[Diagnostic accuracy of malignancy risk index II in post-menopausal women with adnexal tumours]. / Exactitud diagnóstica del índice de riesgo de malignidad II en mujeres posmenopáusicas con tumor anexial.

BACKGROUND: The purpose of the diagnostic evaluation of adnexal tumours is to exclude the possibility of malignancy. The malignancy risk index II identifies patients at high risk for ovarian cancer. The cut-off value is greater than 200. OBJECTIVE: To evaluate the diagnostic accuracy of malignancy risk index II in post-menopausal women with adnexal tumours in relation to the histopathological results. MATERIAL AND METHODS: A total of 138 women with an adnexal mass were studied. The malignancy risk index II was determined in all of them. They were divided into two groups according to the histopathology results; 69 patients with benign tumours and 69 patients with malignant tumours. A diagnostic test type analysis was performed with respect to the results of malignancy risk index II ≤ 200 or greater than this. RESULTS: The percentages and 95% confidence intervals were calculated. The accuracy was 81.8% (75.5-88.3), sensitivity 76.8% (66.9-86.7), specificity 87% (79.1-94.9), with a positive predictive value of 85.5% (76.7-94.3), and a negative predictive value of 78.9% (69.7-88.1). The positive likelihood ratio was 590, and the negative likelihood ratio was 0.266. CONCLUSIONS: The malignancy risk index II has good performance in the proper classification of post-menopausal women with adnexal masses, both benign and malignant, with an accuracy of 81.8%.

The effect of insulin resistance on breast cancer risk in Latinas of Mexican origin.

BACKGROUND: Conclusive evidence has yet to emerge regarding the association between markers of hyperinsulinemia and breast cancer. We determined the effect of insulin resistance (IR) on breast cancer risk in Latinas of Mexican origin who did not have a direct family history of breast cancer and had not been previously diagnosed with prediabetes or diabetes. METHODS: This was a case-control study in which a case (n=124) was defined as a patient with a recent histopathologic diagnosis of breast cancer and a control (n=197) was defined as a participant who had recently undergone a mammography and had either a Breast Imaging, Reporting & Data System (BI-RADS)-1 or a BI-RADS-2 score. Plasma glucose, insulin, and glycated hemoglobin (HbA1c) levels were measured. IR was determined by using the homeostasis model assessment (HOMA-IR) criterion. Odds ratios (OR) and 95% confidence intervals (CI) were determined using unconditional binary logistic regression analysis. RESULTS: IR was detected in 33.9% of cases and 41.6% of controls, based on a HOMA-IR ≥3.5. Although multivariate analysis did not show any association between IR and breast cancer risk (OR 0.56, 95% CI 0.31-1.01), it showed that an HbA1c ≥5.7% increased the risk of breast cancer (OR 3.41, 95% CI 1.93-6.01), regardless of menopausal status. CONCLUSIONS: The findings suggest that IR had no effect on breast cancer risk; however HbA1c increased the risk in Latinas of Mexican origin who had not been diagnosed previously with prediabetes or diabetes and had no direct family history of breast cancer. Prospective studies are required to establish the impact of IR over time.

Prediabetes, diabetes, and risk of breast cancer: a case-control study.

BACKGROUND AND AIMS: Although underlying mechanisms have been described to account for the association between prediabetes and diabetes with breast cancer, reported results have been inconsistent. We undertook this study to determine whether prediabetes and diabetes are risk factors for breast cancer in Mexican women with no family history of breast cancer in the mother, daughters, or sisters. METHODS: A case-control study was carried out during 2011-2013. "Case" referred to patients with a histopathological diagnosis of breast cancer (incident and primary cases) (n = 240); "controls" were those with a BI-RADS 1 or 2 mammography result (n = 406). Categorization of prediabetes and diabetes was based on self-reporting or fasting glucose and glycated hemoglobin blood sampling results. Reproductive and sociodemographic data were collected by interview. Odds ratios (ORs) and 95% confidence intervals (CI) were calculated using multivariate unconditional binary logistic regression analysis. RESULTS: Prediabetes increased the risk of breast cancer in postmenopausal women (adjusted OR 2.08, 95% CI 1.10-3.96) as did diabetes (adjusted OR 2.85, 95% CI 1.55-5.26). A history of diabetes preceding breast cancer by ≥7 years and <7 years were both associated with an increased risk for breast cancer (adjusted OR 2.80, 95% CI 1.40-5.60 and 3.00, 95% CI 1.50-5.90, respectively). CONCLUSIONS: This is the first study in Mexico evaluating prediabetes and diabetes as breast cancer risk factors in women with no first-degree relatives with breast cancer. Our findings suggest that women with prediabetes and diabetes should be considered a more vulnerable population for early breast cancer detection.

[Coronary artery disease in Mexican women]. / Cardiopatía isquémica en mujeres mexicanas.

OBJECTIVE: To identify differences between both genders regarding coronary artery disease occurrence. PATIENTS AND METHODS: In referred patients for cardiac catheterization we investigated coronary risk factors, clinical diagnosis, associated diseases, left ventricle ejection fraction, and coronary lesions. Data were analyzed by X2 test, Student t test, odds ratio and confidence intervals, a p value < 0.05 was considered significant. RESULTS: We studied 586 patients, 409 were men. Women were older than men (59.43 +/- 9.93 vs 56.80 +/- 10.14 years old, p < 0.05). The frequency of coronary lesions in women was 56 vs 81% in men. The proportions of positive nuclear medicine studies (14 vs 16%) and exercise treadmill test (36 vs 28%) were similar. Acute myocardial infarction was the most frequent diagnosis in men (46%) whereas in women it was angor pectoris (57%). Smoking was observed more in men (72 vs 26%) and systemic arterial hypertension in women (65 vs 48%), There were no differences in diabetes mellitus and dyslipidemia frequencies. CONCLUSION: Systemic arterial hypertension was the risk factor more frequent in women, where as in men it was smoking. Ischemia induction tests are less specific to identify coronary atherosclerosis in women. In spite of the clinical data, image and laboratory results, we had a great proportion of women without coronary lesions.

Cardiopatía isquémica en mujeres mexicanas / Coronary artery disease in Mexican women

OBJECTIVE: To identify differences between both genders regarding coronary artery disease occurrence. PATIENTS AND METHODS: In referred patients for cardiac catheterization we investigated coronary risk factors, clinical diagnosis, associated diseases, left ventricle ejection fraction, and coronary lesions. Data were analyzed by X2 test, Student t test, odds ratio and confidence intervals, a p value < 0.05 was considered significant. RESULTS: We studied 586 patients, 409 were men. Women were older than men (59.43 +/- 9.93 vs 56.80 +/- 10.14 years old, p < 0.05). The frequency of coronary lesions in women was 56 vs 81% in men. The proportions of positive nuclear medicine studies (14 vs 16%) and exercise treadmill test (36 vs 28%) were similar. Acute myocardial infarction was the most frequent diagnosis in men (46%) whereas in women it was angor pectoris (57%). Smoking was observed more in men (72 vs 26%) and systemic arterial hypertension in women (65 vs 48%), There were no differences in diabetes mellitus and dyslipidemia frequencies. CONCLUSION: Systemic arterial hypertension was the risk factor more frequent in women, where as in men it was smoking. Ischemia induction tests are less specific to identify coronary atherosclerosis in women. In spite of the clinical data, image and laboratory results, we had a great proportion of women without coronary lesions.

[Nonatherosclerotic coronary artery lesions]. / Lesiones arteriales coronarias ajenas a la aterosclesosis.

Atherosclerosis is the most frequent etiology of ischemic cardiopathy. At the present time, the scope of nonatherosclerotic coronary artery lesions has increased, in part, because collagen diseases affecting the epicardial or microcirculation of the coronary arteries are more frequently diagnosed during catheterization. Acquired nonatherosclerotic coronary artery diseases may occur as a primary abnormality or as part of a multisystem disorder and may mimic atherosclerotic disease. In this paper we present a review of the main collagen diseases that cause coronary artery lesions.

[Shunt and short circuit]. / Derivación y cortocircuito.

Shunt and short circuit are antonyms. In French, the term shunt has been adopted to denote the alternative pathway of blood flow. However, in French, as well as in Spanish, the word short circuit (court-circuit and cortocircuito) is synonymous with shunt, giving rise to a linguistic and scientific inconsistency. Scientific because shunt and short circuit made reference to a phenomenon that occurs in the field of the physics. Because shunt and short circuit are antonyms, it is necessary to clarify that shunt is an alternative pathway of flow from a net of high resistance to a net of low resistance, maintaining the stream. Short circuit is the interruption of the flow, because a high resistance impeaches the flood. This concept is applied to electrical and cardiovascular physiology, as well as to the metabolic pathways.

Iatrogenic dissection of the right coronary artery and the ascending aorta secondary to endoluminal angioplasty. A case report.

The authors present the case of a 54-year-old woman with iatrogenic dissection of the right coronary artery ostium and extension of the dissection to the ascending aorta during the intraluminal angioplasty of an obstructive lesion in the middle portion of the right coronary artery. In order to maintain coronary blood flow before surgery, the coronary dissection was treated with the implantation of three direct coronary stents that dilated the stenosis and sealed the dissection of the coronary artery. The aortic dissection needed treatment with the implantation of a Haenoshield aortic graft. During the surgery, it was decided to implant an aortocoronary bypass graft to guarantee the distal right coronary blood flow, given the possible increased risk of thrombosis of the stents because of the large thrombogenic metallic surface of the stents. On the other hand, the administration of anticoagulants and antithrombotic drugs were not indicated because of the intended surgery of the aortic dissection. The evolution of the patient was satisfactory. Causes, frequency, and treatment procedures of this iatrogeny are discussed.

Assessment of a predictive index for coronary artery disease in patients with rheumatic valvular disease.

OBJECTIVE: The authors studied the sensitivity and specificity, as well the positive and negative predictive values, of a prognostic index conformed by diastolic blood pressure, total number of cigarettes smoked during the lifetime, severity of angina pectoris, positive family history of ischemic heart diseases, age (years), current cigarette smoking, and total to HDL-cholesterol ratio in order to anticipate the presence of significant coronary artery disease in patients with rheumatic cardiac valvulopathy. MATERIAL AND METHODS: A prospective, observational, non-randomized, cross-sectional and comparative study was performed in men and women > or = 30 and < or = 78 years of age, with rheumatic valve cardiopathy and who were submitted to catheterization and coronary angiography. RESULTS: We studied 102 patients (61 women and 41 men) 55.63 +/- 9.88 years of age, range: 30-78 years (women 56.09 +/- 11.48, and men 54.6 +/- 11.35 years of age, respectively). The patients had mitral valve disease 30 (29.41%), 49 (48.03%) had mitral valve disease associated with aortic valve disease and 23 (22.55%) had aortic valvular disease. Significant coronary artery atherosclerosis was present in eight patients (7.84%). Sensitivity and specificity analysis resulted as follows: sensitivity, 50% and specificity, 80.85%. Positive predictive value was 0.18 and negative predictive value 0.95. CONCLUSIONS: The index analyzed here is useful to predict cases without significant coronary artery disease in patients with rheumatic heart valvulopathy, but this index is not useful to identify significant coronary artery disease in such patients.

Intraluminal aortoplasty vs. surgical aortic resection in congenital aortic coarctation. A clinical random study in pediatric patients.

BACKGROUND: Our objective was to compare results of two therapeutic modalities to treat congenital aortic coarctation: intraluminal aortoplasty without endoluminal stent installation (patients in group A) vs. surgical aortic resection (patients in group B). Trans-coarctation gradient pressure was evaluated prior to and immediately after treatment. Re-coarctation, aneurysm formation, in-hospital morbidity and mortality, and complications related to treatment were also evaluated. METHODS: A clinical, randomized, multicenter study was performed in pediatric patients with congenital aortic coarctation. Immediate and mid- to late therapeutic results were evaluated. With regard to statistics, we evaluated event variations by Kaplan-Meier model, nonparametric Wilcoxon test, Mann-Whitney U test, two-tailed Student t and chi-square tests, and Fisher analysis. Significance was considered relevant when p<0.05. RESULTS: There were no differences in demographic variables, procedure failure, complications, mortality, or aortic aneurysm between groups A and B, respectively. Intraluminal angioplasty and surgical aortic resection were similarly effective in reducing trans-coarctation pressure gradient, as well as arterial systemic pressure. However, differences were found between groups A and B at follow-up. Group A showed higher re-coarctation (50 vs. 21%). Absence of peripheral arterial pulses in limbs was higher in group A (50 vs. 21%), as well as persistence of arterial hypertension (49 vs. 19%); these differences were significant (p<0.05). On the other hand, complications observed after surgical aortic resection were more serious than post-angioplasty complications, but these differences were not statistically significant. CONCLUSIONS: Although re-coarctation and persistency of arterial hypertension were less frequent after surgical aortic resection, complications observed with this procedure are more serious than complications related to angioplasty, although these differences are not statistically significant.

Comisurotomía mitral percutánea con balón de Inoue durante el embarazo / percuteneous mitral valvuloplasty during pregnancy

Los autores presentan tres casos de mujeres embarazadas con estenosis mitral severa sintomática, con edad media de 28.6 ñ 2.3 años y con embarazo de 27.6 ñ 1.52 semanas, sometidas a comisurotomía mitral percutánea (CMP). A pesar del tratamiento médico, dos pacientes estaban en clase funcional III y una en clase IV de la New York Heart Association (NYHA). Las tres pacientes tenían área valvular mitral igual o menor de 1cm², con "Score" de Wilkins de 7 a 9 puntos e insuficiencia mitral grado I en dos casos. Dos tenían hipertensión arterial pulmonar severa (presión media de arteria pulmonar > 50 mm Hg). Tras la CMP el área valvular mitral determinada por ecocardiografía bidimensional aumentó de 0.83 ñ 0.2 cm² a 1.8 ñ 0.15 cm²; el gradiente medio transmitral se redujo de 13 ñ 3.4 mm Hg a 3.6 ñ 1.15 mm Hg; el grado de insuficiencia mitral no se modificó en ningún caso. Los resultados hemodinámicos mostraron un incremento del área valvular mitral de 0.83 ñ 0.18 cm² a 2.23 ñ 0.3 cm²; el gradiente medio transmitral disminuyó de 21.6 ñ 9 a 4.3 ñ 0.5 mm Hg; la presión media de aurícula izquierda de 30 ñ 12 a 12.3 ñ mm Hg; la presión media de arteria pulmonar disminuyó inmediatamente de 44.3 ñ 16 a 25.6 ñ 11 mm Hg. El tiempo promedio de fluoroscopía fue 15.3 minutos. No hubo complicaciones. Las pacientes fueron egresadas 48 horas después del procedimiento y continuaron el resto del embarazo en clase I NYHA, resolviéndose éste por vía vaginal sin complicaciones, con productos sanos. Se concluye que la CMP es una alternativa terapéutica segura y eficaz para obtener mejoría clínica y hemodinámica en pacientes embarazadas con estenosis mitral severa sintomátia, refractaria a tratamiento médico