BRCA mutation carriers have an increased risk of breast cancer. Among the risk- reducing measures is prophylactic bilateral mastectomy. In less than 1% of BRCA patients undergoing this surgery, previously undetected b...
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BRCA mutation carriers have an increased risk of breast cancer. Among the risk- reducing measures is prophylactic bilateral mastectomy. In less than 1% of BRCA patients undergoing this surgery, previously undetected breast cancer is found. Routine sentinel lymph node biopsy has not shown benefit because few patients have occult cancer, and it is a technique that also involves morbidity. If a carcinoma is found in the specimen, axillary staging should be done in a second procedure, which has traditionally been performed with lymphadenectomy due to the absence of breast tissue and the belief that sentinel lymph node biopsy (SLNB) is not feasible. We present the case of a patient diagnosed with an infiltrating tumor in the left mastectomy specimen, and successful SLNB performed in a second procedure. Four nodes were sent for intraoperative analysis with negative results. Axillary lymphadenectomy was avoided, achieving proper axillary staging. It is technically feasible to perform SLNB after a skin- and nipple-sparing mastectomy, avoiding systematic axillary lymphadenectomy for staging in these patients, thus avoiding the morbidity associated with this technique. (c) 2025 SESPM. Published by Elsevier Espa & ntilde;a, S.L.U. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Aim To determine the predictive value of the definition of bronchopulmonary dysplasia (BPD) on spirometric parameters of very low birthweight (VLBW) children of school age between 1 January 2008 and 31 December 2016. ...
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Aim To determine the predictive value of the definition of bronchopulmonary dysplasia (BPD) on spirometric parameters of very low birthweight (VLBW) children of school age between 1 January 2008 and 31 December 2016. Methods In this longitudinal retrospective observational study, we analyse a cohort of children admitted to a neonatal intensive care unit between 1 January 2008 and 31 December 2016. All newborns weighing <1500 g and born before 32 weeks of gestational age were included in the study (VLBW newborns). The existence of BPD was established retrospectively according to the definitions proposed by the National Institutes of Health (NIH) in 2001 and the National Institute of Child Health and Human Development (NICHD) in 2018. Lung function of the school-age cohort was evaluated prospectively as FEV1, FVC, FEF25-75% and FEV1/FVC by spirometry. The predictive analysis was performed by multivariate linear regression. Results Of the 145 children included in the study cohort, 60 were diagnosed with BPD according to the NIH definition and 36 according to that of the NICHD. Lung function was reduced by about 20% in patients with BPD, irrespective of the definition applied. However, the predictive regression model only produced a statistically significant fit with the spirometric variables when the NIH definition was adopted. Conclusions Our findings highlight the value of continuing to consider oxygen requirements at 28 days of chronological age in the definition of BPD, in order to obtain higher quality predictions of lung function parameters assessed later, during school age.
Introduction: Anti-NOR90 antibodies were initially described in patients with autoimmune diseases based on staining of a nucleolar region known as the nucleolar organizer region (NOR). This study aims to explore the c...
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Introduction: Anti-NOR90 antibodies were initially described in patients with autoimmune diseases based on staining of a nucleolar region known as the nucleolar organizer region (NOR). This study aims to explore the clinical aspects of anti-NOR90 antibodies in patients with systemic autoimmune diseases. Methods: Observational study of patients with positive anti-NOR90 antibodies using the EUROLINE Systemic Sclerosis profile (IgG) kit (Euroimmun, Germany). Data on demographics, comorbidities, autoimmune diseases, treatment, and clinical manifestations were collected. Results: Fifteen patients with positive anti-NOR90 antibodies were included. Majority were female (86.7%), with median age of 54 years. Most common clinical manifestations were Raynaud's phenomenon, dryness, and interstitial lung disease (ILD). Some patients had hematological or solid organ neoplasms. EPID was prevalent, with one case showing rapid progression requiring aggressive treatment. Discussion and conclusions: This study highlights the association between anti-NOR90 antibodies and systemic autoimmune diseases, particularly SS and ES. EPID was a notable feature, suggesting its consideration in IPAF diagnosis for anti-NOR90 positive patients. Further multicenter studies are needed for better understanding and detection methods optimization. (c) 2024 Elsevier Espana, S.L.U. and Sociedad Espanola de Medicina Interna (SEMI). All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Featured Application This work describes in detail a novel technique quite useful for the nonunion of subtrochanteric hip *** Subtrochanteric nonunion is especially challenging. Extramedullary fixation using fixed-ang...
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Featured Application This work describes in detail a novel technique quite useful for the nonunion of subtrochanteric hip *** Subtrochanteric nonunion is especially challenging. Extramedullary fixation using fixed-angle devices with a closing lateral wedge osteotomy is the standard surgical procedure for restoring the hip's normal alignment and achieving bone union. However, this procedure is technically demanding and relies on devices that facilitate bone union in a non-dynamic manner, along with the limitations that this type of fixation entails, especially in this highly biomechanically stressed area. This paper aims to describe a novel surgical technique to heal subtrochanteric nonunion based on dynamic fixation performed through an over-valgus correction of the hip and fixed with a dynamic hip screw (DHS). Between March 2022 and July 2023, five patients diagnosed with nonunion of a subtrochanteric fracture were operated on by a single surgeon and followed prospectively. The average age of the patients was 64 (range: 34-85). The mean duration of surgery was 112 min (range: 63-153). The femoral neck angle before surgery was 120 degrees (range: 110 degrees-122 degrees) and 147 degrees (range: 142 degrees-150 degrees) after surgery. The mean leg length increased by 8 mm (range: 6-12). The Harris hip score improved from 38 points (range: 30-44) to 90 points (range: 88-96), corresponding to excellent or good results. All patients healed without major complications and were asymptomatic after 12 months of follow-up. In conclusion, over-valgus correction using a DHS is a novel technique that seems helpful for subtrochanteric nonunion. It allows for dynamic fixation, offering the advantages of dynamic fixation, especially in this high-stress area. It is also performed without osteotomy, making it a less demanding technique than the current methods described.
Introduction: Given the lack of comparative studies on adjuvant treatment for clear cell renal cell carcinoma, we present an updated systematic review, exploring the various options for adjuvant therapy. This review i...
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Introduction: Given the lack of comparative studies on adjuvant treatment for clear cell renal cell carcinoma, we present an updated systematic review, exploring the various options for adjuvant therapy. This review is conducted in accordance with the PRISMA guidelines. Material and method: A systematic review was conducted, and 13 clinical trials were included after applying the pre-specified inclusion criteria. The risk of bias and the level of evidence were assessed. Subsequently, the requisite data were extracted in order to present the findings of the studies. Results and discussion: The present systematic review establishes that pembrolizumab can be used as adjuvant therapy in patients with advanced renal cancer at high risk after nephrectomy. This is supported by the KEYNOTE-564 study, which concluded that it increased disease-free survival (DFS) and overall survival. The use of sunitinib is discussed, since the study published in NEJM shows a modest benefit in terms of DFS, but only in an independent and blinded central review. According to the PROTECT study, pazopanib has no overall benefit. The EVEREST study showed no significant benefit over everolimus. Further studies are needed to confirm the use of axitinib, as the ATLAS trial showed statistically significant results in DFS in higher-risk population based on investigator assessment, but not based on independent central review. Therapy with 5-FU, a-IFN and IL-2, atezolizumab, sorafenib, thalidomide, nivolumab + ipilimumab should not be used in the adjuvant setting.
Background We sought to clarify the current incidence, risk factors and symptoms of disseminated Mycobacterium avium complex (dMAC) infection in admitted people living with HIV in a hospital in the Southeast of *** 5-...
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Background We sought to clarify the current incidence, risk factors and symptoms of disseminated Mycobacterium avium complex (dMAC) infection in admitted people living with HIV in a hospital in the Southeast of *** 5-years observational, retrospective and single-centre study. Demographic, clinical and analytical variables, along with microbiological, treatment and follow-up were *** Five cases of dMAC infection in severely immunocompromised people living with HIV people living were found. dMAC was diagnosed in 22.7% of patients under 100 CD4. All patients presented with fever and clinical manifestations of pneumonia, lymphadenopathy, or gastrointestinal symptoms. Despite low CD4 levels and high viral loads in some cases, primary prophylaxis had not been previously *** Until 2018, U.S. American guidelines recommended antimycobacterial prophylaxis for patients with low CD4 cell counts, a practice not adopted in Europe. Untreated dMAC infection is associated with high morbidity and mortality rates. dMAC infection represents a prevalent disease in severely immunosuppressed people living with HIV. dMAC requires a high index of suspicion in this population, in order to perform mycobacterial cultures from different samples.
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