Cribado en pacientes con riesgo incrementado de cáncer de mama (parte 1). Pros y contras del cribado con resonancia magnética / Screening in patients with increased risk of breast cancer (part 1): pros and cons of MRI screening

En mujeres con alto riesgo de padecer cáncer de mama, la detección precoz tiene un importante papel. Debido a la alta incidencia de cáncer mamario y a edades más tempranas que en la población general, se recomienda que el cribado comience en edad más joven, y existe amplia evidencia de que la resonancia magnética es la herramienta diagnóstica más sensible: las principales guías americanas y europeas coinciden en la recomendación de realizar resonancia magnética anual (con mamografía anual suplementaria) como modalidad óptima de cribado. No obstante, no hay un total consenso actual entre las guías sobre algunos subgrupos de pacientes a incluir en la recomendación de cribado con resonancia magnética. El objetivo de esta primera parte de nuestro trabajo es, mediante una revisión de la bibliografía, explicar y valorar las ventajas que este tipo de cribado con resonancia magnética proporciona respecto al cribado solo con mamografía, como son: mayor detección de cánceres de menor tamaño y con menor afectación ganglionar asociada y una reducción de los cánceres de intervalo, lo que puede tener repercusión en supervivencia y mortalidad, con efectos comparables a otras medidas de prevención. Pero, a su vez, también queremos reflejar los inconvenientes que el cribado con resonancia magnética conlleva, y que dificultan su aplicabilidad

Screening plays an important role in women with a high risk of breast cancer. Given this population's high incidence of breast cancer and younger age of onset compared to the general population, it is recommended that screening starts earlier. There is ample evidence that magnetic resonance imaging (MRI) is the most sensitive diagnostic tool, and American and the European guidelines both recommend annual MRI screening (with supplementary annual mammography) as the optimum screening modality. Nevertheless, the current guidelines do not totally agree about the recommendations for MRI screening in some subgroups of patients. The first part of this article on screening in women with increased risk of breast cancer reviews the literature to explain and evaluate the advantages of MRI screening compared to screening with mammography alone: increased detection of smaller cancers with less associated lymph node involvement and a reduction in the rate of interval cancers, which can have an impact on survival and mortality (with comparable effects to other preventative measures). At the same time, however, we would like to reflect on the drawbacks of MRI screening that affect its applicability

Screening in patients with increased risk of breast cancer (part 2). Where are we now? Actual MRI screening controversies. / Cribado en pacientes con riesgo incrementado de cáncer de mama (parte 2). ¿Dónde estamos? Controversias actuales del cribado con resonancia magnética.

For women with a high risk of breast cancer, early detection plays an important role. Due to the high incidence of breast cancer, and at a younger age than in the general population, screening begins earlier, and there is considerable evidence that magnetic resonance is the most sensitive diagnostic tool, and the principal American and European guidelines agree on the recommendation to perform annual magnetic resonance (with supplemental annual mammography) as an optimal mode of screening. In addition to the absence of current consensus on which patients should be included in the recommendation for magnetic resonance screening (widely discussed in the introduction of part 1 of this work), there are other aspects that are different between guidelines, that are not specified, or that are susceptible to change based on the evidence of several years of experience, that we have called «controversies¼, such as the age to begin screening, the possible advisability of using a different strategy in different subgroups, performing alternate versus synchronous magnetic resonance and mammography, the age at which to terminate the two techniques, or how to follow up after risk reduction surgery.The aim of the second part of the paper is, by reviewing the literature, to provide an update in relation to some of the main «controversies¼ in high risk screening with magnetic resonance. And finally, based on all this, to propose a possible model of optimal and updated screening protocol.

Screening in patients with increased risk of breast cancer (part 1): pros and cons of MRI screening. / Cribado en pacientes con riesgo incrementado de cáncer de mama (parte 1). Pros y contras del cribado con resonancia magnética.

Screening plays an important role in women with a high risk of breast cancer. Given this population's high incidence of breast cancer and younger age of onset compared to the general population, it is recommended that screening starts earlier. There is ample evidence that magnetic resonance imaging (MRI) is the most sensitive diagnostic tool, and American and the European guidelines both recommend annual MRI screening (with supplementary annual mammography) as the optimum screening modality. Nevertheless, the current guidelines do not totally agree about the recommendations for MRI screening in some subgroups of patients. The first part of this article on screening in women with increased risk of breast cancer reviews the literature to explain and evaluate the advantages of MRI screening compared to screening with mammography alone: increased detection of smaller cancers with less associated lymph node involvement and a reduction in the rate of interval cancers, which can have an impact on survival and mortality (with comparable effects to other preventative measures). At the same time, however, we would like to reflect on the drawbacks of MRI screening that affect its applicability.

Abordaje en el cribado de cáncer mamario en grupos poblacionales de riesgo elevado / Breast cancer screening in high risk populations

El objetivo de este trabajo es definir qué pacientes integran los grupos de riesgo alto e intermedio de padecer cáncer mamario, hacer una revisión de los estudios de cribado con resonancia magnética añadida a mamografía en pacientes de alto riesgo (y describir las características de imagen de los cánceres en este grupo), revisar los estudios con resonancia magnética realizados en subgrupos de riesgo intermedio, y realizar una actualización en recomendaciones en el cribado en pacientes con riesgo alto e intermedio (basada en las recomendaciones recientes de las principales sociedades/guías americanas y europeas)(AU)

We aim to define which patients make up the populations with high and intermediate risk of developing breast cancer, to review the studies of screening with magnetic resonance imaging in addition to mammography in high risk patients (describing the imaging characteristics of the cancers in this group), to review the studies of screening with magnetic resonance imaging in patients with intermediate risk, and to update the guidelines for screening in patients with high or intermediate risk (based on the recent recommendations of the main scientific societies/American and European guidelines)(AU)

[Breast cancer screening in high risk populations]. / Abordaje en el cribado de cáncer mamario en grupos poblacionales de riesgo elevado.

We aim to define which patients make up the populations with high and intermediate risk of developing breast cancer, to review the studies of screening with magnetic resonance imaging in addition to mammography in high risk patients (describing the imaging characteristics of the cancers in this group), to review the studies of screening with magnetic resonance imaging in patients with intermediate risk, and to update the guidelines for screening in patients with high or intermediate risk (based on the recent recommendations of the main scientific societies/American and European guidelines).

Sonographic findings of additional malignant lesions in breast carcinoma seen by second look ultrasound.

OBJECTIVE: The aim is to show ultrasound (US) findings of additional malignant lesions of breast carcinoma visualized on targeted second-look US that were not identified by mammography or US prior to the time of diagnosis. MATERIALS AND METHODS: A double-blind retrospective review of the US results from January 2008 through August 2010 of 228 patients with known breast cancer was conducted by two expert radiologists. The focus of the review was on the second-look US characteristics (following BI-RADS criteria) of 26 documented additional malignant lesions of the 76 with successful sonographic correlation from the 123 lesions detected by magnetic resonance imaging (MRI). All of them, before the MRI, had an initial mammography and a US with a histopathological biopsy of the primary lesion. RESULTS: Approximately 60 to 70% of the findings were classified as BI-RADS 2 and BI-RADS 3, while assessing the final US category. The review of the second-look US showed the size of the second malignant additional lesion ranged from 3 to 22 mm, of which 90% were smaller than 10 mm and 66% were smaller than 7 mm. CONCLUSIONS: Most additional malignant lesions, nonpalpable carcinomas, which were previously not detected by mammography and US at first-look diagnosis, were detected by a targeted second-look US examination. These lesions were of category BI-RADS 2 and BI-RADS 3 and smaller than 7 mm.

[Rationale for the local treatment of metastases]. / Pourquoi un traitement local des métastases?

The local treatment of metastases is based on the natural history of the cancer and its modifications following medical treatment. Local treatment of metastases may be a component of the global treatment of the disease. Local treatment of metastases often is entertained for symptomatic relief. There is a theoretical analogy between surgery, the gold standard of local treatment, and more recent interventional radiology procedures. Local treatment may sometimes lead to discontinuation of medical therapy, either permanently or temporarily, and may at times provide prolonged complete response. The purpose of this article is to further the understanding of the place of local treatment in patients with metastatic solid tumors.

Evolución de receptores de trasplante renal de alto y bajo riesgo inmunológico sometidos a diferente inmunosupresión / No disponible

La timoglobulina forma parte del esquema de inmunosupresión en receptores de trasplante renal de alto riesgo inmunológico. Hemos comparado, en un estudio observacional y prospectivo, la incidencia de rechazo agudo, de infecciones oportunistas y de neoplasias, así como la supervivencia del injerto y del receptor, entre un grupo de 50 receptores de alto riesgo inmunológico con tratamiento de inducción que incluía timoglobulina, frente a un grupo de bajo riesgo cuyos 50 receptores recibieron injertos procedentes de los mismos donantes, en nuestro hospital en el período 2002-2006. El grupo de alto riesgo estaba formado por receptores hiperinmunizados (>50%), retrasplantes con pérdida de injerto previa inmunológica, reactividad en prueba cruzada, raza negra, o alta incompatiblidad HLA. La inmunosupresión consistió en administrar timoglobulina a dosis que mantuvieran un recuento de linfocitos T inferior a 10 μl, FK a partir del día 5, micofenolato mofetil y esteroides, y los pacientes recibían profilaxis frente al CMV con ganciclovir. El grupo de bajo riesgo incluía los pacientes sin estas características, a quienes se les realizaba la inmunosupresión con ciclosporina A, micofenolato mofetil y prednisona. Todos los receptores seronegativos con donantes seropositivos recibieron valganciclovir durante 100 días. Se descartaron aquellos pacientes en quienes se perdió el injerto por causas técnicas en el postoperatorio inmediato, junto con sus parejas. En todos los receptores se llevó a cabo un seguimiento mínimo de un año posterior al trasplante, con una mediana de 41,7 meses. Los dos grupos eran homogéneos en cuanto a edad y sexo del donante, edad del receptor e incompatibilidades HLA, pero el porcentaje de receptores varones era significativamente superior en el grupo control. El porcentaje de retrasplantes y de receptores hiperinmunizados fue significativamente superior en el grupo de alto riesgo, de acuerdo con los criterios de selección del grupo. La incidencia de rechazo agudo histológicamente probado fue superior en el grupo control (el 30 frente al 6%; p =0,003) y no se han producido diferencias significativas en cuanto a la incidencia de infecciones oportunistas ni de neoplasias; se ha diagnosticado un caso de leucemia aguda y un caso de enfermedad linfoproliferativa en el grupo de bajo riesgo. La supervivencia de los pacientes fue del 97,9% en ambos grupos al año y a los 3 años, mientras que la supervivencia del injerto fue del 89,8 y del 84,8% en el grupo de alto riesgo frente al 93,8 y al 90,4% en el grupo sin riesgo al año y a los 3 años (p = NS). En nuestra experiencia, la evolución de receptores de trasplante renal con alto riesgo inmunológico es similar a la del grupo de riesgo normal mientras se utilice una inmunosupresión lo suficientemente potente, que condicionó una incidencia de rechazo agudo significativamente menor en el grupo de alto riesgo (AU)

We evaluate the incidence of acute rejection, oportunistic infections and non-dermatological malignancies, graft and recipient survival between a group of high immunological risk renal transplant recipients and a group of patients without immunological risk, who received grafts from the same cadaveric donors since 2001 to 2006. This is a prospective and observational study. The risk group (n = 50) included patients with high rate of antibodies (>50%), recipients who had lost their first graft due to early rejection, cross match positive, black race or important histoincompatibility. They received thymoglobulin to mantain T-cell around 10 cells/μl, FK 506 after five days, mycophenolate mofetyl and steroids, with ganciclovir prophylaxis for CMV. The normal risk group (n = 50), cyclosporine, mycophenolate mofetil and steroids. Recipients who lost their graft due to technical failure were excluded. All CMV seronegative recipients who received seropositive grafts were treated with valganciclovir for 100 days. The mean follow-up was 42.7 months. Both groups were similar respect to donor and recipient gender and age, HLA incompatibility, but the percentage of patients with high rate of performed antibodies and second transplant recipients was higher in the high risk group according to the criteria of the study The incidence of acute rejection histologically diagnosed was higher in the normal risk group (30% against 6 %, p = 0.03). There was no difference in opportunistic infections or malignancies, although 2 recipients of the normal risk group developed lymphoproliferative disorders. The recipients survival was 97.9% at 1 and 3 years in both groups, and the graft survival was 89.8% and 84.8% in the high risk group against 93.8% and 90.4% at 1 and 3 years in the normal group (p = NS). We conclude that the evolution of high risk renal transplant recipients is similar to normal risk patients if a potent enough immunosuppression is used. The incidence of acute rejection was higher in the normal risk group (AU)

[Clinical course of high and low immunological risk renal transplant receptors subjected to different immunosuppressive treatments]. / Evolución de receptores de trasplante renal de alto y bajo riesgo inmunológico sometidos a diferente inmunosupresión.

We evaluate the incidence of acute rejection, opportunistic infections and non-dermatological malignancies, graft and recipient survival between a group of high immunological risk renal transplant recipients and a group of patients without immunological risk, who received grafts from the same cadaveric donors since 2001 to 2006. This is a prospective and observational study. The risk group (n= 50) included patients with high rate of antibodies (> 50%), recipients who had lost their first graft due to early rejection, cross match positive, black race or important histoincompatibility. They received thymoglobulin to maintain T-cell around 10 cells/ microl, FK 506 after five days, mycophenolate mofetyl and steroids, with ganciclovir prophylaxis for CMV. The normal risk group (n=50) ,cyclosporine, mycophenolate mofetil and steroids. Recipients who lost their graft due to technical failure were excluded..All CMV seronegative recipients who received seropositive grafts were treated with valganciclovir for 100 days.The mean follow-up was 42,7 months. Both groups were similar respect to donor and recipient gender and age, HLA incompatibility, but the percentage of patients with high rate of performed antibodies and second transplant recipients was higher in the high risk group according to the criteria of the study The incidence of acute rejection histologically diagnosed was higher in the normal risk group (30% against 6 %, p=0.03). There was no difference in opportunistic infections or malignancies, although 2 recipients of the normal risk group developed lymphoproliferative disorders. The recipients survival was 97,9% at 1 and 3 years in both groups, and the graft survival was 89,8% and 84,8% in the high risk group against 93,8 % and 90,4% at 1 and 3 years in the normal group (p=NS). We conclude that the evolution of high risk renal transplant recipients is similar to normal risk patients if a potent enough immunosuppression is used. The incidence of acute rejection was higher in the normal risk group.

Ultrasound and MR findings in tumor and tumor-like lesions of the fingers.

Finger lesions are a frequent problem because of their functional significance and their small size. Because of this, the radiologist has an important role to play in the correct presurgical diagnosis. The aim of this article is to describe the anatomy and the characteristic US and MR findings of the most common tumor and tumor-like lesions of the fingers, and to discuss the differential diagnosis in cases of unspecific or non-diagnostic findings. We present representative cases selected from 62 patients evaluated at our institution, with pathologic correlation.

Evaluation of institutional cancer registries in Colombia.

The four primary objectives of this descriptive study were to: 1) design a quality-measurement instrument for institutional cancer registries (ICRs), 2) evaluate the existing ICRs in Colombia with the designed instrument, 3) categorize the different registries according to their quality and prioritize efforts that will efficiently promote better registries with the limited resources available, and 4) determine the institution with the greatest likelihood of successfully establishing Colombia's second population-based cancer registry. In 1990 the National Cancer Institute of Colombia developed 13 institution-based cancer registries in different Colombian cities in order to promote the collection of data from a large group of cancer diagnostic and treatment centers. During the first half of 1997, this evaluation reviewed 12 registries; one of the original 13 no longer existed. All of the Colombian institutions (hospitals) that maintain institution-based cancer registries were included in the study. At each institution, a brief survey was administered to the hospital director, the registry coordinator, and the registrar (data manager). Researchers investigated the institutions by looking at six domains that are in standard use internationally. Within each domain, questions were developed and selected through the Delphi method. Each domain and each question were assigned weights through a consensus process. In most cases, two interviewers went to each site to collect the information. The university hospitals in Cali, Pereira, and Medellín had substantially higher scores, reflecting a good level of performance. Four of the 12 institutions had almost no cancer registry work going on. Five of the 12 hospital directors considered that the information provided by the cancer registries influenced their administrative decisions. Three of the registries had patient survival data. Four of the institutions allocated specific resources to operate their cancer registries; in the other 8 hospitals there was no clear budget allocation. Seven of the hospital directors could not identify five or more objectives of a cancer registry. Data management was usually poor and resources insufficient at most of the institutions. In summary, the cancer registry system in Colombia varies greatly from institution to institution. A few of the hospitals do a good job while others have neglected the registries. The high, identical total scores for Pereira and Medellín suggest they would be good locations to establish new population-based cancer registries similar to the existing one in Cali. However, the overall characteristics in Pereira may provide a more appropriate environment for the second registry, with Medellín as an alternative.

Guias de diagnostico y tratamiento en medicina / Guides of I diagnose and treatment in medicine

Contiene: Cardiologia, endocrinologia, gasrtoenterologia, hematologia,nefrologia, neumologia, neurologia, psiquiatria, reumatologia, nutricion

Optic nerve regeneration with return of vision through an autologous peripheral nerve graft.

The optic fiber termination layer in the contralateral optic tectum was reinnervated and useful vision was recovered in the adult frog, after successful optic nerve regeneration through an autologous peripheral nerve-bridge used to replace the optic nerve and optic chiasma. During their course through the nerve-bridge, the optic fibers were associated with Schwann cells in the usual relationship observed in peripheral nerve.

A note on the organization of the amphibian olfactory bulb.

After horseradish peroxidase (HRP) injections were made in limited sectors of the main olfactory bulb in the adult frog Rana pipiens, the cellular morphology of mitral cells and granule cells impregnated with HRP were examined in uninjected regions of the bulb. Mitral cells were observed to possess glomerular dendrites and prominent secondary dendrites, both of which have smooth shafts. The glomerular dendrites may be multiple, are often branched, and may arise from secondary dendrites, as well as from the cell body. The axon may also arise from a secondary dendrite. Granule cells have simple or branched peripheral dendrites, and these are spiny, where they intermingle with the mitral cell secondary dendrites. The prominence of the secondary dendrites of frog mitral cells contrasts sharply with their reported insignificance in urodeles, as studied in earlier literature. The layers of the main olfactory bulb are not as fully concentric in the frog, as they are in mammals. The implantation cone and glomerular layer occupy a small part of the surface area of the olfactory bulb on its anteroventral aspect, while the perimeters of the subjacent layers extend farther posteriorly and dorsally in successive steps. The granule cell core extends well beyond the perimeter of the mitral cell layer in a posterior direction. Long secondary dendrites of mitral cells also extend posteriorly beyond the perimeter of the mitral cell-external plexiform layer and interlace with granule cell peripheral dendrites in a plexiform layer external to the posterior region of the granule cell core. This layer, the superficial plexiform layer, forms an apron around the posterior segment of the olfactory bulb and contributes to the interbulbar adhesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Differential projections of the main and accessory olfactory bulb in the frog.

The central projections of the main olfactory bulb and the accessory olfactory bulb of the adult leopard frog (Rana pipiens) were reexamined, by using a horseradish peroxidase anterograde tracing method that fills axons with a continuous deposit of reaction product. The fine morphology preserved by this method allowed the terminal fields of the projection tracts to be delineated reliably, and for the first time. Herrick's amygdala has been newly subdivided into cortical and medial nuclei on the basis of cytoarchitecture, dendritic morphology, and the differential projections of the main and accessory olfactory tracts. The main olfactory bulb projects through the medial and lateral olfactory tracts to the postolfactory eminence, the rostral end of the medial cortex, the rostral end of the medial septal nucleus, the cortical amygdaloid nucleus, the nucleus of the hemispheric sulcus, and both the dorsal and ventral divisions of the lateral cortex, including its retrobulbar fringe. The lateral olfactory tract overlaps the dorsal edge of the striatal plate along the ventral border of the lateral cortex, but it is not certain whether any striatal cells are postsynaptic to the tract fibers. The lateral cortex is the largest of these territories, and receives the terminals of the main olfactory projection throughout its extent. It extends from the olfactory bulb to the posterior pole, and from the striatum to the summit of the hemisphere, where it borders the dorsal cortex. The medial and lateral olfactory tracts combine in the region of the amygdala to form a part of the stria medullaris thalami. These fibers cross in the habenular commissure and terminate in the contralateral cortical amygdaloid nucleus and periamygdaloid part of the lateral cortex. Cells projecting to the main olfactory bulb are found in the diagonal band and adjacent cell groups, but there is no evidence of an interbulbar projection arising from either the olfactory bulb proper or a putative anterior olfactory nucleus. The accessory olfactory bulb projects through the accessory olfactory tract to the medial and cortical amygdaloid nuclei. A fascicle of the tract crosses in the anterior commissure to terminate in the contralateral amygdala. While the main and accessory olfactory projections may converge in the cortical amygdaloid nucleus, the medial amygdaloid nucleus is connected exclusively with the accessory olfactory bulb.

Frecuencia de las hemoglobinopatías en un pilotaje en nuestro medio / Frecuency of the hemoglobinopathies in our hospitals

En 16 802 electroforesis de hemoglobinas realizadas a mujeres en edad reproductiva encontramos que el 7,4 por ciento de ellas tienen una hemoglobinopatía que resulta con mayor frecuencia (5,9 por ciento) en portadores asintomáticos de la hemoglobina S (Hemoglobina A/S). Se obtuvo un buen trabajo en el año 1983 en Maternidad Norte, con el 88,4 por ciento, seguido de Maternidad Este, mientras que Maternidad Sur no ha alcanzado buenas cifras al respecto(AU)