Cancer-related fatigue and its determinants in a cohort of women with breast cancer: the DAMA Cohort.

Cancer-related fatigue (CRF) is one of the most prolonged discomforts suffered by people who have had cancer. Seventy-eight to ninety-six percent of cancer patients experience fatigue, especially while undergoing treatment. CRF is related to insomnia, anxiety, depression, and also varies depending on age. However, little is known about the factors contributing to CRF and better understanding of determinants of CRF makes it easier to identify early patients at risk and in designing intervention planning. The aim of this study was to assess the influence of precipitating factors (diagnosis of breast cancer and other clinical aspects) and perpetuating factors (social network, quality of life, mental disorders) on the presence of chronic fatigue in women from our cultural context, by social class each other determinants. METHODS: It was carried out a mixed cohort study (prospective and retrospective) using a convenience sample of women diagnosed with breast cancer. The information sources were data from the Brief Fatigue Inventory questionnaire and hospital medical records. The dependent variable was fatigue and the independent variables were age, social class, time since diagnoses, cohabitation, comorbidity, relapse, body mass index, mental health (anxiety and depression), social network, social support, and quality of life. RESULTS: Seventy-two percent of the women in the DAMA cohort reported moderate to severe fatigue. Risk of suffering from severe fatigue was greatest among individuals with low social class, those aged under 50 years, those with chronic disorders who had relapsed, and those with symptoms of anxiety and depression. In our study, CRF did not appear to be related to the stage of the cancer at diagnosis, or to the time since diagnosis. CONCLUSIONS: CRF is an element that the professionals responsible for the control and monitoring of women should take into account as another element to be taken into consideration.

Radioactive and non-radioactive seeds as surgical localization method of non-palpable breast lesions.

The increasingly early diagnosis of breast disease and the more widespread use of primary systemic therapy leads to an increasing number of surgeries for non-palpable breast lesions (NPL) in clinical practice. Breast-conserving surgery often requires the use of an image-guided preoperative localization procedure, in which a device is placed within the lesion to be removed to guide the surgeon during surgery. These are patients with small, non-palpable tumors detected in the population screening mammogram, cases with significant reduction of the lesion after neoadjuvant chemotherapy and sometimes it is even necessary to mark axillary lymphadenopathies prior to systemic treatment. For decades, wire localization has been the standard for preoperative marking in breast cancer. Due to the external component of this device, extreme care must be taken not to alter its position before surgery, which is why it is placed hours before surgery and entails complex and limited flexibility in surgical programming. Intraoperative ultrasound improves this drawback but has the limitation that it can only be performed in those NPLs that have ultrasound translation. The Radioguided Occult Lesion Localization (ROLL) technique, although it is another alternative adopted by many institutions, is not without complications, among which the possibility of diffusion of the radiotracer into healthy tissue stands out. To overcome these problems, more recently, 125I radioactive seeds began to be used. Subsequently, thanks to technological advances, non-radioactive seed alternatives such as radar reflectors, magnetic seeds and radio frequency markers have emerged. These locating devices can be placed days before surgery, avoiding wire-related problems and complications. They are introduced percutaneously and identified intraoperatively using a detector device. There is no perfect intraoperative localization method for NPL excision, but fortunately, we have multiple techniques with different advantages and disadvantages that must be assessed and adapted to the center's own resources, the type of surgery, and always to the benefit of the patient.

Multiparametric MR imaging to assess response following neoadjuvant systemic treatment in various breast cancer subtypes: Comparison between different definitions of pathologic complete response.

OBJECTIVES: To validate the performance of multiparametric magnetic resonance (MR) imaging to assess pathologic response to neoadjuvant systemic therapy (NST) in various breast cancer subtypes considering two definitions of pCR: absence of any residual invasive cancer or DCIS (ypT0) and absence of invasive tumour cells (ypT0/is). METHODS: Institutional review board-approved retrospective study, with waiver of the need to obtain informed consent. From January 2015 to June 2017, 81 women with 82 breast cancers undergoing NST were included. Eighteen lesions (22%) were immunohistochemically HER2-positive, 12 (15%) triple negative (TN), 42 (51%) luminal B-like and 10 (12%) luminal B-like/HER2-positive. Breast MR imaging was performed before and after NST. A comparative analysis considering pCR as ypT0 and ypT0/is was carried out. Performance of univariate and multivariate models to potentially predict pathologic response were evaluated. RESULTS: ypT0 was attained in 23% (19/82) of cases and ypT0/is in 33% (27/82) of cases. In both scenarios, HER2-positive subtype achieved the best response, 53% and 48%, respectively. A significant relationship was found between late enhancement and pathologic response (p < 0.001) regardless of pCR definition. In the ypT0 scenario, mean ADC ratio in the pCR subgroup was significantly higher than that in the non-pCR subgroup (p = 0.021) but no significant relationship was noted in ypT0/is. A multivariate model including MR late enhancement, ADC ratio and tumor subtype identified pathologic response with 86% and 84% accuracy when ypT0 and ypT0/is were considered, respectively. CONCLUSION: MR imaging late enhancement and ADC ratio along with breast cancer IHC subtype identify pathologic response following NST with high accuracy, achieving the highest NPV in TN and HER2-positive tumors and the highest PPV in luminal B-like subtypes, regardless of the definition of pCR as ypT0 or ypT0/is. In light of these findings and given that residual DCIS does not have an impact on survival rates, ypT0/is seems to be the preferable definition of pCR.

Anxiety and depression in women with breast cancer: Social and clinical determinants and influence of the social network and social support (DAMA cohort).

BACKGROUND: Anxiety and depression are the most prevalent mental health pathologies among women with breast cancer. Social, clinical and contextual variables may influence emotional stress among women with breast cancer. The aim of this work is to study anxiety and depression in a cohort of women diagnosed with breast cancer between 2003 and 2013 in Barcelona. We evaluate social and clinical determinants. METHODS: We performed a mixed cohort study (prospective and retrospective) using a convenience sample of women diagnosed with breast cancer. The information sources were the Hospital Anxiety and Depression questionnaire and hospital medical records. Dependent variables were anxiety and depression; independent variables were social class, age, employment status, tumour stage at diagnosis, time since diagnosis, social network and social support. We performed a descriptive analysis, a bivariate analysis, and a multivariate logistic regression analysis. RESULTS: A total of 1086 (48.6%) women had some degree of anxiety-related problem. As for depression. In the case of depression, 225 (15%) women had some degree of depression-related problem. Low emotional support and social isolation were clear risk factors for having more anxiety and depression. Low social class was also a risk factor, and age also played a role. DISCUSSION: Our results show that women long period of cancer survival have high prevalences of anxiety than depression, and this prevalence of anxiety is higher than the general population. In addition, we found inequalities between social classes and the isolation and social support are worse too in low social class.

Semillas radiactivas y no radiactivas como método de localización quirúrgica de las lesiones mamarias no palpables / Radioactive and non-radioactive seeds as surgical localization method of non-palpable breast lesions

El diagnóstico cada vez más precoz de la enfermedad mamaria y el uso más extendido del tratamiento sistémico primario conlleva en la práctica clínica un creciente número de cirugías de lesiones mamarias no palpables (LMNP).La cirugía conservadora de la mama requiere a menudo la utilización de un procedimiento de localización preoperatorio guiado por imagen, en el cual se coloca un dispositivo en el interior de la lesión a extirpar para guiar al cirujano durante la cirugía. Se trata de pacientes con tumores pequeños, no palpables, detectados en la mamografía de cribado poblacional, casos con significativa reducción de la lesión tras la quimioterapia neoadyuvante e incluso en ocasiones es necesario el marcaje de adenopatías axilares previo al tratamiento sistémico.Durante décadas, la localización con arpón ha sido el estándar para el marcaje preoperatorio en cáncer de mama. Debido al componente externo del arpón, se debe extremar el cuidado de no alterar su posición antes de la cirugía, por lo que se coloca horas antes de la cirugía y conlleva una compleja y limitada flexibilidad de programación quirúrgica.La ecografía intraoperatoria subsana este inconveniente, pero tiene la limitación de que únicamente va a poder realizarse en aquellas LMNP que tienen traducción ecográfica. La técnica Radioguided Ocult Lesión Localization (ROLL), si bien es otra alternativa adoptada por muchas instituciones, no está exenta de complicaciones, entre las que destaca la posibilidad de difusión del radiotrazador hacia el tejido sano.Para solventar estos inconvenientes, más recientemente, se comenzaron a utilizar las semillas radiactivas de 125I. Posteriormente, gracias a los avances tecnológicos, han surgido alternativas de semillas no radiactivas como los reflectores de radar, las semillas magnéticas y los marcadores por radiofrecuencia. Estos dispositivos de localización se pueden colocar días antes de la cirugía

The increasingly early diagnosis of breast disease and the more widespread use of primary systemic therapy leads to an increasing number of surgeries for non-palpable breast lesions (NPL) in clinical practice.Breast-conserving surgery often requires the use of an image-guided preoperative localization procedure, in which a device is placed within the lesion to be removed to guide the surgeon during surgery. These are patients with small, non-palpable tumors detected in the population screening mammogram, cases with significant reduction of the lesion after neoadjuvant chemotherapy and sometimes it is even necessary to mark axillary lymphadenopathies prior to systemic treatment.For decades, wire localization has been the standard for preoperative marking in breast cancer. Due to the external component of this device, extreme care must be taken not to alter its position before surgery, which is why it is placed hours before surgery and entails complex and limited flexibility in surgical programming.Intraoperative ultrasound improves this drawback but has the limitation that it can only be performed in those NPLs that have ultrasound translation. The Radioguided Occult Lesion Localization (ROLL) technique, although it is another alternative adopted by many institutions, is not without complications, among which the possibility of diffusion of the radiotracer into healthy tissue stands out.To overcome these problems, more recently, 125I radioactive seeds began to be used. Subsequently, thanks to technological advances, non-radioactive seed alternatives such as radar reflectors, magnetic seeds and radio frequency markers have emerged. These locating devices can be placed days before surgery, avoiding wire-related problems and complications. They are introduced percutaneously and identified intraoperatively using a detector device.There is no perfect intraoperative localization method for NPL excision, but fortunately, we have multiple techniques

[Obliterating bronchiolitis with organized pneumonia. Experience in a general hospital]. / Bronquiolitis obliterante con neumonía organizada. Experiencia en un hospital general.

Bronchiolitis obliterans with organizing pneumonia (BOOP) is a histopathologic entity that has been described in association with numerous clinical conditions. In the 1980s an idiopathic form was described as a definite clinicopathologic entity differentiated from other infiltrative pulmonary processes. We present 7 patients diagnosed of BOOP over the past 6 years and discuss their clinical and radiologic signs as well as their response to steroid treatment. Our patients' evolution was subacute, cough and fever being the main symptoms. Lung function tests revealed a pattern that was predominantly restrictive. Radiology showed 1 or several alveolar infiltrates in all patients; these were migratory in 3. Bilateral pleural effusion with marked eosinophilia in pleural fluid was observed in 1 patient. In another cavitated nodules were present in chest-X-ray, with no evidence of vasculitis in tissue examination. All patients were treated with steroids (mean 10 months) and a low maintenance dose was required in only 1. The remaining patients experienced full recovery.

[Nosocomial legionellosis: study of 51 cases]. / Legionelosis nosocomial: estudio de 51 casos.

We report the features of 51 cases of hospital-acquired Legionella pneumophila pneumonia (HLP), diagnosed in our hospital during a period of about 5 years. Mean age was 64.6 years, and the male:female ratio 1.6. 29% of HLP involved patients who were not admitted to the hospital at the time of diagnosis. The monthly distribution showed a maximal incidence in July and August. Only 6% of cases involved patients without underlying diseases. The most common underlying diseases were chronic obstructive lung disease (COLD) (37%), heart disease (29%) and immunosuppressant therapy (29%). 21% of the patients with renal transplant had HLP. The only constant clinical feature was fever of 37.8 degrees C or higher. During the first 24-48 hours of illness, respiratory symptoms were not present in 41% of cases, and thoracic abnormalities in the physical examination were not present in 31%. The laboratory abnormalities were nonspecific and with incidence rates lower than 50%. In 41% of patients there was hypoxemia (60 mmHg or lower) with FiO2 of 0.21. The most common radiological finding was the initial unilateral and unilobar involvement. Pleural effusion and cavitation developed in 20% and 4%, respectively. Overall mortality rate was 12%. In the 43 patients treated early with intravenous erythromycin, mortality rate was 7%. We think that the relatively low incidence of severe underlying immunosuppression and the inclusion of hospital-acquired pneumonia in our institution influenced the low mortality rate of the present study, in contrast with other series of hospital-acquired legionellosis.

[Intercostal neurofibroma in a patient with von Recklinghausen's disease. Diagnostic utility of helical CT and nuclear magnetic resonance]. / Neurofibroma intercostal en paciente con enfermedad de Von Recklinghausen. Utilidad diagnóstica de la TC helicoidal y la RNM.

A 44 year-old man with a type I Neurofibromatosis (NFI) and an intercostal mass is presented. By means of percutaneous fine needle aspiration punction under CT control, this tumor could be diagnosed of neurofibroma. It is important to remark not only the role of helical CT with anatomical reconstruction in the diagnosis of intercostal tumors, but also that intercostal location of neurofibromas has been rarely reported in the literature. Because of frequent association between NFI and neoplasms, it is always necessary to perform histological study of every new tumor that appears in the course of this entity.

[Respiratory muscle involvement in systemic lupus erythematosus: retracted lung syndrome]. / Afección muscular respiratoria en el lupus eritematoso sistémico: síndrome del pulmón retraído.

We describe a case of the Syndrome of Retracted Lung (SRL), a very rare entity which is part of the respiratory pathology that may be seen in the Lupus Erithematosus Systemic (LES). Detailed clinical data are presented and general relevant aspects related to this type of lupidic manifestation are reviewed.

[Ultrasound-guided posterior approach to block the sciatic nerve at the popliteal fossa]. / Bloqueo poplíteo posterior guiado por ecografía.

The recent introduction of ultrasound guidance for locating peripheral nerves and nerve plexi has allowed injection of anesthetic agents to block the sciatic nerve at the popliteal fossa proximal to division, thus preventing damage to adjacent structures, repeated punctures, and multiple nerve stimulations to verify anesthetic diffusion around the nerve. We report the case of a 23-year-old man, ASA I, who underwent reduction and osteosynthesis of a fractured right fibula. Ultrasound was used to guide the needle after identification of the sciatic nerve 10 cm from the knee fold and 3.5 cm deep. When the point of the needle was near the nerve, the nerve stimulator was switched on to 0.5 mA, and when no response was obtained the current was increased to 1.5 mA. The needle was moved slightly (1-2 mm) to produce a plantar flexion (tibial component) that persisted until stimulation had been reduced to 0.4 mA, at which time 30 mL of 1.5% mepivacaine was injected. The sonographic image during injection showed that the anesthetic had surrounded the nerve (donut sign). The motor and sensory block of the sciatic nerve was complete and no adverse events occurred during or after surgery. We conclude that the combination of ultrasound guidance and nerve stimulation allows the sciatic nerve to be located easily. The approach to the point before division of the sciatic nerve can be guaranteed so that puncture of neighboring vessels can be avoided and optimal anesthesia provided.

[Is the routine chest radiography following thoracentesis necessary?]. / ¿Es necesaria la práctica sistemática de radiografía de tórax postoracocentesis?

OBJECTIVES: To assess the routine indication of chest roentgenogram after thoracentesis in function of iatrogenic pneumothorax causation, following a procedure protocol. PATIENTS AND METHODS: Prospective study of 104 consecutive thoracentesis procedures performed in 76 patients. The procedure was protocolized and after each thoracentesis a chest roentgenogram was obtained within 6 hours after the procedure. The attending physician completed a questionnaire relative to patients data characteristics of the pleural effusion. RESULTS: Two pneumothorax were noted following thoracentesis (2%) which did not require pleural drainage. These pneumothorax occurred in patients with parapneumonic pleural effusions. CONCLUSIONS: The routine practice of chest roentgenogram after thoracentesis does not seem to be warranted and should be individualized. The performance of thoracentesis by physicians in training period, with procedure protocolization, minimizes the risk of pneumothorax.

Punción intraneural del nervio ciático en la región poplítea. Demostración mediante el uso de la ecografía / No disponible

No disponible

¿Es necesariala práctica sistemática de radiografía de tórax postoracocentesis? / Is the routine chest radiography following thoracentesis necessary?

Objetivos. Valorar la indicación sistemática de radiografía de tórax postoracocentesis en función de la incidencia de neumotórax yatrógeno tras protocolización de la técnica. Pacientes y métodos. Estudio prospectivo de 104 toracocentesis consecutivas en 76 pacientes. Se protocolizó la técnica y tras cada toracocentesis se practicó radiografía de tórax en las 6 horas siguientes. Cada facultativo completó una recogida de los datos de cada paciente y características del derrame pleural. Resultados. Se constataron 2 neumotórax secundarios a toracocentesis (2 por ciento) que no precisaron drenaje torácico. Éstos aparecieron en pacientes con derrame pleural paraneumónico. Conclusiones. La práctica sistemática de radiografía de tórax postoracocentesis no parece justificada y ha de individualizarse. La realización de toracocentesis por médicos en formación supervisados por facultativos expertos, con protocolización de la técnica, minimiza el riesgo de neumotórax (AU)