Partial-accelerated irradiation with stereotactic radiotherapy at a dose of 30 Gy in 5 fractions in early breast cancer.

PURPOSE: To evaluate feasibility of accelerated partial breast irradiation (APBI) using stereotactic radiotherapy (SBRT) Thirty Gy delivered in 5 fractions for patients with early breast cancer. METHODS: Between January 1st, 2018, and December 31s, 2022, we conducted 117 treatments for patients with early-stage breast cancer. All patients underwent conservative surgery followed by APBI using stereotactic external beam radiotherapy. We analyzed local, regional, distant control, overall survival, toxicity, and cosmetic outcomes. RESULTS: The average age was 62 years. 21.3% ductal and 78.7% invasive carcinomas. Regarding the PTV volume, the median was 198.8 cc (38-794 cc). Treatments were completed in all cases. The median follow-up period was of 21 months (1-62 months). Regarding acute toxicity, no Grade 3-4 toxicities were recorded. One patient experienced Grade 2 neuropathic pain. One patient developed subacute fibrosis and two patients developed telangiectasia as subacute and chronic toxicity. Cosmetic results were "good" or "very good" in 96.3% of cases. None of the patients relapsed at any level (local, regional, or distant) and overall survival during follow.up was 100%. CONCLUSION: APBI with SBRT 30 Gy in 5 fractions in early-stage breast cancer is a feasible technique, very-well tolerated and has excellent oncologic and cosmetic outcome during our follow-up period.

Current status of precision medicine in pediatric oncology in Spain: a consensus report by the Spanish Society of Paediatric Haematology and Oncology (SEHOP).

The study analyzes the current status of personalized medicine in pediatric oncology in Spain. It gathers national data on the tumor molecular studies and genomic sequencing carried out at diagnosis and at relapse, the centers that perform these studies, the technology used and the interpretation and clinical applicability of the results. Current challenges and future directions to achieve a coordinated national personalized medicine strategy in pediatric oncology are also discussed. Next generation sequencing-based (NGS) gene panels are the technology used in the majority of centers and financial limitations are the main reason for not incorporating these studies into routine care. Nowadays, the application of precision medicine in pediatric oncology is a reality in a great number of Spanish centers. However, its implementation is uneven and lacks standardization of protocols; therefore, national coordination to overcome the inequalities is required. Collaborative work within the Personalized Medicine Group of SEHOP is an adequate framework for encouraging a step forward in the effort to move precision medicine into the national healthcare system.

The paediatric cancer clinical research landscape in Spain: a 13-year multicentre experience of the new agents group of the Spanish Society of Paediatric Haematology and Oncology (SEHOP).

PURPOSE: Early phase trials are crucial in developing innovative effective agents for childhood malignancies. We report the activity in early phase paediatric oncology trials in Spain from its beginning to the present time and incorporate longitudinal data to evaluate the trends in trial characteristics and recruitment rates. METHODS: Members of SEHOP were contacted to obtain information about the open trials at their institutions. The study period was split into two equal periods for analysis: 2007-2013 and 2014-2020. RESULTS: Eighty-one trials and two molecular platforms have been initiated. The number of trials has increased over the time of the study for all tumour types, with a predominance of trials available for solid tumours (66%). The number of trials addressed to tumours harbouring specific molecular alterations has doubled during the second period. The proportion of industry-sponsored compared to academic trials has increased over the same years. A total of 565 children and adolescents were included, with an increasing trend over the study period. For international trials, the median time between the first country study approval and the Spanish competent authority approval was 2 months (IQR 0-6.5). Fourteen out of 81 trials were sponsored by Spanish academic institutions. CONCLUSIONS: The number of available trials, and the number of participating patients, has increased in Spain from 2007. Studies focused on molecular-specific targets are now being implemented. Barriers to accessing new drugs for all ranges of age and cancer diseases remain. Additionally, opportunities to improve academic research are still required in Spain.

Late vascular complications after cranial radiotherapy: A report of two illustrative cases.

Cranial radiotherapy (CRT) is used to treat a large variety of benign and malignant disorders. We present two cases of late neurological complications after CRT and briefly discuss its diagnosis and their shared pathophysiological aspects. The first case is a patient with cognitive impairment associated to mineralizing microangiopathy ten years after CRT for nasopharyngeal carcinoma and the second one is a woman with Stroke-like Migraine Attacks after Radiation Therapy (SMART) syndrome two years after CRT for anaplastic meningioma. Nowadays, higher survival rates might cause an increase in appearance of late neurological complications after CTR. These reported cases show that late complications can mimic a wide variety of neurological conditions and the importance of magnetic resonance image (MRI) to get a diagnosis.

Histopathological classification of lesions observed in natural cases of paratuberculosis in free-ranging fallow deer (Dama dama).

Ninety-five adult fallow deer, legally hunted in the Regional Hunting Reserve of El Sueve (Northern Spain), were subjected to a post-mortem examination for paratuberculosis, samples being taken from the proximal and distal jejunum, proximal and distal ileum, ileocaecal valve and associated lymph nodes. The lesions were divided into four categories. Focal lesions (n=19 cases) consisted of small granulomas, mainly in the jejunal and ileal lymph nodes. Multifocal lesions (n=4) consisted of well-demarcated granulomas in the intestinal lymphoid tissue and also in the intestinal lamina propria. Diffuse multibacillary lesions (n=2) were characterized by a severe granulomatous enteritis and lymphadenitis. Macrophages and numerous Langhans giant cells containing many mycobacteria were present, resulting in macroscopical changes in the normal gut morphology. These changes were found from the proximal jejunum to the ileocaecal valve, but lesions were always particularly severe in the distal jejunum. In diffuse intermediate (multibacillary-lymphocytic) lesions (n=3) the infiltrate consisted of lymphocytes, macrophages and Langhans giant cells, with small numbers of mycobacteria. Mycobacterium avium subspecies paratuberculosis was identified by a polymerase chain reaction technique. The widespread occurrence of paratuberculosis in fallow deer in this Reserve represents a potential source of infection for other susceptible species.

[Human African trypanosomiasis in the mangrove forest in Guinea: epidemiological and clinical features in two adjacent outbreak areas]. / La Trypanosomose Humaine Africaine en zone de mangrove en République de Guinée: caractéristiques épidémiologiques et cuniques de deux foyers voisins.

The purpose of this study carried out in two adjacent areas of the coastal mangrove forest of Guinea (Dubreka and Boffa) was to screen the population for disease, provide information on human African trypanosomiasis (HAT, a.k.a. sleeping sickness) and compare the epidemiologic and clinical features with those of outbreak areas in the Ivory Coast where more data is currently available. Cases of HAT were confirmed by parasitological testing after active medical work-up (91 of 9637 patients examined). Five cases were confirmed in patients in treatment centers. Of the first 57 cases admitted for treatment in the Dubreka and Boffa centers, 29 were responded to a clinical and epidemiological questionnaire and underwent thorough clinical examination. Disease stage was determined by cytochemical testing of cerebrospinal fluid. As in outbreak areas of the Ivory Coast, sleeping sickness in Dubreka and Boffa is a rural disease mainly affecting the working population. Most cases identified in Guinea involved men and women working in farming, fishing, or salt extraction. However unlike Ivory Coast outbreak areas where ethnic diversity related to share cropping is considered to play a major role in maintaining endemicity, almost all patients in our study (98%) were from the native Soussou population that is self employed and lives in villages with no immigrant population. While clinical symptoms observed in these patients were not different from those reported elsewhere, there was a high frequency of cervical adenopathy (93%). This finding could provide a useful diagnostic sign for screening populations living in these mangrove forest regions and as a source for parasitological diagnosis as shown by the fact that 88.5% of patients were screened on the basis of lymph node fluid specimens. Most patients including among those identified by active work-up (5%) were in the meningo-encephalitis phase of the disease (98%). The findings of this study underline the need not only to continue surveillance in these regions but also to extend surveillance throughout the country as a means of avoiding recrudescence and extension of the disease.

Cisplatin, radiation, and amifostine in carcinoma of the uterine cervix.

A pilot, open, comparative study was performed on patients with locally advanced cervical cancer to investigate the efficacy and safety of amifostine. Twenty patients with a histologic diagnosis of squamous cervical cancer were treated with radiotherapy and randomized in two groups. Group A received cisplatin at 20 mg/m2 for five days in two cycles during intracavitary radiotherapy and 100 mg/m2 x 2 cycles during external radiotherapy, and amifostine 825 mg/m2 15 min before the cisplatin infusion. Patients in group B received cisplatin in the same doses without amifostine. All patients had complete responses during a median follow-up of 20 months. Grade three neutropenia was present in two patients in group A and in four of the control group, P = 0.31; grade 2 neurologic toxicity was seen in four patients in group B and in one of the patients in group A, P = 0.15. One patient needed temporary interruption of amifostine due to hypotension. Eight of 10 patients in group A developed hypocalcemia during the treatment with amifostine. Our findings indicate that amifostine was well tolerated. In this series a mild neurologic and hematologic protection was found in patients that received amifostine, although this was not statistically significant. No differences in disease-free survival response and overall survival was seen between the two groups.

Divertículo de la uretra femenina: experiencia de tres casos / Female urethra diverticulum

Se realiza una revisión de los datos clínicos, radiológicos y ecográficos observados en 3 casos de diverticulos de la uretra femenina. Se practicó cistouretrografía miccional a todas las pacientes, ecografía por vía vaginal y suprapúbica. Se discuten los resultados del estudio, así como el diagnóstico diferencial con otras masas de la misma localización

[The clinical significance of fetal hydronephrosis of moderate extent]. / Significato clinico delle idronefrosi fetali di modesta entità.

Twelve fetuses with renal pelvis dilatation < 15 mm have been followed up until a year after birth. Dilatation cleared up in 59% of the cases within the last weeks of pregnancy and in 33% in the first months of life, while was asymptomatically detected in one case only a year after birth. A grade I and II vesico-ureteral reflux was diagnosed in two babies. Scheduled ultrasonographic examinations together with routine biochemical tests only are suggested by the kidney anatomical-functional normal parameters. Possible recurrent infections may be prevented through urine culture. Voiding cystourethrography is performed only when a recurrent infection is present because a reflux may be detected. Lacking a definite prognostic parameter, pre- and postnatal ultrasonographic follow-up is necessary although the little renal pelvis dilatation is to be considered negligible.

Compartmentation of calcium in digitonin-disrupted guinea pig pancreatic acinar cells.

The treatment of guinea pig pancreatic acinar cells with digitonin leads to disruption of the plasma membrane, as judged by the liberation of cytosolic enzymes, without significant alteration of the mitochondrial membrane. The transport of calcium by the particulate residue was studied, and two different pools could be distinguished. One was supported by ATP or ADP, succinate providing the respiratory substrate, and was sensitive to the inhibitors, Ruthenium red and azide. The other pool needed the presence of ATP, ADP being ineffective, and also was unaffected by Ruthenium red or by azide, but was stimulated several-fold by oxalate. The Ruthenium red-sensitive calcium pool has characteristics resembling those of the transport of calcium by a mitochondrial fraction prepared from digitonin-treated acinar cells. In contrast, the Ruthenium red-insensitive calcium transport has characteristics resembling those of a microsomal fraction obtained from guinea pig pancreas. When the transport of calcium in digitonized cells was assayed at a calcium concentration range of 10(-8)-10(-4) M, preferential Ruthenium red-insensitive calcium transport could be observed at submicromolar calcium concentrations.