Early Symptoms and Long-Term Clinical Outcomes of Distal Limb's Cutaneous Arterio-Venous Malformations: A Retrospective Multicentre Study of 19 Adult Patients

International audienceINTRODUCTION: Cutaneous arterio-venous malformations (AVM) are high-flow vascular malformations made up of a direct link between arteries and veins without intermediary capillary space. 'Distal limb's AVM', which mean involving hands or feet, are rare and their functional prognosis is often poor. Little is known about their early clinical symptoms. The objectives of this study were to identify early clinical symptoms of distal limb's cutaneous AVMs and to determine their long-term clinical outcome. METHODS: A retrospective study was carried out including adult patients who had distal limb's AVM, who were followed up between January 2000 and November 2013 in two regional tertiary care centres. The information was collected from patients' clinical records and completed by a structured telephone questionnaire. RESULTS: Nineteen patients were included in the study: four (21%) with foot AVM and 15 (79%) with hand AVM. The first clinical symptoms were as follows: swelling (47%), pain (47%), one or several venous dilatations (37%) and rarely abnormal skin colour, hyperthermia and pulsating sensation. The median diagnosis delay was 9 years after the onset of first manifestations. Amongst the 17 patients who underwent a treatment, 53% had embolotherapy session(s), 12% surgery and 35% had both. After an average follow-up of 57.6 months, 31% of the 13 patients contacted who were receiving treatment were in complete remission; 31% had partial remission; 15% had relapse after initial improvement and 23% had treatment failure. Overall, 74% of patients had a serious development of the AVM: 37% had digital or hand amputation, and 42% remained symptomatic and/or unstable. CONCLUSION: This study suggests that initial manifestations of distal limb's AVMs are discreet and non-specific, leading to a diagnosis delay of about 10 years, with poor prognosis. Doctors should evoke the diagnosis earlier, when these symptoms are shown: pain and/or swelling, sometimes with a large vein

Morbidity of breast cancer and cervico-uterine cancer in women from the occidental region of Mexico

Background. The incidences of breast cancer (BC) and cervico-uterine cancer (CC) vary widely from country to country. In Mexico, BC mortality has doubled in the last 20 years to become the second leading cause of death for women aged 30 to 54 years. CC is the most common cause of death from neoplasia in women over 25 years old. In 2006, the state of Nayarit had one of the highest mortality rates for these types of cancers in Mexico. Objective. To analyze and characterize the current demographics and morbidities associated with BC and CC in the state of Nayarit. Material and methods. In this retrospective study, the clinical histories of patients who were diagnosed with BC or CC at the State Cancer Center from January 2006 to December 2010 were analyzed. Results. A total of 406 patients with BC and 328 patients with CC were registered. The most common clinical stage for both cancer types was IIB. The municipalities of San Pedro Lagunillas and El Nayar presented the highest prevalences of BC and CC, respectively. Conclusion. Our results suggest that women living in poorer and more marginalized regions have a higher possibility of developing BC and CC. Because BC and CC are preventable and treatable in their early stages, demographic information from population records for these cancers is helpful in determining the incidence rates and patterns and improving decision-making processes.Antecedentes. La incidencia de cáncer de mama (CaMa) y cervicouterino (CaCu) varía ampliamente entre países. En México, la mortalidad por CaMa se ha duplicado en los últimos 20 años y se ha convertido en la segunda causa de muerte en mujeres de 30 a 54 años de edad. Mientras que el CaCu representa la primera causa de muerte por neoplasia en mujeres mayores de 25 años. Para 2006 Nayarit ocupó uno de los primeros lugares a nivel nacional en mortalidad por estos tipos de cáncer. Objetivo. Analizar y describir las tendencias actuales de distribución demográfica y morbilidad derivada de CaMa y CaCu en el estado de Nayarit. Material y métodos. Se realizó un estudio retrospectivo donde se analizaron los expedientes clínicos de las pacientes a quienes se les diagnosticó CaMa o CaCu en el Centro Estatal de Cancerología, durante enero 2006 y diciembre 2010. Resultados. Se registraron 406 pacientes con CaMa y 328 con CaCu. El estadio clínico más frecuente para ambos tipos de cáncer fue el IIB. Los municipios de San Pedro Lagunillas y El Nayar presentaron la mayor prevalencia de CaMa y CaCu, respectivamente. Conclusión. De acuerdo con los resultados obtenidos del presente estudio, se puede sugerir que las mujeres que viven en la región más pobre y marginada, probablemente tienen mayor posibilidad de desarrollar CaMa y CaCu. Debido a que CaMa y CaCu son prevenibles y tratables en sus etapas iniciales, la información demográfica de los registros poblacionales para estos tipos de cáncer, ayudará a determinar las tasas de incidencia y coadyuvará en la toma de decisiones