Interest of diffusion-weighted echo-planar MR imaging and apparent diffusion coefficient mapping in gynecological malignancies: a review.

Magnetic resonance imaging (MRI) remains the standard modality for the local staging of gynecological malignancies but it has several limitations, particularly for lymph node staging or evaluating peritoneal carcinomatosis. Consequently, there has been a growing interest in functional imaging modalities. Based on molecular diffusion, diffusion-weighted imaging (DWI) is a unique, noninvasive modality that provides excellent tissue contrast and was shown to improve the radiological diagnosis of malignant tumors. Using quantitative apparent diffusion coefficient (ADC) measurement of DWI provides a new tool for better distinguishing malignant tissues from benign tumors. The aim of the present review is to report on the results of DWI for the assessment of patients with gynecological malignancies. An analysis of the literature suggests that DWI studies would improve the diagnosis of cervical and endometrial tumors. It may also improve the assessment of tumor extension in patients with peritoneal carcinomatosis from gynecological malignancies. However, since the signal intensity of some cancers can range from high intensity to low intensity, a degree of uncertainty was demonstrated due to the proximity of the normal uterine myometrium and ovaries. Interestingly, there is also evidence that ADC might improve the follow-up and monitoring of patients who receive anticancer therapies, including chemotherapy or radiation therapy.

Is regional lymph node irradiation necessary in stage II to III breast cancer patients with negative pathologic node status after neoadjuvant chemotherapy?

PURPOSE: Neoadjuvant chemotherapy (NAC) generally induces significant changes in the pathologic extent of disease. This potential down-staging challenges the standard indications of adjuvant radiation therapy. We assessed the utility of lymph node irradiation (LNI) in breast cancer (BC) patients with pathologic N0 status (pN0) after NAC and breast-conserving surgery (BCS). METHODS AND MATERIALS: Among 1,054 BC patients treated with NAC in our institution between 1990 and 2004, 248 patients with clinical N0 or N1 to N2 lymph node status at diagnosis had pN0 status after NAC and BCS. Cox regression analysis was used to identify factors influencing locoregional recurrence-free survival (LRR-FS), disease-free survival (DFS), and overall survival (OS). RESULTS: All 248 patients underwent breast irradiation, and 158 patients (63.7%) also received LNI. With a median follow-up of 88 months, the 5-year LRR-FS and OS rates were respectively 89.4% and 88.7% with LNI and 86.2% and 92% without LNI (no significant difference). Survival was poorer among patients who did not have a pathologic complete primary tumor response (hazard ratio, 3.05; 95% confidence interval, 1.17-7.99) and in patients with N1 to N2 clinical status at diagnosis (hazard ratio = 2.24; 95% confidence interval, 1.15-4.36). LNI did not significantly affect survival. CONCLUSIONS: Relative to combined breast and local lymph node irradiation, isolated breast irradiation does not appear to be associated with a higher risk of locoregional relapse or death among cN0 to cN2 breast cancer patients with pN0 status after NAC. These results need to be confirmed in a prospective study.

¿Es posible tener un incendio en un quirófano? / Is it possible to have a fi re in an operating theatre?

Podemos pensar que un quirófano es el Sancta Sanctorum de un Hospital, el sitio más “seguro” dentro del entorno más controlado, en todos los aspectos.Pero, es un hecho contrastado, aunque no siempre difundido, que los incendios en quirófano existen y suelen ser por causas internas al propio quirófano.Durante una intervención quirúrgica tenemos una posibilidad de sufrir un incendio en el momento más peligroso de la vida de un paciente y crear una situación de emergencia en un área crítica. Los objetivos de esta investigación son:— Incidir en la posibilidad de tener un incendio en quirófano.— Analizar las posibilidades del riesgo.— Detectar conductas y elementos peligrosos.— Analizar las medidas preventivas a adoptar (AU)

We might think that an operating theatre is the sanctum sanctorum of a Hospital. The ‘safest’ place within a very much controlled environment in all aspects.But it is a contrasted fact, although not always published, that fires in operating theatres exist and that they are normally caused by situations in the operating theatre itself. During an operation there is the possibility of having a fire in the most dangerous moment for the life of a patient and in the most critical zones of a hospital.The objectives of this research are the following: — To emphasize the possibility of fire in an operating theatre— To analyse the possibilities of risk— To detect hazardous elements and behaviour— To analyse the preventive measures to be adopted (AU)