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Purpose To analyze the prognostic impact of immunophenotyping in patients with multiple myeloma (MM). Patients and Methods We have prospectively analyzed the prognostic impact of antigenic markers, assessed by multiparametric flow cytometry, in a series of 685 newly diagnosed MM patients that were uniformly treated according to the GEM 2000 protocol. Results Our results show that expression of both CD19 and CD28 as well as the absence of CD117 were associated with a significantly shorter progression free-survival (PFS) and overall survival (OS). Interestingly, the CD28 expression correlated with t(14;16) and del(17p), while CD117-negative patients were associated with t(4;14) and del(13q). Simultaneous assessment of CD28 and CD117 antigens allowed stratification of patients with MM into three risk categories: poor risk (CD28 positive CD117 negative), intermediate (either both markers negative or both positive), and good risk (CD28 negative CD117 positive), with PFS rates of 30, 37, and 45 months, respectively (P = .01), and OS rates of 45, 68, and not reached, respectively (P = .0001). Conclusion To the best of our knowledge, this is the first prospective analysis in which the prognostic impact of a relatively high number of antigenic markers has been simultaneously analyzed in a large series of uniformly treated patients, showing that the expression of several antigens (particularly CD28 and CD117) on bone marrow plasma cells from patients with MM can help to identify patients at high risk of progression.

Fluorescence in situ hybridization (FISH) has become a powerful technique for prognostic assessment in multiple myeloma (MM). However, the existence of associations between cytogenetic abnormalities compels us to re-assess the value of each abnormality. A total of 260 patients with MM at the time of diagnosis, enrolled in the GEM-2000 Spanish transplant protocol, have been analyzed by FISH in order to ascertain the independent influence on myeloma prognosis of IGH translocations, as well as RB and P53 deletions. Survival analyses showed that patients with t(4;14), RB or P53 deletions had a significantly shorter survival than patients without these abnormalities. However, patients with RB deletions without other abnormalities in FISH analysis, displayed a similar outcome to those patients without genetic changes by FISH (46 vs 54 months, P=0.3). In the multivariate analysis the presence of t(4;14), RB deletion associated with other abnormalities, age >60 years, high proportion of S-phase cells and advanced stage of the disease according to the International Staging System retained their independent prognostic influence. In summary, RB deletion as a sole abnormality does not lead to a shortening in the survival of MM patients, whereas t(4;14) confers the worst prognosis in MM patients treated with high-dose chemotherapy.

Resumen Objetivo Estudiar la utilidad clinica del cuestionario generico de calidad de vida relacionada con la salud (CVRS) SF-36 en los servicios de asistencia sanitaria. Metodo Se llevo a cabo un estudio descriptivo con 691 pacientes con distintos diagnosticos medicos reclutados en el ambito de consultas externas de un hospital general. Los grupos diagnosticos fueron cancer de pulmon (CP) y hematologico (CH), osteoartrosis de cadera (OAC), trastornos de la alimentacion (TA) y enfermedad inflamatoria intestinal cronica (EIIC). Los pacientes incluidos en el estudio cumplimentaron el SF-36, un instrumento generico de CVRS. Con los pacientes con OAC que iban a ser operados de protesis de cadera (PC) fue realizado un estudio de seguimiento antes y despues de la intervencion. Resultados Los pacientes con TA presentaban puntuaciones bajas en las areas mentales, funcionamiento social y rol fisico. Aquellos con CP contaban con valores bajos en todas las areas del SF-36, que eran menores en las fisicas y ligeramente mas bajas que en los pacientes con CH. Los pacientes con OAC presentaban un impacto importante en las areas fisicas, principalmente en el area de dolor corporal; las mejoras tras la intervencion eran mayores en las areas fisicas. Aquellos pacientes con EIIC, evidenciaban afeccion principal en el area de salud general. Conclusiones El SF-36 es capaz de discriminar entre distintas enfermedades. Estos resultados apoyan su validez discriminante como un indicador para la evaluacion de resultados de procedimientos medicos entre centros y entre grupos de pacientes.

ObjetivoConocer el patrón de causas de mortalidad de la Zona Básica de Salud de Chantrea (Navarra) y las tendencias para las principales causas de muerte entre 1987 y 1995.DiseñoEstudio descriptivo.EmplazamientoCentro urbano de atención primaria.SujetosPoblación de la Zona Básica de Salud de Chantrea.IntervencionesSe cruzaron datos del Padrón de Habitantes de Chantrea de 1986 con el listado de mortalidad de Navarra para conocer los fallecimientos producidos entre 1986 y 1995. Se analizaron, para ambos sexos y para los períodos 1987-1990 y 1991-1995, la mortalidad global y la mortalidad para las principales causas.ResultadosEl barrio de Chantrea en Pamplona presentó en el período 1991-1995 una tasa de mortalidad ajustada a la población europea de 711 por 100.000 habitantes entre los varones y de 403 por 100.000 habitantes entre las mujeres. Las principales causas de mortalidad fueron: enfermedades del aparato circulatorio, tumores, enfermedades respiratorias y causas externas. Las tasas de mortalidad global descendieron un 11,8% en los varones y un 8% en las mujeres entre el período 1987-1990 y el 1991-1995. Se observaron descensos estadísticamente significativos de la mortalidad por enfermedades del aparato circulatorio y del tumor maligno de esófago en varones. El sida aumentó significativamente entre los varones como causa de muerte.ConclusionesBajas tasas de mortalidad global en varones y mujeres de Chantrea y, especialmente, las tasas de mortalidad por enfermedades del aparato circulatorio, que se encuentran por debajo de las cifras registradas en la mayoría de los países europeos. Otras causas de muerte, como accidentes de tráfico, sida o tumores malignos relacionados con el tabaco, presentan tasas moderadamente altas.ObjectiveTo find the pattern of causes of mortality in the Chantrea (Navarra) Health District and the trends in main causes of death between 1987 and 1995.DesignDescriptive study.SettingUrban primary care centre.Study populationPopulation belonging to the Chantrea Health District.Interventions1986 data from the Municipal Roll of inhabitants of Chantrea were crossed with the Navarra mortality figures to find the deaths occurred between 1986 and 1995. Overall mortality and mortality for the main reasons were analysed for both sexes and for the periods 1987-1990 and 1991-1995.ResultsBetween 1991 and 1995, Chantrea had a mortality rate close to that of the European population: 711 per 100000 inhabitants for men and 403 per 100000 for women. The main causes of death were circulatory diseases, tumours, respiratory diseases and external causes. Overall mortality rates dropped by 11.8% among men and by 8% among women from the 1987-1990 period to the 1991-1995 period. Statistically significant drops in mortality were noted for circulatory diseases and for malignant oesophageal tumours in men. AIDS as cause of death increased significantly among men.ConclusionsLow rates of overall mortality in men and women of Chantrea and, in particular, mortality rates for circulatory disease were below the figures recorded in most European countries. Other causes of death, such as traffic accidents, AIDS or malignant tobacco-related tumours had moderately high rates.

As important as the advance of computer technology is the development of suitable software for the exploitation of computer capacity. In this sense LAPACK (Andersen et al., LAPACK User's Guide, release 1.0, SIAM, Philadelphia, 1992) appears as the most efficient library in the dense linear algebra field, obtaining good results on vector and parallel computers, and in general, on hierarchical memory machines. However, some deficiencies in the general matrix LU decomposition were detected in DGETRF subroutine. On hierarchical memory machines not only the cache and TLB faults have to be minimized, but also the page faults, which cause excessive I/O operations. The blocking strategy used by DGETRF (and LAPACK in general) makes good use of the cache memory, but does not seem to be enough to avoid unnecessary I/O operations. Therefore, DGETRF does not provide satisfactory run times for large dimension matrices. In this paper a new code using a double blocking strategy will be described, which attains better run times than DGETRF.

OBJECTIVE: To find the pattern of causes of mortality in the Chantrea (Navarra) Health District and the trends in main causes of death between 1987 and 1995. DESIGN: Descriptive study. SETTING: Urban primary care centre. STUDY POPULATION: Population belonging to the Chantrea Health District. INTERVENTIONS: 1986 data from the Municipal Roll of inhabitants of Chantrea were crossed with the Navarra mortality figures to find the deaths occurred between 1986 and 1995. Overall mortality and mortality for the main reasons were analysed for both sexes and for the periods 1987-1990 and 1991-1995. RESULTS: Between 1991 and 1995, Chantrea had a mortality rate close to that of the European population: 711 per 100000 inhabitants for men and 403 per 100000 for women. The main causes of death were circulatory diseases, tumours, respiratory diseases and external causes. Overall mortality rates dropped by 11.8% among men and by 8% among women from the 1987-1990 period to the 1991-1995 period. Statistically significant drops in mortality were noted for circulatory diseases and for malignant oesophageal tumours in men. AIDS as cause of death increased significantly among men. CONCLUSIONS: Low rates of overall mortality in men and women of Chantrea and, in particular, mortality rates for circulatory disease were below the figures recorded in most European countries. Other causes of death, such as traffic accidents, AIDS or malignant tobacco-related tumours had moderately high rates.

Genitourinary tract involvement arising from non-Hodgkin lymphoma occurs in 10% of patients; prostatic infiltration is uncommon and accounts for less than 0.1%. The uncommon clinical onset of this infrequent condition prompted us to report on the present case.A 41-year-old male patient with lower urinary tract outflow obstruction arising from prostatic enlargement secondary to non-Hodgkin lymphoma (Burkitt's lymphoma) is described. Treatment with chemotherapy achieved good results. The clinical features, diagnostic and therapeutic aspects are discussed and the literature briefly reviewed.The present case emphasizes the need to include non-Hodgkin lymphoma in the differential diagnosis of lower urinary tract outflow obstructive symptoms in young men with prostatic enlargement.

Analysis of the antigenic profile of malignant cells has shown to be a valuable tool for the diagnosis and the identification of prognostic markers in haematological malignancies. By contrast, in multiple myeloma (MM), immunophenotyping is rarely used in clinical practice. Moreover, conflicting results have been reported probably because they were based on short series of heterogeneously treated MM patients. In the present study, we have prospectively analysed the prognostic impact of antigenic markers, assessed by multiparametric flow cytometry, in a series of 685 newly diagnosed MM patients that were uniformly treated according to the GEM-2000 protocol. The results show that three antigenic markers (CD19, CD28 and CD117) afford prognostic information. The expression of both CD19 and CD28 as well as the absence of CD117 were associated with a significantly shorter progression free-survival (PFS) and overall survival (OS). Interestingly, the CD28 expression correlated with t(14;16) and Del(17p), while CD117 negative cases were associated with t(4;14) and Del(13q) as well as several other disease characteristics. The simultaneous assessment of CD28 and CD117 antigens, allowed stratification of myeloma patients into three risk categories: poor risk (CD28+CD117−), intermediate (either both markers negative or both positive), and good risk (CD28−CD117+), with PFS rates of 30, 37 and 45 months, respectively (p=0.01), and OS of 45, 68 and not reached, respectively (p=0.0001). To the best of our knowledge, this is the first prospective analysis in which the prognostic impact of a relatively high number of antigenic markers has been simultaneously analysed in a large series of uniformly treated patients.