Biopsia del ganglio centinela y disección axilar dirigida en mujeres con cáncer de mama y axila positiva en el momento del diagnóstico: caminando hacia el futuro / Sentinel node biopsy and targeted axillary dissection in women with positive axilla breast cancer at diagnosis: walking into the future

Objetivo: conocer la tasa de concordancia del ganglio marcado con semilla Magseed® con el ganglio centinela marcado mediante tecnecio, en las pacientes con enfermedad ganglionar en el momento del diagnóstico que han recibido tratamiento neoadyuvante. Pacientes y métodos: estudio descriptivo retrospectivo de 44 mujeres diagnosticadas de carcinoma de mama estadios cT1-4/cN1/cM0, que recibieron quimioterapia neoadyuvante entre enero 2016 y diciembre 2020, y que tras una reevaluación radiológica se realizaron una cirugía mamaria con ganglio centinela en el Hospital General Universitario de Alicante. En las pacientes cN1 con respuesta radiológica axilar completa, la detección del ganglio centinela se llevó a cabo mediante doble técnica, extrayéndose por lo menos 3 ganglios. Además, se realizó una disección axilar dirigida mediante semilla magnética Magseed®, para su correcta localización y escisión. Resultados: la tasa de concordancia al realizar la disección axilar dirigida fue del 93,2%. La tasa de respuesta completa tras la quimioterapia neoadyuvante fue del 45,45%. Conclusiones: la disección axilar dirigida mejora la estadificación axilar tras la quimioterapia neoadyuvante, ya que reduce la tasa de falsos negativos respecto a la biopsia selectiva del ganglio centinela de manera aislada. (AU)

Objectives:To know the concordance rate of the ganglion marked with Magseed® with the sentinel node marked by technetium, in patients with limph node disease at diagnosis, that had received neoadjuvant treatment. Patients and methods: Retrospective descriptive study of 44 women, diagnosed with stage cT1-4 / cN1 / cM0 breast carcinoma, who received neoadjuvant chemotherapy between January 2016 and December 2020, and who after radiological re-evaluation, have undergone breast surgery with sentinel node at the General University Hospital of Alicante. In cN1 patients with a complete axillary radiological response, detection of the sentinel node is performed using a double technique, removing at least 3 nodes. In addition, axillary dissection directed by Magseed® magnetic seed is performed, for its correct location and excision. Results: The concordance rate when performing targeted axillary dissection was 93.2%. The complete response rate after neoadjuvant chemotherapy was 45.45%. Conclusions: Targeted axillary dissection improves the axillary staging after neoadjuvant chemotherapy, since it improves the false negative rate with respect to sentinel lymph node biopsy in isolation. (AU)

Presence of human papillomavirus DNA in breast cancer: a Spanish case-control study.

BACKGROUND: Breast cancer is one of the most important neoplasia among women. It was recently suggested that biological agents could be the etiological cause, particularly Human Papilloma Virus (HPV). The aim of this study was to explore the presence of HPV DNA in a case-control study. METHODS: We performed our study including 251 cases (breast cancer) and 186 controls (benign breast tumors), using three different molecular techniques with PCR (GP5/GP6, CLART® and DIRECT FLOW CHIP®). RESULTS: HPV DNA was evidenced in 51.8% of the cases and in 26.3% of the controls (p < 0.001). HPV-16 was the most prevalent serotype. The odds ratio (OR) of HPV within a multivariate model, taking into account age and breastfeeding, was 4.034. CONCLUSIONS: Our study, with methodological rigour and a sample size not previously found in the literature, demonstrate a significant presence of HPV DNA in breast cancer samples. A possible causal relationship, or mediation or not as a cofactor, remains to be established by future studies.

Acute genital ulcers.

Acute genital ulcers, also known as acute vulvar ulcers, ulcus vulvae acutum or Lipschütz ulcers, refer to an ulceration of the vulva or lower vagina of non-venereal origin that usually presents in young women, predominantly virgins. Although its incidence is unknown, it seems a rare entity, with few cases reported in the literature. Their aetiology and pathogenesis are still unknown. The disease is characterised by an acute onset of flu-like symptoms with single or multiple painful ulcers on the vulva. Diagnosis is mainly clinical, after exclusion of other causes of vulvar ulcers. The treatment is mainly symptomatic, with spontaneous resolution in 2 weeks and without recurrences in most cases. We present a case report of a 13-year-old girl with two episodes of acute ulcers that fit the clinical criteria for Lipschütz ulcers.

Prenatal diagnosis of a female fetus with ring chromosome 9, 46,XX,r(9)(p24q34), and a de novo interstitial 9p deletion.

Ring chromosomes are circular structures formed as a result of breaks in the chromosome arms and the fusion of the proximal broken ends with a loss of distal material, or by fusion of dysfunctional telomeres without any loss. The mechanism underlying this process has not yet been sufficiently explained. Commonly, rings occur as acquired genetic abnormalities; however, sometimes they are found as constitutional aberrations with a prevalence of around 1:50,000 live births. Here, we present a new case of r(9) in a female fetus with intrauterine growth retardation and slight craniofacial dysmorphisms. Both parents had a normal phenotype. Amniotic fluid karyotype showed r(9)(p24q34). An array CGH revealed 3 deletion segments: a ring chromosome with a 2.57-Mb deletion at 9pterp24.2 (chr9:163,131-2,729,722), a 2.60-Mb deletion at 9q34.3qter (chr9:138,523,302-141,122,055), and also a 0.15-Mb interstitial deletion at 9p24.1 (chr9:5,090,443-5,235,765). These deletions overlap with proposed regions for the 9p24.3 deletion and Kleefstra syndrome. Segregation analysis revealed a maternal origin of the rearranged chromosome. We conclude that both the ring chromosome and the interstitial deletion occurred de novo. This last deletion has not been reported before. Prenatal array CGH, combined with fine mapping of breakpoints contributes to the assessment of genotype-phenotype correlations.

Prenatal diagnosis of caudal dysplasia sequence associated with undiagnosed type I diabetes.

Caudal regression or caudal dysplasia sequence (CDS) is a rare congenital malformation, which includes a wide spectrum of musculoskeletal abnormalities involving the lumbosacral spine, pelvis and lower limbs. It can be associated to visceral defects in various degrees. Maternal diabetes, genetic predisposition and vascular hypoperfusion have been suggested as possible causative factors. Women with diabetes who are dependent on insulin are 200-400 times more likely to have a child with caudal regression, making CDS the most characteristic fetal abnormality of diabetic embryopathy. Prenatal diagnosis is possible by ultrasonographic examination. The sonographic findings include abrupt interruption of the lumbar spine and 'Buddha or frog position' of the lower limbs. MRI has demonstrated the level of the vertebral anomalies as well as the associated abnormalities and this is crucial because the prognosis of this condition depends on the severity of the lesion and the presence of associated disorders.

Métodos anticonceptivos ¿Cuáles se utilizan realmente? / Anticonceptive methods What are actually used?

Objetivo: Obtener información acerca de los métodos anticonceptivos utilizados por nuestras usuarias en el momento de la consulta, grado de satisfacción, conocimiento e información recibida respecto al mismo, cumplimiento, embarazos no planificados y otros datos de interés ginecológicos y socio-demográficos. Población, Material y Métodos: Estudio descriptivo, longitudinal y prospectivo basado en los resultados obtenidos de un cuestionario realizado a una muestra de las pacientes (n=87), de entre 16 y 45 años, que acudieron al Servicio de Urgencias Ginecológicas del Hospital General Universitario de Alicante durante el periodo comprendido entre junio 2010 y noviembre de 2011. Resultados: El método anticonceptivo más utilizado por las usuarias encuestadas es el preservativo (88,5%) con un nivel de satisfacción de uso de 6,3, seguido por la píldora ( 75,9% ). El 20,6% (13% ella+ 7,6% familiares y amigos) de las mujeres eligió el método anticonceptivo sin consultar previamente con un profesional sanitario. La edad de inicio de las relaciones coitales fue de 16,9 años. Un 35.6% refería haber tenido al menos un embarazo no planificado y el 70,9% de las mismas refieren haber recurrido a una interrupción legal del embarazo (ILE). El 58,6% (n=51) de las usuarias refieren haber mantenido en alguna ocasión, relaciones sexuales de riesgo. Conclusiones: Consideramos que la educación es el arma principal de la que disponemos los profesionales sanitarios para alcanzar el objetivo que, en esta materia de salud sexual y reproductiva es, evitar embarazos no deseados y que las mujeres y sus parejas puedan disfrutar de una plena y satisfactoria sexualidad a través un adecuado acceso a la planificación familiar (AU)

The aim of this study is to obtain some information about the anticonceptive methods used by our patients in terms of: type, satisfaction, knowledge or information about it, grade of compliance, not desired pregnancy and other data with gynecologist, social or demographic interest. Material and Methods:We conducted a descriptive, prospective and longitudinal study. We ask our patients to complete a questionnaire. A total of 87 women, assisted in the emergency gynecology department at the “Hospital General de Alicante”, participated. Women were aged between 16 and 45 years old, from June 2010 and November 2011. Results: The most employed anticonceptive method among our patients is the preservative (88,5%), which satisfaction level was 6,3 , followed by the contraceptive pill (75,9%). 20,6% of women selected the anticonceptive method without consulting a health worker. Sexual relationships beginning. The mean age of coital debut was 16,9 years old. A 35,6% have had an unplanned pregnancy and a 70,9% a legal abortion. A 58,6% (n = 51) of patients declared a sexual risk behaviour at least once. Conclusion: Education is the most powerful weapon of health workers to achieve the most important objective in sexual matter, to avoid unplanned pregnancies. Women and their partners must enjoy a satisfactory sex life through an adequate upon family planning (AU)

Wernicke's encephalopathy induced by hyperemesis gravidarum.

Wernicke's encephalopathy (WE) is a reversible neurological emergency caused by thiamine deficiency. Prolonged vomiting in pregnancy results in thiamine depletion. The early recognition of its clinical signs and symptoms is essential to establish the suspected diagnosis and can be confirmed by MRI. Prompt administration of thiamine is important for preventing the occurrence of sequelae in the mother and for improving the fetal prognostic. We report a case of WE induced by hyperemesis gravidarum with a good maternal and fetal outcome.