Ganglio centinela en cáncer de mama: ¿histológico o molecular? Estudio diagnóstico comparativo multicéntrico español. Grupo de Estudios Senológicos / Nodisponible

Introducción: La biopsia del ganglio centinela (GC) estáaceptada como el procedimiento estándar para la cirugía conservadorade la axila en el cáncer de mama, pero la gran variabilidadexistente en los protocolos de estudio anatomopatológicoshan impedido una correcta estandarizacióndiagnóstica.Objetivo: Comparar los resultados de un nuevo métodomolecular (“One-step-Nucleic-Acid-Amplification”, OSNA)con los resultados de los procedimientos habituales y evaluar sies posible la implementación del OSNA como procedimientode elección para el diagnóstico intraoperatorio.Material y métodos: Se estudió una serie de 181 GC procedentesde seis hospitales. De cada ganglio, se realizaron seccionesde 2 mm de espesor hasta agotar el ganglio. Se incluyerontodas las secciones de manera alternativa “a” y “c” paraestudio histológico, y “b” y “d” para OSNA.Resultados: Se obtuvo un nivel de concordancia entre elprocedimiento histológico y el molecular del 99,45%.Conclusiones: El estudio multicéntrico demuestra que elOSNA es un procedimiento altamente sensible, específico yreproducible y que permite la estandarización del diagnósticointraoperatorio del GC en cáncer de mama(AU)

Background: The biopsy of the sentinel node (SN) hasbeen established as the standard procedure for conservativeaxillary surgery but its adequate diagnostic standardization hasnot yet been achieved since the protocols for histopathologicstudy have been highly variable.Objective: Our goal is to compare the results of this newmethod with the results of conventional histological tests, toevaluate the feasibility of this procedure for the intra-operativestudy of SN in breast cancer surgery and to evaluate it as away to standardize the sentinel node procedure.Material and methods: The study included 181 cases. Parallel,2 mm-thick sections were performed to drain the lymphnode which were then processed alternately for histologicalanalysis (“a” and “c”) and the others (“b” and d”) following theOSNA procedure.Results: A concordance level of 99.45% was found betweenthe histological and the molecular procedure.Conclusions: Our multicentric OSNA assay for sentinelnode in breast cancer demonstrates that this is a highly sensitive,specific and reproducible technique that allows the standardizationof the diagnostic procedure, a needed and up tonow unresolved question(AU)

Leiomiomatosis peritoneal diseminada. A propósito de un caso y revisión bibliográfica / Leiomyomatosis peritonealis disseminata. Case report and review of the literature

Se presenta un caso clínico de leiomiomatosis peritoneal diseminada, en una paciente de 40 años, con antecedentes de miomas uterinos y múltiples tumoraciones intraabdominales detectadas mediante ecografía y TC. El tratamiento se realizó mediante cirugía hormonosupresora de estrógenos y progesterona y exéresis de las tumoraciones. Revisamos en la bibliografía la frecuencia, la técnicas diagnósticas y el diagnóstico diferencial, así como las posibilidades terapéuticas de esta rara enfermedad (AU)

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[Thrombolytic delay in myocardial infarction and primary care]. / Retraso trombolítico del infarto de miocardio y atención primaria.

OBJECTIVES: To analyse the effect of a primary care consultation at a health centre or at home and to determine the effect of the use of the pre-hospital electrocardiogram on thrombolytic delay. DESIGN: Analytical cross-sectional study. SETTING: La Safor county (136,000 inhabitants), Valencia, Spain. PATIENTS: Sample of 137 patients from the area admitted for acute myocardial infarction. INTERVENTION: None. MEASUREMENTS AND RESULTS: Multivariate analysis through Cox regression models of the thrombolytic delay, comparing the patients who attended a primary care centre (40, 29.2%) and those who called out a doctor to their home (26, 19.0%) with those who attended hospital (71, 51.8%). The thrombolysis proportions in the groups were analysed with logistic regression. Patients referred from primary care arrived at hospital later than those who attended directly, although a greater thrombolytic delay was only seen in those visited at home (RR 0.25, 95% CI 0.09-0.71). A primary care electrocardiogram (14 patients, 10.2%) reduced the thrombolytic delay (RR 8.81, 95% CI 1.20-64.91) by reducing intra-hospital delay. There were no differences between the groups for the thrombolysis proportion (67 patients, 48.9%). CONCLUSIONS: Patients with infarction seen in primary care reach hospital later. Calling and waiting for the doctor at home increases the thrombolytic delay. An electrocardiogram on the infarction patients who attend a health centre reduces thrombolytic delay by reducing intra-hospital delay.

Retraso trombolítico del infarto de miocardio y atención primaria / Thrombolytic delay in myocardial infarction and primary care

Objetivo. Analizar la influencia de la visita en atención primaria en un centro de salud o en el domicilio y determinar la utilidad del electrocardiograma prehospitalario en el retraso trombolítico del infarto de miocardio. Diseño. Estudio transversal. Emplazamiento. Comarca de la Safor (136.000 habitantes), Valencia (España). Pacientes. Muestra de 137 pacientes ingresados por infarto agudo de miocardio procedentes de la comunidad. Intervenciones. Ninguna. Mediciones y resultados. Análisis multivariante mediante modelos de regresión de Cox del retraso trombolítico comparando los pacientes que acudieron a un centro de atención primaria (40 [29,2 por ciento]) y los que llamaron al médico al domicilio (26 [19,0 por ciento]) con los que acudieron el hospital (71 [51,8 por ciento]). Análisis de la proporción de trombólisis en los grupos mediante regresión logística. Los pacientes remitidos desde atención primaria llegaron más tarde al hospital que los que acudieron directamente, aunque sólo se observó un mayor retraso trombolítico en los visitados en el domicilio (RR 0,25; IC del 95 por ciento, 0,09-0,71). La realización de un electrocardiograma en atención primaria (14 pacientes [10,2 por ciento]) redujo el retraso trombolítico (RR 8,81; IC del 95 por ciento, 1,20-64,91) al disminuir el retraso intrahospitalario. No hubo diferencias en la proporción de trombólisis (67 pacientes [48,9 por ciento]) entre los grupos. Conclusiones. Los pacientes con infarto visitados en atención primaria llegan más tarde al hospital. Llamar y esperar al médico en el domicilio incrementa el retraso trombolítico. La realización de un electrocardiograma a los pacientes con infarto que acuden a un centro de salud reduce el retraso trombolítico al disminuir el retraso intrahospitalario (AU)

Effect of hydrocolloid dressings on healing by second intention after excision of pilonidal sinus.

OBJECTIVE: To assess the efficacy of hydrocolloid dressings in wound management after excision of pilonidal sinus. DESIGN: Prospective randomised trial. SETTING: District hospital, Spain. PATIENTS: 38 patients with chronic pilonidal sinus. INTERVENTIONS: Open excision with healing by second intention. Divided into three groups: conventional gauze dressing (control, n = 15), Comfeel (n = 12) and Varihesive (n = 11). MAIN OUTCOME MEASURES: Median healing time, infection rate, intolerance, pain, comfort, ease of management, leakage, and recurrence. RESULTS: Median healing time was 68 days (range 33-168) in the control group, compared with 65 days (range 40-137) in the two hydrocolloid groups combined. There were no differences between the hydrocolloid groups. There were no recurrences during the 74 months of follow-up. A third of the postoperative cultures in the control group grew pathogens compared with 1/23 of the patients treated with hydrocolloid dressings (p = 0.03). This was of no clinical relevance. 14/23 in the hydrocolloid group developed leaks. Pain was significantly less in the first four postoperative weeks among the patients in the hydrocolloid group than in the control group (p < 0.05). CONCLUSIONS: Hydrocolloid dressings lessen pain and increase comfort for patients after excision of pilonidal sinus, though time to healing is no shorten than when a conventional gauze dressing is used.

[Validity of semiquantitative methods of microalbuminuria screening in diabetes mellitus]. / Validez de los métodos semicuantitativos de cribado de la microalbuminuria en la diabetes mellitus.

OBJECTIVE: To analyse the validity of the Micraltest and Microbumintest semi-quantitative methods for microalbuminuria screening in type 2 diabetes mellitus in primary care clinics. DESIGN: Crossover study to validate diagnostic tests. SETTING: Three general practices at an urban health centre. PATIENTS: Consecutive sample of 64 diabetics not dependent on insulin. MEASUREMENTS AND MAIN RESULTS: Each patient's own doctor performed in the consultation the semi-quantitative determinations in a simple sample of the morning's first urine. As standard, a rate of albumin excretion above 20 micrograms/min, determined by immunonephelometry in a 2-hour controlled time sample, was used. The prevalence of Microalbuminuria was 25% (C.I. 95%, 14.4-35.6). The sensitivity of Micraltest was 69% (CI, 42-88), and its specificity 52% (CI, 37-67), corresponding to the cut-off point of 10 mg/L. The sensitivity of Microbumintest was 63% (CI, 36-84), and its specificity 67% (CI, 52-79). The combination of both tests in one sample had 75% sensitivity (CI, 47-92) and 44% specificity (CI, 30-59). Negative predictive values ranged between 84 and 85%. CONCLUSIONS: The semi-quantitative microalbuminuria detection tests are of limited use in the primary care clinic. Their sensitivity and the negative predictive value obtained in an isolated sample do not seem acceptable for a screening method.

[Primary care research in the Valencia community. Original articles published over a 4-year period (1990-1993)]. / Investigaciíon en atención primaria en la Comunidad Valenciana. Artículos originales publicados durante 4 años (1990-1993).

OBJECTIVE: To evaluate the quality of Primary Care (PC) research in the Community of Valencia through research articles. DESIGN: Descriptive study. SETTING: Primary Care in the community of Valencia. PATIENTS AND OTHER PARTICIPANTS: Research articles on PC published 1990-1993 by professionals from the Community of Valencia in: Atención Primaria, Medicina Clínica, Revista Clínica Española and Gaceta Sanitaria. MEASUREMENTS AND MAIN RESULTS: 43 articles published between 1990 and 1993 (6, 6, 9 and 22, respectively) were obtained from the Medline and Indice Médico Español (Spanish Medical Index) bases. Characteristics of the study, authors and bibliographic references were analysed. The greatest number of studies were published in Atención Primaria (81%), making up consistently about 10% of the annual total of articles in this journal. A descriptive design and inferential statistical analysis (comparison of proportions) were mainly used. Average number of authors was 5.14 (C.I. 95%, 4.7 - 5.6). The participation of residents (39%) was greater than that of family doctors and below that of other specialists, suggesting a certain disenchantment with research. The collaboration of different centres (49%) was high, fundamentally Health Centres among themselves and with universities. CONCLUSIONS: PC research in the Community of Valencia appears to be experiencing similar growth to that in the rest of Spain.

[Study of early response to cases of acute myocardial infarction in primary care]. / Estudio de la atención inicial a pacientes con infarto aguto de miocardio en atención primaria.

OBJECTIVE: To discover the present role of Primary Care (PC) in the early response to Acute Myocardial Infarction (AMI) in a health area, defining the diagnostic and therapeutic measures employed and whether these cause delay in thrombolytic treatment. DESIGN: Prospective, observational study of cohorts. SETTING: Casualty departments at the primary and hospital levels. PATIENTS: All AMI patients admitted to the only Intensive Therapy Unit (ITU) in a health area over a three-month period (No. = 28). MEASUREMENTS AND MAIN RESULTS: The patients were divided into two groups, defined by whether they had attended PC or hospital. The time elapsed before ITU admission, and the diagnostic methods and treatments in PC were investigated. Nine patients (32%) attended PC and 19 (67%), hospital. The average delay was 6.7 hours. The percentage of patients who were admitted to the ITU before four hours had elapsed was higher for those who had previously attended PC (p < 0.05; Chi squared, Yates correction). In PC neither ECG, nor anti-aggregants nor analgesics were used in any of the cases. Nitrites were used on 4 patients (44%). CONCLUSIONS: Patients with AMI preferred to go directly to hospital. Initial care in PC did not necessarily lead to any delay in the thrombolysis: indeed it led to a higher percentage of admissions during the first four hours. There was insufficient use of diagnostic procedures and drugs in the initial stage of AMI in PC.