MR-Proadrenomedullin as biomarker of renal damage in urinary tract infection in children.

BACKGROUND: Midregional-proadrenomedullin (MR-proADM) is a useful prognostic peptide in severe infectious pathologies in the adult population. However, there are no studies that analyze its utility in febrile urinary tract infection (fUTI) in children. An accurate biomarker would provide an early detection of patients with kidney damage, avoiding other invasive tests like renal scintigraphy scans. Our objective is to study the usefulness of MR-proADM as a biomarker of acute and chronic renal parenchymal damage in fUTI within the pediatric population. METHODS: A prospective cohort study was conducted in pediatric patients with fUTI between January 2015 and December 2018. Plasma and urine MR-proADM levels were measured at admission in addition to other laboratory parameters. After confirmation of fUTI, renal scintigraphy scans were performed during the acute and follow-up stages. A descriptive study has been carried out and sensitivity, specificity and ROC curves for MR-proADM, C-reactive protein, and procalcitonin were calculated. RESULTS: 62 pediatric patients (34 female) were enrolled. Scintigraphy showed acute pyelonephritis in 35 patients (56.5%). Of those patients, the median of plasmatic MR-proADM (P-MR-proADM) showed no differences compared to patients without pyelonephritis. 7 patients (11.3%) developed renal scars (RS). Their median P-MR-proADM levels were 1.07 nmol/L (IQR 0.66-1.59), while in patients without RS were 0.48 nmol/L (0.43-0.63) (p < 0.01). The AUC in this case was 0.92 (95% CI 0.77-0.99). We established an optimal cut-off point at 0.66 nmol/L with sensitivity 83.3% and specificity 81.8%. CONCLUSION: MR-ProADM has demonstrated a poor ability to diagnose pyelonephritis in pediatric patients with fUTI. However, P-MR-proADM proved to be a very reliable biomarker for RS prediction.

[Effect of compliance with an antibiotic prophylaxis protocol in surgical site infections in appendectomies. Prospective cohort study]. / Efecto de la adecuación a protocolo de la profilaxis antibiótica en la incidencia de infección quirúrgica en apendicectomías. Estudio de cohortes prospectivo.

BACKGROUND: Antibiotic prophylaxis is the most suitable tool for preventing surgical site infection. This study assessed compliance with antibiotic prophylaxis in surgery for acute appendicitis, and the effect of this compliance on surgical site infection. MATERIAL AND METHODS: Prospective cohort study to evaluate compliance with antibiotic prophylaxis protocol in appendectomies. An assessment was made of the level of compliance with prophylaxis, as well as the causes of non-compliance. The incidence of surgical site infection was studied after a maximum incubation period of 30 days. The relative risk adjusted with a logistic regression model was used to assess the effect of non-compliance of prophylaxis on surgical site infection. RESULTS: The study included a total of 930 patients. Antibiotic prophylaxis was indicated in all patients, and administered in 71.3% of cases, with an overall protocol compliance of 86.1%. The principal cause of non-compliance was time of initiation. Cumulative incidence of surgical site infection was 4.6%. No relationship was found between inadequate prophylaxis compliance and infection (relative risk=0.5; 95% CI: 0.1-1.9) (P>.05). CONCLUSIONS: Compliance of antibiotic prophylaxis was high, but could be improved. No relationship was found between prophylaxis compliance and surgical site infection rate.

[Sentinel lymph node biopsy in melanoma: our experience over 8 years in a universitary hospital]. / Biopsia selectiva del ganglio centinela en melanoma: experiencia durante 8 años en un hospital universitario.

BACKGROUND: Since the introduction of sentinel lymph node biopsy, its use as a standard of care for patients with clinically node-negative cutaneous melanoma remains controversial. Our experience of sentinel lymph node biopsy for melanoma is presented and evaluated. MATERIAL AND METHODS: A cohort study was conducted on 69 patients with a primary cutaneous melanoma and with no clinical evidence of metastasis, who had sentinel lymph node biopsy from October-2005 to December-2013. Sentinel lymph node biopsy was identified using preoperative lymphoscintigraphy and subsequent intraoperative detection with gamma probe. RESULTS: The sentinel lymph node biopsy identification rate was 98.5%. The sentinel lymph node biopsy was positive for metastases in 23 patients (33.8%). Postoperative complications after sentinel lymph node biopsy were observed in 4.4% compared to 38% of complications in patients who had complete lymphadenectomy. CONCLUSION: The sentinel lymph node biopsy in melanoma offers useful information about the lymphatic dissemination of melanoma and allows an approximation to the regional staging, sparing the secondary effects of lymphadenectomy. More studies with larger number of patients and long term follow-up will be necessary to confirm the validity of sentinel lymph node biopsy in melanoma patients, and especially of lymphadenectomy in patients with positive sentinel lymph node biopsy.

[Diagnostic validity of the intraoperative analysis in frozen section of the sentinel lymph node in the surgical management of breast cancer]. / Validez diagnóstica del análisis intraoperatorio mediante sección en congelación del ganglio centinela en el manejo quirúrgico del cáncer de mama.

OBJECTIVE: The method for intraoperative sentinel lymph node (SLN) evaluation has still not been established in breast cancer staging. This study has evaluated the diagnostic validity and impact of intraoperative analysis using the frozen section (FS) of SLN. MATERIAL AND METHODS: We performed a descriptive study of the diagnostic validity of the FS of the SLN in patients with breast cancer and selective sentinel node biopsy (SSNB) from October-2006 to October-2012. The diagnostic validity indexes were evaluated using sensitivity, specificity, positive and negative predictive values and global value. Gold standard was considered as the final histopathological results of the biopsies. RESULTS: A total of 370 patients were studied. Sensitivity and specificity for detection of metastasis by FS in the SLN were 67% and 100%, respectively. Global diagnostic validity was 95%. There was a correlation between detection of metastasis and tumor size (p<0.05). Twelve of the 15 patients with SLN micro-metastases underwent axillary lymph node dissection (ALND). Metastatic lymph nodes were not found in any of them. CONCLUSIONS: Intraoperative FS examination of the SLN is a useful and reliable predictor of axillary lymph node staging in patients with initial stages of breast cancer. FS reduces the need for second interventions, at least for most patients who have breast cancer with identifiable positive SLN and unequivocal evidence of positive lymph node disease.

[Selective biopsy of the sentinel lymph node in breast cancer: without axillary recurrences after a mean follow-up of 4.5 years]. / Biopsia selectiva del ganglio centinela en cáncer de mama: sin recurrencias axilares tras un seguimiento medio de 4,5 años.

OBJECTIVE: To analyze the rate of axillary recurrences (AR) in patients with early breast cancer who had not undergone an axillary node dissection (ALND) because of a negative sentinel lymph node biopsy (SLNB). MATERIAL AND METHODS: The study includes 173 patients operated on for breast cancer and selective node biopsy. In 32 patients the SLNB was positive and undergone subsequent ALND. We followed up 141 patients with negative SLNB without LDN, with a median follow up of 55 months (range 74-36). RESULTS: The detection rate of SLN was of 99.42%. After a median follow-up of 4.5 years, there were no axillary recurrences. Two patients developed local recurrence, other two patients developed distant metastases and four patients developed a metachronous tumor. Four patients died, none of them because of breast cancer. CONCLUSIONS: The results obtained support the SLNB as an accurate technique in the axillary stratification of patients with breast cancer, offering in the cases of negative SLNB a safe axillary control after 4.5 year follow-up.

Validez diagnóstica del análisis intraoperatorio mediante sección en congelación del ganglio centinela en el manejo quirúrgico del cáncer de mama / Diagnostic validity of the intraoperative analysis in frozen section of the sentinel lymph node in the surgical management of breast cancer

Objetivo: En la estadificación del cáncer de mama, el método del análisis intraoperatorio del ganglio centinela (GC) no ha sido todavía adecuadamente establecido. Hemos evaluado la validez diagnóstica y el impacto del análisis intraoperatorio mediante sección en congelación (SC) del GC. Material y métodos: Se ha realizado un estudio descriptivo de validez diagnóstica de la SC del GC en las pacientes con cáncer de mama a las que se realizó biopsia selectiva del ganglio centinela (BSGC) desde octubre de 2006 hasta octubre de 2012. Se evaluaron los índices de validez diagnóstica sensibilidad, especificidad, valores predictivos positivo y negativo y valor global. Se consideró patrón oro el estudio anatomopatológico definitivo de las biopsias. Resultados: Se estudiaron 370 pacientes. La sensibilidad y especificidad para la detección de metástasis mediante la SC en el GC ha sido del 67% y del 100%, y la validez diagnóstica global del 95%. Se encontró relación entre tamaño del tumor y detección de metástasis (p < 0,05). Doce de las 15 pacientes con micrometástasis se sometieron a linfadenectomía y no se hallaron ganglios metastáticos en ninguna de ellas. Conclusiones: El análisis intraoperatorio mediante SC del GC es un método útil y fiable para la estadificación de los ganglios linfáticos axilares en pacientes con cáncer de mama en estadios iniciales. La SC reduce la necesidad de realizar una segunda cirugía, al menos en la mayoría de los pacientes con cáncer de mama y evidencia inequívoca de GC positivo (AU)

Objective: The method for intraoperative sentinel lymph node (SLN) evaluation has still not been established in breast cancer staging. This study has evaluated the diagnostic validity and impact of intraoperative analysis using the frozen section (FS) of SLN. Material and methods: We performed a descriptive study of the diagnostic validity of the FS of the SLN in patients with breast cancer and selective sentinel node biopsy (SSNB) from October-2006 to October- 2012. The diagnostic validity indexes were evaluated using sensitivity, specificity, positive and negative predictive values and global value. Gold standard was considered as the final histopathological results of the biopsies. Results: A total of 370 patients were studied. Sensitivity and specificity for detection of metastasis by FS in the SLN were 67% and 100%, respectively. Global diagnostic validity was 95%. There was a correlation between detection of metastasis and tumor size (p < 0.05). Twelve of the 15 patients with SLN micrometastases underwent axillary lymph node dissection (ALND). Metastatic lymph nodes were not found in any of them. Conclusions: Intraoperative FS examination of the SLN is a useful and reliable predictor of axillary lymph node staging in patients with initial stages of breast cancer. FS reduces the need for second interventions, at least for most patients who have breast cancer with identifiable positive SLN and unequivocal evidence of positive lymph node disease (AU)

Biopsia selectiva del ganglio centinela en cáncer de mama: sin recurrencias axilares tras un seguimiento medio de 4, 5 años / Selective biopsy of the sentinel lymph node in breast cancer: Without axillary recurrences after a mean follow-up of 4.5 years

Objetivo. Analizar la tasa de recurrencias axilares (RA) en pacientes con cáncer de mama en estadios iniciales y biopsia selectiva del ganglio centinela negativa (BSGC) sin linfadenectomía (LDN) posterior. Material y métodos. Se han incluido un total de 173 pacientes a quienes se aplicó la BSGC tras diagnóstico de cáncer de mama en estadios iniciales. En 32 pacientes la BSGC fue positiva y estas pacientes fueron sometidas a LDN. Se han seguido 141 pacientes con BSGC negativa sin LDN, por un periodo medio de 55 meses (rango 74-36). Resultados. La tasa de detección del GC fue del 99,42%. Después de un periodo de seguimiento medio de 4,5 años no se han detectado RA. Dos pacientes desarrollaron recidiva local, otras 2 desarrollaron metástasis a distancia y 4 desarrollaron un cáncer intercurrente. Se produjeron 4 muertes, ninguna de ellas asociadas al cáncer de mama. Conclusiones. Los resultados obtenidos apoyan la BSGC como una técnica exacta en la estadificación axilar de los pacientes con cáncer de mama en estadios iniciales, ofreciendo en los casos de BSGC negativa un control axilar seguro después de 4,5 años de seguimiento medio (AU)

Objective. To analyze the rate of axillary recurrences (AR) in patients with early breast cancer who had not undergone an axillary node dissection (ALND) because of a negative sentinel lymph node biopsy (SLNB). Material and methods. The study includes 173 patients operated on for breast cancer and selective node biopsy. In 32 patients the SLNB was positive and undergone subsequent ALND. We followed up 141 patients with negative SLNB without LDN, with a median follow up of 55 months (range 74-36). Results. The detection rate of SLN was of 99.42%. After a median follow-up of 4.5 years, there were no axillary recurrences. Two patients developed local recurrence, other two patients developed distant metastases and four patients developed a metachronous tumor. Four patients died, none of them because of breast cancer. Conclusions. The results obtained support the SLNB as an accurate technique in the axillary stratification of patients with breast cancer, offering in the cases of negative SLNB a safe axillary control after 4.5 year follow-up (AU)