Consensus of the Spanish society of laboratory medicine and the Spanish society of medical oncology on the methodology and criteria for evaluation of circulating tumour markers in breast cancer.

The measurement of circulating tumour markers (TMs) for the diagnosis or monitoring of breast cancer has sometimes been considered of limited utility. In addition to the overinterpretation of irrelevant changes in marker levels, the characteristics of the patient, the disease or other pathologies that can modify them are often not considered in their evaluation. On the other hand, there are recent data on the relationship of TMs with molecular subtypes and on their prognostic value, the knowledge of which may improve their clinical utility. This consensus article arises from a collaboration between the Spanish Society of Laboratory Medicine (SEQCML) and the Spanish Society of Medical Oncology (SEOM). It aims to improve the use and interpretation of circulating TMs in breast cancer. The text summarizes the current knowledge and available evidence on the subject and proposes a series of recommendations mainly focussed on the indication, the frequency of testing and the factors that should be considered for correctly interpreting changes in the levels of TMs.

Quality of life in elderly breast cancer patients with localized disease receiving endocrine treatment: a prospective study.

PURPOSE: In this paper we study the quality of life (QoL) of elderly breast cancer patients receiving endocrine treatment (ET). More QoL data on elderly patients treated with ET are needed. Our aims are to study QoL in early-stage breast cancer patients throughout the treatment period and compare the QoL of ET groups. METHODS: 148 patients > 65 years who began ET with either tamoxifen or aromatase inhibitor (AI) completed the EORTC QLQ-C30 and QLQ-BR23 and the Interview for Deterioration in Daily Living Activities in Dementia (IDDD) questionnaires three times over 3 years of ET. Linear mixed-effect models were used to evaluate longitudinal QoL changes. ET group comparisons were conducted after 3 years of treatment via ANCOVA adjusted by basal QoL. RESULTS: QoL scores were high (> 80/100 points) in most QoL areas, with moderate limitations (> 30) in sexual functioning and enjoyment and in future perspective. After 3 years of ET, four QoL areas improved (< 6 points) compared to baseline and 3-month assessments. Hot flushes worsened (8 points) at the 3-month assessment but by 3 years had recovered. AI patients showed more hot flushes, pain and diarrhea and less sexual enjoyment than tamoxifen patients after 3 years of ET (differences 3-12 points). CONCLUSIONS: Results indicate that elderly early-stage breast cancer patients adapted well to their disease and ET treatment over the 3 years. Few QoL differences were observed between ET groups.

SEOM clinical guidelines on cardiovascular toxicity (2018).

One of the most common side effects of cancer treatment is cardiovascular disease, which substantially impacts long-term survivor's prognosis. Cardiotoxicity can be related with either a direct side effect of antitumor therapies or an accelerated development of cardiovascular diseases in the presence of preexisting risk factors. Even though it is widely recognized as an alarming clinical problem, scientific evidence is scarce in the management of these complications in cancer patients. Consequently, current recommendations are based on expert consensus. This Guideline represents SEOM's ongoing commitment to progressing and improving supportive care for cancer patients.

Childhood cerebral palsy and the use of positioning systems to control body posture: Current practices. / Parálisis cerebral infantil y el uso de sistemas de posicionamiento para el control postural: estado actual del arte.

INTRODUCTION: One of the consequences of poor postural control in children with cerebral palsy is hip dislocation. This is due to the lack of weight-bearing in the sitting and standing positions. Orthotic aids can be used to prevent onset and/or progression. OBJECTIVE: The aim of this study is to analyse the effectiveness of positioning systems in achieving postural control in patients with cerebral palsy, and discuss these findings with an emphasis on what may be of interest in the field of neurology. DISCUSSION: We selected a total of 18 articles on interventions in cerebral palsy addressing posture and maintenance of ideal postures to prevent deformities and related problems. The main therapeutic approaches employed combinations of botulinum toxin and orthoses, which reduced the incidence of hip dislocation although these results were not significant. On the other hand, using positioning systems in 3 different positions decreases use of botulinum toxin and surgery in children under 5 years old. The drawback is that these systems are very uncomfortable. CONCLUSION: Postural control systems helps control hip deformities in children with cerebral palsy. However, these systems must be used for prolonged periods of time before their effects can be observed.

SEOM Clinical Guideline of fertility preservation and reproduction in cancer patients (2016).

Chemotherapy and radiotherapy often result in reduced fertility in cancer patients. With increasing survival rates, fertility is an important quality-of-life concern for many young cancer patients. Around 70-75% of young cancer survivors are interested in parenthood but the numbers of patients who access fertility preservation techniques prior to treatment are significantly lower. Moreover, despite existing guidelines, healthcare professionals do not address fertility preservation issues adequately. There is a critical need for improvements in clinical care to ensure patients are well informed about infertility risks and fertility preservation options and to support them in their reproductive decision-making prior to cancer treatment.

Erratum:Quality of life in long-term premenopausal early-stage breast cancer survivors from Spain. Effects of surgery and time since surgery.

In this article published in Volume 21, issue 5, the authors' names were incorrectly stated in the Pubmed abstract as: "Ignacio Arraras J(1), Juan Illarramendi J, de la Cruz S, Asin G, Manterola A, Ibanez B, Salgado E, Cambra K, Zarandona U, Angel Dominguez M, Vera R.". The correct authors' names are: "Arraras JI(1), Illarramendi JJ, de la Cruz S, Asin G, Manterola A, Ibanez B, Salgado E, Cambra K, Zarandona U, Dominguez MA, Vera R.". This error appeared only in the PubMed database and not in the print form of the Journal.

[Hormonal therapy in breast cancer]. / Tratamiento hormonal del cáncer de mama.

Hormonal therapy has been the first systemic treatment against breast cancer. Up to now Tamoxifen and ovarian supression/ablation were the best optionts we had to treat early breast cancer as advancer disease. The advent of aromatase inhibitors, new SERMS and antistrogen Fulvestrant have supoused a great advance in the treatment of this disease and at the same time have complicated the election of the optimal drug for each patient. This article tries to review the aviable treatment options insiting on its indications.

Primary central nervous system lymphoma treated with rituximab plus temozolomide in a second line schedule.

We report a case of primary CNS lymphoma treated with high-dose methotrexate in the first line. After disease progression the patient received cranial radiotherapy with concomitant temozolomide, followed by rituximab plus temozolomide, with complete remission of the disease maintained for at least two years and without major toxicity.

[Bilateral ovary massive edema. Unusual gynecologic pathology. Report of 2 cases]. / Edema masivo de ovario bilateral. Patología ginecológica poco frecuente. Informe de dos casos.

We report two cases of bilateral massive ovarian edema occurred in a concentration hospital in the last five years. This condition was first described by Kalstone et al. in 1969. It may be uni or bilateral, the last one is very uncommon, until the moment of this work there have been reported only ten cases in the world literature. The main symptoms are: abdominal pain or distention, menstrual irregularity and infertility. Two features are characteristic of this pathology: 1) Fast growing in size and volume of the ovary, and 2) Abscense of neoplastic changes with extensive edema of the stroma particularly in the medulla. The current treatment is oophorectomy. In bilateral cases may be intended a conservative management with wedge resection and fixation of the ovaries to the uterus in order to prevent further torsion. We conclude that massive ovarian edema is an uncommon pathology more frequent as a cause of abdominal pain and fast growing anexial mass in young women.

Clinicopathologic correlations in lupus nephritis in Lima, Peru.

BACKGROUND: We assessed whether immunohistologic markers for glomerular or tubulointerstitial injury might provide better correlations with ongoing renal function and disease activity as compared with the WHO classification or the NIH activity and chronicity indices in lupus nephritis. METHODS: Thirty-three patients with clinically defined systemic lupus underwent renal biopsy over a 1-year period at Hospital Loayza in Lima, Peru. Biopsy specimens were evaluated for macrophages, proliferating cells, alpha-actin expression, and type IV collagen deposition in both glomeruli and the tubulointerstitium and the results compared with the current WHO and NIH classifications in relation to the clinical presentation. RESULTS: Patients with WHO class IV lupus nephritis were more likely to have lower serum complements, greater proteinuria and hematuria, and worse renal function. An elevated NIH activity index correlated with microhematuria, proteinuria, and impaired renal function, whereas an elevated chronicity index correlated with renal function, hypertension, and microhematuria, but not with proteinuria. The presence of glomerular macrophages correlated with both glomerular alpha-actin expression and type IV collagen deposition, but did not correlate with renal function or proteinuria. In contrast, interstitial macrophages correlated not only with interstitial collagen deposition and myofibroblast accumulation, but also correlated with both renal function and the presence of nephrotic syndrome. CONCLUSIONS: Both the WHO classification and the NIH activity/chronicity indices correlate with clinical manifestations of lupus nephritis. While glomerular macrophage accumulation correlates with mesangial cell activation (alpha-actin expression) and collagen deposition, and interstitial macrophage accumulation correlates with interstitial fibroblast activation and collagen deposition, only interstitial macrophages correlate with renal function. Of particular interest will be future studies to determine whether these markers correlate with the prognosis.

[Uterine leiomyomatosis in the female in late menopause]. / Miomatosis uterina en la mujer en la posmenopausia tardía.

Leiomyomatosis is less frequent in old woman, and its clinical and histological characteristic in late postmenopause are unknown. Uterine leiomyomas were confirmed histologically in 14 out of 69 patients (20.2%) who were 65 or older and in whom a vaginal hysterectomy was performed. Another group without myomas was paired by age to the study group. In both groups, the uterine volume and the minor diameter of the uterus were compared, as well as age at menarche, menopause and duration of the menstrual life. Statistical analysis was done with ANOVA. It was observed, as expected, that uterine volumes of women with leiomyomatosis were significantly greater (p < 0.01) than those of women that did not have myomas; however, the smaller uterine diameters were not significantly different between the two groups, which is an important finding for surgical treatment of these patients. In addition, the menstrual life of patients with myomas was significantly greater (p < 0.04) than that of women without leiomyomatosis. In conclusion, one fifth women 65 years old or older can present myomas and consequently an increase in uterine volume, but without increase in minor diameters. Furthermore, the greater menstrual life span must be recognized as possible risk factor for the presence of leiomyomatosis.

[Para-tubal cysts: frequency and clinical, ultrasonographic and histological correlations]. / Quistes paratubarios: Frecuencia y correlación clínica, ultrasonográfica e histológica.

We Reviewed 5,100 biopsies, between November 1994 to November 1995 We found 100 paratubval cysts. The 80% of the cases were surgical findings. The 40% of the cases had pain. The 3% of the patients had acute pain, that made necessary an urgent surgery. The ultrasonogram revealed an ovarian cyst in 38% of the cases and it couldn't detect them in 63% of the cases. The cysts sizes were: 6 cm. (84%) *12% 9 between 6-12 cm. and 43% between 12-18 cm. The histopathology report was: 57% of serous cyst and 43% simple cyst.

[Myomatosis of rare localization]. / Miomatosis de localización poco frecuente.

We described three cases of female patients with myomata of rare location. A 37 year old female with abnormal genital bleeding, secondary to cervical neoplasm; underwent total abdominal hysterectomy in 1993. A year later an excision of anterior vaginal dependent neoplasm was performed. A 16 year old female with Bartholinitis. Excision of vulvar tumor was performed. A 35 year old female with urinary stress incontinence, hematuria, referring foreign body sensation in the vagina, with a neoplasm in the urethra. The patient underwent for excision of the tumor. In all three cases the neoplasm excised underwent histopathologic analysis resulting as vulvar, vaginal and urethral myomata.

[Obesity as a risk factor in surgery for urinary incontinence]. / La obesidad como factor de riesgo en la cirugía anti-incontinencia.

There is controversy in the literature related with the prognosis of incontinent obese patient. The objective of this study was to demonstrate if obesity has influence on the relapse of postsurgical incontinence in genuine urinary incontinence. 148 patients were included measuring their Body Mass Index and divided in two groups: Group "A" 74 patients without relapse and Group "B" 74 patients with relapse. The results showed in the obese patients the double of surgical failures than in those with our it (P < 0.05). In conclusion obesity is a adverse prognostic factor in the postsurgical evolution in these patients.

[Invasive studies at the office in the diagnosis of stress urinary incontinence]. / Estudios invasivos de consultorio en el diagnóstico de incontinencia urinaria de esfuerzo.

A revision of the available diagnostic method is being made for the stress urinary incontinence, paying special attention to those which can be enhanced in the doctor's office. Three of the requiring catheters, endoscopic instruments or another kind of advices for his realization and they can be considered such as "Invasive test". There is mentioned that with these techniques there can be found an appropriate diagnosis of the genuine incontinence even up to a 75% of the cases. The remaining percentage requires studies either urodynamic or of any other kind in order to complete the diagnosis. The criterions are enlisted in order to send the patient to a specialized center.

[Criteria for the selection of surgical technic in patients with anatomical urinary stress incontinence]. / Criterios de selección de técnicas quirúrgicas en la paciente con incontinecia urinaria de esfuerzo anatómica.

In this paper it is described the minimum necessary investigation in the evaluation of the incontinent patient, the surgical methods accepted up to date for the treatment of genuine incontinence as well as the facts to be considered and the interrogatives to be solved for the candidate patient ready for surgery as a guide for the election of the most adecuate surgical procedure for the patient. This stands out that the position that the preoperatory measurement of pressure of the urethral closing can lead to the evolution in the operated patients.

[Stress urinary incontinence. A comparison of of 4 methods of cystourethropexy. A 2-year follow-up]. / Incontinencia urinaria de esfuerzo. Comparación de cuatro métodos de cistouretropexia. Seguimiento a dos años.

All successful operations for relief of genuine stress urinary incontinence (SUI) have three objectives: elevation and retropubic maintenance during stress of the urethrovesical junction. The present study was realized at the Urogynecologic Service of the "Luis Castelazo Ayala" hospital IMSS to evaluate the results in a two years follow up of 597 patients that suffered from SUI treated by retropubic urethropexy, from February 1984 to May 1991. Patients were studied according to the service norms, previously published. We realized four types of procedures: Pereyra (379 cases), Burch (90 cases), Marchall-Marchetti-Kratz (60 cases) and Powell surgery (68 cases). Vaginal approach was realized in cases of pelvigenital statics disturbances like cysto- or rectocele; and abdominal approach was indicated in patients with enlarged uterus or pelvic masses. The complications rate was 15.3%. Success rate was 87.06% for all procedures and not statistic significance was found (p > or = 0.1 and X2 = 6.15), the best rate to the Burch and Pereyra procedures. We conclude the most important tip to successful rate in SUI surgery is correct choice of the procedure according to the patient.