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Lluch-Bernal M.,Hospital Universitario La Paz | Lluch-Bernal M.,Hospital Virgen Del Valle | Dordal M.T.,Hospital Municipal Badalona | Anton E.,Hospital Universitario Marques Of Valdecilla | And 15 more authors.
Journal of Investigational Allergology and Clinical Immunology | Year: 2015

Nasal hyperreactivity is the abnormal reaction of nasal tissue to a stimulus that is innocuous to most people. This response is caused by dysregulation of the autonomic nervous system at various levels of the nasal autonomic reflex arc. Various stimuli (methacholine, histamine, adenosine 5´-monophosphate, cold air, mannitol, capsaicin, phentolamine, and distilled water) have been used in an attempt to find the test that most reliably differentiates between healthy individuals and patients and also between different types of rhinitis. Despite the small number of publications available, in the present review, we provide an update on current nonspecific nasal provocation techniques. The studies published to date are not comparable: the stimuli applied act through different mechanisms and are used to assess different pathways, and the methodologies differ in terms of selection of participants, concentrations used, and assessment of response (criteria for positivity). Given the limited use of nonspecific nasal provocation tests in routine clinical practice, we believe that more studies are warranted to address the research issues we present at the end of the present review, for example, the need to standardize the methodology for each test or even the clinical benefits of knowing whether or not a patient has nasal hyperreactivity. © 2015 Esmon Publicidad.


Esteban F.,Hospital Clinico San Carlos | Cerdan F.J.,Hospital Clinico San Carlos | Garcia-Alonso M.,Hospital Clinico San Carlos | Sanz-Lopez R.,Hospital Clinico San Carlos | And 6 more authors.
Colorectal Disease | Year: 2014

Aim: The introduction of multimodal or fast track (FT) rehabilitation and laparoscopy in colorectal surgery has improved patient recovery and shortened hospital stay (HS). This study aimed to determine the influence of laparoscopic or open surgery on the postoperative recovery of colorectal cancer patients having a conventional care (CC) or FT protocol in the postoperative period. Method: A multicentre prospective study was controlled with a retrospective group. The prospective group included 300 patients having elective colorectal resection for cancer. The retrospective control group included 201 patients with the same characteristics who were treated before the introduction of the programme. The patients were divided into four groups including laparoscopy + FT, open surgery + FT, laparoscopy + CC, and open surgery + CC. The primary end-points were HS and morbidity. Secondary end-points included mortality and reoperation rates. Results: The overall median HS was 7 days. The median HS for laparoscopy + FT was 5 days, open + FT 6 days, laparoscopy + CC 9 days and open + CC 10 days (P < 0.001). In the regression model the laparoscopy + FT group had the greatest reduction in HS (P < 0.001). A significant reduction in HS was observed in the laparoscopy + FT group compared with laparoscopy + CC (P < 0.001). The overall patient morbidity was 30.6%. The logistic regression model adjusted for propensity score showed no statistically significant differences between the study groups regarding all other end-points. Conclusion: Colorectal cancer patients who underwent laparoscopic surgery within a multimodal rehabilitation protocol experienced the shortest HS and the lowest morbidity. © 2013 The Association of Coloproctology of Great Britain and Ireland.


OBJECTIVES: To determine the clinical significance of diagnosis and treatment of prostate cancer diagnosed in asymptomatic patients, in terms of survival and to face its disadvantages. METHODS: We reviewed the literature in order to know the number of men that must be reviewed through analysis of PSA, biopsy and surgery to prevent the death of one of them, as well as knowing the amount of disadvantages associated with the process. RESULTS: We summarized, in the case of men older than 50 years, that 1 in 9 have PSA greater than 4 ng/ml. We must biopsy 3 men if PSA is between 4-10 ng/ml to find one prostate cancer. In order to prolong the life of one patient it is necessary a total of 18.5 prostatectomies if the tumor is palpable and the number of prostatectomies needed in the case of non-palpable tumors is estimated five times higher. In return, there will be one death per 9791 males initially checked, one incontinence per 147 males and one impotence per 58 male impotence. Three papers report that tumor spread may be caused by the biopsies. CONCLUSIONS: We highlight the limited evidence for the data in terms of survival. It warns about the difference in results between the centers of excellence and the rest, and creates doubts about the definition of cancer when it cannot be demonstrated beyond the biopsy. The usefulness of finding and treating early prostate cancers is questionable in terms of cost-benefit, recommending the transfer of this information to patients, before deciding on one or another option. We stress the need for long-term prospective investigations to clarify which cases need to be treated and to prevent overdiagnosis. We should consider whether it is worth looking further histological findings, in increasingly younger males and with lower PSA limits.

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