La atención primaria de salud como estrategia para el bienestar de las personas mayores / Primary healthcare as a strategy for well being in the elderly

El siglo XXI viene marcado por un incremento en las tendencias demográficas de su antecesor. De esta manera existe un incremento de la esperanza de vida y un ritmo cada vez mayor de incremento en la población que envejece luego de los 60 años de edad. Esto tiene cada vez mayores impactos sobre el sistema de atención de salud, la seguridad social y su capacidad para atender una población con mayor susceptibilidad y riesgo a los nuevos escenarios epidemiológicos producto del cambio climático y la globalización mundial.

The 21th Century shows marked changes in demographic trends compared to 20th Century. Consequently, now there is an increase in life expectancy and a greater proportion of elderly people. This poses a significant impact on healthcare systems and social security services, as well as on their capability for taking care of a progressively susceptible population, particularly in the context of a new epidemiological scenario which is a consequence of climatic change and globalization.

The maxillary protraction treatment: description of a laser Er:Yag-assisted surgical technique. Case report.

The surgically aided rapid maxillary expansion (SARME) is indicated to treat the hypoplasia of the upper jaw, with a reduction of the palatal transverse diameters, even in absence of mono- or bilateral crossbite, in the adult patient. In such cases, maxillary osteotomies are made in order to reduce the sutural resistance and facilitate the expansion of the maxillary complex. A case of surgically-aided expansion of the maxilla by the use of laser Er:Yag is reported. This device is able to guarantee targeted osteotomies of the bone, without inducing iatrogenic damages of the soft tissues. The orthodontic treatment has been performed using a bonded palatal expander (type Hyrax) in association with a class III orthopedic traction (face mask). After this a fixed appliance at both the arches was bonded. The preliminary radiographic examination and the cefalometric evaluation have been repeated at the end of the maxillary protraction (60 days after surgery) and at the end of the orthodontic treatment. The entire duration of the treatment was 18 months. The use of the laser Er:Yag has showed several advantages if compared to the traditional tools (bur), as more safety, more cutting precision and less probability to determine side effects on the soft tissue. The orthodontic treatment has been performed according to the standard protocol and the results were similar to the referred in literature.

Time course of serum collagen types I and III metabolism products after reperfused acute myocardial infarction in patients with and without systemic hypertension.

We examined 55 consecutive patients successfully treated with primary percutaneous coronary intervention (PCI) for a first acute myocardial infarction with left ventricular (LV) systolic dysfunction. In all patients we performed echocardiographic examination, dosage of plasma brain natriuretic peptide, serum carboxy-terminal propeptide and telopeptide of procollagen type I and amino-terminal propeptide of procollagen type III at days 1 and 3, and at 1 and 6 months after index infarction. The hypertensive patients (group 1; n=30) differed for higher baseline blood pressure (133+/-4 mm Hg vs 118+/-4 mm Hg; P=0.03), greater LV mass index (108+/-5 vs 94+/-4 g m(-2), P=0.03) and lower mitral E/A wave peak (0.8+/-0.06 vs 1.1+/-0.12, P=0.02) with respect to non-hypertensive patients (group 2; n=25). From day 1 to month 6 carboxy-terminal propeptide of procollagen type I and amino-terminal propeptide of procollagen type III increased (P<0.005 and P<0.05, respectively) in both groups, whereas carboxy-terminal telopeptide of procollagen type I increased from day 1 to day 3 (P<0.01 in both groups, respectively) and then decreased from day 3 to month 6 (P<0.01 and P<0.05 in both groups, respectively). From day 1, brain natriuretic peptide decreased in both groups (P<0.005). There was no significant difference between the two groups in values of procollagens and natriuretic peptide. Finally, LV diastolic volume and function at 6 months were similar in the two groups. Thus, in patients with reperfused acute myocardial infarction and LV dysfunction, antecedent hypertension was not associated with a different pattern of serum procollagen release and ventricular remodelling at 6 months of follow-up.

Determinants of final infarct size and incidence of aborted infarction in patients treated with primary coronary intervention and adjunctive abciximab therapy.

AIMS: Assess the determinants of final infarct size in patients successfully treated with primary percutaneous coronary intervention (PCI) and abciximab therapy and check whether infarct abortion may occur. PATIENTS, METHODS: In 208 patients we examined the parameters that predict final infarct size and the incidence of aborted infarction, defined by completely normal perfusion and regional wall motion plus >50% left ventricular ejection fraction (LVEF) in gated single-photon emission computed tomography (SPECT) acquired at one month. RESULTS: In linear regression analysis, sex (p<0.0001), high cholesterol (p<0.05), Killip class (p<0.0001), symptom-to-reperfusion time (p<0.001), admission ST segment elevation (p<0.0001), infarct related artery (p<0.05), and pre-procedural TIMI flow (p<0.002) were significant univariate predictors of final infarct size. In multiple linear regression analysis, symptom-to-reperfusion time (p<0.001), Killip class (p<0.0001), ST segment elevation (p<0.003), and sex (p<0.03) remained significant predictors, model R(2)=0.53. Aborted infarction was registered in 32 patients, more frequently female (59% versus 21%, p<0.00001), older (p<0.02), with larger prevalence of TIMI grade 3 (p<0.05) and lower ST segment elevation at admission (p<0.05). CONCLUSIONS: Sex, reperfusion delay, and initial infarct severity as indicated by Killip class and/or ST segment elevation appear the determinants of final infarct size in patients treated with primary PCI. The presence of aborted infarction seems related to the same factors and to preserved TIMI 3 flow.

[Mechanical reperfusion in patients with acute myocardial infarction]. / La riperfusione meccanica nei pazienti con infarto miocardico acuto.

UNLABELLED: Natural history of patients with acute myocardial infarction has significantly improved in the last 20 years. The main reason for this progress was the introduction of effective reperfusion strategies. It has been clearly documented that the speed, extension, and duration of reperfusion are key prognostic factors. Mechanical reperfusion during primary percutaneous coronary interventions has been shown to be superior to fibrinolysis in order to achieve these RESULTS: All the techniques able to positively interact with the ischemia-reperfusion process and that have been evaluated so far (stent, adjunctive pharmacological therapy, anti-embolic devices, etc.) will be discussed.

Five year outcome after primary coronary intervention for acute ST elevation myocardial infarction: results from a single centre experience.

OBJECTIVES: To analyse the five year outcome of unselected patients with acute myocardial infarction (AMI) treated by primary percutaneous coronary intervention (PCI). SETTING: High volume PCI tertiary centre. DESIGN AND RESULTS: The study was based on a sample of 1009 consecutive patients with ST elevation AMI treated by primary PCI. The mean (SD) clinical follow up was 51 (21) months and the follow up rate was 97.8%. The overall mortality was 20% and cardiac mortality was 16%. Non-fatal reinfarction rate was 5% and additional revascularisation procedure rate was 19%. Hospitalisation for heart failure was needed by 42 patients (4%). The variables related to mortality in multivariate Cox analysis were age (hazard ratio (HR) 1.054, 95% confidence interval (CI) 1.039 to 1.069, p < 0.0001), cardiogenic shock (HR 2.985, 95% CI 2.157 to 4.129, p < 0.0001), previous myocardial infarction (HR 1.696, 95% CI 1.199 to 2.398, p = 0.0003), and the presence of multivessel coronary artery disease (HR 1.820, 95% CI 1.317 to 2.514, p = 0.0003). Each additional high risk feature was associated with a relative risk for five year death of 2.328 (95% CI 2.048 to 2.646, p < 0.0001). CONCLUSIONS: The satisfactory results of routine mechanical revascularisation strategy in AMI were maintained during several years of follow up. Patients at risk of death during long term follow up may be identified by simple clinical and angiographic characteristics, such as old age, cardiogenic shock, previous myocardial infarction, and multivessel coronary artery disease. The risk of death progressively increases with the number of these high risk features.

[Reduction of the incidence of nosocomial infections after assessing and revising the quality of assistance in a thoracic surgery unit]. / Riduzione del tasso d'incidenza delle infezioni ospedaliere in una U.O. di Chirurgia Toracica mediante verifica e revisione della qualità assistenziale.

An active surveillance for nosocomial infections has been lead in a Thoracic Surgery with the intention, first to point out their frequency and characteristics, and then to outline all the measures to remove the main risk factors checking the results obtained. A prospective incidence study has been promoted in a Thoracic Surgery in the years 2000, 2001, 2002. The analysis has been lead weekly gathering all necessary data from the health records and making laboratory tests to look for microbes growth in the air of Thoracic Surgery Operating Rooms. A nosocomial infections incidence of 13.3% among surgically treated patients has been registered in 2000. Deep surgical site infections were the most frequent localizations, and microbes isolated were Staphylococcus aureus and coagulase negative Staphylococcus with an high oxacillin resistance (70.6%-76.5%). From the observation of the risk factors the sterilization system has been modified and the assistance and environmental protocols have been improved. In the further evaluation period, a global reduction of nosocomial infections incidence (7.1%), of surgical site infections (from 10.1% to 4.5%) (p = 0.007), of Staphylococcus aureus and coagulase negative Staphylococcus isolations have been obtained even if short results in antibiotic resistances have been registered. Thoracic Surgery has to be considered an area at medium-high risk of nosocomial infections. The quite high incidence of nosocomial infections recorded at the beginning of the study in presence of prevalent deep surgical site infections from staphylococci with an high oxacillin resistance compelled to promote corrections. These lead to a remarkable decrease in incidence of nosocomial infections even if the same results can not be reached in antibiotic resistances.

Cisplatin versus carboplatin in combination with mitomycin and vinblastine in advanced non small cell lung cancer. A multicenter, randomized phase III trial.

BACKGROUND: In advanced not selected NSCLC chemotherapy achieved an advantage of approximately 1-2 months on median survival versus best supportive care. Chemotherapy seems to improve symptoms control, even if randomised studies with quality of life as first endpoint are lacking and often chemotherapy toxicity compromises the frail cost/benefit ratio. The aim of the present study is to evaluate the impact on QoL, substituting cisplatin, a pivot drug in NSCLC therapy, with carboplatin, an analogue with an improved toxicity profile. The combination of cisplatin with Mitomycin and Vinblastine was one of the most frequently used in the palliative setting at the time of design of our study. METHODS: Patients were randomized to receive MVP regimen (Mitomycin-C 8 mg/m2 d1, Vinblastine 4 mg/m2 d 1-8, Cisplatin 100 mg/m2 d1) or MVC regimen (Mitomycin-C 8 mg/m2 d1, Vinblastine 4 mg/m2 d 1-8, Carboplatin 300 mg/m2 d1) every 3 weeks. The QoL was evaluated by the Spitzer QL-Index and by the EORTC QLQ-C30+LC 13 questionnaires before chemotherapy, after one cycle, after three cycles, and then every 6 weeks in the first 6 months and every 3 months thenafter. RESULTS: From September 1994 to July 1997, 153 consecutive patients were randomized to MVP (75 patients) or MVC arm (78 patients). Despite difficulties in carrying out and analysing QoL items in such patients, the global QoL evaluated by the Spitzer's questionnaire suggested an advantage for MVC regimen (P=0.05) and a significant difference was observed in global health subdomain (P=0.04). The disease-related symptoms improved with time, and the benefits lasted for the entire treatment period. When evaluated with the EORTC questionnaire there was significantly less nausea and vomiting (P=0.0001), appetite loss (P=0.01), insomnia (P=0.03), constipation (P=0.01) and peripheral neuropathy (P=0.01) in favour of MVC, and a trend for less hair loss (P=0.05). The advantage lasted for all the duration of chemotherapy. No differences were observed in global quality of life subdomain (P=0.40) between the two regimen. QoL was the first endpoint and the statistical power was inadequate to assess other parameters. However, we reported a response rate of 43.1 and 38.6%, respectively, in MVP and MVC arm (P=0.59) and a median survival of 10.2 and 7.2 months, respectively, for cisplatin and carboplatin arm (P=0.39). CONCLUSIONS: The carboplatin containing regimen (MVC) has a significant better toxicity profile than the cisplatin containing (MVP) regimen as proven both by the EORTC questionnaires and by the WHO toxicity data reported by physicians. No significant differences in terms of response rate, time to progression and overall survival were observed between the two regimen. The two chemotherapy regimen showed a similar effectiveness in symptom palliation when evaluated with C30 addendum of EORTC QOL questionnaire. With the Spitzer's questionnaires a trend towards an improved quality of life index was observed during treatment with the carboplatin combination in comparison to the cisplatin combination. This difference, however, was not observed when the global quality of life was evaluated with the EORTC patients compiled questionnaires. A carboplatin containing regimen with better toxicity profile and a similar potentiality for symptoms control offers an option in comparison to similar cisplatin containing combinations in the palliative treatment of advanced NSCLC.

Abscesses of the breast. US-guided serial percutaneous aspiration and local antibiotic therapy after unsuccessful systemic antibiotic therapy.

PURPOSE: The usual therapeutic approach to acute breast abscesses (ABAs) not responsive to systemic antibiotics is surgical incision and drainage. Our purpose was to assess the efficacy of treating ABAs with serial US-guided percutaneous aspiration and local injection of antibiotics. MATERIAL AND METHODS: Twenty-six patients with 28 ABAs, in whom systemic antibiotic therapy had failed, underwent serial US-guided aspiration with local injection a of large-spectrum antibiotic. The treatment was repeated weekly until complete resolution was observed at clinical and US examination. The volume of the ABAs was calculated before each US-guided aspiration. Follow-up US examinations were performed at 1, 4, and 12 weeks after clinical and US resolution. A comparison betweeen costs of surgical and US-guided treatment of ABAs in our institution was done. RESULTS: In 27 ABAs the treatment was successful: a progressive volume reduction and a complete resolution at clinical and US examination was observed within 1 to 7 weeks. In 1 case only, with a large ABA markedly increased in volume at the second examination, surgical drainage was performed. CONCLUSION: US-guided aspiration with local antibiotic injection is a safe and effective approach to ABAs, cheaper than surgical drainage of these lesions.

High dose dipyridamole myocardial imaging: simultaneous sestamibi scintigraphy and two-dimensional echocardiography in the detection and evaluation of coronary artery disease. Italian Group of Nuclear Cardiology.

BACKGROUND: Dipyridamole stress combined with echocardiography or perfusion scintigraphy can be used to detect coronary artery disease, but head-to-head comparative data are lacking. The aim of this study was to compare the relative accuracy of high-dose dipyridamole stress imaging (up to 0.84 mg/kg over 10 min) with two-dimensional echocardiography and sestamibi perfusion scintigraphy in detecting coronary artery disease. METHODS: One-hundred and one patients with a history of chest pain and no previous myocardial infarction, were studied simultaneously using planar perfusion scintigraphy and echocardiography during a high-dose dipyridamole stress, at seven different institutions. RESULTS: During coronary angiography, 21 patients had non-significant lesions, and 80 had significant lesions (> or = 50% diameter reduction): 37 had single-, 19 double- and 24 triple-vessel disease. Sensitivity for disease detection was 78% [95% confidence interval (CI) 67-86%] for echocardiography and 79% (CI 68-87%) for scintigraphy. The specificity was 76% (CI 67-84%) for echocardiography and 90% (CI 83-95%) for scintigraphy. The inter-center variation in accuracy ranged from 50 to 100% for echocardiography (coefficient of variation 19.7%) and from 71 to 100% for scintigraphy (coefficient of variation 15%). The angiographically assessed extent and severity of coronary artery disease, evaluated using the Duke score, was correlated to the extent and severity of perfusion defects with scintigraphy (r = 0.65, P < 0.0001) and regional wall motion abnormalities by echocardiography (r = 0.57, P < 0.0001). CONCLUSIONS: Perfusion scintigraphy and echocardiography have similar accuracies for the non-invasive identification of angiographically assessed coronary artery disease during high-dose dipyridamole stress. Inter-center variability in diagnostic accuracy is higher for echocardiography than scintigraphy. Both methods allow a reasonably accurate estimation of extent and severity of disease, via a semiquantitative assessment of extent and severity of perfusion of functional defects.

Dynamic helical CT of breast tumors.

PURPOSE: The purpose of our study was to test dynamic helical CT (hCT) in the evaluation of breast tumors. METHOD: Thirty-six patients with 39 suspected lesions underwent breast hCT before and 1, 3, and 8 min after intravenous contrast medium administration. A marked enhancement (> or = 100%) at 1 or 3 min without increase at 8 minutes was considered as the primary indicator for malignancy. Twenty carcinomas, one metastatic non-Hodgkin lymphoma, six fibroadenomas, and six other benign findings were histologically assessed. Six cases had negative fine needle aspiration cytology and at least a 2 year negative follow-up. RESULTS: hCT showed a 100% sensitivity and 83.3% specificity. Considering carcinomas and fibroadenomas, significant differences were found for the percent enhancement at 1 min (p = 0.002) as well as for the density increase or decrease at 3 versus 1 min (p = 0.0035), at 8 versus 1 min (p = 0.0027), and at 8 versus 3 min (p = 0.0180). CONCLUSION: hCT proved to have a high diagnostic efficacy in evaluating breast tumors. Even though it involves some exposure to radiation, it should be considered in patients in whom MR is contraindicated.

Magnetic resonance imaging of the breast in characterizing positive or uncertain mammographic findings.

A total of 38 suspected primary (26) or recurrent (12) breast tumors underwent enhanced magnetic resonance imaging (MRI) of the breast after positive (19) or uncertain (19) mammography. Spin echo T1-weighted images before and after intravenous administration of 0.15 mmol/kg Gd-DTPA, the latter ones at 1, 3, and 5 min, were obtained to characterize the mammographic findings. When contrast enhancement was absent, the same images were also obtained at 10 min. Evident and early focal enhancement was considered as an MRI sign of malignancy. All the lesions were submitted to histological examination (seven by core-biopsy only). Mammography results were 23 true positives and 15 false positives. MRI results were 22 true positives, 13 true negatives, 2 false positives, and 1 false negative. Twelve uncertain-mammography cases became true negatives at MRI; 1 uncertain-mammography case was the only MRI false negative; 1 positive-mammography cases became true negative at MRI. Resting on this limited series of patients, MRI is confirmed as a useful imaging technique after uncertain mammography.

Homogeneously reduced versus regionally impaired myocardial blood flow in hypertensive patients: two different patterns of myocardial perfusion associated with degree of hypertrophy.

OBJECTIVES: The aim of this study was to quantitatively measure regional and global myocardial blood flow and coronary reserve in hypertensive patients without coronary artery disease and to assess the correlation with left ventricular mass. BACKGROUND: The effect of left ventricular hypertrophy on regional vasodilating coronary capability in arterial hypertension is controversial, and no quantitative method has been applied to assess a possible correlation. METHODS: Positron emission tomography was performed in 50 untreated hypertensive patients and 13 normotensive subjects. Blood flow at baseline and after dipyridamole was globally and regionally measured by using nitrogen-13 ammonia; coronary reserve and resistance were calculated. Left ventricular mass was assessed by two-dimensional echocardiography. RESULTS: In hypertensive patients, flow at baseline was similar to that of normotensive subjects (p = 0.21), but values were reduced after pharmacologic vasodilation (p < 0.05). This impairment of maximal coronary flow was not correlated with left ventricular mass (p = 0.13). Among hypertensive patients, we identified a group with a homogeneous distribution of perfusion and a group with a heterogeneous flow pattern. Flow was globally reduced in the former group, but it was abnormal only at the site of perfusion defects in the latter. Patients with regional defects showed the highest likelihood of having an increased left ventricular mass. CONCLUSIONS: In arterial hypertension, left ventricular mass is not correlated with global myocardial blood flow. Nevertheless, patients with ventricular hypertrophy are likely to show a heterogeneous flow pattern with regional defects and almost normal blood flow in nonaffected regions. In hypertensive patients with a homogeneous perfusion pattern during stress, myocardial blood flow frequently shows a diffuse reduction.

Flow-function relation in patients with chronic coronary artery disease and reduced regional function. A positron emission tomographic and two-dimensional echocardiographic study with coronary vasodilator stress.

OBJECTIVES: We sought to elucidate the flow-function relation in chronic postischemic dysfunction during vasodilator stress. BACKGROUND: In patients with ischemia and regional dysfunction, stress echocardiography can elicit three responses in the dysfunctioning segments: no change, improvement or worsening. The physiology underlying these responses is unclear. METHODS: Seventeen patients with ischemia and left ventricular dysfunction underwent evaluation of regional function by two-dimensional echocardiography and myocardial blood flow by positron emission tomography and 13N-ammonia. Flow (ml/min per g) and function (regional wall motion score [RWMS] from 1 = normal to 4 = dyskinetic) were evaluated both at rest and after dipyridamole (0.56 mg/kg body weight over 4 min). RESULTS: In 45 normal segments, rest to dipyridamole flow increased from 0.83 +/- 0.22 (mean +/- 1 SD) to 1.87 +/- 0.90 (p < 0.01) with a hyperkinetic contraction pattern. Among dysfunctioning segments, responders (n = 11) showed an upsloping flow-function curve during stress (i.e., increased function [RWMS rest 2.5 +/- 0.5 vs. dipyridamole 1.2 +/- 0.4] and increased flow [rest 0.69 +/- 0.30 vs. dipyridamole 1.89 +/- 1.43, p < 0.01]); nonresponders (n = 20) had a flat flow-function curve during dipyridamole (i.e., fixed function [RWMS rest and dipyridamole 2.6 +/- 0.5] and no flow increase [rest 0.64 +/- 0.24 vs. dipyridamole 0.87 +/- 0.51, p = NS): Ischemic segments (n = 9) exhibited a downsloping flow-function curve during dipyridamole (i.e., worsened function [RWMS rest 2 +/- 0.5, dipyridamole 3.1 +/- 0.6] and no significant flow change [rest 0.67 +/- 0.29 vs. dipyridamole 0.79 +/- 0.23, p = NS]). CONCLUSIONS: Myocardial segments with rest dysfunction and a contractile reserve elicitable by a vasodilator stress more often exhibit residual flow reserve, whereas segments with a fixed or worsening mechanical response during stress show a flat flow response.

Celulitis facial bacterémica / Facial bacteremic cellulitis

Una de las complicaciones más serias de la celulitis facial bacterémica es la meningitis bacteriana aguda. En el presente estudio fueron revisadas retrospectivamente las fichas de 39 niños menores de 2 años ingresados con el diagnóstico de celulitis facial en la Unidad de Infecciosos del Hospital Roberto del Río entre agosto de 1992 y marzo de 1996. De los resultados destaca que de los 39 niños con celulitis facial estudiados 4 presentaron bacteremia a H. influenzae, 1 de éstos con meningitis asociada (2,5 por ciento de 39 casos). Los 4 casos tuvieron en común la ausencia de puerta de entrada. El análisis conjunto de este trabajo y otro anterior efectuado en la misma Unidad y publicado en 1993 permite concluir que la ausencia de puerta de entrada predice el riesgo de bacteremía y meningitis. Actualmente se siguen buscando criterios clínicos y de laboratorio en la celulitis facial que sugieran bacteremia y riesgo de compromiso meníngeo. Estos criterios orientarían a decidir en qué casos es necesario llevar a cabo un estudio acabado para descartar la meningitis bacteriana aguda como complicación

High-dose versus low-dose cisplatin in combination with cyclophosphamide and epidoxorubicin in suboptimal ovarian cancer: a randomized study of the Gruppo Oncologico Nord-Ovest.

PURPOSE: The aim of the study was to compare high-versus low-dose cisplatin in combination with cyclophosphamide and epidoxorubicin as primary chemotherapy for suboptimal stage III and IV ovarian cancer. PATIENTS AND METHODS: One hundred forty-five patients were randomized to receive six courses of cisplatin 50 or 100 mg/m2 plus epidoxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2. The two treatment arms were well balanced; all patients had greater than 2 cm and 37.2% had greater than 5 cm of residual disease; 29.6% had stage IV disease. RESULTS: Patients in the high-dose arm received a double dose-intensity and double total dose of cisplatin. The high-dose regimen induced significantly more episodes of leukopenia (47.8% v 32.8%, P = .05), thrombocytopenia (21.7% v 3.2%, P = .003), anemia (37.6% v 12.5%, P = .002), nephrotoxicity (six v one patient), and neurotoxicity (30.4% v 6.3%, P = .002). There were no significant differences in efficacy in terms of clinical response rate (high-dose 57.5% v low-dose 61.1%), pathologic complete response (CR) (9.6% v 18.1%), median survival times (29 v 24 months), and median progression-free survival (18 v 13 months). CONCLUSION: This study shows that doubling the dose-intensity and total dose of cisplatin in combination with epidoxorubicin and cyclophosphamide has significant toxic effects and does not improve clinical outcome in patients with suboptimal ovarian cancer.

Non palpable breast lesions: preoperative sonographic localization.

From 1987 to 1992 at our Institute, 253 patients with non palpable breast lesions (NBPL) underwent a surgical excision. Fifty-one lesions (19.7%) were localized by an injection of a sterile 3% charcoal suspension under sonographic guide. The sonographic features of NBPL were classified as follows: positive in one case (2%), doubtful in 31 cases (60%) and negative in 19 cases (38%). According to our data the preoperative sonographic localization is a useful alternative procedure to stereotactis mammography in case of breast masses and/or areas of increased tissue density or distorted breast architecture.

Pre-operative localization of non-palpable lesions in breast cancer by charcoal suspension.

The use of preoperative localization procedures for non-palpable breast lesions (NPBL) is becoming more and more widespread, increasing the detection of early breast cancers. From October 1987 to July 1992, at our Institution, 253 patients (pts) with clinically non-palpable lesions underwent surgical treatment. Of the 253 pts, the lesions have been localized in 95 cases by a needle system, and in the other 158 cases by a dye injection of a 3% sterile charcoal suspension using stereotactic method (118 cases) or sonography (40 cases). The patients' mean age was 53 years (range 30-75). Mammography revealed regular opacities in 133 cases, clustered microcalcification in 75, diffuse microcalcification in 24, opacities with irregular borders in nine and opacities with internal microcalcifications in 12. The histological findings showed benign breast disease in 175 cases (69.2%), borderline breast disease in 23 (9.1%) and malignancy in 55 (21.7%). The benign/malignant/borderline lesions ratio was 3.2:1. The majority (70%) of these malignant lesions were small cancers (less than 1 cm in diameter) and without lymph-node involvement. The biopsy cost (benign/malignant/borderline ratio, patients discomfort and cosmetic result) has been acceptable.

Feasibility of thymidine labelling index on fine needle aspirates from breast cancer: comparison with surgical samples.

Fine-needle aspiration (FNA) provides a suitable diagnostic tool in the management of patients with breast cancer lesions. The current study reports on tumor proliferative activity, by 3H-Thymidine Labelling Index (TLI), assessed on 59 FNA (TLI1) and 28 surgical specimens (TLI2) from the same breast cancer patients. Median TLI values from FNA and surgical material were 1.0% and 0.7%, respectively. In the 28 patients, evaluable for the comparison between TLI1 and TLI2, the association was found to be highly significant (p = 0.000). Moreover, no change in tumor proliferative activity was observed in the majority (79%) of cases when evaluated preoperatively and at surgery. This study confirms the feasibility of TLI analysis on FNA from breast cancer and provides results superimposable on those obtained in a tissue sample from the same patient.

Prevalencia de obesidad en escolares de enseñanza básica / Prevalence of obesity among basic school children

La obesidad en el niño produce a mediano y largo plazo graves trastornos metabólicos y en forma inmediata tiene serias consecuencias psicológicas. Este estudio se realizó con el propósito de describir la prevalencia de obesidad en la población escolar, comparando sexo, edad y nivel socioeconómico (NSE). Se estudiaron 1.219 niños de un colegio de la comuna de las Condes (colegio A) y 1.030 niños de un colegio de la comuna de San Miguel (colegio B). En todos se registró peso, talla, edad, que varió entre 5,5 y 15,5 años. El estado nutricional se evaluó mediante tablas NCHS peso/edad y talla/edad, calculando el índice peso talla según Durant, definiendo obesidad por un índice igual o mayor a 120. E1 NSE determinado mediante escala de Graffar modificada, aplicada a 83 niños del colegio A y a 129 del colegio B, fue significativamente mejor en el colegio A (p<0,01). La prevalencia de obesidad del colegio A fue 12,63 por ciento y la del colegio B 9,03 por ciento (p<0,05). Se encontró que las mujeres del colegio A en el rango 5,5 a 8,5 años eran las mas obesas. Al comparar los hombres de ambos colegios se encontró un porcentaje mayor de obesidad en el rango de 9 a 12 años en el colegio A (p<0,05). Respecto a la edad, sólo se encontró tendencia a la disminución de la obesidad con la edad, pero esta no fue significativa. Puesto que la obesidad en la edad escolar está fuertemente asociada a la del adulto, este grupo constituye un objetivo adecuado para la prevención y tratamiento de ella