Anales de la Real Academia Nacional de Medicina最新文献

{"title":"Hypotension in Older Treated Hypertensive Patients. Epidemiological Burden and Detection Efficiency","authors":"J. Banegas","doi":"10.32440/ar.2022.139.02.rev02","DOIUrl":"https://doi.org/10.32440/ar.2022.139.02.rev02","url":null,"abstract":"Hypertension (systolic/diastolic blood pressure [SBP/DBP] ≥140 and/or ≥90 mmHg) is a very common condition in older people (prevalence >60%) and one of the leading causes of death and disability worldwide. The cardiovascular, cerebrovascular, and renal benefits of treating it properly are abundantly supported by clinical trials. However, an excessive reduction in BP (e.g., postural or pharmacological), especially if it is sustained over time, is less known but apparently more frequent than expected and clinically-efficient to detect (e.g., with ambulatory monitoring [ABPM] or home-BP self-measurement). Some studies have associated hypotension with a greater risk of fatigue, dizziness, imbalance, falls, cardiovascular disease, kidney damage, and dementia. In older and frail patients with treated hypertension, some proposed safety margins are SBP/DBP of 130-139 (if tolerated)/70-79 mmHg and, in general, BP should not be reduced below these values. Orthostatic hypotension (>20/10 mmHg fall in SBP/DBP within 3 minutes of erect standing) and ambulatory hypotension (mean daytime BP <110/70 mmHg) can be detected measuring standing BP in the office and with 24-hour ABPM, respectively. Several studies suggest that there may not be a single treatment goal for all patients because the BP/outcome relation seems to be modified by the patient’s age, co-morbidities, drugs, etc., and ignorance of this can lead to hypotension and other deleterious effects. The balance between efficacy and safety of the drug treatment of hypertension can be reasonably achieved by the good doctor practicing personalized medicine, individualizing the treatment of each of his older patients (who are genetic, demographic, physiological, metabolic, psychological, and culturally different), combining the updated scientific evidence, his/her experience and comprehensive knowledge of the patient (age, co-morbidities, etc), and the preferences of the patient or their caregiver. Most of this review is supported by some recent clinical practice guidelines.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47654487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of Ultrasound versus Magnetic Resonance Imaging in hemophilic joint involvement","authors":"C.M. Baracaldo Silva, I. Elía, F. Querol-Fuentes, J.J. Carrasco, P. Nogués-Meléndez, C. Ramírez-Fuentes, L. Martí-Bonmatí","doi":"10.32440/ar.2022.139.02.org01","DOIUrl":"https://doi.org/10.32440/ar.2022.139.02.org01","url":null,"abstract":"Background and objectives: In hemophiliac patients, recurrent intra-articular bleeding leads to progressive arthropathy. Magnetic resonance imaging (MRI) is the gold-standard technique for joint assessment. The development of ultrasound protocols and standardized scales such as “Hemophilia Early Arthropathy Detection with Ultrasound” (HEAD-US) and “Point-of-care Ultrasonography” (POC-US) allow patient monitoring. Our main objective is to establish the diagnostic accuracy of ultrasound in the early detection of hemophilic arthropathy, with MRI as the gold standard. The interobserver variability in the ultrasound and MRI scales, the association between the POC-US and HEAD-US protocol, and the ability of ultrasound to detect haemosiderotic remnants will also be established.\u0000Patients and Methods: 45 hemophiliac patients were included. 180 joints (knees and ankles) were evaluated with MRI (Denver scale) and Ultrasound (HEAD-US and POC-US scale).\u0000Results: There is a high and statistically significant association between the ultrasound and MRI scales. Only for the ankle effusion variable the association was medium. The specificity of HEAD-US was ≥90% in both joints. Sensitivity in the knee did not exceed 82% in any assessed aspect, being high in the ankle for the cartilage and bone alterations (97%) but low for effusions (55%). In general, the predictive values ​​were high, with the exception of the negative predictive value of joint leak in knee and ankle (close to 70%). Ultrasound did not detect haemosiderotic remnants in any case. Statistically significant interobserver agreement was obtained for HEAD-US and Denver-MRI assessment. The level of association between the HEAD-US scale and the POC-US protocol was medium.\u0000Conclusions: Ultrasound is a technique with high diagnostic accuracy and reproducibility to detect and quantify the early signs of hemophilic arthropathy. Ultrasound is insensitive to detect haemosiderin in synovial hypertrophy.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48252485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Penile Cancer in a tertiary care hospital in Mexico City: Risk factors description and frequencies in Mexican population","authors":"J.C. Angulo Lozano, L.F. Sánchez Musi, R. Racilla González, J.F. Virgen Gutiérrez","doi":"10.32440/ar.2022.139.02.org03","DOIUrl":"https://doi.org/10.32440/ar.2022.139.02.org03","url":null,"abstract":"Objective: To determine and analyze the prevalence of the principal risk factors in patients with penile cancer in General Hospital “Dr. Eduardo Liceaga” and their survival rate at 24 months.\u0000Methods: Cross-sectional, descriptive study. The population (n=93) are hispanic, adult male residents of Mexico City with penile cancer diagnosed. The variables analyzed are: Age, smoking status, HPV status, presence of vascular invasion, treatment and survival status after 24 months.\u0000Results: Mean age (n=93) was 57.87. 55.9% were active smokers. 100% were uncircumcised. Only 17.2% were HPV +. Squamous Cell Carcinoma was the predominant type with 86%. 18.3% had vascular invasion. At 24 months after diagnosis with treatment 84.9% patients were alive, 6.5% died of cancer related causes, 6.5% of other causes and (2.2%) of chemotherapy toxicity.\u0000Conclusion: This infrequent disease requires a high quality multidisciplinary treatment. Squamous cell carcinomas are the predominant type in Mexico City, risk factors such as smoking, uncircumcised, age and HPV infection were present. HPV vaccines in men could help reduce a proportion of malignancies but there is no data related. Adjuvant therapy should be considered since the survival rate at 24 months of study was lower than first world countries. Periodic evaluation of chemotherapy adverse effects should be considered since a significant proportion died because of toxicity.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42803290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peptide receptor radionuclide therapy for malignant insulinoma: New horizons","authors":"F. Sebastian-Valles, M. Sampedro-Nuñez, M. Marazuela","doi":"10.32440/ar.2022.139.02.cc01","DOIUrl":"https://doi.org/10.32440/ar.2022.139.02.cc01","url":null,"abstract":"Malignant insulinoma is a rare neuroendocrine tumor, located exclusively in the pancreas, characterized by severe hypoglycemia secondary to excessive insulin secretion. Somatostatin analogs (SSA) and everolimus have been added to the classic treatment with diazoxide in the last years. Peptide receptor radionuclide therapy (PRRT) has also been recently tested in a few patients with insulinoma with apparently satisfactory results. We present a 49-year-old woman with a loss of consciousness in the context of severe hypoglycemia that was diagnosed of malignant insulinoma. She underwent tumor excision and a total pancreatectomy and after an extended hospital stay, she was discharged without hypoglycemia under treatment with ASS.\u0000After observing tumor progression, treatment with 4 cycles of PRRT was performed with symptomatic control, reduction of some of the metastatic lesions and stabilization of other lesions with excellent tolerance to treatment. PRRT is a possible alternative for the symptomatic and etiological treatment of malignant insulinoma.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48813932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conservative surgery of the spleen. Bases and technical options","authors":"Rodríguez Montes","doi":"10.32440/ar.2022.139.02.rev06","DOIUrl":"https://doi.org/10.32440/ar.2022.139.02.rev06","url":null,"abstract":"Review of the literature regarding spleen surgery shows us that total splenectomy, regardless of the degree of splenic injury, has been established over the centuries in the treatment of choice, not only because of the lack of more conservative methods because it was not possible to identify some important function of the spleen.\u0000Although the spleen is not essential for life, its removal can cause lower resistance to systemic infections, and easier diffusion by hematic route of bacteria although their functions can be assumed by other lymphoid organs and bone marrow.\u0000Recognition of immune functions and the segmental structure of the spleen have been that have laid the bases of conservative surgery in spleen trauma, and the increased risk of infection has gone, in particular the post-splenectomy sepsis, who has promoted the design and application of different methods and operative techniques to avoid the total splenectomy, since the conservation of a portion of organ could be enough to prevent such a fearsone complication.\u0000In this article the fundamentals and technical options of conservative surgery in spleen trauma are exposed.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41380260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and treatment of Inflammatory Bowel Disease in 2022","authors":"G. López-Roldán, C. López, C. Taxonera","doi":"10.32440/ar.2022.139.01.doc01","DOIUrl":"https://doi.org/10.32440/ar.2022.139.01.doc01","url":null,"abstract":"Since the first report of a disease that today we call ulcerative colitis at the end of the 18th century, the knowledge in Inflammatory Bowel Disease (IBD) has radically changed. From using tuberculostatics to treat Crohn’s disease and rectal irrigations in ulcerative colitis, to developing specific drugs targeted to specific molecules, our pharmacological, endoscopic, and surgical tools have evolved and allowed us to treat its severe and challenging variants, traditionally considered to be fatal. Much of the credit of our success controlling these conditions comes from a better understanding of the complex underlying immune alterations and permanent inflammation that cause them; and maybe, one of the greatest achievements in IBD has been the design of the so-called biologic therapy. Moreover, the development of clinical tests to detect inflammatory activity in blood and stool, the apparition of new ways of detecting premalignant lesions and minimal invasive therapy for complications, and new surgical strategies have let us to individualize treatment and monitoring the disease and improve life quality in our patients. However, we still find lots of diagnostic and treatment challenges in IBD in our daily practice, today. We present our review of the management of Crohn’s disease, ulcerative colitis, and indeterminate colitis in 2022.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42078859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hodgkin Lymphoma (HL) a success story over 50 years","authors":"J.M. Fernández-Rañada de la Gándara","doi":"10.32440/ar.2022.139.01.rev07","DOIUrl":"https://doi.org/10.32440/ar.2022.139.01.rev07","url":null,"abstract":"Hodgkin Lymphoma (HL) is a rare B-origin lymphoma that accounts for approximately 10% of all lymphomas. HL is made up of two different entities: on the one hand, the Classical Hodgkin Lymphoma (CHL), consisting of the histological forms of predominantly lymphocytic, nodular sclerosis, mixed cellularity and lymphocytic depletion and, on the other, the Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL). During the last 50 years, we have seen a move from a monovalent therapy – with a 5-10% survival probability at 5 years – to a combination chemotherapy and a therapeutic approach aimed at reducing the treatment toxicity while maintaining a high probability of cure even in advanced cases. The curative role of radiotherapy in patients with localized Hodgkin’s lymphomas has been observed for about a century. New agents such as Brentuximab and PD-1 antibodies have recently proven to be efficient in recurrent cases and their incorporation to the first line is being studied.\u0000Likewise, the role of autologous haematopoietic stem cell transplantation after salvage chemotherapy in first relapse and the role of allogeneic transplantation and the use of anti-CD30 CAR T-cell therapy in relapsed or refractory Hodgkin’s lymphoma are discussed.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41425022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Blood Salvage after knee arthroplasty: are they still useful? A retrospective cohort study","authors":"I. Valbuena, E. Guasch, N. Brogly, R. Schiraldi, J. Díez, F. Gilsanz","doi":"10.32440/ar.2022.139.01.org02","DOIUrl":"https://doi.org/10.32440/ar.2022.139.01.org02","url":null,"abstract":"Background and Goal of Study: Blood salvage (BS) is important to implement the second pillar of Patient Blood Management to avoid anaemia after total knee arthroplasty (TKA). Our primary outcome was to assess BS usefulness to decrease allogenic blood transfusion (ABT) rate in TKA.\u0000Materials and Methods: a retrospective, observational cohort study was conducted on consecutive patients scheduled for TKA with BS or not. Demographic, comorbidity, surgical and anesthetic data, laboratory pre and postoperative results, volume of blood drained, and reinfused from BS and the requirement of ABT were recorded. Parametric and non-parametric tests were employed. p< 0.05 was accepted as significant.\u0000Results: 260 patients were included (130 per cohort). The amount of postoperative bleeding was 713.1 +445.4 ml. 26.5% received ABT. BS reduced transfusion in 13,1% (p=0,024) with RR 1,65 (CI 1,085-2,52)]. Risk factors for postoperative bleeding were: male gender, atrial fibrillation, preoperative anti-platelet therapy and cementless primary TKA. Risk factors for ABT: ASA > II, preoperative hemoglobin < 13 g/dl, knee revision, anti-platelet therapy, longer surgery time. Patients transfused had lower hemoglobin values (p<0.001), and longer medium LOS (+2.5 days, p=0.026).\u0000Conclusion: The use of BS in TKA showed benefits reducing allogenic blood transfusion and length of hospital stay. BS would remain an effective, safe and cheap alternative to tranexamic acid in patients with high risk of thromboembolism events operated of TKA.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42912562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personal experience on abdominal organ transplantation in \"Doce de Octubre University Hospital\"","authors":"E. Moreno-González, C. Jiménez-Romero, C. Loinaz-Segurola, Á. García‐Sesma, A. Manrique-Municio, J. Calvo-Pulido, F. Cambra-Molero, M. Abradelo-Usera, Ó. Caso-Maestro, A. Marcacuzco-Quinto, C. Alegre-Torrado","doi":"10.32440/ar.2022.139.01.rev04","DOIUrl":"https://doi.org/10.32440/ar.2022.139.01.rev04","url":null,"abstract":"Since April 26th, 1986 until December 2020 we performed 2.811 abdominal organ transplantation in the Department of surgery of the University Hospital “Doce de Octubre”. Madrid. Spain.\u0000The aim is to describe our experience in the separate groups: 1) Use of the Bio-pump; 2) Reuse of liver grafts; 3) Use of grafts with steatosis; 4) Transplantation on recipients with porto-mesenteric thrombosis; 5) Use of older donor; 6) Liver Transplantation on pregnant; 7) Transplantation on neighborn; 8) Split; 9) Use of nombeating donors; 10) Living related donors; 11) Transplantation in echinococus granulosus disease; 12) Liver pancreas, liver kidney, liver heart transplantation, pancreas kidney transplantation, jejuno-ileal and cluster transplantation.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42004832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limitations and challenges of uro-oncologic surgery in elderly patients: A critical review of the management of prostate, bladder and kidney cancer","authors":"A. Artiles-Medina, F. Burgos-Revilla","doi":"10.32440/ar.2022.139.01.rev05","DOIUrl":"https://doi.org/10.32440/ar.2022.139.01.rev05","url":null,"abstract":"Due to the increase in life expectancy, challenging scenarios in oncogeriatrics are becoming more common in clinical practice. The outcomes of curative cancer treatments, which have shown benefits in the general population, are not always studied in elderly patients. Chronological age alone may not accurately correlate with the risk of complications or the potential benefit in survival, in contrast to the increasingly used frailty scores. Therefore, an adequate preoperative comprehensive geriatric assessment is essential.\u0000This review addresses the challenge of decision-making regarding surgical treatment of the most frequent urological cancers in elderly patients.\u0000Prostate cancer in elderly patients implies a complex scenario; life expectancy represents a determining factor given its often indolent behavior, in order to avoid overtreatment. It is crucial to face this challenge focusing on cancer screening primarily. In the literature, there are heterogeneous data regarding survival, although a similar rate of surgical complications and worse functional outcomes than younger patients have been reported.\u0000Muscle-invasive bladder cancer in the elderly also represents a challenge, because of the high rate of complications of radical cystectomy and the evidence of lower overall and cancer-specific survival in this group of patients.\u0000Finally, the key elements in the management of kidney cancer in elderly patients who are candidates for surgical treatment are the need to preserve renal function (considering nephron-sparing surgery) and the limited data regarding benefit in overall survival. For this reason, active surveillance of small renal masses can be a useful strategy.","PeriodicalId":75487,"journal":{"name":"Anales de la Real Academia Nacional de Medicina","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46340805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}