[Overdiagnosis in prostate cancer]. / Sobrediagnostico en cancer de prostata.

Prostate cancer screening is an absolutely controversial topic and under debate. The points of view from which the problem is analyzed also influence this issue; patient, physician and Health Care authorities have different interests that most of the times are not comprehensively analyzed. Currently, no clinical guideline supports the performance of a population screening with active recruitment, but they do support the credible information to the man who desires its performance of potential benefits and risks (opportunistic screening), as well as its performance in certain risk groups. Nevertheless, what is inherent to any screening program is the overdiagnosis of clinically irrelevant disease, which in prostate cancer has been calculated around 50%, and that, from our point of view, gives cause to the correct implementation of active surveillance programs to tamponade the potential deleterious effects of active therapies of prostate cancer.

Sobrediagnóstico en cáncer de próstata / Overdiagnosis in prostate cancer

El tamizaje, screening o cribado en cáncer de próstata es un tema actualmente en debate y absolutamente controvertido. En esta problemática también influyen los puntos de vista desde donde se analice el problema; paciente, profesional y autoridades sanitarias tienen intereses diferentes que la mayoría de veces no se analizan integralmente. Actualmente ninguna Guía Clínica avala la realización de un screening poblacional con reclutamiento activo, pero sí la información fehaciente de sus posibles beneficios y riesgos al hombre que desea su realización (screenig oportunista), así como su realización en determinados grupos de riesgo. Pero lo que es inherente a cualquier programa de screening es el sobrediagnóstico que se realiza de enfermedad clínicamente irrelevante, que en cáncer de próstata se ha llegado a cifrar en torno al 50%, y que desde nuestro punto de vista da pie a la correcta implementación de los programas de vigilancia activa para tamponar los potenciales efectos deletéreos que los tratamientos activos del cáncer de próstata pudieran ocasionar

Prostate cancer screening is an absolutely controversial topic and under debate. The points of view from which the problem is analyzed also influence this issue; patient, physician and Health Care authorities have different interests that most of the times are not comprehensively analyzed. Currently, no clinical guideline supports the performance of a population screening with active recruitment, but they do support the credible information to the man who desires its performance of potential benefits and risks (opportunistic screening), as well as its performance in certain risk groups. Nevertheless, what is inherent to any screening program is the overdiagnosis of clinically irrelevant disease, which in prostate cancer has been calculated around 50%, and that, from our point of view, gives cause to the correct implementation of active surveillance programs to tamponade the potential deleterious effects of active therapies of prostate cancer

Potential additional effect of omentectomy on metabolic syndrome, acute-phase reactants, and inflammatory mediators in grade III obese patients undergoing laparoscopic Roux-en-Y gastric bypass: a randomized trial.

OBJECTIVE: To assess the additional effect of sudden visceral fat reduction by omentectomy on metabolic syndrome, acute-phase reactants, and inflammatory mediators in patients with grade III obesity (G-III O) undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB). RESEARCH DESIGN AND METHODS: Twenty-two patients were randomized into two groups, LRYGB alone or with omentectomy. Levels of interleukin-6, C-reactive protein, tumor necrosis factor-alpha, leptin, adiponectin, glucose, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides, as well as clinical characteristics, were evaluated before surgery and at 1, 3, 6, and 12 months after surgery. Results were compared between groups. RESULTS: Baseline characteristics were comparable in both groups. Mean operative time was significantly higher in the group of patients who underwent omentectomy (P < 0.001). Median weight of the omentum was 795 +/- 341 g. In one patient, a duodenal perforation occurred at the time of omentectomy. BMI, blood pressure, glucose, total cholesterol, LDL, and triglycerides significantly improved in both groups at 1, 3, 6, and 12 months of follow-up when compared with basal values. However, there were no consistent statistically significant differences among the groups in terms of metabolic syndrome components, acute-phase reactants, and inflammatory mediators. CONCLUSIONS: Omentectomy does not have an ancillary short-term significant impact on the components of metabolic syndrome and does not induce important changes in the inflammatory mediators in patients undergoing LRYGB. Operative time is more prolonged when omentectomy is performed.

[Giant ovarian cyst extraction by means of minilaparotomy: hourglass technique]. / Extracción de quiste gigante de ovario por minilaparotomía: técnica de reloj de arena.

UNLABELLED: We report a case of a giant ovarian cyst and its removal by means of a newly and low morbid technique. It's about a 40 years-old female with intervascular closing cardiovascular surgery history, 25 years before, and one pregnancy and one delivery. She has two years development of middle effort dyspnea, weight gain and abdominal distension. Physical examination reveals a weight of 160 kg, 1.60 m of height, mild teguments paleness, and walkinf difficulty due to its grate distension; blood pressure was 150/70 mmHg, cardiac frequency of 95 bpm, I to II grade systolic murmur at the aortic focal accessory (in a I to VI scale), hypoventilated lung fields, grate abdominal distension, mild percussion pain, and low peristalsis. External genitals were normal, and wide vagina. Cervix of uterus was hardly seen due to its small size, without evident damage; nor uterus nor appendages can be delimited during vaginal touch. There was venous failure in lower limbs with ++ edema. An 8 cm supraumbilical minilaparotomy was performed, and 45 liters of citrin were aspired. When tumor tension decreases it was placed a Mayo table with sterile fields next to surgical table, and the abdomen was pulled laterally until tumor protrusion trough surgical incision, liquid weight puts tumor out of the abdomen. Cyst total weight was 55 kg, and hystopathological report was benign serous giant ovarian cyst. CONCLUSIONS: Hourglass technique used in this report is simple, practical, and safe, requires a small incision and has lower morbidity in patients with high surgical risk.

Diagnostic sensitivity and specificity of the radionuclide (indium)-labeled leukocyte scan.

OBJECTIVE: Evaluate the sensitivity and specificity of Indium(111)-labeled leukocyte scans as used in a general, tertiary care hospital. METHODS: Retrospective review of electronic medical records from all patients who underwent Indium(111) scan at two large Veterans Affairs Medical Centers, 1999-2005, to determine congruence between Indium(111) scan readings and final clinical diagnoses, using all available data with at least 6 months of follow-up. RESULTS: Of 145 indium scans done for possible skeletal infection, infection was judged to be present in 52 cases. The sensitivity was 83%, and the specificity was 90%, with a diagnostic accuracy of 88%. Fifty-nine scans were done for indications other than skeletal infection. In 20 instances, when specific foci were suspected, the suspicion was correctly confirmed by indium scan in every case, without false positives or negatives (sensitivity and specificity, 100%). In 39 scans done to search for a possible source of nonspecific findings of infection (fever, leukocytosis, bacteremia), the sensitivity and specificity were 81% and 87%, respectively, with a diagnostic accuracy of 85%. CONCLUSION: Except as a means to confirm an already-suspected clinical focus, the indium scan appears to offer relatively little definitive information that can be used for diagnosis or treatment of infection.