Role of boost radiotherapy for local control of pure ductal carcinoma in situ after breast-conserving surgery: a multicenter, retrospective study of 622 patients.

PURPOSE: To evaluate the effect of boost radiotherapy on ipsilateral breast tumor recurrence (IBTR) for ductal carcinoma in situ (DCIS) after breast-conserving surgery and whole breast radiotherapy (WBRT) with or without boost. METHODS AND MATERIALS: Retrospective, multicentre study of 622 patients (624 tumors) diagnosed with pure DCIS from 1993-2011. RESULTS: Most tumors (377/624; 60.4%) received a boost. At a median follow-up of 8.8 years, IBTR occurred in 64 cases (10.3%). A higher percentage of patients with risk factors for IBTR received a boost (p < 0.05). Boost was not associated with lower rates of IBTR than WBRT alone (HR 0.75, 95% CI 0.42-1.35). On the univariate analyses, IBTR was significantly associated with tumor size (11-20 mm, HR 2.32, 95% CI 1.27-4.24; and > 20 mm, HR 2.10, 95% CI 1.14-3.88), re-excision (HR 1.76, 95% CI 1.04-2.96), and tamoxifen (HR 2.03, 95% CI 1.12-3.70). Boost dose > 16 Gy had a protective effect (HR 0.39, 95% CI 0.187-0.824). Multivariate analyses confirmed the independent associations between IBTR and 11-20 mm (p = 0.02) and > 20 mm (p = 0.009) tumours, and re-excision (p = 0.006). On the margin-stratified multivariate analysis, tamoxifen was a poor prognostic factor in the close/positive margin subgroup (HR 4.28 95% CI 1.23-14.88), while the highest boost dose ( > 16 Gy) had a significant positive effect (HR 0.34, 95% CI 0.13-0.86) in the negative margin subgroup. CONCLUSIONS: Radiotherapy boost did not improve the risk of IBTR. Boost radiotherapy was more common in patients with high-risk disease. Tumor size and re-excision were significant independent prognostic factors.

Reflex sympathetic dystrophy in hypophosphataemic osteomalacia with femoral neck fracture: a case report.

We report a male patient who presented with suspicion of skeletal metastases based upon an abnormal 99-mTc bone scan, which showed increased uptake at both femoral heads, left femoral neck, and several ribs. The images also suggested reflex sympathetic dystrophy, subcapital fracture of the left femur, and rib fractures. A diagnosis of hypophosphataemic osteomalacia was finally made.

Longterm therapy in polymyalgia rheumatica: effect of coexistent temporal arteritis.

OBJECTIVE: To analyze the clinical course and duration of therapy in a series of 104 patients with polymyalgia rheumatica (PMR), identifying factors that influence prolonged steroid use and relapses. METHODS: Retrospective study of 104 cases of PMR diagnosed from 1985 to 1995. Patients were followed from time of diagnosis until either their death or December 31, 1995. To assess the effects of the coexistence of temporal arteritis (TA) on outcome in PMR, patients were grouped according to the absence or presence of arteritis. Kaplan-Meier survival analysis was performed to evaluate the duration of therapy, the incidence of prolonged remissions and relapses, and the average time to relapse. The log-rank test was used to test for significant differences between groups. Multivariate Cox proportional hazards regression models were used to identify variables associated with the occurrence of these events. RESULTS: Of 104 patients, 69 had pure PMR and 35 had both PMR and TA. Although some patients had limited disease requiring limited corticosteroid (CS) therapy (usually about 2 years), a significant number of patients had sustained disease requiring longterm treatment. Patients with simultaneous arteritis tended to have a longer duration of therapy, but no increased risk of relapse. By multivariate analysis, increasing age at diagnosis, female sex, higher baseline erythrocyte sedimentation rate, and lower daily CS dose were significant risk factors associated with long duration of therapy. No clinical feature predicted patients who were more likely to relapse. CONCLUSION: Although there was great individual patient variation, we found that typically CS therapy lasted at least 2 years. Our findings allow the identification of patients who are particularly predisposed to need prolonged and higher dose cumulative steroid therapy and merit preventive strategies to decrease the incidence of steroid related adverse events.

[Secondary amyloidosis in rheumatoid arthritis. A clinical study of 29 patients]. / Amiloidosis secundaria a la artritis reumatoide. Estudio clínico de una serie de 29 casos.

BACKGROUND: To study the clinical features, outcome and response to therapy in 29 cases of rheumatoid arthritis (RA) with secondary amyloidosis (AA). PATIENTS AND METHOD: Twenty-nine patients with RA and AA who were diagnosed during 11 years. RESULTS: The mean age and the mean duration of RA were 63 +/- 12 years and 15 +/- 7 years respectively. The most common initial clinical feature was renal involvement (83%). Nineteen patients were treated with methotrexate. The mean survival time was 42 +/- 8 months. Eleven patients (38%) have deceased. CONCLUSION: Our data confirms that AA in RA is a serious complication with a bleak prognosis. A normal renal function is a good prognosis indicator.

[Are food intake and life styles related with bone mass in fertile women?]. / Hay relación entre los hábitos alimenticios y estilo de vida con la masa ósea en mujeres fértiles?

BACKGROUND: To study the relationship between current and adolescent calcium intake and bone mineral density (BMD) in 76 premenopausal women of 42 y. with regular menses and without pathologies associated with body weight, body morphology or BMD. METHODS: Was measured: the lumbar and femoral BMD by dual energy X-Ray absorptiometer, calcium and protein intake by a week frequencies questionnaire, and calciuria. Obesity, exercise, alcohol, tobacco and family history of osteoporosis were considered. Levels of BMD < -1SD was considered as osteopenia. RESULTS: Calcium intake average was 989 mg/day, 62% by dairy. Twenty-five percent presented osteopenia in some bone site. BMD was not correlated with calcium or protein intake, calcium/protein nor calciuria. No differences was found between normal and osteopenic group for any of the studied variables, except lower body mass index in the femoral osteopenic group. Those women who decreased the calcium intake from adolescence had 8.2% less femoral BMD tha those who increased the consumption (p = 0.05). CONCLUSION: Current and adolescent calcium intake, family history of osteoporosi calciuria, and exercise have not found useful as screening of osteopenia in premenopausal women with moderated exercise level and low consumption of alcohol and tobacco.

Rotated intestinal anastomoses.

Using a technique of end-to-end intestinal anastomosis, based upon a 90 degree axial rotation, the conjunction of both mesenteric edges without peritoneal serosa is avoided; theoretically, this would be the weakest area of such an anastomosis. This theory was experimentally tested in the colon of rabbits and the technique compared with the usual, so-called exact facing technique, justifying its clinical use in the hope of improving the results of gastrointestinal operations.