Pathology findings and clinical outcomes after risk reduction salpingo-oophorectomy in BRCA mutation carriers: a multicenter Spanish study

Objective: To determine the incidence of serous tubal intraepithelial carcinoma (STIC) after risk reduction salpingo-oophorectomy(RRSO), and to describe oncological outcomes after RRSO. Materials and methods: BRCA pathogenic mutation carriers who had undergone an RRSO were evaluated in this retrospective multicenter observational study. Patients were only included when fallopian tubes were analyzed following the protocol for Sectioning and Extensively Examining the FIMbria (SEE-FIM). Surgeries were performed between June 2010 and April 2017 at eight Spanish hospitals.Results: A total of 359 patients met the inclusion criteria. STIC was diagnosed in 3 (0.8%) patients; one of them underwent surgical staging due to positive peritoneal washing, with absence of disease at the final pathology report. None of the three patients received adjuvant chemotherapy and were free of disease at last follow-up. Fallopian tube and ovarian carcinoma were diagnosed in 5 (1.4%) and 1 (0.3%), respectively. At a median (range) follow-up time of 29 (3-92) months, five patients had a newly diagnosed breast cancer. Other types of cancer, which were diagnosed during the follow-up time, included: serous primary peritoneal carcinoma (n = 1), serous endometrial carcinoma (n = 1), colon (n = 1), pancreas (n = 1), jaw (n = 1), and lymphoma (n = 1). Seven patients died due to different types of cancer: breast (n = 4), pancreas (n = 1), jaw (n = 1), and colon (n = 1). Conclusion: The incidence of STIC after RRSO in BRCA mutation carriers is low (0.8%) and it presents an excellent oncological outcome. Patients after RRSO, however, run the risk to develop other types of cancer during follow-up and should be properly advised before the prophylactic surgery

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Pathology findings and clinical outcomes after risk reduction salpingo-oophorectomy in BRCA mutation carriers: a multicenter Spanish study.

OBJECTIVE: To determine the incidence of serous tubal intraepithelial carcinoma (STIC) after risk reduction salpingo-oophorectomy(RRSO), and to describe oncological outcomes after RRSO. MATERIALS AND METHODS: BRCA pathogenic mutation carriers who had undergone an RRSO were evaluated in this retrospective multicenter observational study. Patients were only included when fallopian tubes were analyzed following the protocol for Sectioning and Extensively Examining the FIMbria (SEE-FIM). Surgeries were performed between June 2010 and April 2017 at eight Spanish hospitals. RESULTS: A total of 359 patients met the inclusion criteria. STIC was diagnosed in 3 (0.8%) patients; one of them underwent surgical staging due to positive peritoneal washing, with absence of disease at the final pathology report. None of the three patients received adjuvant chemotherapy and were free of disease at last follow-up. Fallopian tube and ovarian carcinoma were diagnosed in 5 (1.4%) and 1 (0.3%), respectively. At a median (range) follow-up time of 29 (3-92) months, five patients had a newly diagnosed breast cancer. Other types of cancer, which were diagnosed during the follow-up time, included: serous primary peritoneal carcinoma (n = 1), serous endometrial carcinoma (n = 1), colon (n = 1), pancreas (n = 1), jaw (n = 1), and lymphoma (n = 1). Seven patients died due to different types of cancer: breast (n = 4), pancreas (n = 1), jaw (n = 1), and colon (n = 1). CONCLUSION: The incidence of STIC after RRSO in BRCA mutation carriers is low (0.8%) and it presents an excellent oncological outcome. Patients after RRSO, however, run the risk to develop other types of cancer during follow-up and should be properly advised before the prophylactic surgery.

[Reference values in the usual laboratory data for sub-Saharan immigrants. Importance in the management of infectious diseases]. / Valores de referencia en los datos de laboratorio habituales en inmigrantes subsaharianos. Importancia en el manejo de las enfermedades infecciosas.

BACKGROUND AND AIMS: The progressive increase in the number of immigrants to Spain in recent years has made it necessary for health-care professionals to be aware about the specific characteristics of this population. An attempt is made in this study to define the normal range of common laboratory values in healthy sub-Saharan adults. SUBJECTS AND METHODS: Common laboratory values were studied (blood cell counts, clotting tests and blood biochemistry values) and were measured in 150 sub-Saharan immigrants previously defined as healthy according to a complete health evaluation that included a clinical history, physical examination, serologic tests and study of stool parasites. These results were compared to those from a control group consisting of 81 age-and-sex matched healthy blood donors taken from the Spanish native population. RESULTS: Statistically significant differences were obtained in the following values. Mean corpuscular volume (MCV), red cell distribution width (RDW), total leukocytes, and serum levels of creatinine, uric acid, total protein content, creatin-kinase (CK), aspartate aminotransferase (AST), gamma-glutamyl-transpeptidase (GGT), Immunoglobulin G (IgG) and M (IgM). If evaluated according to the normal values in native people, a considerable percentage of healthy sub-Saharan immigrants would present <> values (with potential clinical relevance) in the following parameters. MCV, RDW, total leukocyte counts and serum levels of CK, IgG and IgM. CONCLUSIONS: A proper interpretation of the common laboratory values in sub-Saharan immigrants, and probably in other foreign collectives, requires a previously-established range of normality in these parameters for those populations in order to avoid diagnostic mistakes and inadequate work-up and management.

Valores de referencia en los datos de laboratorio habituales en inmigrantes subsaharianos. Importancia en el manejo de las enfermedades infecciosas / Reference values in the usual laboratory data for sub-Saharan immigrants. Importance in the management of infectious diseases

Fundamento y objetivos. El incremento progresivo del número de inmigrantes en España en los últimos años ha obligado a los profesionales sanitarios a considerar las características específicas de esta población. En este estudio se intentan determinar los valores normales de los inmigrantes procedentes del África subsahariana en los valores analíticos solicitados con mayor frecuencia en la práctica clínica. Sujetos de estudio y métodos. Se estudiaron los valores habituales de laboratorio (hemograma, pruebas de coagulación y estudios bioquímicos sanguíneos) en 150 inmigrantes previamente definidos como sanos tras efectuar un examen de salud que incluía una historia clínica protocolizada, estudios serológicos y estudio coproparasitario. Estos datos se compararon con los de un grupo control de 81 donantes sanos, de edad y sexo similares, de población autóctona. Resultados. Se encontraron diferencias estadísticamente significativas entre ambos grupos en la determinación de volumen corpuscular medio(VCM), amplitud de distribución eritrocitaria, leucocitos totales, creatinina, ácido úrico, proteínas totales, creatin quinasa (CK), aspartato aminotransferasa, gamma glutamil transpeptidasa, inmunoglobulinas G y M (IgG, IgM). Teniendo en cuenta los valores de referencia, un porcentaje significativo de personas subsaharianas sanaspresentarían valores «anormales» en las siguientes magnitudes: VCM, ADE, leucocitos totales proteínas totales, CK, IgG e IgM. Conclusiones. La valoración de los datos de laboratorio en la población subsahariana, y posiblemente en otros grupos de inmigrantes, requiere establecer previamente el rango de normalidad adecuado para evitar errores diagnósticos y actitudes terapéuticas erróneas (AU)

Background and aims. The progressive increase in the number of immigrants to Spain in recent years has made it necessary for health-care professionals to be aware about the specific characteristics of this population. An attempt is made in this study to define the normal range of common laboratory values in healthy sub-Saharan adults. Subjects and methods. Common laboratory values were studied (blood cell counts, clotting tests and blood biochemistry values) and were measured in150 sub-Saharan immigrants previously defined as healthy according to a complete health evaluation that included a clinical history, physical examination, serologic tests and study of stool parasites. These results were compared to those from a control group consisting of 81 age-and-sex matched healthy blood donors taken from the Spanish native population. Results. Statistically significant differences were obtained in the following values. mean corpuscular volume (MCV), red cell distribution width (RDW), total leukocytes, and serum levels of creatinine, uric acid, total protein content, creatin-kinase (CK), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase(GGT), Immunoglobulin G (IgG) and M(IgM). If evaluated according to the normal values in native people, a considerable percentage of healthy sub-Saharan immigrants would present «abnormal» values (with potential clinical relevance) in the following parameters. MCV, RDW, total leukocyte counts and serum levels of CK, IgG and IgM. Conclusions. A proper interpretation of the common laboratory values in sub-Saharan immigrants, and probably in other foreign collectives, requires a previously-established range of normality in these parameters for those populations in order to avoid diagnostic mistakes and inadequate work-up and management (AU)

Estudio retrospectivo de 49 pacientes con parálisis braquial obstétrica: factores de riesgo, incidencia y evolución / Retrospective study of 49 patients with obstetric brachial palsy: risk factors, incidence and evolution

Introducción. La parálisis braquial obstétrica (PBO) es la lesión del plexo braquial en el período neonatal asociada al parto. Objetivos. Conocer la incidencia de PBO en los niños nacidos en el Hospital Materno Infantil de Canarias en los últimos 5 años, estudiar los factores de riesgo de embarazo y parto asociados, revisar la literatura comparando los resultados obtenidos y seguir la evolución de los pacientes. Método. Estudio observacional retrospectivo de todos los pacientes afectos de PBO nacidos entre enero de 2000 y diciembre de 2004. Se recogieron datos de la madre, del recién nacido, tipo de parto y de la lesión, que fueron comparados con el resto de los partos. Análisis estadístico: programa informático SPSS versión 13.0. Se halló la incidencia de PBO por mil nacidos con intervalos de confianza del 95 %. Se analizaron por separado los niños afectos de PBO transitoria (curación antes del año) de los niños afectos de PBO permanente (persistencia al año). Resultados. Se diagnosticaron 49 pacientes afectos de PBO. La incidencia fue de 1,23 ‰. Se encontraron resultados significativos entre la incidencia de PBO y el alto peso al nacimiento, el uso de fórceps, la existencia de test de Apgar y pH inferior al habitual. A los 12 meses un 86 % de los pacientes presentaban movilidad simétrica. Conclusiones. La PBO está relacionada con los factores de riesgo habituales. Los resultados son similares a los encontrados en la literatura. El control de los niños con PBO es primordial para minimizar la aparición de secuelas

Introduction. Obstetric brachial palsy (OBP) is a lesion of the brachial plexus during the neonatal period associated to delivery. Objectives. Know the incidence of OBP in children born in the Materno Infantil University Hospital of the Canary Islands in the last 5 years, study the risk factors of pregnancy and delivery associated to OBP, make a review of the literature in order to compare the results obtained and follow the patient’s evolution. Method. Observational retrospective study of all patients affected by OBP born at our hospital between January 2000 and December 2004. Data of the mother, newborn, type of delivery and lesion were recorded and compared with the rest of deliveries. Statistical analysis: we used the SPSS 13.0 program. Results are expressed as incidence of OBP per thousand, with confidence intervals at 95 %. In addition, children affected by a transitory OBP (those who had been cured before one year) were analyzed separately from those affected by a permanent OBP (with clinical affectation persisting one year later). Results. A total of 49 patients affected by OBP were diagnosed. Incidence was 1.23 ‰. Statistically significant results were found between OBP incidence and high birth weight, use of forceps and the existence of Apgar’s test and pH with lower than usual scores. At 12 months 86 % of the patients presented symmetric mobility. No cases of distal palsies were found. Conclusions. Brachial plexus lesions are related to the common risk factors. The results are similar to those found in the literature. Control of children with OBP is essential to minimize the appearance of sequelae

Fetos siaameses cefalópagos-toracópagos en gestación triple / Cephalopagus and throacopagus conjoined twins in a triple pregnancy

Describimos un caso de gestación triple complicada con fetos siameses diagnosticada por un estudio ecográfico durante el primer trimestre. En la revisión bibliográfica posterior se encontraron otros 11 casos diferentes publicados. Se trata de una extraña condición, la presentación de siameses en un embarazo triple, lo que supone un importante reto para el obstetra en cuanto a su diagnóstico y manejo. El diagnóstico preciso de la corionicidad en estos casos tiene un papel fundamental en determinar el manejo y resultado de esta entidad (AU)

The report a case of conjoined twins complicating a triplet pregnancy diagnosed by two-dimensional ultrasound in the first trimester of pregnancy and a review of the literature is done to revealed other 11 cases diagnosed prenatally by ultrasound. The rare condition of conjoined twins in a triplet pregnancy poses a significant obstetric challenge from both diagnostic and management points of view. Accurate determination of chorionicity in these cases plays a critical role in determining management and outcome (AU)