Cancer antigen (CA) 125 tumor-associated antigen is a high molecular glycoprotein used for follow-up of epithelial ovarian cancer. The test is often requested as a differential diagnosis in patients ...with pleural or peritoneal fluid. This study analyzes the prevalence of CA-125 increases in a population of patients attending a general hospital and discusses the possible clinical implications of increased levels.
On 4 different days, 380 CA-125 assays were performed in randomly selected patients attending our hospital. Serum CA-125 was measured with a commercial enzyme immunoassay, and clinical records were reviewed for assessment of clinical parameters.
Sixty-one patients (16%) had increased CA-125. The pathologies of these patients were heart failure in 9 (14.7%), lung disease 11 (18%), hepatic cirrhosis in 7 (11.4%), malignant tumors in 9 (14.7%), intra-abdominal nonhepatic disease in 6 (10%), previous surgery in 17 (27.8%), and miscellaneous in 2 (3%). Effusions were seen in 34 patients (55.7%).
Our data confirm the variety of benign and malignant pathologies coursing with increased CA-125. Cardiovascular and chronic liver disease were the most frequent diagnoses in patients with increased CA-125; this supports the opinion that CA-125 lacks utility as a marker for malignancy. CA-125 could have a role in the follow-up of cardiovascular, hepatic, and tumoral diseases with serosal involvement.
Endovascular techniques have become an essential tool for the treatment of descending thoracic aortic disease (thoracic endovascular aneurysm repair TEVAR). The aim is to analyze the indications and ...outcomes of emergency TEVAR at national level in relation to elective surgery.
A retrospective multicenter registry of patients with descending thoracic aortic disease treated on an emergency basis using endovascular techniques between 2012–2016, in 11 clinical units.
1) Ruptured descending thoracic aortic aneurysms (RTAA); 2) Blunt traumatic thoracic aortic injury (TAI); and 3) Complicated acute type B aortic dissections (TBADc).
Patient mortality, survival and reoperation rate.
Demographic data, cardiovascular risk factors, specific data by indication, technical resources and postoperative complications.
A total of 135 urgent TEVARs were included (111 men, mean age 60.4 ± 16.3 years): 43 ruptured thoracic aortic aneurysms (31.9%), 54 type B dissections (40%) and 32 traumatic aortic injuries (23.7%), and other etiologies 4.4%. The overall mortality rate at 30 days was 18.5%, and proved higher in the RTAA group (27.9%). The mean actuarial survival rate was 67 ± 6% at 5 years. The postoperative stroke rate was 5.2%, and the paraplegia rate was 5.9%. Aortic reoperations proved necessary in 12 patients (9%).
Emergency descending thoracic aortic diseases can be treated by endovascular techniques with optimal results and low morbidity and mortality — though the figures are slightly higher than in elective cases. This registry provides, for the first time, real information on the daily clinical practice of emergency TEVAR in Spain.
Las técnicas endovasculares se han convertido en una herramienta esencial para el tratamiento de la patología de aorta torácica descendente (TEVAR). El objetivo es analizar las indicaciones y resultados del TEVAR urgente a nivel nacional en relación con la cirugía programada.
Registro multicéntrico retrospectivo de pacientes con patología de aorta torácica descendente tratados de urgencia mediante técnicas endovasculares entre los años 2012–2016 en 11 servicios clínicos.
1) Aneurismas de aorta torácica rotos (AATR), 2) roturas traumáticas de aorta torácica (TAT) y 3) disecciones de aorta torácica tipo B (DATBc) complicadas.
Mortalidad, supervivencia y tasa de reintervenciones.
Datos demográficos, factores de riesgo cardiovasculares, datos específicos por indicación, datos técnicos y complicaciones postoperatorias.
Se obtuvieron 135 TEVAR urgentes (111 varones, edad media 60,4 ± 16,3 años): 43 aneurismas aórticos rotos (31,9%), 54 disecciones tipo B (40%) y 32 roturas aórticas traumáticas (23,7%) y otras etiologías 4,4%. La mortalidad global a los 30 días fue del 18,5%, siendo superior en los AATR (27,9%). La supervivencia media actuarial ha sido del 67 ± 6% a los 5 años. La tasa de ictus postoperatoria fue del 5,2% y la tasa de isquemia medular del 5,9%. Las reintervenciones aórticas fueron necesarias en 12 pacientes (9%).
La patología de aorta descendente urgente puede ser tratada mediante técnicas endovasculares con resultados óptimos y baja morbimortalidad, aunque ligeramente superior a los casos electivos. Este registro aporta por primera vez, información de la realidad clínica diaria del TEVAR urgente en España.
42-year-old man with pain in the posterolateral region of the right knee that began while he was running. Initially, it was diagnosed by magnetic resonance (MR) as a possible aggressive process ...(osteosarcoma or Ewing's sarcoma) but with computed tomography it was noted a cortical hypodense linear longitudinal image with a continuous, homogeneous and solid periosteal reaction without clear soft tissue mass that in this patient suggest a longitudinal distal femoral fatigue stress fracture. This type of fracture at this location is very rare. Stress fractures are entities that can be confused with an agressive process. MR iscurrently the most sensitive and specific imaging method for its diagnosis.
RESUMEN Introducción La presencia de síntomas depresivos en los mayores es un problema importante de salud, se puede considerar como la alteración de la salud mental, más frecuente en ancianos en los ...países desarrollados. Se asocia al sufrimiento y a un incremento de la prevalencia y mala evolución de los problemas de salud. Objetivo Determinar la prevalencia de la depresión y factores asociados en personas mayores de 75 años de la ciudad de Castellón de la Plana. Material y métodos Estudio observacional, transversal y analítico, realizado mediante cuestionario sobre una muestra de 400 individuos mayores de 75 años residentes en la comunidad, que fueron seleccionados mediante muestreo intencionado durante el año 2015. Resultados Prevalencia de síntomas depresivos 30,5%, las mujeres los presentan en mayor proporción (40,1%). Los mayores que viven solos presentan en mayor medida síntomas de depresión 26,6% frente al 16,1% (p= 0,011). La buena autopercepción de la salud se relaciona con menor proporción de síntomas depresivos y en relación a la fragilidad, los individuos no frágiles presentan síntomas depresivos en menor proporción (12,1%) que los frágiles (30,8%) y los prefragiles (57%) p<0,05. Los aspectos negativos en las relaciones sociales obtienen una puntuación media menor (0,003) en los individuos sin síntomas depresivos (p=0.006) Conclusiones Existe asociación entre la presencia de síntomas depresivos y el sexo, autopercepción de salud, convivencia y fragilidad.
Liver transplantation (LT) is one of the most complex surgical procedures. Enhanced recovery after surgery (ERAS) aims to reduce the risk of postoperative complications. When patients achieve all ...desirable outcomes after a procedure, they are considered to have experienced a textbook outcome (TO).
Two cohorts of patients undergoing low (n = 101) or medium risk (n = 15) LT were identified. The remaining patients (n = 65) were grouped separately. The ERAS protocol included pre-, intra-, and post-operative steps. TO was defined as the absence of complications, prolonged length of hospital stays, readmission and mortality during the first 90 days.
One third of patients who underwent ERAS after LT experienced a TO. On multivariable analysis, age (OR, 1.05 95% CI, 1.01–1.09; P = .02), and having hepatocellular carcinoma (OR, 2.83 95% CI, 1.37–6.03; P = .005) were individually associated with a greater probability of achieving a TO. Belonging to the cohorts of medium risk or outside the selection criteria was associated with a lower probability of achieving a TO (OR, 0.46 96% CI, 0.22–0.93; P = .03). Patients less likely to experience TO required more hospital resources. Patients who achieved TO were more likely to remain free of chronic kidney disease (achieved TO, 83.8% 82.7–85.6; failed TO, 67.9% 66.9–70.2; P < .05). Tacrolimus dose and trough levels were similar.
A novel finding of our study is that short and medium-term kidney function is better preserved in patients who experience a TO. Better kidney function of patients who achieve TO is not due to lower tacrolimus dosage.
•One in three patients achieve textbook outcome after liver transplantation•Achievement of textbook outcome entails a reduction of costs•Patients who experience textbook outcome are more likely to maintain kidney function•Dose of tacrolimus is similar among patients who fail or achieve textbook outcome•Better kidney function is not due to lower dose of tacrolimus in these patients
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