Mortality of women with ductal carcinoma in situ of the breast: a population-based study from the Girona province, Spain (1994-2013).

PURPOSE: We aim to comprehensively describe the incidence and mortality trends of ductal carcinoma in situ (DCIS) in the Girona province, Spain (1994-2013) and to estimate the all-cause mortality excess risk of diagnosed women. METHODS: Age-standardized rates of DCIS were estimated between 1994 and 2013. Standard mortality ratios (SMR) and absolute excess mortality were calculated overall and by tumor and patient characteristics. A sensitivity analysis was conducted excluding cases with a subsequent invasive breast cancer (sIBC). RESULTS: Of the 641 women included, 56 died (follow-up time: 8.4 person-years). Between 1994 and 2013, a significant increase in incidence and decrease in mortality was identified among women aged between 50 and 69 years old. Neoplasms and circulatory system disease were the most common causes of death. No excess risk of death was found overall, except for women aged < 50 years (SMR = 3.44, 95% CI 1.85; 6.40) and those with a sIBC (SMR = 2.51, 95% CI 1.26; 5.02), risk that lessened when cases with sIBC were excluded. Patients with sIBC also showed an excess risk (SMR = 2.29, 95% CI 1.03; 5.10). CONCLUSIONS: Among women aged 50-69 years old, incidence of DCIS has significantly increased yet mortality has decreased. Overall, the all-cause mortality risk of women diagnosed with DCIS remains similar to that of the general population except for women diagnosed before age 50 and those with sIBC, who showed a significant increased risk. Differential management of these patients should be considered.

Manejo percutáneo de las colecciones pancréaticas que complican pancreatitis agudas de causa infrecunte / Percutaneous drainage of peripancreatic collections following acute pancreatitis of unusual origin

Objetivo: Evaluar la efectividad del drenaje percutáneo de las colecciones complicando pancreatitis agudas (PA) de causa enfrecuente. Material y método: Se evaluron 131 pacientes con pancreatitis aguda complicada con colecciones líquidas que fueron evacuados mediante drenaje percutáneo. Del todo de esta serie 19 pacientes sufrieron PA por causas infrecuentes. Los indicaciones para el drenaje guiado por imágenes fueron la presencia de dolor, obstrucción de la vía biliar o digestiva, y sepsis. Los catéteres fueron removidos cuando existió mejoría clínica del paciente con desaparición del dolor, normalización de las enzimas pancreáticas en sangre, ausencia de fístula en el sinograma y un volumen de drenaje menor a 10 ml cada 24 horas. Resultados: Las colecciones pancreáticas complicando pancreatitis de causa infrecuente fueron resueltas con drenaje percutáneo en 15 de los 19 pacientes (79 por ciento). No hubo complicaciones relacionadas con el procedimiento. Cuatro pacientes murieron: falla multiorgánica, 3 pacientes; embolismo pulmonar, 1 paciente. Conclusión: El resultado de los drenajes percutáneos en pacientes con PA de causa infrecuente medida como la resolución de las colecciones pancreáticas fue similar a los del resto de la serie. El manejo percutáneo de las colecciones pancráticas complicando pancreatitis de causa infrecuente fue un procedimiento eficáz para su resolución. La severidad de la pancreatitis más que la causa aparece como el factor determinante de la duración del drenaje y su resultado (AU)

Manejo percutáneo de las colecciones pancréaticas que complican pancreatitis agudas de causa infrecunte / Percutaneous drainage of peripancreatic collections following acute pancreatitis of unusual origin

Objetivo: Evaluar la efectividad del drenaje percutáneo de las colecciones complicando pancreatitis agudas (PA) de causa enfrecuente. Material y método: Se evaluron 131 pacientes con pancreatitis aguda complicada con colecciones líquidas que fueron evacuados mediante drenaje percutáneo. Del todo de esta serie 19 pacientes sufrieron PA por causas infrecuentes. Los indicaciones para el drenaje guiado por imágenes fueron la presencia de dolor, obstrucción de la vía biliar o digestiva, y sepsis. Los catéteres fueron removidos cuando existió mejoría clínica del paciente con desaparición del dolor, normalización de las enzimas pancreáticas en sangre, ausencia de fístula en el sinograma y un volumen de drenaje menor a 10 ml cada 24 horas. Resultados: Las colecciones pancreáticas complicando pancreatitis de causa infrecuente fueron resueltas con drenaje percutáneo en 15 de los 19 pacientes (79 por ciento). No hubo complicaciones relacionadas con el procedimiento. Cuatro pacientes murieron: falla multiorgánica, 3 pacientes; embolismo pulmonar, 1 paciente. Conclusión: El resultado de los drenajes percutáneos en pacientes con PA de causa infrecuente medida como la resolución de las colecciones pancreáticas fue similar a los del resto de la serie. El manejo percutáneo de las colecciones pancráticas complicando pancreatitis de causa infrecuente fue un procedimiento eficáz para su resolución. La severidad de la pancreatitis más que la causa aparece como el factor determinante de la duración del drenaje y su resultado

Risk factors associated with human cystic echinococcosis in Florida, Uruguay: results of a mass screening study using ultrasound and serology.

Sonographic evidence of asymptomatic Echinococcus granulosus lesions in the liver was found in 156 of 9,515 persons in the Department of Florida, Uruguay. The sensitivity of ELISA and latex agglutination serology compared with ultrasound was 47.6% and 28.1%, respectively, and specificity was > 85%. There was a significant positive association between positive sonography and a personal history of previous but treated Echinococcus infection while those that were seropositive but ultrasound-negative were significantly more likely to have a personal history of infection or a history of infection in their family. Prevalence of infection increased significantly with age. There was no correlation between echinococcosis and dog ownership or home slaughter of sheep but offal disposal was important, with an increased prevalence of infection of 3.2%, 2.8%, and 3.1%, respectively, in persons feeding offal to dogs or burying or burning it compared with a prevalence of 0.8-1.5% in those using other methods of disposal. Almost half the population, when questioned, seemed to have sound knowledge about E. granulosus and described correct treatment of E. granulosus in dogs but this did not affect prevalence. There was a significant positive association between infection and the presence of a fenced fruit/vegetable garden and use of rural waters, particularly the cachimba (a small dam) and the aljibe (a cistern or tank) that collect rainwater from the ground surface and roofs, respectively.

Principles of the surgical approach in human liver cystic echinococcosis.

Ultrasonography (USG) has recently contributed much to the diagnostic of hepatic cystic echinococcosis (CE). The use of portable ultrasonograph allowed us to perform a community survey among 9482 people living in a high risk area for CE in the Florida Department (Uruguay). Positive USG results were found in 123 asymptomatic patients. 48 out of 51 USG positive cases were surgically confirmed and 3 were found to be false positive. The results of this survey allowed us to propose a new classification of the echographic imaging based on the parasite's various evolutive and involutive stages. The Echinococcus granulosus cyst size was compared with the parasite's evolutive stages. The cyst's segmentary topography and the related risk of CE is evaluated. The importance of cystic-biliary communication is pointed out and its rational surgical treatment described. Finally, an algorithm is presented facilitating the choice of a rational treatment.

Comparison of serodiagnostic tests and ultrasonography for cystic hydatidosis in an epidemiological study of rural Uruguay.

Cystic hydatidosis (CH) caused by Echinococcus granulosus is an important zoonosis worldwide. Several serodiagnostic and ultrasound tests are currently used for screening asymptomatic CH. The sensitivity of the serodiagnostic tests has been demonstrated by several groups to be lower than ultrasonography (US). To explain the mechanism of the difference in sensitivity, a large-scale US survey combined with an IgG4-enzyme-linked immunosorbent assay test was conducted in Uruguay. Our results suggest that certain cyst images, e.g., multivesicular cysts, may be closely associated with a high antibody response regardless of the cyst size, whereas other hydatid lesions, e.g., solid images with/without rolled parasite membranes, have lower antibody responses with a close relationship to cyst size. Seropositivity of subjects who had been treated surgically for removal of hydatid cysts in the last 5 yr was closest to that of actual CH patients, albeit free from CH by US. These findings are important for the proper use of serodiagnostic tests and US for community-based epidemiological studies.