Impact of dementia on 30-, 180-, and 365-day mortality during the first pandemic wave in older adults seen in spanish emergency departments diagnosed with or without COVID-19.

OBJECTIVES: To assess whether dementia is an independent predictor of death after a hospital emergency department (ED) visit by older adults with or without a COVID-19 diagnosis during the first pandemic wave. METHOD: We used data from the EDEN-Covid (Emergency Department and Elderly Needs during Covid) cohort formed by all patients ≥65 years seen in 52 Spanish EDs from March 30 to April 5, 2020. The association of prior history of dementia with mortality at 30, 180 and 365 d was evaluated in the overall sample and according to a COVID-19 or non COVID diagnosis. RESULTS: We included 9,770 patients aged 78.7 ± 8.3 years, 51.1% men, 1513 (15.5%) subjects with prior history of dementia and 3055 (31.3%) with COVID-19 diagnosis. 1399 patients (14.3%) died at 30 d, 2008 (20.6%) at 180 days and 2456 (25.1%) at 365 d. The adjusted Hazard Ratio (aHR) for age, sex, comorbidity, disability and diagnosis for death associated with dementia were 1.16 (95% CI 1.01-1.34) at 30 d; 1.15 at 180 d (95% CI 1.03-1.30) and 1.19 at 365 d (95% CI 1.07-1.32), p < .001. In patients with COVID-19, the aHR were 1.26 (95% CI: 1.04-1.52) at 30 days; 1.29 at 180 d (95% CI: 1.09-1.53) and 1.35 at 365 d (95% CI: 1.15-1.58). CONCLUSION: Dementia in older adults attending Spanish EDs during the first pandemic wave was independently associated with 30-, 180- and 365-day mortality. This impact was lower when adjusted for age, sex, comorbidity and disability, and was greater in patients diagnosed with COVID-19.

Is contrast-enhanced mammography (CEM) an alternative to MRI in assessing the response to primary systemic therapy of breast cancer?

PURPOSE: To evaluate the accuracy of contrast-enhanced mammography (CEM) and magnetic resonance imaging (MRI) in the assessing radiological response to primary systemic therapy (PST). METHOD: Prospective study between February 2021 and October 2022. Women with breast cancer and indication of PST were enrolled. CEM and MRI were performed before and after PST, and the findings, including size and radiological response pattern, were compared with the size of the residual lesion measured in surgical specimens and its Miller-Payne classification (considered the gold standard). Two of four independent radiologists, with 2 years of CEM experience and 10 years of MRI experience, reviewed the images while being blinded to the results of the other technique. The agreement between measurements was evaluated using the Pearson correlation coefficient (r) and Lin's coefficient. RESULTS: Forty-eight women with breast cancer who required PST were enrolled in the study, with a mean age of 57.21 ± 10.14 years. A total of thirty-three participants (68.75 %) completed the study. The correlation between CEM and MRI measurements was high before PST (r: 0.97), and local staging was identical for 45 out of 48 patients. MRI demonstrated better accuracy in predicting residual tumor size than CEM, with Lin's coefficient 0.91 and 0.73, respectively. However, no significant differences were observed in predicting response to therapy. Both methods tended to overestimate the size and degree of response in our study, with mean overestimations of 2.87 mm in CEM and 0.51 mm in MRI. CONCLUSION: CEM was found to be as accurate as MRI in predicting response to PST, indicating its potential as an alternative imaging technique, but further research is necessary.

Análisis de los factores radiopatológicos del cáncer de mama triple negativo y determinación de perfiles de riesgo / Analysis of the radio-pathological factors of triple negative breast cancer and determination of risk profiles

OBJETIVO: Los tumores triples negativos (TN) constituyen el subgrupo de cáncer de mama (CM) más agresivo. Nuestro objetivo es analizar los principales factores radiopatológicos de estos tumores para crear un perfil de riesgo. MATERIALES Y MÉTODOS: Es un estudio constituido por 140 pacientes diagnosticadas de CM TN desde enero del 2007 a diciembre del 2016. Se analizaron los factores radiológicos en resonancia magnética (RM) de estadificación: tamaño, necrosis, hallazgos asociados, adenopatías, parámetros de perfusión y difusión. En biopsias diagnósticas se estudiaron características del componente infiltrante: tipo histológico, Scarf-Bloom, Ki67 y p53 y el componente in situ. Se analizaron las adenopatías histológicamente positivas y en las piezas quirúrgicas: tamaño, invasión linfovascular/perineural y adenosis microglandular. El seguimiento finalizó en abril de 2018. Se evaluó la relación de los factores radiopatológicos con la recidiva y la supervivencia libre de enfermedad (SLE). RESULTADOS: Los tumores con tamaño igual o superior a 25 mm en RM, realce no nodular, edema mamario o retracción del complejo aréola-pezón y adenopatías presentaron más recidivas y menor SLE. Los carcinomas lobulillares infiltrantes, el tamaño posquirúrgico>20 mm y p53 <15% también se asociaron con la recidiva y una menor SLE. Las adenopatías histológicamente positivas se relacionaron con un mayor porcentaje de recidivas, y la invasión linfovascular, con una menor SLE. El análisis multivariante ha definido que el tamaño en RM>25 mm, el realce no nodular, las adenopatías en RM, y la expresión menor del 15% de p53 son variables pronósticas independientes. CONCLUSIONES: El tamaño igual o superior a 25 mm, realce no nodular y adenopatías en RM, y una expresión inferior al 15% de p53 condicionan una menor SLE

OBJECTIVE: Triple-negative tumors are the most aggressive type of breast cancer. We aimed to analyze the main radiologic and histopathologic factors of these tumors to create a risk profile. MATERIALS AND METHODS: We analyzed data from 140 patients diagnosed with triple-negative breast cancer between January 2007 and December 2016, with follow-up through April 2018. We analyzed the following variables in the breast MRI done for staging: size, necrosis, associated findings, adenopathies, and perfusion and diffusion parameters. We analyzed the following variables in histopathologic studies of biopsy specimens: histological type, Scarf-Bloom, Ki67, and p53 in the infiltrating component as well as in the in situ component. We analyzed the following variables in histopathologic studies of positive lymph nodes and surgical specimens: size, lymphovascular/perineural invasion, and microglandular adenosis. We analyzed the relation between the radiologic and histopathologic factors and recurrence and disease-free survival. RESULTS: MRI tumor size>25mm, non-nodular enhancement, breast edema, areola-nipple complex retraction, and lymph-node involvement were associated with recurrence and lower disease-free survival. Invasive lobular carcinoma, postsurgical size>20mm, and p53<15% were also associated with recurrence and lower disease-free survival. Histologically positive lymph nodes were associated with a greater percentage of recurrence and lymphovascular invasion and with lower disease-free survival. The multivariate analysis found that the variables MRI size>25mm, non-nodular enhancement, adenopathies on MRI, and p53 expression <15% were independent predictors of lower disease-free survival. CONCLUSIONS: In triple-negative breast tumors, factors associated with lower disease-free survival are non-nodular enhancement, size>25mm, and adenopathies on MRI, and p53 expression <15% on histopathologic study

Analysis of the radio-pathological factors of triple negative breast cancer and determination of risk profiles. / Análisis de los factores radiopatológicos del cáncer de mama triple negativo y determinación de perfiles de riesgo.

OBJECTIVE: Triple-negative tumors are the most aggressive type of breast cancer. We aimed to analyze the main radiologic and histopathologic factors of these tumors to create a risk profile. MATERIALS AND METHODS: We analyzed data from 140 patients diagnosed with triple-negative breast cancer between January 2007 and December 2016, with follow-up through April 2018. We analyzed the following variables in the breast MRI done for staging: size, necrosis, associated findings, adenopathies, and perfusion and diffusion parameters. We analyzed the following variables in histopathologic studies of biopsy specimens: histological type, Scarf-Bloom, Ki67, and p53 in the infiltrating component as well as in the in situ component. We analyzed the following variables in histopathologic studies of positive lymph nodes and surgical specimens: size, lymphovascular/perineural invasion, and microglandular adenosis. We analyzed the relation between the radiologic and histopathologic factors and recurrence and disease-free survival. RESULTS: MRI tumor size>25mm, non-nodular enhancement, breast edema, areola-nipple complex retraction, and lymph-node involvement were associated with recurrence and lower disease-free survival. Invasive lobular carcinoma, postsurgical size>20mm, and p53<15% were also associated with recurrence and lower disease-free survival. Histologically positive lymph nodes were associated with a greater percentage of recurrence and lymphovascular invasion and with lower disease-free survival. The multivariate analysis found that the variables MRI size>25mm, non-nodular enhancement, adenopathies on MRI, and p53 expression <15% were independent predictors of lower disease-free survival. CONCLUSIONS: In triple-negative breast tumors, factors associated with lower disease-free survival are non-nodular enhancement, size>25mm, and adenopathies on MRI, and p53 expression <15% on histopathologic study.

Modelo de riesgo a 30 días en los pacientes adultos con crisis epiléptica dados de alta de urgencias (RACESUR) / Adults discharged after an epileptic seizure: a model of 30-day risk for adverse outcomes

Objetivo: Diseñar un modelo de riesgo para predecir resultado adverso a los 30 días del alta en pacientes adultos atendidos por crisis epiléptica en servicios de urgencias hospitalarios (SUH). Metodología: ACESUR fue un registro observacional de cohortes multipropósito, prospectivo, multicéntrico, con muestreo sistemático y con seguimiento telefónico a 30 días. La variable principal fue la presencia de algún resultado adverso (recurrencia de crisis, revisita al SUH, hospitalización o fallecimiento) a 30 días del alta del SUH. Resultados: Se incluyeron 489 (74%) pacientes de 48 años de mediana (RIC 34-66), dados de alta de 18 SUH con datos de seguimiento. Ciento cuarenta y cuatro (29,4%) presentaron algún resultado adverso a 30 días del alta del SUH. El Modelo RACESUR incluyó la presencia de crisis epiléptica no convulsiva generalizada tónico-clónica como motivo de consulta (OR 2,42; IC 95% 1,49-3,90; p < 0,001), consumo habitual de $ 3 fármacos (OR 1,98; IC 95% 1,283,07; p = 0,002) y visita al SUH en el semestre anterior por cualquier causa (OR 2,34; IC 95% 1,7-3,70; p < 0,001). Cada ítem vale 1 punto. El riesgo de padecer un resultado adverso a 30 días fue de un 62,2% con 3 puntos, 38,5% con 2, 25,9% con 1 y 10,9% con 0 puntos. El área bajo la curva del modelo fue de 0,72 (IC 95% 0,675-0,772; p = 0,025). Conclusiones: El Modelo RACESUR podría ser una herramienta pronóstico de utilidad para identificar al paciente adulto con crisis epiléptica y alto riesgo de presentar resultado adverso a los 30 días del alta de urgencias

Objective: To develop a risk model to predict adverse outcomes within 30 days of discharge in adults attended by hospital emergency departments for an epileptic seizure. Methods: ACESUR (Acute Epileptic Seizures in the Emergency Department) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling. We made follow-up telephone calls to registered patients 30 days after discharge. Clinical variables for the index visit were extracted from the register and variables at 30 days were collected by telephone. The main outcome variable was the occurrence of any adverse outcome (seizure recurrence, emergency department revisit, hospitalization, or death) within 30 days of discharge. Results: Of the patients from the ACESUR registry discharged from 18 hospitals, we included 489 (74%) with complete follow-up information. The median (interquartile range) age was de 48 (34-66) years. One hundred forty-four patients (29.4%) experienced an adverse outcome within 30 days of discharge. Factors included in the ACESUR risk model were generalized nonconvulsive tonic-clonic epileptic seizure as the reason for the index visit (odds ratio [OR], 2.42; 95% CI, 1.49-3.90; P<.001), ongoing use of 3 or more medications (OR, 1.98; 95% CI, 1.28-3.07; P=.002), and an emergency visit for any reason in the 6 months prior to the index event (OR, 2.34; 95% CI, 1.47-3.70; P<.001). Each factor contributed 1 point to the risk score. A score of 3 was associated with a 62.2% risk of an adverse outcome within 30 days, a score of 2 was associated with a 38.5% risk, a score of 1 with a 25.9% risk, and a score of 0 with a 10.9% risk. The area under the curve receiver operating characteristic curve was 0.72 (95% CI, 0.675-0.772; P=.025). Conclusion: The ACESUR risk model may provide a useful score for identifying patients at high risk of an adverse outcome within 30 days of emergency department discharge after an epileptic seizure

Adults discharged after an epileptic seizure: a model of 30-day risk for adverse outcomes. / Modelo de riesgo a 30 días en los pacientes adultos con crisis epiléptica dados de alta de urgencias (RACESUR).

OBJECTIVES: To develop a risk model to predict adverse outcomes within 30 days of discharge in adults attended by hospital emergency departments for an epileptic seizure. METHODS: ACESUR (Acute Epileptic Seizures in the Emergency Department) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling. We made follow-up telephone calls to registered patients 30 days after discharge. Clinical variables for the index visit were extracted from the register and variables at 30 days were collected by telephone. The main outcome variable was the occurrence of any adverse outcome (seizure recurrence, emergency department revisit, hospitalization, or death) within 30 days of discharge. RESULTS: Of the patients from the ACESUR registry discharged from 18 hospitals, we included 489 (74%) with complete follow-up information. The median (interquartile range) age was de 48 (34-66) years. One hundred forty-four patients (29.4%) experienced an adverse outcome within 30 days of discharge. Factors included in the ACESUR risk model were generalized nonconvulsive tonic-clonic epileptic seizure as the reason for the index visit (odds ratio [OR], 2.42; 95% CI, 1.49-3.90; P<.001), ongoing use of 3 or more medications (OR, 1.98; 95% CI, 1.28-3.07; P=.002), and an emergency visit for any reason in the 6 months prior to the index event (OR, 2.34; 95% CI, 1.47-3.70; P<.001). Each factor contributed 1 point to the risk score. A score of 3 was associated with a 62.2% risk of an adverse outcome within 30 days, a score of 2 was associated with a 38.5% risk, a score of 1 with a 25.9% risk, and a score of 0 with a 10.9% risk. The area under the curve receiver operating characteristic curve was 0.72 (95% CI, 0.675-0.772; P=.025). CONCLUSION: The ACESUR risk model may provide a useful score for identifying patients at high risk of an adverse outcome within 30 days of emergency department discharge after an epileptic seizure.

OBJETIVO: Diseñar un modelo de riesgo para predecir resultado adverso a los 30 días del alta en pacientes adultos atendidos por crisis epiléptica en servicios de urgencias hospitalarios (SUH). METODO: ACESUR fue un registro observacional de cohortes multipropósito, prospectivo, multicéntrico, con muestreo sistemático y con seguimiento telefónico a 30 días. La variable principal fue la presencia de algún resultado adverso (recurrencia de crisis, revisita al SUH, hospitalización o fallecimiento) a 30 días del alta del SUH. RESULTADOS: Se incluyeron 489 (74%) pacientes de 48 años de mediana (RIC 34-66), dados de alta de 18 SUH con datos de seguimiento. Ciento cuarenta y cuatro (29,4%) presentaron algún resultado adverso a 30 días del alta del SUH. El Modelo RACESUR incluyó la presencia de crisis epiléptica no convulsiva generalizada tónico-clónica como motivo de consulta (OR 2,42; IC 95% 1,49-3,90; p < 0,001), consumo habitual de $ 3 fármacos (OR 1,98; IC 95% 1,28- 3,07; p = 0,002) y visita al SUH en el semestre anterior por cualquier causa (OR 2,34; IC 95% 1,7-3,70; p < 0,001). Cada ítem vale 1 punto. El riesgo de padecer un resultado adverso a 30 días fue de un 62,2% con 3 puntos, 38,5% con 2, 25,9% con 1 y 10,9% con 0 puntos. El área bajo la curva del modelo fue de 0,72 (IC 95% 0,675-0,772; p = 0,025). CONCLUSIONES: El Modelo RACESUR podría ser una herramienta pronóstico de utilidad para identificar al paciente adulto con crisis epiléptica y alto riesgo de presentar resultado adverso a los 30 días del alta de urgencias.

Differences in emergency department care of adults with a first epileptic seizure versus a recurrent seizure: a study of the ACESUR (Acute Epileptic Seizures in the Emergency Department) registr. / Registro ACESUR: atención de pacientes adultos con crisis epilépticas en servicios de urgencias: diferencias entre primer episodio y recurrencia.

OBJECTIVES: To describe the characteristics of care received by patients who come to the emergency department with a first epileptic seizure versus a recurrent seizure in a patient with diagnosed epileps. MATERIAL AND METHODS: ACESUR (Acute Epileptic Seizures in the Emergency Department) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling on even days in February and July 2017 and on odd days in April and October 2017. Patients were aged 18 years or older and had an emergency department diagnosis of epileptic seizure. We recorded clinical variables and details related to care given during each patient's visit, including whether the event was a first or recurrent seizure. RESULTS: A total of 664 patients attended by 18 Spanish emergency departments were entered into the ACESUR registry. Two hundred twenty-nine (34.5%) were first seizures and 435 (65.5%) were recurrences. Patients who were attended for first seizures were older, consulted for a wider variety of reasons, and were transported in ambulances (P<.001, all comparisons). Care received differed between patients with first seizures versus recurrent seizures. Specific complementary testing was more likely in patients with first seizures (adjusted odds ratio [aOR], 13.94; 95% CI, 29-26.7; P<.001), and they were more often hospitalized or stayed longer in the emergency department, (aOR, 1.69; 95% CI, 1.11-2.58; P=.015). Pharmacologic treatment did not differ between the groups, either in the acute phase or for prevention (aOR, 1.40; 95% CI, 0.94-2.09; P=.096). Antiepileptic drugs were given to 100 patients (43.7%) after a first seizure and were restarted or changed in 142 patients with recurrent seizure (32.6%). CONCLUSION: The clinical characteristics of adults attended for a first epileptic seizure differ from those of patients with diagnosed epilepsy who were attended for recurrent seizures in Spain. The care received also differs.

OBJETIVO: Describir las características y la atención recibida de pacientes adultos que consultan por crisis epiléptica (CE) en los servicios de urgencias hospitalarios (SUH), diferenciando entre primera crisis y recurrencia en epiléptico conocido. METODO: ACESUR es un registro observacional de cohortes multipropósito, prospectivo y multicéntrico con un muestreo sistemático, los días pares de febrero y julio alternando con los impares de abril y octubre de 2017. Se incluyeron pacientes 18 años con diagnóstico de CE en los SUH. Se recogieron variables clínico-asistenciales de la visita índice de pacientes, distinguiendo entre primera CE y recurrencia en epiléptico. RESULTADOS: El registro ACESUR recogió a 664 pacientes procedentes de 18 SUH españoles, 229 (34,5%) con primera CE y 435 (65,5%) con CE recurrentes. Los pacientes con primera CE fueron de mayor edad (p < 0,001), presentaron motivos de consulta distintos (p < 0,001) y requirieron más traslados en ambulancia (p < 0,001). La atención recibida en el SUH fue diferente, en pacientes con primera CE se solicitó con mayor probabilidad una prueba complementaria específica (OR ajustada = 13,94; IC95%:7,29-26,7; p < 0,001) y se necesitó mayor hospitalización o estancia prolongada en el SUH (OR ajustada = 1,69; IC95%:1,11-2,58; p = 0,015). No hubo diferencias en cuanto al tratamiento farmacológico en fase aguda ni preventivo (OR ajustada = 1,40; IC95%:0,94-2,09; p = 0,096). Se inició tratamiento con fármacos antiepiépticos (FAE) en 100 pacientes (43,7%) tras primera CE y se reinició o modificó añadiendo nuevo FAE en 142 pacientes (32,6%) con CE recurrentes. CONCLUSIONES: Las características clínicas y la atención recibida de pacientes adultos con primera CE en SUH en España difieren de las recurrencias en epiléptico conocido.

Registro ACESUR: atención de pacientes adultos con crisis epilépticas en servicios de urgencias: diferencias entre primer episodio y recurrencia / Differences in emergency department care of adults with a first epileptic seizure versus a recurrent seizure: a study of the ACESUR (Acute Epileptic Seizures in the Emergency Department) registry

Objetivo: Describir las características y la atención recibida de pacientes adultos que consultan por crisis epiléptica (CE) en los servicios de urgencias hospitalarios (SUH), diferenciando entre primera crisis y recurrencia en epiléptico conocido. Método: ACESUR es un registro observacional de cohortes multipropósito, prospectivo y multicéntrico con un muestreo sistemático, los días pares de febrero y julio alternando con los impares de abril y octubre de 2017. Se incluyeron pacientes 18 años con diagnóstico de CE en los SUH. Se recogieron variables clínico-asistenciales de la visita índice de pacientes, distinguiendo entre primera CE y recurrencia en epiléptico. Resultados: El registro ACESUR recogió a 664 pacientes procedentes de 18 SUH españoles, 229 (34,5%) con primera CE y 435 (65,5%) con CE recurrentes. Los pacientes con primera CE fueron de mayor edad (p < 0,001), presentaron motivos de consulta distintos (p < 0,001) y requirieron más traslados en ambulancia (p < 0,001). La atención recibida en el SUH fue diferente, en pacientes con primera CE se solicitó con mayor probabilidad una prueba complementaria específica (OR ajustada = 13,94; IC95%:7,29-26,7; p < 0,001) y se necesitó mayor hospitalización o estancia prolongada en el SUH (OR ajustada = 1,69; IC95%:1,11-2,58; p = 0,015). No hubo diferencias en cuanto al tratamiento farmacológico en fase aguda ni preventivo (OR ajustada = 1,40; IC95%:0,94-2,09; p = 0,096). Se inició tratamiento con fármacos antiepiépticos (FAE) en 100 pacientes (43,7%) tras primera CE y se reinició o modificó añadiendo nuevo FAE en 142 pacientes (32,6%) con CE recurrentes. Conclusiones: Las características clínicas y la atención recibida de pacientes adultos con primera CE en SUH en España difieren de las recurrencias en epiléptico conocido

Objective: To describe the characteristics of care received by patients who come to the emergency department with a first epileptic seizure versus a recurrent seizure in a patient with diagnosed epilepsy. Methods: ACESUR (Acute Epileptic Seizures in the Emergency Department) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling on even days in February and July 2017 and on odd days in April and October 2017. Patients were aged 18 years or older and had an emergency department diagnosis of epileptic seizure. We recorded clinical variables and details related to care given during each patient's visit, including whether the event was a first or recurrent seizure. Results: A total of 664 patients attended by 18 Spanish emergency departments were entered into the ACESUR registry. Two hundred twenty-nine (34.5%) were first seizures and 435 (65.5%) were recurrences. Patients who were attended for first seizures were older, consulted for a wider variety of reasons, and were transported in ambulances (P<.001, all comparisons). Care received differed between patients with first seizures versus recurrent seizures. Specific complementary testing was more likely in patients with first seizures (adjusted odds ratio [aOR], 13.94; 95% CI, 29-26.7; P<.001), and they were more often hospitalized or stayed longer in the emergency department, (aOR, 1.69; 95% CI, 1.11-2.58; P=.015). Pharmacologic treatment did not differ between the groups, either in the acute phase or for prevention (aOR, 1.40; 95% CI, 0.94-2.09; P=.096). Antiepileptic drugs were given to 100 patients (43.7%) after a first seizure and were restarted or changed in 142 patients with recurrent seizure (32.6%). Conclusions: The clinical characteristics of adults attended for a first epileptic seizure differ from those of patients with diagnosed epilepsy who were attended for recurrent seizures in Spain. The care received also differs

[Osteoporotic pubic rami fracture: a benign injury?] / Fracturas osteoporóticas de ramas pélvicas: ¿Son una lesión benigna?

Objective: We analized patients treated for osteoporotic rami fractures in our hospital. Methods: We examined the records of patients presenting to the emergency department with osteoporotic low-impact rami fractures. We describe demographic, previously ambulatory ability, diagnosis, associated injuries, comorbility, complications and 1 year mortality. Results: 60 patients (51 women) with a mean age of 83,5 (range, 65,1-99) years had osteoporotic rami fracture. Six patients had previously a rami fracture and 23 a osteoporotic fracture. 27 patients associated other pelvic fracture. Three pacientes had other extrapelvic fracture and six a craneoencephalic trauma. 41 patients had any complication at follow up. Eigth patients (13,3%) were admitted to hospital with a median length of stay in the hospital of 18 days. Eight (13,3%) patients died within 1 year of injury. Conclusions: Low-impact rami fractures affect predominantly elderly women with pre-existing comorbidities. A substantial amount of complications are described in this fractures with a high 1 year mortality. Early rehabilitation therapy with adequate analgesic therapy should be recommended.

Objetivo: Analizar los pacientes tratados por fractura osteoporótica de ramas pélvicas en nuestro hospital. Métodos: Analizamos retrospectivamente pacientes con fracturas de ramas pélvicas atendidos en el Servicio de Urgencias de nuestro hospital. Los parámetros analizados incluyen datos demográficos, diagnósticos, lesiones asociadas, comorbilidades, autonomía previa, complicaciones y mortalidad al año. Resultados: 60 pacientes (51 mujeres) con una edad media de 83,5 años (rango, 65,1-99) presentaron fractura osteoporótica de ramas pélvicas. 6 pacientes presentaban antecedentes de fractura de ramas pélvicas y 23 de fractura osteoporótica de otra localización. En 27 casos se asociaban a lesiones en otras localizaciones de la pelvis. 3 pacientes asociaban fracturas extrapélvicas y 6 traumatismos craneoencefálicos. 41 pacientes experimentaron complicaciones de algún tipo. Se requirió ingreso hospitalario en 8 casos, con una estancia media de 18 días. La mortalidad al año fue de 13,3%. Conclusiones: Las fracturas osteoporóticas de ramas pélvicas afectan predominantemente a mujeres con numerosas comorbilidades. Muchas son las complicaciones descritas en estos pacientes con una mortalidad anual elevada. Es remendable un adecuado tratamiento analgésico que permita una movilización precoz del paciente tras descartar lesiones asociadas en la pelvis.

Análisis de los factores radio-patológicos y terapéuticos del cáncer de mama triple negativo y su influencia en la recidiva y supervivencia libre de enfermedad / Analysis of the radiopathological and therapeutic factors in triple-negative breast cancer and their influence on relapse and disease-free survival

Objetivo. Analizar la asociación entre la densidad mamográfica, la invasión linfovascular, la adenosis microglandular y el estado ganglionar de los tumores triples negativos (TN) con la recidiva tumoral y la supervivencia libre de enfermedad. Estudiar si la perfusión tumoral en las RM de estadificación se correlaciona con la recidiva tumoral, la supervivencia libre de enfermedad o los valores de restricción a la difusión. Analizar si la administración de quimioterapia neoadyuvante (QTN) o el tipo de tratamiento quirúrgico (cirugía conservadora o mastectomía) se asocian a un peor pronóstico. Pacientes y métodos. Estudio retrospectivo de las mamografías y de las RM pretratamiento de 122 pacientes con tumores TN entre los años 2007 y 2014. Se valoró la densidad mamaria en estudios mamográficos realizados en el momento del diagnóstico. El estado ganglionar se analizó en muestras de biopsia o quirúrgicas, mientras que la invasión linfovascular y la adenosis microglandular se estudió únicamente en muestras quirúrgicas. Resultados. La densidad mamográfica y los factores anatomo-patológicos no se asociaron con la recidiva tumoral. Los valores de realce máximo en la secuencia dinámica eran más altos en las pacientes sin recidiva tumoral (p=0,028), sin demostrar relación con la restricción a la difusión. Conclusiones. Los tumores con valores más altos de realce interno en RM de estadificación presentan un menor índice de recidivas. No se demostró correlación entre los valores de realce interno tumoral y de restricción a la difusión. Y no se observó asociación pronóstica con el resto de factores radio-patológicos (AU)

Objective. To analyse the association between breast density, lymphovascular invasion, microglandular adenosis and the axillary node status of triple-negative tumours (TN) with tumour recurrence and disease-free survival. To study whether tumour perfusion in MRI staging correlates with tumour recurrence, disease-free survival or diffusion restriction. To analyse whether the administration of neoadjuvant chemotherapy (NC) or the type of surgical treatment (breast-conserving surgery or mastectomy) are associated with a worse prognosis. Patients and methods. A retrospective study of mammograms and staging MRIs was performed from 2007 to 2014, including 122 women with TN breast cancer. Breast density was assessed in mammographic studies performed at the time of diagnosis. Lymph node status was analysed in biopsy or surgical specimens, whereas lymphovascular invasion and microglandular adenosis were studied only in surgical specimens. Results. Breast density and histopathological factors were not associated with tumour recurrence. The maximum enhancement values in the dynamic sequence were higher in patients without tumour recurrence (P=.028), without demonstrating a relationship with diffusion restriction. Conclusions. Tumours with higher values of internal enhancement showed less tumour recurrence. There was no correlation between the values of internal tumour enhancement and diffusion restriction. No prognostic association was observed with the remaining radiopathological factors (AU)

Factores pronósticos de respuesta a quimioterapia mediante RM en tumores triple negativos / Prognostic factors of chemotherapy response at MRI in triple-negative tumours

Objetivo. Analizar si la perfusión y restricción a la difusión de los tumores triple negativos en la resonancia magnética de estadificación se correlacionan con la respuesta a la quimioterapia neoadyuvante (QTN). Correlacionar la respuesta radiopatológica a la QTN y estudiar si el grado de respuesta asocia un peor pronóstico. Pacientes y métodos. Estudio retrospectivo de 73 pacientes con tumores triple negativos diagnosticados entre los años 2007 y 2014 con resonancia magnética de estadificación y de control posterior al tratamiento QTN. Se valoró el grado de respuesta radiológica al tratamiento QTN mediante resonancia magnética y la respuesta patológica en muestras quirúrgicas, siendo posible la correlación radiopatológica en 46 pacientes. Resultados. Se determinó moderada concordancia radiopatológica a la respuesta quimioterápica (kappa=0,590). Los tumores con un menor time to peak asociaban porcentajes mayores de respuesta radiológica completa (p=0,022) y los tumores con curvas funcionales tipo 3 se asociaban a mayores porcentajes de respuesta completa patológica (p=0,024). Se demostró menor supervivencia en las pacientes con menor respuesta radiológica (p=0,004) o patológica (p=0,04). No se encontró correlación entre los grupos de respuesta completa radiopatológica respecto al resto de grupos de respuesta y la supervivencia libre de enfermedad. Conclusiones. Los tumores triple negativos con menor time to peak o con curvas tipo 3 presentaban mejor respuesta al tratamiento. Se ha demostrado mayor supervivencia en tumores con mayor grado de respuesta radiopatológica (AU)

Objectives. To analyse whether perfusion and diffusion restriction in staging magnetic resonance imaging of triple-negative tumours correlate with response to neoadjuvant chemotherapy (NC). To correlate the radio-pathological chemotherapy response and determine whether the response is associated with a worse prognosis. Patients and methods. Retrospective study of 73 patients with triple-negative tumours diagnosed between 2007 and 2014 with staging magnetic resonance imaging and follow-up magnetic resonance imaging after NC treatment. The radiological response to NC treatment at magnetic resonance imaging and the pathological response in surgical specimens were assessed. Radio-pathological correlation was feasible in only 46 patients. Results. A moderate radiological-pathological concordance was found in relation to chemotherapy response (kappa=0.590). Tumours with lower time to peak of radiological complete response (P=.022) and tumours with functional type 3 curves were associated with higher percentages of pathological complete response (P=.024). Lower survival was demonstrated in patients with lower radiological (P=.004) or pathological (P=.04) response. No correlation was found between the complete radio-pathological response groups with respect to the rest of the response groups and disease-free survival. Conclusions. Triple-negative N tumours with lower time to peak or type 3 curves showed better response to treatment. Increased survival was found in tumours with a higher level of radio-pathological response (AU)

Fracturas osteoporóticas de ramas pélvicas: A Benign Injury? / Fractures ostéoporotiques des branches pubiennes, est-ce qu'elles sont bénignes? / Osteoporotic Pubic Rami Fracture

Objetivo: analizar los pacientes tratados por fractura osteoporótica de ramas pélvicas en nuestro hospital. Métodos: se analizan retrospectivamente pacientes con fracturas de ramas pélvicas atendidos en el Servicio de Urgencias de nuestro hospital. Los parámetros examinados incluyen datos demográficos, diagnósticos, lesiones asociadas, comorbilidades, autonomía previa, complicaciones y mortalidad al año. Resultados: 60 pacientes (51 mujeres) con una edad media de 83,5 años (rango, 65,1-99) presentaron fractura osteoporótica de ramas pélvicas; 6 pacientes presentaban antecedentes de fractura de ramas pélvicas y 23 de fractura osteoporótica de otra localización. En 27 casos se asociaban a lesiones en otras localizaciones de la pelvis, 3 pacientes asociaban fracturas extrapélvicas y 6 traumatismos craneoencefálicos; 41 pacientes experimentaron complicaciones de algún tipo. Se requirió ingreso hospitalario en 8 casos, con una estancia media de 18 días. La mortalidad al año fue de 13,3 por ciento. Conclusiones: las fracturas osteoporóticas de ramas pélvicas afectan predominantemente a mujeres con numerosas comorbilidades. Muchas son las complicaciones descritas en estos pacientes con una mortalidad anual elevada. Es recomendable un adecuado tratamiento analgésico que permita la movilización precoz del paciente tras descartar lesiones asociadas en la pelvis(AU)

Objective: we analysed patients treated for osteoporotic rami fractures in our hospital. Methods: the records of patients were examined presenting to the emergency department with osteoporotic low-impact rami fractures. Demographic, previously ambulatory ability, diagnosis, associated injuries; comorbidity, complications, and 1-year mortality were described. Results: 60 patients (51 women) with mean age of 83,5 (range, 65,1-99) years had osteoporotic rami fracture. Six patients had previous rami fracture and 23 a osteoporotic fracture. Twenty-seven patients had other pelvic fracture associated. Three patients had other extra pelvic fracture and six had crane encephalic trauma. Forty-one patients had some kind of complication at follow up. Eight patients (13, 3 percent) were admitted to hospital with median length of stay in the hospital of 18 days. Eight (13, 3 percent) patients died within 1 year of injury. Conclusions: low-impact rami fractures affect predominantly elderly women with pre-existing comorbidities. A substantial amount of complications is described in these fractures with high annual mortality. Early rehabilitation therapy with adequate analgesic therapy is recommended(AU)

Objectif: l'objectif de cette étude est d'analyser les patients traités à cause de fractures ostéoporotiques des branches pubiennes à l'hôpital universitaire Miguel Servet, hôpital de référence du secteur 2 à Zaragoza (Espagne). Méthodes: une étude rétrospective de patients atteints de fractures des branches pubiennes, et soignés au service d'urgences de cet hôpital, a été réalisée. On a examiné des paramètres, tels que données démographiques, diagnostics, lésions associées, comorbidités, autonomie préalable, complications, et taux de mortalité par an. Résultats: soixante patients (51 femmes), dont l'âge moyen a été 83,5 ans (rang 65,1-99), souffraient de fractures ostéoporotiques des branches pubiennes ; 6 patients avaient une histoire de fractures des branches pubiennes, et 23 étaient atteints de fractures ostéoporotiques ayant une autre localisation. Dans 27 cas, les fractures étaient liées à des lésions ayant d'autres localisations du bassin, 3 patients souffraient de fractures extra-pelviennes associées, et 6 des traumatismes cranio-encéphaliques ; 41 patients ont éprouvé des complications de quelque type. Huit patients ont été hospitalisés, ayant un séjour hospitalier de 18 jours en moyenne. Le taux de mortalité par an a été 13,3 pourcent. Conclusions: les fractures ostéoporotiques pelviennes touchent souvent les femmes souffrant plusieurs comorbidités. Un grand nombre de complications se produisent chez ces patients, provoquant ainsi un haut taux de mortalité par an. Après avoir écarté la possibilité de lésions associées au niveau du bassin, il est conseillé d'appliquer un traitement analgésique permettant la mobilité précoce du patient(AU)