Factores predictivos de toxicidad urinaria y rectal tras radioterapia externa conformada en el cáncer de próstata: correlación de parámetros clínicos, tumorales y dosimétricos con radioterapia radical y postoperatoria / Predictors of urinary and rectal toxicity after external conformed radiation therapy in prostate cancer: Correlation between clinical, tumour and dosimetric parameters and radical and postoperative radiation therapy

Objetivo: Determinar la toxicidad rectal y urinaria tras radioterapia externa (EBRT), valorando resultados de pacientes sometidos a tratamiento radical o postoperatorio por cáncer de próstata y su correlación con potenciales factores de riesgo. Método: Trescientos treinta y tres pacientes tratados con EBRT, 285 radicales y 48 tras cirugía (39 rescate; 9 adyuvante). Se recopilaron variables clínicas, tumorales y dosimétricas a correlacionar con parámetros de toxicidad. Se elaboraron árboles de decisión según el grado de significación estadística. Resultados: La toxicidad aguda severa, tanto urinaria como rectal, fue del 5,4% y del 1,5%, respectivamente. La toxicidad crónica fue del 4,5% y del 2,7%. Veintisiete pacientes presentaron hematuria y 9 rectitis hemorrágica. Veinticinco (7,5%) presentaron secuelas permanentes limitantes. Los pacientes con síntomas del tracto urinario inferior previos a la RT presentaron peor tolerancia, con mayor toxicidad vesical aguda (p = 0,041). Respecto a la toxicidad rectal aguda, pacientes con dosis media en recto > 45 Gy, con tratamiento anticoagulante/antiagregante, desarrollaban un 63% de toxicidad leve frente al 37% de los pacientes con dosis media rectal< 45 Gy y sin anticoagulantes. No se han podido establecer factores predictivos de toxicidad crónica en el análisis multivariable. Las secuelas a largo plazo son más elevadas en los pacientes con cirugías urológicas previas a la RT que siguen tratamiento anticoagulante. Conclusiones: La tolerancia a EBRT es buena y la toxicidad severa poco frecuente. La sintomatología urinaria basal es el factor predictor que más influye en la toxicidad urinaria aguda. La toxicidad rectal se relaciona con la dosis media al recto y con el tratamiento anticoagulante/antiagregante. No existen diferencias significativas en la toxicidad grave entre RT radical y a RT postoperatoria

Objective: To determine rectal and urinary toxicity after external beam radiation therapy (EBRT), assessing the results of patients who undergo radical or postoperative therapy for prostate cancer (pancreatic cancer) and their correlation with potential risk factors. Method: A total of 333 patients were treated with EBRT. Of these, 285 underwent radical therapy and 48 underwent postoperative therapy (39 cases of rescue and 9 of adjuvant therapy). We collected clinical, tumour and dosimetric variable to correlate with toxicity parameters. We developed decision trees based on the degree of statistical significance. Results: The rate of severe acute toxicity, both urinary and rectal, was 5.4% and 1.5%, respectively. The rate of chronic toxicity was 4.5% and 2.7%, respectively. Twenty-seven patients presented haematuria, and 9 presented haemorrhagic rectitis. Twenty-five patients (7.5%) presented permanent limiting sequela. The patients with lower urinary tract symptoms prior to the radiation therapy presented poorer tolerance, with greater acute bladder toxicity (P = 0.041). In terms of acute rectal toxicity, 63% of the patients with mean rectal doses > 45Gy and anticoagulant/antiplatelet therapy developed mild toxicity compared with 37% of the patients with mean rectal doses <45 Gy and without anticoagulant therapy. We were unable to establish predictors of chronic toxicity in the multivariate analysis. The long-term sequelae were greater in the patients who underwent urological operations prior to the radiation therapy and who were undergoing anticoagulant therapy. Conclusions: The tolerance to EBRT was good, and severe toxicity was uncommon. Baseline urinary symptoms constitute the predictor that most influenced the acute urinary toxicity. Rectal toxicity is related to the mean rectal dose and with anticoagulant/antiplatelet therapy. There were no significant differences in severe toxicity between radical versus postoperative radiation therapy

Predictors of urinary and rectal toxicity after external conformed radiation therapy in prostate cancer: Correlation between clinical, tumour and dosimetric parameters and radical and postoperative radiation therapy. / Factores predictivos de toxicidad urinaria y rectal tras radioterapia externa conformada en el cáncer de próstata: correlación de parámetros clínicos, tumorales y dosimétricos con radioterapia radical y postoperatoria.

OBJECTIVE: To determine rectal and urinary toxicity after external beam radiation therapy (EBRT), assessing the results of patients who undergo radical or postoperative therapy for prostate cancer (pancreatic cancer) and their correlation with potential risk factors. METHOD: A total of 333 patients were treated with EBRT. Of these, 285 underwent radical therapy and 48 underwent postoperative therapy (39 cases of rescue and 9 of adjuvant therapy). We collected clinical, tumour and dosimetric variable to correlate with toxicity parameters. We developed decision trees based on the degree of statistical significance. RESULTS: The rate of severe acute toxicity, both urinary and rectal, was 5.4% and 1.5%, respectively. The rate of chronic toxicity was 4.5% and 2.7%, respectively. Twenty-seven patients presented haematuria, and 9 presented haemorrhagic rectitis. Twenty-five patients (7.5%) presented permanent limiting sequela. The patients with lower urinary tract symptoms prior to the radiation therapy presented poorer tolerance, with greater acute bladder toxicity (P=0.041). In terms of acute rectal toxicity, 63% of the patients with mean rectal doses >45Gy and anticoagulant/antiplatelet therapy developed mild toxicity compared with 37% of the patients with mean rectal doses <45 Gy and without anticoagulant therapy. We were unable to establish predictors of chronic toxicity in the multivariate analysis. The long-term sequelae were greater in the patients who underwent urological operations prior to the radiation therapy and who were undergoing anticoagulant therapy. CONCLUSIONS: The tolerance to EBRT was good, and severe toxicity was uncommon. Baseline urinary symptoms constitute the predictor that most influenced the acute urinary toxicity. Rectal toxicity is related to the mean rectal dose and with anticoagulant/antiplatelet therapy. There were no significant differences in severe toxicity between radical versus postoperative radiation therapy.

[Analysis of 73 cases of significant pericardiac effusion]. / Análisis de 73 casos de derrame pericárdico significativo.

Seventy-three patients with significant pericardiac effusion (SPE) are analyzed retrospectively. The results concerning etiology, clinical findings, evolution, echocardiography findings and pericardiac effusion (PE) findings are summarized. Conclusions drawn are: 1) the pericardiac effusion (PE) is a difficult diagnosis without the assistance of the echocardiogram; 2) the echocardiogram signs of hemodynamic alterations have prognostic value; 3) the most frequent causes of SPE are: tumors, idiopathic acute pericarditis, and iatrogenesis; 4) in an important percentage of DPS patients the cause is not identified; 5) the clinical presentation as pericardiac tamponade (PT) is most frequent in the tumors; 6) the analysis of the PE has a low yield, which means that diagnostic pericardicentesis is not justified in all patients with SPE; 7) the pericardiac biopsy hasa low diagnostic yield; 8) the predictive mortality factors are: presentation as PT and tumor etiology, and 9) because of the dynamic character of the SPE, it is important to carry out a progress follow-up of it.

Análisis de 73 casos de derrame pericárdico significativo / Analysis of 73 cases of significant pericardiac effusion

Se analizan retrospectivamente 73 pacientes con derrame pericárdico significativo (DPS). Se resumen los hallazgos referentes a etiología, clínica, evolución, hallazgos ecocardiográficos y en líquido pericárdico (LP). Las conclusiones extraídas son: 1) el derrame pericárdico (DP) es de difícil diagnóstico sin la ayuda del ecocardiograma; 2) los signos ecocardiográficos de compromiso hemodinámico tienen valor pronóstico; 3) las causas más frecuentes de DPS son tumores, pericarditis aguda idiopática y yatrogenia; 4) en un porcentaje importante de DPS no se consigue identificar la causa; 5) la presentación como taponamiento pericárdico (TP) es más frecuente en los tumores; 6) el análisis del LP tiene una rentabilidad baja, por lo que no está justificada la pericardiocentesis diagnóstica en todos los DPS; 7) la biopsia pericárdica tuvo una baja rentabilidad diagnóstica; 8) los factores predictivos de mortalidad son presentación como TP y etiología tumoral, y 9) dado el carácter dinámico de los DPS es importante realizar un seguimiento evolutivo de los mismos (AU)

[Development of pre-hepatic portal hypertension of the rat]. / Tipos evolutivos de hipertensión portal prehepática en la rata.

OBJECTIVE: A long-term study of the prehepatic portal hypertension model by triple stenosing ligation of the portal vein in the rat. METHOD: A cluster analysis of the animals in the different evolutive stages of portal hypertension (1 1/2, 6, 12 and 14 months) has been carried out. This analysis has made it possible to identify three homogeneous groups (A, B and C) in relationship to the liver weight. RESULTS: The animals with liver atrophy (group C) show a decrease of body, splenic and testicular weights as well as a higher development of the portosystemic collateral circulation in relation to the A and B groups. CONCLUSION: The percentage of animals belonging to the group C decrease progressively during the evolution of portal hypertension and those animals corresponding to the group A, in which is superior the liver weight, increase, while the B group does not change.

Tipos evolutivos de hipertensión portal prehepática en la rata / Evolutive types of prehepatic portal hypertension of the rat

Objetivo: Estudio a largo plazo del modelo de hipertensión portal prehepática en la rata por triple ligadura estenosante portal. Método: En los diferentes estadios evolutivos de la hipertensión portal (1 y1/2, 6, 12 y 14 meses) se realizó un análisis cluster de los animales que permite identificar tres grupos homogéneos (A, B y C) según el peso hepático. Resultados: Los animales con atrofia hepática (grupo C) presentan disminución del peso corporal, esplénico y testicular, así como mayor desarrollo de circulación colateral portosistémica respecto de los grupos A y B. Conclusión: Durante la evolución de la hipertensión portal disminuye de forma progresiva el porcentaje de animales perteneciente al grupo C y aumenta el correspondiente al grupo A, con hepatomegalia, en tanto que el grupo B permanece invariable (AU)

Objective: A long-term study of the prehepatic portal hypertension model by triple stenosing ligation of the portal vein in the rat. Method: A cluster analysis of the animals in the different evolutive stages of portal hypertension (1 1/2, 6, 12 and 14 months) has been carried out. This analysis has made it possible to identify three homogeneous groups (A, B and C) in relationship to the liver weight. Results: The animals with liver atrophy (group C) show a decrease of body, splenic and testicular weights as well as a higher development of the portosystemic collateral circulation in relation to the A and B groups. Conclusion: The percentage of animals belonging to the group C decrease progressively during the evolution of portal hypertension and those animals corresponding to the group A, in which is superior the liver weight, increase, while the B group does not change (AU)

Radioquimioterapia concurrente en cáncer no microcítico de pulmón: experiencia de una sola institución / Concurrent radio-chemotherapy in non-small-cell lung cancer: experience of a single institution

Introducción: La mejor secuencia de aplicación de los tratamientos de quimioterapia (QT) y radioterapia (RT) en el cáncer de pulmón no microcítico inoperable, sigue siendo un tema de debate. Material y métodos: 81 pacientes consecutivos recibieron RT + cisplatino (CDDP) diario según el esquema de la EORTC. En 54 pacientes se aplicó previamente QT con diferentes combinaciones de CDDP. En 27 pacientes el esquema de Shaake-Koning fue la única modalidad de tratamiento. Resultados: La supervivencia global de toda la serie fue de 32ñ5 por ciento a los 2 años. La mediana de supervivencia fue de 14 meses (IC 95 por ciento: 13-20). No se observaron diferencias significativas entre los pacientes que recibieron previamente QT y los que no la recibieron (27ñ6 por ciento vs 41ñ10 por ciento). La duración total del tratamiento y el número de ingresos hospitalarios fue menor en el segundo grupo de tratamiento. Conclusión: El esquema de RT + CDDP diario, en el tratamiento del cáncer de pulmón no microcítico inoperable, es un régimen que consigue resultados similares a los obtenidos con la adición de QT de inducción pero con una mejor tolerancia y una mayor supervivencia libre de tratamiento (AU)

[Nitric oxide treatment in children: clinical course, toxicity and factors influencing its effects]. / Tratamiento con óxido nítrico en niños: evolución clínica, toxicidad y factores que influyen en la respuesta.

OBJECTIVE: The purpose of this study was to analyze the clinical evolution, acute toxicity and factors which influence the response to nitric oxide treatment in children. PATIENTS AND METHODS: We studied prospectively 25 children, 14 boys and 11 girls, between 15 days and 16 years of age. Seventeen patients were diagnosed with ARDS and 8 with PHT. All patients presented hypoxemia and/or PHT refractory to conventional therapy and were treated with inhaled NO (1.5 to 45 ppm) between 45 minutes to 47 days. We studied the secondary effects, morbidity and mortality, and analyzed the relationship between NO effects and age, sex, diagnosis, infection, previous PaO2/FiO2 ratio, previous oxygenation index and previous mean pulmonary arterial pressure (mPAP)/mean systemic arterial pressure (mSAP). RESULTS: The effect of NO was maintained during the time of administration without tachyphylaxis. There were no secondary effects of NO administration. NO2 was always < 2 ppm and metahemoglobinemia was below 3.5%. There was no relationship between the effect of NO and the rest of the factors analyzed. Twelve patients (48%) survived, 9 of the children with ARDS (53%) and 3 of the children with PHT (38%). Eleven of the 21 patients who improved with NO treatment survived (52%), as did 1 of the 4 patients who did not improve (25%). CONCLUSIONS: Prolonged administration of inhaled NO at low concentrations maintains the improvement of oxygenation and pulmonary hypertension without acute secondary effects. We have not found factors that could predict the clinical response to NO.