First multicenter experience using the Silk Vista flow diverter in 60 consecutive intracranial aneurysms: technical aspects.

BACKGROUND: The aim of this study was to assess the technical success and procedural safety of the new Silk Vista device (SV) by evaluating the intraprocedural and periprocedural complication rate after its use in several institutions worldwide. METHODS: The study involved a retrospective review of multicenter data regarding a consecutive series of patients with intracranial aneurysms, treated with the SV between September 2020 and January 2021. Clinical, intra/periprocedural and angiographic data, including approach, materials used, aneurysm size and location, device/s, technical details and initial angiographic aneurysm occlusion, were analyzed. RESULTS: 60 aneurysms were treated with SV in 57 procedures. 66 devices were used, 3 removed and 63 implanted. The devices opened instantaneously in 60 out of 66 (91%) cases and complete wall apposition was achieved in 58 out of 63 (92%) devices implanted. In 4 out of 66 (6%) devices a partial opening of the distal end occurred, and in 5 (8%) devices incomplete apposition was reported. There were 3 (5%) intraprocedural thromboembolic events managed successfully with no permanent neurological morbidity, and 4 (7%) postprocedural events. There was no mortality in this study. The initial occlusion rates in the 60 aneurysms were as follows: O'Kelly-Marotta (OKM) A in 34 (57%) cases, OKM B in 15 (25%) cases, OKM C in 6 (10%) cases, and OKM D in 5 (8%) cases. CONCLUSIONS: Our study demonstrated that the use of the new flow diverter Silk Vista for the treatment of intracranial aneurysms is feasible and technically safe.

Carotid stent occlusion after emergent stenting in acute ischemic stroke: Incidence, predictors and clinical relevance.

BACKGROUND AND AIMS: Emergent stent placement may be required during neurothrombectomy. Our aim was to investigate the incidence, predictors and clinical relevance of early extracranial carotid stent occlusion following neurothrombectomy. METHODS: We retrospectively analyzed a cohort of 761 consecutive neurothrombectomies performed at our center between May 2010 and August 2018, from whom a total of 106 patients had acute internal carotid artery occlusions. Early stent occlusion was defined as complete vessel occlusion within 24 h of neurothrombectomy. Clinical outcome was evaluated at day 90 with the modified Rankin Score scale (mRS). Pretreatment, procedural and outcome variables were recorded and analyzed using logistic regression. RESULTS: Carotid stenting was performed in 99 (13%) patients. Of those, 22 (22%) had early stent occlusion at follow-up. Stent occlusion was associated with a lower use of post-stenting angioplasty [adjusted OR (aOR) = 11.2, 95%CI = 2.49-50.78, p = 0.002)], increased residual intrastent stenosis (aOR = 2.1, 95%CI = 1.38-3.06, p < 0.001) and unsuccesful intracranial recanalization (modified TICI score 0-2a) (aOR = 13.5, 95%CI = 1.97-92.24, p = 0.008). Stent occlusion was associated with poor clinical outcome at day 90 (poorer mRS shift, aOR = 3.9, 95%CI = 1.3-11.3, p = 0.014; mRS>2, aOR = 6.3, 95%CI = 1.8-22.7, p = 0.005), and with an increased rate of symptomatic intracranial hemorrhage at 24 h (14% versus 1%, p = 0.033). CONCLUSIONS: Early carotid stent occlusion occurred in one out of five neurothrombectomies and was associated with periprocedural factors that included increased residual intrastent stenosis, a lower use of post-stenting angioplasty and unsuccessful intracranial recanalization. Further investigation is warranted for the evaluation of strategies aimed to prevent carotid stent occlusion.

Urinary metabolite and lipid alterations in Colombian Hispanic women with breast cancer: A pilot study.

Metabolic biomarkers for breast cancer (BC) prognosis and diagnosis are required, given the increment of BC incidence rates in developing countries and its prevalence in women worldwide. Human urine represents a useful resource of metabolites for biomarker discovery, because it could reflect metabolic alterations caused by a particular pathological state. Furthermore, urine analysis is readily available, it is non-invasive and allows in-time monitoring. Therefore, in present study, a metabolic- and lipid fingerprinting of urine was performed using an analytical multiplatform approach. The study was conducted in order to identify alterated metabolites which can be helpful in the understanding of metabolic alterations driven by BC as well as their potential usage as biomarkers. Urine samples collected from healthy controls and BC subjects were analyzed using LC-MS and GC-MS. Subsequently, significantly altered metabolites were determined by employing univariate and multivariate statistical analyses. An overall decrease of intermediates of the tricarboxylic acid cycle and metabolites belonging to amino acids and nucleotides were observed, along with an increment of lipid-related compounds. Receiver operating characteristic analysis evaluated the combination of dimethylheptanoylcarnitine and succinic acid as potential urinary markers, achieving a sensitivity of 93% and a specificity of 86%. The present analytical multiplatform approach enabled a wide coverage of urine metabolites that revealed significant alterations in BC samples, demonstrating its usefulness for biomarker discovery in selected populations.

Multiplatform plasma metabolic and lipid fingerprinting of breast cancer: A pilot control-case study in Colombian Hispanic women.

Breast cancer (BC) is a highly heterogeneous disease associated with metabolic reprogramming. The shifts in the metabolome caused by BC still lack data from Latin populations of Hispanic origin. In this pilot study, metabolomic and lipidomic approaches were performed to establish a plasma metabolic fingerprint of Colombian Hispanic women with BC. Data from 1H-NMR, GC-MS and LC-MS were combined and compared. Statistics showed discrimination between breast cancer and healthy subjects on all analytical platforms. The differentiating metabolites were involved in glycerolipid, glycerophospholipid, amino acid and fatty acid metabolism. This study demonstrates the usefulness of multiplatform approaches in metabolic/lipid fingerprinting studies to broaden the outlook of possible shifts in metabolism. Our findings propose relevant plasma metabolites that could contribute to a better understanding of underlying metabolic shifts driven by BC in women of Colombian Hispanic origin. Particularly, the understanding of the up-regulation of long chain fatty acyl carnitines and the down-regulation of cyclic phosphatidic acid (cPA). In addition, the mapped metabolic signatures in breast cancer were similar but not identical to those reported for non-Hispanic women, despite racial differences.

Prevalencia de malignidad en las secreciones patológicas por pezón evaluadas en consulta de mastología / Prevalence of malignancy in patients with abnormal nipple discharge assessed at the breast specialist clinic

Objetivo: Describir la prevalencia de malignidad en las pacientes que presentan secreciones patológicas por pezón y que fueron evaluadas en la consulta de mastología en los hospitales de San José e Infantil Universitario de San José entre enero de 2009 a enero de 2015. Materiales y métodos: Estudio de corte transversal en pacientes que consultaron por secreción patológica por pezón o en quienes se encontró este hallazgo al examen físico. Se excluyeron hombres, embarazadas y mujeres en período de lactancia. Resultados: Se presentaron 70 pacientes con telorrea, de las cuales en el 38,5% se comprometió la mama derecha (27 mamas), en el 32,8% la mama izquierda (23 mamas) y hubo compromiso bilateral en el 28,5% de las pacientes (40 mamas), obteniendo un total de 90 mamas afectadas. El 98,6% presentó este síntoma como motivo de consulta. Se presentó mayor número de casos en la población de mujeres premenopáusicas (47,1%, 33/70). El papiloma intraductal se reconoció como agente causal en el 16,6%, la tasa de malignidad en estas secreciones fue de 2,8% (2/70 pacientes). Conclusiones: En las pacientes con secreción por el pezón se debe descartar la presencia de enfermedad maligna mediante la toma de imágenes complementarias, para así poder definir la mejor conducta médica.

Objective: To describe the prevalence of malignancy in patients presenting with pathologic nipple discharge (ND) attending the breast specialist clinic of San José and Infantil Universitario de San José hospitals between January 2009 and January 2015 Materials and methods: A cross-sectional cohort study conducted in patients who consulted for abnormal ND or with ND found in the clinical examination. Men and lactating and pregnant women were excluded. Results: Seventy (70) patients consulted for abnormal ND, 38.5% had discharge from the right nipple (27 breasts), 32.8% from the left nipple (23 breasts) and 28.5% had bilateral ND (40 breasts), obtaining a total of 90 affected breasts. This complaint was the reason for consultation in 98.6%. Most of the cases were found in the premenopausal women population (47.1%, 33/70). An intraductal papilloma was the cause of ND in 16.6% and the malignancy rate found in these patients was 2.8% (2/70 patients) Conclusions: A malignant lesion must be ruled out in patients presenting with nipple discharge by performing further imaging investigations to best define medical management.

Localized Castleman's Disease in the Breast in a Young Woman.

Castleman's disease (CD) is a rare lymphoproliferative disorder of unknown etiology. It typically occurs in adulthood but it may also develop in childhood. Clinically, this disease may be classified as localized (unicentric) or systemic (multicentric). Six cases of breast CD have been described in the literature, and all have been reported in adults. Herein we describe the case of a 15-year-old female who presented with a slow-growing tumor in the right breast. The tumor was excised and histopathological examination demonstrated hyaline vascular variant CD. After two years of follow-up, the patient was asymptomatic without evidence of cervical or axillary lymphadenopathy.

Tumor fibroso solitario de la mama: presentación de caso y revisión de la literatura / Solitary fibrous tumor of the breast: Case report and literature review

El tumor fibroso solitario, previamente denominado hemangiopericitoma, es un tumor mesenquimal benigno compuesto por células fusiformes con forma ovoide dentro de las fibras de colágeno. Su presentación en mama es poco frecuente; se han reportado alrededor de 50 casos en la literatura. Presentamos el caso de una mujer de 36 años con lesión en la mama derecha con características fenotípicas e inmunohistoquímicas de tumor fibroso solitario. Además, realizamos una revisión de la literatura de los casos publicados (AU)

Solitary fibrous tumor, previously called hemangiopericytoma, is a benign mesenchymal tumor composed of ovoid spindle cells within collagen fibers. Its presentation in the breast is rare, with around 50 cases reported in the medical literature. We present the case of a 36-year-old woman with a right breast mass with phenotypic and immunohistochemical features of solitary fibrous tumor. In addition, we provide a review of published cases in the literature (AU)

Frecuencia de cáncer en pacientes con ecografía mamaria BI-RADS 4A / Rate of breast cancer diagnosis in patients categorized as bi-rads 4A on screening ultrasound

Las imágenes son fundamentales en la evaluación de la patología mamaria. El Colegio Americano de Radiología estandarizó los reportes con el Breast Imaging Reporting and Data System (BI-RADS), que permite predecir según las características morfológicas la probabilidad de malignidad y la conducta a seguir. En la cuarta edición de 2003 se amplió para incluir el primer lexicón de ecografía. Los BI-RADS 4 y 5 corresponden a lesiones sospechosas de malignidad y en la 4 fue necesario crear tres subgrupos, de los cuales el 4A son lesiones con posibilidad baja de cáncer (entre 2% y 10%). Como en la primera publicación presentamos los resultados del valor predictivo positivo del reporte BI-RADS 4A mamográfico, el objetivo del presente estudio es determinar la tasa de malignidad en BI-RADS 4A ecográfico en los hospitales de San José e Infantil Universitario de San José de Bogotá DC, Colombia, incluyendo casos de BI-RADS 4A mamográfico para contrastar con el estudio inicial. Cuatro de 72 pacientes con ecografía mamaria BI-RADS 4A fueron diagnosticadas con cáncer de mama (VPP del 5.5%), todos en nódulos sólidos. Algunos pudieron catalogarse como BI-RADS 3 por los radiólogos...

Imaging is essential for breast pathology evaluation. The American College of Radiology provides a standardized classification system the Breast Imaging-Reporting and Data System (BI-RADS), allowing prediction of malignancy probability based on appearance and providing guidelines to be followed. The 2003 fourth edition was extended to include the first ultrasound lexicon. BI-RADS 4 and 5 categories are lesions with suspicious changes of malignancy, and category 4 was divided into three sub groups, 4A lesions have low possibility of cancer (between 2% and 10%). As our first publication presented the results of the positive predictive value of BI-RADS 4A mammographic reports, the objective of the present study is to determine the malignancy rate in BI-RADS 4A ultrasound reports at San José and Infantil Universitario de San José hospitals in Bogotá DC, Colombia, including BI-RADS 4A mammographic exam cases to compare with the initial study. Of the 72 BI-RADS 4a lesions on ultrasound screening, four were malignant (VPP 5.5%) all detected as solid nodules. Some could have been categorized as BI-RADS 3 by radiologists...

Conización con asa de radiofrecuencia: experiencia en el Hospital de San José / Conization with radio frequency handle: experience in the Hospital of San José

Con el objetivo de evaluar la experiencia del Hospital de San José en la conización cervical con asa de radiofrecuencia, se realizó una investigación retrospectiva, transversal y analítica con 390 pacientes que fueron sometidas a dicho procedimiento en nuestro hospital entre abril de 1998 y marzo de 2004. las variables evaluadas fueron: edad, factores de riesgo para cáncer cervical, diagnóstico citológico, colposcópico e histológico tanto de la biopsia dirigida como del cono, el manejo y seguimiento post-conización y las complicaciones. El rango de edad predominante fue de 26 a 35 años en 39% de los casos; el 73% eran portadoras de lesiones de alto grado y 14% de bajo grado por diagnóstico histológico previo al cono, 12% de las pacientes presentaron discordancia en citología ­ colposcopia - biopsia y 3% con sospecha de lesión oculta fueron sometidas al procedimiento. la correlación histológica biopsia vs. cono fue de 74%. En el 82% el cono fue suficiente, 14% de los casos presentaron bordes de sección comprometidos, 3% cubo endocervical positivo y 2% legrado del lecho del cono positivo. al 23.6% de las pacientes se les realizó tratamiento complementario posterior a la conización, de las cuales el 75% fueron llevadas a histerectomia abdominal ampliada y 5% a reconización. la frecuencia de complicaciones fue muy baja (6.7%). Se concluyó que la conización del cérvix con asa de radiofrecuencia es una técnica quirúrgica efectiva para el diagnóstico y la terapia de las neoplasias intraepiteliales del cuello uterino.