Biopsia de ganglio centinela en pacientes con cáncer de mama y cirugía mamaria previa / Sentinel node biopsy in patients with breast cancer and previous breast surgery

Objetivo. El objetivo de este estudio fue determinar la eficacia y seguridad de la biopsia del ganglio centinela para la estadificación linfática en pacientes con cáncer de mama y cirugía previa mamaria, considerando la extensión, localización y tiempo desde el procedimiento quirúrgico anterior. Material y métodos. Realizamos biopsia de ganglio centinela a 38 pacientes con cáncer de mama precoz y algún antecedente quirúrgico mamario: biopsia escisional reciente en 22 pacientes (grupo I), tumorectomía o mamoplastia antigua en 16 (grupo II), incluyendo una cirugía conservadora por cáncer de mama (recurrencia tumoral). Se realizó linfogammagrafía tras inyección periareolar y ocasionalmente también peri-cicatricial. Tras la exéresis del ganglio centinela se practicó linfadenectomía axilar solo cuando el ganglio fue positivo (o no localizado). Resultados. La eficacia de localización gammagráfica del ganglio centinela fue 92,1%, con 15,8% de drenajes extra-axilares; la tasa de detección quirúrgica axilar fue 81,6%. La identificación resultó similar tras biopsia escisional reciente y cirugía antigua (81,8 frente a 81,2%), con mayor porcentaje de ganglios extra-axilares en el segundo grupo (9,1% frente a 25%). La localización del antecedente quirúrgico en el cuadrante supero-externo produjo más drenajes extra-axilares (27,2% frente a 11,1%); la eficacia de detección axilar fue similar al resto de cuadrantes (81,8% frente a 81,5%). La tasa actual de eventos relacionados con la enfermedad es 5,2% (2/38), sin recurrencias locorregionales (seguimiento medio tres años). Conclusión. La biopsia del ganglio centinela tras cirugía mamaria no extensa puede realizarse con seguridad. Los drenajes extra-axilares son más frecuentes cuando el antecedente quirúrgico es amplio, remoto y en el cuadrante superoexterno(AU)

Aim. The aim of this study was to establish the efficacy and safety of sentinel lymph node biopsy for lymph node staging in patients with breast cancer and prior breast surgery, considering its extension, localization and time since the previous surgical procedure. Material and methods. A sentinel lymph node biopsy was performed in 38 patients with early breast cancer and previous breast surgery: recent excisional biopsy in 22 patients (Group I), previous lumpectomy or mammoplasty in 16, including one case of cancer treated with breast-conserving surgery (tumor recurrence). Lymphoscintigraphy was performed after periareolar injection, also sometimes adding an injection near to the surgical scar. After removing the sentinel node, axillary lymph node dissection was performed when the lymph node was positive (and not localized). Results. The efficacy of the scintigraphic localization of the sentinel node was 92.1% of the patients, with 15.8% of extra-axillary drainages. Axillary intraoperative detection was 81.6%. The identification rate after recent excisional biopsy or previous surgery was similar (81.8 vs 81.2%). However, extra-axillary sentinel nodes were more frequent in Group II (9.1 vs 25%). Having a localization of previous surgical procedures in upper outer quadrant caused drainages outside of the axilla more frequently (27.2 vs 11.1%). Axillary detection rate was similar to other quadrants (81.8 vs 81.5%). The rate of breast cancer-related events was 5.2% (2/38), without axillary recurrences (mean follow-up: 3 years). Conclusion. Sentinel lymph node biopsy in patients with previous but not extensive breast surgery is safe. Extra-axillary drainages are more common when the previous surgical area was wide, especially in the upper-outer quadrant(AU)

[Sentinel node biopsy in patients with breast cancer and previous breast surgery]. / Biopsia de ganglio centinela en pacientes con cáncer de mama y cirugía mamaria previa.

AIM: The aim of this study was to establish the efficacy and safety of sentinel lymph node biopsy for lymph node staging in patients with breast cancer and prior breast surgery, considering its extension, localization and time since the previous surgical procedure. MATERIAL AND METHODS: A sentinel lymph node biopsy was performed in 38 patients with early breast cancer and previous breast surgery: recent excisional biopsy in 22 patients (Group I), previous lumpectomy or mammoplasty in 16, including one case of cancer treated with breast-conserving surgery (tumor recurrence). Lymphoscintigraphy was performed after periareolar injection, also sometimes adding an injection near to the surgical scar. After removing the sentinel node, axillary lymph node dissection was performed when the lymph node was positive (and not localized). RESULTS: The efficacy of the scintigraphic localization of the sentinel node was 92.1% of the patients, with 15.8% of extra-axillary drainages. Axillary intraoperative detection was 81.6%. The identification rate after recent excisional biopsy or previous surgery was similar (81.8 vs 81.2%). However, extra-axillary sentinel nodes were more frequent in Group II (9.1 vs 25%). Having a localization of previous surgical procedures in upper outer quadrant caused drainages outside of the axilla more frequently (27.2 vs 11.1%). Axillary detection rate was similar to other quadrants (81.8 vs 81.5%). The rate of breast cancer-related events was 5.2% (2/38), without axillary recurrences (mean follow-up: 3 years). CONCLUSION: Sentinel lymph node biopsy in patients with previous but not extensive breast surgery is safe. Extra-axillary drainages are more common when the previous surgical area was wide, especially in the upper-outer quadrant.

Continuous thermal hydrolysis and energy integration in sludge anaerobic digestion plants.

A thermal hydrolysis pilot plant with direct steam injection heating was designed and constructed. In a first period the equipment was operated in batch to verify the effect of sludge type, pressure and temperature, residence time and solids concentration. Optimal operation conditions were reached for secondary sludge at 170 degrees C, 7 bar and 30 minutes residence time, obtaining a disintegration factor higher than 10, methane production increase by 50% and easy centrifugation In a second period the pilot plant was operated working with continuous feed, testing the efficiency by using two continuous anaerobic digester operating in the mesophilic and thermophilic range. Working at 12 days residence time, biogas production increases by 40-50%. Integrating the energy transfer it is possible to design a self-sufficient system that takes advantage of this methane increase to produce 40% more electric energy.

Use of dogs as indicators of metal exposure in rural and urban habitats in NW Spain.

Many different species have been used in environmental biomonitoring studies in diverse habitats including forest, farmland, and urban and sub-urban areas. However, there is little information on domestic animals living in rural or urban habitats and exposed to the same pollutants as the human population. In this connection, pets could prove to be good indicators of human metal exposure since they closely share the same environment as their owners, and are therefore exposed, at least in part, to the same pollutants. The present study investigated toxic metal exposure in dogs in NW Spain and compared metal exposures between dogs from rural and urban habitats, considering the influence of diet, sex and age. Samples of liver and kidney from 57 male and female dogs, aged between 6 months and 18 years, were collected after euthanasia at veterinary clinics. Samples were acid-digested and metal concentrations determined by ICP-MS. Geometric mean concentrations of metals in the liver and kidney (microg/kg wet weight) were 12.6 and 15.9 for arsenic, 58.0 and 175 for cadmium, 32.7 and 53.4 for mercury, and 57.7 and 23.1 respectively. Hepatic lead concentrations were significantly higher (p<0.05) in dogs fed commercial diets than dogs fed home-made feed (32%) or a mixture of commercial and home-made feeds (95%). Mercury concentrations in the kidney were significantly higher (3-fold, p<0.05) in dogs from urban areas than in dogs from rural areas. Cadmium levels in kidney were significantly higher (p<0.05) in females (67%) and increased with age (p<0.001). Although no human samples were obtained in this study and no direct correlations between dogs and human metal exposure have been conducted, given our results pets could be suggested as surrogate indicators of human metal exposure.

Trombosis de vena ovárica derecha: complicación mortal en la mujer puérpera. A propósito de un caso / Right ovarian vein thrombosis: Fatal complication in puerperium. Case report

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Síndrome de Dandy-Walker: un hallazgo casual en la autopsia médico-forense / The Dandy-Walker Syndrome, a casual finding in a forensic autopsy

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Rotura de quiste aracnoideo tras traumatismo craneoencefálico leve. Exposición de un caso y revisión de la literatura / Traumatic rupture of arachnoid cyst resulting in acute subdural haematoma. Case report and literature review

La presencia de un hematoma subdural (HSD) en personas ancianas no constituye un hallazgo inusual, aunque puede ser objeto de complejas consideraciones medicolegales cuando se produce el fallecimiento tras un traumatismo leve reciente. Presentamos el caso de una mujer adulta añosa (87 años) que es asistida en un servicio de urgencia hospitalario tras sufrir traumatismo craneoencefálico (TCE) por caída en una residencia de la tercera edad, al presentar deterioro progresivo del nivel de conciencia y anisocoria transcurridas varias horas desde el trauma. Se practica tomografía axial computerizada (TAC) craneal sin contraste donde se aprecian lesiones compatibles con HSD crónico con resangrado. El estudio neuropatológico pone de manifiesto la existencia de un HSD agudo sobre quiste aracnoideo roto, hipertensión intracraneal, enclavamiento y hemorragias compatibles con daño axonal difuso grado III

The presence of a subdural hematoma (SDH) in aging people is not uncommon, although it can be the cause of complex medicolegal deliberations when death occurs after a recent head trauma. We present the case of an old woman (87 years old) who is attended in a hospital emergency service after suffering a fall with closed head injury, because of progressive stupor and anisocoria several hours later. A chronic SDH with new hemorrhage was diagnosed in a cranial computerized tomography (CT) without contrast. The neuropathological examination showed an acute SDH, arachnoid cyst elements, raised intracraneal pressure lesions with Duret hemorrhage and hemorrhages characteristic of grade III diffuse axonal injury

Traumatismos oculares: aspectos médico-legales / Ocular traumatism: forensic aspects

La patología ocular supone para la mayoría de los médicos forenses, no especialistas en la misma, un serio problema a la hora de establecer la etiología de las lesiones y su seguimiento posterior, dada su complejidad y especificidad. Por ello hemos hecho un breve repaso de todas las lesiones oftalmológicas que pueden sobrevenir tras un traumatismo, detallando su tratamiento médico y seguimiento, intentando además hacer un diagnóstico diferencial con la enfermedad común cuando así sea posible (AU)

Síndrome de Dandy-Walker, un hallazgo casual en la autopsia médico-forense / The Dandy-Walker Syndrome, a casual finding in a forensic autopsy

Se describe un síndrome de Dandy Walker, a propósito de un hallazgo casual, encontrado en la autopsia judicial de una mujer de 64 años que fallece a su ingreso en el servicio de urgencias del hospital sin antecedentes neurológicos conocidos (AU)

Estudio comparativo entre la herniorrafia inguinal clásica y la hernioplastia con malla de polipropileno / A comparative study of conventional inguinal hernia repair and hernioplasty with polypropylene mesh

Introducción. El objetivo de este trabajo es analizar y comparar en términos de morbilidad y recidiva la herniorrafia inguinal clásica frente a la herniorrafia inguinal con implante de malla de polipropileno. Pacientes y métodos. Se revisan un total de 356 hernias inguinales intervenidas entre enero de 1996 y enero de 1998, 251 reparadas mediante procedimientos clásicos y 105 mediante inclusión de malla de polipropileno según la técnica de Lichtenstein. Edad, sexo y antecedentes de riesgo tuvieron una distribución homogénea en ambos grupos, siendo el índice de hernias con recidiva previa superior en el grupo de hernioplastia (24,8 por ciento). Recibieron profilaxis antibiótica el 9 por ciento y sólo el 4,5 por ciento de las intervenciones tuvieron carácter de urgencia. El seguimiento medio fue de 23,8 meses (10-37 meses). Resultados. Presentaron morbilidad el 27 por ciento de los pacientes, siendo ésta superior en el grupo de hernioplastia, con valores significativos (p = 0,05). Se reconocieron dos intolerancias a la malla (1,9 por ciento). La tasa de recidivas global fue del 7,9 por ciento, siendo ésta del 8,8 por ciento para el grupo de herniorrafia y del 5,7 por ciento para el grupo de hernioplastia, no resultando estas diferencias significativas. La presencia de recidiva previa condicionó una mayor tasa de recidiva y morbilidad. Al comparar la tasa de recidivas sobre hernias primarias (un 7,9 por ciento de herniorrafia frente a un 1,3 por ciento de hernioplastia) se demuestran diferencias estadísticamente significativas (p = 0,037). Conclusiones. No hubo diferencias al comparar la estancia y el consumo de analgésicos en ambos grupos. La hernioplastia con colocación de malla se asocia estadísticamente a una menor tasa de recidivas cuando se comparan hernias primarias. Aunque la tasa de morbilidad es superior en el grupo de hernioplastia, debe valorarse el mayor índice de hernias con recidiva previa de este grupo (AU)

Trombosis de vena ovárica derecha: complicación mortal en la mujer puérpera, a propósito de un caso / Right ovarian vein thrombosis: fatal complication in puerperium. Case report

Tras el parto, la mujer entra en un período, el puerperio, durante el cual pueden sobrevenir múltiples complicaciones, algunas de ellas mortales. Describimos el caso de una puérpera que, transcurridos catorce días del alumbramiento, fallece por un tromboembolismo pulmonar masivo cuyo origen es una trombosis de la vena ovárica derecha.Se revisan la incidencia, etiopatogenia, sintomatología y manejo de estos pacientes, así como el abordaje necrápsico (AU)

[Preliminary and multidisciplinary study of three Coptic mummies of the Testut-Latarjet museum at Lyon]. / Etude pluridisciplinaire et préliminaire de trois momies coptes du Musée Testut-Latarjet de Lyon.

In 1901 Albert Gayet raked up from Antinoe three mummies exhibited to day at the Anatomy Museum of Lyon. The study of the three mummies was made in detail as to their dress, anthropometric and scannographic findings. The clothes were characteristic of coptic civilization. The radiographic date gave a life span of around 40 years. The X-ray imagery shows the remains of cerebral and visceral organs. The sexual criteria are thought to be those of two women and undetermined for the child. Later, several investigations like endoscopic autopsy, tooth microscopy and chromosomic map will be necessary.