Retrospective study assesing the role of MRI in the diagnostic procedures for early breast carcinoma: a correlation of new foci in the MRI with tumor pathological features

BACKGROUND: Use of breast magnetic resonance imaging (MRI) to detect breast cancer has generated significant debate. We analyze the role of breast MRI in the detection of additional disease and the need to perform additional biopsies in early breast carcinoma patients. In addition, we correlate the detection of new foci with tumor pathological features. METHODS: Early breast carcinoma patients that had undergone an MRI as well as a mammography as diagnostic procedures were included in the study. The following pathologic features were studied: carcinoma type, histological grade, estrogen receptors (ER), progesterone receptors (PR), HER2 and Ki67. Univariate analysis was conducted to ascertain significant correlation among detection of new foci and each of the tumor pathological features. RESULTS: Data from 98 patients have been analyzed: median age 49 years (range 35-79); carcinoma type: (a) infiltrative ductal carcinoma (n = 73, 74 %), (b) infiltrative lobular cancer (n = 12, 12 %), (c) ductal carcinoma in situ (n = 6, 6 %); amplified HER2 (n = 18, 18 %); grade III (n = 33, 33 %); Ki67 ≥ 25 % (n = 33, 33.67 %); positive ER and PR (n = 79, 80 %); triple negative tumors (n = 8, 8 %). MRI detected additional disease in 38 cases (39.58 %), and 20 led to an additional biopsy (20.4 %). Thirty-eight patients (39 %) underwent mastectomy. We found a statistically significant correlation between new foci in MRI and high Ki67 ≥ 25 % (p < 0.005). No other statistically significant correlation was established. CONCLUSION: MRI detected additional disease in 39 % cases, requiring an additional biopsy 20 %. Tumors with high proliferative index were significantly correlated with the detection of new foci in MRI (AU)

Retrospective study assessing the role of MRI in the diagnostic procedures for early breast carcinoma: a correlation of new foci in the MRI with tumor pathological features.

BACKGROUND: Use of breast magnetic resonance imaging (MRI) to detect breast cancer has generated significant debate. We analyze the role of breast MRI in the detection of additional disease and the need to perform additional biopsies in early breast carcinoma patients. In addition, we correlate the detection of new foci with tumor pathological features. METHODS: Early breast carcinoma patients that had undergone an MRI as well as a mammography as diagnostic procedures were included in the study. The following pathologic features were studied: carcinoma type, histological grade, estrogen receptors (ER), progesterone receptors (PR), HER2 and Ki67. Univariate analysis was conducted to ascertain significant correlation among detection of new foci and each of the tumor pathological features. RESULTS: Data from 98 patients have been analyzed: median age 49 years (range 35-79); carcinoma type: (a) infiltrative ductal carcinoma (n = 73, 74 %), (b) infiltrative lobular cancer (n = 12, 12 %), (c) ductal carcinoma in situ (n = 6, 6 %); amplified HER2 (n = 18, 18 %); grade III (n = 33, 33 %); Ki67 ≥ 25 % (n = 33, 33.67 %); positive ER and PR (n = 79, 80 %); triple negative tumors (n = 8, 8 %). MRI detected additional disease in 38 cases (39.58 %), and 20 led to an additional biopsy (20.4 %). Thirty-eight patients (39 %) underwent mastectomy. We found a statistically significant correlation between new foci in MRI and high Ki67 ≥ 25 % (p < 0.005). No other statistically significant correlation was established. CONCLUSION: MRI detected additional disease in 39 % cases, requiring an additional biopsy 20 %. Tumors with high proliferative index were significantly correlated with the detection of new foci in MRI.

Mixed paratesticular liposarcoma with osteosarcoma elements

Spermatic cord sarcomas (SCS) are very infrequent and sometimes misdiagnosed malignancies. Moreover, their optimal management remains undefined with ongoing controversy about the indications for adjuvant therapy. Histologically, liposarcomas are the most common type. Osteosarcoma is rarely observed in this location and combined tumours with this component have not been described. We present a case of SCS with mixed differentiation with both liposarcoma and osteosarcoma elements (AU)

[Auditory training with wide-band white noise: effects on the recruitment (III)]. / Entrenamiento auditivo con ruido blanco de banda ancha: efectos sobre el reclutamiento (III).

The auditory training with wide-band white noise is a methodology for the qualitative recovery of the hearing loss in people suffering from sensorineural hearing loss. It is based on the application of a wide-band white modified noise. In a prospective study, we have assessed the modifications of the recruitment coefficient in a sample of 48 patients who have followed a program of 15 auditory training with wide-band white noise sessions. The average improvement of the recruitment coefficient expressed in percentage is a 7.7498%, which comes up to 23.5249% in the case of a binaural recruitment coefficient. From our results, it can be deduced that the auditory training with wide-band white noise reduces the recruitment. That is to say, the decrease of the recruitment in high intensities both binaurally and in all ears.

[Auditory training with wide-band white noise: effects on the pain threshold and pure tone thresholds]. / Entrenamiento auditivo con ruido blanco de banda ancha: efectos sobre la algiacusia y los umbrales tonales (IV).

The auditory training with wide-band white noise is a methodology for the qualitative recovery of the hearing loss in people suffering from sensorineural hearing loss. It is based on the application of a wide-band white modified noise. In a prospective study, we have assessed the modifications of the total auditory threshold (UAt), the conversational auditory threshold (UAc), and the pain threshold (Ud) in a sample of 48 patients, who have followed a program of 15 auditory training with wide-band white noise sessions. The average improvements of the variables expressed in percentage are 0.78% for the UAt, 0.64% for the UAc, and 5.31% for the Ud. From our results, it can be deduced that the auditory training with wide-band white noise does not modify the pure tone thresholds, but it moves the pain threshold towards higher intensities, enlarging the dynamic auditory field.

[Auditory training with wide-band white noise: effects on the verbal discrimination]. / Entrenamiento auditivo con ruido blanco de banda ancha: efectos sobre la discriminación verbal (II).

The auditory training with wide-band white noise is a methodology for the qualitative recovery of the hearing loss in people suffering from sensorineural hearing loss. It is based on the application of a wide-band white modified noise. In a prospective study, we have assessed the modifications of the verbal reception threshold URV), the maximum discrimination (Dmax), and the discrimination coefficient (Kd) in a sample of 48 patients, who have followed a program of 15 auditory training with wide-band white noise sessions. The average improvements of the verbal discrimination variables expressed in percentage are 4.23% for the URV, a 9.04% for the kd, a 17.87% for the Dmax, and 4.32%, 10.05%, 13.04% for the binaural URV, Kd and Dmax respectively. From our results, it can be deduced that the auditory training with wide-band white noise improves the verbal discrimination measures. Not only it allows to reach the verbal reception threshold at a lower intensity, but also it moves the discrimination line towards the left. Furthermore, it increases the maximum discrimination both in binaural measurements and in those which consider all the ears.

[Auditory training with wide-band white noise]. / Entrenamiento auditivo con ruido blanco de banda ancha.

The auditory training with wide-band white noise is a methodology for the qualitative recovery of the hearing loss in people suffering from sensorineural hearing loss. It is based on the application of a wide-band modified noise which we will call "K-noise". The auditory trainer GAES 100 KT is a voice amplifier device with earphone outlets. It incorporates a wide-band noise generator which produces a noise that is a mixture of all the audibles frequencies. Therefore, it stimulates all the sensory cells in the organ of Corti, but from 1000 Hz it has a progressive fall towards the high pitch of 6 db per octave. This device consists of a series of controls which make possible to apply both the noise and the phonetic materials--texts and words lists that the therapist's voice presents--to either one of the ears or to both of them, in different intensities and for different periods of time. In this first article of our study of the auditory training with wide-band white noise we will review the different methods of hearing training and present not only the basic concepts on auditory training, but also the systematic we have followed to apply it.

[Olfactory esthesioneuroblastoma. Review of seven cases]. / Estesioneuroblastoma olfatorio. Revisión de siete casos.

Esthesioneuroblastomas are fairly rare malignant tumors: only 20 cases have been reported in Spanish records. It is locally aggressive and produces late recurrences. There is no such thing as a universally accepted treatment model. We describe our experience with 7 cases seen in our hospital from 1980 to 1996. A or B stages can be treated with irradiation, surgery or a combination of both. C stages with the most aggressive tendencies may require the combined use of preoperative irradiation, surgery and chemotherapy. We analyzed the forms of presentation, diagnosis, differential diagnosis, treatment, prognosis, and survival. The 5-year survival rate was 75, 60 and 41% for stages A, B and C, respectively.

[ENT outpatient surgery]. / Cirugía ambulatoria en ORL.

The number of patients who undergo outpatient surgery is constantly growing in Spain. Outpatient surgery is interesting not only because of its economy, but also the social benefits that derive from patients returning home sooner and the rapid reduction of the waiting list. We discuss our experience in the last year with 40 patients who underwent surgery. We made a comparative study of patients with the same pathology and anesthetic risk who were treated by outpatient surgery and those treated by inpatient surgery with a traditional technique who were admitted 24 hours before surgery. Our rate of complications (19%) was close to the traditional rate. However, 3, 927, 000 pesetas were saved and the patients were very satisfied, which encouraged us to continue. Indications and complications are discussed.

[Invasive giant prolactinoma]. / Prolactinoma invasivo gigante.

Large prolactin-secreting tumors are rare and their endocrinological and surgical management may be complex. We report the case of a patient with a prolonged history of unilateral tinnitus and sensation of a stopped-up ear who had a very large, invasive and aggressive tumor of the sphenoidal region with bone destruction, invasion of structures in every direction from the sellar region and extracranial extension to the ethmoid and nasopharynx. Serum prolactin level at the time of diagnosis was 16,860 ng/ml (normal: 3-17 ng/ml). Medical treatment with bromocriptine reduced the prolactin level to 31 ng/ml and reduced the size of the tumor, although less than expected. The literature is reviewed and the rarity of such large, invasive prolactinomas is highlighted, as well as the absence of symptoms and signs suggesting the presence of such a large tumor of the skull base.

[Middle ear carcinoma]. / Carcinoma de oído medio.

Middle-ear cancer represents 5 to 10% of all ear neoplasms. Risk factors include chronic suppurative pathology of the middle ear and prior irradiation. Most malignant tumors are squamous-cell carcinomas. We report the case of a 51-year-old woman with this process. The ideal treatment is mastoidectomy or pterosectomy followed by radiotherapy. We made a bibliographic review of the clinical manifestations, diagnosis, treatment, and prognosis of middle-ear cancer. Five-year survival rates range from 25 to 50% in patients who undergo surgery and radiotherapy.

[Changes in the middle ear mucosa of the Wistar rat after experimental resection and obstruction of the eustachian tube]. / Modificaciones en la mucosa del oído medio de la rata Wistar tras sección y obstrucción experimental de la trompa de Eustaquio.

Eustachian tube (ET) disfunction, alone or combined with other factors, is the main source of middle ear pathogenesis and can lead to other physiopathological events that originate disease (serous otitis media, adhesive otitis, cholesteatoma). In seven Wistar rats (study group), experimental mechanical obstruction of the left Eustachian tube was performed. Using an anterior cervical incision, the osteocartilaginous junction of the ET was severed and obliterated with a bit of muscle in order to prevent rechanneling. After a period of six months, the middle ear mucosa was removed for histological study. Comparisons were made of the experimental ear and the opposite ear, as well as the ears of three rats in the control group. We compared our findings with those of other authors and reviewed experimental animal models of serous otitis media and cholesteatoma that have been used to study the influence of ET in middle ear disease.