Hospital General San Jorge

ABSTRACTBackgroundLimited data are available on the management and outcomes of postoperative Crohn's disease (CD) in older patients. We aimed to describe the management of CD in the postoperative setting and assess surgical postoperative recurrence (POR) in this population.MethodsThis was a case‐control study including all adult patients with CD from the ENEIDA registry who had undergone a first intestinal resection with ileo‐colonic anastomosis. Patients were grouped according to their age at the time of the first surgery in older (over 60 years) subjects and controls (between 18 and 60 years of age).ResultsA total of 3982 (535 older subjects and 3454 controls) underwent a first intestinal resection for CD with an ileo‐colonic anastomosis. Time from CD diagnosis to surgery was significantly longer in older patients (114 ± 128 vs. 93 ± 97 months; p < 0.001). Older patients also had a lower proportion of penetrating CD (25% vs. 39%; p < 0.0001) and perianal disease (14% vs. 25%; p < 0.0001). A significantly lower proportion of older patients started preventive therapies for POR (32% vs. 51%; p < 0.0001). The cumulative risk of surgical POR was 3.2%, 5.3% and 10.1% in the older group and 3.6%, 6.6% and 14.2% in the control group at three, five and 10 years, respectively (p = 0.093). In the multivariate logistic regression analysis, only prevention with thiopurines was associated with a lower risk of surgical POR.ConclusionsAlthough postoperative preventive therapy with immunomodulators or biologicals is prescribed less often in older patients after a first intestinal resection, they develop surgical POR as often as younger adult patients.

Ovine pulmonary adenocarcinoma (OPA) is a naturally occurring lung neoplasia in sheep caused by jaagsiekte sheep retrovirus (JSRV). JSRV infects alveolar type II pneumocytes (ATII) and club cells (CC), and the expression of viral oncoproteins induces a lung adenocarcinoma. The gross pathology of OPA exhibits differences in the anatomical patterns known as classical and atypical forms. Thirty natural OPA tumors, divided equally into early OPA tumors (Group A, GA), atypical tumors (Group B, GB), and classical tumors (Group C, GC), were obtained from adult sheep (2-9 years old). Tumor heterogeneity was studied comparing the histopathology (growth patterns, local invasion, mitotic figures, myxoid nodules), together with immunohistochemistry (IHC) using markers of JSRV-ENV, epithelial cells (ATII cells, CC, ki67), progenitor-stem epithelial cells (K5, p63, CD44), and the anterior grade protein 2 (AGR2). Papillary pattern was predominant in all groups. Lepidic pattern was also relevant in GA, and acinar pattern was relevant in GB. Low proliferation indexes and local invasion were observed in all groups. Myxoid nodules were few. IHC showed that all samples were positive for JSRV-ENV. Cell markers demonstrated that GA was different when compared to GB and GC, showing significantly the highest levels of CC, K5, and p63 positive tumor cells. There were no significant differences between GB and GC. The heterogeneity analysis of OPA tumors revealed that in early tumors, repair is important but is not reflected in classical or atypical different anatomical OPA forms.

Las heridas son lesiones en la piel o mucosas causadas por agentes externos, representando una alta demanda en los servicios de urgencias. Su tratamiento busca prevenir infecciones, controlar el sangrado y mejorar la cicatrización. Una evaluación adecuada es esencial para elegir la mejor técnica de cierre, reduciendo riesgos como infección, dehiscencia o cicatrices hipertróficas. Los principales métodos de cierre incluyen: ● Suturas, absorbibles y no absorbibles, utilizadas según la profundidad y localización de la herida. ● Grapas, rápidas y eficientes en incisiones quirúrgicas o heridas con sangrado intenso. ● Tiras adhesivas, recomendadas en lesiones superficiales con buena alineación de bordes. ● Adhesivos tisulares, especialmente en pediatría, por su aplicación rápida y sin dolor. Se realizó una revisión bibliográfica en bases de datos científicas, seleccionando cinco estudios relevantes sobre el cierre de heridas. Los hallazgos destacan la importancia de la limpieza previa, la anestesia local y el desbridamiento para optimizar la cicatrización. Aunque las suturas son el método más usado, las grapas ofrecen tiempos de aplicación más cortos. Sin embargo, su impacto en la cicatrización y el riesgo de infección aún generan debate. Las tiras adhesivas y adhesivos tisulares pueden ser opciones menos invasivas con buenos resultados estéticos. No se ha identificado un método óptimo universal para el cierre de heridas, por lo que se requieren más estudios. La elección debe basarse en el tipo de lesión y en la experiencia del profesional de enfermería para reducir complicaciones y mejorar los resultados.

Cardiovascular diseases keep being the leading cause of mortality in Spain. Efforts should be intensified to identify new risk factors that may contribute to increasing cardiovascular risk. Lipoprotein(a) (Lp(a)) has been associated with a higher risk for developing aortic valve stenosis, heart failure, ischemic stroke, ischemic heart disease and peripheral arterial disease. Hyperlipoproteinemia(a) is a common health problem. Between 10 and 30 % of the world population have Lp(a) values exceeding 50 mg/dL. The scientific evidence provided in the recent years confirms an independent association between Lp(a) and the risk for having an arteriosclerotic cardiovascular event. This finding, added to the emergence of new specific therapies for reducing Lp(a) has raised interest in the quantification of this lipoprotein. The objective of this paper was to perform a review of the evidence available to identify the patients who will benefit from undergoing Lp(a) testing and determine the recommended quantification methods, the desirable concentrations, and the role of Lp(a) determination in reclassifying the cardiovascular risk of patients.

BackgroundBefore the incorporation of enfortumab vedotin with pembrolizumab, the standard of care for patients with locally advanced or metastatic urothelial carcinoma who do not progress after platinum-based chemotherapy was avelumab maintenance therapy, as demonstrated by the JAVELIN 100 trial. However, real-world European data remain scarce.Patients and MethodsAVEBLADDER is a retrospective study conducted at 14 hospitals in Northern Spain, including patients with locally advanced or metastatic urothelial carcinoma diagnosed between January 2021 and June 2023. Outcomes of overall survival (OS) and progression-free survival (PFS) were analyzed for patients treated with platinum-based chemotherapy, with and without subsequent avelumab maintenance therapy. non-avelumab patients. Median PFS was 11.33 months (95% CI: 10–13.6) with avelumab and 6.43 months (95% CI: 6–7.6) without. One-year OS probabilities were 81.6% vs. 45.6% (p < 0.001) in the avelumab and non-avelumab groups, respectively. No unexpected toxicities were reported.ConclusionsDespite proven survival benefits, avelumab uptake in real-world practice is limited by barriers like access, reimbursement, and awareness. These findings align with JAVELIN 100 and underscore the need for further real-world studies to address treatment disparities.

Resumen Introducción: La enfermedad de Dieulafoy es una causa infrecuente de hemorragia digestiva alta debida a la rotura de una arteria submucosa. Caso Clínico: Presentamos el caso de un paciente con hemorragia digestiva alta recidivante sin causa filiada que tras dos meses y más de una decena de endoscopias digestivas es sometido a gastrectomía total con hallazgo anatomopatológico de Enfermedad de Dieulafoy. Discusión: El manejo endoscópico (diagnóstico y terapéutico) es efectivo en el 70% de los casos; pudiendo beneficiarse de radiología intervencionista en los casos restantes. La cirugía continúa siendo el tratamiento para aquellos pacientes con hemorragia persistente no controlable por otros medios (2-6%). Conclusiones: La enfermedad de Dieulafoy continúa siendo un reto diagnóstico y terapéutico que debe tenerse en cuenta en el diagnóstico diferencial de la hemorragia gastrointestinal. La endoscopia es la principal herramienta diagnóstica y terapéutica siendo la cirugía la alternativa para aquellos pacientes con hemorragia persistente no controlable por otros medios.

Human papillomavirus (HPV) infection and menopause entail a considerable impairment in health-related quality of life (HRQoL). The objective of the present study was to analyze the impact of the menopause status on HRQoL in women with HPV infection. A cross-sectional, nationwide, multicenter sample of women with HPV infection was conducted throughout clinics of gynecology representative of the Spanish population with regard to age, geographic density, and autonomous regions. Demographic and clinical characteristics and the specific HPV-QoL questionnaire score with its domains were compared according to reproductive status: premenopausal and peri-/postmenopausal. Correlation with other validated patient-reported outcomes measurements was also tested, including General Health Questionnaire-12 (GHQ-12), Female Sexual Function Index (FSFI), and Hospital Anxiety and Depression Scale (HADS). A sample of 1,016 noninstitutionalized women, aged 18-80 y, was recorded, 191 (18.8%) peri-/postmenopausal and 825 (81.2%) premenopausal. Total HPV-QoL scoring was significantly lower in peri-/postmenopausal (38.8, 95% CI [35.2-42.4]) compared to premenopausal (46.4, 95% CI [45.0-47.8]) women, and also in every domain of the scale (P < 0.05), except in social well-being and health domains, with a small effect size of 0.39. In women with sexual dysfunction according to FSFI, adjusted total scoring and domains sexuality, general well-being, and psychological well-being scored significantly higher in premenopause women (P < 0.01), although the magnitude of differences were of small to moderate size. HRQoL was impaired during menopause in women with HPV infection according to HPV-QoL questionnaire. The sexuality domain was the most differentiating dimension between these populations.