Evaluation of the interval cancer rate and its determinants on the Girona Health Region's early breast cancer detection program.

BACKGROUND: The main aim of this study is to estimate the rate of false negative and true IC on the Program for the Early Detection of Breast Cancer (PEDBC) run by the Girona Health Region (GHR) and compare the clinicopathological characteristics of these tumors with those detected within the same program. METHODS: A retrospective cohort study including all women participating on the Girona PEDBC between 2000 and 2006, with negative mammography screening. The IC included are those detected between the first and second round of screening and between the second and third round. RESULTS: We identified a total of 43 IC, representing an incidence rate of 0.70 cases per 1,000 screened women. Of the 43 probable IC, we were able to classify a total of 22 (51.2%) cases. Of these 22 cases, 54.5% were classified as true interval tumors, 13.6% false negatives, 18.2% occult tumors and the remaining 13.6% minimal sign.We found significant differences in some clinicopathological characteristics of the IC comparing with the tumors detected within the program during the same period. CONCLUSIONS: The IC rate for the PEDBC is within the expected parameters, with a high proportion of cases of true interval cancers (54.5%) and a low proportion of false negatives (13.6%). The results show that the proportional incidence of IC is within the limits set by European Guidelines. Furthermore, it has been confirmed that IC display more aggressive clinicopathological characteristics than screening breast cancers.

Las cicatrices y sus recuerdos / Scars and his reminiscences

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Evolución de las formas de presentación de la enfermedad celíaca en 429 niños a lo largo de veinte años. Estudio multicéntrico / Different clinical presentations of celiac disease over time. Multicentric study of a cohort of 429 children diagnosed over a 20-year period

Fundamento. La enfermedad celíaca es una enfermedadinducida genéticamente, en la que existe una intoleranciapermanente al gluten, y que provoca una lesión severade la mucosa intestinal. En la actualidad se sabe quesu expresividad clínica puede ser muy variada y que, ademásde la forma clásica (diarrea, pérdida de peso, distensiónabdominal, cambio de carácter, etc.), pueden existirformas atípicas, predominantemente extradigestivas, e inclusoformas asintomáticas o silentes.Objetivo. El objetivo de este estudio es conocer las formasde presentación de la enfermedad celíaca en la actualidady su evolución a lo largo de los últimos años.Método. Para ello se ha realizado un estudio multicéntricodescriptivo y retrospectivo, a través de la revisión delas historias clínicas de los pacientes diagnosticados de enfermedadcelíaca en las unidades de gastroenterología infantilde ocho centros hospitalarios, desde 1984 hasta2003, siendo requisito indispensable para la inclusión en elestudio la constatación de lesión de la mucosa intestinalsegún los criterios de Marsh.Resultados. La forma de presentación más frecuentefue la forma digestiva (60%), seguida de las atípicas(33.5%) (retraso de peso, dolor abdominal, distensión abdominal,estreñimiento, retraso de talla, alteraciones aisladasen la analítica sanguínea o vómitos) y las asintomáticaso silentes (6.5%).Se han establecido cuatro periodos de estudio (1984-1988, 1989-1993, 1994-1998 y 1999-2003), y se ha objetivadoun aumento progresivo de la edad media dediagnóstico a lo largo de los diferentes períodos, que secorresponde con un gradual aumento de las formasatípicas, en detrimento de las digestivas, así como unalenta progresión a lo largo del tiempo de las formas silentes diagnosticadas, pasando de un 81.8% de formas digestivasen el primer quinquenio, a un 55.3% en el último. Elanálisis del peso de los enfermos en el momento del diagnósticoen relación con el año en que se realizó éstedemuestra que ha ido mejorando progresivamente a lolargo de los años, lo que es un índice de menor afectacióngeneral en las formas atípicas.Conclusiones. Se concluye que la utilización de marcadoresserológicos para la detección de enfermedad celíacapermite sospechar el diagnóstico en muchos casos de formasatípicas de presentación anteriormente desconocidas,que posteriormente se confirman mediante biopsia intestinal.A medida que esos conocimientos se divulgan, se amplíael campo de investigación y consecuentemente aumentael número de casos diagnosticados

Background. Celiac disease is a genetically-determinedillness characterized by permanent intolerance to gluten,resulting in a severe damage to the intestinal mucosa. It iswell known that celiac disease has a wide spectrum ofclinical presentations; in addition to the classic form, characterizedby diarrhea, weight loss, and abdominal distension,atypical forms with predominantly extraabdominaldisease, and even asymptomatic or silent forms, exist.Objective. The objective of this study is to describe thedifferent presentation forms diagnosed over time.Method. A multicentric retrospective descriptive studywas performed. The medical records of patients diagnosedwith celiac disease in eight gastroenterology units betweenthe years 1984 and 2003, were reviewed. Documentationof the typical intestinal mucosa changes using theMarsh criteria was required.Results. The digestive form was the most common(60%), followed by the atypical form (poor weight orheight gain, abdominal pain, constipation, abnormal laboratorytests, or vomiting) in 33.5%, and the asymptomaticor silent form in 6.5%.The patient population was divided in four periodsaccording to the date of diagnosis (1984-1988, 1989-1993,1994-1998, and 1999-2003). The median age at diagnosisincreased in successive periods, which correlated with agradual increase in the percentage of the atypical andsilent forms. During the first period, 81.8% of celiacdisease cases were digestive forms, compared with 55.3%during the last period. The weight at the time of diagnosisalso increased over time, as a reflection of the less clinicalseverity of the atypical forms.Conclusions. We conclude that the use of serologicalmarkers for the detection of celiac disease allows for thediagnosis of atypical and silent forms, later confirmed byintestinal biopsy. As this knowledge is disseminated, thefield of research is expanded, and the number of casesdiagnosed increasesBackground. Celiac disease is a genetically-determined illness characterized by permanent intolerance to gluten, resulting in a severe damage to the intestinal mucosa. It is well known that celiac disease has a wide spectrum of clinical presentations; in addition to the classic form, characterized by diarrhea, weight loss, and abdominal distension, atypical forms with predominantly extraabdominal disease, and even asymptomatic or silent forms, exist. Objective. The objective of this study is to describe the different presentation forms diagnosed over time. Method. A multicentric retrospective descriptive study was performed. The medical records of patients diagnosed with celiac disease in eight gastroenterology units between the years 1984 and 2003, were reviewed. Documentation of the typical intestinal mucosa changes using the Marsh criteria was required. Results. The digestive form was the most common (60%), followed by the atypical form (poor weight or height gain, abdominal pain, constipation, abnormal laboratory tests, or vomiting) in 33.5%, and the asymptomatic or silent form in 6.5%. The patient population was divided in four periods according to the date of diagnosis (1984-1988, 1989-1993, 1994-1998, and 1999-2003). The median age at diagnosis increased in successive periods, which correlated with a gradual increase in the percentage of the atypical and silent forms. During the first period, 81.8% of celiac disease cases were digestive forms, compared with 55.3% during the last period. The weight at the time of diagnosis also increased over time, as a reflection of the less clinical severity of the atypical forms. Conclusions. We conclude that the use of serological markers for the detection of celiac disease allows for the diagnosis of atypical and silent forms, later confirmed by intestinal biopsy. As this knowledge is disseminated, the field of research is expanded, and the number of cases diagnosed increasesBackground. Celiac disease is a genetically-determined illness characterized by permanent intolerance to gluten, resulting in a severe damage to the intestinal mucosa. It is well known that celiac disease has a wide spectrum of clinical presentations; in addition to the classic form, characterized by diarrhea, weight loss, and abdominal distension, atypical forms with predominantly extraabdominal disease, and even asymptomatic or silent forms, exist. Objective. The objective of this study is to describe the different presentation forms diagnosed over time. Method. A multicentric retrospective descriptive study was performed. The medical records of patients diagnosed with celiac disease in eight gastroenterology units between the years 1984 and 2003, were reviewed. Documentation of the typical intestinal mucosa changes using the Marsh criteria was required. Results. The digestive form was the most common (60%), followed by the atypical form (poor weight or height gain, abdominal pain, constipation, abnormal laboratory tests, or vomiting) in 33.5%, and the asymptomatic or silent form in 6.5%. The patient population was divided in four periods according to the date of diagnosis (1984-1988, 1989-1993, 1994-1998, and 1999-2003). The median age at diagnosis increased in successive periods, which correlated with a gradual increase in the percentage of the atypical and silent forms. During the first period, 81.8% of celiac disease cases were digestive forms, compared with 55.3% during the last period. The weight at the time of diagnosis also increased over time, as a reflection of the less clinical severity of the atypical forms. Conclusions. We conclude that the use of serological markers for the detection of celiac disease allows for the diagnosis of atypical and silent forms, later confirmed by intestinal biopsy. As this knowledge is disseminated, the field of research is expanded, and the number of cases diagnosed increases

Cursos de reanimación cardiopulmonar pediátrica básica para padres y educadores / Training in basic cardiopulmonary resuscitation for parents and educators

Fundamento. Las maniobras de reanimación cardiopulmonar (RCP) pediátrica son útiles cuando comienzan antes de los 4 minutos de haberse producido la parada cardiorespiratoria. Los adultos que normalmente cuidan a los niños (padres y maestros) tienen que conocer estas maniobras. Objetivo. Determinar las características de los alumnos que han realizado el curso de RCP, así como su grado de aceptación y el grado de eficacia, en una consulta privada de pediatría de Terrassa. Método. Entre noviembre de 1999 y junio del 2002 se realizaron 20 cursos de RCP básica dirigidos a padres y maestros de escuela, con 279 alumnos, con una media de 6,1 alumnos por sesión (rango 3-12). Todos los cursos siguieron las recomendaciones de Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal. Resultados. El 75.5 por ciento de los alumnos fueron mujeres. El 61.3 por ciento del total fueron maestros, el 31 por ciento madres y padres, el 5.8 por ciento canguros, el 1 por ciento abuelos y abuelas, y otro 1 por cientovariado. Hay diferencias estadísticamente significativas entre la evaluación teórica inicial y la final (5.3 v. 8.5; p < 0.001). La evaluación práctica refleja que la maniobra más dificultosa por parte del alumno es la apertura de la vía aérea. El 87 por ciento de los alumnos se consideran preparados para realizar una RCP básica al finalizar el curso. Discusión. La población femenina está más sensibilizada. La evaluación teórica y práctica sirve como indicador de la eficacia de los cursos. La encuesta de satisfacción es un buen método de control de calidad. Nuestra experiencia indica que los padres y los maestros aceptan su puesto dentro de la cadena de supervivencia (AU)