Survival analysis of the surgical treatment of hepatocellular carcinoma at a tertiary care center.

INTRODUCTION AND AIMS: Hepatocellular carcinoma (HCC) is a primary malignant tumor of liver epithelial cells and is the most frequent primary liver cancer. The broadening of transplantation and resectability criteria has made therapeutic decisions more complex. Our aim was to describe the clinical and survival characteristics of patients with HCC treated through resection or liver transplantation at our hospital and identify the presence of factors that enable outcome prediction and facilitate therapeutic decision-making. MATERIALS AND METHODS: Patients with HCC that underwent surgery with curative intent at the Hospital Universitario Marqués de Valdecilla, within the time frame of 2007 and 2017, were retrospectively identified. Survival, mortality, disease-free interval, and different outcome-related variables were analyzed. RESULTS: Ninety-six patients with a mean follow-up after surgery of 44 months were included. Overall mortality and recurrence were higher in the resection group. Mean survival was 51.4 months in the liver transplantation group and 37.5 months in the resection group, and the disease-free interval was 49.4 ±â€¯37.2 and 27.4 ±â€¯28.7 months, respectively (p = 0.002). The tumor burden score was statistically significant regarding risk for recurrence and specific mortality. CONCLUSIONS: There appears to be no patient subgroup in whom the results of surgical resection were superior or comparable to those of transplantation. Tumor burden determination could be a useful tool for patient subclassification and help guide therapeutic decision-making.

[Repetition of microbiological tests in suspect of SARS-CoV-2 infection: utility of a score based on clinical probability]. / Repetición de las pruebas microbiológicas en la sospecha de la infección por SARS-CoV-2: utilidad de un score basado en la probabilidad clínica.

OBJECTIVE: The diagnosis of SARS-CoV-2 infection presents some limitations. RT-PCR in nasopharyngeal swabs is considered the gold standard for the diagnosis, although it can have false negative results. We aimed to analyze the accuracy of repeating nasopharyngeal swabs based on different clinical probabilities. METHODS: Retrospective observational study of the first patients admitted to a two COVID Internal Medicine wards at the University Hospital Marqués de Valdecilla, Santander, from March to April 2020. RT-PCR targering E, N, RdRP and ORFab1 genes and antibody tests detecting IgG. RESULTS: A total of 145 hospitalized patients with suspected SARS-Cov2 infection were admitted and in 98 (67.5%) diagnosis was confirmed. The independent predictive variables for SARS-CoV-2 infection were: epidemiological contact, clinical presentation as pneumonia, absence of pneumonia in the last year, onset of symptoms > 7 days, two or more of the following symptoms -dyspnea, cough or fever- and serum lactate dehydrogenase levels >350 U/L (p<0.05). A score based on these variables yielded an AUC-ROC of 0.89 (CI95%, 0.831-0.946; p<0.001). The accuracy of the first nasopharyngeal swabs was 54.9%. Repeating nasopharyngeal swabs two or three times allows to detect an additional 16% of positive cases. The overall accuracy of successive RT-PCR tests in patients with low pre-test probability was <5%. CONCLUSIONS: We have defined a pre-test probability score based on epidemiological and clinical data with a high accuracy for diagnosis of SARS-CoV-2. Repeating nasopharyngeal swabs avoids sampling errors, but only in medium of high probability pre-test clinical scenarios.

[Telmisartan effect's on remodelling bone markers in hypertensive patients]. / Efecto de telmisartan sobre marcadores del remodelado óseo en pacientes hipertensos.

INTRODUCTION: The telmisartan is an angiotensin II receptor blocker (ARB) with a few own characteristics that it allows us to obtain a few additional benefits. It displays the ability to act as a partial agonist of PPARgamma. On the other hand, PPAR gamma intervenes in the control of bone remodelling though with not concordant results. The objective of this study to value the effect of telmisartan on bone markers in hypertensive patients. SUBJECTS: A sample of 31 hypertensive patients with hypertension were included. The dose of telmisartan was of 80 mg/24 h and the period of follow-up was 12 weeks. The control group included 32 hypertensive patients treated before with IECA (enalapril-20 mg/24 h - or quinapril - 40 mg/24 hours). The following parameters were determined P1NP, ß-CTX, 25OHD and PTH , osteocalcin, insulin and adiponectin. RESULTS: The patients treated with Telmisartan shown a significantly decrease in systolic blood pressure (156 ± 19 mmHg vs 133 ± 15 mmHg, p = 0.001) and diastolic blood pressure (92 ± 9 mmHg vs 82 ± 6 mmHg, p = 0.01) . Changes were not observed in other parameter, PTHi (48 ± 22 pg/ml vs 45 ± 22 pg/ml, p > 0.05) and 25-vitamin D (21 ± 10 ng/ml vs 25 ± 8 ng/ml, p > 0.05), CTX (0.195 ± 0.12 ng/ml vs 0.221 ± 0.13 ng/ml, p > 0.05), PINP (39 ± 20 ng/ml vs 40 ± 19 ng/ml, p > 0.05), osteocalcin (11 ± 9 ng/ml vs 11 ± 5 ng/ml, p > 0.05), glucose, adiponectin, insulin and HOMA. When the patients divided in two groups depending on the levels of vitamin D (insufficient and not insufficient), with a cut of 20 ng/ml, there was changes on bone markers but a decrease of the glucose was observed in patients with levels of vitamin D over 20 ng/ml (135 ± 53 mg/dl vs 119 ± 39 mg/dl, p = 0.01). The patients treated with IECAS decreases the systolic blood pressure but the diastolic blood pressure values of arterial systolic does not show changes. CONCLUSIONS: Telmisartan has a neutral effect to level of the bone markers of bone remodelling.

[How should the response to osteoporosis treatment be evaluated?]. / Cómo valorar la respuesta al tratamiento de la osteoporosis.

Osteoporosis is a disease with high morbidity-mortality that is important because it predisposes to fractures. Thus, treatment of this disease is aimed at preventing them. However, and in spite of the fact that the fracture is the truly important consequence of therapeutic failure, it should not be considered to be an exponent of it given that it may be due to factors not related with lack of response such as intrinsic predisposition of the disease to development of fractures or being prone to falls. Thus, as occurs in other diseases such as cardiovascular ones, we must use other variables to evaluate the therapeutic response (surrogated variables), which, in the case of osteoporosis, are bone mineral density (BMD) and bone remodeling markers (BRM). BMD is the closest surrogated markers we have. The current drugs not only decrease the risk of fractures but increase bone mass. However, it must be remembered that changes in BMD are generally late (1-2 years) and that there is controversy about which criterion should be used to define what variation of it can be considered significant (loss of bone mass regarding baseline value?, loss of bone mass greater than the minimum significant change?). Finally, some of the drugs used in the treatment of osteoporosis, specifically anti-resorptive ones, reduce the remodeling markers intensely and early so that they could be useful as complement of BMD, although the variability of the results obtained in the daily clinical practice limit their utility.

[Diagnosis of osteoporosis by lateral chest X-ray]. / Diagnóstico de osteoporosis mediante la radiografía lateral de tórax.

BACKGROUND: Lateral chest X-rays may be helpful in the early detection of osteoporotic patients. We studied the proportion of chest X-ray reports in which the radiologist highlighted the presence of vertebral osteoporotic signs, as well as the proportion of patients with such records who were further studied by their physicians in order to confirm the diagnosis of osteoporosis. PATIENTS AND METHOD: We reviewed both lateral chest X-ray records of 3,500 consecutive patients and their medical records with the ultimate diagnosis. RESULTS: Radiology reports referred to the presence of vertebral abnormalities suggestive of osteoporosis in only 20% of potentially expected cases. Final medical records registered a diagnosis of osteoporosis in only one third of positive radiological records (6.3% of expected cases with vertebral abnormalities). Only two thirds of patients diagnosed with vertebral osteoporosis by their physician were adequately treated (4% of positive lateral chest X-ray reports). CONCLUSION: Osteoporosis is a disease overlooked by both radiologists and clinicians. Lateral chest X-ray is a helpful diagnostic tool for osteoporosis but its usefulness is often

[Femoral osteolytic lesions with soft tissue tumors and hypercalcemia as presentation form of a B-cell lymphoma]. / Lesiones osteolíticas femorales con tumoración de partes blandas e hipercalcemia como forma de presentación de un linfoma de estirpe B.

Hypercalcemia associated with haematological neoplasms account for 15 to 20% of hipercalcemia in malignancy, and occurs usually in patients with multiple myeloma. However, its incidence in patients with linfoma is low, and it is observed usually in T-cell linfomas. Bone affectation is also uncommon in patients with non-Hodgkin linfoma. It usually is seen as a late manifestation of the disease, and its occurrence as the form of presentation is exceptional. We hereby report a patient with a B-cell non-Hodgkin linfoma presenting with hypercalcemia and femoral osteolytic lesions.

[HIV infection and monocyte function]. / Infección por VIH y función monocitaria.

An study of the non-specific function of monocyte in 14 IVDU (intravenous drug-users) was carried out in order to assess the role of HIV in the pathogenesis of monocyte function alteration in this population. Two separate groups were formed depending on whether they were infected with HIV or not. In comparison with the control group, the decreases of the adherence and of chemotaxis found were similar to that previously described. No differences were observed between both groups. Finally, the meaning of these results is discussed.

[Monocyte chemotaxis: critical evaluation of 2 methods of quantification]. / Quimiotaxis de monocitos: valoración crítica de dos métodos de cuantificación.

The mononuclear phagocytic system (Mo) possesses a series of well defined functions regarding both its circulatory components--monocytes--and histiocytic macrophages. These functions--antimicrobial defense, elimination of cellular particles or detritus, immunological interaction with lymphocytes cells, antitumoral defense and control of granulopoiesis--require chemotaxis and phagocytosis or preceding steps. Although knowledge of these functional aspects is continually becoming better--always assured by advances obtained in the study of the function and pathology of polymorphonuclear cells--, an authentic pathology of monocyte chemotaxis as an independent clinical entity doesn't exist. This is attributed to of these cells. The techniques currently in use differ not only in their methodology but also in their bases and thus the results obtained by various authors are not generally comparable. All this led us to do a comparative study, in control subjects, between two techniques which explore the chemotactic capacity of monocytes from peripheral blood. The chemotactic capacity of monocytes from peripheral blood in control subjects, measured by two distinct quantification methods, were studied: Radioanalytic Method (monocytes tagged with 99 mTc) and a morphological method (counting the number of monocytes per field in immersion). The results obtained from both techniques were very similar, the existence of significant differences in cell behavior with exposure to the different chemotactic substances used could not be demonstrated. These results are commented on.

Monocyte functional defects in rheumatoid arthritis.

Monocytes derived from peripheral blood of patients with rheumatoid arthritis (RA) had a marked defect in their chemotactic and phagocytic activity. The chemotactic defect resides at a cellular level, while the phagocytic defect is serum-dependent. Both defects could be of importance in the pathogenicity of RA and the susceptibility to infection such patients show. Finally, monocytes were found to have a negative influence over spontaneous cytotoxicity mediated by T lymphocytes.