Manuel Canteras-Jordana

The effects of different antineoplastic agents and of pretreatment by modulators on three melanoma lines

The chemotherapy of melanoma patients must be improved because of the naturally poor response and acquired resistance of this disease.

Urethrography in Men: Conventional Technique versus Clamp Method

PURPOSE To compare examination adequacy and patient discomfort during retrograde urethrography (RUG) performed by using the conventional balloon method versus those of RUG and voiding cystourethrography (VCUG) performed with the clamp method of using drip infusion for the administration of contrast material. MATERIALS AND METHODS This prospective study was approved by the institutional review board; written informed consent was obtained from all patients. Eighty men (mean age, 64.3 years +/- 16 [standard deviation]; range, 18-85 years) suspected of having urethral stenosis were randomly distributed into two groups for urethrography: a control group (n = 36) and a clamp group (n = 44). In 11 of the 36 patients in the control group, the conventional balloon method could not be used, so these patients were transferred to the clamp group. Drip infusion was used to administer contrast material for RUG, and, except in cases where a suprapubic catheter was used (n = 8), for VCUG. The pain levels reported by patients were recorded by using a verbal descriptor scale (VDS) and a visual analogue scale (VAS). RESULTS In the control group, RUG was successfully performed in 69% of patients (25 of 36), and mean pain levels recorded on inflation of the balloon were distressing according to the VDS and 4.8 +/- 1.4 (range, 2.3-7.5) according to the VAS. In the clamp group, RUG was successfully performed in all cases; in 69% of patients in this group (38 of 55), the pain level recorded at external compression was no pain according to the VDS and 0 according to the VAS, while mean values in the remaining 31% of patients (17 of 55) were mild pain on the VDS and 0.6 +/- 0.3 (range, 0.3-1.2) on the VAS. Bladder filling for VCUG was achieved with drip infusion in 96% of patients (69 of 72) in an average time of 11 minutes. CONCLUSION The conventional balloon method of performing RUG is painful and, in some cases, not effective. The clamp method is a simple, well-tolerated procedure that allowed diagnostic evaluation in all cases. Drip infusion enables RUG and VCUG to be performed without the need for syringes or bladder catheters, thus increasing patient comfort.

Use and influence of Delivery and Birth Plans in the humanizing delivery process

520 Objetivos: conhecer, analisar e descrever a situacao atual dos Planos de Parto e Nascimento no contexto estudado, comparando o processo de parto e sua finalizacao entre as mulheres que apresentaram e as que nao apresentaram um Plano de Parto e Nascimento. Metodo: estudo de coorte quantitativo, transversal, observacional descritivo comparativo, realizado durante um bienio. Foram selecionadas todas as mulheres que deram a luz no periodo estudado, incluindo 9303 mulheres. Resultados: o numero de Planos de Parto e Nascimento apresentados no primeiro ano foi de 132, contra 108 no segundo. Entre as variaveis analisadas, foi encontrada uma diferenca significativa para “contato pele a pele”, “eleicao de posicao de dilatacao e parto”, “uso de enema”, “ingestao de alimentos ou liquidos”, “partos normais”, “clampeamento tardio do cordao” e “depilacao do perineo”. Conclusoes: os Planos de Parto y Nascimento influenciam positivamente o processo de parto e sua finalizacao. Sao necessarias politicas sanitarias para aumentar o numero de Planos de Parto e Nascimento apresentados nos hospitais estudados.

Galactography: An application of the Galactogram Imaging Classification System (GICS)

Background: Galactography is the technique of choice for investigating pathological nipple discharge. However, there is no standardized interpretation system for this procedure. Purpose: To evaluate radiological and histological correlation using a Galactogram Imaging Classification System (GICS). Material and Methods: We retrospectively studied all galactograms obtained in 62 women with pathological nipple discharge who subsequently had biopsy at our institution between 1999 and 2007. The GICS proposes five categories for galactographic findings: GICS 1: negative; GICS 2: benign; GICS 3: probably benign; GICS 4: suspect for malignancy; GICS 5: highly suspect for malignancy. Results: The galactographic findings were classified as follows: GICS 2: 25.8% (16/62); GICS 3: 30.6% (19/62); GICS 4: 25.8% (16/62); and GICS 5: 17.7% (11/62). A good correlation was observed between histological diagnosis and GICS categories (P < 0.05). All the cases diagnosed with carcinoma (n = 11) were classified in GICS category 5. Conclusion: The present study shows a good correlation between GICS categories and histological diagnosis.

Episiotomy and its relationship to various clinical variables that influence its performance

Objetivo: conhecer a taxa de episiotomia e sua relacao com diferentes variaveis clinica. Metodo: e Estudo descritivo, transversal e analitico de 12.093 partos em um hospital terciario. Variaveis: paridade, idade gestacional, inicio do parto, uso de analgesia epidural, uso de oxitocina, posicao durante expulsao do feto, peso do neonato e finalizacao do parto. A analise foi feita com o SPSS 19.0. Resultados: a porcentagem global de episiotomias foi de 50%. As variaveis clinicas que apresentaram uma associacao significativa foram: primiparidade (RR=2,98), idade gestacional >; 41 semanas (RR=1,2), inicio do parto estimulado ou induzido (RR=1,33), uso de analgesia epidural (RR=1,95), uso de ocitocina (RR=1,58), posicao de litotomia durante a expulsao fetal (RR=6,4) e instrumentacao (RR=1,84). Por outro lado, idade materna ≥ 35 anos (RR=0.85) e peso do neonato < 2500 g (RR=0,8) estao associados a uma menor incidencia de episiotomia. Conclusoes: a episiotomia depende de intervencoes obstetricas feitas durante o parto. Se desejarmos reduzir a taxa de episiotomia, sera necessario manter em mente esses fatores de risco para estabelecer politicas para reduzir esse procedimento.Objective: to understand the episiotomy rate and its relationship with various clinical variables. Method: a descriptive, cross-sectional, analytic study of 12,093 births in a tertiary hospital. Variables: Parity, gestational age, start of labor, use of epidural analgesia, oxytocin usage, position during fetal explusion, weight of neonate, and completion of birth. The analysis was performed with SPSS 19.0. Results: the global percentage of episiotomies was 50%. The clinical variables that presented a significant association were primiparity (RR=2.98), gestational age >41 weeks (RR=1.2), augmented or induced labor (RR=1.33), epidural analgesia use (RR=1,95), oxytocin use (RR=1.58), lithotomy position during fetal expulsion (RR=6.4), and instrumentation (RR=1.84). Furthermore, maternal age ≥35 years (RR=0.85) and neonatal weight <2500 g (RR=0.8) were associated with a lower incidence of episiotomy. Conclusions: episiotomy is dependent on obstetric interventions performed during labor. If we wish to reduce the episiotomy rate, it will be necessary to bear in mind these risk factors when establishing policies for reducing this procedure.

Localización anatómica del tumor primario como variable a considerar en la biopsia selectiva del ganglio centinela del melanoma cutáneo

Resumen Introduccion La localizacion anatomica del melanoma cutaneo se ha considerado como un factor pronostico independiente. En este trabajo se trata de comprobar si la localizacion del tumor primario influye en la deteccion del ganglio centinela en el melanoma cutaneo. Pacientes y metodo Se ha estudiado a 212 pacientes con melanoma cutaneo primario (96 en los miembros, 89 en el tronco y 27 en la cabeza o el cuello) en los que se realizo la biopsia del ganglio centinela. Se estudio la adecuada localizacion gammagrafica y quirurgica y se compararon las variables epidemiologicas e histopatologicas, el numero de drenajes por lesion y de ganglios centinela por drenaje y la positividad del estudio de los ganglios. Para los drenajes procedentes de los tumores de la cabeza y el cuello se estudio el drenaje hacia territorio de la glandula salival como variable relacionada con la localizacion del ganglio centinela. Resultados La localizacion fue peor para los tumors de cabeza y cuello (88,8%), tanto gammagrafica (p Conclusiones Los melanomas cutaneos localizados en la cabeza y el cuello presentaron mas fallos en la identificacion del ganglio centinela. La localizacion del ganglio centinela adyacente a una glandula salival es un factor que influye en su adecuada deteccion. Los melanomas cutaneos del tronco presentan un mayor numero de drenajes por lesion que los localizados en las extremidades o en la cabeza y el cuello.

Prospective randomized controlled study to assess the value of a hemostatic and sealing agent for preventing seroma after axillary lymphadenectomy.

Postoperative seroma after axillary lymphadenectomy leads to an increased use of resources and an impaired quality of life of patients. This randomized clinical trial was designed to assess the value of a hemostatic and sealing agent for decreasing seroma occurrence after axillary lymphadenectomy.

Impact of support networks for breastfeeding: A multicentre study

BACKGROUND The rates of breastfeeding worldwide are slowly improving since 1996. Europe is still trailing behind the global breastfeeding incidence and prevalence rates. Thus, breastfeeding promotion, protection, prolongation and support have become an important challenge as breastfeeding sharply decreases in the first six months of life. OBJECTIVES The aim of this project is to determine, assess and identify the real impact of breastfeeding support networks in Murcia (Spain). METHODS After searching unsuccessfully for a validated questionnaire, a specific one was developed and validated for measuring the impact of formal and informal support networks through five dimensions: satisfaction, consultation, experience, problems and support. The questionnaire was provided to 500 mothers with experience in breastfeeding, who brought their children to baby paediatricians between 2 June and 27 November 2014. Upon completion of the survey and fieldwork, a detailed statistical analysis was conducted. RESULTS The degree of satisfaction perceived by the users of the services of support breastfeeding networks is remarkable. In addition, mothers who clarified their doubts and discussed their problems with health professionals and/or breastfeeding support networks were more likely to breastfeed for a longer duration compared to those who did not (p=0.005). Furthermore, mothers who sought support in breastfeeding are more likely to breastfeed for more than 6 months (p<0.0005). CONCLUSION Based on this information, we conclude that breastfeeding support networks have a positive influence in the duration of a womens decision to breastfeed.

Can Clinical Assessment of Locomotive Body Function Explain Gross Motor Environmental Performance in Cerebral Palsy

Gross Motor Function Classification System has discriminative purposes but does not assess short-term therapy goals. Locomotion Stages (LS) classify postural body functions and independent activity components. Assessing the relation between Gross Motor Function Classification System level and Locomotion Stages will make us understand if clinical assessment can explain and predict motor environmental performance in cerebral palsy. A total of 462 children were assessed with both scales. High reliability and strong negative correlation (–0.908) for Gross Motor Function Classification System and Locomotion Stages at any age was found. Sensitivity was 83%, and specificity and positive predictive value were 100% within the same age range. Regression analysis showed detailed probabilities for the realization of the Gross Motor Function Classification System depending on the Locomotion Stages and the age group. Postural body function measure with Locomotion Stages is reliable, sensitive, and specific for gross motor function and able to predict environmental performance.

Acoustic radiation force impulse imaging for detection of liver fibrosis in overweight and obese children

Background Acoustic radiation force impulse (ARFI) is a non-invasive alternative to a liver biopsy for the evaluation of liver fibrosis (LF). Purpose To investigate the potential usefulness of acoustic radiation force impulse ARFI for detecting LF in overweight and obese children Material and Methods A cross-sectional study was conducted in 148 schoolchildren. A diagnosis of non-alcoholic fatty liver disease (NAFLD) and LF was based on ultrasound (US) and ARFI shear wave velocity (SWV). Results The laboratory parameters were normal in all the children. NAFLD was observed in 50 children (33.8%). The median SWV was 1.18 ± 0.28 m/s. Differences between ARFI categories and hepatic steatosis grades were observed (χ2 = 43.38, P = 0.0005). No fibrosis or insignificant fibrosis (SWV ≤ 1.60 m/s) was detected in 137 children (92.5%), and significant fibrosis (SWV > 1.60 m/s) in 11 children (7.5%), nine of whom had normal US or mild steatosis. Conclusion The present study is the first to evaluate the utility of the ARFI technique for detecting LF in overweight and obese children. The results of the study suggest that children with normal laboratory parameters such as normal liver ultrasound or mild steatosis may present with significant LF.