[Correlation of the anatomo-pathological staging of radical prostatectomy specimens with the amount of cancer in the preoperative sextant biopsy]. / Correlación del estadio anatomopatológico de la pieza de prostatectomía radical con la cantidad de cáncer en la biopsia sextante preoperatoria.

OBJECTIVE: We assess the value of the percent of cancer in needle cores of sextant biopsy for predicting the risk of extraprostatic extension at radical retropublic prostatectomy. MATERIAL AND METHODS: We reviewed prostate needle biopsy findings in 97 patients with prostate cancer T1c-T2, who subsequently underwent radical retropubic prostatectomy. In each needle biopsy were assessed, number of cores positive, percent of cores positive, percent cancer in all cores, Gleason score, intraepithelial neoplasia, perineural invasion and vascular invasion. Initial PSA and preoperative clinical stage were incorporated with biopsy results into a univariate and multivariate model to determine the parameters most predictive of pathological stage. RESULTS: Of the 97 patients, 72 (74%) had organ confined cancer and 25 (26%) had extraprostatic extension. The average of cores positive for organ confined cancer was 4.2 (median 4) vs. 6.9 (median 6) for extraprostatic extension (p = 0.001), the percent of cores positive for organ confined cancer was 34.9% (median 28) vs. 53.8% (median 46) for extraprostatic extension (p = 0.013). The average of cancer in all cores in organ confined cancer was 13.6% (median 6) vs. 30.5% (median 30) for extraprostatic extension (p = 0.002). The mean Gleason score in needle cores was 5.9 (median 6) in organ confined cancer vs. 6.6 (median 7) in extraprostatic extension (p = 0.007). The average of intraepithelial neoplasia in needle cores was 3 (4%) in organ confined cancer vs. 1 (4%) in extraprostatic extension (p = 0.972). The perineural invasion of needle cores was 6 (8.3%) in confined cancer vs. 4 (16%) in extraprostatic extension (p = 0.355). Univariate analysis demonstrated that the risk of extraprostatic extension is predicted by the number of cores positive (p = 0.003), the percent of cores positive (p = 0.006), the percent of cancer in all cores (p = 0.001), the Gleason score (p = 0.002), the clinical stage (p = 0.019) and initial PSA (p = 0.032). Extraprostatic extension is not predicted by the intraepithelial neoplasia (p = 0.971), vascular invasion and perineural invasion (p = 0.285). Multivariate analysis showed that the percent of cancer in all cores is the strongest predictor of extraprostatic extension (p = 0.035). With a percent of cancer less than 3% in the biopsy specimen, the risk of extraprostatic extension is 11.5%. CONCLUSIONS: The amount of cancer on preoperative needle sextant biopsy is the strongest predictor of prostate stage, but it is slightly practical at the moment of admitting or to reject a patient for radical prostatectomy.

[Ambulatory mouth surgery. Experience at a buccal-dental health unit in primary care]. / Cirugía oral ambulatoria. Experiencia en una unidad de salud bucodental en atención primaria.

OBJECTIVES: To describe the results obtained from conducting non-hospital mouth surgery in a buccal-dental health unit, to evaluate the quality of care and to monitor its evolution over two years. DESIGN: Descriptive, retrospective study with quality assessment methodology. PARTICIPANTS: Oral surgery interventions conducted during 1998 and 1999. SETTING: Primary care. Buccal-Dental Health Unit at Villanueva de la Serena. MEASUREMENTS AND MAIN RESULTS: 140 interventions took place in 1998 and 1999. 12 descriptive variables were analysed. 10 explicit standard quality criteria were worked out. Scientific and technical quality was measured through compliance rates. The radicular remains (28.6%) and the cordal remains included or retained (24.3%) were the most common diagnoses. The most frequently employed surgical procedures were: residual root extraction (28.6%) and the surgical extraction of included tooth (24.3%). 100% of users had signed an informed consent. In 9.9% of procedures a biopsy was performed: it gave 92.8% concordance with the diagnosis. In 1998, 6 of the 10 criteria scored above 90%. The mean of criteria satisfied per intervention was 7.4. There were clear deficiencies in anamnesis data collection (9.24%) and recording of post-operative complications (0% compliance). 60% of criteria did not achieve the standard. In 1999, 40% of criteria had a figure between 99 and 100%. 70% of criteria achieved the standard. The quantification of the improvement was significant in anamnesis (p < 0.001), analysis (p < 0.001) and post-operative complications (p < 0.001). CONCLUSIONS: Performing mouth surgery is a feasible non-hospital service. The quality cycle installed was highly effective.

Influencia de la tiroidectomía sobre la pérdida de masa ósea en relación con el déficit de calcitonina y el tratamiento con tiroxina / Influence of thyroidectomy and thyroxin treatment on bone mass loss and calcitonin deficit

Introducción. Durante las últimas décadas se ha intentado valorar si la tiroidectomía y el tratamiento con tiroxina tienen un efecto negativo sobre la masa ósea. Los resultados publicados presentan discrepancias, faltan, además, estudios en pacientes con tratamiento sustitutivo. Material y métodos. Se realiza un estudio de casos y controles, comparando a mujeres tiroidectomizadas (n = 60) con mujeres sin enfermedad tiroidea, de la misma situación estrogénica y edad, peso y talla similares. Se determinan T3, T4, TSH, PTH, vitamina D, calcitonina basal e inducida, densitometría ósea lumbar y femoral (AXD) y marcadores de la actividad ósea (osteocalcina, FATR, hidroxiprolina y deoxipiridinolina), así como las dosis de tiroxina y el tiempo de tratamiento en cada paciente. Resultados. La comparación entre casos y controles no presentó diferencias en edad, peso, talla, PTH y vitamina D. No se hallaron diferencias densitométricas globales ni aumento de pérdida de densidad ósea en los subgrupos estrogénicos de las tiroidectomizadas. Tampoco se apreciaron diferencias en la osteocalcina y en la deoxipiridinolina. La calcitonina basal fue de 6,9 ñ 4,4 pg/ml en los controles y de 4,6 ñ 1,9 pg/ml en los casos (p < 0,01). No hubo respuesta al estímulo en las tiroidectomías totales, que presentó un incremento mínimo a los 5 minutos en las subtotales. Conclusiones. No existe aumento de pérdida de mineral óseo en mujeres tiroidectomizadas por enfermedad benigna no hipertiroidea tratadas con tiroxina. Éstas presentan valores de calcitonina inferiores a los controles con incapacidad de respuesta al estímulo con calcio (AU)

[Adenosine deaminase activity in the pleural effusion. A study of 64 cases]. / Actividad de adenosindesaminasa en líquido pleural. Estudio realizado en 64 casos.

Clinical and analytic data of 64 patients with firm etiologic diagnosis of pleural effusion with adenosine deaminase (ADA) present, were analyzed retrospectively. The patients had entered our hospital over a 40-month period. ADA activity in pleural fluid was analyzed by the Blake and Berman kinetic method. Mean ADA activity of the total sample was 32 U/l (SD:23.9). In patients with tuberculous pleural effusion ADA activity was higher than in the remaining patients (47.7, SD:21.4, versus 15.5 SD: 13.2; p < 0.0001). In the group of patients with tuberculous pleuritis diagnosed by pleural biopsy (22 cases) the presence of necrotizing granulomas was associated with slightly higher ADA activity although the difference was not statistically significant (49.2 SD 10.1 versus 41.3 SD 8.9; p = 0.07). Among only patients with tuberculous pleuritis or neoplasia with lymphocytic exudate, a cut off point greater than 23 U for ADA predicted a diagnosis of tuberculous pleuritis with a sensitivity of 0.96, specificity of 1, positive predictive value of 1, negative predictive value of 0.94, and a confidence limit of 0.97. In conclusion, ADA activity greater than 23 U determined by the kinetic method in pleural fluid with signs of lymphocytic exudate is strongly suggestive of pleural tuberculosis based on our sample of patients with pleural effusion.