Validation of an Argentine version of Lupus Quality of Life questionnaire.

OBJECTIVE: To determine reproducibility and validity of an Argentine version of the Lupus Quality of Life questionnaire (LupusQoL) and to determine cut-off values in the questionnaire. MATERIALS AND METHODS: One hundred and forty-seven systemic lupus erythematosus patients (American College of Rheumatology 1982/1997) were assessed from April 2014 to July 2014. Demographic and socioeconomic variables were collected, as well as SELENA/SLEDAI, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index Score, comorbidities and treatment data. Patients completed LupusQoL-Argentine version and European Quality of Life Questionnaire (EuroQoL-5D). Internal consistency and reliability were examined. Convergent validity with EuroQoL-5D was assessed through analysis of latent classes, which established homogeneous categories from the responses of each domain of LupusQoL and for the total. RESULTS: Out of 147 patients, 93.2% were female, mean age 36.4 ± 11.1 years, mean disease duration 2.7 ± 9 years, mean SELENA/SLEDAI 2.7 ± 3 points. The cut-off point that defined good or bad quality of life was 0.739 for EuroQoL 5D and 63 for LupusQoL. Cut-off values for each LupusQoL domain were also defined, creating two classes in each of them. There was moderate to high concordance to classify quality of life (Kappa = 0.74, 95% confidence interval = 0.54, 0.95). CONCLUSION: The Argentine version of LupusQoL is a valid, reliable and reproducible instrument to assess quality of life. In this study, cut-off points that allow the classification of patients regarding whether they have good or bad quality of life are established for the first time.

Concordancia de los nuevos criterios ACR/EULAR y los ACR 1980 para la clasificación de la esclerosis sistémica / Concordance of the new ACR/EULAR criteria and the ACR 1980 for the classification of systemic sclerosis

Objetivo: Evaluar cumplimiento, y así mismo concordancia y discordancia de los criterios de clasificación de Esclerosis Sistémica (ES) ACR/EULAR 2013 y ACR 1980 en pacientes con diagnóstico clínico de la enfermedad. Método: Se incluyeron 169 pacientes con diagnóstico de Esclerosis Sistémica. Resultados: El 72,2 por ciento cumplía los criterios ACR 1980, y el 99,4 por ciento (168 pacientes) cumplía los criterios ACR/EULAR 2013. La concordancia absoluta de toda la muestra fue 72,7 por ciento, para el subtipo limitado 35,2 por ciento, y 100 por ciento el difuso. Se subanalizaron los pacientes con limitada que sólo cumplían criterios ACR/EULAR 2013, y se comparó con el resto de las limitadas. Los primeros presentaron en forma estadísticamente significativa menor esclerodactilia distal a MCF, menor presencia de úlceras digitales y pitting scars, menor afectación intersticial pulmonar, y mayor daño microvascular en la capilaroscopia. Conclusión: Los nuevos criterios de clasificación de Esclerosis Sistémica serían más adecuados para detectar esclerodermias limitadas, siendo dicho hallazgo estadísticamente significativo.

Objective: To evaluate the performance, and likewise concordance and discordance of the classification criteria of Systemic Sclerosis ACR/EULAR 2013 and ACR 1980 in a group of patients with clinical diagnosis of SSc. Methods: We enrolled 169 patients with diagnosis of Systemic Sclerosis. Results: 72.2 percent met the 1980 ACR criteria, and 99.4 percent met the ACR/EULAR 2013 criteria. The absolute agreement of the entire sample was 72.7 percent, 35.2 percent for the limited subtype, and 100 percent for the diffuse. Those patients with limited subtype who only met the ACR/EULAR 2013 criteria were compared with the rest of limited patients. The first group had statistically significantly lower sclerodactyly distal to MCF, lower presence of digital ulcers and pitting scars, less interstitial lung involvement, and greater abnormal nail fold capillaries. Conclusion: The new classification criteria for systemic sclerosis seem to be more suitable for detecting limited scleroderma. In the present study, statistically significant discrepancy was found in the limited subtype.

Estudio multicéntrico de deterioro cognitivo en lupus eritematoso sistémico: ECLES / Multicenter study of cognitive decline in systemic lupus erythematousus: ECLES

Introducción: los pacientes lúpicos presentan un riesgo incrementado de deterioro cognitivo (DC) comparado con individuos sanos, el cual puede ser debido a múltiples causas. Objetivo: Describir la frecuencia y características del deterioro cognitivo en pacientes con lupus sin manifestaciones neuropsiquiátricas conocidas. Materiales y método: Se incluyeron pacientes de 16 a 55 años con diagnóstico de LES según criterios del Colegio Americano de Reumatología (ACR) de 1997. Se incluyeron test neuropsicológicos acordes a la propuesta del ACR y el cuestionario de Beck para evaluar depresión. Se definió DC a valores de <2 o más desvíos estándar comparada con la media de población normal en al menos un test. Se consideró focal cuando afectó una o más medidas de un dominio y multifocal en 2 o más dominios. Para comparar proporciones se utilizó prueba exacta de Fisher y para comparar variables numéricas se usó prueba de Kruskal-Wallis. Se consideró significativo un valor de p <0,05. Resultados: Se estudiaron 86 pacientes con lupus, el 90% de origen caucásico, 8% mestizos y 1% amerindio. El 82% alcanzó nivel secundario. La frecuencia de DC fue del 65% (56/86). Los dominios afectados: memoria 45%, funciones ejecutivas 30%, atención 29%, lenguaje 4,6%. Se detectó depresión en un 48% de los pacientes. Se analizaron diferentes factores de riesgo, sin hallar diferencias estadísticamente significativas a excepción de la etnia (p=0,02). Conclusión: Se halló una frecuencia elevada de deterioro cognitivo en pacientes con LES, los pacientes no caucásicos tuvieron mayor DC con diferencias significativas en comparación con los pacientes caucásicos.

Background: patients with systemic lupus erythematosus (SLE)have an increased risk of cognitive impairment (CI) compared tohealthy individuals and it may be due to multiple causes. Objective: To determine the frequency and characteristics of CI inlupus patients without known previous neuropsychiatric events. Methods: Patients aged 16 to 55 fulfilling the 1997 ACR criteria forSLE were included. The neuropsychological test battery proposedby the ACR was used to determine CI and Beck depression werealso assessed. CI was defined as values of ≤2 standard deviationscompared to the mean of the general population in at least one test. It was considered focal involvement if it affected one or more measuresof a single domain and multifocal if 2 or more domains wasaffected. To compare proportions, Fisher’s exact test was used andto compare numerical variables, Kruskal-Wallis. A value of p <0.05was considered significant. Results: 86 patients were evaluated, 90% were Caucasian, 8%mestizos and 1% Amerindian. 82% had high school. CI was foundin 65% of patients (56/86). The affected domains were: memory45%, executive functions 30%, attention 29% and language 4.6%. Depression was detected in 48% of patients. Different risk factorswere analyzed and found no statistically significant differences exceptfor ethnicity (p=0.02). Conclusion: A high frequency of CI was found in patients with SLE,non-Caucasian had higher CI with significant differences in comparisonwith Caucasian patients.

La biopsia del ganglio centinela de la cadena mamaria interna en el manejo del cáncer infiltrante de mama / No disponible

El estado de los ganglios axilares es un elemento pronóstico importante en el cáncer infiltrante de mama. La linfadenectomía axilar ha sido sustituida por la biopsia selectiva del ganglio centinela para la estadificación del cáncer de mama. La cadena mamaria interna es la segunda estación de drenaje de la mama y su afectación metastásica influye negativamente en el pronóstico. La biopsia selectiva del ganglio centinela de la mamaria interna es un procedimiento controvertido en el cáncer de mama. La controversia se relaciona con la técnica de medicina nuclear empleada, la seguridad del procedimiento quirúrgico y las consecuencias derivadas para las pacientes. Pensamos que dicha biopsia se debe considerar en la práctica clínica de las unidades especializadas en el tratamiento del cáncer de mama, para una correcta estadificación. Nos permite además seleccionar a las pacientes con metástasis en la cadena mamaria interna y adaptar el tratamiento adyuvante de un modo más eficaz. Es un procedimiento multidisciplinar, asequible después de un periodo de aprendizaje, con escasa morbilidad y de poca relevancia. Son fundamentales el buen juicio clínico y la individualización de los pacientes para establecer una adecuada relación riesgo/beneficio del procedimiento. Se necesitan estudios prospectivos y multicéntricos para poder aclarar los aspectos de controversia(AU)

The axillary lymph node status is still considered an important prognosis factor in infiltrating breast cancer. The sentinel lymph node biopsy proves to be an efficient option to the axillary lymphadenectomy for the purpose of staging, having less morbidity and a similar diagnostic precision. The internal mammary chain represents a second regional basin of lymph drainage from the breast and its metastatic involvement is associated with a less favourable prognosis. Sentinel node biopsy of the internal mammary chain is a controversial procedure and most centers do not perform it. Controversial points are the lymphoscintigraphy technique, security of the surgical procedure and the practical consequences derived to the patients. We believe that we should consider the sentinel node biopsy of the internal mammary on a clinical practice in units specialized on breast cancer for a correct staging. It is a feasible technique after a learning period and has a low rate of complications. It allows us to select positive internal mammary patients and to adjust the adjuvant treatments more effectively. A good clinical judgement and the individualization of the risk-benefit relation should be a priority. Prospective multicenter studies are necessary if we want to resolve the controversial aspects(AU)

Sentinel lymph node biopsy in selected cases of ductal carcinoma in situ

INTRODUCTION: Axillary lymphadenectomy is nowadays not recommended to treat ductal carcinoma in situ (DCIS), but there is controversy surrounding the indication for sentinel lymph node biopsy (SLNB). MATERIALS AND METHODS: A prospective study of a selected group of patients diagnosed preoperatively with DCIS was performed between 2004 and 2009. Indications for SLNB were histologically determined high-grade tumours, tumour size >2 cm and patients scheduled to undergo a mastectomy. RESULTS: Sixty-five patients were analysed. Surgical technique was mastectomy in 39 patients (60%) and conservative breast surgery in 26 (40%). Definitive histological study of the resected breast tumour revealed 43 cases (66.2%) of DCIS, 15 (23.1%) of ductal invasive carcinoma and seven (10.7%) microinvasive tumours. In confirmed DCIS, only 6.9% of sentinel lymph nodes were positive, in microinvasive carcinoma 28.5% and in invasive carcinoma 40% were positive. Total number of patients with positive sentinel lymph nodes was 11 (16.9%). Of 39 mastectomies, 12 corresponded to microinvasive or invasive carcinoma and six (50%) showed a positive SLNB. CONCLUSIONS: Performing SLNB avoids an unnecessary second surgery to study axillary lymph nodes in invasive carcinoma diagnosed after definitive histological study. In patients undergoing a mastectomy, this study requires an axillary lymphadenectomy that is not useful in up to 50% of cases. We think that in a selected group of patients with DCIS, SLNB improves tumour staging, adapts the treatment and avoids second surgery in this group of patients (AU)

Utilidad de la clasificación TNM para el cáncer de mama en la toma de decisiones quirúrgicas / No disponible

La clasificación TNM (UICC) pretende agrupar en sus diferentesapartados a tumores de características similares enlos que el pronóstico sea parecido y el tratamiento pueda serhomogéneo.En la medida en que los conocimientos sobre el cáncer demama han ido progresando, la clasificación TNM ha sufridodistintas modificaciones y adaptaciones a los mismos. La últimaedición, la sexta, se produce en el año 2002.Sus diferentes modificaciones no han podido dar una respuestasatisfactoria y estable a las distintas situaciones clínicas.Nos preguntamos en qué medida la vigente clasificaciónTNM contribuye a facilitar la planificación quirúrgica en elcáncer de mama, que es uno de sus objetivos, y analizamoscon sentido crítico aquellas circunstancias que puedan tenerun mayor impacto, o planteen más dudas para el cirujano.Reconociendo la extraordinaria aportación de la clasificaciónTNM, debemos aceptar que hoy desempeña un papelmenor en la práctica quirúrgica diaria.La dirección de las investigaciones y del tratamiento seorientan claramente hacia factores biológicos y no en variablesanatómicas e histológicas, que son la base del sistemaTNM.Debe diseñarse un sistema de clasificación más adecuado,que contemple otras variables y que nos ayude mejor en lasdecisiones de tratamiento.Mientras ese nuevo sistema llega, debemos seguir elTNM, complementado por otros factores de los que ya disponemoshoy día (receptores hormonales, grado histológico,P53, índice de proliferación, HER2, perfil genético, etc.).La necesidad de un nuevo sistema de clasificación para elcáncer de mama parece evidente, también para una mejorplanificación quirúrgica(AU)

The TNM staging system (UICC) is used to determine theanatomical extent of malignant disease on the basis of clinicaland pathological criteria. It pretends to group tumors with similarprognosis and therefore treatment would be homogeneous.The TNM system in breast cancer is periodically revisedwith advances in biology, diagnosis and treatment. Significantmodifications were made to the breast cancer staging systemin the sixth edition, published in 2002, with the aim of providingmore reliable prognostic information.The TNM classification system was also designed with theaims of assisting treatment planning, surgical treatment included,providing prognostic guidance and improving understandingof the neoplastic process.How the current TNM staging help to the surgical treatmentdecision? We analyse some confused and polemical surgicalaspects of the breast cancer.We conclude that in current surgical practice, the TNM systemplays a minor part in the management of breast cancerand there are many confusing points.The TNM staging system has failed to fulfil its objectives,and an alternative staging approach that would more suitableto assist treatment decisions should be devised. The limitationsare a reflection of the biological heterogeneity of the breastcancer and new prognostic factors may help improve and adjusttreatments.While the new staging system comes, the TNM is the bestone for the breast cancer, complemented with other prognosticfactors currently in use (hormonal receptors, P53,HER2/neu, etc.).The future for the TNM classification seems brief and surgeonsneed also a new staging system for the best breast cancertreatment choice(AU)

Papillary serous carcinoma of peritoneum: presentation of 2 cases

Papillar serous carcinoma of peritoneum (PSPC) is an unfrequent neoplasm, histologically similar to papillar serous carcinoma of ovarium. It presents as peritoneal carcinomatosis without evident tumoral focus. Management of PSPC is similar to ovaric neoplasms, although prognosis should be worse. Long-term survival has been described with cytoreductive surgery and adjuvant chemotherapy with platinum. We present hereby 2 cases of PSPC (AU)

20 years experience in the management of Zenker's diverticulum in a third-level hospital.

Zenker s diverticulum arises in the posterior wall of the pharynx, above the cricopharyngeal muscle, secondary to a functional cricopharyngeal disorder. We describe our experience with the management of Zenker s diverticulum from 1985 to this day in a third-level hospital. We review clinical data from 27 patients (78% males) with a mean age of 60.4 years. The most common clinical manifestations were dysphagia, regurgitation, syalorrhea, cough, and weight loss. All cases were diagnosed using an esophagogram. A diverticulectomy with cricopharingeal myotomy was performed in 74% of patients. Complications developed in 5 cases (21%), and the recurrence rate was 4% (1 of 3 cases, where myotomy was not performed).