Cáncer de mama en pacientes octogenarias / Breast cancer treatment in octogenarian patients

IntroducciónEl objetivo del estudio fue analizar el tratamiento quirúrgico recibido en pacientes octogenarias con cáncer de mama en un centro hospitalario de tercer nivel, analizar la calidad de vida de estas pacientes, así como la influencia del tratamiento en la supervivencia global.Material y métodosSe ha diseñado un estudio de cohorte retrospectivo. Se han analizado los resultados del tratamiento recibido, calidad de vida y supervivencia desde 2011 hasta 2015, con seguimiento prospectivo.ResultadosLa primera opción de tratamiento fue la cirugía en el 97% de los casos, a pesar de presentar elevadas comorbilidades según el índice de Charlson ajustado por edad. Más de la mitad de las pacientes respondieron a la pregunta sobre autopercepción de su salud como excelente, muy buena o buena (53%), observándose una tendencia a mayor supervivencia en estas pacientes. La mortalidad a los siete años fue del 46%. Sin embargo, la causa de la muerte estaba relacionada con el cáncer de mama solo en el 31% de los casos.ConclusionesLa mayoría de las pacientes octogenarias de nuestra cohorte se sometieron a cirugía como tratamiento de primera línea y se mostraron satisfechas con los resultados. La calidad de vida y la buena autopercepción del envejecimiento son un objetivo clave en las pacientes de edad avanzada y deben tenerse en cuenta.Es preciso realizar estudios analizando los resultados de la cirugía en pacientes de edad avanzada con cáncer de mama para mejorar la medicina basada en la evidencia y optimizar su tratamiento.

BackgroundThe study objective was to analyse the results of surgical treatment of breast cancer in octogenarian women and to analyse these patients’ quality of life and factors related to treatment and its influence on overall survival over a 7-year follow-up.MethodsA cohort cross-sectional observational study was designed. We analysed the results of treatment of octogenarian women with breast cancer in the Hospital Germans Trias i Pujol from 2011 to 2015 with follow-up until February 2018.ResultsThe first treatment option was surgery in 97% of cases, despite their having a high comorbidity burden according to the age-adjusted Charlson Index. More than half the patients responded to the question on self-perceived health that their health was excellent, very good or good (53%) and survival was higher in patients reporting good self-perceived health. Mortality at 7 years was 46%. However, the cause of death was related to cancer in only 31% of cases.ConclusionsMost of the octogenarian patients in our cohort underwent surgery as the first-line treatment and were satisfied with it. Quality of life and good self-perception of aging are a key aim in older adult patients and should be considered.Additional studies analysing results of surgery for breast cancer in older adult patients are warranted to improve evidence-based medicine and optimize treatment, thus enhancing their quality of life and increasing their survival.

[The effect of cerebrolysin on the regeneration of the peripheral nerve depending on the scheme of paraneural administration].

An experimental morphological study in 56 animals has been performed in order to analyze the effect of cerebrolysin on the dynamics and long-term results of peripheral nerve regeneration after the transection and microsurgical suturing depending on the scheme of the preparation of paraneural infusion. The regeneration process was evaluated after 2.5; 4; 6 and 12 months. There was a stimulating effect of the preparation on the regenerative growth and differentiation of nerve fiber axial cylinders, vascularization of the distal segment of regenerating nerve and the trophic condition of myelin-forming Schwann cells. When the preparation is used according to the prolonged scheme, the effect persists for up to 10.5 months after the end of paraneural injection course.

[State of lower alveolar and mental nerves by mandible fractures healing under transbone osteosynthesis].

Fracture of mandibular body at the level of P3-P4 with symphysis rupture was modeled, reposition and transosseous osteosynthesis with a specially developed device were performed under anesthesia in the operating room in 17 adult mongrel dogs in order to specify the pathogenesis and the dynamics of injury and jaw nerve regeneration. It has been established, that the arrangement of the neurovascular bundle in medullary canal predetermines the development of acute and chronic compression-and-ischemic neuropathy even if accurate reposition of bone fragments takes place. The histological signs of nerve fiber regeneration, the loss of the quantity of myelin-free nerve conductors and the retrograde spreading of degenerative changes in myelinized nerve conductors, including regenerating ones, have been found beginning from 4 weeks after injury. It has been concluded, that spontaneous nerve regeneration in case of mandibular fractures should be actively supported by neuroprotective, anti-edematous and anti-inflammatory therapy.

[Morphometric evaluation of the effectiveness of post-traumatic peripheral nerve regeneration after a single and repeated courses of electrostimulation].

Sciatic nerve (SN) transection and microsurgical suture were performed in 41 dogs to assess the effect of electrostimulation (ES) on peripheral nerve regeneration. 23 dogs served as a control group, ES of the spinal cord and SN was made with alternating current of 50-Hz frequency in 18 dogs: in 13 dogs one course of 18 sessions was performed within the period of 1-2.5 months after surgery (ESL1), in 5 dogs two courses were performed: the first one--in a similar time interval, the second one--within 6-7.5 months after surgery (ES2). The mean diameter of myelinated fibers (MF) after 2.5, 4, 6, and 12 postoperational months for ES1 was significantly greater than the control values, mainly due to the increase of axonal diameter. After 12 months, the tendency towards the restoration of MF diameter bimodal distribution was marked in ES2, and, to a lesser degree, in ES1. Thus, it was found that ES effectively activates the regeneration and differentiation of MF, but leads to their relative hypomyelination.

[Intranasal administration of immunoglobulins--perspectives for use in medical practice].

Effectiveness of topical use of immunoglobulines in respiratory infections along with preparations for parenteral use is discussed. Immunoglobuline preparations for intranasal use (drops, spays, aerosols) should take place among preparations intended for prevention and treatment of influenza, parainfluenza, respiratory syncitial virus infection and others. Potential to intranasal use of complex immunoglobulin preparation containing polymeric and monomeric antibodies of different isotypes is also discussed.

[Peculiarities of sciatic nerve endoneurium cellular composition in hip distraction osteosynthesis in dogs].

Using light and electron microscopy, sciatic nerve endoneurium cellular content was studied in 14 adult mongrel dogs subjected to hip elongation for 28-35 days after osteotomy. For light microscopy, semithin sections were prepared. The application of an automated image analysis has demonstrated a moderate increase in macrophage, fibroblast and mast cell content, which remained undetected during visual examination. The morphofunctional state and the distribution of these cells is suggestive of their participation in the extracellular matrix synthesis and remodeling, angiogenesis control, blood flow and endoneurial fluid content regulation in the process of peripheral nerve structural adaptation to extremity elongation.

[Clinical manifestations of cross-allergic reactions to food among children].

Scientists have recently studied the frequency and possible forms of clinical manifestations of cross-reactivity to food among 239 of Abakan at the age from 6 month to 15 years with skin, respiratory and combined manifestation of atopy It was proved that risk factors of development of cross-reactivity to food occur among 80% of children who have various forms of allergic diseases moreover the cross allergic reactions between the foodstuffs most frequently occur with the gastrointestinal and with skin forms of food allergy and the cross allergic reactions between the pollen and food allergens more frequently occut with the respiratory forms of atopy and dermorespiratory syndrome. Considerably more rarely this type of reactions is discovered between the epidermal and food allergens, which most frequently were revealed with the dermatorespiratory syndrome.

[Risk factors and etiological structure of children's cross-allergic reactions to food products]. / Faktory riska i étiologicheskaia struktura perekrestnykh allergicheskikh reaktsii na pishchevye produkty u detei.

Authors of article have recently analyzed the frequency of prevalence and risk factors of cross-reactivity to foodstuffs among 239 children of Abakan in the age of from 6 months till 15 years with skin, respiratory and combined manifestation of atopy. It was proved that risk factors of development of cross-reactivity to food among children of the first years of life are hereditary predisposition to allergic diseases (77.8%) and early introductions of supplemental feeding (44%). Among children older then 7 years pollen sensitization (62%) which preceded the development of cross allergic reactions between separate foodstuffs reaches up to 73.7%, between pollen and foodstuff up to 79% and between epidermal and food up to 10.1%.

[Types of coaptation of nerve fiber bundles and effectiveness of the nerve suture]. / Tipy koaptatsii puchkov nervnykh volokon i rezul'tativnost' shva nerva.

Experiments in 26 dogs were carried out in order to analyze the quality of comparing the nerve fiber bundles, morphometrical and functional parameters of regeneration after the restoration of the nerve with a standard epineural microsurgical suture and by an original method including the coaptation of the freshened ends by a relaxation transneural suture followed by epiperineural microneurorrhaphy. Five variants of the comparison of the nerve fiber bundles in the suture zone are described. The results of expert assessments and computed morphometry allowed to register higher indices of regeneration and differentiation of nerve fibers.

[Evaluation on monkeys of reactogenicity and effectiveness of the complex immunoglobulin preparation formulation]. / Otsenka na obez'ianakh reaktogennocti i éffektivnosti lekarstvennykh form kompleksnogo immunoglobulinovogo preparata.

Experiments on 75 monkeys, 20--healthy and 75--with diarrhea, showed that ready medicinal forms of the complex immunoglobulin preparation in tablets, capsules or in a dried form (vials) were safe, well tolerated, clinically and bacteriologically effective. When used simultaneously with antiparasitic treatment, this preparation, irrespective of the kind of its ready medicinal form, showed high curative effect (80-90%). The diarrhea ceasing was accompanied by the gradual normalization of intestinal microbiocenosis (an increased concentrations of Escherichia coli and Bifidobacterium, a decreased amount of opportunistic bacteria). The complex method of the treatment of diarrhea in monkeys (antibiotics, trichopol, phage and probiotics) made it possible to achieve curative effect only in 60% of cases, which required the additional course of treatment, namely the use of rehydration therapy.

[The effect of the antioxidants elton and leveton on the physical work capacity of athletes]. / Vliianie antioksidantov éltona i levetona na fizicheskuiu rabotosposobnost' sportsmenov.

Study of 44 athletes of various sport skill undergoing training for endurance showed the chemiluminescence method to be an important parameter indicating that a person is trained for physical exertion. The broad-spectrum adaptogenic agents elton and leveton reduced in in-vitro experiments the superweak luminescence of urine, which is evidence of their direct antioxidant effect. Twenty-day administration of elton and leveton reduced chemiluminescence and the level of malonic dialdehyde in the urine of highly skilled athletes and increased their physical working capacity tested by bicycle ergometry with gradually increasing physical loads.

[The biorhythmological types of work capacity and the late prognosis for patients who have had a myocardial infarct]. / Bioritmologicheskie tipy rabotosposobnosti i otdalennyi prognoz bol'nykh, perenesshik infarkt miokarda.

The authors analyze postmyocardial infarction 10-year survival and frequency of repeated cardiac accidents (fatal and nonfatal MI and sudden cardiac death). Biorhythmological types of mental and muscular performance were involved in long-term MI prognosis. Of 412 males who had their first myocardial infarction at the age under 59, 10-year prognosis was poor for those with early pattern of efficient work vs good prognosis in those who work most efficiently in the evening. The differences in the long-term prognosis of acute myocardial infarction related to performance biorhythm were observed both for subjects performing muscular and mental work.

[The morphological characteristics of craniocerebral and cerebrospinal hernias in children after the accident at the Chernobyl Atomic Electric Power Station]. / Morfologicheskie osobennosti cherepno-mozgovoi i spinnomozgovoi gryzhi u detei posle avarii na Chernobyl'skoi AES.

In the post-Chernobyl period of time the quantity of children operated for congenital cerebral and cerebrospinal hernia has been increased almost by two times. The signs of degeneration were not observed while morphological study of hernial sac wall in 96 children operated on from 1981 till 1986 year. Of 167 children operated on after the Chernobyl accident (1986-1992 yrs) in 10 (5.9%) of them the degeneration of substantia medullaris astrocytes was observed.

[Emergency in children with implanted cerebrospinal fluid shunt]. / Neotlozhnoe sostoianie u detei s implantirovannoi likvoroshuntiruiushchei sistemoi.

In 455 pediatric patients with progressive hydrocephaly of non-tumour genesis, a valve liquoro-shunting system was implanted. At different periods after the operation (up to 5 years), 4.8% of the patients developed the purulent-infective complications, dysfunction of a system occurred--in 20.4%. The causes, clinical signs of the emergency state are analysed, the recommendations on carrying out the therapeutic measures are given.

[The effect of L-carnitine and acetyl-L-carnitine on blood serum lipid peroxidation in vitro]. / Vliianie L-karnitina i atsetil-L-karnitina na perekisnoe okislenie lipidov syvorotki krovi in vitro.

In the action mode of carnitine derivatives, the leading role is played by lipid transport inside the cell. Bearing in mind the important role of lipid peroxidation in lipid metabolism in the body and broad-range indications for use of carnitine derivatives in medical practice, it was decided to investigate the influence of carnitine derivatives on lipid peroxidation (LPO) in vitro to have a better understanding of the action mode of these drugs, as carnitine, according to the reported data, may affect certain LPO parameters in vivo.

[Computer application in business games at the military department of medical school]. / O primenenii EVM v delovykh igrakh pri obuchenii studentov na voennoi kafedre medinstituta.

Computerized practical games are considered to be an effective method that could intensity and enhance the quality of training for medical service reserve officers. At the military chair of Kursk State Medical Institute a fund of practical games was created. It includes final themes on the courses of organization and tactics of medical service, military toxicology and NBC medical defense. Practical games develop students' ability to analyse combat, logistic and medical situation, help them make a correct assignment of medical forces and means, or take opportune steps in decision-making.

[Supratentorial extra-axial arachnoid brain cysts]. / Supratentorial'nye ékstraaksial'nye arakhnoidal'nye kisty golovnogo mozga.

Supratentorial extra-axial arachnoidal cysts are congenital benign formations of intracranial location filled with cerebrospinal fluid. The clinical symptomatology of arachnoidal cysts depended on the age of the patient and presence of complications. The pathogenetically justified surgical method of treatment of arachnoidal cysts in children is excision of cyst wall, emptying of its cavity, creation of shunt with the subarachnoidal spaces and basal cisternae in association with cystoperitoneostomy. In the adult patients additional cystoperitoneotomy is not performed.