El rendimiento de la RM en la estadificación preoperatoria del carcinoma de mama sería independiente de factores clínicos y patológicos: análisis de subgrupos / Is the performance of MRI in preoperative staging of breast cancer independent of clinical and histological factors? A subgroup analysis

Objetivo: Determinar si la densidad mamaria, la edad, el estado menopáusico y el carcinoma in situ en la biopsia constituyen grupos de pacientes en quienes la RM mamaria preoperatoria es más rentable. Material y métodos: Estudiamos retrospectivamente a 264 pacientes intervenidas por cáncer de mama a las que se había realizado mamografía, ecografía y RM. Comparamos el tamaño tumoral medido con las 3 técnicas y su sensibilidad para detectar lesiones adicionales, tanto en todas los pacientes como en las clasificadas por densidad mamaria, edad, estado menopáusico o presencia de carcinoma intraductal en el estudio anatomopatológico. El estándar de referencia fue el diagnóstico anatomopatológico definitivo. Resultados: La RM fue la técnica que coincidió más con el tamaño anatomopatológico y mejor detectó las lesiones adicionales. Con la RM no observamos diferencias entre grupos al establecer el tamaño tanto en el total de la muestra como en el subgrupo de pacientes donde la RM tuvo valor añadido. Tampoco hubo diferencias para detectar lesiones adicionales en el grupo general excepto para lesiones multicéntricas, mayor en pacientes de más edad (p = 0,02). En el grupo de pacientes donde la RM tuvo valor añadido, la sensibilidad para las lesiones bilaterales fue superior en las pacientes con mamas grasas (p = 0,04). Las lesiones multifocales se detectaron significativamente mejor en pacientes premenopáusicas (p = 0,03). Conclusiones: La RM es mejor que la mamografía y la ecografía para establecer el tamaño tumoral y detectar lesiones adicionales. Nuestros resultados no identifican subgrupos donde la técnica sea más rentable (AU)

Objective: To determine whether preoperative breast MRI is more useful in patients according to their breast density, age, menopausal status, and biopsy findings of carcinoma in situ. Material and methods: We retrospectively studied 264 patients treated for breast cancer who had undergone mammography, ultrasonography, and MRI. We compared the size of the tumor on the three techniques and the sensitivity of the techniques for detecting additional lesions both in the overall group and in subgroups of patients classified according to their breast density, age, menopausal status, and histological findings of intraductal carcinoma. The definitive histological diagnosis was used as the gold standard. Results: MRI was the technique that was most concordant with the histological findings for the size of the lesion, and it was also the technique that detected the most additional lesions. With MRI, we observed no differences in lesion size between the overall group and the subgroups in which MRI provided added value. Likewise, we observed no differences in the number of additional lesions detected in the overall group except for multicentric lesions, which was larger in older patients (P=.02). In the subgroup of patients in which MRI provided added value, the sensitivity for bilateral lesions was higher in patients with fatty breasts (P=.04). Multifocal lesions were detected significantly better in premenopausal patients (P=.03). Conclusions: MRI is better than mammography and better than ultrasonography for establishing the size of the tumor and for detecting additional lesions. Our results did not identify any subgroups in which the technique was more useful (AU)

Is the performance of MRI in preoperative staging of breast cancer independent of clinical and histological factors? A subgroup analysis.

OBJECTIVE: To determine whether preoperative breast MRI is more useful in patients according to their breast density, age, menopausal status, and biopsy findings of carcinoma in situ. MATERIAL AND METHODS: We retrospectively studied 264 patients treated for breast cancer who had undergone mammography, ultrasonography, and MRI. We compared the size of the tumor on the three techniques and the sensitivity of the techniques for detecting additional lesions both in the overall group and in subgroups of patients classified according to their breast density, age, menopausal status, and histological findings of intraductal carcinoma. The definitive histological diagnosis was used as the gold standard. RESULTS: MRI was the technique that was most concordant with the histological findings for the size of the lesion, and it was also the technique that detected the most additional lesions. With MRI, we observed no differences in lesion size between the overall group and the subgroups in which MRI provided added value. Likewise, we observed no differences in the number of additional lesions detected in the overall group except for multicentric lesions, which was larger in older patients (P=.02). In the subgroup of patients in which MRI provided added value, the sensitivity for bilateral lesions was higher in patients with fatty breasts (P=.04). Multifocal lesions were detected significantly better in premenopausal patients (P=.03). CONCLUSIONS: MRI is better than mammography and better than ultrasonography for establishing the size of the tumor and for detecting additional lesions. Our results did not identify any subgroups in which the technique was more useful.

A study of the relationship between impulsiveness and obsessiveness in the general population. Inconsistency of the idea of the spectrum.

INTRODUCTION: The obsessivity and the impulsivity as personality traits have been object of few studies on the general population. The authors outline as objective to study if such features are co-existing constructs, as advocate some authors or the opposite extremes of a continuum as assert other. MATERIAL AND METHODS: They are studied the answers to a questionnaire on obsessive traits of the personality (MIRAP) and other referred to the impulsivity as trait, also, (ECIRYC) of a random sample of 418 subject extracted of the general population. They are applied multivariate statistic analysis technical (Factorial Analysis, Correspondence Analysis, and linear Regression Analysis) to establish the type of relationship that have the two studied personality traits. RESULTS: The total scores of the MIRAP and the ECIRYC are correlated of a manner statistically significant (r = .39; p< .01). The Correspondence Analysis of those total scores distributed in deciles and two linear Regression Analysis show, also, a direct relationship between both traits that it is statistically significant. The obsessivity and the impulsivity do not correlate with the principal factor of the opposite trait. All the factors of both traits are grouped mutually in a factor in a positive way, except the impulsive factor "haste" that makes it negatively with the obsessive factor "order". CONCLUSIONS: Our results indicate that the obsessivity and the impulsivity, as personality traits, they are constructs convergent and not opposite poles of a continuum. But, simultaneously, one of the five factors of each trait ("haste" and "order"), yes are behaved as opposite extremes of a continuum, within conceptual framework, wider, of the traits to those which belong.

Un estudio de la relación entre impulsividad y obsesividad en la población general. Inconsistencia de la idea del espectro / A study of the relationship between impulsiveness and obsessivity in the general population. Inconsistency of the idea of the spectrum

Introducción. La obsesividad y la impulsividad como rasgos de la personalidad han sido objeto de pocos estudios sobre la población general. Los autores plantean como objetivo estudiar si tales rasgos son constructos coexistentes, como abogan algunos autores o los polos opuestos de un continuum como afirman otros. Material y Métodos. Se estudian las respuestas a un cuestionario sobre rasgos obsesivos de la personalidad (MIRAP) y otro referido a la impulsividad como rasgo (ECIR y C) de 418 sujetos extraídos al azar de la población general. Se aplican técnicas de análisis estadístico multivariantes (Análisis Factorial, Análisis de Correspondencias, Análisis de Regresión lineal) para establecer el tipo de relación que tienen los dos rasgos estudiados. Resultados. Las puntuaciones totales del MIRAP y la ECIR y C correlacionan de un modo estadísticamente significativo(r=0,39; p<0,01). El Análisis de Correspondencias de esas puntuaciones totales distribuidas en deciles y dos Análisis de Regresión lineal muestran, también, una relación directa entre ambos rasgos que es estadísticamente significativa. La obsesividad y la impulsividad no correlacionan con el principal factor del rasgo opuesto. Todos los factores de ambos rasgos se agrupan factorialmente entre sí de forma positiva, excepto el factor impulsivo “precipitación” que lo hace negativamente con el factor obsesivo “orden”. Conclusiones. Nuestros resultados señalan que la obsesividad y la impulsividad, como rasgos de la personalidad, son constructos convergentes y no polos opuestos de un continuum. Pero, simultáneamente, uno de los factores de cada rasgo (“precipitación” y “orden”), entre cinco, sí se comportan como polos opuestos de un continuum, dentro del marco conceptual, más amplio, de los rasgos a los que pertenecen (AU)

Introduction. The obsessivity and the impulsivity as personality traits have been object of few studies on the general population. The authors outline as objective to study if such features are co-existing constructs, as advocate some authors or the opposite extremes of a continuum as assert other. Material and Methods. They are studied the answers to a questionnaire on obsessive traits of the personality (MIRAP) and other referred to the impulsivity as trait, also, (ECIRYC) of a random sample of 418 subject extracted of the general population. They are applied multivariate statistic analysis technical (Factorial Analysis, Correspondence Analysis, and linear Regression Analysis) to establish the type of relationship that have the two studied personality traits. Results. The total scores of the MIRAP and the ECIRYC are correlated of a manner statistically significant(r = 0.39; p< 0.01). The Correspondence Analysis of those total scores distributed in deciles and two linear Regression Analysis show, also, a direct relationship between both traits that it is statistically significant. The obsessivity and the impulsivity do not correlate with the principal factor of the opposite trait. All the factors of both traits are grouped mutually in a factor in a positive way, except the impulsive factor “haste” that makes it negatively with the obsessive factor “order”. Conclusions. Our results indicate that the obsessivity and the impulsivity, as personality traits, they are constructs convergent and not opposite poles of a continuum. But, simultaneously, one of the five factors of each trait (“haste” and “order”), yes are behaved as opposite extremes of a continuum, within conceptual framework, wider, of the traits to those which belong (AU)

[Comparative analysis of renal graft function after open vs. laparoscopic nephrectomy: experimental model]. / Análisis comparativo de la función del injerto renal de donante vivo tras nefrectomía abierta y laparoscópica: modelo experimental.

INTRODUCTION: Living donor renal transplant reports a higher patient and graft survival in comparison to cadaver donor and represents a good alternative facing the current lack of organs for transplant. GOALS: To analyze comparatively in an experimental model (pig) the influence of ischemia-reperfusion and functional outcome of renal graft retrieved by open Vs laparoscopic nephrectomy. MATERIAL AND METHODS: 30 lab pigs were nephrectomized (left kidney): 15 by laparoscopy and 15 by open surgery, as living donors, in a model of renal autotransplant. Renal blood flow (RBF) was measured by means of an electromagnetic probe and creatinine levels during the first week after the implant. RESULTS: Comparative analysis of RBF during the immediate 60 min after unclamping showed a significant reduction of average RBF in laparoscopic group in comparison to open group (p < 0.001), with a more evident reduction of RBF in the laparoscopic group during the 5-min period after unclamping (p < 0.001) and a progressive recuperation of RBF during the 1st hour, slowest in laparoscopic group. Creatinine levels in the first week after the transplant decreased progressively from 1.3 to 0.8 mgrs/dl in the open group and from 2 to 1.1 mg/dl in laparoscopic group (p < 0.001). CONCLUSIONS: Renal grafts retrieved by laparoscopy presents a more evident ischemia-reperfusion syndrome shown by a lower average RBF after unclamping and a significant deterioration of renal function during the first week after transplant.

Análisis comparativo de la función del injerto renal de donante vivo tras nefrectomía abierta y laparoscópica: modelo experimental / Comparative analysis of renal graft fuction after open vs laparoscopic nephrectomy: experimental model

Introducción: El trasplante renal (TR) de donante vivo presenta una supervivencia del injerto y del paciente superior al TR procedente de cadáver y representa una alternativa eficaz frente al problema de la escasez de órganos. Objetivo: Analizar comparativamente en un modelo experimental en cerdo, la influencia del síndrome de isquemia repercusión y la evolución funcional del injerto renal extraído mediante nefrectomía abierta y laparoscópica. Material y métodos: 30 cerdos fueron sometidos a nefrectomía izquierda: 15 por laparoscopia y 15 por vía abierta, como donantes vivos en un modelo de autotrasplante renal. Se midió el flujo sanguíneo renal (FSR) postdesclampaje mediante sonda electromagnética y los niveles de creatinina (Cr) durante la primera semana postrasplante. Resultados: El análisis comparativo del FSR en la 1ª hora postTR objetivó: una disminución significativa del FSR medio en el grupo de laparoscopia frente al abierto (p<0,001), con una reducción del FSR en los primeros 5 minutos más acusado en el grupo laparoscópico (p<0,001), y una recuperación progresiva del FSR durante la 1ª hora, que es más lenta para el grupo laparoscópico. Los niveles de Cr en la primera semana postrasplante descendieron progresivamente desde 1,3 a 0,8 mg/dl en el grupo abierto, y de 2 a 1,1 mg/dl en el grupo laparoscópico (p<0,001). Conclusiones: Los injertos renales extraídos vía laparoscópica presentan una acentuación del síndrome de isquemiareperfusión manifestado por un FSR postdesclampaje inferior al FSR prenefrectomía y un deterioro significativo de la función renal durante la primera semana postrasplante

Introduction: Living donor renal transplant reports a higher patient and graft survival in comparison to cadaver donor and represents a good alternative facing the current lack of organs for transplant. Goals: To analyze comparatively in an experimental model (pig) the influence of ischemia-reperfusion and functional outcome of renal graft retrieved by open Vs laparoscopic nephrectomy. Material and methods: 30 lab pigs were nephrectomized (left kidney): 15 by laparoscopy and 15 by open surgery, as living donors, in a model of renal autotransplant. Renal blood flow (RBF) was measured by means of an electromagnetic probe and creatinine levels during the first week after the implant. Results: Comparative analysis of RBF during the immediate 60 min after unclamping showed a significant reduction of average RBF in laparoscopic group in comparison to open group (p<0.001), with a more evident reduction of RBF in the laparoscopic group during the 5-min period after unclamping (p<0.001) and a progressive recuperation of RBF during the 1st hour, slowest in laparoscopic group. Creatinine levels in the first week after the transplant decreased progressively from 1.3 to 0.8 mgrs/dl in the open group and from 2 to 1.1 mg/dl in laparoscopic group (p<0.001). Conclusions: Renal grafts retrieved by laparoscopy presents a more evident ischemia-reperfusion syndrome shown by a lower average RBF after unclamping and a significant deterioration of renal function during the first week after transplant

Análisis comparativo de las modificaciones hemodinámicas y del flujo sanguíneo renal (FSR) durante la nefrectomía abierta y laparoscópica. Modelo experimental / Comparative analysis about hemodynamic and renal blood flow effects during open versus laparoscopic nephrectomy. An experimental study

Introducción: El aumento de la presión intraabdominal (PIA) por encima de 10 mmHg conlleva una reducción del flujo sanguíneo renal (FSR). El neumoperitoneo inducido durante las técnicas laparoscópicas, condiciona presiones intraabdominales (PIA) próximas a 15 mmHg, circunstancia que reduce el FSR, la diuresis y el filtrado glomerular (FG). Objetivo: Analizar comparativamente en un modelo experimental en cerdo, las modificaciones del FSR, la diuresis y el FG inducidas por las nefrectomías abierta y laparoscópica. Material y métodos: Un total de 30 cerdos (peso medio = 22,6+3,2 Kg) han sido sometidos a nefrectomía izquierda: 15 por laparoscopia y 15 por vía abierta, como donantes vivos en un modelo de autotrasplante renal. Se midió la diuresis y el FG basales y a los 30 y 60 min del inicio de la nefrectomía. El FSR medio se determinó mediante sonda electromagnética en la arteria renal principal durante la primera hora de la cirugía. Resultados: Se objetivó una reducción significativa del FSR (80+2,7 vs 262+3 ml/min) (p<0,005) durante la nefrectomía laparoscópica frente a la abierta. También se demostró una disminución significativa de la diuresis (42%) y del FG (38%) del grupo laparoscópico frente al abierto. Conclusiones: La nefrectomía laparoscópica conlleva una disminución significativa del FSR, circunstancia potencialmente trascendente en el TR con donante vivo, así como del FG y de la diuresis

Background: The increase of intraabdominal pressure to 10 mmHg provokes a decrease of renal blood flow (RBF). Pneumoperitoneum during laparoscopic techniques with intra-abdominal pressure (IAP) to 15 mmHg, results in a decrease in RBF, urine output and glomerular filtration rate (GFR). PURPOSE: Analyze the changes in RBF, urine output an GFR in a porcine experimental model during open vs laparoscopic nephrectomy. Materials and methods: 30 pigs (medium weigh= 22.6+3.2 Kg) were divided into two groups: Laparoscopic nephrectomy was performed using 15 pigs and open nephrectomy in 15 pigs, following a living donor nephrectomy autotransplantation model. Study parameters were urine volume and GFR baseline values, 30 and 60 minutes during nephrectomy. RBF was measured using an electromagnetic flow catheter around the main renal artery during the initial 60 minutes of nephrectomy. Results: The laparoscopic technique was associated with a significant reduction of RBF (80+2.7 vs 262+3 ml/min) (p<0.005), diuresis (42%) and GFR (38%), vs the open group. Conclusions: Laparoscopic nephrectomy involves a significant reduction of RBF, GFR and diuresis, which is potentially transcendent in living donor nephrectomy and kidney transplantation

Measuring anankastic personality traits.

INTRODUCTION: The authors validate a 20 item scale designed to measure anankastic (obsessive) personality traits: the Mini-Inventory of Anankastic Personality Traits, 2nd version (MIAPT-2). MATERIAL AND METHODS: The answers of a sample of 418 subject of both genders obtained from the general population were used to analyze construct validity (factorial analysis), its alpha reliability and its internal consistency through the item/total correlations and the two halves test. An additional sample of 22 medical students was used to analyze the concurrent validity of the scale (external criterion: the Maudsley Obsessional-Compulsive Inventory) and the temporary reliability with the test-retest method. After this, the total scores of the instrument and the factorial scores were standardized and distributed into percentiles. RESULTS: The scale shows good concurrent validity (r = 0.67; p < 0.000) and construct validity (56 % of the total of the variance explained by the factorial analysis) as well as a good internal consistency through the item/total correlations (all p = 0.000) and two halves test (r = 0.71; p < 0.000; with the Spearman-Brown correction R= 0.83). The alpha reliability of the scale (alpha = 0.84), and the test-retest (r = 0.69; p < 0.000) are high. CONCLUSIONS: The validated MIAPT-2 shows good validity and reliability to evaluate anankastic personality traits. The authors include an appendix with the scale and the standardization of its total and factorial scores distributed into percentiles to be used in clinical and general population samples.

Evaluando los rasgos anacásticos de la personalidad / Measuring anankastic personality traits

Introducción. Los autores validan una escala de 20 ítems diseñada para medir rasgos anancásticos de la personalidad: el Mini-Inventario de Rasgos Anancásticos de la Personalidad, segunda versión (MIRAP-2). Material y métodos. Utilizan las respuestas de una muestra de 418 sujetos de ambos sexos extraídos de la población general para analizar la validez de constructo (análisis factorial), su fiabilidad alfa y su consistencia interna mediante la correlación ítem/total y prueba de las dos mitades. Se utiliza una muestra adicional de 22 estudiantes de medicina para analizar la validez concurrente de la escala (criterio externo: el Maudsley Obsessional-Compulsive Inventory) y la fiabilidad temporal mediante la prueba testretest. Tras ello se procede a estandarizar las puntuaciones totales del instrumento y las puntuaciones factoriales, distribuyéndolas en percentiles. Resultados. La escala muestra una buena validez concurrente (r = 0,67; p < 0,000) y validez de constructo (56 % del total de la varianza explicada por el análisis factorial), así como una buena consistencia interna mediante las correlaciones ítem/total (todas p = 0,000) y prueba de las dos mitades (r = 0,71; p < 0,000; con la corrección de Spearman-Brown R= 0,83). La fiabilidad alfa de la escala es elevada (α= 0,84), así como lo es la prueba test-retest (r = 0,69; p < 0,000). Conclusiones. La escala validada muestra una buena validez y fiabilidad para evaluar los rasgos anacásticos de la personalidad. Los autores incluyen un apéndice con la escala y la estandarización de sus puntuaciones totales y factoriales distribuidas en percentiles para su uso en muestras tanto clínicas como de la población general

Introduction. The authors validate a 20 item scale designed to measure anankastic (obsessive) personality traits: the Mini-Inventory of Anankastic Personality Traits, 2nd version (MIAPT-2). Material and methods. The answers of a sample of 418 subject of both genders obtained from the general population were used to analyze construct validity (factorial analysis), its alpha reliability and its internal consistency through the item/total correlations and the two halves test. An additional sample of 22 medical students was used to analyze the concurrent validity of the scale (external criterion: the Maudsley Obsessional-Compulsive Inventory) and the temporary reliability with the testretest method. After this, the total scores of the instrument and the factorial scores were standardized and distributed into percentiles. Results. The scale shows good concurrent validity (r = 0.67; p < 0.000) and construct validity (56 % of the total of the variance explained by the factorial analysis) as well as a good internal consistency through the item/total correlations (all p = 0.000) and two halves test (r = 0.71; p < 0.000; with the Spearman-Brown correction R= 0.83). The alpha reliability of the scale (α = 0.84), and the test-retest (r = 0.69; p < 0.000) are high. Conclusions. The validated MIAPT-2 shows good validity and reliability to evaluate anankastic personality traits. The authors include an appendix with the scale and the standardization of its total and factorial scores distributed into percentiles to be used in clinical and general population samples