Active surveillance for prostate cancer.

It is worth distinguishing between the two strategies of expectant management for prostate cancer. Watchful waiting entails administering non-curative androgen deprivation therapy to patients on development of symptomatic progression, whereas active surveillance entails delivering curative treatment on signs of disease progression. The objectives of the two management strategies and the patients enrolled in either are different: (i) to review the role of active surveillance as a management strategy for patients with low-risk prostate cancer; and (ii) review the benefits and pitfalls of active surveillance. We carried out a systematic review of active surveillance for prostate cancer in the literature using the National Center for Biotechnology Information's electronic database, PubMed. We carried out a search in English using the terms: active surveillance, prostate cancer, watchful waiting and conservative management. Selected studies were required to have a comprehensive description of the demographic and disease characteristics of the patients at the time of diagnosis, inclusion criteria for surveillance, and a protocol for the patients' follow up. Review articles were included, but not multiple papers from the same datasets. Active surveillance appears to reduce overtreatment in patients with low-risk prostate cancer without compromising cancer-specific survival at 10 years. Therefore, active surveillance is an option for select patients who want to avoid the side-effects inherent to the different types of immediate treatment. However, inclusion criteria for active surveillance and the most appropriate method of monitoring patients on active surveillance have not yet been standardized.

La deshidratación al ingreso es un factor de riesgo para la recuperación incompleta de la función renal en niños con síndrome urémico hemolítico / Dehydration upon admission is a risk factor for incomplete recovery of renal function in children with haemolytic uremic syndrome

Antecedentes: El síndrome urémico hemolítico (SUH) es la causa más común de insuficiencia renal aguda y la segunda de insuficiencia renal crónica (IRC) durante la infancia. Los factores que condicionan la recuperación incompleta de la función renal antes del ingreso hospitalario han sido poco estudiados. Objetivos: Identificar en niños con SUH, antes de su internación, los factores de riesgo que determinan una recuperación incompleta de la función renal. Métodos: Estudio retrospectivo de caso control. Variables: edad, sexo, duración de la diarrea (D+), deposiciones con sangre, vómitos, fiebre, deshidratación, antibiótico en terapia previa y recuperación incompleta de la función renal definida como la presencia de proteinuria, hipertensión arterial, aclaramiento reducido de creatinina e IRC durante el seguimiento. Se incluyeron pacientes de ambos sexos, menores de 15 años, con SUH. Resultados: Se estudiaron 36 pacientes, 23 de ellos varones (65,3 %, intervalo de confianza [IC] 95 % 45,8-80,9). Con una media de edad de 2,5 ± 1,4 años. 21 requirieron diálisis (58 %, IC 95 % 40,8 a 75,8) y 13 (36,1 %, IC 95 % 19,0 a 53,1) no recuperaron por completo su función renal. En un modelo de análisis bivariado solo fue un factor de riesgo significativo la deshidratación definida como una pérdida de peso > de 5 % (odds ratio [OR] 5,3, IC 95 % 1,4 a 12,3; p 0,0220). En un modelo multivariado (regresión de Cox), fue marginalmente significativa la deshidratación (CR 95,823, IC 95 % 93,175 a 109,948; p = 0,085). Conclusiones: Los resultados obtenidos sugieren que la deshidratación previa a la internación puede constituir un factor que incrementa el riesgo de presentar una recuperación incompleta de la función renal a largo plazo en niños que padecieron SUH D+. Por ello, se recomienda una cuidadosa vigilancia del estado de hidratación en niños con riesgo de desarrollar SUH D+ durante los cuidados ambulatorios (AU)

Background: Haemolytic uremic syndrome (HUS) is the most common cause of acute renal failure and the second leading cause of chronic renal failure in children. The factors that affect incomplete renal function recovery prior to hospital admission are poorly understood. Objective: To analyse the risk factors that determine incomplete recovery of renal function prior to hospitalisation in children with HUS. Method: A retrospective case-control study. Variables: age, sex, duration of diarrhoea, bloody stools, vomiting, fever, dehydration, previous use of antibiotics, and incomplete recovery of renal function (proteinuria, hypertension, reduced creatinine clearance, and chronic renal failure during follow-up). Patients of both sexes under 15 years of age were included. Results: Of 36 patients, 23 were males (65.3%; 95%CI: 45.8 to 80.9), with an average age of 2.5±1.4 years. Twenty-one patients required dialysis (58%; 95% CI: 40.8 to 75.8), and 13 (36.1%; 95% CI: 19.0 to 53.1) did not recover renal function. In the bivariate model, the only significant risk factor was dehydration (defined as weight loss >5%) [(OR: 5.3; 95% CI: 1.4 to 12.3; P=.0220]. In the multivariate analysis (Cox multiple regression), only dehydration was marginally significant (HR: 95.823; 95% CI: 93.175 to 109.948; P=.085). Conclusions: Our data suggest that dehydration prior to admission may be a factor that increases the risk of incomplete recovery of renal function during long-term follow-up in children who develop HUS D+. Consequently, in patients with diarrhoea who are at risk of HUS, dehydration should be strongly avoided during outpatient care to preserve long-term renal function. These results must be confirmed by larger prospective studies (AU)

Dehydration upon admission is a risk factor for incomplete recovery of renal function in children with haemolytic uremic syndrome.

BACKGROUND: Haemolytic uremic syndrome (HUS) is the most common cause of acute renal failure and the second leading cause of chronic renal failure in children. The factors that affect incomplete renal function recovery prior to hospital admission are poorly understood. OBJECTIVE: To analyse the risk factors that determine incomplete recovery of renal function prior to hospitalisation in children with HUS. METHOD: A retrospective case-control study. VARIABLES: age, sex, duration of diarrhoea, bloody stools, vomiting, fever, dehydration, previous use of antibiotics, and incomplete recovery of renal function (proteinuria, hypertension, reduced creatinine clearance, and chronic renal failure during follow-up). Patients of both sexes under 15 years of age were included. RESULTS: Of 36 patients, 23 were males (65.3%; 95%CI: 45.8 to 80.9), with an average age of 2.5 ± 1.4 years. Twenty-one patients required dialysis (58%; 95% CI: 40.8 to 75.8), and 13 (36.1%; 95% CI: 19.0 to 53.1) did not recover renal function. In the bivariate model, the only significant risk factor was dehydration (defined as weight loss >5%) [(OR: 5.3; 95% CI: 1.4 to 12.3; P=.0220]. In the multivariate analysis (Cox multiple regression), only dehydration was marginally significant (HR: 95.823; 95% CI: 93.175 to 109.948; P=.085). CONCLUSIONS: Our data suggest that dehydration prior to admission may be a factor that increases the risk of incomplete recovery of renal function during long-term follow-up in children who develop HUS D+. Consequently, in patients with diarrhoea who are at risk of HUS, dehydration should be strongly avoided during outpatient care to preserve long-term renal function. These results must be confirmed by larger prospective studies.

Exploring the relation between human papilloma virus and larynx cancer.

Human papilloma virus (HPV) has a role in benign and malignant pathology of the larynx. In this review we present the biological and epidemiological aspects related to these issues.

Infecciones por virus papiloma humano en la patogenia del cáncer cervicouterino / Human papillomavirus infection in the pathogenesis of cervical cancer

Las evidencias epidemiológicas, virológicas y clínicas demuestran que hay una estrecha asociación entre tipos específicos de HPV y cáncer cervicouterino. La infección por HPV precede el desarrollo de la enfermedad cervical. Los HPV están presentes en las lesiones precursoras. La infección por HPV es una condición necesaria pero no suficiente, se requiere de factores que participan en la oncogénesis cervical. No se conoce la función que ejercen algunos factores asociados. Una pequeña proporción de las infecciones por HPV de alto riesgo desarrollan una neoplasia maligna.

Molecular detection and typing of human papillomavirus in laryngeal carcinoma specimens.

CONCLUSIONS: Human papillomavirus (HPV) DNA was detected in 32% of laryngeal carcinoma biopsy samples studied. The genotypes identified were high-risk types, the most frequent being HPV 16. Viral DNA was integrated into the host genome (genotype HPV 16), providing supporting evidence for a role of HPV in the carcinogenic pathway of laryngeal squamous cell carcinoma. OBJECTIVE: HPV has been detected in laryngeal lesions, both benign and neoplastic, with a variable frequency (8-60%). These viral agents have been proposed as an adjuvant or cofactor in head and neck carcinogenesis because of their oncogenic properties. The aims of this study were to identify HPV in laryngeal carcinoma samples and to describe the physical state of the viral genome, i.e. its integration to the host DNA. MATERIAL AND METHODS: Formalin-fixed, paraffin wax-embedded tumor samples from patients with newly diagnosed laryngeal carcinomas were collected. The HPV genome was identified using polymerase chain reaction (PCR) with primers complementary to the conserved region L1 (MY09-11). Genotyping was accomplished by restriction fragment length polymorphism. Samples positive for HPV 16 were assayed by PCR with primers complementary to region E2, interrupted during viral genome integration. RESULTS: Ten of the 31 samples (32%) were positive for HPV DNA and all of the samples were positive for human beta-globin. The genotypes identified were HPV 16 (n=3), HPV 58 (n=2) and HPV 39, 45, 51, 59, 66 and 69 (n=1 for each). The three samples positive for HPV 16 had lost region E2, meaning that the viral DNA had been integrated into the host genome.

Population-based prevalence and age distribution of human papillomavirus among women in Santiago, Chile.

UNLABELLED: More than 18 types of human papillomavirus (HPV) are associated with cervical cancer, the relative importance of the HPV types may vary in different populations. OBJECTIVE: To investigate the types of HPV, age distribution, and risk factors for HPV infection in women from Santiago, Chile. METHODS: We interviewed and obtained two cervical specimens from a population-based random sample of 1,038 sexually active women (age range, 15-69 years). Specimens were tested for the presence of HPV DNA using a GP5+/6+ primer-mediated PCR and for cervical cytologic abnormalities by Papanicolaou smears. RESULTS: 122 women tested positive for HPV DNA, 87 with high risk types (HR), and 35 with low risks (LR) only. Standardized prevalence of HPV DNA was 14.0% [95% confidence interval (95% CI), 11.5-16.4]. HR HPV by age showed a J reverse curve, whereas LR HPV showed a U curve, both statistically significant in comparison with no effect or with a linear effect. We found 34 HPV types (13 HR and 21 LR); HPV 16, 56, 31, 58, 59, 18, and 52 accounted for 75.4% of HR infections. Thirty-four (3.6%) women had cytologic lesions. Main risk factor for HPV and for cytologic abnormalities was number of lifetime sexual partners, odds ratios for > or =3 versus 1 were 2.8 (95% CI, 1.6-5.0) and 3.8 (95% CI, 1.3-11.4), respectively. CONCLUSIONS: LR HPV presented a clear bimodal age pattern; HR HPV presented a J reverse curve. HPV prevalence was similar to that described in most Latin American countries.

p53 codon 72 polymorphism and risk of cervical cancer.

Storey et al. (1998) implicated the proline/argine polymorphism of the codon 72 of the tumor-suppressor gene p53 in the development of cervical cancer (CC) with the observation that the p53 protein is more efficiently inactivated by the E6 oncoprotein of human papillomavirus in p53 arginine as compared with its proline isoform. These authors further noted that in the United Kingdom, individuals homozygous for the arginine allele were several times more susceptible to HPV-associated tumorigenesis that proline/arginine heterozygotes. Subsequent studies in different countries failed to unanimously confirm this association. Motivated by the high incidence of CC in Chile, we undertook a case control study obtaining the following frequencies for genotypes PP, AP and AA in 60 ICC cases and 53 carefully selected controls: 0.067, 0.250, 0.683 and 0.075, 0.453, 0.472 respectively. A significant difference (X2 = 3.19 p < 0.02) and an odds ratio of 2.62 supported Storey et al (1998)'s results. In addition, rejecting previous hypotheses about the world distribution of the p53 codon 72 polymorphism, we conclude that this distribution most likely represents ancient human dispersal routes. Several methodological and biological explanations for the results obtained in previous negative association studies are briefly discussed.

P53 Codon 72 polymorphism and risk of cervical cancer

Storey et al. (1998) implicated the proline/argine polymorphism of the codon 72 of the tumor-suppressor gene p53 in the development of cervical cancer (CC) with the observation that the p53 protein is more efficiently inactivated by the E6 oncoprotein of human papillomavirus in p53 arginine as compared with its proline isoform. These authors further noted that in the United Kingdom, individuals homozygous for the arginine allele were several times more susceptible to HPV-associated tumorigenesis that proline/arginine heterozygotes. Subsequent studies in different countries failed to unanimously confirm this association. Motivated by the high incidence of CC in Chile, we undertook a case control study obtaining the following frequencies for genotypes PP, AP and AA in 60 ICC cases and 53 carefully selected controls: 0.067, 0.250, 0.683 and 0.075, 0.453, 0.472 respectively. A significant difference (X2 = 3.19 p < 0.02) and an odds ratio of 2.62 supported Storey et al (1998)'s results. In addition, rejecting previous hypotheses about the world distribution of the p53 codon 72 polymorphism, we conclude that this distribution most likely represents ancient human dispersal routes. Several methodological and biological explanations for the results obtained in previous negative association studies are briefly discussed