Sistema de soporte a la toma de decisiones clínicas: monitorización farmacocinética integrada en la historia clínica electrónica / No disponible

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Role of lymphadenectomy in endometrioid endometrial cancer.

OBJECTIVE: To assess the risk factors associated with node involvement. STUDY DESIGN: In the period 1990-2008 a total of 265 endometrial cancers were treated in the Institut Universitari Dexeus. We analysed the rate of myometrial invasion, tumour grade, histological type and node involvement. RESULTS: Overall, 86% of tumours were endometrioid, 5.3% papillary serous, 4.9% mixed and 2.6% endometrial stroma sarcoma. Among those with endometrioid histology, lymphadenectomy was not performed (NL) in 85 cases (37.2%), whereas pelvic lymphadenectomy (PL) or pelvic and aortic lymphadenectomy (PAL) was carried out in 84 (36.84%) and 59 patients (25.87%), respectively. In NL patients the overall disease-free survival (DFS) rate at five years was 92.8%. In the PL group, node involvement was observed in 2.4% of cases and the five-year DFS rate was 92.3%. Among PAL patients, 18.6% showed node involvement (72.7% positive pelvic nodes and 63.6% aortic). Aortic involvement was present in 5.9% of cases when there was no pelvic disease, whereas in the presence of positive pelvic nodes the rate of aortic involvement was 50%. The DFS rate at five years was 93.6%. Referring to the risk factors, when infiltration was > 50% of the myometrium, lymph node involvement occurred in 37% of cases and G3 tumors in 45.5%. CONCLUSIONS: Node involvement is more commonly observed in cases with > 50% myometrial invasion and G3, accounting for 25% of cases that can be considered as at-risk patients. When node involvement is present it is equally distributed between the pelvic and aortic levels. As node involvement is a predictive factor for distant metastasis, the 25% of patients considered to be at risk should undergo pelvic and aortic lymphadenectomy

[The suprahyoid muscles and functional appliances]. / Muscles sus-hyoïdiens et appareils fonctionnels.

Once it is reviewed orthodontic literature about functional appliances ways of acting, there is exposed another factor that could influence mandibular growth, that is suprahyoidic muscles. Depending on their balance or unbalance they will increase or decrease growth. This is an hypothesis because experimental evidence is difficult. Physiology of the muscles is commented. There are also described their functions and their undoubtable relationship with the tongue. The conclusion is that from the therapeutic point of view this muscles can be adjusted with tongue re-education or using functional appliances with advanced jaw position in the constructive bite. Finally, three cases are exposed, studying what has happened to hyoidic bone once the treatment has been performed.