Tratamiento neoayuvante en el cáncer de mama gestacional / Neoadjuvant therapy in gestational breast cancer

El cáncer de mama gestacional, o el cáncer de mama asociado al embarazo se define como aquel que se diagnostica durante el embarazo, el primer año postparto o en cualquier momento durante la lactancia, su incidencia está entre el 0,2% y el 2,6%, pero esta cifra va en aumento en la medida en que la mujer retrasa la maternidad. Predominantemente son tumores pobremente diferenciados y se diagnostican en estadíos avanzados, particularmente cuando esto ocurre durante la lactancia. El tratamiento debe de tener intención curativa, y no debe retrasarse con motivo de la gestación. Los estudios sugieren que es seguro administrar algunos agentes quimioterápicos, sobre todo cuando se inician después del primer trimestre de la gestación, y que en la mayoría de las ocasiones los embarazos acaban con un recién nacido vivo con bajas tasas de morbilidad y mortalidad (1). Estudios recientes han evaluado específicamente los resultados en mujeres diagnosticadas de cáncer de mama durante la gestación y han demostrado que esta no tiene un impacto negativo en la supervivencia (2,3) (AU)

Gestational or pregnancy-associated breast cancer is defined as breast cancer that is diagnosed during pregnancy, in the first postpartum year, or any time during lantation. The incidence of pregnancy-associated breast cancer is between 0.2% and 2.6% and is currently increasing due to delayed childbearing. It´s predominantly poorly differenciated and diagnosed at an advanced stage, particlarly those diagnosed in lactating women. The treatmen should be approached with curative intent, and it should not be unnecessarily delayed because of pregnancy. The data suggest it is safe to administer many agents used in the treatmen of breast cancer during pregnancy when initiated after the first trimester, and that the majority of pregnancies result in live births with low related morbidity in the newborns (1). Contemporrary studies that specifically evaluated the outcomes of women diagnosed with breast cancer during pregnancy have consistently shown that there is no negative impact on survival (2,3) (AU)

Gender specific differences in oxidative stress and inflammatory signaling in healthy term neonates and their mothers.

BACKGROUND: Gender is a crucial determinant of life span, but little is known about gender differences in free radical homeostasis and inflammatory signaling. The aim of the study was to determine gender-related differences concerning oxidative stress and inflammatory signaling of healthy neonates and mothers. METHODS: Fifty-six mothers with normal gestational course and spontaneous delivery were selected. Blood samples were collected from the mother (at the beginning of delivery and start of expulsive period) and from neonate (from umbilical cord vein and artery). RESULTS: The mothers of girls featured a higher total antioxidant status and lower plasma hydroperoxides than the mother of boys. Regarding the neonates, the girls featured a higher total antioxidant status and lower plasma membrane hydroperoxides in umbilical cord artery together with higher catalase, glutathione peroxidase, and superoxide dismutase activities. Lower levels of interleukin 6, tumor necrosis factor alpha, and prostaglandin E2 were observed in the mothers of girls and higher level of soluble tumor necrosis factor receptor II. In the neonates, lower levels of interleukin 6 and tumor necrosis factor alpha were observed in umbilical artery and higher soluble tumor necrosis factor receptor II in umbilical cord vein and artery of girls. CONCLUSION: An association between gender, oxidative stress, and inflammation signaling exists, leading to a renewed interest in the neonate's sex as a potential risk factor to several alterations.

Tumor germinal de tipo yolk sac en paciente perimenopáusica / Germinal yolk sac tumor type in perimenopause patient

Los tumores germinales suelen aparecer en niñas o en mujeres jóvenes y tener un crecimiento muy rápido. Presentamos un caso de un tumor germinal de tipo yolk sac gigante que apareció en una paciente perimenopaúsica sin otros antecedentes de interés. Actualmente el pronóstico de estos tumores es muy bueno; se pueden conseguir remisiones completas gracias a la cirugía radical y a la poliquiometarapia (AU)

Germ cell tumours usually occur in girls or young women and have a very rapid growth. We present a case of germ cell tumour, type giant "yolk sac", that appeared in a perimenopausal patient with no other relevant history. Currently, the prognosis of these tumours has improved and complete remission can be obtained after radical surgery and polychemotherapy (AU)

Biopsia de ganglio centinela en cáncer de mama con drenaje axilar bilateral / Sentinel node biopsy in breast cancer with bilateral axillary drainage

La biopsia selectiva del ganglio centinela (BSGC) es el método estándar para la estadificación axilar en pacientes con cáncer de mama con axila clínicamente negativa. Actualmente se acepta que algunas pacientes con ganglio centinela positivo se traten sin linfadenectomía axilar y el estudio intraoperatorio deja de ser imprescindible. La radioterapia axilar será la alternativa en estos casos. La localización del tumor primario tenía un factor pronóstico en el cáncer de mama operable, gracias a la BSGC se ha abandonado esta idea. El drenaje linfático axilar bilateral es raro en tumores de corta evolución (AU)

Sentinel lymph node (SLN) biopsy is the standard of practice for assessing axillary spread in clinically node-negative breast cancer patients. Currently, some patients with positive SLN can be treated without axillary lymph node dissection (ALND) or intraoperative biopsy. Axillary radiation therapy is an alternative to ALND in these patients. Due to SLN biopsy, the location of the primary tumor is no longer a prognostic factor in operable breast cancer. Bilateral axillary drainage is rare in tumors that are detected early (AU)

The timing of cord clamping and oxidative stress in term newborns.

BACKGROUND: Clamping and cutting of the umbilical cord is the most prevalent of all operations, but the optimal timing of cord clamping is controversial, with different timings offering advantages and disadvantages. This study, for the first time, compares the influence of early and late cord clamping in correlation with oxidative stress and inflammation signaling, Because cord clamping timing may have a significant influence on placenta-to-infant blood transfer, thereby modifying oxygenation of maternal and fetal tissues, and on the transfer of inflammatory mediators throughout the placenta. METHODS: Sixty-four pregnant subjects were selected at the Gynecology and Obstetrics Services Department of the Clinico San Cecilio Hospital, Granada, Spain, based on disease-free women who experienced a normal course of pregnancy and a spontaneous, vaginal, single delivery. Half of the subjects had deliveries with early-clamped newborn infants (at 10 s), and the other half had late-clamped deliveries (at 2 min). RESULTS: Erythrocyte catalase activity was significantly greater in the late-clamped group than in the early-clamped group (P < .01 for the umbilical vein and P < .001 for the artery). The values for superoxide dismutase, total antioxidant status, and soluble tumor necrosis factor receptor II were all significantly higher in the late-clamped group compared with the early-clamped group (P < .01, P < .001, and P < .001, respectively). CONCLUSIONS: The results suggest a beneficial effect of late cord clamping, produced by an increase in antioxidant capacity and moderation of the inflammatory-mediated effects induced during delivery of term neonates.