La incontinencia urinaria en el cáncer de próstata: diseño de un programa de rehabilitación / Urinary incontinence and prostate cancer: A rehabilitation program design

Introducción y objetivo: Este trabajo presenta el diseño e implementación de un programa progresivo de rehabilitación basado en los ejercicios musculares del suelo pélvico, incorporando el trabajo muscular de fuerza contrarresistencia. Material y método: El diseño del estudio es casi experimental. La muestra es de 33 participantes en fase de tratamiento. Las variables de estudio son las antropométricas, las relacionadas con la evolución de la incontinencia urinaria (IU) (intensidad, dificultad, frecuencia y limitación de las actividades), la obesidad, fatiga y dolor, la fuerza muscular y la calidad de vida (CdV). Para evaluar el cambio intrasujeto se tomaron medidas pretest (semana 0) y postest (semana 24). En el análisis estadístico se utilizan las pruebas t Student-Fisher, Wilcoxon o U de Mann Whitney y el test del χ2. El análisis se realiza con el programa SPSS versión 15. El nivel de significación escogido es del 5%. Resultados: Al finalizar las 24 semanas del programa se identifica una disminución significativa de las variables antropométricas índice de cintura-cadera (p=0,003), perímetro de cintura (p≤0,001) y porcentaje de masa de grasa (p≤0,001); de las variables de IU: intensidad (p≤0,0001), frecuencia y dificultad y su relación con la limitación de las actividades (p≤0,0001), así como la relación existente entre la mejora de IU y la mejora de la CdV (p=0,039). Conclusiones: Queda científicamente demostrada la eficacia del programa progresivo de fuerza para disminuir la IU. La mejora de la CdV del hombre mayor con cáncer de próstata viene mediada por la mejora de la continencia urinaria (AU)

Introduction and objectives: This article presents the design and implementation of a rehabilitation program based on the muscular exercises of pelvic floor, incorporating the strength resistance work. Materials and methods: The design in quasi-experimental. The sample is formed by 33 participants in treatment phase. The variable studied are: anthropometrics variables, variables related to IU evolution (intensity, difficulty, frequency and activities limitation), obesity, fatigue and pain, muscular strength and quality of life. Measures pre (0 week) and post test (24 weeks) are taken with the aim of evaluate intra-subject change. Statistic analysis is made with t Student-fisher test, Wilcoxon or U Man Whitney, and X2 test. Analysis was performed with SPSS program version 15. Signification level chosen was 5%. Results: After 24 weeks of program an improvement was identify in: anthropometric variables waist-to- hip ratio (p=,003), waist perimeter (p≤,001), body fat percentage (p≤,001), IU intensity (p≤,0001), frequency and difficulty and they relation with activities limitation (p≤,0001), and also the existing relationship between the improvement of IU and the improvement of QoL (p=,039). Conclusions: The article establishes scientifically the efficacy of the progressive strength to diminish IU. The improvement of QoL of men with prostate cancer is mediated by the improvement of the urinary continence (AU)

Long term results of a phase II trial of induction chemotherapy with uracil-ftegafur (UFT), vinorelbine and cisplatin (UFTVP) followed by radiotherapy concomitant with UFT and carboplatin (RT/UFTJ) in non-resectable locally advanced (stage IV-B) squamous cell head and neck carcinoma and peripheral blood stem cell support (PBSCS) with febrile neutropenia

PURPOSE: To evaluate the response of advanced squamous cell head and neck carcinoma to a combination of induction chemotherapy and radiotherapy. METHODS: We present long-term results of a phase II trial of Induction Chemotherapy with UFT 200 mg/m(2) p.o. days 1 to 21, Vinorelbine 25 mg/m(2) i.v. days 1 and 8 and Cisplatin 100 mg/m(2) i.v. day 1 (UFTVP) each 21 days for 4 courses, followed by Radiotherapy concomitant with UFT 100 mg/m(2) p.o. daily and Carboplatin AUC = 0.5 i.v. weekly (RT/UFTJ) in patients (pts) with Non-Resectable Locally Advanced (Stage IV-B) Squamous Cell Head and Neck Carcinoma (IV-B-SCHNC). Primary endpoint was Complete Response to induction UFTVP and secondary endpoints were Disease Free Status Rate after locoregional treatment and long-term Overall Survival. Between 1994 and 1997, 32 pts were included. RESULTS: Complete Response to Induction UFTVP was 59% (95% CI: 48%-70%). Main toxicity of UFTVP was G 3,4 neutropenia (94% of pts; 25% developed febrile neutropenia and 1 of this pts dead). After Induction Chemotherapy with UFTVP, 30 pts received radiotherapy and 25 of them received concomitant Carboplatin and UFT (RT/UFTJ): main toxicity was mucositis (G3-4: 72%) and one patient died during RT/UFTJ because pneumonia. Twenty-five pts (78%) were alive and disease free at the end of the whole treatment. Actuarial 5 year Overall survival is 32%. CONCLUSION: Although toxicity is important, this approach has interesting activity and deserves further investigation (AU)

Tratamiento quirúrgico del hiperparatiroidismo primario en el embarazo / Surgical treatment of primary hyperparathyroidism in pregnancy

El hiperparatiroidismo primario en la gestación es una enfermedad de incidencia desconocida que presenta particularidades desde el punto de vista fisiológico, pronóstico y terapéutico, lo que conlleva una mayor dificultad en el diagnóstico y un elevado riesgo de complicaciones. Presentamos el caso de una gestante de 16 semanas que presentaba una hipercalcemia asintomática secundaria a un adenoma único de paratiroides. Ante la ausencia de mejoría con medidas conservadoras se decidió realizar tratamiento quirúrgico en el segundo trimestre de gestación, con resultado satisfactorio y evolución posterior del embarazo y del período neonatal sin incidencias. La cirugía en el segundo trimestre de gestación constituye una alternativa eficaz y segura frente al tratamiento conservador (AU)

Primary hyperparathyroidism during pregnancy is a pathological entity with an unknown incidence that presents certain physiological, therapeutic and prognostic characteristics leading to greater difficulty in diagnosis and a high risk of complications. We present the case of a 16-week pregnant woman who presented with asymptomatic hypercalcemia secondary to a solitary parathyroid adenoma. Since conservative measures produced no improvement, surgery was performed in the second trimester of pregnancy, with satisfactory pre- and postnatal results. Surgery in the second trimester constitutes a safe alternative to conservative treatment (AU)