Breast-implant-associated anaplastic large-cell lymphoma.

Breast-implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is an uncommon, recently recognized disease that seems to occur only in relation with implants with textured surfaces. Most cases present with late-onset peri-implant effusion or fluid collections that develop more than 12 months after insertion of the implant. The diagnosis is reached by cytological analysis of fluid samples obtained by ultrasound-guided fine-needle aspiration. These patients usually have a good prognosis after surgical removal of the implant. A small percentage of patients present with a nodule or mass adjacent to the implant that usually develops late. In these cases, the diagnosis is reached by the histological analysis of core-needle biopsy specimens. These patients have a worse prognosis and require a combination of surgery and systemic chemotherapy. The main immunophenotypic characteristics of this lymphoma are intense expression of CD30 and a lack of expression of anaplastic lymphoma kinase (ALK). Here we present a case of BIA-ALCL in a patient with implants with a textured surface that presented with peri-implant effusion and incipient formation of a millimetric nodule and was treated with removal of the implant and bilateral capsulectomy. It is important to point out that the disease requires multidisciplinary management and that the Spanish Agency of Medicines and Medical Devices (AEMPS) should be notified when the diagnosis is confirmed.

Breast-implant-associated anaplastic large-cell lymphoma. / Linfoma anaplásico de células grandes asociado a implantes mamarios.

Breast-implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is an uncommon, recently recognized disease that seems to occur only in relation with implants with textured surfaces. Most cases present with late-onset peri-implant effusion or fluid collections that develop more than 12 months after insertion of the implant. The diagnosis is reached by cytological analysis of fluid samples obtained by ultrasound-guided fine-needle aspiration. These patients usually have a good prognosis after surgical removal of the implant. A small percentage of patients present with a nodule or mass adjacent to the implant that usually develops late. In these cases, the diagnosis is reached by the histological analysis of core-needle biopsy specimens. These patients have a worse prognosis and require a combination of surgery and systemic chemotherapy. The main immunophenotypic characteristics of this lymphoma are intense expression of CD30 and a lack of expression of anaplastic lymphoma kinase (ALK). Here we present a case of BIA-ALCL in a patient with implants with a textured surface that presented with peri-implant effusion and incipient formation of a millimetric nodule and was treated with removal of the implant and bilateral capsulectomy. It is important to point out that the disease requires multidisciplinary management and that the Spanish Agency of Medicines and Medical Devices (AEMPS) should be notified when the diagnosis is confirmed.

High sensitivity and specificity of a new functional flow cytometry assay for clinically significant heparin-induced thrombocytopenia antibodies.

INTRODUCTION: Heparin-induced thrombocytopenia (HIT) is a life-threatening condition, in which the anticoagulant heparin, platelet factor 4 (PF4), and platelet-activating antibodies form complexes with prothrombotic properties. Laboratory tests to support clinical diagnosis are subdivided into functional, platelet activation assays, which lack standardization, or immunological assays, which have moderate specificity toward HIT. In this study, clinical performance of HITAlert, a novel in vitro diagnostic (IVD) registered platelet activation assay, was tested in a large cohort of HIT-suspected patients and compared with immunological assays. METHODS: From 346 HIT-suspected patients (single center), clinical data including 4T pretest probability results, citrated platelet-poor plasmas, and sera were collected, allowing direct comparison of clinical observations with HITAlert results. HITAlert performance was compared with PF4 IgG ELISA (246 patients, three centers) and PF4 PaGIA (298 patients, single center). RESULTS: HITAlert showed high sensitivity (88.2%) and specificity (99.1%) when compared with clinical diagnosis. Agreement of HITAlert with PF4 ELISA- and PF4 PaGIA-positive patients is low (52.7 and 23.2%, respectively), while agreement with PF4 IgG ELISA- and PF4 PaGIA-negative patients is very high (98.1 and 99.1%, respectively). CONCLUSION: HITAlert performance is excellent when compared with clinical HIT diagnosis, making it a suitable assay for rapid testing of platelet activation due to anticoagulant therapy.

Aspectos éticos y legales de la práctica en salud mental infanto-juvenil / Ethical and Legal Issues in Child and Adolescent Mental Health Practice

El principal objetivo de este artículo es clarificar los aspectos éticos y legales de la práctica en Salud Mental Infanto-juvenil. Se han revisado los principales textos sobre el tema legal, adaptando las ideas al campo de la pr áctica con niños y adolescentes. Un tema central es el secreto profesional y aquellas situaciones en que puede ser violado. También se abordan los aspectos legales de la historia cl ínica, así como el consentimiento informado y la hospitalización. Por último se han revisado las cuestiones éticas de la relación entre actividad pública y privada y se sugiere una guía ética de consenso entre los profesionales de los equipos de SMIJ

The aim of this paper is to clarify legal and ethical issues in CAMH practice. A review of main legal psychiatry text-books, regarding those specific aspects, has been done. Professional secret and those situations in which it would be broken are main concerns in this field. Legal procedure for psychiatric hospitalisation, informed consent and medical records are also reviewed. Finally some ethical issues regarding public and private practice are discussed and some ethical guidelines for CAMH workers are suggested

Proyecto de Salud Mental Infanto Juvenil para Cantabria II: descripción, características y plan de actuación / Child and Adolescent Mental Health Project in Cantabria II: Characteristics and Implementation Program

Antecedentes y metodología: En esta segunda parte del artículo se describen las características del Servicio de Salud Mental Infanto Juvenil de Cantabria y se elabora el plan de actuación teniendo en cuenta el estudio de necesidades, la priorización de las mismas, las experiencias en otras regiones y las limitaciones en la dotación de recursos.Resultados: Se decide como más adecuada la asistencia a un segundo nivel, con un reparto territorial similar al ya existente para la salud mental de adultos. Se presenta el esquema general de composición, actividades y funciones del equipo, así como el reparto en tiempo dedicado a cada actividad. El plan de actuación se desarrolla en cuatro etapas, comenzando por la asistencia integral hasta 14 años, para ir progresivamente, y en función de que se cumplan los objetivos generales de cada etapa, ampliando el resto de la población hasta 18 años.Conclusiones: se describen las diferentes etapas y el proceso de toma de decisiones en la planificación del programa de Salud mental para niños y adolescentes de Cantabria (AU)

Farmacodependencia en el Ecuador: Informe de la investigación nacional sobre uso de alcohol, tabaco y drogas / Farmacodependencia in Ecuador: Report of the national investigation on use of alcohol, tobacco and drugs

Presenta estadísticas acerca del uso de drogas tanto legales como ilegales en el Ecuador. Proponen test para conocer el uso de drogas al interior de la familia. Muestra mapas para ubicar el tipo de drogas que son preferencia o de menor consumo en las diferentes provincias del país. Hacen una diferencia sobre los tipos de droga que se consumen en los diferentes estratos sociales...