed is not accepted, due to the existence of some modifications pund in the factorial analysis. Finally, the established dimensions: Physical and Emotional Capacity (PEC), 5 items; General Symptoms (GS), 4 items; Pain (P), 3 items; Ligh Functional Capcity (LFC), 4 items; Serious Functional Capacity (SFC), 2 items; Economic State (ES), 3 items; Social and Family State (SFE), 5 items; Capacity Sexual (CSX), 2 items; Isolated Variables (IV), 2 items; and Specific Questionnaire (P), 6 items. The ESCAP is a scale with a normal distribution. Approach or external validity analysis: The ESCAP test is well correlated with the other two scales. Reliability test retest: The interclass correlation coefficient is 0.94 in the ESCAP, not so in the KARNOFSKY that is 0.77. CONCLUSIONS: The ESCAP-CDV is a new instrument of valuation of the QLRH composed of a general questionnaire and other specific test of prostate cancer. It has turned out to be a very homogeneous scale due to its internal consistence (alfa of Cronbach of 0.93), showing that it has a normal distribution, that correlates correctly with the scales compared and it is a valid scale to measure the prostate cancer patients' quality of life. The ESCAP-CDV has shown to be a scale with a high reliability (0.94), setting up as an instrument not only useful for investigation, but to clinical use, as well.

[Development of the ESCAP-CDV as measuring tool for the assessment of quality of life in prostatic cancer]. / Desarrollo del ESCAP-CDV como instrumento de medida para la valoración de la calidad de vida en el cáncer de próstata. Primera parte.

The current following of oncological patients is based in a biopsychosocial model where in addition to evaluate the response to treatment, the interval free of illness and the global survival it includes the functional capacity and the psychosocial charge the illness causes in patients. Nowadays, different treatments have improved the survival, therefore the number of years of inability increase. It creates a new variable, the quality of life related to health (QLRH) that valves the individual respond to the physical, mental and social effects that health or illness produces on patients daily life. To establish the QLRH as an instrument of measure is needed. In Spain there isn't any validated instrument for the evaluation of it in patients with prostate cancer. We have developed the ESCAP-CDV (Quality of Life study on prostate cancer) an instrument elaborated by an interdisciplinary group made of urologist, psichologists and a doctor specialized in family medicine expert in psychometric validation of scales. We evaluate multiple dimensions of quality of life in a questionnaires autoadministed.

Validación del escap-cdv como instrumento de medida para la valoración de la calidad de vida en el cáncer de próstata. 2ª parte / Validation of SCAP-CDV as an instrument of measure for the valuation of the quality of life on the prostate cancer

Para que una medida de calidad de vida relacionada con la salud (CVRS) sea útil en la investigación debe de cumplir las propiedades psicométricas (validez, fiabilidad y sensibilidad). La selección de un instrumento es tarea del clínico que debe escoger aquel más efectivo para cada objetivo propuesto. Nos marcamos unos objetivos para validar el ESCAP-CDV en un estudio multicéntrico andaluz. Se recogieron 88 pacientes que se someten al instrumento presentado a validación y dos test más reconocidos en la actualidad: el QLQ C30 de la EORTC gold estándar en Europa en la valoración de la calidad de vida del paciente neoplásico y el KARNOFSKY, índice de mayor utilidad clínica en los pacientes neoplásicos que sirven para correlacionar los ítems entre sí. RESULTADOS: Análisis de aceptación de los cuestionarios: La dificultad de compresión fue mayor para los ítems del QLQ C30 (6,81 per cent) que para el ESCAP (1,98 per cent). El tiempo necesario para cumplimentar el test fue menor en el ESCAP (9,84 min) que en el QLQ C30 (13.13).Análisis estructural o de validez interna: El índice de homogeneidad de los ítems es alto (alfa de Cronbach = 0,93). La dimensionalidad propuesta no se acepta, existiendo una serie de modificaciones que se pone de manifiesto en el análisis factorial. Las dimensiones definitivas quedan establecidas: Capacidad Psíquica y Emocional (CPS), 5 ítems; Síntomas Generales (SG), 4 ítems; Dolor (D), 3 ítems; Capacidad Funcional Leve (CFL), 4 ítems; Capacidad Funcional Grave (CFG), 2 ítems; Estado Económico (EE), 3 ítems; Estado Social y Familiar (ESF), 5 ítems; Capacidad sexual (CSX), 2 ítems; Variables Aisladas (VA), 2 ítems y Cuestionario Específico (P), 6 ítems. El ESCAP es una escala con distribución normal. Análisis de criterio o validez externa: El ESCAP se correlaciona bien con las otras dos escalas. Fiabilidad test retest : El coeficiente de correlación interclase es de 0,94 en el ESCAP, no así en el KARNOFSKY que es de 0,77. CONCLUSIONES: El ESCAP-CDV es un instrumento nuevo de valoración de la CVRS constituido por un cuestionario general y otro específico del cáncer de próstata. Ha resultado ser una escala muy homogénea debido a su consistencia interna (alfa de Crombach de 0,93), demostrándose que posee una distribución normal, que se correlaciona muy bien con las escalas comparadas y que es escala válida para medir la calidad de vida de los pacientes con cáncer de próstata. El ESCAP-CDV ha mostrado ser una escala con una alta fiabilidad (0,94), constituyéndose en un intrumento no sólo útil para investigación sino para uso clínico (AU)

Desarrollo del escap-CDV como instrumento de medida para la valoración de la calidad de vida en el cáncer de próstata. Primera parte / Development of escap-DCV as an instrument of measure for the valuation of the quality of life on the prostate cancer

El seguimiento actual de los pacientes oncológicos está basado en un modelo biopsicosocial donde además de valorar la respuesta al tratamiento, el intervalo libre de enfermedad y la supervivencia global se incluye la capacidad funcional y la carga psicosocial que la enfermedad desarrolla en los pacientes. Los distintos tratamientos actuales han hecho mejorar la supervivencia, por lo que el número de años con incapacidad aumenta. Se crea una nueva variable, la Calidad de Vida Relacionada con la Salud (CVRS) que valora las respuestas individuales a los efectos físicos, mentales y sociales que la salud o la enfermedad produce sobre la vida diaria de los pacientes. Para establecer la CVRS hace falta un instrumento de medida. En España no existe ningún instrumento validado para la valoración de ésta en los pacientes con cáncer de próstata. Hemos desarrollado el ESCAP-CDV (Estudio sobre la Calidad de Vida en el Cáncer de Próstata), un instrumento elaborado por un grupo interdisciplinar compuesto por urólogos, psicólogos y médico especialista en medicina de familia experto en validación psicométrica de escala. Valoramos múltiple dimensiones de la calidad de vida en un cuestionario auto-administrado (AU)

[Radical prostatectomy or radiotherapy? A qualitative structured review]. / Prostatectomía radical o radioterapia? Una revisión estructurada cualitativa.

We performed a structured literature review to define de effectiveness of radical prostatectomy and external radiotherapy for treatment of localized prostate cancer. We identified 463 articles in MEDLINE for January 1990 through april 2000. As judged from our analysis, prostatectomy radical has marginal benefit in terms of supervivency and disease free respect to external radiotherapy with the same quality of life.