[Tissue expression of mismatch repair proteins and tumor lymphocytic infiltration: prognostic significance in resected colorectal carcinoma]. / Expresión tisular de proteínas reparadoras e infiltración linfocítica tumoral: significado pronóstico en el carcinoma colorrectal resecado.

BACKGROUND: In colorectal cancer there is discussion about the possible relation between the mismatch repair protein expression (MMRPE) and tumour lymphocytic infiltration (TLI), as well as the possible prognostic effect of both factors. METHODS: A review was made of 243 colorectal cancers, consecutively resected. We made an immunohystochemical study of the MMRPE of MLH1, MSH2 and MSH6. The TLI was evaluated through CD3 staining in the tumoural epithelium. We compared mortality and post-operative tumoural progression amongst the cases with and without MMRPE and with and without TLI. Additionally, we studied mortality and tumoural progression amongst MMRPE (+) cases, according to whether or not they presented TLI. RESULTS: Thirteen point six percent of the tumours expressed MMRPE (+) and 25.5% TLI (+). The follow-up was: 73.8±34.6 months. The frequency of TLI (+) turned out to be similar between MMRPE (+) tumours: 27.3% and MMRPE (-): 25.2% (p = 0.80). The MMRPE (+) cases showed less mortality: 12.1% versus 23.3% (p = 0.15) and less tumoural progression: 21.2% versus 29% (p = 0.35). The ITL neoplasias (+) had a lower mortality: 9.7% versus 26% [p = 0.007; OR = 3.27(1.25-9.05)] and tumoural progression: 12.9% versus 33.1% [p = 0.002; OR = 3.35 (1.42-8.15)]. The 9 MMRPE (+) and ILT (+) tumours did not present mortality or tumoural progression, against a mortality: 16.7% and progression: 29.2% of the 24 MMRPE (+) and TLI (-) cases p = 0.19 and p = 0.07 respectively. CONCLUSIONS: No relation was found between MMRPE and TLI, with very similar rates of TLI (+) between cases with and without MMRPE. The LTI (+) showed a favourable prognostic effect higher than that of the MMRPE (+). The combination of LTI (+) and MMRPE (+) seems to have an accumulative protective effect, although its limited frequency reduces the significance of the finding.

[Malignant transformation of a nevus of Ito: description of a rare case]. / Transformación maligna de un nevus de Ito: descripción de un caso extraordinario.

Dermal melanocytosis refers to congenital or acquired lesions characterized by the presence of dendritic cells derived from melanocytes that migrate from the neural crest to the epidermis. The nevus of Ito develops in the territory supplied by the acromioclavicular nerve. Malignant transformation in dermal melanocytosis is extremely rare, with only isolated case reports; only 2 cases of malignant transformation of a nevus of Ito have been reported. We report a very rare case that is the third to be described in the literature. The patient was a 24-year-old man who presented with a subcutaneous nodule that had developed in the anterolateral region of the thorax over the previous 8 months. The nodule was located beneath a faint blue-gray macule with poorly defined borders. Biopsy of the nodule revealed malignant melanoma; biopsies of the adjacent skin lesion showed a diffuse proliferation of scattered melanocytes in a collagen stroma in the reticular dermis. A diagnosis of malignant transformation of a nevus of Ito was made after other possibilities were ruled out.

Estudio de las lesiones neoplásicas metacrónicas en el carcinoma colorrectal / Study of colorectal metachronous neoplastic lesions

Fundamento. Analizar la frecuencia y las características delas lesiones neoplásicas metacrónicas, carcinomas y adenomas,tras la resección de un cáncer colo-rectal (CCR).Pacientes y métodos. Revisamos 382 CCR operados y seguidosmediante colonoscopias completas en dos hospitalesde nuestra comunidad. Analizamos las lesiones metacrónicasregistradas valorando su localización, momento deldiagnóstico, histología, número y tamaño. Estudiamos lafrecuencia de adenomas de aparición precoz (12 meses),comparando su tamaño con respecto al resto de lesiones.Resultados. La mediana de seguimiento fue de 48 meses (12-112), con 2,74±1,47 colonoscopias/caso. Diagnosticamos 7cánceres metacrónicos (1,8%), 4 de ellos en estadio I. La medianade tiempo hasta su diagnóstico fue de 24 meses (13-54).Registramos adenomas metacrónicos en 162 casos (42,4%),sin diferencias entre los dos hospitales: 42,1% vs. 43,8%(p=0,88). Un 6,3% de los pacientes presentaron adenomasavanzados. En 164 casos en que el primer control se efectuó alos 12 meses, la incidencia de adenomas fue del 24%. Los adenomasfueron mayoritariamente únicos (60,8%) y menores de5 mm (68,5%). En un 55,5% de los casos con pólipos, algunotenía una localización proximal. El diagnóstico se realizó enla 1ª exploración (56,2%), 2ª (27,8%) ó 3ª (9%). La mediana detiempo hasta el diagnóstico fue de 21 meses (12-112) para eladenoma simple y de 35 (12-112) para el avanzado.Conclusiones. Nuestro seguimiento permitió aplicar untratamiento teóricamente curativo en la mayoría de los carcinomasmetacrónicos diagnosticados. La alta incidenciade adenomas y su frecuente localización proximal hacennecesario un seguimiento con colonoscopias completas,que debería iniciarse al año de la operación y podría pasara ser menos estricto tras tres exploraciones consecutivassin pólipos(AU)

Background. To analyse the frequency and characteristicsof metachronous neoplastic lesions, carcinomas and adenomas,following resection of colorectal cancer.Patients and methods. We reviewed 382 patients subjectedto CCR operations and followed up through completecolonoscopies in two hospitals in our province. We analysedthe metachronous lesions registered, evaluating theirlocalisation, time of diagnosis, histology, number and size.We studied the frequency of early adenomas (12 months),comparing their size with the rest of the lesions.Results. The average follow-up was 48 months (12-112), with2.74±1.47 colonoscopies/case. We diagnosed 7 metachronouscancers (1.8%), 4 of them in stage I. The average time untiltheir diagnosis was 24 months (13-54). We registered metachronousadenomas in 162 cases (42.4%), without differencesbetween the two hospitals: 42.1% vs. 43.8% (p=0.88). Six pointthree percent of the patients presented advanced adenomas.In 164 cases where the control was carried out after 12 months,the incidence of adenomas was 24%. In the majority ofcases, the adenomas were sole (60.8%) and smaller than 5mm (68.5%). In 55.5% of the cases with polyps, some had aproximal localisation. Diagnosis was made on the 1st exploration(56.2%), the 2nd (27.8%) or the 3rd (9%). Average time untildiagnosis was 21 months (12-112) for simple adenoma and 35(12-112) for advanced adenoma.Conclusions. Our follow up made it possible to apply atheoretically curative treatment in the majority of the metachronouscarcinomas diagnosed. The high incidence ofadenomas and the frequent proximal localisation make afollow up with complete colonoscopies necessary, whichmust be started one year after the surgery and can becomeless strict following three consecutive explorations withoutpolyps(AU)

[Incidence and characteristics of eosinophilic esophagitis in adults]. / Incidencia y características de la esofagitis eosinofílica (EE) en adultos.

Eosinophilic esophagitis (EE) is a disease characterised by the infiltration of esophageal mucous by eosinophils, whose incidence in adults seems to have been increasing in recent years, in a way that is similar to what is occurring with other diseases of a probable immunoallergic aetiology. It predominates in young adults and is mainly expressed by dysphagia and esophageal food impactation. Treatment is based on eliminating the allergen that is potentially involved and the administration of corticoids. This article offers a retrospective review of EE cases diagnosed in the Hospital de Navarra between January 2002 and August 2008, with 25 patients found, which represents an incidence of 2.13 cases/105 inhabitants/year. Seventy-two percent of our patients showed dysphagia and 52% a history of food bolus impaction, with endoscopic alterations found in 23 of the 25 cases. Out of 24 patients studied, 76% showed an alimentary allergy or neumoallergens, which supports the immunoallergic basis of the disease and the need for an allergy exam in all patients with EE. The majority of our patients (22 out of 24 evaluated) presented a good clinical response to treatment, which was based on avoiding exposure to the potentially involved allergen and/or the administration of corticoids (topical or systemic) and/or the administration of proton pump inhibitors.

[Study of colorectal metachronous neoplastic lesions]. / Estudio de las lesiones neoplásicas metacrónicas en el carcinoma colorrectal.

BACKGROUND: To analyse the frequency and characteristics of metachronous neoplastic lesions, carcinomas and adenomas, following resection of colorectal cancer. PATIENTS AND METHODS: We reviewed 382 patients subjected to RCC operations and followed up through complete colonoscopies in two hospitals in our province. We analysed the metachronous lesions registered, evaluating their localisation, time of diagnosis, histology, number and size. We studied the frequency of early adenomas (12 months), comparing their size with the rest of the lesions. RESULTS: The average follow-up was 48 months (12-112), with 2.74+/-1.47 colonoscopies/case. We diagnosed 7 metachronous cancers (1.8%), 4 of them in stage I. The average time until their diagnosis was 24 months (13-54). We registered metachronous adenomas in 162 cases (42.4%), without differences between the two hospitals: 42.1% vs. 43.8% (p=0.88). Six point three percent of the patients presented advanced adenomas. In 164 cases where the control was carried out after 12 months, the incidence of adenomas was 24%. In the majority of cases, the adenomas were sole (60.8%) and smaller than 5 mm (68.5%). In 55.5% of the cases with polyps, some had a proximal localisation. Diagnosis was made on the 1st exploration (56.2%), the 2nd (27.8%) or the 3rd (9%). Average time until diagnosis was 21 months (12-112) for simple adenoma and 35 (12-112) for advanced adenoma. CONCLUSIONS: Our follow up made it possible to apply a theoretically curative treatment in the majority of the metachronous carcinomas diagnosed. The high incidence of adenomas and the frequent proximal localisation make a follow up with complete colonoscopies necessary, which must be started one year after the operation and can become less strict following three consecutive explorations without polyps.

[Synchronous neoplastic lesions in colorectal cancer. An analysis of possible risk factors favouring presentation]. / Lesiones neoplásicas sincrónicas en el cáncer colorectal. Análisis de posibles factores que favorezcan su presentación.

AIM: few data have been published regarding the causes of synchronous lesions in patients with colorectal cancer. The aim of our study was to identify potential factors that might be implicated in the development of multicentric lesions, since this knowledge could be useful for tailored follow-up once initial synchronous lesions have been removed. METHODS: we retrospectively reviewed 382 colorectal cancer cases diagnosed by total colonoscopy and histological study of surgical specimens. We divided our population into 2 groups, based on whether they had synchronous lesions or otherwise. Several data related to personal and family history, habits, symptoms, and tumor characteristics were assessed. Univariate and multivariate statistical analyses were performed. RESULTS: 208 (54.5%) patients had synchronous adenomas and 28 (7.3%) had synchronous cancer. A multivariate analysis showed that the following parameters were consistently related to the presence of multicentric lesions--male gender: OR = 1.97; CI = 1.13-3.45; p = 0.017; age = 59 years: OR = 2.57; CI = 1.54-4.29; p < 0.001; personal history of colonic adenomas: OR = 3.04; CI = 1.04-8.85; p = 0.042; and obstructive tumors: OR = 0.48; CI = 0.27-0.85; p = 0.012. CONCLUSION: our results show that several parameters that are easy to measure could be considered risk factors for the development of multicentric lesions. These factors need to be confirmed with follow-up studies analyzing their role in patients with and without metachronic lesions once all synchronous lesions have been removed.

Estudio de la frecuencia, distribución y rendimiento diagnóstico en las lesiones neoplásicas sincrónicas del carcinoma colo-rectal / Study of frequency, distribution and diagnostic performance in synchronic neoplastic lesions of colorectal carcinoma

Objetivo: Analizar la frecuencia, características y el diagnóstico de las lesiones neoplásicas sincrónicas en el cáncer colo-rectal. Material y métodos: Se han revisado 384 cánceres colorectales, diagnosticados mediante colonoscopia completa y resecados. Se ha determinado los cánceres sincrónicos y las características de los adenomas: número, tamaño, tipo histológico,displasia, así como su localización en el colon y respecto al carcinoma. Resultados: Se han encontrado 28 cánceres sincrónicos (7,3% del global): 8 tumores desarrollados y 20 pólipos malignizados. El 54,4% de los casos tenía algún adenoma sincrónico. En los pacientes con lesiones sincrónicas, un 43% presentaba un adenoma avanzado. El 20% de los pólipos sincrónicos encontrados fueron proximales al ángulo esplénico; distales el 41% y con ambas localizaciones el 38%. El 59,1% de los pacientes tenía algún adenoma proximal con respecto al cáncer, con criterios de adenoma avanzado en el 13,9%. La distribución de los adenomas estuvo más uniformemente repartida en los cánceres de localización proximal (p = 0,038). Un 17% de los cánceres distales presentó lesiones sincrónicas localizadas exclusivamente en colon proximal. Las endoscopias parciales diagnosticarían los cánceres distales, pero omitirían un adenoma sincrónico en el 42,3% de las sigmoidoscopias y en el 40% de las colonoscopias cortas. Conclusiones: Se registraron unas elevadas tasas de carcinoma y adenomas sincrónicos. Destacamos el alto índice de adenomas avanzados y la frecuencia de lesiones sincrónicas proximales al cáncer, por lo que las colonoscopias incompletas, aunque permitan el diagnóstico del cáncer distal, omiten un alto porcentaje de adenomas sincrónicos, incluyendo lesiones avanzadas. Todo ello confirma la necesidad de efectuar una colonoscopia completa pre, intra o post-quirúrgica en el cáncer colo-rectal resecable (AU)

Aim: To analyse the frequency, characteristics and diagnosis of synchronic neoplastic lesions in colorectal cancer. Methods: A review was carried out of 384 colorectal cancers, diagnosed through complete colonoscopy and resected. The synchronic cancers and the characteristics of the adenomas were determined: number, size, histological type, dysplasia, as well as their localisation in the colon and with respect to the carcinoma. Results: Twenty-eight synchronic cancers were found (7.3% of the total); 8 developed tumours and 20 malignant polyps. In 54.4% of the cases there was a synchronic adenoma. In patients with synchronic lesions, 43% showed an advanced adenoma. Twenty percent of the synchronic polyps found were proximal to the splenic flexure; 41% were distal and 38% had both localisations. Fifty-nine point one percent of the patients had some adenoma proximal to the cancer, with criteria of advanced adenoma in 13.9%. The distribution of the adenomas was more uniformly spread in the cancers with a proximal localisation (p = 0.038). Seventeen percent of the distal cancers presented synchronic lesions with a proximal colon localization exclusively. Partial endoscopies would diagnose the distal cancers, but would omit a synchronic adenoma in 42.3% of the sigmoidoscopies and 40% of the short colonoscopies. Conclusions: High rates of carcinoma and synchronic adenomas were registered. We underline the high index of advanced adenomas and the frequency of synchronic lesions proximal to the cancer, which is why incomplete colonoscopies, although allowing the diagnosis of the distal cancer, omit a high percentage of synchronic adenomas, including advanced lesions. All of this confirms the need to perform a complete pre-, intra- and post operational colonoscopy in resectable colorectal cancer (AU)

Lesiones neoplásicas sincrónicas en el cáncer colorrectal. Análisis de posibles factores que favorezcan su presentación / No disponible

Objetivo: en el cáncer colorrectal son poco conocidas las causasdel frecuente desarrollo de lesiones neoplásicas sincrónicas.Pretendemos identificar posibles factores que pudieran influir enla multicentricidad lesional. Su conocimiento sería útil para, tras eltratamiento de las lesiones iniciales, optimizar el seguimiento enlos pacientes que los presentaran.Pacientes y métodos: estudiamos retrospectivamente 382cánceres colorrectales diagnosticados mediante colonoscopiacompleta y estudio de la pieza quirúrgica. Comparamos una seriede parámetros referentes a los antecedentes personales y familiares,hábitos, datos clínicos y del tumor entre los grupos con y sinlesiones neoplásicas sincrónicas, mediante análisis estadístico univariabley multivariable.Resultados: doscientos ocho (54,5%) pacientes presentaronadenomas sincrónicos y 28 (7,3%) carcinoma sincrónico. En el análisismultivariable el sexo masculino: OR = 1,97; IC = 1,13-3,45,p = 0,017; la edad superior a 59 años: OR = 2,57; IC = 1,54-4,29,p < 0,001; el antecedente personal de pólipo colónico: OR = 3,04,IC = 1,04-8,85, p = 0,042 y el carácter obstructivo del cáncer:OR = 0,48; IC = 0,27-0,85, p = 0,012 se asocian significativamentecon la multicentricidad lesional.Conclusión: en los enfermos con cáncer colorrectal, nuestroestudio muestra una serie de parámetros, de fácil determinación,que podrían comportarse como factores de riesgo para el desarrollode multicentricidad lesional. Estos factores deberán confirmarsemediante un estudio de seguimiento, analizando su comportamientoentre los pacientes que presenten o no lesionesmetacrónicas tras la limpieza quirúrgico-endoscópica inicial

Aim: few data have been published regarding the causes ofsynchronous lesions in patients with colorectal cancer. The aim ofour study was to identify potential factors that might be implicatedin the development of multicentric lesions, since this knowledgecould be useful for tailored follow-up once initial synchronous lesionshave been removed.Methods: we retrospectively reviewed 382 colorectal cancercases diagnosed by total colonoscopy and histological study ofsurgical specimens. We divided our population into 2 groups,based on whether they had synchronous lesions or otherwise.Several data related to personal and family history, habits, symptoms,and tumor characteristics were assessed. Univariate andmultivariate statistical analyses were performed.Results: 208 (54.5%) patients had synchronous adenomasand 28 (7.3%) had synchronous cancer. A multivariate analysisshowed that the following parameters were consistently relatedto the presence of multicentric lesions –male gender: OR = 1.97;CI = 1.13-3.45; p = 0.017; age >= 59 years: OR = 2.57;CI = 1.54-4.29; p < 0.001; personal history of colonic adenomas:OR = 3.04; CI = 1.04-8.85; p = 0.042; and obstructive tumors:OR = 0.48; CI = 0.27-0.85; p = 0.012 .Conclusion: our results show that several parameters that areeasy to measure could be considered risk factors for the developmentof multicentric lesions. These factors need to be confirmedwith follow-up studies analyzing their role in patients with andwithout metachronic lesions once all synchronous lesions havebeen removed

[Incidence and mortality due to cancer in Navarre, 1998-2002. Trends in the last 30 years]. / Incidencia y mortalidad por cáncer en Navarra, 1998-2002. Evolución en los últimos 30 años.

Between 1998-2002, 16,952 new cases of cancer were registered in Navarre. In men, the most frequently diagnosed cancers were in the following order: prostate, lung, colon and rectum, bladder and stomach, which accounted for 63.2%. In women, the sites were breast, colon and rectum, corpus uteri, stomach and ovary, which accounted for 57.6% of the cases. In the same period, 1998-2002, 4,127 men and 2,470 women died from cancer. Sixty percent of all deaths due to malign tumours in men were due to cancer of the lung, prostate, colon and rectum, stomach and bladder. In women this was due to cancers of colon and rectum, breast, stomach, pancreas and lung, which accounted for 49% of the cases. In men in Navarre there has been an increase in the incidence rates of cancer of the prostate, kidney and non-Hodgkin lymphoma. Avoidable cancers such as those related to smoking (lung, oral cavity and pharynx or pancreas) continue to rise, and represent a greater global risk of dying from cancer in the latest period studied than in the decades of the 1970s and 1980s. From 1995 up to the present, mortality due to cancer has moved from occupying the second place to become the first cause of death among men in Navarre. The global risk of death due to cancer in men is now equal to the first period studied, 1975-1977. Amongst women the global risk of death due to cancer fell by 25% between 1975 and 2002, basically at the cost of breast and stomach cancer. Tumours related to smoking increased both in mortality and in incidence and appear as a significant health problem amongst women in Navarre. Breast cancer has increased in incidence, with lower mortality figures than those of the first period 1975-1977. Invasive cancer of the cervix remains at very low rates in comparison with many European countries, including Spain. In both sexes colorectal and skin cancer has increased, while the incidence and mortality of stomach cancer continues to fall.

Modulación de la fisiología gastrointestinal mediante cepas probióticas de Lactobacillus casei y Bifidobacterium bifidum / Modulation of gastrointestinal physiology through probiotic strains of Lactobacillus casei and Bifidobacterium bifidum

En el contexto de la alimentación y la promoción de la salud se sitúan los productos denominados alimentos funcionales que tienen diversos efectos beneficiosos en el organismo, además de los meramente nutricionales. Dentro de estos alimentos funcionales, entre otros, podemos distinguir entre compuestos probióticos y prebióticos. Los microorganismos más utilizados en alimentos probióticos pertenecen a los géneros Lactobacillus y Bifidobacterium. En el presente trabajo se ha estudiado el efecto de dietas suplementadas con Lactobacillus casei o Bifidobacterium bifidum en el desarrollo animal y en especial sobre la función intestinal, centrada en su actividad immunitaria, digestiva y absortiva de animales en crecimiento. Las cepas bacterianas utilizadas modifican la actividad del intestino delgado de los ratones sanos, afectando significativamente a su actividad enzimática (sacarasa, maltasa y aminopeptidasa) y a la captación de nutrientes (galactosa y glicilsarcosina), así como a la actividad inmune intestinal (mayor número de placas de Peyer). Sin embargo, estos efectos no parecen perturbar el desarrollo de los animales en crecimiento ya que no se aprecian diferencias significativas en su peso corporal ni en sus parámetros sanguíneos. Estos resultados ponen de manifiesto los posibles efectos beneficiosos en la fisiología intestinal y contribuyen al conocimiento de los posibles mecanismos de acción de los probióticos, que se pudieran utilizar en el tratamiento preventivo de diferentes patologías relacionadas con el aparato digestivo

The products called functional foods, which besides being merely nutritional have different beneficial effects on the organism, are situated in the context of diet and health promotion. Amongst these functional foods we can distinguish, amongst others, between probiotic and prebiotic compounds. The microorganisms most widely used in probiotic foods belong to the Lactobacillus and Bifidobacterium types. In this article we have studied the effect of diets supplemented with Lactobacillus casei or Bifidobacterium bifidum on animal development and especially on the intestinal function, centred on their immune, digestive and absorptive activity in growing animals. The bacteria strains used modify the activity of the small intestine of healthy mice, significantly affecting their enzymatic activity (sucrase, maltase and aminopeptidase) and the collection of nutrients (galactose and glycilsarcosine), as well as the intestinal immune activity (higher number of Peyer’s patches). However, these effects do not appear to disturb the development of the growing animals since no significant differences are appreciated in their body weight or in their blood parameters. These results make clear the possible beneficial effects on intestinal physiology and contribute to the understanding of the possible mechanisms of action of the probiotics, which could be employed in the preventive treatment of different pathologies related to the digestive apparatus

Modulación en la expresión de biomarcadores (RE, RP y C-erbB2) en cáncer de mama tras tratamiento neoadyuvante / Modulation of biomarkers expression (OR, PR and C-erbB2) in breast

Introducción. El tratamiento oncológico pre ypostoperatorio en pacientes con carcinoma de mamaestá condicionado entre otros factores, por el resultadodel estudio inmunohistoquímico de los receptoreshormonales y por la expresión de c-erbB2. El objetivodel estudio es determinar la influencia del tratamientoneoadyuvante en la expresión de receptores de estrógeno(RE), progesterona (PR) y c-erbB2.Material y métodos. Estudiamos 53 pacientes concáncer de mama diagnosticadas mediante biopsia“trucut”. Las pacientes con carcinoma localmenteavanzado (20) se someten a quimioterapia preoperatoria.Se realiza extirpación quirúrgica en todos loscasos. Comparamos la expresión de receptores deestrógeno (RE), receptores de progesterona (PR) y cerbB2,en la biopsia”trucut” y en la pieza quirúrgica.Resultados. Encontramos diferencias significativasen la expresión de RE, RP entre biopsia/pieza quirúrgica,comparando el grupo de pacientes sometidasa tratamiento neoadyuvante frente al grupo de pacientessin tratamiento oncológico prequirúrgico.Encontramos diferencias de signo (positivizacióny negativización) entre un 10 y un 40% de casos en laexpresión inmunohistoquímica para RE, RP y c-erbB2entre la biopsia”trucut” y la resección quirúrgica en laspacientes tratadas con neoadyuvancia. Estas diferenciasde signo no tienen significación estadística

Introduction. Pre and post-operative oncological therapy in patients with breast cancer is determined, amongst other factors, by hormone receptor status and by c-erbB2 expression. The aim of this study is to determine the influence of neoadjuvant therapy on the expression of oestrogen receptor (OR), progesterone receptor (PR) and c-erbB2. Methods. Fifty-three patients with breast cancer diagnosed by tru-cut biopsy were studied. Patients with locally advanced carcinoma (20) had preoperative treatment. All patients underwent surgical resection. Expression of OR, PR and c-erbB2 in both the tru-cut biopsy and the gross specimen was compared. Results: We found significant differences in OR, PR expression in both biopsy and gross specimen, between the group of patients who underwent neoadjuvant treatment and the group without pre-surgical treatment. Changes in PR, OR and c-erbB2 status were found between the tru-cut biopsy and the gross specimen, in about 10 to 40% of the cases who received neoadjuvant therapy. These changes had no statistical significance

Effect of dietary quercetin and sphingomyelin on intestinal nutrient absorption and animal growth.

Research on cancer and other conditions has shown flavonoids and sphingolipids to be food components capable of exerting chemoprotective action. Nevertheless, little is known about their effects on healthy individuals and their potential usefulness as therapeutic agents. The present study examined the possible action of a dietary flavonoid, quercetin, and a sphingolipid, sphingomyelin, as functional foods in healthy animals. In particular, the effect on animal growth of supplementing a conventional diet with one or other of these substances (0.5 % quercetin and 0.05 % sphingomyelin) was considered. Possible action affecting intestinal physiology was also analysed by measuring the uptake of sugar and dipeptide, mediated by the Na(+)-dependent sugar transporter SGLT1 and the dipeptide Na(+)/H(+) exchanger PEPT1 respectively, and the activity of related intestinal enzymes such as sucrase, maltase and aminopeptidase N. Both substances seemed to modify small intestinal activity in healthy mice, altering intestinal enzymatic activity and nutrient uptake. These effects observed in the small intestine did not impair normal development of the animals, as no differences in serum biochemical parameters or in organ and body weights were found. The findings should help in elucidating the mechanisms of action of these food components with a view to their possible use in the prevention of certain pathological conditions.

[Modulation of gastrointestinal physiology through probiotic strains of Lactobacillus casei and Bifidobacterium bifidum]. / Modulación de la fisiología gastrointestinal mediante cepas probióticas de Lactobacillus casei y Bifidobacterium bifidum.

The products called functional foods, which besides being merely nutritional have different beneficial effects on the organism, are situated in the context of diet and health promotion. Amongst these functional foods we can distinguish, amongst others, between probiotic and prebiotic compounds. The micro-organisms most widely used in probiotic foods belong to the Lactobacillus and Bifidobacterium types. In this article we have studied the effect of diets supplemented with Lactobacillus casei or Bifidobacterium bifidum on animal development and especially on the intestinal function, centred on their immune, digestive and absorptive activity in growing animals. The bacteria strains used modify the activity of the small intestine of healthy mice, significantly affecting their enzymatic activity (sucrase, maltase and aminopeptidase) and the collection of nutrients (galactose and glycilsarcosine), as well as the intestinal immune activity (higher number of Peyer's patches). However, these effects do not appear to disturb the development of the growing animals since no significant differences are appreciated in their body weight or in their blood parameters. These results make clear the possible beneficial effects on intestinal physiology and contribute to the understanding of the possible mechanisms of action of the probiotics, which could be employed in the preventive treatment of different pathologies related to the digestive apparatus.

[Modulation of biomarkers expression (OR, PR and C-erbB2) in breast cancer following neoadjuvant treatment]. / Modulación en la expresión de biomarcadores (RE, RP y C-erbB2) en cáncer de mama tras tratamiento neoadyuvante.

INTRODUCTION: Pre and post-operative oncological therapy in patients with breast cancer is determined, amongst other factors, by hormone receptor status and by c-erbB2 expression. The aim of this study is to determine the influence of neoadjuvant therapy on the expression of oestrogen receptor (OR), progesterone receptor (PR) and c-erbB2. METHODS: Fifty-three patients with breast cancer diagnosed by tru-cut biopsy were studied. Patients with locally advanced carcinoma (20) had preoperative treatment. All patients underwent surgical resection. Expression of OR, PR and c-erbB2 in both the tru-cut biopsy and the gross specimen was compared. RESULTS: We found significant differences in OR, PR expression in both biopsy and gross specimen, between the group of patients who underwent neoadjuvant treatment and the group without pre-surgical treatment. Changes in PR, OR and c-erbB2 status were found between the tru-cut biopsy and the gross specimen, in about 10 to 40% of the cases who received neoadjuvant therapy. These changes had no statistical significance.

Genetic heterogeneity in supratentorial and infratentorial primitive neuroectodermal tumours of the central nervous system.

AIMS: Medulloblastoma (MB), a kind of infratentorial primitive neuroectodermal tumour (PNET), is the most frequent malignant brain tumour in childhood. In contrast, supratentorial PNET (sPNET) are very infrequent tumours, but they are histologically similar to MB, although they present a worse clinical outcome. We investigated the differences in genetic abnormalities between sPNET and MB. METHODS AND RESULTS: We analysed 20 central PNET (14 MB and six sPNET) by conventional comparative genomic hybridization (CGH) in order to determine whether a different genetic profile for each tumour exists. Isochromosome 17q was detected in four of the 14 MB cases, but not in any sPNET. Gains at 17q and 7 happened more frequently in MB, and those at 1q in sPNET. Losses at chromosome 10 were detected only in MB, while losses at 16p and 19p happened more frequently in sPNET. A new amplification site, on 4q12, was detected in two MB. CONCLUSIONS: Central PNET are a heterogeneous group of tumours from the genetic point of view. The present and previous data, together with further results from larger series, might contribute to the establishment of specific treatments for supratentorial and infratentorial PNET.

[Ductal regeneration in vanishing bile duct syndrome in Hodgkin's lymphoma]. / Recuperación ductular en el síndrome de los conductillos biliares evanescent en paciente con linfoma de Hodgkin.

We present the case of a 17-year-old male patient with Hodgkin's lymphoma (nodular sclerosis) in the mediastinum. During the postoperative period treatment with erythromycin was started and the patient developed progressive jaundice and cholestasis. Treatment modified for the lymphoma was initiated, which achieved complete remission and subsequent improvement and resolution of the cholestasis. Histological study of the liver revealed massive loss of bile ducts. After resolution of the cholestasis, consecutive biopsies revealed ductal proliferation. The present report therefore illustrates a case of ductopenia or vanishing bile duct syndrome (VBDS) with ad integrum regeneration of the bile ducts simultaneous with lymphoma remission. Because the 2 possible causes, erythromycin toxicity and Hodgkin's lymphoma, occurred simultaneously, the etiology of the VBDS cannot be definitively established.

[Chronic hepatitis C virus infection]. / Infección crónica por el VHC.

Following acute hepatitis C virus infection (HCV), a significant percentage of patients do not clear the virus and develop a chronic hepatitis C. The symptoms, when they exist, are usually unspecific. Besides, approximately one third of the patients present extrahepatic manifestations of the infection, basically due to the lymphotropism of HCV. Outstanding amongst these, due to their clear association with HCV, are mixed cryoglobulinaemia and the production of autoantibodies (autoAb). Other diseases such as non-Hodgkin lynphoma (NHL) or autoimmune thyroiditis do not have a clearly established association. Although the majority of patients with chronic hepatitis C have slight or moderately high levels and fluctuations of transaminases, as many as one third of those infected can show persistently normal levels of transaminases. The diagnosis of chronic HCV infection is based on serological tests, which detect the presence of antibodies against HCV, and on virological tests that detect RNA of the HCV, which confirm the existence of active infection. Finally, an important topic of chronic HCV infection, following diagnosis, is to ascertain the stage of fibrosis and the degree of inflammation, since both characteristics are very important for predicting the natural evolution and the need for treatment. Nowadays, this information can only be obtained through liver biopsy, which is recommended in patients with chronic HCV infection and high transaminases. Whether liver biopsy should be performed in patients with normal transaminases is still subject of controversy.

[Sentinel node in breast cancer. Histological study of 67 cases]. / Ganglio centinela en cáncer de mama. Estudio histológico de 67 casos.

BACKGROUND: The extirpation of the sentinel node is a widespread surgical technique whose aim is to avoid axillary resection in patients with breast cancer at early stages. Determination of tumoral infiltration can be evident in the case of macrometastasis (>2mm), or difficult to detect in micrometastasis (<2mm). For this reason we use a protocol of serialized sections, to increase our capacity for detecting micrometastasis. Realisation of this protocol is highly laborious and represents a high cost, thus its effectiveness and efficacy must be studied. MATERIAL AND METHODS: We reviewed 67 sentinel nodes corresponding to 48 patients with breast cancer treated at our hospital in the last three years. All the samples received at the Pathology Unit were included. Serialized sections of three microns were made on each node and with a depth of 40 microns between them. A total of fourteen cuts were made. Every five cuts there was an alternation of immunostaining with a cocktail of queratines (AE1/AE3) and with haemotoxylin-eosin. RESULTS: Sixty-seven sentinel nodes were extirpated from 48 patients. Fourteen positive (20%) were detected. Of these metastases, 6 were macrometastases >2mm, 5 were micrometastases <2mm and 3 were isolated cellular groups (between 0.2 and 2mm). In 6 cases (43%), the metastases only became evident with queratine staining in serialized cuts. Axillary resection was carried out in 44 cases. CONCLUSIONS: The histological study of the sentinel nodes makes it possible to evaluate the status of tumoral infiltration of the axillary ganglions and to greatly reduce axillary lymphadenectomies. The conventional study of the sentinel node (with a single section) is insufficient for the diagnosis of tumoral infiltration. In our series, histological study using a protocol of serialized sections has enabled us to detect some 43% of metastases in the sentinel node that were not evident in the initial section.

Ganglio centinela en cáncer de mama. Estudio histológico de 67 casos / Sentinel node in breast cancer. Histological study of 67 cases

Fundamento. La extirpación del ganglio centinela es una técnica quirúrgica muy extendida cuyo objetivo es evitar el vaciamiento axilar en pacientes con cáncer de mama en estadios iniciales. La determinación de la infiltración tumoral puede ser evidente en caso de macrometástasis (>2mm), o difícil de detectar en las micrometástasis (2mm, 5 fueron micrometástasis <2 mm y 3 grupo celular aislado (entre 0,2 y 2 mm) . En 6 casos (43 por ciento), las metástasis sólo se hicieron patentes con la tinción de queratina en los cortes seriados. Se realizó resección axilar en 44 casos. Conclusiones. El estudio histológico del ganglio centinela permite evaluar el estatus de infiltración tumoral de los ganglios axilares y reducir en gran medida las linfadenectomías axilares. El estudio convencional del ganglio centinela (con un único corte) resulta insuficiente para el diagnóstico de la infiltración tumoral. En nuestra serie el estudio histológico mediante un protocolo de cortes seriados nos ha permitido detectar un 43 por ciento de metástasis en ganglio centinela que no eran evidentes en el corte inicial (AU)

Genomic imbalances detected by comparative genomic hybridization are prognostic markers in invasive ductal breast carcinomas.

AIMS: The aim of this work is the study of the prognostic significance of the chromosomal aberrations described in a series of invasive ductal breast carcinomas. METHODS AND RESULTS: We analysed by comparative genomic hybridization a group of 70 formalin-fixed paraffin-embedded invasive ductal breast carcinomas. Aberrations showed a frequency similar to previous studies using frozen tumours. Interestingly, we identified gains involving 6q16-q24 more frequently than in other series. We analysed the association among the chromosomal imbalances, 11 histopathological factors, relapse rate and overall survival of patients. Associations showed 16q losses as a potential marker of good prognosis, as they were more frequent in node-negative (P=0.025) and in oestrogen-positive tumours (P < 0.001). Furthermore, 100% of bcl-2+ tumours presented this aberration compared with 29.3% in bcl-2- (P=0.014). 1q, 11q, 17q and 20q gains were associated with poor prognosis: 95% of cases with 1q gains were bigger than 20 mm (P=0.041). Tumours with 1q and 11q gains showed a higher relapse rate (P=0.063; P=0.066). Within the good prognosis group of lymph node-negative patients, 17q and 20q gains identify a subgroup with increased relapse rate (P=0.039). CONCLUSIONS: Chromosomal imbalances, together with histopathological factors, may help to predict outcome in breast cancer patients.