Enfermedad residual después de cirugía conservadora por cáncer de mama / Residual disease after breast conserving surgery for breast cancer

Objetivo: El objetivo de este estudio es evaluar los factores relacionados con la presencia de tumor residual, después de tumorectomía por cáncer de mama y así poder determinar la óptima distancia tumor-margen de resección que nos garantice la ausencia de enfermedad residual.Material y métodos: Se revisaron retrospectivamente las historias clínicas de 118 pacientes con cáncer de mama, intervenidas inicialmente con tumorectomía en nuestro servicio, durante el período comprendido entre junio de 2004 y diciembre de 2006.Los parámetros analizados fueron: edad, palpabilidad, método diagnóstico, tipo de cirugía inicial y definitiva, tipo histológico, tamaño, invasión vasculolinfática, grado, componente intraductal extenso (CIE), receptores de estrógenos (RE), márgenes quirúrgicos, rescisión y existencia de tumor residual.Resultados: Se demostró tumor residual en el 27%. En el análisis univariante de las variables analizadas, sólo han sido estadísticamente significativas, en relación con la presencia de tumor residual, los márgenes (p = 0,015), el CIE (p = 0,026) y el tamaño (p = 0,025). En el análisis de regresión lineal simple sólo lo fueron los márgenes (p = 0,008) y el CIE (p = 0,025).Conclusiones: Consideramos suficiente para garantizar la ausencia de tumor residual una distancia mínima de 2 mm si no hay CIE. En pacientes con márgenes ≤ 2 mm, la presencia de CIE es una indicación de alto riesgo de enfermedad residual (AU)

Objective: To evaluate which factors are related to the presence of residual tumor after lumpectomy for breast cancer with a view to determining the excisional biopsy margins that guarantee a complete excision.Material and methods: The records of 118 women with invasive breast carcinoma who were treated with lumpectomy in our service between June 2004 and December 2006 were retrospectively reviewed. The parameters evaluated were age, palpability, diagnostic method, type of initial and definitive surgery, histologic type, tumor size, lymphovascular invasion, presence/absence of extensive intraductal component (EIC), estrogen receptors, surgical margins, reexcision, and the presence of residual tumor.Results: Residual disease was found in 27%. In the univariate analysis, only margins (P=.015), EIC (P=.026) and size (P=.025) were significantly associated with the presence of residual tumor. With simple lineal regression analysis, only margins (P=.008) and EIC (P=.025) showed a significant association.Conclusions: We believe that a minimum margin of 2 mm is enough to guarantee the absence of residual breast cancer if there is no EIC. In patients with margins ≤ 2 mm, the presence of EIC is an indication of high risk of residual disease (AU)

[Clostridium myonecrosis: a complication of inguinal hernia repair]. / Mionecrosis por Clostridium como complicación de hernioplastia inguinal.

Clostridial myonecrosis is a necrotizing soft tissue infection characterized by muscular necrosis and, by extension, that of the surrounding tissue. If this infection develops quickly, it can cause septic shock and death if treatment is delayed. This infection does not occur frequently in civil medicine but nor is it exceptional after traumatic injuries or as a septic infection resulting from certain surgical interventions. Spontaneous development of clostridial myonecrosis is not uncommon (most commonly produced by the Clostridium septicum genus), propagated mainly from the colon in patients with neoplasia and in poor health. Consequently, in patients of bacteremia caused by C. septicum, colonic tumor must be ruled out. We present a new case of C. septicum myonecrosis of the abdominal after elective inguinal hernia repair.

Mionecrosis por Clostridium como complicación de hernioplastia inguinal / Clostridium myonecrosis: a complication of inguinal hernia repair

La mionecrosis clostrídica es una infección necrosante de partes blandas caracterizada por la necrosis muscular y, de forma diferida, también la de los tejidos subyacentes, con evolución rápida al shock séptico y la muerte si se produce un retraso en el tratamiento. En la práctica civil no es frecuente, pero tampoco es excepcional su desarrollo después de heridas traumáticas o como secuela séptica de determinadas intervenciones quirúrgicas. No es del todo infrecuente la aparición espontánea (producida con mayor frecuencia por el género Clostridium septicum), que se propaga principalmente desde el colon, en pacientes con neoplasias y con malas condiciones, por lo que ante una bacteriemia por C. septicum es obligado descartar una neoplasia oculta de colon. Presentamos un nuevo caso de mionecrosis de pared abdominal por C. septicum después de cirugía electiva de hernia inguinal (AU)

Clostridial myonecrosis is a necrotizing soft tissue infection characterized by muscular necrosis and, by extension, that of the surrounding tissue. If this infection develops quickly, it can cause septic shock and death if treatment is delayed. This infection does not occur frequently in civil medicine but nor is it exceptional after traumatic injuries or as a septic infection resulting from certain surgical interventions. Spontaneous development of clostridial myonecrosis is not uncommon (most commonly produced by the Clostridium septicum genus), propagated mainly from the colon in patients with neoplasia and in poor health. Consequently, in patients of bacteremia caused by C. septicum, colonic tumor must be ruled out. We present a new case of C. septicum myonecrosis of the abdominal after elective inguinal hernia repair (AU)

[Association of pheochromocytoma with contralateral nonfunctioning adrenal adenoma]. / Asociación de feocromocitoma con adenoma suprarrenal contralateral no funcionante.

A 52-year-old woman complaining of abdominal pain, headaches and palpitations was admitted to our hospital for investigation of a bilateral adrenal tumor. Bilateral adrenalectomy was subsequently performed. The definitive diagnosis was right pheochromocytoma and left adrenocortical adenoma. Only four cases of pheochromocytoma associated with nonfunctioning adrenal adenoma have previously been reported. The coexistence of both entities is currently believed to be coincidental. Further examination of cases similar to ours might reveal the underlying mechanisms for the coexistence of these tumors.

Asociación de feocromocitoma con adenoma suprarrenal contralateral no funcionante / Association of pheochromocytoma with contralateral nonfunctioning adrenal adenoma

Mujer de 52 años, afectada de dolor abdominal, cefaleas y palpitaciones, que fue admitida en nuestro hospital para ser estudiada de una tumoración adrenal bilateral, y posteriormente se le practicó una adrenalectomía bilateral. Tan sólo se han publicado previamente 4 casos de coexistencia de feocromocitoma y adenoma suprarrenal no funcionante. La coexistencia de ambas lesiones en la actualidad se considera una mera coincidencia. El estudio de casos similares en el futuro permitirá conocer los mecanismos fisiopatológicos de la coexistencia de estos tumores (AU)

A 52-year-old woman complaining of abdominal pain, headaches and palpitations was admitted to our hospital for investigation of a bilateral adrenal tumor. Bilateral adrenalectomy was subsequently performed. The definitive diagnosis was right pheochromocytoma and left adrenocortical adenoma. Only four cases of pheochromocytoma associated with nonfunctioning adrenal adenoma have previously been reported. The coexistence of both entities is currently believed to be coincidental. Further examination of cases similar to ours might reveal the underlying mechanisms for the coexistence of these tumors (AU)