Surgical Treatment of Nonmineralized Supraspinatus Tendinopathy in Dogs: A Retrospective Long-Term Follow-Up.

(1) Background: two forms of supraspinatus tendinopathy (ST) have been reported in dogs: mineralized and non-mineralized. Surgical treatment consists of longitudinal incisions (splitting) in the tendon of insertion of the supraspinatus muscle. The purpose of this retrospective study is to describe the diagnostic workout, the surgical procedure and the short and long term follow up of dogs treated for non-mineralized ST. (2) Methods: medical records (2010-2017) of dogs diagnosed with non-mineralized ST that underwent surgical treatment were reviewed. Data retrieved were: signalment, history, clinical signs, orthopaedic examination findings, diagnostic imaging findings, surgical treatment, histopathologic diagnosis and clinical outcome. (3) Results: A total of 27 dogs met the inclusion criteria. The most consistent clinical findings were intermittent lameness accompanied by pain on palpation of the insertion of the supraspinatus. Magnetic resonance imaging (MRI) of 27 shoulders distended sheaths of the biceps tendon (10/27), compression of the biceps brachii tendon sheaths (5/27) and enlargement of the supraspinatus tendon (3/27) were observed. The most prominent histologic finding was severe myxomatous degeneration in all 27 samples. Resolution of lameness was achieved in 80% of the cases surgically treated without any further lameness episodes in the long-term follow-up. (4) Conclusions: the surgical splitting of the non-mineralized supraspinatus tendon is an effective procedure with no intra-operative complications and a low incidence of minor (18%) and major (4%) complications.

Comparison of post-operative outcomes after open or closed surgical techniques to stabilize metacarpal and metatarsal fractures in dogs and cats.

BACKFROUND: Treatment options for metacarpal/metatarsal fractures include conservative and surgical management. The aim of this study is to determine whether there is any significant difference in healing and complication rates, between open and closed treatment. Medical records of dogs and cats with metacarpal/metatarsal fractures with complete follow-up were retrospectively reviewed. Patients were allocated in two groups: open or closed stabilization. Minor and major complications were recorded and compared. Fracture healing was classified as good, delayed and non-union, and it was statistically compared. RESULTS: Sixty-three patients (35 dogs and 28 cats) were included. Thirty-one were treated with an open approach and 32 by a closed stabilization. Regarding fracture healing a significantly higher proportion of delayed healing/non-union was found in the closed group (12/32 vs 2/31). Regarding postoperative complications, a significantly higher number of animals in the open group did not develop any complications (12/31 vs 3/32). A significantly higher proportion of minor complications were reported in the closed group (27/32 vs 12/31). However, a higher number of major complications was reported in the open group (7/31 vs 2/32) although this was not statistically significant. Fracture malalignment was significantly more prevalent in patients undergoing closed stabilization (11/32 vs 2/31). CONCLUSION: According to the results, better healing, fracture alignment and a lower complication rate are found when fractures are stabilised with an open technique. However, other factors such as configuration of the fracture, soft tissue involvement, patient´s character and client´s situation would also need to be taken into account in the decision of stabilization technique.

Comparison of surgical and obstetric outcomes in women with uterine leiomyomas after laparoscopic vs. abdominal myomectomy: A single-center cohort study.

Our aim was to study the advantages, complications and obstetrical outcomes of laparoscopic myomectomy (LM) compared with abdominal myomectomy (AM). We conducted a retrospective cohort study at La Paz University Hospital that included LMs and AMs performed between 2012 and 2018, analyzing 254 myomectomies (142 AMs [55.7%] and 112 LMs [43.9%]). The mean number of fibroids was 1.8 ± 1.5 and 3 ± 2.9 for the LM and AM groups, respectively (p < 0.006). The mean size of the largest myoma was 7.6 cm ± 2.7 cm and 10.2 cm ± 5.4 cm for the LM and AM groups, respectively (p < 0.001). LMs were associated with longer surgical times (p < 0.001) and shorter hospitalizations (p = 0.001). There were no significant differences in the intraoperative and postoperative complication rates (p = 0.075 and p = 0.285 for LM and AM, respectively). The subsequent pregnancy rate was higher for the LM group (30.8% vs. 16.8%, p = 0.009), with a vaginal delivery rate of 69% and no cases of uterine rupture.

Traumatic stifle injury in 72 cats: a multicentre retrospective study.

OBJECTIVES: The aim of the study was to describe traumatic stifle injury in cats and report complications and long-term outcome. METHODS: The medical records from seven veterinary hospitals of cats treated for traumatic stifle injury were reviewed. Long-term follow-up data were collected from referring veterinarians and using the Feline Musculoskeletal Pain Index, collected from owners. RESULTS: Seventy-two cats were included in the study. The most common combination of ligament injury involved both cruciate ligaments and the lateral collateral ligament (25.4%). Medial meniscal injury was more common (66.2%) than lateral meniscal injury (59.4%). A temporary transarticular pin was used intraoperatively to aid reduction in 23/73 (31.5%) surgeries. Postoperative immobilisation was applied in 41/72 (56.9%) cats with a mean duration of 4.8 weeks. Short-term complications occurred in 40/64 (62.5%) cats. Long-term complications occurred in seven (17.5%) cats. Overall outcome was excellent in 25/61 (41%) cats, good in 13/61 (21.3%) cats, fair in 11/61 (18%) cats and poor in 12/61 (19.7%) cats. Mean length of follow-up was 29.6 months (range 0.5-204). A significantly poorer outcome was observed in cats with medial meniscal injury and those undergoing revision surgery. Use of a transarticular pin when left in situ for postoperative immobilisation was associated with a poorer outcome (P = 0.043) and a higher risk of complications (P = 0.018). Postoperative immobilisation was not related to outcome. CONCLUSIONS AND RELEVANCE: Traumatic stifle injury in cats can lead to rupture of multiple ligaments causing significant instability of the joint. Surgical treatment is associated with a high rate of short-term complications, although long-term outcome may still be good to excellent in the majority of cats (62.3%). In cats where follow-up was available, postoperative immobilisation had no positive effect on outcome and may not be required. Leaving a transarticular pin for postoperative immobilisation is not recommended as it was significantly associated with a poorer outcome and a higher complication rate.

Vaginal health, endometrial thickness and changes in bone markers in postmenopausal women after 6 months of treatment with ospemifene in real clinical practice.

OBJECTIVE: To assess vaginal health, endometrial thickness, and changes in bone markers in postmenopausal women with vulvovaginal atrophy (VVA) treated with 60 mg/day of ospemifene under routine clinical practice. METHODS: The AYSEX study is a Spanish observational and prospective study performed in one center in which 5 gynecologists recruited postmenopausal women with VVA in routine clinical practice treated continuously with ospemifene 60 mg/day for 12 months as an appropriate therapeutic option. This article refers to the 3- and 6-months analysis. Vaginal health was assessed by pH and using Vaginal Health Index (VHI) at baseline and 3 months later. Endometrial thickness, measured by vaginal ultrasonography, and bone resorption marker (CTx) were assessed at baseline and 6 months later. RESULTS: A total of 100 postmenopausal women cytologically and clinically diagnosed with VVA were included in the study. After 3 months of treatment with ospemifene, pH improved from 6.1 to 4.5 (p < .0001), and VHI improved from 10 to 19 points (p < .0001). The percentage of patients with VVA according to VHI decreased from 100% to 5.2% (p < .0001). After 6 months, mean CTx levels decreased from 0.42 pg/ml at baseline to 0.37 pg/ml 6 months later (p = .0018), and mean endometrial thickness changed from 2.24 to 2.15 mm (p = .6066). CONCLUSIONS: Up to date, this is the only prospective and observational study with ospemifene in routine clinical practice conditions and confirms the results previously reported from randomized controlled clinical trials, improving VVA, not increasing endometrial thickness, and decreasing CTx levels by exerting an anti-resorptive function.

Evaluation of Quadratus Lumborum Block as Part of an Opioid-Free Anaesthesia for Canine Ovariohysterectomy.

Quadratus lumborum block (QLB) is used to provide analgesia for abdominal surgery in humans. The aim of this study was to assess an anaesthetic protocol involving the QLB for canine ovariohysterectomy. Ten dogs were included. Anaesthetic protocol consisted of premedication with IM medetomidine (20 µg kg-1) and SC meloxicam (0.1 mg kg-1), induction with propofol to effect, and maintenance with sevoflurane in oxygen/medical air. QLB was performed injecting 0.4 mL kg-1 of 0.25% bupivacaine/iohexol per side. Computed Tomography (CT) was performed before and after surgery. Fentanyl was administered as rescue analgesia during surgery. The Short Form of The Glasgow Composite Pain Scale and thermal threshold (TT) at the level of the elbow, T10, T13 and L3 were assessed before premedication and every hour postoperatively. Methadone was given as rescue analgesia postoperatively when pain score was >3. A Yuen's test on trimmed means for dependent samples was used to analyse the data (p < 0.05). CT images showed spreading of the contrast/block for a median (range) of 3 (2-5) vertebrae, without differences between preoperative and postoperative images. One dog needed rescue analgesia during surgery. Pain score was less than 4/24 in all the animals during the first 4 h after surgery. TT showed a significant increased signal in all the areas tested, apart from the humerus, 30 min after surgery. The QLB may provide additional analgesia for canine ovariohysterectomy. Further studies are needed to assess the specific contribution of the QLB in abdominal analgesia.

Reacciones adversas a montelukast: de la teoría a la práctica. Serie de casos / Adverse drug reactions of montelukast: from theory to practice. Case report

El montelukast se utiliza ampliamente en el tratamiento de sibilancias recurrentes y/o asma. Están descritas numerosas reacciones adversas medicamentosas (RAM) en niños relacionadas con montelukast; se destacan las neuropsiquiátricas. Realizamos un estudio observacional, retrospectivo, descriptivo, sobre RAM relacionadas con montelukast. Entre enero de 2012 y diciembre de 2017, en la Unidad de Neumonología Pediátrica se trataron con Montelukast 348 pacientes; de ellos, 20 presentaron RAM. Los síntomas más frecuentes fueron insomnio (n = 7), hiperactividad (n = 4), pesadillas (n = 3), dolor abdominal (n = 2) y parestesias en extremidades (n = 2). Se presentaron desde días hasta meses tras iniciar el tratamiento, y desaparecieron tras su suspensión. Se destacan dos pacientes con parestesias en extremidades, síntoma no descrito antes en niños. El 5,7 % de los pacientes tratados con montelukast presentaron RAM que requirieron suspender el tratamiento. Los trastornos del sueño fueron los más frecuentes.

Montelukast is widely used in recurrent wheezing and/or asthma treatment. Several adverse drug reactions (ADRs) have been described in children related to montelukast. Neuropsychiatric reactions are one of the most important. We designed an observational, retrospective, descriptive study on ADRs related to montelukast in the Pediatric Pulmonology Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain. Between January 2012 and December 2017, in the Pediatric Pulmonology Unit, 348 patients were treated with Montelukast; of them, 20 presented RAM. The main symptoms described were insomnia (n = 7), hyperactivity (n = 4), nightmares (n = 3), abdominal pain (n = 2) and paraesthesia in extremities (n = 2). They appeared from the first days to months after the start of treatment and disappeared after stopping it. Two patients presented limb paresthesia, not described previously in children. The 5.7 % of our patients treated with montelukast had ADRs that required treatment discontinuation. Sleep disorders were the most frequent.

Ospemifene in clinical practice for vulvo-vaginal atrophy: results at 3 months of follow-up of use.

OBJECTIVE: To assess the effect of ospemifene 60 mg/day in vulvovaginal atrophy (VVA) in postmenopausal women under conditions of routine clinical practice after 3 months of follow-up. METHODS: The AYSEX study is a Spanish observational, prospective, and unicentric study in which 5 gynecologists recruited postmenopausal women with VVA in routine clinical practice treated with ospemifene 60 mg/day as an appropriate therapeutic option. Vaginal health, sexual health, dryness, dyspareunia, quality of life, and satisfaction with treatment were assessed at baseline and after three months using validated scales. RESULTS: A total of 100 postmenopausal women cytologically and clinically diagnosed with VVA were included in the study. After 3 months of treatment with ospemifene, vaginal health index increased and vaginal pH, dryness, and dyspareunia decreased significantly (p < .0001). A significant improvement was observed in sexual function and quality of life. CONCLUSIONS: This study in routine clinical practice conditions confirms the results previously reported by randomized controlled trials, including a significant improvement in VVA, sexual function, quality of life, and satisfaction with the treatment.

Deformidad torácica como causa de compresión traqueobronquial. A propósito de un caso clínico pediátrico / Chest deformity as a cause of tracheobronchial compression. A pediatric case

La escoliosis idiopática es la flexión y rotación anómala de los cuerpos vertebrales, que puede causar sintomatología respiratoria y alteración de función pulmonar. El síndrome de la espalda recta es una alteración caracterizada por una disminución del diámetro anteroposterior del tórax. Se presenta a una paciente de 13 años afectada de escoliosis idiopática que desarrolló disnea de esfuerzo progresiva, estridor inspiratorio y disminución importante de función pulmonar, secundaria a compresión extrínseca del bronquio principal derecho y tercio medio traqueal por cuerpos vertebrales torácicos. A su vez, tenía una disminución del diámetro anteroposterior del tórax, factor determinante en la aparición de los síntomas. Se intervino mediante fijación de vértebra torácica T3-T11, con posterior mejoría clínica y funcional respiratoria.La escoliosis asociada a alteración de función pulmonar y estridor debe hacer sospechar la existencia de compresión de la vía aérea, especialmente, en pacientes con reducción del diámetro anteroposterior del tóra

Idiopathic scoliosis is the abnormal flexion and rotation of the vertebral bodies, causing respiratory symptoms and altered pulmonary function. Straight back syndrome is a decreased in the anteroposterior diameter of the thorax. We present a 13-year-old patient with idiopathic scoliosis who developed progressive dyspnea, inspiratory stridor and a significant decrease in pulmonary function, because of extrinsic compression of the right main bronchus and the middle third of trachea by the thoracic vertebral bodies. She had also a decreased anteroposterior diameter of the thorax, being a determining factor in the appearance of symptoms. Surgery was performed by thoracic vertebra fixation T3 to T11, with subsequent clinical and functional respiratory improvement.Scoliosis associated with altered pulmonary function and stridor should make us suspect the existence of airway compression, especially in patients with reduction of the anteroposterior diameter of the thorax

[Chest deformity as a cause of tracheobronchial compression. A pediatric case]. / Deformidad torácica como causa de compresión traqueobronquial. A propósito de un caso clínico pediátrico.

Idiopathic scoliosis is the abnormal flexion and rotation of the vertebral bodies, causing respiratory symptoms and altered pulmonary function. Straight back syndrome is a decreased in the anteroposterior diameter of the thorax. We present a 13-year-old patient with idiopathic scoliosis who Deformidad torácica como causa de compresión traqueobronquial. A propósito de un caso clínico pediátrico Chest deformity as a cause of tracheobronchial compression. A pediatric case developed progressive dyspnea, inspiratory stridor and a significant decrease in pulmonary function, because of extrinsic compression of the right main bronchus and the middle third of trachea by the thoracic vertebral bodies. She had also a decreased anteroposterior diameter of the thorax, being a determining factor in the appearance of symptoms. Surgery was performed by thoracic vertebra fixation T3 to T11, with subsequent clinical and functional respiratory improvement. Scoliosis associated with altered pulmonary function and stridor should make us suspect the existence of airway compression, especially in patients with reduction of the anteroposterior diameter of the thorax.

La escoliosis idiopática es la flexión y rotación anómala de los cuerpos vertebrales, que puede causar sintomatología respiratoria y alteración de función pulmonar. El síndrome de la espalda recta es una alteración caracterizada por una disminución del diámetro anteroposterior del tórax. Se presenta a una paciente de 13 años afectada de escoliosis idiopática que desarrolló disnea de esfuerzo progresiva, estridor inspiratorio y disminución importante de función pulmonar, secundaria a compresión extrínseca del bronquio principal derecho y tercio medio traqueal por cuerpos vertebrales torácicos. A su vez, tenía una disminución del diámetro anteroposterior del tórax, factor determinante en la aparición de los síntomas. Se intervino mediante fijación de vértebra torácica T3-T11, con posterior mejoría clínica y funcional respiratoria. La escoliosis asociada a alteración de función pulmonar y estridor debe hacer sospechar la existencia de compresión de la vía aérea, especialmente, en pacientes con reducción del diámetro anteroposterior del tórax.

Feline skull injuries: Treatment goals and recommended approaches.

PRACTICAL RELEVANCE: Skull trauma in cats, which includes fractures of the mandible and maxilla, as well as temporomandibular joint (TMJ) conditions, is frequently encountered in general practice. CLINICAL APPROACH: Head trauma requires immediate attention and the initial approach should be focused on stabilisation of the patient and evaluation of the major body systems, including respiratory and cardiovascular assessment, and neurological and ophthalmic examination. The head, oral occlusion and the patient's ability to open and close the mouth should be carefully evaluated. Once the cat is stable enough for anaesthesia, diagnostic imaging is essential to assess for skull injuries. Radiography may be helpful, although some conditions may be difficult to visualise due to soft tissue and bony structure superimposition. CT is a more sensitive technique for detecting skull injuries. TREATMENT GOALS AND TECHNIQUES: A variety of stabilisation techniques have been described in the feline patient, and repair goals focus on restoration of the animal's oral function, while ensuring adequate dental occlusion, minimal invasiveness and morbidity, and pain relief. Surgical repair of mandibular and maxillary fractures may variously involve interdental wiring, interarcade wiring or suture, use of interfragmentary wires, plate and screw fixation, external skeletal fixation and use of dental acrylic. Decision-making with regard to treatment options depends on dental occlusion, type and location of the fracture, fracture stability and pain. AIM: This review, directed at general practitioners working with cats, describes the relevant anatomy of the feline skull, the most common mandibular, maxillary and TMJ conditions, and their recommended management.

Investigation into clients' perception of postoperative physiotherapy for dogs undergoing cranial cruciate ligament disease surgery.

AIM: To evaluate clients' understanding, perception and experience of postoperative physiotherapy after undergoing an osteotomy technique for cranial cruciate ligament disease (CCLD). METHOD: A retrospective questionnaire was sent to 202 owners of dogs that underwent CCLD surgery at the Queen Mother Hospital for Animals between 1 January 2015 and 31 December 2017, with 63 responses obtained. RESULTS: Significant differences were found in choice of physiotherapy between clients recommended or not by their vets (p<0.01), and between those offered additional information and those who were not (p<0.01). Of those who chose physiotherapy, 85% had a satisfactory experience. No difference was found in choice of physiotherapy between clients aware of its availability and those who were not (p=0.069). No association was found between cost of the service and clients' perception of cost-worthiness (p=0.169) or between cost-worthiness and recovery outcome (p=0.420). A correlation was found between clients' perception of cost-worthiness and satisfaction level (p=0.03). Clients' knowledge was related to the choice of physiotherapy (p=0.01), but not to other investigated factors. A significant relationship was found between clients' age and choice of physiotherapy (p=0.01), with younger clients choosing physiotherapy more often. CONCLUSION: Veterinarians recommending physiotherapy and providing accurate information affect clients' decision to choose, and perception of, physiotherapy, in addition to clients' own knowledge.

Treatment of hemorrhagic hepatic cysts with omentalization in a serval.

A 2 year old, spayed female African serval was evaluated for a history of abdominal distention. Physical examination findings were consistent with cranial abdominal masses and anemia. Abdominal imaging revealed soft tissue opacity masses in the cranial abdomen and hypoechoic cysts arising from the liver parenchyma. Conservative management failed to improve clinical signs, and a midline exploratory laparotomy was performed. Three large hemorrhagic cysts were visualized occupying a significant amount of the liver parenchyma. The cysts were drained, omentalized and partially closed with a surgical stapler and suture. Histopatological evaluation of the resected tissue was consistent with a chronic hepatic hematoma. The patient recovered well and was discharged 3 days postoperatively. Two years later, the patient was readmitted with the same clinical signs and large multiple hepatic cysts involving most of the liver lobes. These were surgically omentalized similarly to the previous surgery and the patient recovered well postoperatively. Two years later, return to normal life and no recurrence of the cysts was reported.

Palliative Epineurotomy for Focal Radial Malignant Peripheral Nerve Sheath Tumor in a Dog.

This case report describes the diagnosis of a peripheral nerve sheath tumor of the deep branch of the radial nerve distal to the elbow in a dog. The lesion was identified using computed tomography and ultrasonography and confirmed as sarcoma on histopathological analysis of incisional biopsies. Clinical signs dramatically improved following surgical biopsy before recurring three months later. Repeat epineurotomy of the deep branch of the radial nerve resulted in clinical improvement for a further month before signs once again returned. Epineurotomy as a palliative treatment for peripheral nerve sheath tumors has not been previously described, but may have a place in palliation of clinical signs in specific cases of peripheral nerve sheath tumors in which limb amputation is not an option.

Young, male neutered, obese, lame? Non-traumatic fractures of the femoral head and neck.

PATIENT GROUP: Young, male neutered, obese cats are predisposed to sustaining spontaneous capital physeal fractures, as well as fractures of the femoral neck secondary to metaphyseal osteopathy. PRACTICAL RELEVANCE: Although femoral head and neck excision generally leads to adequate limb function, and is appropriate for chronic fractures, it is a salvage procedure and irreversible. Ideally, for acute capital physeal fractures an attempt should be made to stabilise the fracture and save the coxofemoral joint. This requires early detection of the femoral fracture. CLINICAL CHALLENGES: Orthopaedic examination in cats can be challenging. Yet thorough assessment is needed to allow localisation of the pathology to the hip joint, and to rule out other orthopaedic conditions such as cranial cruciate ligament rupture. Stabilisation of these types of fracture may also prove challenging. AUDIENCE: This review is aimed at general practitioners who have some experience in orthopaedic surgical procedures, as well as those simply wishing to expand their knowledge of feline orthopaedic conditions.

Experimental study of bone lengthening in dogs by means of backscattered scanning electron microscopy.

OBJECTIVE: To describe the morphology of calcified tissues involved in distraction osteogenesis (DO) by means of backscattered scanning electron microscopy (BS-SEM). STUDY DESIGN: Experimental study. ANIMALS: Adult female Beagle dogs (n=12). METHODS: Non-simultaneous and bilateral transverse mid-diaphyseal osteotomies performed in tibiae were stabilized and distracted by a Type Ia external skeletal fixation device. After a latency period of 5 days, distraction was applied at a rate of 0.5 mm every 12 hours for 10 days. Then, the external fixator was maintained in a static mode during the consolidation period until bone healing or euthanasia at 1, 2, 3, 4, 6, 8, 10, 12, 14, and 18 weeks after operations, whichever came first. Distracted regions were isolated and their structure was examined by BS-SEM. RESULTS: Calcified chondroid tissue was prominent during distraction and calcified cartilaginous tissue during consolidation; both tissues were successively replaced by woven, lamellar, and osteonal bone. CONCLUSIONS: In osteotomized tibia, chondroid tissue is the main component of the mineralization front during distraction, calcified cartilaginous tissue during consolidation, and then both tissues are replaced by woven, lamellar, and osteonal bone. The ossification mechanism of distraction callus is transchondroidal. CLINICAL RELEVANCE: BS-SEM is an effective technique for studying progression of bone healing during DO. The presence of chondroid tissue during DO explains why callus mineralization occurs more rapidly during distraction than during static stabilization.

Proliferation measurement in breast cancer by two different methods.

BACKGROUND: Different studies show that proliferation measurement in breast cancer may have an independent prognostic value. In the present study, tumor proliferation in breast cancer was analyzed by two radically different methods according to the technique used (immunohistochemistry and flow cytometry), associated costs and necessary equipment. The aim was to evaluate which method discriminates better between tumors with high and low proliferation in relation to all other available clinical and biological parameters. MATERIALS AND METHODS: Two hundred and eighty breast cancers (231 ductal infiltrating, 30 lobular, 19 or less frequent varieties) were studied. The post-surgical staging was as follows: 164 pT1, 87 pT2, 7 pT3, the remaining 22 were multifocal, diffuse tumors. Axillary nodal invasion was found in 99 cases (35.4%). Proliferation was studied by means of flow cytometry (DNA index and S-phase) in fresh tumor tissue and immunohistochemistry (Ki67) in paraffin-embedded tissue. Furthermore, hormone receptor (estrogen receptor, ER; progesterone receptor, PR), c-erb-B2 and p53 expressions were studied using the same method. Finally, histological and nuclear grade, tumor size and axillary nodal invasion were also included as variables of the study. RESULTS: A DNA index >1 (aneuploidy) correlated significantly with histological grade 3 (p = 0.01), nuclear grade 3 (p < 0.0001), nodal invasion (p = 0.007), absence of ER (p = 0.006) and of PR (p = 0.002), c-erb-B2 expression (p = 0.008), p53 expression (p = 0.007) and tumor size (p = 0.01). An expression of Ki67 in 20% or more of tumor cell nuclei, on the other hand, correlated significantly with histological grade 3 (p < 0.0001), nuclear grade 3 (p < 0.0001), absence of ER (p < 0.0001) and of PR (p < 0.0001), c-erb-B2 expression (p < 0.0001), p53 expression (p < 0.0001) and tumor size (p = 0.0005), but not with nodal invasion. CONCLUSION: Although flow cytometry provides additional data (association with nodal invasion), the study of Ki67 expression emerges from this study as a simple, inexpensive and reliable method to study the proliferation rate of breast cancer.