Clinical application of the sentinel lymph node technique in early ovarian cancer: a pilot study.

INTRODUCTION: There is limited evidence favoring the use of the sentinel lymph node technique in ovarian cancer, and no standardized approach has been studied. The objective of the present pilot study is to determine the feasibility of the sentinel lymph node technique by applying a clinical algorithm. METHODS: Patients with confirmed ovarian cancer were included. 99mTc and indocyanine green were injected into the ovarian and infundubulo-pelvic ligament stump. A gamma probe and near-infrared fluorescence imaging were used for sentinel lymph node detection. RESULTS: The sentinel lymph node technique was performed in nine patients with a detection rate in the pelvic and/or para-aortic region of 100%. The tracer distribution rates of sentinel lymph nodes in the pelvic and para-aortic regions were 87.5% and 70%, respectively. CONCLUSION: The detection of sentinel lymph nodes in early-stage ovarian cancer appears to be achievable. Based on these results, a clinical trial entitled SENTOV (SENtinel lymph node Technique in OVarian cancer) will be performed.

Evaluation of PET texture features with heterogeneous phantoms: complementarity and effect of motion and segmentation method.

A major source of error in quantitative PET/CT scans of lung cancer tumors is respiratory motion. Regarding the variability of PET texture features (TF), the impact of respiratory motion has not been properly studied with experimental phantoms. The primary aim of this work was to evaluate the current use of PET texture analysis for heterogeneity characterization in lesions affected by respiratory motion. Twenty-eight heterogeneous lesions were simulated by a mixture of alginate and 18 F-fluoro-2-deoxy-D-glucose (FDG). Sixteen respiratory patterns were applied. Firstly, the TF response for different heterogeneous phantoms and its robustness with respect to the segmentation method were calculated. Secondly, the variability for TF derived from PET image with (gated, G-) and without (ungated, U-) motion compensation was analyzed. Finally, TF complementarity was assessed. In the comparison of TF derived from the ideal contour with respect to TF derived from 40%-threshold and adaptive-threshold PET contours, 7/8 TF showed strong linear correlation (LC) (p < 0.001, r > 0.75), despite a significant volume underestimation. Independence of lesion movement (LC in 100% of the combined pairs of movements, p < 0.05) was obtained for 1/8 TF with U-image (width of the volume-activity histogram, WH) and 4/8 TF with G-image (WH and energy (ENG), local-homogeneity (LH) and entropy (ENT), derived from the co-ocurrence matrix). Their variability in terms of the coefficient of variance ([Formula: see text]) resulted in [Formula: see text](WH) = 0.18 on the U-image and [Formula: see text](WH) = 0.24, [Formula: see text](ENG) = 0.15, [Formula: see text](LH) = 0.07 and [Formula: see text](ENT) = 0.06 on the G-image. Apart from WH (r > 0.9, p < 0.001), not one of these TF has shown LC with C max. Complementarity was observed for the TF pairs: ENG-LH, CONT (contrast)-ENT and LH-ENT. In conclusion, the effect of respiratory motion should be taken into account when the heterogeneity of lung cancer is quantified on PET/CT images. Despite inaccurate volume delineation, TF derived from 40% and COA contours could be reliable for their prognostic use. The TF that exhibited simultaneous added value and independence of lesion movement were ENG and ENT computed from the G-image. Their use is therefore recommended for heterogeneity quantification of lesions affected by respiratory motion.

177Lu-DOTATATE treatment in neuroendocrine tumours. A preliminary study. / Tratamiento con 177LU-DOTATATE en tumores neuroendocrinos. Estudio preliminar.

Therapy with radiolabelled somatostatin analogue peptides is a promising new therapy to treat neuroendocrine tumours. The aim of this preliminary study is to present our experience with 177Lu-DOTATATE therapy, and evaluate tolerability and short-term efficacy in patients with tumours expressing somatostatin receptors. A total of 7 patients with metastatic neuroendocrine tumours were treated, each with 4 doses of 177Lu-DOTATATE. The treatment response was evaluated in the form of biochemical response (tumour markers), imaging methods (somatostatin receptor scintigraphy, computed tomography, and magnetic resonance), and functional and quality of life responses using the Karnofsky performance status scale. Treatment toxicity was also evaluated. The results obtained were as follows: Biochemical response: 60% of patients showed tumour marker levels returning to normal, while they decreased significantly in the remaining 40%. Imaging response: 85.7% had a partial response, while 14.3% showed stable disease. All (100%) patients showed a significant improvement in quality of life, with increased Karnofsky scale scores. No patient had acute or chronic toxicity, and subacute transient haematological toxicity was observed in 42.8% of patients. Despite being a preliminary study, it was found that treatment with 177Lu-DOTATATE is a safe treatment with few side effects, and an objective response was achieved in most patients.

Intervención educativa de enfermería para fomentar el autocuidado de la mujer durante el climaterio / Nursing educational intervention to foster women's self-care during their climacteric period / Intervenção educativa de enfermagem para o autocuidado em mulheres durante o climatério

Objetivo: Evaluar las intervenciones educativas de enfermería para el autocuidado en las mujeres durante el climaterio. Método: Cuantitativo, cuasiexperimental y transversal. Muestreo de tipo no probabilístico en el que participaron 30 mujeres. Se aplicaron 2 instrumentos: Uno que incluyó datos sociodemográficos y el otro, un cuestionario de autocuidado. Se llevó a cabo en 3 etapas: Diagnóstica, de intervención y de evaluación. Se aplicó prueba de t de Student no paramétrica para comparar grupos dependientes. Resultados: Antes de las intervenciones educativas del personal de enfermería, el 90% de las mujeres refirieron un autocuidado regular, el 6.7% bueno y el 3.3% malo; después del programa de intervenciones, el 60% refieren autocuidado regular y el 40%, bueno. Conclusión: Las intervenciones educativas de enfermería para el autocuidado -mediante la aplicación de un programa- dirigido a mujeres durante el climaterio, permitieron modificar el autocuidado al contribuir en la concientización, toma de decisiones, cambios de conducta. De tal forma que la participación de enfermería dentro de la promoción de la salud es fundamental, ya que busca el bienestar integral y el desarrollo de la mujer en esta etapa de la vida.

Objective: To assess nursing educational interventions fostering women's self-care during their climacteric period. Method: This is a quantitative, quasi-experimental, and transversal study with non-probabilistic sampling. Thirty women participated. Two instruments were used: One to gather social and demographic data, and the other to obtain the self-care data. The study was carried out in 3 stages: Diagnosis, intervention, and evaluation. The non-parametric Student's t test was calculated to compare dependent groups. Results: Before the interventions, 90% of the women referred having a just-fair self-care level, while 6.7% a good one, and 3.3% a bad one. After the interventions program, 60% of the women referred having a just-fair self-care level, but 40% reported a good one. Conclusion: Nursing educational interventions fostering women's self-care during their climacteric period led to a positive modification of self-care behaviors among these women by contributing to their awareness and good decision-making. Nursing participation in the promotion of health is fundamental, including women's wellbeing during this difficult stage of their lives.

Objetivo: Avaliar as intervenções educativas de enfermagem para o autocuidado nas mulheres durante o climatério. Método: Quantitativo, quase experimental e transversal. Amostragem de tipo não probabilística, participaram 30 mulheres. Aplicaram-se 2 instrumentos, um que incluiu dados sociodemográficos e o questionário de autocuidado. Executou-se em três etapas: Diagnóstica, de intervenção e de avaliação. Aplicou-se prova de t de Student não paramédica para comparar grupos dependentes. Resultados: Antes das intervenções educativas do pessoal de enfermagem, o 90% das mulheres referiram um autocuidado regular, 6.7% bom e 3.3% mau, depois do programa de intervenções, 60% referem autocuidado regular e 40% bom. Conclusão: As intervenções educativas de enfermagem para o autocuidado-mediante a aplicação do programa- dirigido a mulheres durante o climatério permitiram modificar o autocuidado para contribuir na conscientização, tomada de decisões, mudanças de conduta. De tal forma que a participação de enfermagem dentro da promoção da saúde é fundamental, dado que procura o bem-estar integral e o desenvolvimento da mulher nesta etapa da vida.

Individualised dosimetry in patients with differentiated thyroid cancer based on external dose-rate. Optimisation of the number of measurements.

OBJECTIVES: To compare the results of individual dosimetry in differentiated thyroid cancer patients treated with (131)I at our centre with the established limits and dosimetry results of published studies. Analysis of the optimal number of measurements necessary to reduce the impact of dosimetry for the comfort of the patient and, secondly, on the workload of health workers. MATERIAL AND METHODS: Dosimetry was performed in the Nuclear Medicine Department of the University and Polytechnic Hospital La Fe, on 29 patients suffering from differentiated thyroid cancer and treated with activities between 1.02 and 5.51 GBq (mean 2.68 GBq) of (131)I. The Spanish Society of Medical Physics (SEFM) protocol was used, based on measurements of external dose rate adjusted to a bi-exponential curve according to a two compartment model. Different dosimetries were performed on each patient, taking different selections of the available measurements in order to find the optimal number. RESULTS: Results are well below the dosimetry limits, and are consistent with those obtained in other centres. The number of measurements can be reduced from 5, as proposed in the SEFM protocol, to 4 without significant loss of accuracy. Further reducing measures may be justified in individual cases. CONCLUSIONS: The values obtained for the dosimetry quantities are significantly below the established limits. A reduction in measurements can be assumed at the cost of a moderate increase in uncertainty, benefiting the patient.

Sympathetic reinnervation 1 year after heart transplantation, assessed using iodine-123 metaiodobenzylguanidine imaging.

Complete allograft denervation occurs during heart transplantation (HT). Partial ventricular sympathetic reinnervation that may develop after transplantation can be measured using iodine-123 meta iodobenzylguanidine (MIBG) uptake. Previous studies have suggested that reinnervation is likely to be a slow process, only occurring after 1 year posttransplantation. However, the reinnervation prevalence at 1 year after HT remains unknown. This study sought to determine sympathetic reinnervation measured by MIBG at 12 months after surgery. We performed serial cardiac MIBG imaging in 45 cardiac transplant recipients, including 32 males and 13 females, early (2 months) and late (12 months) after the operation. The intensity of myocardial MIBG uptaken was quantified by heart-to-mediastinum ratios (HMR). Reinnervation was considered when the HMR was >1.3. HMR was significantly higher at 12 months: 1.16 ± 0.10 at 2 vs 1.30 ± 0.15 at 12 months (P < .001). Eighteen (40%) of 45 subjects developed visible cardiac MIBG uptake at 1 year after transplantation with HMR >1.3. In conclusion, partial sympathetic reinnervation increases with time after HT; it was seen in 40% of patients at 1 year after the operation.

Estudio de compromiso ocular en pacientes con rosácea / Ocular involvement in patients with cutaneous rosacea

La rosácea cutánea (RC) es una enfermedad crónica relativamente común que puede presentarse con afectación ocular. La rosácea ocular es considerada una enfermedad bilateral, manifestándose en la mayoría de los casos en forma simultánea al compromiso cutáneo. El objetivo del estudio es determinar el compromiso ocular de pacientes portadores de RC comparados con un grupo control y la asociación de severidad entre el compromiso cutáneo y el ocular. Se analizó un total de 112 pacientes; un primer grupo de 70 pacientes portadores de RC en un período de dos años, y el segundo constituido por 42 controles sanos. Observamos que en nuestros pacientes con RC hay una alteración de la función lagrimal y no existe relación estadísticamente significativa entre la severidad del compromiso cutáneo y el compromiso ocular. Debido a que el compromiso ocular en la RC es subestimado, es importante la evaluación de síntomas oculares en los pacientes con RC para continuar un manejo bidisciplinario entre dermatólogos y oftalmólogos.

Cutaneous rosacea (CR) is a relatively common chronic disease that can occur with ocular involvement. Ocular rosacea is considered a bilateral entity that usually manifests simultaneously with cutaneous disease. The objective of this study is to determine ocular involvement in CR patients, compared with a control group, and to establish the association between severity of cutaneous and ocular involvement. 112 patients were analyzed; a first group of 70 patients with a two year story of CR, and the second group consisting of 42 healthy controls. At the end of the study, we observed that patients with CR had tear dysfunction and there was no statistically significant relationship between the severity of cutaneous and ocular involvement. Since eye involvement in CR is underestimated, we consider it important to investigate ocular symptoms in patients with CR and maintain multi-disciplinary management between dermatologists and ophthalmologists.

Edad materna y malformaciones congénitas: Un registro de 35 años: 1970-2005: [revisión] / The association between maternal age and congenital malformations: [review]

Background: There is an association between extreme maternal ages and the risk of congenital malformations. This is specially true for chromosomal abnormalities among women of advanced ages and disruptive malformation among teenage mothers. Aim: To determine the association between maternal ages and incidence of congenital malformations at the obstetric ward of a clinical hospital. To compare these figures with those of Chile. Material and methods: The hospital registries of the Latin American Collaborative Study of Congenital Malformations (ECLAMC) between 1996 and 2005, were consulted. This is a database of all marformations detected in newborns at the hospital. Results: An overall prevalence of malformations of8,4 percent was detected at the hospital. There is a significantly lower frequency of mothers aged less than 20 years than in the rest of Chile. Mothers aged between 20 and 29 years have the lower frequency of malformed children. Women aged íess than 20 years and over 39 years of age, account for 56 percent of malformed children. Maternal ages and the rates of malformations, increased in a parallel fashion at a rate of 0.2 years and 2.2 malformed children per 1,000 born alive, per calendar year, respectively. Conclusions: The association between prevalence rates of congenital malformations and maternal age is U chaped with a higher proportion of malformed children among women aged íess than 20 years or more than 39 years.

Una metodología de series de tiempo para el área de la salud; caso práctico / A methodology of time series for the health field -a practical case

En los últimos años, las series de tiempo han tenido desarrollos y aplicaciones importantes en el área de la salud; por ello, el presente artículo muestra una metodología ensayada en estudios anteriores, en que se esbozan los pasos en el análisis de series de tiempo para un enfoque clásico. El objetivo permite identificar un buen modelo de pronóstico usando técnicas de suavización: exponencial, simple, Holt y Winter. Además, se realiza la validación de los supuestos de los residuales, dando confiabilidad a los resultados del modelo encontrado. Para aplicar el procedimiento se utilizaron los datos del número de consultas externas realizadas en la IPS de la Universidad de Antioquia durante abril del 2001 y septiembre del 2005.

During the last years time series have had developments and important applications in the field of health. The present article shows a methodology tried in previous studies and outlines the steps in the analysis of time series for a classical approach. The objective allows identifying a good model of prognosis by using smoothing methods: exponential, simple, Holt and Winter. In addition, the validation of the assumptions of the residuals is made managing to give trustworthiness to the results of the found model. In order to apply the procedure, data of number of outpatient appointments performed at the University of Antioquia Health Service from April 2001 to September 2005 were used.

Integrated pollution prevention and control for heavy ceramic industry in Galicia (NW Spain).

The heavy ceramic industry (building materials and refractory products manufacture) is an important source of pollutants to the environment. For this reason these industrial sub-sectors are included in prevention and control pollution policies, specifically those of the European Union. The IPPC Directive pays particular attention to the mineral industries, not least to the ceramic industry (epigraph 3.5, Annex I). In this paper, a methodology which is being applied to support IPPC installations and the competent administrative authority in Galicia (NW Spain) is presented. For that, the Galician heavy ceramic industry is analysed, as also are the ways to study the Best Available Techniques (BAT) with a view to establishing the emission limit values (ELV) for each specific case. Hence, a technological state of the art has been carried out for both sub-sectors, from the point of view of implementation of the IPPC in Galicia. Following this, the processes are described briefly and an analysis of the consumption and emission levels of the main pollutants is made. An inventory that includes the best environmental practices and the preventive and abatement candidate techniques as BAT was elaborated for both considered sub-sectors. An information data sheet for each candidate BAT is presented as a method to help both the industries and the competent authority to identify a candidate technique of the inventory as BAT. Three illustrative examples of the application of this procedure are presented for different emissions to environmental media for Galician installations.

[The association between maternal age and congenital malformations]. / Edad materna y malformaciones congénitas: un registro de 35 años. 1970-2005.

BACKGROUND: There is an association between extreme maternal ages and the risk of congenital malformations. This is specially true for chromosomal abnormalities among women of advanced ages and disruptive malformation among teenage mothers. AIM: To determine the association between maternal ages and incidence of congenital malformations at the obstetric ward of a clinical hospital. To compare these figures with those of Chile. MATERIAL AND METHODS: The hospital registries of the Latin American Collaborative Study of Congenital Malformations (ECLAMC) between 1996 and 2005, were consulted. This is a database of all malformations detected in newborns at the hospital. RESULTS: An overall prevalence of malformations of 8,4% was detected at the hospital. There is a significantly lower frequency of mothers aged less than 20 years than in the rest of Chile. Mothers aged between 20 and 29 years have the lower frequency of malformed children. Women aged less than 20 years and over 39 years of age account for 56% of malformed children. Maternal ages and the rates of malformations, increased in a parallel fashion at a rate of 0.2 years and 2.2 malformed children per 1,000 born alive, per calendar year, respectively. CONCLUSIONS: The association between prevalence rates of congenital malformations and maternal age is U shaped with a higher proportion of malformed children among women aged less than 20 years or more than 39 years.

Consulta dermatológica en el Servicio de Urgencia del Hospital Clínico de la Universidad de Chile durante los meses de julio y diciembre del año 2005 / Dermatological consultations at the Emergency Service of the Hospital Clinico of Universidad de Chile during July and December, 2005

La patología dermatológica es una causa relativamente infrecuente de consulta en los Servicios de Urgencia a nivel mundial. Quizás es por ello que sus características han sido poco descritas en la literatura. Con el objetivo de conocer un poco más acerca de este tema, realizamos un estudio descriptivo y retrospectivo de las consultas dermatológicas realizadas tanto por adultos como por niños al Servicio de Urgencia del Hospital Clínico de la Universidad de Chile durante julio y diciembre de 2005, meses representativos de invierno y verano, respectivamente. Los resultados obtenidos muestran que las causas dermatológicas representan alrededor del 5 por ciento del total de consultas realizadas al Servicio de Urgencia. Sin embargo, esta cifra no es igual en ambos meses, ya que corroboramos un aumento porcentual significativo de las consultas por patología cutánea durante el mes de diciembre. De igual forma, observamos que la proporción de consultas de urgencias atribuibles a una causa dermatológica en pacientes pediátricos es mayor que la correspondiente a pacientes adultos. Por último, y en concordancia con lo reportado a nivel internacional, las etiologías infecciosas y alérgicas fueron las principales causas pesquisadas.

Dermatological pathology is a relatively infrequent cause of consultation in emergency services throughout the world. Perhaps this is why their characteristics have been poorly described in literature. In order to know a little more about this subject, we made a descriptive and retrospective study of the dermatological consultations made, by both adults and children, to the Clinical Hospital University of Chile Emergency Service during July and December, 2005, representative months of Winter and Summer, respectively. Results show that dermatological causes represent approximately 5 percent of all consultations made to the Emergency Service. Nevertheless, this number is not equal in both months, since we corroborated a significant percentage increase of consultations for cutaneous pathology during the month of December. Similarly, we observed that the proportion of emergency consultations attributable to a dermatological cause in pediatric patients is greater than that corresponding to adult patients. Finally and in agreement with international literature, infectious and allergic etiologies were the main causes found.

Prevalencia de defectos de la pared abdominal al nacer: estudio ECLAMC / Prevalence of abdominal wall defects in newborns: ECLAMC Study, 1982-2005

Introducción: Onfalocele y gastrosquisis son los defectos de la pared abdominal (DPA) más frecuentes. Ambos necesitan un diagnóstico precoz y tratamiento quirúrgico oportuno para sobrevivir. Objetivos: Determinar la prevalencia al nacimiento de los DPA en la maternidad del Hospital Clínico de la Universidad de Chile (HCUCH) y compararla con la del total de maternidades chilenas (MCh) y los resultados del Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC). Resultados: La prevalencia global de onfalocele fue de 3,4/ 10 000 nacimientos y 3,8/10 000 para gastrosquisis. La prevalencia de onfalocele fue 9/10.000 en HCUCH y 2,77/10 000 en MCh (p = 0,006) y la de gastrosquisis fue 1,9/10 000 en HCUCH y 1,1/10 000 en MCh (p = 0,036). El promedio de edad materna fue 24,2 años para gastrosquisis y 33,6 para onfalocele (p < 0,004). La sobrevida de gastrosquisis fue 100 por ciento versus 31,7 por ciento en onfalocele (p < 0,0425). Todos los RN con onfalocele, salvo uno, presentaban asociación con otras MC graves. El peso de nacimiento y edad gestacional fueron significativamente menores en onfalocele. Conclusión: La prevalencia de DPA fue significativamente mayor en el HCUCH que en el resto de las maternidades chilenas. Gastrosquisis se presentó en hijos de mujeres más jóvenes y onfalocele en las de mayor edad.

Enfermedad de injerto versus huésped / Graft-versus-host disease

La enfermedad de Injerto contra Huésped (EICH) es una cuadro que se produce en algunos de los pacientes receptores de un trasplante de médula ósea, en el cual los linfocitos T inmunocompetentes del tejido trasplantado reaccionan en contra de los tejidos del receptor (huésped). Se divide en dos grandes grupos: agudo y crónico. Sus manifestaciones clínicas son diversas, dadas por el compromiso variable de piel, hígado, tracto gastrointestinal, entre otros. Las lesiones cutáneas suelen ser el hallazgos más frecuente tanto en la forma aguda como crónica. Dada la existencia de múltiples procesos patológicos que pueden simular una EIDCH, su diagnóstico requiere, además de un alto índice de sospecha, el estudio histológico y el seguimiento cercano de los pacientes. Dado que cada vez son más frecuentes los trasplantes de médula ósea, así como sus manifestaciones más habituales y precoces ocurren en la piel, es muy importante para los dermatólogos estar familiarizados con este cuadro clínico.