Impacto de los subtipos intrínsecos del cáncer de mama en la predicción de metástasis en los ganglios axilares / Impact of intrinsic subtypes of breast cancer in predicting axillary node metastases

Resumen: Introducción: Observamos que el compromiso axilar es uno de los factores de pronóstico más importantes. Aunque la asociación entre el compromiso axilar y el tamaño tumoral ha sido estudiada en varias series, la relación del subtipo según la inmunohistoquímica (IHQ) para predecir compromiso axilar, no es muy conocida. El objetivo de este estudio es correlacionar los subtipos intrínsecos según la IHQ con la afectación axilar. Como objetivos secundarios evaluamos la sobrevida global y libre de enfermedad. Material y métodos: Se incluyeron en este estudio 1.413 pacientes operadas en forma consecutiva en el Hospital Italiano de Buenos Aires con diagnóstico de cáncer de mama primario (se excluyeron los estadios IV) entre los años 2007 y 2012. Fueron analizados los datos clínicos y patológicos de las pacientes que realizaron la biopsia del ganglio centinela o la linfadenectomía axilar. Los subtipos se clasificaron en cuatro grupos según la IHQ: luminal A (RE+, RP+, HER–, Ki67 <15%); luminal B (RE+, RP+, HER+, Ki67 >14%); HER2 (RE–, RP–, HER+); y triple negativo (RE–, RP–, HER–). Resultados: Evaluamos 1.413 pacientes de las cuales se analizaron 1.248 casos, donde 386 casos (31%) mostraron metástasis en los ganglios axilares. Tomando como referencia al grupo luminal A encontramos que la presencia de compromiso axilar es significativo en aquellos subtipos luminal B y HER (p<0,0001), no así en el subtipo TN (p=0,4468). Mediante un modelo de regresión logística múltiple se evaluó la probabilidad de compromiso axilar ajustado por cada uno de los diferentes subtipos tumorales, tamaño tumoral. En aquellos tumores menores de 2 cm observamos que los tumores luminal B y los TN aumentan el riesgo de compromiso axilar con un OR=2,73 (95% IC: 1,73-4,31; p>0,000), y un OR=2,05 (95% IC: 1,13-3,70; p=0,017), respectivamente, y los tumores HER2 aumentan el riesgo con un OR=6,62 (95% IC: 3,02-14,50; p>0,000).

Fetal Doppler mechanical PR interval: correlation with fetal heart rate, gestational age and fetal sex.

OBJECTIVES: To establish normal fetal values for the mechanical PR interval by pulsed-wave Doppler at 16-36 weeks of gestation, and to evaluate the influence of fetal heart rate (FHR), gestational age (GA) and fetal sex. METHODS: Fetal mechanical PR intervals were evaluated prospectively by obstetric ultrasound examination. Healthy mothers with sonographically normal fetuses from singleton pregnancies were included. Mechanical PR intervals were measured from simultaneous mitral and aortic Doppler waveforms, from the onset of left atrial contraction (mitral A-wave) to the onset of left ventricular ejection (aortic pulse wave). Simple and multiple linear regression analyses were performed to examine the correlation between PR interval and GA, FHR and fetal sex. RESULTS: We evaluated 336 fetuses at 16-36 weeks. The mean +/- SD FHR was 143.4 +/- 8.3 beats per min (bpm). The PR intervals had a typical Gaussian distribution with a mean +/- SD of 122.4 +/- 10.3 ms. Robust linear regression showed that the PR increased by about 0.40 ms (95% CI, 0.22-0.58) per gestational week (P < 0.001), and this relationship remained after adjustment for FHR and fetal sex. PR intervals diminished by 1.4 (95% CI, 0.75 to 2.0) ms for each 5 bpm increase in FHR (P < 0.001), independently of GA and fetal sex. No fetal sex differences were observed. CONCLUSIONS: We provide normal fetal values for the mechanical PR interval at 16-36 weeks of gestation. Mechanical PR intervals in normal fetuses are influenced by GA and FHR independently, and both variables should be taken into account when evaluating fetuses at risk for congenital heart block.

The effect of early versus delayed postcaesarean feeding on women's satisfaction: a randomised controlled trial.

OBJECTIVE: To evaluate the effect of early versus delayed feeding after caesarean section on the woman's satisfaction. DESIGN: Randomised, controlled trial. SETTING: Tertiary care hospital. POPULATION: Healthy pregnant women were enrolled for the study during antenatal care visits. METHODS: Uncomplicated singleton pregnancies undergoing a planned or intrapartum caesarean section performed under regional anaesthesia were randomly assigned to either (1) a 'delayed feeding' group who started oral fluids 4 hours after surgery with diet introduced at 24 hours; or (2) an 'early feeding' group who were offered a regular diet within the first 8 hours. MAIN OUTCOME MEASURES: Primary outcome was the woman's satisfaction measured with a visual analogue scale (VAS) before their hospital discharge. The secondary outcomes were: pain, anorexia, abdominal distension, persistent nausea and/or vomiting, time to the first bowel movement and passage of flatus. RESULTS: Two hundred women were recruited, with 103 randomised to delayed feeding and 97 to early feeding. The woman's satisfaction (mean VAS +/- SD) was similar in both groups; 73 +/- 17 mm in the delayed feeding group and 77 +/- 13 mm in the early feeding group (P= 0.12). A statistically significant difference was observed in mean postoperative pain: 29 +/- 13 mm in the delayed feeding group versus 24 +/- 11 mm in the early feeding group (P= 0.008). No other significant differences in postoperative variables were recorded, and there were no major postoperative complications observed in either group. CONCLUSION: Early feeding after uncomplicated caesarean in low-risk women is equivalent in terms of the woman's satisfaction and the reduced perceived pain.

Prenatal diagnosis of fetal bilateral adrenal carcinoma.

Fetal malignancies that are capable of metastasizing to other fetal organs and the placenta are exceedingly rare. Fetal tumors are suspected on ultrasonography in the presence of structures of abnormal shape or size that are occasionally associated with polyhydramnios and hydrops. Most of the large abdominal masses detected antenatally are renal in origin, although adrenal tumors should also be kept in mind in their differential diagnosis. We report a case of a large-for-gestational-age fetus with abdominal distention secondary to bilateral adrenal carcinoma, polyhydramnios and placental enlargement. Postmortem histological findings included nesidioblastosis, (i.e. hyperplasia of the cells of the islets of Langerhans) and adrenocortical cytomegaly, suggestive of a form of Beckwith-Wiedemann syndrome.

Tristeza puerperal: síntoma o enfermedad / Postpartum depression: symptom of disease

Este trabajo tiene por objeto determinar a través de un test psicométrico, si las mujeres puérperas presentan características que las distinguen de la población considerada normal

Tristeza puerperal: síntoma o enfermedad / Postpartum depression: symptom of disease

Este trabajo tiene por objeto determinar a través de un test psicométrico, si las mujeres puérperas presentan características que las distinguen de la población considerada normal