Quality Evaluation of Consumer Health Information Websites Found on Google Using DISCERN, CRAAP, and HONcode.

Online health misinformation is a growing problem, and health information professionals and consumers would benefit from an evaluation of health websites for reliability and trustworthiness. Terms from the Google COVID-19 Search Trends dataset were searched on Google to determine the most frequently appearing consumer health information websites. The quality of the resulting top five websites was evaluated. The top five websites that appeared most frequently were WebMD, Mayo Clinic, Healthline, MedlinePlus, and Medical News Today, respectively. All websites, except Medline Plus, received HONcode certification. Based on DISCERN and CRAAP scores, MedlinePlus was found to be the most reliable health website.

Systematic Literature Review of Quetiapine for the Treatment of Psychosis in Patients With Parkinsonism.

OBJECTIVE: The purpose of this article was to determine the efficacy and tolerability of quetiapine compared with placebo or other interventions for psychosis in parkinsonism. METHODS: Participants with a diagnosis of parkinsonism participated in randomized controlled trials (RCTs) investigating the efficacy and tolerability of quetiapine for psychotic symptoms within a defined follow-up period. The authors conducted searches on PubMed, Cochrane Controlled Register of Trials, and EMBASE for articles published from January 1991 to October 2017. Study methodology and patient- and treatment-level data were independently extracted and summarized by using descriptive statistics. Studies underwent quality assessment for risk of bias. RESULTS: A total of 17,615 unique records were identified, and seven RCTs (total N=241) met inclusion criteria. Five RCTs were placebo controlled, and two compared quetiapine against clozapine. The mean study duration was 12 weeks, and the mean daily quetiapine dose was 103 mg per day (range, 12.5-300 mg). In four of five placebo-controlled RCTs, quetiapine failed to demonstrate significant improvement of psychosis in parkinsonism compared with placebo. In two clozapine-comparator RCTs, quetiapine was better tolerated but no more effective than clozapine. Across all RCTs, the mean completion rates for quetiapine, clozapine, and placebo were 66%, 68.5%, and 66%, respectively. Quetiapine did not significantly worsen motor function. CONCLUSIONS: The efficacy of quetiapine in RCTs for psychosis in parkinsonism is no better than that for placebo or clozapine. On the basis of novel data, clinicians should reevaluate traditional viewpoints on the benefits of quetiapine for psychosis in parkinsonism.

Standing and Supine Blood Pressure Outcomes Associated With Droxidopa and Midodrine in Patients With Neurogenic Orthostatic Hypotension: A Bayesian Meta-analysis and Mixed Treatment Comparison of Randomized Trials.

BACKGROUND: The comparative effects of droxidopa and midodrine on standing systolic blood pressure (sSBP) and risk of supine hypertension in patients with neurogenic orthostatic hypotension (NOH) are unknown. OBJECTIVE: To perform a Bayesian mixed-treatment comparison meta-analysis of droxidopa and midodrine in the treatment of NOH. METHODS: The PubMed, CENTRAL, and EMBASE databases were searched up to November 16, 2016. Study selection consisted of randomized trials comparing droxidopa or midodrine with placebo and reporting on changes in sSBP and supine hypertension events. Data were pooled to perform a comparison among interventions in a Bayesian fixed-effects model using vague priors and Markov chain Monte Carlo simulation with Gibbs sampling, calculating pooled mean changes in sSBP and risk ratios (RRs) for supine hypertension with associated 95% credible intervals (CrIs). RESULTS: Six studies (4 administering droxidopa and 2 administering midodrine) enrolling a total of 783 patients were included for analysis. The mean change from baseline in sSBP was significantly greater for both drugs when compared with placebo (droxidopa 6.2 mm Hg [95% CrI = 2.4-10] and midodrine 17 mm Hg [95% CrI = 11.4-23]). Comparative analysis revealed a significant credible difference between droxidopa and midodrine. The RR for supine hypertension was significantly greater for midodrine, but not droxidopa, when compared with placebo (droxidopa RR = 1.4 [95% CrI = 0.7-2.7] and midodrine RR = 5.1 [95% CrI = 1.6-24]). Conclusion and Relevance: In patients with NOH, both droxidopa and midodrine significantly increase sSBP, the latter to a greater extent. However, midodrine, but not droxidopa, significantly increases risk of supine hypertension.

What quantifies good primary care in the United States? A review of algorithms and metrics using real-world data.

Primary care physicians (PCPs) play an indispensable role in providing comprehensive care and referring patients for specialty care and other medical services. As the COVID-19 outbreak disrupts patient access to care, understanding the quality of primary care is critical at this unprecedented moment to support patients with complex medical needs in the primary care setting and inform policymakers to redesign our primary care system. The traditional way of collecting information from patient surveys is time-consuming and costly, and novel data collection and analysis methods are needed. In this review paper, we describe the existing algorithms and metrics that use the real-world data to qualify and quantify primary care, including the identification of an individual's likely PCP (identification of plurality provider and major provider), assessment of process quality (for example, appropriate-care-model composite measures), and continuity and regularity of care index (including the interval index, variance index and relative variance index), and highlight the strength and limitation of real world data from electronic health records (EHRs) and claims data in determining the quality of PCP care. The EHR audits facilitate assessing the quality of the workflow process and clinical appropriateness of primary care practices. With extensive and diverse records, administrative claims data can provide reliable information as it assesses primary care quality through coded information from different providers or networks. The use of EHRs and administrative claims data may be a cost-effective analytic strategy for evaluating the quality of primary care.

Effects of GLP-1 receptor agonists on cardiovascular outcomes in patients with type 2 diabetes and chronic kidney disease: A systematic review and meta-analysis.

AIM: To evaluate the cardiovascular outcomes of glucagon-like peptide-1 receptor agonists (GLP1-RA) in patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD). MATERIALS AND METHODS: We searched PubMed, Ovid MEDLINE, CINAHL, and Web of Science databases for randomized controlled trials reporting event rates for a composite cardiovascular outcome of cardiovascular death, myocardial infarction, and stroke in patients with T2DM and CKD receiving GLP1-RA or placebo. Studies were restricted to those reporting specific event rates for patients with CKD separately from the overall population. We conducted a meta-analysis using a random-effects model. This meta-analysis was registered on PROSPERO (CRD42022320157). RESULTS: A total of four studies comprising 7130 patients was included in our analysis. Four different GLP1-RA were assessed in a population with CKD defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 . Treatment with GLP1-RA was not associated with a significant reduction in the composite cardiovascular end point of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke (odds ratio (OR) 0.80; 95% confidence interval (CI), 0.59-1.07; p = 0.13) among patients with T2DM and CKD. Individual components of the composite cardiovascular end point were assessed in two trials and did not show evidence of an effect of GLP1-RA in reducing cardiovascular end points. CONCLUSIONS: Pooled analysis of clinical trials reporting separate cardiovascular events rates in patients with T2DM and CKD did not find GLP1-RA to be associated with a reduction in composite cardiovascular event rates. Select GLP1-RA may offer cardiovascular event reduction in patients with T2DM and CKD, but this does not appear to be a class effect. Use of GLP1-RA with demonstrated cardiovascular benefits should be preferred in patients with CKD and T2DM to further reduce cardiovascular risk.

Drug interactions with antimalarial medications in older travelers: a clinical guide.

Increasingly older adults are traveling to international destinations with malaria as a present risk. Surveillance systems indicate that older adults are more likely to suffer severe complications from malaria. The role of health care providers in selecting an appropriate medication for chemoprophylaxis or treatment of malaria in adults becomes more difficult as older adults undergo physiologic changes that alter the pharmacokinetic and pharmacodynamic nature of medications potentially causing increased drug interactions, adverse events and altered drug action. A comprehensive literature search from 1970 to present, with a focus on the past 10 years, was conducted on drug interactions, pharmacokinetic and pharmacodynamic effects on antimalarials in adults. It was determined that due to pharmacodynamic and pharmacokinetic changes in older adults, especially renal and cardiovascular, special attention should be given to this population of travelers in order to minimize the likelihood of adverse events or altered drug efficacy. Antimalarial drug-disease interactions in older adults can occur more often due to QT prolongation, exacerbation of hypoglycemia, decreased renal elimination and decreased hepatic metabolism. Older antimalarials have well-documented drug-drug interactions. Tafenoquine, a new antimalarial, requires glucose-6-phosphate dehydrogenase screening like primaquine and monitoring of new potential drug interaction with MATE1 and OCT2 substrates. While drug-drug interactions in older travelers may occur more often as a result of polypharmacy, data did not indicate adverse reactions or decreased drug efficacy is greater compared with younger adults. Overall, with the exception of recently approved tafenoquine, much is known about antimalarial drug and disease interactions, but new drugs are always being approved, requiring travel health providers to understand the pharmacokinetics and pharmacodynamics of antimalarial drugs to predict the impact on safety and efficacy in travelers. This guide provides travel health providers with valuable insights on potential outcomes associated with drug interactions in adults and recommended monitoring or drug regimen modification.

Efficacy and renal outcomes of SGLT2 inhibitors in patients with type 2 diabetes and chronic kidney disease.

OBJECTIVE: To review glucose-lowering efficacy and changes in renal function associated with sodium-glucose co-transporter 2 (SGLT2) inhibitors among patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). DATA SOURCES: A literature search of MEDLINE and Cochrane databases was performed from 2000 to August 2018 using search terms: SGLT2 inhibitors, sodium glucose co-transporter 2, canagliflozin, empagliflozin, dapagliflozin, ertugliflozin, and chronic kidney disease. References of identified articles were also reviewed. STUDY SELECTION AND DATA EXTRACTION: English-language studies investigating glucose-lowering endpoints and/or changes in renal function with one of four U.S. approved SGLT2 inhibitors were included. A total of 10 studies met inclusion criteria and are included in this review. RESULTS: In patients with T2DM and CKD, SGLT2 inhibitors are modestly effective in lowering hemoglobin A1C and fasting plasma glucose compared to placebo. Small reductions in eGFR are seen shortly after initiating therapy with SGLT2 inhibitors, but return to baseline levels after discontinuation. SGLT2 inhibitors are associated with a substantial reduction in albuminuria and reduced risk of progression to albuminuria. CONCLUSIONS: In patients with T2DM and CKD, SGLT2 inhibitors have a decreased glucose-lowering effect compared to patients without CKD. Renal benefits among patients with CKD are similar to those without CKD and include a significant reduction in albuminuria and reduced incidence of worsening albuminuria. Given that CKD and T2DM are both associated with increased cardiovascular risk, we believe these agents should considered as preferred add-on agents in most patients with uncontrolled T2DM and eGFR >30 ml/min/1.73 m2. Ongoing studies will provide additional information as to whether these agents should be added to the current standard of care for CKD patients, with and without T2DM.

Addressing common barriers in adult immunizations: a review of interventions.

Introduction: Low levels of adult vaccination have been documented in the United States and globally. Research has been conducted to identify reasons for low immunization rates; however, the most useful studies are those that implemented interventions for identified barriers to evaluate their impact on rates of immunization. Identifying successful interventions provides immunization providers with evidence-based methods that can be utilized to increase the uptake of recommended vaccines.Areas covered: This review focuses on known barriers to adult immunizations and the interventions available in the literature to overcome these barriers. It outlines interventions that may increase vaccine uptake in the adult population through addressing barriers related to lack of vaccine knowledge, cost, access, provider and practice-based challenges, and racial and ethnic disparities.Expert opinion: Improving adult immunization rates is critical to protecting a population against vaccine-preventable diseases. Those interventions that appeared to increase immunization rates in the adult population included education and reminders about vaccination using text and telephone calls, low-cost or subsidized vaccines, easy access to immunization services, and understanding the cultural and social needs of different racial and ethnic populations. It is likely that an evidence-based multimodal approach using different categories of interventions is necessary to significantly improve adult immunization rates.

[Comparative study of clinical and pathological features of breast cancer in women with 40 years old and younger vs 70 years old and older]. / Comparación de las características de pacientes de 40 o menos y 70 años o más de edad con carcinoma mamario.

BACKGROUND: Invasive breast cancer is the most common neoplasia in women attended at IMSS health system since 2004. OBJECTIVE: To compare clinical and radiological characteristics on initial appraisal, as well as surgical treatment, pathological features and adjuvant treatment in women with primary breast cancer of 40 years old and younger vs 70 years old and older. MATERIAL AND METHOD: Clinical, radiological and pathological data of 150 patients with breast cancer treated at Hospital de ginecoobstetricia Luis Castelazo Ayala, from January 2003 to June 2006 were collected, and after divided in two groups: 1) patients with 40 years old and younger (n = 50), and 2) patients with 70 years old and older (n = 100). RESULTS: Tumoral size and radiological characteristics were similar in both groups. Group 1 and group 2 had 22 and 13%, respectively, of family history of breast cancer. Fine needle biopsy has positive predictive value of 50% for group 1, and 36% for group 2. Conservative surgery was less common at group 2. Most frequent histological type in both groups was infiltrating ductal carcinoma, followed by infiltrating lobular carcinoma, most common in older women (19 vs 12%), and we found more well differentiated ductal carcinomas in the group of 70 years old and older (12 vs 4%). Seventy-six percent of group 1 and 75% of group 2 were classified as early stage breast cancer (stages I and II). Cytotoxic therapy was offered mostly to group 1, 92 vs 35%. Radiotherapy (80 vs 59%), and hormonal therapy was given only to 56% of group 1 vs 80% of group 2. CONCLUSIONS: Clinical and staging features were similar in both groups. Family history was more influential to group 1. Fine needle biopsy has a low positive predictive value for diagnostic. Well-differentiated carcinomas were higher in patients of group 2, and group 1 had more high-grade carcinomas. There was a trend to perform more conservative surgery at group 1, as well as they underwent more adjuvant chemotherapy and radiotherapy. Use of hormonal therapy was more common at group 2.

[Identification of surgical margins by intraoperative mammography of quadrantectomys specimens for breast cancer and histopathological comparison]. / Identificación de los márgenes quirúrgicos mediante mastografía transoperatoria de cuadrantectomías por cáncer de mama y comparación histopatológica.

BACKGROUND: Wide surgical margins are prognostic indicators to prevent recurrences after conservative surgery in breast cancer; type of surgery and histopathological analysis are key factors too. OBJECTIVES: To evaluate tumoral size and surgical margins of quadrantectomy specimens utilizing mammography and histopathology, and decide if mammography of quadrantectomy specimens are useful for close margins prediction. MATERIALS AND METHODS: Prospective, observational and descriptive study based on the findings of specimen projections of two mammography quadrantectomies, and histopathological data. Ten patients with breast cancer were evaluated from May to November 2006. Surgical margins of quadrantectomys were marked with radiopaque material. RESULTS: Tumoral size was similar in mammography and histopathological analysis of quadrantectomys, however there was a tendency to report a larger size in mammography. With mammography only one case was reported as close superficial margin, the rest of patients has adequate margins (1 cm or higer). Five cases were close by histopathology (3 in the deep margin, one superior and one more in the superior and inferior margins), and five had adequate margins. Four additional surgical procedures where practiced (3 re-excisions and one mastectomy), in one of them additional surgery was unnecessary. CONCLUSIONS: Mammography evaluation was useful to identify peripheral margins (superior, inferior medial and lateral) as well as tumoral size, but useless to identify close borders (deep and superficial areas). It is necessary to evaluate more cases to improve this technique and to establish a common language between specialists.

PREVALENCIA DE LA ENFERMEDAD ARTERIAL PERIFÉRICA EN PACIENTES DIABETICOS TIPO 2, APLICANDO EL INDICE TOBILLO - BRAZO EN EL HOSPITAL “SEGURO SOCIAL UNIVERSITARIO” / PREVALENCE OF PERIPHERAL ARTERIAL DISEASE IN TYPE 2 DIABETIC PATIENTS, APPLYING THE ANKLE - ARM INDEX IN THE HOSPITAL "SEGURO SOCIAL UNIVERSITARIO

La enfermedad arterial periférica (EAP) es causa importante de ulceraciones persistentes, dolor y amputaciones en pacientes con diabetes tipo 2. Esta enfermedad es de 2 a 4 veces mayor en pacientes con diabetes que la población general. El índice tobillo/brazo (ITB) ecodoppler portátil, menor de 0,90 tiene una sensibilidad de 90 % y una especificidad de 95 % para el diagnostico de la enfermedad arterial periférica, es simple, barato, rápido y reproducible. Objetivo: Determinar la prevalencia de la enfermedad arterial periférica en pacientes diabéticos tipo 2 calculando el índice tobillo/ brazo con ecodoppler portátil. Material y métodos: Es un estudio prospectivo, trasversal, descriptivo y aplicativo, se aplicó y se midió el índice tobillo/brazo con ecodoppler portátil a 76 pacientes con diabetes mellitus tipo 2, como criterio de inclusión fueron: pacientes con Diabetes Mellitus tipo 2, criterios de exclusión: pacientes con ITB ≥ 1,3. Se utilizó tensiómetro con manguito manual, ecodoppler portátil, gel conductor, bolígrafos Resultados: De los 76 pacientes que se realizaron la medición del índice tobillo/brazo con ecodoppler, 16 (21.05%) pacientes tienen según el índice Tobillo/brazo EAP, 50 (65.78%) pacientes tenían índice dentro la normalidad y 10(13.15%) no valorable. , prevalencia fue de 18.89% (13.52%, 24,25%) Conclusiones: La prevalencia de la enfermedad arterial periférica en pacientes con diabetes mellitus tipo 2 es de prevalencia de 18.89% (13.52%, 24,25%).

Peripheral arterial disease (PAD ) is an important cause of persistent ulcerations , pain and amputations in patients with type 2 diabetes. This disease is 2 to 4 times higher in patients with diabetes than the general population. The ankle/brachial index (ABI) doppler portable, less than 0.90 as a sensitivity of 90 % and a specificity of 95 % for the diagnosis of peripheral arterial disease, is simple, inexpensive , rapid and reproducible. Objective: To determine the prevalence of peripheral arterial disease in type 2 diabetic patients by calculating the ankle/brachial index with portable Doppler ultrasound. Material and methods: A prospective , transversal, descriptive and application study was applied and the ankle/brachial index with portable Doppler ultrasound was measured in 76 patients with diabetes mellitus type 2 , as inclusion criteria were: patients with type 2 diabetes , exclusion criteria : patients with ABI ≥ 1.3. Tensiometer with manual sleeve, portable doppler , conductive gel, pens Results were used: Of the 76 patients that the measurement of the ankle/brachial index were performed with Doppler ultrasound , 16 (21.05 %) patients have under Ankle / brachial index EAP, 50 ( 65.78 %) patients were within normal rate and 10 (13.15 %) were not assessable, Prevalence was 18.89 % (13.52 % , 24.25% ) Conclusions: The prevalence of peripheral arterial disease in patients with type 2 diabetes mellitus prevalence is 18.89 % (13.52% , 24.25%) .

Microalbuminuria:: factor predictor de la función renal en mujeres gestantes / Micralbuminuria:: predictor factor in renal function of pregnant women

Introducción: La microalbuminuria es un marcador de disfunción vascular generalizada y predictor independiente de riesgo aumentado de morbimortalidad cardiovascular en pacientes con diabetes e hipertensión, así como en la población general Pregunta de investigación: ¿Constituye la Microalbuminuria un factor predictor de la función renal en las mujeres gestantes? Material y Métodos: TIPO DE ESTUDIO: Analitico, prospectivo, longitudinal. UNIVERSO DE ESTUDIO: Mujeres gestantes (75) en control prenatal del Consultorio No 1 del Policlinico Miraflores, de la Caja Nacional de Salud, La Paz, Bolivia. TIEMPO DE ESTUDIO: Marzo a Junio 2014. METODO DEL ESTUDIO, DE RECOLECCION Y ANALISIS DE LA MUESTRA: Examen clínico de la paciente, Llenado de hoja de control prenatal del MSD (CLAP), Recoleccion de orina de 24 horas para determinación de Microalbuminuria. EXAMENES COMPLEMENTARIOS ADICIONALES: Hemograma, Glucemia, Creatinina, Acido urico, TGO, TGP, Examen general de orina. METODOLOGIA ESTADISTICA: Metodos de localización estadística generales (media, desviación standard). Metodos de inferencia: Determinación del valor P y chi square a través de paquete estadístico SPSS V 21.0. VALOR DE SIGNIFICACION ESTADISTICA: P<0,01 Conclusiones: La Microalbuminuria fue un predictor de función renal precoz, identificando que 11,2% de mujeres gestantes de nuestro universo presentaron valores positivos cuando otros marcadores como la creatinina sérica permanecían normales. La prevalencia de la microalbuminuria fue del 11,2%. La Microalbuminuria se correlacionó de forma positiva con estados hipertensivos de la gestación con un valor P = 0,0023. y con diabetes en la gestación estableciéndose un valor P = 0,00187.

Introduction: Microalbuminuria is a marker of generalized vascular dysfunction and an independent predictor of increased risk of cardiovascular morbidity and mortality in patients with diabetes and hypertension as well as in the general population Research Question: Does the Microalbuminuria a predictor of renal function factor in pregnant women?. Material and Methods: TYPE OF STUDY: Analytical, prospective, longitudinal. UNIVERSE STUDY: Pregnant women (75) in the prenatal control of Policlinico Miraflores, Caja Nacional de Salud, La Paz, Bolivia. STUDY TIME. March to June 2014. METHOD OF STUDY COLLECTION AND ANALYSIS OF THE SAMPLE: Clinical examination of the patient, filling sheet prenatal MSD (CLAP), Collection of 24-hour urine for determination of microalbuminuria. ADDITIONAL SUPPLEMENTARY EXAMS: CBC, Blood glucose, creatinine, uric acid, SGOT, SGPT, Urinalysis. STATISTICAL METHODOLOGY: Statistical Methods general location (mean, standard deviation). Inference Methods: Determination of P and chi square value through SPSS V 21.0. VALUE OF STATISTICAL SIGNIFICANCE: P <0.01. Conclusions: Microalbuminuria was an early predictor of renal function, identifying that 11.2% of pregnant women in our universe had positive values when other markers such as serum creatinine remained normal. The prevalence of microalbuminuria was 11.2%. The Microalbuminuria is positively correlated with hypertensive states of pregnancy at P = 0.0023., And gestational diabetes establishing a value P = 0.00187.

Impacto del margen en el control locoregional en cirugía conservadora en cáncer de mama invasor en etapas tempranas / Margin impat on local control with conservtive surgery for invasive breasst cancer in early staees

Hay intentos de no seguir realizando mutilaciones y se comienza a preconizar el concepto de enfermedad sistémica en cáncer de mama, por ello Mustakalio, en Finlandia y Baclesse, en Francia, son los pioneros en realizar tratamientos no mutilantes del cáncer de mama. El Objetivo de este estudio es el analizar si el margen ideal es de más o menos de 10 mm para un buen tratamiento locorregional en cáncer de mama invasor en etapas tempranas. Estudio retrospectivo, analítico y descriptivo de 194 pacientes , tratados desde el 2005 hasta el 2010 , de los cuales se toman como factores pronóstico de importancia para recurrencia locorregional, a la etapa patológica, edad, grado histológico, receptores estrogenicos y progestágenos positivos y negativos y adyuvancia con quimioterapia y/o radioterapia, numero de ganglios positivos, se comparara los márgenes en 3 grupos , uno de ellos con 1-2 márgenes menores de 10 mm ; segundo grupo con 3-5 márgenes menores de 10 mm comparados con un tercer grupo que tenían márgenes mayores a 10 mm. Se encontró 12 recurrencias locorregionales un 6.38% siendo las recurrencias en los dos primeros grupos señalados. Conclusión: Concluimos que el margen adecuado para tener un éxito en el manejo conservador de cáncer de mama invasor en etapas tempranas es de mas de 10 mm. que estéticamente muchas veces pueden ser difíciles de lograrlo, para tal efecto se tendrá que evaluar antes de la cirugía, tomando como referencian la relación tumor con mama, que no debe pasar más del 25 % del volumen de la mama ; por otra parte en mujeres post menopaúsica la recurrencia locorregional probablemente no sea tan frecuente puesto que a esta edad la diseminación por los conductos ductales es pobre, perse a la falta de estimulo del estrógeno a la mama.

There are attempts to not continue maiming and begins to advocate the concept of systemic disease in breast cancer, why Mustakalio, Baclesse in Finland and in France, are the pioneers in performing treatments not maiming of breast cancer. The objective of this study is to analyze if the margin is ideal for more than 10 mm or less for a good locoregional treatment in invasive breast cancer in its early stages. Retrospective, analytical study of 194 cases treated from 2005 until 2010, of which they take like factors importance prognosis for recurrence locorregional, to the pathological stage, age, histological grade, recipients estrogenicos and progestágenos positive and negative and adyuvancia with chemotherapy and/or radiotherapy, I number of positive ganglions, the margins will be compared in 3 groups, one of them with 1-2 less 10 mm margins; the second group with 3-5 less margins of 10 mm compared with a third group that had margins bigger than 10 mm. 6.38 % found 12 recurrencias locorregionales being the recurrencias in the first two special groups. Conclusion: We conclude that the margin adapted to be successful in the conservative handling of invading breast cancer in early stages is of more than 10 mm. that esthetically often can be difficult to achieve it, for such an effect it will be necessary to evaluate before the surgery, taking as they index the relation tumor with breast, which must not to spend(pass) any more than 25 % of the volume of the breast; on the other hand in women post menopausica the recurrence locorregional probably is not so frequent position that at this age the dissemination for the conduits ductales is poor, perse to the absence ofstimulus of the estrogen to the breast.

Patología de la mama durante el embarazo y lactancia / Pathology of the breast during pregnancy and lactation

Una de cada 7 mujeres embarazadas y lactantes tendrá un evento patológico en la mama. La evaluación mamaria debe ser parte de la rutina en la paciente obstétrica. La experiencia de la Gineco 4 del IMSS revela que de un total de 77,740 pacientes evaluadas en el Servicio de Oncología Mamaria, en el periodo comprendido de enero de 1990 a diciembre de 2000, 716 casos correspondieron a mastitis asociados a lactancia y 32 carcinomas durante el embarazo. El manejo integral debe incluir una evaluación cuidadosa con estudios de imagen cuando estén indicados, biopsias y cultivos. Se presentan las características clínicas, paraclínicas y el manejo de patología benigna tumoral y no tumoral durante el embarazo y la lactancia y se finaliza presentando lineamientos básicos para el manejo del cáncer mamario en las diferentes etapas clínicas y durante los diferentes trimestres del embarazo.

One of every seven women pregnant or in lactation period will present a breast pathological event. Breast evaluation should be part of the routine obstetric evaluation. Experience at the Gineco-obstetric Hospital # 4, IMSS, reveals that a total of 77,740 patients where evaluated between January of 1990 and December of 2000, 716 cases where lactation mastitis and 32 cases of breast cancer associated to pregnancy. The management should include a careful evaluation with image studies, biopsies and tissue cultures when necessary. We present the clinical and paraclinical characteristics ofbenign tumoral and non-tumoral disease ofthe breast during pregnancy and lactation, and we present the guidelines for treatment of breast cancer, according to stage and pregnancy trimester.