ABSTRACT
BACKGROUND: There is no evidence that supports the recommendation of sentinel lymph node biopsy (SLNB) in patients with breast cancer who have treated with neoadjuvant chemotherapy (NAC) to downsize tumors in order to allow breast conservation surgery, because NAC induces anatomical alterations of the lymphatic drainage. We evaluated the effectiveness of SLNB using intraoperative one-step nucleic acid amplification (OSNA) method to detect microscopic metastases or isolated tumor cells after NAC in patients with clinically negative axillary nodes at initial presentation. PATIENTS AND METHODS: We evaluated in patients with breast cancer and clinically negative axilla at presentation, the effectiveness of SLNB by OSNA after NAC (71 patients) or prior to NAC (40 patients). RESULTS: The rate of SLN identification was 100% in both groups. 17 women with SLNB prior to systemic treatment showed positive nodes (14 macrometastases and 3 micrometastases), and positive SLNB were detected in 15 women with SLNB after NAC, which were 14 macrometastases and 1 micrometastase. The negative predictive value of ultrasonography was 57.5% in patients with SLNB prior to neoadjuvant therapy and 78.9% in patients with chemotherapy followed by SLNB. CONCLUSIONS: Intraoperative SLNB using OSNA in women with clinically negative axillary lymph nodes at initial presentation who received NAC could predict axillary status with high accuracy. Also it allows us to take decisions about the indication or not to perform an axillary dissection at the moment, thus avoiding delay in the administration of chemotherapy and benefiting the patients from a single surgical procedure.
Subject(s)
Breast Neoplasms/drug therapy , Breast Neoplasms/surgery , Lymph Nodes/surgery , Neoadjuvant Therapy , Sentinel Lymph Node Biopsy/methods , Adult , Aged , Axilla , Breast Neoplasms/mortality , Breast Neoplasms/pathology , Case-Control Studies , Chi-Square Distribution , Cohort Studies , Disease-Free Survival , Female , Humans , Intraoperative Care/methods , Lymph Node Excision/methods , Lymph Nodes/pathology , Middle Aged , Neoplasm Invasiveness/pathology , Neoplasm Staging , Nucleic Acid Amplification Techniques , Predictive Value of Tests , Prognosis , Risk Assessment , Statistics, Nonparametric , Survival Analysis , Treatment OutcomeABSTRACT
Se presentan dos casos de linfoma de localización mamaria. En el primer caso el nódulo mamario fue la primera manifestación clínica de un linfoma. El segundo caso se trata de un linfoma secundario de mama, en el que la afectación mamaria es la expresión de la recurrencia de un linfoma no-Hodgkin. Se comentan los aspectos clínicos y diagnósticos de ambos casos, así como la controversia existente en cuanto a las distintas opciones terapéuticas(AU)
Herein we report on two cases of breast lymphoma. In the first case the mammary nodule was the first clinical manifestation of a lymphoma. The second case is a secondary lymphoma with breast involvement, as an expression of recurrence of a systemic non Hodgkin lymphoma. Clinical and diagnostic aspects of both cases are commented so as controversies about the different therapeutic options(AU)
Subject(s)
Humans , Female , Middle Aged , Lymphoma/complications , Lymphoma/pathology , Lymphoma , Lymphoma, Non-Hodgkin/complications , Lymphoma, Non-Hodgkin/diagnosis , Mammography/methods , Ultrasonography, Mammary , Carcinoma/diagnosis , /methods , Immunohistochemistry/trends , Immunohistochemistry , Cohort StudiesABSTRACT
BACKGROUND: Low rectal cancers situated less than 5 cm from the anal margin are still usually treated with abdomino-perineal excision (APE). Our aim is to compare the quality of life (QOL) of five-year survivors treated for low or very low rectal cancer with an advanced/complex coloanal procedure with the QOL of patients submitted to a standard APE with a definitive abdominal stoma. METHODS: Sixty-two patients, operated on radically for low or very low rectal cancer, who came for their fifth year follow-up visit and were free from cancer, were studied. Thirty patients (group 1) had an APE with permanent abdominal stoma. Thirty-two patients (group 2) had undergone a radical advanced and complex procedure to avoid the abdominal stoma. The patients received the European Organisation for the Research and Treatment of Cancer (EORTC) QOL-30 generic and the CR38 colorectal cancer QOL questionnaires with the recommendation to return the questionnaire to the hospital. The Mann-Whitney U-test and chi (2) Fisher test were employed for statistical analysis. RESULTS: All questionnaires were returned. Patients without a terminal abdominal stoma had a better score in six categories of the QOL 30 and in two categories of the CR38. No differences were observed in the other variables examined. CONCLUSIONS: After five years, cancer-free patients operated on for low or very low rectal cancer have a better QOL if a definitive terminal abdominal stoma was avoided.
Subject(s)
Colostomy , Quality of Life , Rectal Neoplasms/surgery , Aged , Colectomy , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Rectal Neoplasms/therapy , Surgical Stomas , Survival AnalysisABSTRACT
La necesidad de los médicos de acceder a información útil para el manejo de los pacientes, está limitada tanto por la gran cantidad de literatura científica que se publica como por su validez y relevancia. La medicina basada en la evidencia (MBE) es un instrumento de gran ayuda para conseguir esta información, a la vez que permite una autoformación continuada de calidad.En este trabajo se han aplicado los principios de la MBE.Así, hemos llevado a cabo una revisión sistemática de la bibliografía internacional, seleccionándose aquellos trabajos relevantes. Se analizaron dos escenarios: a) la revascularización coronaria frente a trasplante cardíaco y b) la angioplastia percutánea en la era del stent contra la cirugía de revascularización coronaria. De acuerdo con los criterios de inclusión se seleccionaron cuatro estudios en el primer apartado y tres trabajos en el segundo, dos de ellos son ensayos clínicos. Además se discuten aspectos relevantes sobre viabilidad miocárdica, punto este clave en la toma de decisiones terapéuticas en este tipo de pacientes.La MBE es una herramienta eficaz y fácilmente aplicable por cualquier médico interesado en mantener una formación continuada de calidad. (AU)
Subject(s)
Male , Middle Aged , Humans , Myocardial Ischemia/therapy , Evidence-Based Medicine , Stroke Volume , Myocardial Revascularization , Angioplasty, Balloon , Myocardial Ischemia/mortality , Heart TransplantationABSTRACT
Es un estudio de procedimiento y de caracter retrospectivo, transversal y epidemiologico, realizado en el Instituto Gastronterologico Boliviano Japones de Cochabamba, el material utilizado comprende, reporte microbiologico e historia clínica
Subject(s)
Female , Male , Humans , Adult , Aged , Urinary Tract InfectionsABSTRACT
El presente estudio tuvo como objetivo central determinar la tasa de aborto provocado en las mujeres del grupo etareo comprendido entre los 14 a 19 años, que estan incluidas en la educacion formal urbana del Departamento de Cochabamba. Nuestro pais, en uno de los peores contextos socio-economicos de America Latina, presenta pocos estudios respecto a aborto provocado, ninguno de ellos con estadisticas de los cuales se pueda inferir una realidad aproximada. Se considero como universo, a la poblacion total del nivel medio de educacion formal, urbana (fiscal y particular) del departamento de Cochabamba. De la poblacion del ultimo curso se extrajo una muestra del 16.5%, que corresponde al 3.2% respecto a todo el ciclo medio. Los resultados mas importantes son: una tasa de aborto provocado del 3.36% para el grupo etareo de 14 a 19 años de las estudiantes del ciclo educativo mencionado, dato que corresponde con una, relativamente baja tasa de inicio de relaciones sexuales para el mismo grupo: 23.36
