The role of personality dimensions, depressive symptoms and other psychosocial variables in predicting postpartum suicidal ideation: a cohort study.

Suicidability has been associated with neuroticism and psychoticism, but its role during perinatal period has not been analyzed. We explore the association between personality dimensions, depressive symptoms, and other psychosocial variables in postpartum suicidal ideation. A cohort of 1795 healthy Spanish women from the general population was assessed for suicidal ideation (EPDS-Item10) in early postpartum, 8 and 32 weeks postpartum. Sociodemographic, obstetric, and reproductive variables, psychiatric history, social support, stressful life-events during pregnancy, depressive symptoms (EPDS), and the Eysenck's personality dimensions (EPQ-RS) were also assessed at baseline. A major depressive episode (DSM-IV) was confirmed in women with EPDS>10 at follow-up assessments. Descriptive, bivariate, and multivariate analyses were conducted. Adjusted logistic regression analysis was reported as odds ratio (ORs) with 95% confidence intervals (CIs). Seven percent of mothers reported suicidal ideation during the first 8 months postpartum. Sixty-two percent of women with suicidal ideation had a major depressive episode at 8 weeks, and 70% at 32 weeks postpartum. Neuroticism and psychoticism predicted suicidal ideation throughout the first 2 weeks after delivery (OR, 1.03; 95%CI 1.01-1.06; and OR, 1.03; 95%CI 1.01-1.05 respectively). Early postpartum depressive symptoms (OR 1.2; 95%CI 1.11-1.26), personal psychiatric history (OR 2.1; 95%CI 1.33-3.27), and stressful life events during pregnancy (OR 1.88; 95%CI 1.12-3.16) also emerged as predictors of postpartum suicidal ideation. Analysis of women for postpartum suicidal ideation should include not only psychiatric symptoms but also psychosocial assessment (i.e., covering psychiatric history, stressful events, or long-standing personality vulnerabilities) in order to identify those in need of early psychosocial or psychiatric care.

Micrometástasis en el ganglio centinela del cáncer de mama. Revisión de literatura / Sentinel lymph node metatases in breast cancer. Review of literature

OBJETIVO. El resultado de micrometástasis y células tumorales aisladas como única expresión de extensión linfática de un cáncer de mama es algo relativamente frecuente. Actualmente se plantea la posibilidad de no realizar la linfadenectomía axilar tras el hallazgo histológico de una micrometástasis en la biopsia de ganglio centinela, por la baja frecuencia de afectación del resto de los ganglios axilares y el aumento significativo de morbilidad de dicha técnica. MATERIAL Y MÉTODOS. Se incluyen todas las pacientes sometidas a biopsia de ganglio centinela durante los años 2010 y 2011 en el Hospital Universitario Río Hortega de Valladolid. En todos los casos de macro y micrometástasis se realizó una linfadenectomía posterior para valorar el grado de afectación axilar. RESULTADOS. En el año 2010 se intervinieron en el HURH de Valladolid 126 casos de cáncer de mama, de los cuales 77 (65%) fueron candidatas para la realización de la biopsia de ganglio centinela, obteniéndose 47 negativos, 16 positivos para macrometástasis, 9 micrometástasis, 3 células tumorales aisladas y en 2 casos no hubo migración del trazador. En el año 2011 se operaron 140 casos de cáncer de mama, de los cuales 102 casos (73%) sometidas a biopsia de ganglio centinela, obteniéndose 77 negativos, 13 positivos para macrometástasis, 7 micrometástasis, 2 células tumorales aisladas y en 3 casos no hubo migración del trazador lo que obligó a realizar la linfadenectomía clásica. Durante estos dos años se realizó linfadenectomía posterior en todos los casos de afectación del ganglio centinela con macro y micrometástasis y no se realizó con ganglios negativos y células tumorales aisladas. En el caso de las micrometástasis no se objetivó afectación de ningún otro ganglio linfático en la disección axilar. DISCUSIÓN. Según los datos de nuestra actividad quirúrgica, la disección axilar de las pacientes con afectación del ganglio centinela por micrometástasis podría evitarse (AU)

AIM. The result of micrometastases and isolated tumor cells as the only expression of lymphatic spread of breast cancer is relatively frequent. The possibility of avoiding complete axillary lymphadenectomy in those patients who are only affected by micrometastasis is proposed because of the low incidence of further involvement of the remaining lymph nodes and the significant increase in morbidity of the technique. MATERIAL AND METHOD. We included all patients undergoing sentinel node biopsy during the years 2010 and 2011 at Hospital Universitario Rio Hortega. Complete axillary lymphadenectomy was performed when micro or macrometastases were found in the sentinel node, in order to determine the degree of axillary involvement.RESULTS. In 2010 126 breast cancers were operated in the HURH from Valladolid. 77 (65%) have benefited from the use of axillary sentinel node biopsy, which 47 were negative, 16 were affected by macrometastasis a, 3 isolated tumor cells and 9 by micrometastasis. In 2 cases there was no migration. In 2011, 140 breast cancer were operated in our hospital, and 102 (73%) were able to performed sentinel node biopsy. 77 were negative, 13 positive, 2 with isolated tumor cells and 7 micrometastasis. In 3 cases there was no migration. Complete axillary lymphadenectomy was performed when micro o macrometastases were found in the sentinel node. There was no other axillary lymph node involved in patient with micrometastasis. DISCUSSION. It is possible to speculate that, in the future, axillary dissection can be avoided in those patients diagnosed of micrometastasis in the sentinel node (AU)

Mood changes after delivery: role of the serotonin transporter gene.

BACKGROUND: Polymorphic variations in the serotonin transporter gene (5-HTT) moderate the depressogenic effects of tryptophan depletion. After childbirth there is a sharp reduction in brain tryptophan availability, thus polymorphic variations in 5-HTT may play a similar role in the post-partum period. AIMS: To study the role of 5-HTT polymorphic variations in mood changes after delivery. METHOD: One thousand, eight hundred and four depression-free Spanish women were studied post-partum. We evaluated depressive symptoms at 2-3 days, 8 weeks and 32 weeks post-partum. We used diagnostic interview to confirm major depression for all probable cases. Based on two polymorphisms of 5-HTT (5-HTTLPR and STin2 VNTR), three genotype combinations were created to reflect different levels of 5-HTT expression. RESULTS: One hundred and seventy-three women (12.7%) experienced major depression during the 32-week post-partum period. Depressive symptoms were associated with the high-expression 5-HTT genotypes in a dose-response fashion at 8 weeks post-partum, but not at 32 weeks. CONCLUSIONS: High-expression 5-HTT genotypes may render women more vulnerable to depressive symptoms after childbirth.

Hyperbranched polymers as drug carriers: microencapsulation and release kinetics.

The aim of this work was to study the feasibility of hyperbranched polymers as drug carriers by employing different microparticle formation methods and the influence of loading methods on release kinetics. Commercially available hyperbranched polyester (Perstorp) and three polyesteramides (DSM) were loaded with the pharmaceutical acetaminophen. The gas antisolvent precipitation (GAS), the coacervation, and the particles from gas saturated solutions (PGSS) are among conventional processes that were used to prepare microparticles of drug-loaded hyperbranched polyesters for the first time. For preparing solid dispersions of drug-loaded hyperbranched polyesteramides the solvent method was applied. Infrared (IR) and differential thermal analysis (DTA) studies suggest that acetaminophen is partly dissolved in the polymer matrix and partly crystallized outside the polymer matrix. For acetaminophen-loaded polyesters prepared by the GAS method, the presence of free drugs is predominant when compared to microparticles prepared by the coacervation method. This event disappears for microparticles prepared by the PGSS method. Moreover, the release of drug from drug-loaded Bol-GAS is biphasic, where the initial burst (48%), indicating the presence of unincorporated drugs, is followed by a slow-release phase, suggesting the diffusion of drug through polymer matrices. The release of drugs from drug-loaded Bol-PGSS do not show this behavior since the drug is better dissolved or dispersed in polymer matrices. In the case of drug-loaded polyesteramides, coevaporates prepared from 3 hyperbranched structures (H1690, H1200, and H1500) using the solvent method result in different release kinetics. The hydrophobic characteristic of hyperbranched polyesteramide H1500 shows the biphasic release kinetic whereas the drug released from hydrophilic matrices H1690 and H1200 exhibits fast release comparable to that of pure drug.

A fragile X case with an amplification/deletion mosaic pattern.

Fragile X syndrome is the most common cause of hereditary mental retardation. The FMR1 gene, which is involved in fragile X syndrome, contains a polymorphic CGG repeat, which expands in affected patients. Expanding triplet repeats have been shown to be a new type of mutation, termed "dynamic mutation", responsible for more than 12 genetic diseases. These mutations occur as multiple steps rather than as a single event. The first step leads to an unstable allele that then becomes increasingly unstable generally achieving further increases in copy or occasionally contraction. In this report, we describe a fragile X boy with both a hypermethylated full mutation and a deletion of 905 bp encompassing the CGG repeat. The upstream breakpoint is 438 bp 5' to the CGG repeat and the downstream breakpoint is 420 bp 3' of the triplet repeats. The deletion includes the ATG starting codon for translation of the FMR1 gene. This was confirmed by using FMRP immunocytochemistry both on blood smears and hair roots. The deleted region is flanked by a ccgg direct repeat next to the breakpoints; this may have had a critical role in the formation of a secondary DNA structure leading to the deletion.

Assessment of FMR1 expression by reverse transcriptase-polymerase chain reaction of KH domains.

The fragile X syndrome is the most frequent form of inherited mental retardation. This is caused by the transcriptional inactivation of the FMR1 gene. The KH domain is an evolutionarily conserved sequence motif present in many RNA-binding proteins including the fragile X mental retardation gene product. We have studied the expression of the gene in fresh leukocytes derived from patients and normal controls by using a reverse transcriptase-polymerase chain reaction (RT-PCR) protocol that amplifies the region of the FMR1 that contains the KH1 and KH2 domains and that has not been used in previous studies. As expected, normal expression was observed in control subjects and carriers, but FMR1 mRNA was absent in male patients with fragile X syndrome. This method was also proved to be useful for testing the expression of FMR1 in samples from several species and tissues. In all cases we obtained a similar and unique transcript. We suggest that RT-PCR from the KH domains could be the method of choice for studying FMR1 expression.

Instability of the CGG repeat at the FRAXA locus and variable phenotypic expression in a large fragile X pedigree.

Fragile X syndrome is the major cause of inherited mental retardation. The molecular basis for the expression of the fragile X phenotype is the expansion of an unstable CGG repeat element which inhibits transcription of the FMR1 gene. The fragile X syndrome shows great diversity in its phenotype as well as in its cytogenetic and molecular status. We have studied, in a large fragile X family, the correlation between the molecular data and the phenotypic expression of the syndrome. We report two brothers who carry identical unmethylated premutated alleles but present different clinical phenotypes. We also suggest that reductions in allele size from one generation to another may be, as in other diseases, because of triplet amplifications, more common at the FRAXA locus than previously thought.

[Hepatic hematoma and pleural hemorrhages caused by prolonged ingestion of oral contraceptives]. / Hematoma hepático y derrames pleurales por ingesta prolongada de anovulatorios orales.

PIP: The case is described of a 32-year old woman with an 8 year history of oral contraceptive (OC) use who developed vascular complications. Significant findings in the patient's history included an appendectomy and repeated biliary colic dating back 7 years. The patient sought help for an attack of hepatic colic with vomiting, chills, and fever, dyspepsia, and intolerance of fats. Pain was noted on palpation and the clinical and sonographic findings indicated hepatomegaly. Based on the other clinical and laboratory findings, a preliminary diagnosis of infected hepatic hydatidic cyst was made and the intrahepatic hematoma was drained. The postoperative diagnosis was a large hematoma occupying the greater part of the right hepatic lobe. A pleural hemorrhage occurred during postoperative hospitalization and was treated medically, but 4 days after discharge from the hospital the patient returned with a pleural hemorrhage that required drainage. Hydatidosis is endemic in the region of Spain where the case occurred, and the grounds for differential diagnosis are specified. Several illustrations including sonograms, X-rays, and results of computerized axial tomography are included and explained. With the increasing use of OCs in Spain, it is likely that more such cases will be seen.^ieng

[Ultrasound diagnosis of neonatal adrenal haemorrhage (author's transl)]. / Diagnóstico ecográfico de la hemorragia suprarenal en el recién nacido. Presentación de dos casos.

Two cases of neonatal adrenal haemorrhage are presented. Abdominal mass or jaundice appears in clinical study. Conventional diagnosis procedures are analyzed and advantages of abdominal echographic exploration is evaluated in order of precocious diagnosis and adequate monitoring of lesion evolution. Likewise, usefulness of ultrasounds in establishing differential diagnosis of adrenal haemorrhage in relation to other abdominal masses, important fact to save laparotomy, is emphasized.