Prevalencia de lesiones premalignas y carcinoma oculto en piezas de resección mamaria, estudio retrospectivo a 5 años / Prevalence of premalignant lesions and occult carcinoma in breast resection specimens, a 5-year retrospective study

Introducción y objetivo: El cáncer de mama es la neoplasia maligna con mayor incidencia y prevalencia mundial (excluyendo tumores cutáneos no melanoma), con cifras crecientes. Por ello, cualquier tejido extraído de la mama, con independencia del motivo, debe ser enviado a estudio anatomopatológico. El objetivo de este estudio es determinar la prevalencia de lesiones premalignas y carcinoma oculto en las piezas de resección de mamas intervenidas por motivos no oncológicos durante 5 años en el Servicio de Cirugía Plástica, Estética y Reparadora del Hospital Universitario Río Hortega de Valladolid, España. Material y método: Analizamos las piezas de resección mamaria de 253 pacientes sin diagnóstico clínico de cáncer de mama clasificadas previamente en grupos de riesgo teórico creciente de neoplasia asociada, con el objetivo de identificar la prevalencia de lesiones premalignas y carcinoma oculto en nuestra población. Resultados: La prevalencia de lesiones malignas mostró un incremento progresivo desde el grupo control (2.25%): pacientes sin antecedente personal de neoplasia mamaria ni factor de riesgo genético, a los grupos A (7.07%): pacientes con antecedente de neoplasia mamaria; B (11.43%): pacientes con factor de riesgo genético; y C (16.67%): pacientes con antecedente de neoplasia mamaria y factor de riesgo genético, con una edad media al diagnóstico de 48.11 años. Conclusiones: Los resultados obtenidos se correlacionan con la literatura existente y ponen de manifiesto que el hallazgo casual de lesiones premalignas y malignas en pacientes sin diagnóstico de cáncer de mama es una realidad relativamente común, especialmente en mujeres con factores de riesgo genético y/o diagnóstico de neoplasia mamaria previa.Nivel de evidencia científica 4b Diagnóstico

Background and objective: Breast cancer is the malignancy with the highest incidence and prevalence worldwide (excluding non-melanoma skin cancer), with growing rates. This is why any tissue removed from a breast (whatever the cause) must be properly analyzed. The aim of this study is to determine the prevalence of premalignant lesions and occult carcinoma in resected breast specimens operated for non-oncological reasons over a period of 5 years in the Plastic, Aesthetic, and Reconstructive Surgery Department at the Río Hortega University Hospital in Valladolid, Spain. Methods: We analyzed the breast resection specimens belonging to 253 patients without a clinical diagnosis of breast cancer, previously classified in groups of increasing theoretical risk of breast cancer, with the aim of identifying the prevalence of premalignant lesions and occult carcinoma in our population. Results: The prevalence of malignant lesions showed a progressive increase from the control group (2.25%): patients without personal history of breast neoplasia or genetic risk factor; to groups A (7,07%): patients with history of breast neoplasia; B (11.43%): patients with genetic risk factor; and C (16.67%): patients with history of breast neoplasia and genetic risk factor, with an average age at diagnosis of 48.11 years. Conclusions: The results correlate with the existing literature show that the casual finding of premalignant and malignant lesions in patients without a diagnosis of breast cancer is relatively common, especially in women with genetic risk factors and/or a prior diagnosis of breast cancer.(AU)

Process, structural, and outcome quality indicators to support perioperative opioid stewardship: a rapid review.

Opioids are effective analgesics but can cause harm. Opioid stewardship is key to ensuring that opioids are used effectively and safely. There is no agreed set of quality indicators relating to the use of opioids perioperatively. This work is part of the Yorkshire Cancer Research Bowel Cancer Quality Improvement programme and aims to develop useful quality indicators for the improvement of care and patient outcomes at all stages of the perioperative journey.A rapid review was performed to identify original research and reviews in which quality indicators for perioperative opioid use are described. A data tool was developed to enable reliable and reproducible extraction of opioid quality indicators.A review of 628 abstracts and 118 full-text publications was undertaken. Opioid quality indicators were identified from 47 full-text publications. In total, 128 structure, process and outcome quality indicators were extracted. Duplicates were merged, with the final extraction of 24 discrete indicators. These indicators are based on five topics: patient education, clinician education, pre-operative optimization, procedure, and patient-specific prescribing and de-prescribing and opioid-related adverse drug events.The quality indicators are presented as a toolkit to contribute to practical opioid stewardship. Process indicators were most commonly identified and contribute most to quality improvement. Fewer quality indicators relating to intraoperative and immediate recovery stages of the patient journey were identified. An expert clinician panel will be convened to agree which of the quality indicators identified will be most valuable in our region for the management of patients undergoing surgery for bowel cancer.

Testosterone therapy has positive effects on anthropometric measures, metabolic syndrome components (obesity, lipid profile, Diabetes Mellitus control), blood indices, liver enzymes, and prostate health indicators in elderly hypogonadal men.

To alleviate late-onset hypogonadism, testosterone treatment is offered to suitable patients. Although testosterone treatment is commonly given to late-onset hypogonadism patients, there remains uncertainty about the metabolic effects during follow-ups. We assessed the associations between testosterone treatment and wide range of characteristics that included hormonal, anthropometric, biochemical features. Patients received intramuscular 1,000 mg testosterone undecanoate for 1 year. Patient anthropometric measurements were undertaken at baseline and at each visit, and blood samples were drawn at each visit, prior to the next testosterone undecanoate. Eighty-eight patients (51.1 ± 13.0 years) completed the follow-up period. Testosterone treatment was associated with significant increase in serum testosterone levels and significant stepladder decrease in body mass index, total cholesterol, triglycerides and glycated haemoglobin from baseline values among all patients. There was no significant increase in liver enzymes. There was an increase in haemoglobin and haematocrit, as well as in prostate-specific antigen and prostate volume, but no prostate biopsy intervention was needed for study patients during 1-year testosterone treatment follow-up. Testosterone treatment with long-acting testosterone undecanoate improved the constituents of metabolic syndrome and improved glycated haemoglobin in a stepladder fashion, with no adverse effects.

Comparison of kaolin and tissue factor activated thromboelastography in haemophilia.

A limitation of bypassing agent therapy for haemophilia patients with inhibitors is the absence of a laboratory assay, which predicts the clinical response to treatment. Recent investigations have demonstrated the potential for thromboelastography to assess the effects of bypassing agent therapy in this patient population. While tissue factor activation has been used in several prior studies, a recent multicentre study failed to demonstrate an expected concentration-response effect of rFVIIa and called into question the tissue factor activation methods that have been employed. A comparison of kaolin to two concentrations of tissue factor as the activation method for thromboelastography was investigated in patients with haemophilia. We performed kaolin and tissue factor activated thromboelastography on blood from inhibitor and non-inhibitor patients with and without addition of rFVIIa and rFVIII. The results demonstrate that kaolin leads to a longer R, K and angle than the higher dilution of tissue factor (1:17 000) at baseline (no factor) and after addition of rFVIIa for both the inhibitor and non-inhibitor patients. Kaolin led to a longer R and K in comparison to a low dilution of tissue factor (1:42 000) following the addition of rFVIIa in the inhibitor patients. The longer R and K allows for better discrimination of the effects of rFVIIa thus making kaolin the most sensitive activation method in this setting. Thus kaolin activated thromboelastography should be considered an effective, perhaps the most effective, activator when utilizing thromboelastography to assess the effects of rFVIIa in haemophilia patients with inhibitors.

Treatment of cutaneous leishmaniasis by direct current electrotherapy: the Baghdadin device.

Electrical stimulation has been used as a mode of therapy for a number of clinical conditions. However, it has not been used for the treatment of cutaneous leishmaniasis (CL). For this purpose, we designed the "Baghdadin device". A total of 146 lesions of acute CL in 54 patients were treated by this device. Twenty-one lesions in the same patients were left untreated as controls. In addition, 36 lesions in 15 patients were treated with intralesional sodium stibogluconate. Treatment by the Baghdadin device consisted of weekly sessions of 10 minutes of direct current electrical stimulation. The intensity of the direct current ranged between 5 and 15 milliamperes, and the voltage was kept below 40 volts. Of the 146 lesions, 135 (92.5%) showed total clearance or marked improvement in 4-6 weeks time. Approximately 67% of the lesions needed only one or two sessions. Scarring was not observed after resolution. None of the untreated lesions showed any signs of improvement in 6 weeks. Of the lesions treated with sodium stibogluconate, 32 lesions (88.9%) showed total clearance or marked improvement, which was not significantly different from the results with the Baghdadin device.

Molecular epidemiology of acute lymphoblastic leukemia in Egypt.

We have characterized immunophenotypically defined acute lymphoblastic leukemia (ALL) in Egypt for rearrangements of the antigen receptor genes, and correlated this with rearrangements of ALL-1 and the presence of p53 mutations. Thirty-nine cases were analyzed for rearrangements of the immunoglobulin (Ig) and T-cell receptor (TCR) genes. All precursor B-cell ALLs (12 cases) contained rearranged Ig heavy-chain (JH) region which was biallelic in 92% of these tumors. In addition to JH rearrangements, TCR delta, beta and gamma rearrangements were observed in 80, 40 and 30% of these cases, respectively. TCR genes were invariably rearranged in T-cell ALLs (11 cases). A small fraction (2/11) of T-cell ALL showed concurrent IgJH rearrangement which was monoallelic. Simultaneous rearrangement of IgJH and TCR genes was also observed in both cases of biphenotypic ALL (coexpressing B and T markers). We observed marked heterogeneity in the pattern of rearrangement of antigen receptor genes in mixed-lineage leukemias (ALL coexpressing myeloid-associated markers), including the retention of germline configuration in two cases. Rearrangements of the ALL-1 gene were confined to the leukemias that demonstrated lineage infidelity. Mutations in p53 were infrequent and were present in only three of 47 ALL cases (6%) analyzed; two of these were mixed-lineage leukemias. These results suggest that mixed-lineage and biphenotypic leukemias accumulate pathogenetic lesions that are distinct from B- and T-cell ALL, and that ALL in developing countries includes molecular entities similar to those in developed countries.

The breakdown of 2,3-bis(phospho)-D-glycerate by Fe(III)-haemoglobin.

Fe(III)-haemoglobin is shown to catalyse the hydrolysis of 2,3-bis(phospho)-D-glycerate to Pi and 3-phosphoglycerate, although the rate is slow, even when the protein is present at concentrations in the millimolar range. The rate of hydrolysis is proportional to the subtrate concentration up to at least 10 mM, so if the process is enzymic, the Km must be high.