Value of 3D Preoperative Planning for Primary Total Hip Arthroplasty Based on Biplanar Weightbearing Radiographs.

Two-dimensional (2D) planning on standard radiographs for total hip arthroplasty may not be sufficiently accurate to predict implant sizing or restore leg length and femoral offset, whereas 3D planning avoids magnification and projection errors. Furthermore, weightbearing measures are not available with computed tomography (CT) and leg length and offset are rarely checked postoperatively using any imaging modality. Navigation can usually achieve a surgical plan precisely, but the choice of that plan remains key, which is best guided by preoperative planning. The study objectives were therefore to (1) evaluate the accuracy of stem/cup size prediction using dedicated 3D planning software based on biplanar radiographic imaging under weightbearing and (2) compare the preplanned leg length and femoral offset with the postoperative result. This single-centre, single-surgeon prospective study consisted of a cohort of 33 patients operated on over 24 months. The routine clinical workflow consisted of preoperative biplanar weightbearing imaging, 3D surgical planning, navigated surgery to execute the plan, and postoperative biplanar imaging to verify the radiological outcomes in 3D weightbearing. 3D planning was performed with the dedicated hipEOS® planning software to determine stem and cup size and position, plus 3D anatomical and functional parameters, in particular variations in leg length and femoral offset. Component size planning accuracy was 94% (31/33) within one size for the femoral stem and 100% (33/33) within one size for the acetabular cup. There were no significant differences between planned versus implanted femoral stem size or planned versus measured changes in leg length or offset. Cup size did differ significantly, tending towards implanting one size larger when there was a difference. Biplanar radiographs plus hipEOS planning software showed good reliability for predicting implant size, leg length, and femoral offset and postoperatively provided a check on the navigated surgery. Compared to previous studies, the predictive results were better than 2D planning on conventional radiography and equal to 3D planning on CT images, with lower radiation dose, and in the weightbearing position.

The importance of a thorough medical and pharmacological history before dental implant placement.

The risk of osteonecrosis in patients treated with bisphosphonates is well known and guidelines intended to prevent this complication have been established and accepted. Bisphosphonate related osteonecrosis of the jaws (BRONJ) is a unique condition in which even past administration of medication may be of current and future relevance. We present a case of BRONJ in the maxilla after dental implant placement. The patient suffered from osteoporosis and had been treated with oral alendronate sodium in the past. However, the medication was stopped two years before implant placement, and the treating dentist was unaware of the patient's past bisphosphonate use. Prevention of BRONJ is based on identifying at-risk patients, and then avoiding or modifying dentoalveolar surgical procedures in these individuals. Nevertheless, there seems to be some difficulties identifying patients at risk. We present some of the challenges that impede thorough assessment of a patient's medical background (review of systems) in the dental office, and suggest possible solutions.

Pseudomyxoma peritonei.

The authors report a case of a 60 years old Romanian male with peritoneal pseudomyxoma that was discovered to have a primary location in the greater omentum. Pseudomyxoma peritonei arising into the greater omentum is very rare. It is an original case report and the new data represents a well-balanced summary of a timely subject, with reference to the literature. This it is a significantly advance in our understanding of a particular disease etiology. Until now, only a few primary greater omentum pseudomyxoma peritonei have been described. Clinical and pathologic findings of this case are presented and the topic of primary location in the great omentum of pseudomyxoma peritonei was reviewed. Preoperative ultrasound examination showed the presence of an "eyes of net" tumoral-mass formation, in the greater omentum, and a fluid collection was found in the abdomen (Morrison space and the pouch of Douglas). Notwithstanding, diagnosis of pseudomyxoma was preoperatively considered less probable due to the rarity of the affection and the advanced age. During laparotomy, the presence of the large mass observed at the ultrasound examination was revealed. Mucinous ascites was present with invasive mucinous implants in the peritoneum and in the greater omentum. Operation consisted in the total removal of the mass followed by evacuation of the mucinous ascites. Histological examination confirmed the clinical diagnosis of pseudomyxoma peritonei.

Osteoarticular tuberculosis--a ten years case review.

Extrapulmonary sites of tuberculosis must not be neglected as they are not so rarely fortuitous discovering. The morphological diagnosis of tuberculosis is generally easy to do. However, there are the atypical lesions rising diagnostic difficulties. The authors reviewed the histopathological diagnostic in 19 cases of osteoarticular tuberculosis lesions selected from 390 cases of surgical extrapulmonary granulomatous lesions, using for difficult cases, with atypical lesions, new diagnostic tools as immunohistochemistry and DNA amplification technique by the polymerase chain reaction.

Morphoclinical study of intracerebral haemorrhage with intraventricular extension.

AIMS: The study is an integrated assessment of clinical, image and morphological parameters in severe intracerebral haemorrhages (ICH) complicated with intraventricular extension (IVE). MATERIAL AND METHODS: The studied group had 93 cases of patients with ICH and IVE who were hospitalized in the Emergency County Hospital of Craiova and died during hospitalization. The parameters evaluated were clinical (relation with the seasons, age, sex, arterial blood pressure, the motor deficit, degree of coma, Glasgow score at admission and medical care) and morphological (the sites of the intraparenchymal haematoma and IVE, the size of the intraparenchymal haematoma, the presence of the mass effect, perilesional oedema and subarachnoid effusion). The latter were assessed on CT films and during autopsy. RESULTS: The presence of IVE as a complication of ICH showed a predilection for cold seasons, especially autumn. From the 93 studied cases 51 were men and 42, women. 52.6% of the patients were in the fifth and sixth life decade. Almost 80% of the patients had IIIrd stage arterial hypertension at admission, over 80% motor deficits and almost 60% Glasgow scores lower than 6. The ventricular effusion involved at least one of the lateral ventricles. The hematomas had huge dimensions as compared to hosting encephalic structures, in lobar sites involving more than one lobe. Other risk factors as mass effect and perilesional oedema were constantly present. CONCLUSIONS: The association of IVE with other independent risk factors such as hypertension, low Glasgow scores volume of intraventricular bleeding, dimensions of haemorrhagic foci, presence of mass effect and perilesional oedema results in the death of patient despite any sustained therapeutic intervention.

Study of cerebral vascular structures in hypertensive intracerebral haemorrhage.

AIMS: The study was performed in order to assess the alterations of extra-parenchymal and intraparenchymal vascular structures in 82 hypertensive patients suspected of primary intraparenchymal hematoma, which died and were autopsied in order to confirm the diagnosis. MATERIAL AND METHODS: The studied material consisted of nervous tissue situated near and distant from the haemorrhagic lesion. The specimens of nervous tissue were processed by the classical histological technique and stained with the usual stainings and with immunohistochemical stains for basement membranes and endothelial cells. RESULTS: Extra-parenchymal arteries showed classic lesions of atherosclerosis. Atheromatous lesions were of all types, even the extension towards the media being encountered a complication with thrombosis. At the level of the intraparenchymal blood vessels, the spectrum of the lesions due to arterial hypertension included all steps of vascular wall degeneration, from hypertrophy of smooth muscle layer to complete hyalinization of arterial wall, but with a focal irregular distribution, not related with the proximity of haemorrhagic focus. High arterial blood pressure also influenced the capillary walls which showed focal or circumferential thickening due to the densification of the type IV collagen material from the basement membrane structure. The CD34 immunostaining showed that endothelial cells kept their structural integrity. CONCLUSIONS: The sequence of degenerative lesions of the cerebral vascular wall culminates with the hyalinization of excessive fibrillar material form arteriolar wall or from basement membranes. Hyalin material is weakening the wall resistance to the stress determined by the high values of blood pressure in hypertension, and, correlated with a minimal resistance of the surrounding cerebral parenchyma, can explain why the cerebral parenchyma is the only tissue in which blood pressure variations can determinate vascular rupture and cerebral haemorrhage. The more adequate term for describing the vascular wall changes seems to be sclerosis (arteriolar and even capillary) with hyalinosis.

[Elements of gynecology pathology in girls before and during puberty age]. / Elemente de patologie ginecologica la fetite înainte si la vârsta pubertatii.

PURPOSE: The annexial pathology in little girls is representing a more and more frequent form of acute and chronic abdomen, especially in girls around the age of puberty with dysfunction of the menstrual cycle correlated with disturbance of growing and the occurrence of secondary sexual characters. If this kind of pathology is frequent in the period of puberty, there are cases diagnosticated at small ages. MATERIAL & METHODS: The authors are communicating a number of 25 cases with anexial pathology some of them manifesting the symptoms of the acute abdomen (most of them with torsion of the normal or pathological annexes) others having a chronic aspect. The clinical examination correlated with the imagistic investigations were the main elements for the diagnosis. RESULTS & CONCLUSIONS: The results were good, the follow-up of the patients is including social therapy with the girls and their families, for integration in the family, evaluating the chance of giving birth. The occurrence of some forms of acute abdomen was frequent on a pathologic annexes (malformated annexes), causing sometimes the excision of it, extended to the uterus. The presence of a malign tumour can be related with different malformations, also caused by exposure to some risk factors: radiation, pollution, chemical agriculture, deficitary alimentation, stress etc.).

[Intestinal tuberculosis in children. Differential diagnosis and treatment]. / Tuberculoza intestinala la copil. Diagnostic diferential, conduita terapeutica.

Lately, tuberculosis has became a top priority problem in health all over the world. The actual level of epidemiological indicates of tuberculosis Shaw that Romania is the country that has the most unfavorable situation in Europe except for Bosnia-Herzegovina. Tuberculosis incidence from 1996 to 1997 ranks Dolj county second in Romania from the point of view of the increasing rate (154.3% + 25.4% versus 107% + 4.3%). The National Programme of Controlling Tuberculosis for 1997-2000 has as main object the neutralization of a least 85% of the discovered contamination sources. At the same time with the pulmonary tuberculosis were discovered 17.2% extrapulmonary localizations. The purpose of these works is that of presenting in the frame of extrapulmonary TBC the localization of intestinal TBC with children (peritonitic form with infants and pseudotumoral with child). In class cooperation with the veterinary Medicine Service we have also studied the possibility of same sources of TBC infection of animal origin, knowing the fact that besides the human Koch bacillus were discovered bovine, ovine, poultry sources. Presenting a number of 16 cases of intestinal tuberculosis with children, rare cases of extra pulmonary tuberculosis, the authors also present 2 cases with children whose differential diagnosis had to be made ou a histopathological base between tuberculosis with an abdominal lymphoma or peritonitic carcinomatosis. The results of the surgical treatment that made the diagnosis with the help of the histopathological examination and the tuberculostatic treatment were very good, the evolution and the control in true of all the patients, proving that intestinal tuberculosis extrapulmonary form with children can be cured.

[Sacrococcygeal teratoma in children. Anatomo-clinical, therapeutic and prognostic considerations]. / Teratomul sacro-coccigian la copil. Consideratii anatomo-clinico-terapeutice si prognostice.

Presentation of potentially malignant tumours, highly frequently found in children, developed out of embrionary remnants. Study of clinical observation files, iconography resources, histopathological samples and surgical operation notes, corroborated with patient's reexamination several years later. There are presented nine clinic cases of tumours found in newborn, babies and even in young children, with teratome-like structure, that have malignant potential if excised late. Histopathological laboratory tests of the biotic sample are of paramount importance in establishing the structure of the tumour, its malignization abilities and the therapeutical conduct to be adopted. Other useful investigations: radiographs of the vertebral column, abdominal echographs, computerized tomography. Besides sacrococcygian, large and anesthetic, location in newborn, there are presented cases of intra-abdominal teratomes and one case of ovarian teratome. The study also contains a general opinion upon the patients operated on the reexamined several years later.

Assessment of Gleason system use on different types of prostatic tissue samples.

One of the well-known and accepted methods of prostatic adenocarcinoma grading is Gleason system. The authors made a retrospective analysis of 221 prostatic adenocarcinomas divided into three groups (transvesical prostatectomies, transurethral resections and needle biopsies) following the type of surgical procedure used for drawing the tissue. Gleason scores and comparison between odd and even Gleason scores were assessed in the entire group and in each subgroup. High scores prevailed, meaning a tendency towards a low grade of differentiation. Even scores also prevailed meaning, on one hand, that, often, the examined specimen reveals only one pattern and, on the other hand, that surgical procedures as transurethral resections and unique needle biopsies cannot offer a sufficient material for examination, the multicentricity of prostatic carcinoma being well known.

Comparative study between prostatic carcinoma G1-G3 and Gleason grading systems.

The need of an accurate and prognostically valuable method for grading the prostatic carcinoma resulted in, in the last decades, a large number of systems, none of them succeeding in being unanimously accepted by the pathologists family. The authors selected and reassessed using Gleason system a group of 221 cases with prostatic adenocarcinoma previously diagnosed using a combined G1-G3 system. The results were converted from Gleason system to G1-G3 system and then compared with the initial diagnostics. The group was divided, following the type of surgical procedure used for drawing the tissue, into three groups: transvesical prostatectomies (TVP), transurethral resections (TUR) and needle biopsies (B). The concordance between the two systems was good, even the number of TUR and B specimens was significant (85% of the studied group) showing that any of them can be successfully used in current practice, depending only on pathologist's experience.

Histopathologic and immunohistochemic correlations in virus B chronic hepatitis.

Complete diagnosis of chronic hepatitis relies on exploring the liver by bipsic punction, performing the classic histopathologic and immunohistochemic exams. We worked out viral antigens hepatocytes by using avidin-biotin-peroxidase complex technique as following: Ag HBs placed in cytoplasm or at the level of the cell membrane. Ag HBc preferably placed in nucleus and, a small part of it, in cytoplasm. Ag HD present especially in nucleus. A correlation between tissular antigen expression and hepatic histopathologic aspect was established. Two main types of viral expression were remarked: a regressive type reflected by cytoplasmatic Ag HBs in the absence of generalised nuclear Ag HBc--situations linked to persistent chronic hepatitis: an aggressive type characterised by the presence of the focal nuclear Ag HBc, cytoplasmatic Ag HBc or antigen HD--situations linked to active chronic hepatitis with various degrees of severity.

Manejo del carcinoma temprano de cuello uterino sólo con radioterapia intracavitaria / Treatment of initial cervical cancer with intracavitary radiotherapy as an only treatment

Entre 1984 y 1988, 36 pacientes portadores de carcinoma temprano de cervix (CTC) médicamente inoperables, fueron admitidas en el Departamento de Radioterapia del Instituto Nacional de Enfermedades Neoplásicas de Lima, Perú. Todas recibieron como tratamiento único, terapia intracavitaria, mediante una o dos aplicaciones de Ra 126. Los autores reportan los resultados de un análisis retrospectivo no randomizado con seguimiento mínimo de cinco años. La distribución por estadios fue: Ca in situ: 1 paciente (2.47 por ciento), Estadio IA: 6 pacientes (16.6 por ciento) y Estadio IB occ: 29 pacientes (80.7 por ciento). El diagnóstico histológico fue carcinoma epidermoide en todos los casos. El promedio de edad fue de 55 años (menor edad 32 años, mayor edad 78 años). El tratamiento consistió en 2 aplicaciones de Ra 126 intracavitario durante 120 horas c/u (intervalo de un mes entre aplicación y aplicación) en 30 pacientes (Ca in situ=1, Estadio IA=4 y Estadio Ib occ=25). Dos aplicaciones de 72 horas c/u (intevalo de 15 días entre aplicación y aplicación) en 4 pacientes (Estadio IA =1, Estadio IB occ=3) ó una sola aplicación de 120 horas en las dos restantes (Estadio IA=1, Estadio IB occ=1). Se obtuvo control local en la paciente portadora de Ca in situ, y en todas en estadio IA, y 28/29 en estadio IB occ (96.55 por ciento). La sobrevida a cinco años fue de 100 por ciento en el caso de Ca in situ, 83 por ciento en el estadio IA y 86 por ciento en el estadio IB occ. La incidencia de complicaciones fue baja y resuelta sólo con tratamiento médico. Una paciente desarrolló adenocarcinoma de recto a los tres años del tratamiento. Los autores concluyen que la irradiación intracavitaria como única modalidad de tratamiento en los casos de cáncer de cuello uterino temprano, médicamente inoperable, es una excelente opción con resultados semejantes a los obtenidos con cirugía

Radioterapia en cáncer de pulmón no-oat cell / Radiotherapy in no oat-cell lung cancer

Se han revisado 96 historias correspondientes a pacientes portadores de cáncer de pulmón no-oat cell tratados con Radioterapia o Radioterapia postquirúrgica, de 1988 a 1990 en el Instituto Nacional de Enfermedades Neoplásicas. Las edades estuvieron entre 30 y 91 años, estando la mayoría en la sexta década de la vida, 76 fueron varones y 20 mujeres. Se encontró 56 casos de carcinoma epidermoide , 37 adenocarcinomas, 4 otros y 2 no tuvieron datos histológicos. La mayor parte correspondió a neoplasias avanzadas, cuya distribución por estadíos clínicos fue la siguiente: I 0, II 3, IIIA 21, IIIB 37, IV 33, no determinado 2. No han sido considerados para esta evaluación los pacientes que tuvieron tratamiento sistémico. Todos los casos fueron tratados con radioterapia externa usando para ello Cobalto 60, con múltiples fraccionamientos. Se evalúa en este estudio el cumplimiento de éste y el resultado en cuanto a la mejoría clínica a fin de intentar determinar el esquema óptimo, pues la mayoría presentó enfermedad avanzada con una expectativa de vida corta. Se logró alcanzar 53.12 por ciento de mejoría clínica en forma global, siendo las curvas de sobrevida similares para los diferentes esquemas de tratamiento. En la actualidad hay solamente 4 pacientes vivos

Terapia intracavitaria en el tratamiento del cáncer de cuello uterino / Intracavitery therapy in the treatment of cervix's cancer

Los autores realizan una revisión retrospectiva de 43 planificaciones computarizadas correspondientes a igual número de casos de cáncer de cuello uterino tratados entre enero y febrero de 1992 en el Departamento de Radioterapia del INEN. Se considera la dosis absorbida en diferentes puntos de referencia según el reporte ICRU 38 y gLAC. Se llega a la conclusión que dichos puntos de referencia guardan relación entre sí y que los de mayor importancia son los que se encuentran a nivel de vejiga y recto puesto que la dosis de tolerancia a dicho nivel será la que decida la dosis total. Se recomienda un seguimiento a futuro en los casos para poder establecer una correlación más estrecha entre dosis absorbida en los diferentes puntos de referencia con control local y complicaciones tardías

Sindrome de compresión medular / Spinal cord compression syndrome

Los autores realizan una revisión retrospectiva de 105 casos tratados en el Departamento de Radioterapia del instituto de Enfermedades Neoplásicas atendidos entre 1973 y 1992. La finalidad de la presente evaluación fue determinar la influencia del tratamiento de radiaciones en los pacientes con síndrome de compresión medular en lo referente a paliación de la sintomatología (dolor) y mejoría del déficit funcional (deambulación) porpio de este síndrome. Se recurrió a las fichas de tratamiento del archivo del Departamento de Radioterápia del INEN que tenían el diagnóstico de síndrome de compresión medular y con los números de las historias clínicas procedimos a recolectar los datos que en ella se reportan. Treitidós, de treitinueve pacientes (82 por ciento), que acudieron por sus propios medios a recibir tratamiento luego del diagnóstico de síndrome de compresión medular, continuaron caminando luego de recibir tratamiento. Ocho de sesentiseís pacientes (12 por ciento) que acudieron en silla de ruedas o cama, a recibir tratamiento, pudieron movilizarse por sus propios medios una vez finalizado el tratamiento con radiaciones. Cuarentiún pacientes (64 por ciento) tuvieron mejoría parcial del dolor y quince (24 por ciento) total, luego de recibir tratamiento. En los pacientes que acudieron por sus propios medios y no perdieron esta característica luego del tratamiento, se observó mejoría en su funcionalidad. Concluimos que el tratamiento con radiaciones ofrece beneficio paliativo en los pacientes con síndrome de compresión medular.

[The relationship of the lesions in choroidal benign nevus-malignant melanoma]. / Filiatia lezionala nev benign-melanom malign coroidian.

The paper presents the case of a 67-year-old female patient with an old posterior choroidal nevus, which has became malignant later. Microscopically, at the periphery of the malignant melanoma, long benign melanic cells are revealed, with nuclei centrally disposed and net cellular limits. The pigmentation of these cells, in parallel sequences of 4-5 rows each, is intense. The external part of the choroid, which has a regular aspect, is continued with B-type malignant cells. Finally, the origin of the malignant melanoma, derived from preexistent nevi, is discussed.

Cancer de cuello uterino ECIIB: una alternativa en el tratamiento radical. comparación de un esquema corto de radioterapia vs. el concencional / Stage IIIB cervical cancer: an alternative for the radical treatment.

Entre agosto de 1991 y enero de 1992, cien pacientes portadoras de Ca de Cervíx EC IIIB fueron ramdomizadas para recicir uno de los esquemas de fraccionamiento de radioterapia. La finalida fue comparar tolerancia y respuesta tumoral al emplear un esquema convencional de tratamiento y otro corto, pero con dosis radiobiológicamente equivalentes. 50 pacientes recibieron 50 Gy a la pelvis administrados en 25 fracciones, 2 Gy por fracción, 5 veces por semana por 34 días (Grupo A). Las 50 pacientes restantes recibieron 39 Gy a la pelvis en 13 fracciones, 3 Gy por fracción, 5 veces por semana por 18 días (Grupo B). En todos los casos se usó energía de Co 60. Luego de finalizada la teleterapia, las pacientes de ambos grupos completaron el tratamiento de braquiterapia. La dosis promedio fue de 50 Gy al punto A mediante una aplicación de Ra-226. Se emplearon aplicadores de carga diferida (Fletcher-Suit-Delclos) en la mayoría de los casos. Los dos grupos fueron similares con respecto a distribución etarea, estadio clínico según la F.I.G.O. e historia clínica. El seguimiento fue por un mínimo de 22 meses y un máximo de 27 meses. Los resultados en ambos grupos fueron similares y no se halló diferencia estadisticamente significativa. Se observó náusea en 20/50 pacientes del grupo A y en 26/50 del grupo B (p= 0.2286). Se presentó vómito en 9/26 y 7/20 pacientes (p= 0.9783) de los grupos A y B respectivamente.Otra manifestación de toxicida gastrointestinal fue diarrea en 19/50 pacientes del grupo A y 16/50 pacientes del grupo B (p= 0.8359). Dermatitis por radiación fue observada en 18/50 pacientes que recibieron 50 Gy y en 16/50 de las que recibieron 39 Gy (p= 0.6729). En ningún caso fue necesario la suspensión del tratamiento. 31 pacientes del grupo A y 28 del grupo B fueron catalogadas como pacientes con control local de la enfermedad (p= 0.5419). Las tasas de recurrencia fueron de 12 por ciento y 10 por ciento (p=0.7492), mientras que la sobrevida a 2 años fue de 76 y 68 por ciento (p= 0.3730) para el grupo A y B, respectivamente. Nuestros resultados son halagadores y muestran que no existe diferncia significativa entre ambos grupos. Nuestras pacientes se encuentran en evaluación permanente para observar resultados a 5 y 10 años, de tal forma que si no encontramos alteraciones significativas, 39 Gy en 13 fracciones podrá ser considerada como alternativa al tratamiento convencional en nuestras pacientes portadoras de Ca de Cérvix IIIB.

Metastasis cerebral por cáncer de mama / Brain metastases from breast cancer

Se revisaron las historias clínicas de 82 pacientes portadoras de metástasis cerebral por cáncer de mama que recibieron irradiación en el cráneo en el Departamento de Radioterapia del INEN entre 1986 y 1992. La edad promedio de presentación fue de 47.76 años con una desviación estándar 10.70 para un rango de edad que varió entre 27 y 78 años. El síntoma de presentación más frecuente fue cefalea en 34/82 pacientes (41.46 por ciento) seguido por déficit focal en 16/82 pacientes (19.51 por ciento) y convulsiones en 13/82 casos (15.85 por ciento) principalmente. El intervalo entre el diagnóstico del primario y aparición de la metástasis cerebral fue de 39.78 meses en promedio con una mediana de 28.43 meses y desviación estándar de 35.17 para un rango que varió entre 0 y 168 meses. 57 pacientes presentaron metástasis en otro lugar; 30 casos de localización múltiple (53.6 por ciento), 13 en partes blandas (19.6 por ciento), 8 en estructuras óseas (14.3 por ciento) y 7 en el pulmón (12.5 por ciento). Las dosis de tratamiento variaron entre 30 y 60 Gy. Se obtuvo respuesta objetiva en 45/60 pacientes evaluables (75 por ciento). La sobrevida promedio fue de 5.44 meses con una media de 4 meses y desviación estándar de 7.89 para un rango que varió entre 1 y 48 meses. Las pacientes que tuvieron diagnóstico tomográfico de lesión única tuvieron mejor pronóstico, estadisticamente significativo, con respecto a las que tuvieron lesiones múltiples (p=0.032). En conclusión el presente estudio demuestra que la metástasis por cáncer de mama no guarda relación con la presencia de factores que influyan en la sobrevida total, salvo que se trate de una lesión única.