Análisis de la variabilidad del resultado del cultivo para «Streptococcus agalactiae» entre la semana 35-37 de gestación y el ingreso en sala de partos / Analysis of the variability of the culture outcome for «Streptococcus agalactiae» between week 35-37 of gestation and admission to delivery

Objetivo: Analizar la variabilidad del resultado del cultivo para Streptococcus agalactiae entre la semana 35-37 de gestación y el ingreso en sala de partos, así como las posibles variables influyentes en este cambio. Metodología: Estudio observacional, descriptivo y transversal. Se realizó un análisis descriptivo e inferencial, uni y bivariante. Técnica de muestreo no probabilística accidental. Resultados: Participaron 304 mujeres gestantes (608 muestras). La prevalencia de S. agalactiae se situó en el 15,1 % (preingreso) y el 15,6 % (ingreso). El 7,2 % de las mujeres (22) presentaron variabilidad de resultado entre el primer y el segundo cultivos. El 4,2 % (8) positivizó y un 3 % (14) negativizó. El 22,9 % (29) de los casos positivos presentaron cepas resistentes a clindamicina.Un antecedente de cultivo positivo aumentó la probabilidad de positividad cuatro veces durante la gestación actual. Los principales factores que influyeron en el cambio del resultado del cultivo aumentando su probabilidad fueron: la etnia (6,155 veces), el primer cultivo positivo (15,203 veces), la presencia de infecciones de transmisión sexual (3,8 veces), la edad (x2 0,005) y el peso (x2 0,044) con resultados estadísticamente relevantes. (AU)

Purpose: To investigate the variability of the culture result for Streptococcus agalactiae between weeks 35-37 of gestation and admissions to the delivery room and the possible variables influencing this change. Material and methods: An observational, descriptive, cross-sectional study of a series of cases was conducted with 304 (608 cultures) pregnant women. An accidental non-probabilistic sampling technique was used. Results: The results’ variability occurred in 7.2% (22) of the sample, where 4% (9) changed from positive to negative, and 26% (14) changed from negative to positive. The prevalence of pregnant women with positive Streptococcus agalactiae was 50 positives in the first culture (15.6%) and 46 (15.1%) in a second time. 4.2% (8) were positive and 3% (14) were negative. 22.9% (29) of the positive cases presented strains resistant to clindamycin.Presenting a history of positive culture in another pregnancy increased the probability of positivity four times during the current pregnancy. Likewise, obtaining a positive result in the first culture registered the probability of continuing to be positive in subsequent determinations in 9.5 times. The presence of a history of sexually transmitted infections increased the probability of suffering a change in result by 3.8 times. (AU)

Infecciones de transmisión sexual e influencia en la positividad y/o modificación del resultado del cultivo para Streptococcus agalactiae durante la gestación / Sexually transmitted infections and influence on positivity and/or modification of culture results for Streptococcus agalactiae during gestation

Objetivo: Analizar la relación entre las infecciones de transmisión sexual (ITS) y la positividad para Streptococcus agalactiae (SGB) y/o la modificación del resultado del cultivo para SGB durante el tercer trimestre de gestación. Metodología: Estudio observacional, descriptivo y transversal de serie de casos en gestantes durante el periodo 2016-2018. Muestreo no probabilístico, accidental consecutivo, con un análisis descriptivo e inferencial y una recogida de datos ambispectiva. Resultados: La muestra del estudio fue de 304 gestantes (608 cultivos). La prevalencia de SGB en gestantes fue de 48 (15,3%). Existió una variabilidad de resultados entre los cultivos de 22 (7,2%). Un total de 25 gestantes (8,2%) presentaron antecedentes de ITS, lo que multiplicó el riesgo en 3,8 veces (p= 0,01) para la modificación y/o positividad del cultivo. No se halló asociación entre el tipo de ITS y el cultivo positivo para SGB y/o modificación de éste. Conclusiones: El estudio actualiza la prevalencia de SGB en nuestro medio en el 15,1-15,6%, y muestra una variabilidad del resultado del cultivo para SGB durante el tercer trimestre de gestación del 7,2%.El antecedente de ITS se asoció con una mayor probabilidad de modificación del cultivo para SGB (p= 0,01), así como de positividad del cultivo para SGB (p= 0,01) durante el tercer trimestre de gestación.Se debería considerar el antecedente de ITS, dada su influencia en el resultado final y/o positividad del cultivo rectovaginal. Se precisarían estudios de mayor amplitud y prospectivos para optimizar el cribado para SGB durante la gestación. (AU)

Objective: To analyze the relationship between sexually transmitted infections (STIs) and positivity for Streptococcus agalactiae (GBS) and/or the modification of the culture result during third trimester of pregnancy.Methodology: Observational, descriptive, cross-sectional study of a series of cases in pregnancy women during the years 2016-2018. Non probabilistic, accidental and consecutive sampling with a descriptive and inferential analysis.Results: The study sample was 304 pregnant women (608 cultures). The prevalence of GBS was 48 (15.3%). There was a variability of results between the cultures of 22 (7.2%). 25(8.2%) of the pregnant women had a history of STIs, multiplying the risk by 3.8 times (p= 0.01) for the modification and/or positivity of the culture. There was no association between the type of STIs and the positive culture for GBS and/or its modification.Conclusions: The study updates the prevalence of GBS in our environment and shows a variability of between 15.1-15.6% and variability for the result of the culture during the third trimester of pregnancy of 7.2%.The history of STI was also associated with a greater probability of modification (p= 0.01) and positivity (p= 0.01) of the culture for GBS during the third trimester of gestation.A history of STI should be considered given its influence on the result and positivity of the vaginal-rectal culture. A larger study is required to optimize screening for GBS in pregnancy. (AU)

El sujetador mamario como herramienta de salud en la mujer / The breast bra as a health tool for women

Objetivo: Estudiar la literatura existente sobre el sujetador mamario como herramienta de bienestar y/o salud en la mujer.Metodología: Revisión bibliográfica en las bases de datos Turning Research Into Practice, Biblioteca Cochrane Plus, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), BMJ Best Practice, Cuiden, Cuidatge y UpToDate en inglés y español de los últimos 10 años. Ultima búsqueda en septiembre de 2021.Resultados: De las 150 referencias bibliográficas halladas, 130 cumplían los criterios de selección. Se seleccionaron 12 artículos: 8 originales, 2 guías de actuación y 2 revisiones sistemáticas. Los principales resultados hacían referencia al dolor de mama y sus causas, procesos dolorosos relacionados con el sujetador y su uso (talla, copa...), situaciones especiales (gestación, lactancia, deportes de impacto o cirugías en la mama), alteraciones biomecánicas e influencia en la calidad de vida relacionada con la depresión y la ansiedad.Conclusiones: No se halló evidencia de que la flacidez de los senos esté causada por no usar sujetador mamario. Tampoco se halló relación entre el uso de sostén y un mayor riesgo de cáncer de mama. Se relacionó el correcto uso del sujetador mamario con mejoras en la mastalgia, alteraciones locales o irradiadas, osteomusculares y nerviosas, alteraciones biomecánicas y del estado de ánimo. Parece que el uso del sujetador es beneficioso en determinadas situaciones, como la gestación y la lactancia, las intervenciones quirúrgicas de la mama y la práctica de deportes de impacto. Se evalúa la prenda del sujetador mamario como una herramienta más de salud en la mujer. (AU)

Objective: To study the existing literature on the bra as a tool for well-being in women.Methodology: Review of the Turning Research into Practice, Cochrane Library Plus, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), BMJ Best Practice and UpToDate databases in English and Spanish for the last 10 years. Last search in September 2021.Results: Of the 150 bibliographic references, 130 met the selection criteria. 12 articles were selected: 8 originals, 2 guidelines for action and 2 systematic review. The main results found were breast pain and causes, painful processes related to the bra, special situations such as pregnancy, lactation or breast surgeries, biomechanical alterations and the influence on quality of life related to depression and anxiety.Conclusions: There is no evidence that sagging breasts are caused by not wearing a bra. Nor is it between wearing a bra and an increased risk of breast cancer. Correct use of the bra was related to improvements in breast pain, biomechanical alterations and mood, breastfeeding, breast surgery and practice of impact sports. The bra garment is evaluated as a health tool in women. (AU)

Utilidad del SPECT-CT en la biopsia del ganglio centinela tras quimioterapia neoadyuvante en cáncer de mama y axila positiva / The usefulness of SPECT-CT in sentinel lymph nodes identification after neoadjuvant chemotherapy in patients with breast cancer and axillary involvement

Objetivo Valorar la utilidad de los estudios híbridos SPECT-CT en la biopsia del ganglio centinela (BGC) post quimioterapia neoadyuvante (QNA) en pacientes cN+. Método Estudio transversal de los resultados obtenidos en un grupo de 25 pacientes tratadas en la Unidad Funcional de Mama del HUGTIP desde marzo de 1918 a septiembre de 2020. La metodología específica para este estudio incluye: 1)ecografía axilar y colocación de marcador ecovisible en el ganglio afecto antes de iniciar la QNA; 2)tras QNA, colocación de marcador ferromagnético (Magseed®) en ganglio marcado previamente (GM); 3)valoración del estado axilar tras la QNA, que incluye estudio linfogammagráfico axilar con SPECT-CT; BGC y exéresis del ganglio marcado (GM) si es distinto al ganglio centinela (GC), y vaciado ganglionar axilar (VGA). Resultados La valoración de los SPECT-CT permitió verificar la coincidencia entre el GM y el GC en 14 casos (56%). En 3 casos no se encontró GC y en 8 casos el marcador magnético no estaba en un GC. La biopsia selectiva de los ganglios (GC y/o GM) fue negativa en 12 pacientes (2 con VGA positivo) y positiva en 13 (4 con VGA positivo). Conclusión El estudio SPECT-CT aportó información adicional sobre la localización y la concordancia del ganglio marcado y el ganglio centinela previa a la cirugía, mejorando la planificación de la misma. (AU)

Objective To evaluate the usefulness of SPECT-CT hybrid studies in the biopsy of sentinel lymph node (SLNB) after neoadjuvant chemotherapy (NAC) in patients with axillary metastatic disease (N+). Methods Cross-sectional study of 25 patients treated in the HUGTIP Breast Functional Unit from March 2018 to September 2020. All patients included in the study were submitted to: (1)axillary ultrasound (US) and US visible marker placement in the affected node before starting the NAC; (2)placement of a ferromagnetic marker in the previously marked lymph node (MLN) after NAC; (3)assessment of axillary status after NAC: it includes SPECT-CT lymphoscintigraphy; SLNB and excision of the MLN whether different from the sentinel lymph node (SLN); and axillary lymph node dissection (ALND). Results In 14 patients (56%) the MLN corresponded with the SLN. In 3 cases it was not possible identify the SLN and in 8 cases the MLN was not a SLN. The biopsy of MLN and SLN was negative for metastasis in 12 patients (2 of them had a positive ALND) and was positive for metastasis in 13 patients (4 of them had a positive ALND). Conclusion The SPECT-CT study provided additional information about the identification and the concordance of the MLN and the SLN improving the surgical planning. (AU)

Advantages of preoperative localization and surgical resection of metastatic axillary lymph nodes using magnetic seeds after neoadjuvant chemotherapy in breast cancer.

PURPOSE: To assess the safety and effectiveness of magnetic seeds in preoperative localization and surgical dissection of metastatic axillary lymph nodes (LN+) in breast cancer patients with axillary involvement, after neoadjuvant chemotherapy (NAC). In addition, to assess the impact of targeted axillary dissection (TAD) in reducing the rate of false negatives (FN) in sentinel lymph node biopsy (SLNB). MATERIALS AND METHODS: A cross-sectional prospective cohort study was conducted from April 2017 to September 2019, including breast cancer patients with axillary lymph node involvement treated with NAC. Prior to NAC, the LN+ were marked by ultrasound-guided clip insertion. After NAC, a magnetic seed (Magseed®) was inserted in the clip-marked lymph node (MLN). During surgery, the MLN was located and removed with the aid of a magnetic detection probe (Sentimag®) and the sentinel lymph node was removed. Axillary lymph node dissection (ALND) was used to determine the rate of FN for SLNB alone and the combination of SLNB and MLN dissection, called TAD. RESULTS: The study included 29 patients (mean age, 55; range, 30-78 years). Selective preoperative localization and surgical dissection were successful for all 30 MLNs (100%). The MLN corresponded to the SLN in 50% of cases. After ALND, there were 21.4% (3/14) FN with SLNB alone and 5.9% (1/17) with TAD. CONCLUSIONS: Following NAC, selective surgical removal of MLN by preoperative localization using magnetic seeds is a safe and effective procedure with a success rate of 100%. Adding TAD reduces the rate of FN associated with SLNB alone.

Pneumoendoscopic single port approach to breast cancer. How we do it?

Endoscopic procedures have not become the gold standard in breast surgery. In order to improve today's outcomes we have developed a pilot study in the Breast Pathology Unit of Hospital Germans Trias i Pujol. A surgical procedure was performed creating a pneumoendoscopic cavity by using a Single Incision Laparoscopic Surgery (Single port) approach with a follow up of four years. Four patients underwent pneumoendoscopic single-port breast surgery receiving skin-sparing quadrantectomy and axillary surgery requiring lymphadenectomy in all of them. All patients had immediate reconstruction with a Latisimus Dorsi flap. No perioperative complications appeared. Mean operative time was 290 min (range 240-315 min) and mean hospital stay was 3,2 days. Surgical margins of all cases were pathologically negative and all patients were disease free after four years of monitoring. All patients were satisfied with the cosmetic outcome in the immediate postoperative and during the follow up. Although all innovative techniques generate hesitation on their beginnings and are liable to improve, we believe that pneumoendoscopic single-port breast surgery can be suitable for breast cancer, offering better cosmetic outcomes with oncological safety.

Anterior intercostal artery perforator flap in immediate breast reconstruction: Anatomical study and clinical application.

BACKGROUND: Although the use of lateral intercostal artery perforator (ICAP) flaps for immediate breast reconstruction has been widely described, data on the use of the anterior ICAP (AICAP) flaps for this indication are limited. In this context, we describe the results of anatomical study and our clinical experience with AICAP flaps for breast reconstruction. METHODS: In this study, the location and characteristics of the AICAPs were dissected in 12 female adult formalin-preserved hemitrunks and two fresh-frozen cadavers. Fourteen patients (mean BMI 23) underwent partial breast resection for a quadrant breast cancer followed by breast reconstruction with an intercostal perforator flap. The mean resection size was 6 × 5 × 5.5 cm (range 3-8 × 3.5-7 × 4-8 cm).The main outcome measures were pre-operative and postradiotherapy health-related quality of life assessed with the BREAST-Q reconstruction survey. RESULTS: According to anatomical study, at least one perforator was found in each third of hemitrunks dissected. The mean of perforator size was in diameter 0.42 ± 0.05 mm and in length 3.1 ± 0.36 cm. In clinical outcomes, the mean of flap size was 16 × 5 × 3 cm (range 14-19 × 3-8 × 2-5 cm). The mean surgical time was 120 min (range 109-125 min). Only one partial flap failure was detected. No postoperative changes in breast size were observed, although soft tissue changes were observed in four patients after radiotherapy. The mean BREAST-Q scores changes were 0 in satisfaction with the breast, 5 in satisfaction with outcome, 0 in psychosocial well-being, 6.15 in sexual well being, and 34.69 in physical well-being. CONCLUSIONS: Based on this anatomical and clinical study, we found AICAP flap has a consistent vascularization with good perforators. And moreover, it is suitable for partial breast reconstruction (quadrantectomy) and does not appear to negatively impact patient satisfaction.

Primary Hormone Therapy in Elderly Women with Hormone-Sensitive Locoregional Breast Cancer: Endocrine Therapy Alone Is a Reasonable Alternative in Selected Patients.

BACKGROUND: Treatment with aromatase inhibitors (AIs) followed by surgery is often recommended for women with locoregional hormone-sensitive breast cancer. However, no study has compared the efficacy of AIs alone versus AIs followed by surgery. METHODS: 33 postmenopausal breast cancer patients were treated with primary hormone therapy. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor type 2 receptor (HER2) expression levels were analyzed by immunohistochemistry. After hormone therapy, eligible patients underwent surgery, and those who were not candidates for surgery continued on hormone therapy. We retrospectively analyzed time to progression, overall survival, response, and impact of surgery on outcome. RESULTS: All patients were ER+. HER2 was successfully analyzed in 30 patients, all of whom were HER2-. The median time to progression was 94 months, and the median overall survival was not reached, while the mean overall survival was 123 months. The overall response rate was 63.6%, with 9.1% complete responses. No significant differences in time to progression or survival were observed between patients who underwent surgery and those who did not. CONCLUSIONS: Primary hormone therapy with AIs is effective in elderly breast cancer patients with high levels of hormone receptors and may provide a feasible and tolerable alternative to surgery in selected hormone-sensitive breast cancer patients.