Preserving fertility in young women undergoing chemotherapy for early breast cancer; the Maastricht experience.

PURPOSE: We assessed the uptake of fertility preservation (FP), recovery of ovarian function (OFR) after chemotherapy, live birth after breast cancer, and breast cancer outcomes in women with early-stage breast cancer. METHODS: Women aged below 41 years and referred to our center for FP counseling between 2008 and 2015 were included. Data on patient and tumor characteristics, ovarian function, cryopreservation (embryo/oocyte) and transfer, live birth, and disease-free survival were collected. Kaplan-Meier analyses were performed for time-to-event analyses including competing risk analyses, and patients with versus without FP were compared using the logrank test. RESULTS: Of 118 counseled women with a median age of 31 years (range 19-40), 34 (29%) chose FP. Women who chose FP had less often children, more often a male partner and more often favorable tumor characteristics. The 5-year OFR rate was 92% for the total group of counseled patients. In total, 26 women gave birth. The 5-year live birth rate was 27% for the total group of counseled patients. Only three women applied for transfer of their cryopreserved embryo(s), in two combined with preimplantation genetic diagnosis (PGD) because of BRCA1-mutation carrier ship. The 5-year disease-free survival rate was 91% versus 88%, for patients with versus without FP (P = 0.42). CONCLUSIONS: Remarkably, most women achieved OFR, probably related to the young age at diagnosis. Most pregnancies occurred spontaneously, two of three women applied for embryo transfer because of the opportunity to apply for PGD.

Prognostic value of serum CA125 levels in diffuse large B-cell lymphoma: potential role of a new sex- and age-adjusted reference value.

CA125, a tumor marker normally used to follow the clinical course of ovarian cancer, also may have a role in lymphoma. All available series were analyzed using the standard reference value 35 U/ml, but age and sex may influence serum CA125 (sCA125) levels. We aim to study the prognostic value of serum CA125 (sCA125) levels in diffuse large B-cell lymphoma (DLBCL), considering the influence of age and sex on sCA125 levels. We investigated the relationship between sCA125 and clinical outcome after treatment in 42 patients with DLBCL, comparing both the standard (35 U/ml) and a new age and sex adjusted (sex/age-adjusted) reference value proposed by our group. We found that patients with elevated sCA125 levels had significantly more adverse prognostic factors at diagnosis, lower CR rates, higher relapse rates and worse survival. In the low-risk IPI categories, the presence of elevated sCA125 defined a particularly high-risk subgroup with poorer 3-year PFS when compared with patients with normal sCA125 levels. The use of a sex/age-adjusted reference value for sCA125 may increase the sensitivity to identify those patients with elevated sCA125 levels truly related to DLBCL activity.

Factors contributing to improved local control after mastectomy in patients with breast cancer aged 40 years or younger.

Long-term local control rates were studied in a series of 659 patients with invasive breast cancer aged 40 years or younger, who underwent mastectomy in general hospitals in the southern part of the Netherlands between 1988 and 2005. During a median follow-up time of 6.0 years, 34 patients developed a local recurrence in the chest wall without previous or simultaneous evidence of distant disease. The 5- and 10-year actuarial local recurrence rates for the total group were 5.6% (95% confidence interval [95% CI], 3.5-7.7%) and 7.3% (95% CI, 4.7-9.9%), respectively. A multivariate analysis showed that patients receiving radiotherapy (hazards ratio [HR], 0.29; 95% CI, 0.10-0.96) or adjuvant systemic treatment (HR 0.23; 95% CI, 0.08-0.65) had a significantly lower risk of local recurrence. It is concluded that excellent local control rates can be obtained with mastectomy in young women with breast cancer, especially in those who receive adjuvant systemic treatment and/or radiotherapy.

[Enteropathic arthritis]. / Artritis enteropática.

AIM: Description of a clinical case of enteropathic arthritis. DESIGN: Descriptive study. SITE. Health Centre. PATIENTS AND OTHER PARTICIPANTS: A clinical case is described, starting with back pain where X-rays perceive no irregularity. Later a diagnosis of Crohn's disease is made. Finally lesions characteristic of anchylo-poyethic spondylitis appear. INTERVENTIONS: Corticosteroid treatment. MEASUREMENTS AND MAIN FINDINGS: Clinical investigations and complementary diagnoses. CONCLUSIONS: Way in which spondylitis presents, with no clear X-ray indications. Importance of closely following the development of this type of patient.

[Pilot study of the evaluation of the nutritional status in a population sample in a health area]. / Estudio piloto de valoración del estado nutricional en una muestra de población de una zona de salud.

We report the evaluation of a pilot study for the nutritional state carried out at a Health Center in Murcia, using a qualitative foodstuff questionnaire related to the previous 24 hours and the evaluation of anthropometric and analytical data. The evaluated individuals were randomly selected between the persons who had previously consulted. The survey was carried out by an interviewer. An outstanding result was that 90% of the surveyed individuals had ingested, at least one foodstuff from each group. The fat compartment was measured through the tricipital and subscapular fold and Quetelet index, and the protein compartment was measured through the muscular area of the arm. As reference values, the NHANES (USA) and the Alastrue Vidal (Spain) tables were used. It was found that the tricipital fold of the investigated population was underrated in the american tables (p less than 0.01).