Prevalencia y características clínicas de la apnea del sueño en una población de mujeres diagnosticadas de cáncer de mama / Prevalence and clinical characteristics of sleep apnea in a population of women diagnosed with breast cancer

Objetivo: a pesar del interés creciente en la asociación entre apnea de sueño (AS) y cáncer, apenas existen estudios que investiguen tumores concretos. Nuestro objetivo fue analizar la prevalencia y características clínicas de la AS en mujeres con cáncer de mama (CM). Métodos: estudio piloto transversal. Se incluyen consecutivamente 83 mujeres entre 18 - 65, años diagnosticadas por primera vez de CM. En todos los casos se realizó un cuestionario clínico y una poligrafía respiratoria domiciliaria. La AS se definió como un índice de apneas-hipopneas (IAH) ≥5, y el síndrome de apneas-hipopneas del sueño (SAHS) como la asociación de un IAH ≥5 y excesiva somnolencia diurna (ESD, Epworth >10). Resultados: la media (DE) de edad fue de 48,8 (8,8) años, el índice de masa corporal (IMC) de 27,4 (5,4) y el 50,6% eran postmenopáusicas. La prevalencia de AS fue del 51,8% (43 casos), y la mediana de IAH de 5,1 (RIQ 2 - 9,4). De las 43 pacientes con AS, 32 presentaron un IAH 5 - 14,9 y 11 IAH ≥15. La prevalencia de SAHS fue del 10,8% (9 casos). Comparadas con las mujeres sin AS, aquellas con AS presentaron más ronquido, pero no hubo diferencias en otros síntomas relacionados con el sueño. En el análisis multivariado, la edad y las variables antropométricas, pero no la ESD, se asociaron independientemente a la AS. Conclusión: la prevalencia de AS es elevada en mujeres de mediana edad diagnosticadas de CM, aunque la mayoría no presentan ESD ni otras características diferenciales. La edad y la obesidad fueron predictores de AS en esta población

Objective: Despite growing interest in the association between sleep apnea and cancer, there are hardly any studies that research specific tumors. Our objective was to analyze the prevalence and characteristics of sleep apnea in women with breast cancer. Methods: A transversal pilot study. 83 women between the ages of 18 and 65 diagnosed with breast cancer for the first time were included consecutively. All participants completed a clinical questionnaire and underwent home respiratory polygraphy. Sleep apnea was defined as an apnea-hypopnea index (AHI) ≥5 and sleep apnea-hypopnea syndrome (SAHS) was defined as the association between an AHI ≥5 and excessive daytime sleepiness (EDS, Epworth >10). Results: The average (SD) age was 48.8 (8.8) years old, the body mass index (BMI) was 27.4 (5.4) and 50.6% were postmenopausal. The prevalence of sleep apnea was 51.8% (43 cases) and the average AHI was 5.1 (IQR: 2 - 9.4). Of the 43 patients with sleep apnea, 32 had an AHI between 5 and 14 and 11 had an AHI ≥15. The prevalence of SAHS was 10.8% (9 cases). Compared to women without sleep apnea, those with the disease snored more, but there were no differences in other sleep-related symptoms. In the multivariate analysis, age and anthropometric variables, but not EDS, were independently associated with sleep apnea. Conclusion: The prevalence of sleep apnea is higher in middle-aged women diagnosed with breast cancer, although the majority do not present with EDS or other distinguishing characteristics. Age and obesity were predictors for sleep apnea in this population

Mastopatía cirrótica / Mastopathy caused by liver cirrhosis

Introducción. Se han descrito diferentes causas de patología inflamatoria mamaria. En ocasiones, existe la necesidad de plantear un diagnóstico diferencial y descartar un carcinoma mamario. Caso clínico. Mujer de 63 años con antecedentes de cirrosis. Presenta mama izquierda aumentada de tamaño, eritematosa y con edema con fóvea. Tras tratamiento antibiótico no existe mejoría. La ecografía, mamografía y biopsia resultan negativas. Finalmente, se plantea el proceso como una descompensación de la cirrosis, a pesar de su manifestación unilateral. Tras tratamiento con diuréticos, observamos una resolución del proceso. Conclusión. El diagnóstico diferencial en patología de la mama en ocasiones resulta muy dificultoso. Además, existen patologías que requieren un manejo rápido dado su mal pronóstico. El caso presentado muestra cómo en la búsqueda de un diagnóstico se deben considerar todas las causas posibles, pero además pensar en los antecedentes médicos del paciente ya que pueden influir o ser la causa del proceso (AU)

Introduction. Various causes of inflammatory breast disease have been described and sometimes a differential diagnosis is required to rule out breast carcinoma. Case report. A 63-year-old woman with a history of cirrhosis had an enlarged left breast, erythema, and edema. Antibiotic treatment produced no improvement. The results of ultrasound, mammography and biopsy were negative. Finally, the process was diagnosed as a decompensation of cirrhosis, despite its unilateral manifestation. The process resolved with diuretic therapy. Conclusion. The differential diagnosis of breast disease is sometimes extremely difficult. Some diseases require rapid treatment due to their poor prognosis. The case presented here illustrates how every possible cause of the entity and the patient's medical history should be considered because they could influence or even cause the process (AU)

[Superior vena cava occlusion syndrome in a patient receiving total parenteral nutrition for short bowel syndrome]. / Síndrome de oclusión de la vena cava superior en paciente con nutrición parenteral total por síndrome de intestino corto.

The use of venous access devices has been increased in recent years. The administration of nutrients parenterally is one of the indications for use of these devices. However, these are not free of complications, with infection and obstruction of the devices being the most common. One fo the less frequent but most feared complications, especially in those patients in whom the parenteral access route is the only access for the supply of nutrients, is that of thrombosis of the large veins. This study presents, along with the bibliographical review of the matter, the diagnostic and therapeutic procedures undertaken in a case of thrombosis of the superior vena cava, in a patient with total parenteral nutrition in the home, due to a short bowel syndrome.

[The administration of intermittent outpatient total parenteral nutrition via a subcutaneous reservoir]. / Administración de una nutrición parenteral total intermitente ambulatoria mediante reservorio subcutáneo.

The development of artificial nutrition has made it possible to maintain the nutritional condition and survival of patients with large intestinal resections along with therapeutic support in certain pathological processes. As such patients have become aware of their potential and the prolonged life expectancy offered, they have increased their demands for enhanced comfort and independence. The experience with a patient with short gut syndrome following quasi-total intestinal resection due to necrosis, and with another with post-esophagocoloplasty necrosis, and the administration of intermittent outpatient total parenteral nutrition through a subcutaneous reservoir in both cases, enabled us to appreciate the advantages of the reservoir in administration of the nutrition. The ease of administration, reduced risk of infection and the positive psychological effect seen in these patients, enabled to lead a "practically normal" life, all vindicate the use of this method.

[Low-residue diets supplemented with fermentable fiber. Effect on experimental colonic anastomosis]. / Dietas de bajo residuo suplementadas con fibra fermentable. Efecto sobre las anastomosis cólicas experimentales.

Presentation of an experimental study comparing the scarring of colic anastomoses performed in Wistar rats fed with three different types of diet: a standard laboratory diet, an enteral low-residue diet and a low-residue diet supplemented with fermentable fibre in short chain fatty acids (pectin). Scarring in the group fed with the standard laboratory diet showed greater anastomotic complications, and the microscopic appearance was more inflamed. The administration of low-residue diets reduced the level of complications, but also reduced the concentration of collagen and the parietal rupture tension. The addition of pectin to a low-residue diet maintained the complications at a low level, and also significantly increased the pressure parameters and the collagen concentration.