Renal function at admission as a prognostic marker for patients hospitalised for a first episode of heart failure. Results of the PREDICE study. / Función renal al ingreso como marcador pronóstico en pacientes hospitalizados por un primer episodio de insuficiencia cardíaca. Resultados del estudio PREDICE.

BACKGROUND AND OBJECTIVE: Heart failure (HF) is a frequent condition that deteriorates quality of life and results in high morbidity and mortality. A considerable number of studies have been implemented in recent years to determine the factors that affect the prognosis of HF; however, few studies have assessed the prognosis of patients hospitalised for their first episode of HF. The aim of our study was to analyse the prognostic impact of renal function on patients hospitalised for a first episode of HF. MATERIAL AND METHODS: We recruited 600 patients hospitalised for a first episode of HF in 3 tertiary Spanish hospitals. We analysed the mortality risk during the first year of follow-up according to renal function at the time of admission. RESULTS: The patients with the highest degree of kidney failure at admission were older (P<.001), were more often women (p=.01) and presented a higher degree of dependence (P<.05), as well as a higher prevalence of arterial hypertension (P<.001), chronic renal failure (P<.001) and anaemia (P<.001). In the multivariate analysis, the degree of kidney failure at admission remained an independent predictor of increased mortality risk during the first year of follow-up. CONCLUSIONS: The presence of kidney failure at admission was a marker of poor prognosis in our cohort of patients hospitalised for a first episode of HF.

Rare surgical procedures for proximal nerve lesions - a case report.

Peripheral nerve injury can result in serious problems with a severe functional deficit. Solutions of individual cases vary and proper management based on the physician's sound professional experience is fundamental. In case of motor nerve lesions, time is the crucial factor due to the ongoing deterioration of motor end plates. Distal nerve transfers are procedures leading to the reduction of distance between the point of injury and the denervated muscles. The authors describe the case of a young boy with proximal ulnar nerve injury to present the method. Key words: ulnar nerve - nerve transfer - nerve injury.

Tumor fusocelular hialinizante con rosetas gigantes: caso clínico y revisión de la literatura / Hyalinizing spindle cell tumor with giant rossetes

El tumor fusocelular hialinizante con rosetas gigantes (TFHRG) pertenece al grupo de los sarcomas fibromixoides de bajo grado (SFBG), representando un 10-25% de estos. Se trata de un tumor de tejidos blandos de estirpe fibroblástica muy poco frecuente y del que hay pocas referencias en la literatura. Es un tumor de lento crecimiento y que raramente produce dolor. Su aparición más frecuente es en tronco y extremidades y suelen localizarse proximales y profundos. Se presenta el caso clí- nico de una mujer de 65 años con una tumoración a nivel de raíz de miembro superior derecho, se realiza exéresis y el resultado anátomo-patológico es compatible con TFHRG. En el estudio de extensión no se evidencian lesiones a distancia. Tras 5 años de seguimiento no presenta datos de recidiva ni metástasis. Dada la rareza del TFHRG, no existen guías diagnóstico-terapéuticas para su manejo, por lo que es interesante señalar cuál es la evidencia clínica actual. El estadiaje inicial está basado en la realización de biopsia y TAC (Tomografía Axial Computarizada) o RMN (Resonancia Magnética Nuclear). El tratamiento de elección es quirúrgico mediante exéresis, tanto en las lesiones primarias como en las metastásicas. En cuanto al pronóstico, inicialmente se creía que era favorable, con bajo índice de recidivas y metástasis, pero en los últimos estudios con períodos de seguimiento a más largo plazo se ha visto que son más frecuentes de lo que se pensaba. Las metástasis son principalmente a pulmón y pleura. Esto hace que nos replanteemos si el término sarcoma fibromixoide de bajo grado es el adecuado

Hyalinizing spindle cell tumor with giant rosettes is a low-grade fibromixoid sarcoma, representing 10-25% of these. It is a fibroblastic soft tissue tumor and only a few cases have been described in literature. The tumors occur principally as a painless, slowly growing, deeply situated mass of the proximal extremities. We describe a 65 year-old man who appeared to have an axillary tumor, which we subsequently removed. The anathomopathologic results revealed hyalinizing spindle cell tumor with giant rosettes. The extension exam did not reveal any metastatic lesions. The first five years after surgery, we didn´t find recurrence or metastatic lesions. This kind of tumor therefore, is very uncommon and protocols for the diagnosis, treatment and following are thus scarce. Having access at the time to a clinical guide to help decipher the complexities surrounding the diagnosis would have been hugely beneficial. Initial treatment should be the same as all other soft-tissue tumors as this treatment is based in image studies and biopsy. Choice treatment is to surgically remove the tumor, both the primary and metastatic lesions. In terms of prognosis, it was initially believed to be consistent with a low rate of recurrence and metastasis. However, actual studies with longer follow-up periods do show recurrence and metastasis to be more common than previously thought. Metastases mainly occur in the lung and pleura. With the actual state we rethink if low-grade fibromixoid sarcoma is a correct term to wedge it

[Therapeutic management of cancer of unknown primary site by pathological types]. / Manejo terapéutico del cáncer de origen desconocido por grupos patológicos.

The term cancer of unknown primary site includes metastatic tumours with different histology and behaviour. Although most of them have a poor short-term prognosis, some patients can benefit from a treatment and will achieve a longer survival. The treatable cases are: metastases of squamous carcinoma in cervical or inguinal adenopathies, metastases of adenocarcinoma in axilar adenopathies in women, malignant ascites due to adenocarcinoma in women, osteoblastic bone metastases in men with elevated serum prostatic specific antigen levels, poorly differentiated tumours with features of a germinal extragonadal tumour, poorly differentiated neuroendocrine carcinomas and patients with a single metastasis. Chemotherapy must be considered in the rest of patients, although the optimum regimen is not well established yet.

[Diagnostic approach to cancer of unknown primary site]. / Aspectos fundamentales del diagnóstico del cáncer de origen desconocido.

Cancer of unknown primary site (CUPS) is a heterogeneous entity defined by the presence of a histologically-proven metastatic neoplasm, in which the original tumor cannot be identified after a targeted study. The current guidelines for CUPS focus is not based on the search for the primary neoplasm but rather on the identification of patients who may benefit from a treatment that will prolong their survival, based on the clinical and histological characteristics of each case. By improving the diagnostic study, we avoid using fruitless tests in patients with limited therapeutic possibilities and poor short-term prognosis.

Carcinoma hepatocelular en el anciano: características clínicas, análisis de supervivencia y factores pronósticos en una cohorte de pacientes españoles mayores de 75 años / No disponible

Objetivos: el carcinoma hepatocelular (CHC) permanece malcaracterizado en pacientes de edad avanzada y comorbilidad, circunstanciaque limita su manejo clínico. Pretendemos analizar lahistoria natural del CHC en mayores de 75 años y determinar losfactores que condicionan su supervivencia.Pacientes y métodos: análisis retrospectivo de 235 pacientescon CHC categorizados según su edad al diagnóstico: ≤ 75 años (n= 186) y > 75 años (n = 49). Tras comparar sus variables clínicas(χ2 y t-Student), realizamos un análisis de regresión logística para determinarlos factores asociados a la recepción de tratamiento locorregional(vs. sintomático); la supervivencia entre ambos grupos fuecomparada mediante el test de log-rank, con posterior análisis multivariante(modelo de riesgos proporcionales de Cox).Resultados: no se obtuvieron diferencias entre ambos gruposen su distribución por sexo, presencia de cirrosis, etiología, Child-Pugh, estadio BCLC, ascitis, trombosis portal, o valores de bilirrubina,AST, ALT, γGT, LDH o hematocrito. Los pacientes de edadavanzada fueron más frecuentemente diagnosticados en presenciade manifestaciones clínicas, con enfermedad multifocal, no localizada,y niveles de α-fetoproteína > 400 ng/ml (todas, p < 0,05). Estegrupo recibió tratamiento exclusivamente sintomático en el 78% delos casos (vs. 33% entre pacientes jóvenes), y sólo tres de ellos fueronsometidos a resección (p < 0,0001). La edad > 75 años actuócomo predictor de la no recepción de terapia locorregional (p <0,0001). La supervivencia del grupo de mayor edad (9,8 ± 1 meses)difirió significativamente respecto a la de los pacientes más jóvenes(25,6 ± 2 meses) (p < 0,00001). En el análisis multivariante, la edadavanzada se mantuvo como factor pronóstico de pobre supervivencia(p = 0,025); sin embargo, pierde su significación al estratificar dichoanálisis por sub-grupos de tratamiento (p = 0,344).Conclusiones: la menor supervivencia demostrada en pacientesancianos con CHC, al margen de diferencias en cuanto a extensióntumoral o insuficiencia hepatocelular, parece condicionada por la aplicaciónde abordajes terapéuticos subóptimos en esta población

Aims: hepatocellular carcinoma (HCC) remains poorly characterizedin elderly patients with comorbid conditions, a fact thatlimits the clinical management of the disease. This study analyzesthe natural history of HCC in patients older than 75, and determinesfactors that condition their survival.Patients and methods: a retrospective analysis of 235 patientswith HCC divided into 2 groups by age at diagnosis: ≤ 75(n = 186) and > 75 (n = 49). After comparing their clinical variables(χ2 and t test), a logistic regression analysis was performed todetermine factors associated with receiving locoregional treatment(versus symptomatic treatment). Survival in the 2 groups wascompared using a log rank test with subsequent multivariateanalysis (Cox proportional hazards model).Results: there were no differences between groups for sex,presence of cirrhosis, etiology, Child-Pugh score, BCLC stage,presence of ascites or portal thrombosis, or bilirubin, AST, ALT,γGT, LDH or hematocrit values. Patients of advanced age weremore frequently diagnosed in the presence of clinical manifestations,and had multifocal, non-localized disease and α-fetoproteinlevels > 400 ng/mL (all p < 0.05). This group received exclusivelysymptomatic treatment in 78% of cases (compared to 33% inyounger patients), and only 3 of them underwent surgical resection(p < 0.0001). Age older than 75 was a predictive factor fornot receiving locoregional therapy (p < 0.0001). Survival in theelderly group (9.8 ± 1 months) differed substantially from that ofyounger patients (25.6 ± 2 months) (p < .00001). Advanced agecontinued to be a prognostic factor of poor survival in the multivariateanalysis (p = 0.025), but lost significance when the analysiswas stratified by treatment subgroups (p = 0.344).Conclusions: the lower survival seen in elderly patients withHCC, beyond differences in tumor extension or liver failure, seemsconditioned by the use of suboptimal treatment in this population

Primary extragastrointestinal stromal tumors in the omentum and mesentery: a clinicopathological and immunohistochemical study.

BACKGROUND/AIMS: This study aimed to describe the clinical, histological and immunohistochemical characteristics of primary extragastrointestinal stromal tumors (EGISTs) of the omentum and mesentery diagnosed in the Hospital 12 de Octubre, in Madrid, Spain, from 1993-2005. METHODOLOGY: The clinical data and histological and immunohistochemical findings of primary mesenchymal neoplasias were revised using the Department of Pathological Anatomy databases. RESULTS: Six EGISTs were identified. Three were primarily of the omentum and 3 mesenteric. They were found in 4 males and 2 females with an average age of 65.16 years. All were c-KIT positive, and the majority CD34 positive, while 3 were positive for muscle-specific actin. The 3 omentum cases had a mixed spindle/epithelioid pattern and low mitotic rate, while the 3 mesenteric cases had a spindle pattern, with a high mitotic rate in 2 cases, where hepatic metastasis appeared at 6 and 32 months respectively. The 3 omentum cases were alive at the time of writing, and free of disease at 16, 21 and 34 months of follow-up. EGISTs represent 11.9% of GIST cases diagnosed in the hospital over the period 2000-2005. CONCLUSIONS: In this study primary EGISTs of the omentum and mesentery showed clinicopathological and immunohistochemical characteristics similar to those previously in the literature for GISTs of the digestive tract, which supports the hypothesis that these tumors originate from extragastrointestinal c-KIT positive cells. Mesenteric location appears to be associated with a poorer prognosis.

Trombosis espontánea idiopática de la vena yugular interna / No disponible

No disponible

Metástasis óseas como forma de presentación en el carcinoma hepatocelular avanzado / No disponible

No disponible

[Hemoperitoenum as presentation of hepatocellular carcinoma: experience in three cases with spontaneous tumoral rupture and review of the literature]. / Hemoperitoneo como forma de presentación del carcinoma hepatocelular: experiencia de tres casos con rotura tumoral espontánea y revisión de la literatura.

Hemoperitoneum due to spontaneous rupture of hepatocellular carcinoma (HCC) constitutes a life-threatening situation if no appropriate therapy is provided. This complication is a well-known form of HCC presentation in countries with high incidence of liver tumours, but is an unusual event in Western countries, where it has been described in 5% or less of cases with HCC. We report three patients admitted to our centre with acute hemoperitoneum secondary to non-traumatic rupture as a first manifestation of not previously diagnosed HCC. A review of the related literature is also performed.

Tumor carcinoide gástrico solitario y anemia perniciosa: tratamiento mediante polipectomía endoscópica / No disponible

No disponible

Hemoperitoneo como forma de presentación del carcinoma hepatocelular: experiencia de tres casos con rotura tumoral espontánea y revisión de la literatura / Hemoperitoneum as presentation of hepatocellular carcinoma: experience in three cases with spontaneous tumoral rupture and review of the literature

El hemoperitoneo secundario a la rotura espontánea de un carcinoma hepatocelular (CHC) supone una complicación potencialmente fatal en ausencia de un abordaje terapéutico apropiado. Constituye una forma de presentación tumoral bien establecida en medios con elevada incidencia de CHC, pero resulta infrecuente en países occidentales, donde se describe en menos del 5% de los casos. Presentamos tres pacientes atendidos en nuestro centro por hemoperitoneo agudo secundario a la rotura no traumática de un CHC, en los que dicha complicación constituyó la primera manifestación del proceso neoplásico. Realizamos igualmente una revisión de la literatura relacionada con el tema

Hemoperitoneum due to spontaneous rupture of hepatocellular carcinoma (HCC) constitutes a life-threatening situation if no appropriate therapy is provided. This complication is a well-known form of HCC presentationin countries with high incidence of liver tumours, but is an unusual event in Western countries, where it has been described in 5% or less of cases with HCC. We report three patients admitted to our centre with acute hemoperitoneum secondary to non-traumatic rupture as a first manifestation of not previously diagnosed HCC. A review of the related literature is also performed

[Hepatocellular carcinoma in the elderly: clinical characteristics, survival analysis, and prognostic indicators in a cohort of Spanish patients older than 75 years]. / Carcinoma hepatocelular en el anciano: características clínicas, análisis de supervivencia y factores pronósticos en una cohorte de pacientes españoles mayores de 75 años.

AIMS: Hepatocellular carcinoma (HCC) remains poorly characterized in elderly patients with comorbid conditions, a fact that limits the clinical management of the disease. This study analyzes the natural history of HCC in patients older than 75, and determines factors that condition their survival. PATIENTS AND METHODS: A retrospective analysis of 235 patients with HCC divided into 2 groups by age at diagnosis: < or = 75 (n = 186) and > 75 (n = 49). After comparing their clinical variables (chi2 and t test), a logistic regression analysis was performed to determine factors associated with receiving locoregional treatment (versus symptomatic treatment). Survival in the 2 groups was compared using a log rank test with subsequent multivariate analysis (Cox proportional hazards model). RESULTS: There were no differences between groups for sex, presence of cirrhosis, etiology, Child-Pugh score, BCLCancer stage, presence of ascites or portal thrombosis, or bilirubin, AST, ALT, gammaGT, LDH or hematocrit values. Patients of advanced age were more frequently diagnosed in the presence of clinical manifestations, and had multifocal, non-localized disease and alpha-fetoprotein levels > 400 ng/mL (all p < 0.05). This group received exclusively symptomatic treatment in 78% of cases (compared to 33% in younger patients), and only 3 of them underwent surgical resection (p < 0.0001). Age older than 75 was a predictive factor for not receiving locoregional therapy (p < 0.0001). Survival in the elderly group (9.8 +/- 1 months) differed substantially from that of younger patients (25.6 +/- 2 months) (p < .00001). Advanced age continued to be a prognostic factor of poor survival in the multivariate analysis (p = 0.025), but lost significance when the analysis was stratified by treatment subgroups (p = 0.344). CONCLUSIONS: The lower survival seen in elderly patients with HCC, beyond differences in tumor extension or liver failure, seems conditioned by the use of suboptimal treatment in this population.