Colitis fulminante por Clostridium difficile / Fulminant Clostridium difficile colitis

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¿Mejora la cirugía mamaria la supervivencia del cáncer oculto de mama? / Does surgery improve survival in occult breast cancer?

Introducción. El cáncer oculto de mama (COM), con una incidencia del 0,3-1%, aún plantea retos diagnósticos y terapéuticos. El objetivo del trabajo fue determinar las características patológicas de nuestra serie de COM, evaluar los resultados de las técnicas diagnósticas y terapéuticas empleadas (cirugía mamaria con linfadenectomía axilar o solo linfadenectomía axilar) y la supervivencia global. Pacientes y métodos. Análisis retrospectivo de 21 pacientes con metástasis ganglionares de cáncer mamario con mamografía y ecografía mamaria negativas. Desde 2003 se incluyó la resonancia magnética nuclear (RMN) en el protocolo de estudio. Se valoró la supervivencia en 2 grupos; grupo A: pacientes con COM tratadas con cirugía mamaria (15 casos), bien mastectomía radical (10 pacientes) bien cirugía conservadora (5 casos), y grupo B: 4 pacientes tratadas quirúrgicamente con linfadenectomía axilar niveles i y ii de Berg. Se asoció radioterapia sobre la mama tras cirugía conservadora (50 Gy) y sobre la axila si > 3 adenopatías axilares tumorales. Resultados. En 9 pacientes (7 de las mastectomías y 2 de las cirugías conservadoras) se identificó histológicamente un carcinoma de mama, de tipo ductal infiltrante en 8 casos y un carcinoma medular. La RMN (6 casos) demostró en 2 pacientes tumor mamario con confirmación histológica de carcinoma. Con una mediana de seguimiento de 87 meses, la supervivencia global fue de 101,2 meses (rango: 12-235 meses) con una supervivencia a 5 años del 69%. La supervivencia media en el grupo A fue de 120 meses, superior a los 41 meses del grupo B (p = 0,05). Conclusiones. En nuestra serie el tratamiento quirúrgico sobre la mama mejora la supervivencia global respecto al grupo tratado solo con linfadenectomía axilar. La RMN ha sido útil para evidenciar nódulos tumorales ante un supuesto COM y permite seleccionar a pacientes para realizar cirugía conservadora de la mama(AU)

Introduction. Occult breast cancer (OBC) has an incidence of 0.3-1% but nevertheless represents a diagnostic and therapeutic challenge. The aim of our study was to determine the pathologic characteristics of patients in our OBC series, compare the results of the different diagnostic and therapeutic techniques available (breast surgery with axillary lymphadenectomy or axillary lymphadenectomy alone), and overall survival. Patients and methods. A retrospective analysis was carried out in 21 patients with axillary lymph node metastases and negative mammography and breast ultrasonography. From 2003 onward, our group included magnetic resonance imaging (MRI) in the study protocol of OBC. Overall survival was determined and 2 groups were compared: Group A consisted of patients with OBC treated with breast surgery (n = 15), either with radical breast mastectomy (n = 10) or breast-conserving surgery (n = 5); and group B consisted of patients (n = 4) treated surgically with Berg level i or ii axillary lymphadenectomy. We added breast radiotherapy (50 Gy) in patients treated with breast-conserving therapy and axillary radiotherapy when there were more than 3 metastatic axillary nodes. Results. In 9 patients (7 mastectomies, 2 breast-conserving interventions), one breast carcinoma, 8 infiltrating ductal carcinomas and one medullar carcinoma were identified by histology. Two breast carcinomas were detected by MRI in 6 patients, which were later confirmed by histologic study. The median follow-up was 87 months, with an overall survival of 101.2 months (range: 12-235 months) and a 5-year survival of 69%. The mean survival was 120 months in group A and 41 months in group B (P = .05). Conclusions. In our series, surgical treatment of OBC improved overall survival compared with lymphadenectomy alone. MRI was useful in the identification of malignant tumors in suspected OBC and allowed patient selection for breast-conserving surgery(AU)

The influence of advanced age on the morbi-mortality of gastric cancer after curative surgery.

INTRODUCTION: gastric cancer (GC) is the fourth leading cause of cancer death in Spain after lung, colorectal, breast and prostate tumours. Surgery remains the only potentially curative treatment in localized gastric cancer. OBJECTIVE: the aim of our study is to evaluate and compare the clinical and surgical aspects, development of postoperative complications and outcomes of patients over 75 years old compared with younger patients in our centre. MATERIAL AND METHODS: comparative retrospective study, from March 2003 to June 2011. We diagnosed 166 cases of GC, 109 (65 %) underwent curative surgery. Two groups were settled: group M: < or = 75 years (41 patients) and group m: < 75 years (68 patients). We analyzed age, sex, comorbidities, tumour location, clinical stage, perioperative chemotherapy, surgical technique, postoperative complications, recurrence and mortality from cancer. RESULTS: a more frequent presence of cardiovascular comorbidities and a greater postoperative mortality by medical causes were the only significant differences between both groups. Also, a lower proportion of patients in group M received preoperative chemotherapy and underwent D1 lymphadenectomy. However, the rate of local and systemic recurrence and overall survival were similar in both groups. CONCLUSIONS: age should not be considered a contraindication for curative surgery on GC. The general condition and comorbidities are more important to contraindicate surgical treatment.

Influencia de la edad avanzada en la morbimortalidad del cáncer gástrico tras la cirugía con intención curativa / The influence of advanced age on the morbi-mortality of gastric cancer after curative surgery

Introducción: el cáncer gástrico (CG) es la cuarta causa de muerte en ambos sexos por cáncer en España tras los tumores de pulmón, colorrectal, mama y próstata. La cirugía continúa siendo el único tratamiento potencialmente curativo en el cáncer gástrico localizado. Objetivo: evaluar y comparar los aspectos clínicos, quirúrgicos, el desarrollo de complicaciones postoperatorias y la evolución de los pacientes mayores de 75 años comparados con los pacientes menores de 75 años intervenidos en nuestro centro. Material y métodos: estudio comparativo retrospectivo desde marzo de 2003 a junio de 2011. Se diagnosticaron 166 casos de CG, de ellos, 109 (65 %) fueron intervenidos con intención curativa, estableciéndose dos grupos: grupo M: ≥ 75 años (41 pacientes) y grupo m: < 75 años (68 pacientes). Se analizaron edad, sexo, comorbilidades, localización tumoral, estadio clínico, administración de quimioterapia perioperatoria, técnica quirúrgica, complicaciones postoperatorias, recidiva y mortalidad por la neoplasia. Resultados: como diferencias estadísticamente significativas entre ambos grupos de edad fueron una mayor presencia de comorbilidades cardiovasculares en el grupo M, así como mayor mortalidad postoperatoria por causa médica. Asimismo, una menor proporción de pacientes del grupo M recibieron quimioterapia preoperatoria y se les realizó linfadenectomía D1. Sin embargo, la tasa de recidivas, local y sistémica, y la supervivencia global fueron similares en ambos grupos. Conclusiones: la edad no debe ser considerada como contraindicación para realizar cirugía curativa del CG, sino que debe ser el estado general y las comorbilidades las que sienten la contraindicación quirúrgica (AU)

Introduction: gastric cancer (GC) is the fourth leading cause of cancer death in Spain after lung, colorectal, breast and prostate tumours. Surgery remains the only potentially curative treatment in localized gastric cancer. Objective: the aim of our study is to evaluate and compare the clinical and surgical aspects, development of postoperative complications and outcomes of patients over 75 years old compared with younger patients in our centre. Material and methods: comparative retrospective study, from March 2003 to June 2011. We diagnosed 166 cases of GC, 109 (65 %) underwent curative surgery. Two groups were settled: group M: ≥ 75 years (41 patients) and group m: < 75 years (68 patients). We analyzed age, sex, comorbidities, tumour location, clinical stage, perioperative chemotherapy, surgical technique, postoperative complications, recurrence and mortality from cancer. Results: a more frequent presence of cardiovascular comorbidities and a greater postoperative mortality by medical causes were the only significant differences between both groups. Also, a lower proportion of patients in group M received preoperative chemo - therapy and underwent D1 lymphadenectomy. However, the rate of local and systemic recurrence and overall survival were similar in both groups. Conclusions: age should not be considered a contraindication for curative surgery on GC. The general condition and comorbidities are more important to contraindicate surgical treatment (AU)

Cáncer de mama y embarazo. Análisis de una serie de 27 pacientes / Breast cancer and pregnancy. Analysis of a series of 27 patients

Objetivo: Realizar un análisis descriptivo de la serie de pacientes con cáncer de mama (CM) y embarazo diagnosticadas en nuestro centro en relación con los métodos terapéuticos empleados y supervivencia global de la serie. Pacientes y métodos: Entre 1982 y 2009, de 5.906 pacientes diagnosticadas de CM, se trató a 27 pacientes con CM y embarazo (0,46%). Analizamos las características clínicas y anatomopatológicas, el diagnóstico, los tratamientos y la evolución de estas pacientes en nuestro centro. Resultados: La edad media al diagnóstico fue de 35 años. Durante la gestación se diagnosticó a 21 pacientes y en el posparto, a 6. El retraso medio diagnóstico desde el inicio de los síntomas fue de 4 meses. Respecto al perfil inmunohistoquímico determinado en 19 pacientes, 5 (26%) eran receptor 2 de factor de crecimiento epidérmico humano (HER2) positivo; otros 5 (26%), triple negativo; 3, luminal A, y en las 6 restantes, luminal B. Al diagnóstico, se clasificó a 5, 9, 11 y 2 pacientes en estadio I, II, III y IV, respectivamente. Histológicamente, 21 (78%) eran carcinomas ductales infiltrantes; 11 (41%), de alto grado histológico, y 4 casos (15%) presentaron características de carcinoma tipo inflamatorio al diagnóstico. Se pautó quimioterapia neoadyuvante en 16 pacientes (59%), sin que se detectaran complicaciones fetales. Se operó a todas las pacientes, y se realizó mastectomía radical modificada en 24 (89%), así como cirugía conservadora en 3. Con un tiempo medio de seguimiento de 60 meses, la supervivencia global fue del 70%. Cuatro pacientes (15%) presentaron recaída local y 13 (48%), recaída sistémica. Conclusiones: El carcinoma de mama durante el embarazo se asocia con un retraso diagnóstico, estadios avanzados y grados histológicos altos. El tratamiento quirúrgico conlleva un alto porcentaje de mastectomías radicales. La quimioterapia no produjo efectos adversos en el feto tras el primer trimestre de gestación. El pronóstico de CM durante el embarazo es similar al de las pacientes no gestantes de la misma edad y estadio tumoral (AU)

Objective: To perform a descriptive analysis of patients with breast cancer (BC) and pregnancy diagnosed in our centre, as regards the therapeutic methods used and the overall survival of the series. Patients and methods: Between 1982-2009, 5906 patients were diagnosed with BC, of whom 27 (0.46%) were treated for pregnancy-associated BC. We analysed the characteristics, diagnosis, treatments and outcome of these patients in our centre. Results: The mean age at diagnosis was 35 years. Twenty-one patients were diagnosed during pregnancy and six of them in the post-partum period. The mean diagnostic delay from the onset of symptoms was four months. In the immunohistochemical profile performed in 19 patients, 5 (26%) were HER2, 5 (26%) were triple-negative, luminal A in three patients, and luminal B in the other 6 cases. At diagnosis, 5, 9, 11 and 2 patients were classified into stages I, II, III and IV, respectively. Histologically, 21 (78%) were infiltrating ductal carcinomas, 11 (41%) were high grade carcinomas and 4 (15%) were inflammatory carcinomas at diagnosis. Neoadjuvant chemotherapy was prescribed in 16 patients (59%), with no foetal complications detected. All patients underwent surgery; 24 (89%) had modified radical mastectomy while three had conservative surgery. The mean follow-up time was 60 months, in which the overall survival was 70%. Four patients (15%) had local recurrence and 13 (48%) had systemic recurrence. Conclusions: Breast carcinoma during pregnancy is associated with diagnostic delay, advanced stages and high histological grades. Surgical treatment involves a high percentage of radical mastectomies. Chemotherapy did not produce adverse effects in the foetus after the first trimester. The prognosis for BC during pregnancy is similar to that of non-pregnant patients of the same age and tumour stage(AU)