Response to methylphenidate by adult and pediatric patients with attention-deficit/hyperactivity disorder: the Spanish multicenter DIHANA study.

BACKGROUND: The purpose of this multicenter Spanish study was to evaluate the response to immediate-release methylphenidate by children and adults diagnosed with attention-deficit/hyperactivity disorder (ADHD), as well as to obtain information on current therapy patterns and safety characteristics. METHODS: This multicenter, observational, retrospective, noninterventional study included 730 patients aged 4-65 years with a diagnosis of ADHD. Information was obtained based on a review of medical records for the years 2002-2006 in sequential order. RESULTS: The ADHD predominantly inattentive subtype affected 29.7% of patients, ADHD predominantly hyperactive-impulsive was found in 5.2%, and the combined subtype in 65.1%. Overall, a significant lower Clinical Global Impression (CGI) score and mean number of DSM-IV TR (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision) symptoms by subtype were found after one year of treatment with immediate-release methylphenidate; CGI decreased from 4.51 to 1.69, symptoms of inattention from 7.90 to 4.34, symptoms of hyperactivity from 6.73 to 3.39, and combined subtype symptoms from 14.62 to 7.7. Satisfaction with immediate-release methylphenidate after one year was evaluated as "very satisfied" or "satisfied" by 86.90% of the sample; 25.75% of all patients reported at least one adverse effect. At the end of the study, 41.47% of all the patients treated with immediate-release methylphenidate were still receiving it, with a mean time of 3.80 years on therapy. CONCLUSION: Good efficacy and safety results were found for immediate-release methylphenidate in patients with ADHD.

Uso del Cuestionario de Capacidades y Dificultades (SDQ) como instrumento de cribado de trastornos psiquiátricos en la consulta de pediatría de Atención Primaria / Use of Strength and Difficulties Questionnaire (SDQ) as a screening tool in psychiatric disorders in the pediatrics consultations of Primary Care

Los trastornos de salud mental afectan a una parte importante de la población infantil. No son motivos habituales de consulta aún cuando están presentes, y el comportamiento de los pacientes es difícil de valorar dentro de su contexto sociocultural y evolutivo. Se diseñó un estudio con el fin de valorar la aplicabilidad del cuestionario SDQ como instrumento de cribado de trastornos de salud mental en una consulta de pediatría de atención primaria. Se incluyeron 108 niños pertenecientes a tres consultas distintas de la misma área sanitaria, entre los que se cumplimentó el cuestionario y se recogió información acerca de factores de riesgo. Quedaron excluidos del estudio los pacientes con diagnóstico psiquiátrico previo y/o que consultaran por este motivo. Del total de niños encuestados, 10presentaron resultado alterado en el test (9,3%) y 9 fueron enviados para valoración al servicio de Psiquiatría Infantojuvenil. Presentaban factores de riesgo 3 pacientes. Se diagnosticó de TDAH a 3 de ellos (2,8%), ninguno con dichos factores. El cuestionario SDQ podría ser en la consulta de atención primaria un instrumento de cribado útil para sospechar trastornos mentales en la edad pediátrica y optimizarla derivación a las Unidades de Psiquiatría (AU)

Mental health disorders affect a significant portion of the child population. Diagnosis is complex because it is difficult to assess the behavior of patients appropriately in their social context and evolving. We designed a study to assess the SDQ questionnaire as a screening tool for disorders of mental health in a pediatric primary care consultation. We included 108 children belonging to three different consultations, which included the questionnaire and collected information about risk factors. Of these, 10 had resulted altered, and 9 were sent for psychiatric assessment at the service of children and adolescents. Five patients had risk factors. ADHD is diagnosed in 3 of them, none of these with risk factors. None of the patients had been informed or consulted the pediatrician for changes in behavior. The questionnaire SDQ represents a useful diagnostic tool in the consultation of pediatric primary care. The screening of patients conducted with the same result of great help in identifying mental disorders, facilitating the diagnosis by the psychiatrist (AU)

Utility of the tumor bed marker in patients with breast cancer receiving induction chemotherapy.

PURPOSE: Induction or neoadjuvant chemotherapy is used in patients with locally advanced breast cancer to offer a higher rate of conservative surgery. The possibility of reduction in size, even in some cases complete clinical and mammographic regression, can make the localization of the tumor bed difficult at the time of surgery. The purpose of this study was to describe our experience about the utility of US-guided implantation of a metallic marker in patients with breast cancer before induction chemotherapy. MATERIAL AND METHODS: Forty-three patients with 44 masses were diagnosed with percutaneous biopsy of breast carcinoma. Before beginning of the induction chemotherapy all of them were referred for metallic marker placement. A metallic harpoon was placed under US guidance. RESULTS: One patient died during the chemotherapy. Six underwent mastectomy, and 9 still had a palpable tumor at the time of surgery. In the remaining 27 patients (with 28 lesions) pre-operative wire localization of the tumor bed was carried out: in 11 cases the harpoon was necessary for the localization of the tumor bed, in 6 the harpoon was useful, and in 11 patients the localization of the tumor could have been done without the marker. No complications were observed and the marker remained stable in all patients. CONCLUSION: In patients who undergo induction chemotherapy, the placement of a metallic harpoon under US guidance is a safe, simple and inexpensive technique for localization of the tumor bed previous to conservative surgery.

Stereotaxic core needle aspiration biopsy with multiple passes in nonpalpable breast lesions.

OBJECTIVE: To compare the grade of histologic agreement between stereotaxic core needle aspiration biopsy (SCNAB) with multiple passes, and surgical excision. METHODS: A total of 180 patients with 182 nonpalpable breast lesions underwent SCNAB with multiple passes in an upright add-on stereotaxic device using a manual 1.8-mm needle (15 G). In this group, 125 patients underwent subsequent surgical excision. RESULTS: A SCNAB result indicative of malignancy (invasive or noninvasive carcinoma) was obtained in 68 (87%) of the 78 breast carcinomas (14 noninvasive and 64 invasive) and definitive surgical therapy with a one-stage procedure was performed. Complete or partial agreement between core biopsy and surgery was observed in 19 (86%) of 22 invasive or noninvasive carcinomas discovered by microcalcifications, 40 (97.5%) of 41 invasive carcinomas discovered by a mass, and 9 (60%) of 15 invasive or noninvasive carcinomas discovered by architectural distortion. Six (33%) of the 18 patients whose core biopsies showed noninvasive carcinoma had an invasive or microinvasive component at subsequent surgery. Atypical hyperplasia or benign core biopsy was observed in 6 (8%) and 4 (5%) breast carcinomas respectively. CONCLUSION: SCNAB with multiple passes is a reliable method for identifying nonpalpable lesions in patients with noninvasive or invasive carcinomas discovered by respectively microcalcifications or mass.

Intraductal placement of a Kopans spring-hookwire guide to localize nonpalpable breast lesions detected by galactography.

PURPOSE: To evaluate a new procedure for locating intraductal breast lesions detected by galactography, using the technique of intraductal placement of a Kopans spring-hookwire guide. MATERIAL AND METHODS: A catheter (0.7 mm) with a Kopans hookwire guide inside it was placed in 34 patients in whom an intraductal growth had been detected by galactography. The catheter was introduced through the discharging duct, with one hand holding the catheter and the other hand gently pushing the Kopans guide until it was anchored in the duct. The correct position of the guide was confirmed with new galactograms. RESULTS: A precise excision of the lesion was satisfactorily executed in 29 of 34 patients (85%) who underwent this procedure. In 5 patients the method was unsuccessful because the Kopans guide was dislodged. CONCLUSION: This method is effective in removing intraductal lesions because it ensures a precise ductal excision and enables the pathologist to find the lesion more easily.

[Testicular tumors. Echographic findings]. / Tumores testiculares. Hallazgos ecográficos.

OBJECTIVES: To analyze the sensitivity and specificity of high resolution ultrasound in testicular tumors. METHODS: The study comprised 18 histologically confirmed testicular tumors. Patient ages ranged from 19 to 79 years (mean 41). The ultrasound and the anatomopathological findings were compared. RESULTS: 12 of 18 were primary testicular tumors: 5 classical seminomas, 1 spermatocytic seminoma, 1 anaplastic seminoma, 3 embryonary carcinoma, 1 mixed teratoma and 1 immature teratoma. Ultrasound detected all tumors, accounting for a sensitivity of 100%. All tumors were hypoechoic. Substantial differences were observed between the classical seminomas and the other tumor types: the echo structure was homogeneous in 60% of the classical seminomas vs 50% for the other tumor types; 80% of the former and none of the other tumor types had well- or partially well-defined tumor margins; and finally, cystic or hyperechoic areas were not observed in the classical seminomas but in 30% of the other tumors. CONCLUSION: High resolution ultrasound should be performed if testicular tumor is suspected. This technique will confirm or discard this condition and, furthermore, if the ultrasound findings show a solid, hypoechoic lesion, regardless of the degree of definition of the tumor margins, with no cystic or hyperechoic areas, a presumptive diagnosis of classical seminoma can be made.