Contrast-enhanced mammography-guided biopsy: technical feasibility and first outcomes.

OBJECTIVES: To evaluate the feasibility of contrast-enhanced mammography (CEM)-guided biopsy at Hospital del Mar, a Spanish university hospital. METHODS: We retrospectively reviewed all consecutive women with a suspicious enhancing finding eligible for CEM-guided biopsy, who were prospectively enrolled in a pre-marketing clinical validation and feasibility study (October 2019 to September 2021). CEM-guided biopsy is a stereotactic-based procedure that, by using intravenous iodinated contrast media administration and dual-energy acquisition, provides localisation of enhancing lesions. All the biopsies were performed using a vacuum-assisted device. We collected procedural characteristics (patient position and type of approach), and histopathological results. Feasibility endpoints included success (visualisation of the enhancing lesion, post-procedural biopsy changes and clip placement), procedural time, number of scout acquisitions and complications. RESULTS: A total of 66 suspicious enhancing lesions (18.0% foci, 44.0% mass, 38.0% non-mass enhancement; median size 8.5 mm) in 64 patients (median age 59 years, mostly minimal [48.4%] or mild [32.8%] background parenchymal enhancement) were referred for CEM-guided biopsy in the study period. The success rate was 63/66 (95.4%). Amongst successful procedures, patients were most frequently seated (52/63, 82.5%) and the preferred approach was horizontal (48/63, 76.2%). Median total time per procedure was 15 min. Median number of acquisitions needed before targeting was 2 (range 1-4). Complications consisted of hematoma (17/63, 27%) and vasovagal reaction (2/63, 3.2%). At histology, the malignancy rate was 25/63 (39.7%). CONCLUSION: In this first patient series, CEM-guided breast biopsy was feasible, with success and complication rates similar to those previously reported for magnetic resonance guidance. KEY POINTS: • CEM may be used to guide biopsy of enhancing lesions through a stereotactic-based procedure combined with intravenous iodinated contrast media administration and dual-energy acquisition. • In this first patient series (n = 64), the success rate of CEM-guided biopsy was above 95%, the only complications were hematoma (22.2%) and vasovagal reaction (3.2%), and median total time per procedure was 15 min. • CEM-guided biopsy is feasible and could potentially be a widely available biopsy technique for enhancing-only lesions.

Outcomes by sex following treatment initiation with darunavir/cobicistat in a large Spanish cohort of the CODAR study (GeSIDA 9316).

BACKGROUND: Few women have been included in darunavir/cobicistat clinical development studies, and hardly any of them were antiretroviral experienced or treated with anything other than triple-based therapies. OBJECTIVES: Our aim was to increase our knowledge about women living with HIV undergoing darunavir/cobicistat-based regimens. METHODS: A multicentre (21 hospitals), retrospective study including a centrally selected random sample of HIV-1 patients starting a darunavir/cobicistat-based regimen from June 2014 to March 2017 was planned. Baseline characteristics, 24 and 48 week viral load response (<50 copies/mL), CD4+ lymphocyte count increase, time to change darunavir/cobicistat and adverse event occurrence were all compared by sex. The study was approved by each of the 21 ethics committees, and patients signed informed consent. RESULTS: Out of 761 participants, 193 were women. Similar characteristics were found for both sexes, except that the women had a longer duration of HIV infection (P = 0.001), and were less frequently pre-treated with darunavir/cobicistat in their previous regimen (P = 0.02). The main reason for using a darunavir/cobicistat-based regimen was simplification, without differences by sex, while monotherapy seems to be more frequently prescribed in women than in men (P = 0.067). The main outcomes, HIV viral load response, CD4+ lymphocyte count increase at 24 or 48 weeks, occurrence of adverse events, main reasons for changing and time to the modify darunavir/cobicistat regimen, did not show differences between the sexes. CONCLUSIONS: No sex disparities were found in the main study outcomes. These results support the use of a darunavir/cobicistat-based regimen in long-term pre-treated women. Clinical Trial.gov No. NCT03042390.

Etiology, diagnosis, and management of pneumonia in immunosuppressed patients.

Patients with a compromised immune system suffer a wide variety of insults. Pulmonary complications remain a major cause of both morbidity and mortality in immunocompromised patients. When such individuals present with radiographic infiltrates, the clinician faces a diagnostic challenge. The differential diagnosis in this setting is broad and includes both infectious and non-infectious conditions. Evaluation of the immunocompromised host with diffuse pulmonary infiltrates can be difficult, frustrating, and time-consuming. This common and serious problem results in significant morbidity and mortality, approaching 90%. Infections are the most common causes of both acute and chronic lung diseases leading to respiratory failure. Non-invasive diagnostic methods for evaluation are often of little value, and an invasive procedure (such as bronchoalveolar lavage, transbronchial biopsy or even open lung biopsy) is therefore performed to obtain a microbiologic and histologic diagnosis. Bronchoscopy allows certain identification of some aetiologies, and often allows the exclusion of infectious agents. Early use of computed tomography scanning is able to demonstrate lesions missed by conventional chest X-ray. However, even when a specific diagnosis is made, it might not impact patient's overall survival and outcomes.

Auditory neuropathy in children.

Auditory neuropathy is a sensorineural disorder characterized by absent or abnormal auditory brainstem evoked potentials and normal cochlear outer hair cell function. A variety of processes is thought to be involved in its pathophysiology and their influence on hearing may be different. We present here the diagnostic sequence and management of two new cases of auditory neuropathy in breastfeeding children.

[Medical counseling, nursing counseling, and nicotine chewing gum for smoking cessation in primary care]. / Consejo médico, consejo de enfermería y chicle de nicotina para dejar de fumar en atención primaria.

The 2-month results of a study designed to compare the effectiveness of three methods to encourage giving up smoking in primary health care are reported: individualized medical counseling (minimal intervention), counseling plus follow-up option by the nurse, and medical counseling plus nicotine chewing gum. Overall 425 smokers between 15 and 65 years of age were included in the study. In 349 of them (82%), short term follow-up was carried out by phone interview. The proportion who declared to have given up smoking, after adjustment for the estimated validity of the phone report of smoking status, was 10, 9%, 10.8% and 11.1%, respectively, without significant differences between the three groups. In the logistic regression analysis, only the existence of concomitant disease and the anticipated difficulty in giving up smoking appeared as predictive variables of abstention. The implications of the results for the strategies to control smoking are discussed.

[A clinical study on the frequency specificity of the 40-hertz potential]. / Estudio clínico sobre la especificidad frecuencial del potencial de 40 hertz.

In this paper we introduce the results obtained using 40 Hz potentials, with 500 and 1,000 Hz stimuli, in patients with neurosensory hearing loss, with and without preservation of low frequencies. We analyze the relation latency/intensity, the percentage of presence of the waves and their amplitude.

[The 40 hertz potential: a preliminary study]. / El potencial de 40 hertz: estudio preliminar.

In this paper we introduce our preliminary results with 40 Hz. potentials in the study of the auditive pathway in a group of normal subjects. Wave characteristics, amplitude and latency in different frequencies and intensities are analyzed.

Torsade de Pointes en un paciente con infección por el virus de la inmunodeficiencia humana y tratamiento con metadona / Torsade de Pointes in patient infected with human inmunodeficiency virus and treated with methadone

No disponible

Taquicardia ventricular y fracaso renal agudo secundario a rabdomiolisis inducido por cocaína / Ventricular tachycardia and acute renal failure secondary to cocaine-induced rhabdomyolysis

No disponible