ABSTRACT
Objetivo. El Ki67 es un marcador de proliferación celular cuya expresión en tumores mamarios se ha relacionado con peor pronóstico y buena respuesta al tratamiento con quimioterapia. Sin embargo, aún no es considerado un marcador independiente y su uso no está extendido en la práctica clínica. El objetivo principal es estudiar el valor del Ki67, determinando su relación con cada uno de los demás factores pronósticos y predictivos clásicos utilizados en el cáncer de mama. Pacientes y método. Estudio transversal descriptivo analítico que incluyó 110 pacientes consecutivas con cáncer de mama en estadios iniciales y candidatas a cirugía como primer tratamiento. Se analizó la relación entre el Ki67 y una serie de factores pronósticos y predictivos clásicos del cáncer de mama. Resultados. El porcentaje de expresión del Ki67 fue significativamente mayor en los tumores con tamaño mayor a 15 mm, grado histológico 3, y que no expresan receptores hormonales. Además se observó una relación inversa entre la sobreexpresión de Ki67 y la expresión del receptor de estrógenos. Conclusiones. Nuestros resultados indican que existe una relación significativa entre el Ki67 y el grado histológico, el tamaño tumoral y los receptores hormonales (AU)
Objective. Ki67 is a biomarker of cell proliferation and its expression in breast tumors has been associated with worse prognosis and a better response to chemotherapy. However, Ki67 is not yet considered an independent marker and is not yet widely used in clinical practice. The aim of this study was to analyze the value of Ki67, by determining the relationship between Ki67 and each of the other predictive and prognostic factors used in breast cancer. Patients and methods. This cross-sectional, analytic and descriptive study included 110 consecutive patients with early-stage breast cancer who were candidates for surgery as the initial treatment. We analyzed the relationship between Ki67 and a series of other classical prognostic and predictive factors. Results. The percentage of Ki67 expression was significantly higher in tumors larger than 15 mm, histological grade 3, and tumors not expressing hormone receptors. Linear regression analysis showed a significant inverse relationship between Ki67 expression and estrogen receptor expression. Conclusions. Our results showed a significant association between Ki67 and histological grade, tumor size, and hormone receptors (AU)
Subject(s)
Humans , Female , Breast Neoplasms/diagnosis , Early Diagnosis , Prognosis , Biomarkers , Proliferating Cell Nuclear Antigen/analysis , Symptom Assessment/trends , Cross-Sectional Studies/methods , Analysis of VarianceABSTRACT
BACKGROUND: Pelvic inflammatory disease is manifested by a broad spectrum of genital tract infections that include: endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis. This disease is associated with evidence of inflammation of the lower genital tract. OBJECTIVE: To evaluate the subgroup of patients with a diagnosis of acute pelvic inflammatory disease requiring hospitalization after implementation of the protocol for action in the patient with suspected pelvic inflammatory disease. MATERIAL AND METHODS: Retrospective analysis conducted between January and December 2011 in a cohort of patients diagnosed with severe pelvic inflammatory disease after implementation of a hospital protocol for suspected patients with this condition. Patients who met the diagnostic criteria of Centers for Disease Control and Prevention (CDC) and required hospitalization were considered with severe pelvic inflammatory disease. In all cases the same complementary tests were conducted and the same antibiotic protocol was prescribed. RESULTS: We included 38 patients and found a statistically significant relationship between the IUD and mixed gram-negative flora etiologic agent (p < 0.05). There was a negative correlation (Pearson correlation coefficient -0.334) between elevated leukocyte at the time of admission and the need for surgery. CONCLUSIONS: In cases of severe pelvic inflammatory disease IUD is associated with gram-negative mixed flora infection. The normal or moderately elevated concentrations of leukocytes were correlated with failure of medical treatment.
Subject(s)
Pelvic Inflammatory Disease/diagnosis , Pelvic Inflammatory Disease/therapy , Adult , Clinical Protocols , Female , Humans , Retrospective Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
Introducción: la embolia de líquido amniótico (ELA) es una entidad poco frecuente, considerada como impredecible y no prevenible, que se asocia a una elevada morbimortalidad materna. El diagnóstico temprano es necesario para mejorar el pronóstico fetal. El objetivo de este reporte de casos es revisar el diagnóstico, el tratamiento y los principales puntos de discusión en la literatura respecto a esta patología.Materiales y métodos: presentamos el reporte de cuatro casos de ELA que se presentaron en un periodo de diez años en el Hospital Universitario La Paz de Madrid, España, centro de alta complejidad perteneciente el sistema nacional de salud. Se presenta de manera detallada uno de los casos por ser el más representativo del cuadro en cuanto a características clínicas y secuencia cronológica de aparición de los síntomas. Se realiza una búsqueda en las bases de datos Medline vía PubMed, en español e inglés en los últimos diez años con los términos: embolia de líquido amniótico, paro cardiaco, coagulación intravascular diseminada y mortalidad neonatal. Se buscaron series de casos, estudios de cohortes, casos y controles, y artículos de revisión.Resultados: se encontraron 150 títulos de los cuales se incluyeron 26, de estos 10 correspondieron a series de casos, 5 cohortes y 11 revisiones. El diagnóstico se basa en criterios clínicos; el tratamiento temprano se enfoca a un soporte cardiorrespiratorio y hemodinámico. Conclusión: es necesario un adecuado conocimiento de la ELA para establecer un diagnóstico de sospecha y poder orientar de la forma más adecuada el manejo terapéutico de estas pacientes en el menor tiempo posible.
Introduction: Amniotic fluid embolism (AFE) is an infrequent condition considered unpredictable and unpreventable, and it is associated with high maternal morbidity and mortality. Early diagnosis is critical in order to improve prognosis. The objective of this case report is to review the diagnosis, treatment and main discussion points found in the literature regarding this disease condition. Material and methods: We report 4 cases of AFE presenting over a period of 10 years to the Hospital Universitario La Paz, in Madrid, Spain, a high complexity center of the national health system. One of the cases is reported in detail because it is the most representative of the disease presentation in terms of the clinical characteristics and the time sequence of symptom onset. A search was conducted in English and Spanish in Medline via Pub Med for the last 10 years, using the terms amniotic fluid embolism, cardiac arrest, disseminated intravascular coagulation, neonatal mortality. The search included case series, cohort studies, cases and controls, and review articles. Results: Of a total of 150 titles found, 26 were included: 10 case series, 5 cohort studies and 11 reviews. The diagnosis is based on clinical criteria and early treatment is focused on cardiorespiratory and hemodynamic support. Conclusion: Adequate knowledge of AFE is required in order to suspect the diagnosis and guide therapeutic management in these patients as adequately and promptly as possible.
