Intraoperative ultrasound in conservative surgery for non-palpable breast cancer after neoadjuvant chemotherapy

AbstractAimsA complete clinical response after neoadjuvant chemotherapy (NACT) in breast cancer patients hinders the localization of the residual lesion and the removal of a minimum amount of breast tissue. The aim of the present work is to report our single-centre experience with intraoperative ultrasound-guided (IOUS) excision performed by surgeons in these patients.Patients and methodsFrom January 2008 to December 2012, IOUS excisions were performed on 58 patients with a previous intralesional ultrasound-detectable metallic marker and non-palpable breast cancer after NACT. The specimen margins were estimated by ultrasonography and macroscopic pathologic examination. Successful lesion removal, specimen weight, and analysis of the results as regards margins were evaluated, and the need for breast-conserving re-excision and mastectomy was considered.ResultsAfter NACT the average ultrasound/mammography and MRI diameters were 11.7 mm (0–30) and 9.1 mm (0–40) respectively. In all cases, the residual lesion or tissue around the marker was removed. The average weight of the specimens was 26.4 g (6–84), being lower in cases of complete response according to ultrasound (p < 0.05). In 4 patients (6.8%), breast-conserving re-excision was carried out, and in 3 patients (5.2%) a secondary mastectomy was performed, two of which had invasive lobular carcinoma.ConclusionsThe emplacement of a readily echodetectable metal marker before NACT makes IOUS excision feasible in an increasing number of complete clinical responses, with the excision of small amounts of breast tissue and a high percentage of conservative breast surgery. This technique requires surgeons to be trained, but has the advantage of a reduced use of other hospital services, better planning of operating theatres, and less discomfort for patients, which means that it is attractive and indeed recommendable

Influence of Ca substitution by Mg on the Ca3Co4O9 performances

Ca3-xMgxCo4O9 polycrystalline thermoelectric ceramics with small amounts of Mg have been synthesized by the classical solid state method. Microstructural characterizations have shown that all the Mg has been incorporated into the Ca3Co4O9 structure and no Mg-based secondary phases have been identified. Apparent density measurements have shown that samples do not modify their density until 0.05 Mg content, decreasing for higher contents. Electrical resistivity decreases and Seebeck coefficient slightly raises when Mg content increases until 0.05 Mg addition. The improvement in both parameters leads to higher power factor values than the usually obtained in samples prepared by the conventional solid state routes and close to those obtained in textured materials.Se han preparado cerámicas termoeléctricas policristalinas de Ca3-xMgxCo4O9, con pequeñas cantidades de Mg, utilizando el método clásico de estado sólido. La caracterización microestructural ha mostrado que el Mg se ha incorporado en la estructura del Ca3Co4O9 y que no se han formado fases secundarias con el Mg. Las medidas de densidad aparente han mostrado que las muestras prácticamente poseen la misma densidad hasta un contenido de 0.05 Mg, disminuyendo para contenidos mayores. La resistividad eléctrica disminuye y el coeficiente Seebeck aumenta cuando el contenido de Mg se incrementa hasta valores de 0.05. La mejora de ambos parámetros conduce a valores del factor de potencia mayores que los obtenidos en muestras preparadas por la vía convencional de estado sólido, alcanzando valores próximos a los que se encuentran en materiales texturados

Influence of Ca substitution by Mg on the Ca3Co4O9 performances

Ca3-xMgxCo4O9 polycrystalline thermoelectric ceramics with small amounts of Mg have been synthesized by the classical solid state method. Microstructural characterizations have shown that all the Mg has been incorporated into the Ca3Co4O9 structure and no Mg-based secondary phases have been identified. Apparent density measurements have shown that samples do not modify their density until 0.05 Mg content, decreasing for higher contents. Electrical resistivity decreases and Seebeck coefficient slightly raises when Mg content increases until 0.05 Mg addition. The improvement in both parameters leads to higher power factor values than the usually obtained in samples prepared by the conventional solid state routes and close to those obtained in textured materials.Se han preparado cerámicas termoeléctricas policristalinas de Ca3-xMgxCo4O9, con pequeñas cantidades de Mg, utilizando el método clásico de estado sólido. La caracterización microestructural ha mostrado que el Mg se ha incorporado en la estructura del Ca3Co4O9 y que no se han formado fases secundarias con el Mg. Las medidas de densidad aparente han mostrado que las muestras prácticamente poseen la misma densidad hasta un contenido de 0.05 Mg, disminuyendo para contenidos mayores. La resistividad eléctrica disminuye y el coeficiente Seebeck aumenta cuando el contenido de Mg se incrementa hasta valores de 0.05. La mejora de ambos parámetros conduce a valores del factor de potencia mayores que los obtenidos en muestras preparadas por la vía convencional de estado sólido, alcanzando valores próximos a los que se encuentran en materiales texturados

Antithrombotic treatment in elderly patients with atrial fibrillation: A practical approach

Background: Atrial fibrillation (AF) in the elderly is a complex condition. It has a direct impact on the underuse of antithrombotic therapy reported in this population. Discussion: All patients aged =75years with AF have an individual yearly risk of stroke >4%. However, the risk of hemorrhage is also increased. Moreover, in this population it is common the presence of other comorbidities, cognitive disorders, risk of falls and polymedication. This may lead to an underuse of anticoagulant therapy. Direct oral anticoagulants (DOACs) are at least as effective as conventional therapy, but with lesser risk of intracranial hemorrhage. The simplification of treatment with these drugs may be an advantage in patients with cognitive impairment. The great majority of elderly patients with AF should receive anticoagulant therapy, unless an unequivocal contraindication. DOACs may be the drugs of choice in many elderly patients with AF. Summary: In this manuscript, the available evidence about the management of anticoagulation in elderly patients with AF is reviewed. In addition, specific practical recommendations about different controversial issues (i.e. patients with anemia, thrombocytopenia, risk of gastrointestinal bleeding, renal dysfunction, cognitive impairment, risk of falls, polymedication, frailty, etc.) are provided

Three novel mutations in the CFTR gene identified in Galician patients

AbstractWe report three novel CFTR missense mutations detected in Spanish patients from Galicia (North West of Spain). In the first case, a patient homozygous for a novel S1045Y mutation died due to pulmonary problems. In the other two cases, both heterozygous for novel mutations combined with the F508del mutation, clinical symptoms were different depending on the mutation, detected as M595I and A107V

Fracture experience among participants from the FROCAT study: what thresholding is appropriate using the FRAX tool?

ObjectiveTo perform an external validation of FRAX algorithm thresholds for reporting level of risk of fracture in Spanish women (low &lt;5%; intermediate ?5% and &lt;7.5%; high ?7.5%) taken from a prospective cohort “FRIDEX”.MethodsA retrospective study of 1090 women aged ?40 and ?90 years old obtained from the general population (FROCAT cohort). FRAX was calculated with data registered in 2002. All fractures were validated in 2012. Sensitivity analysis was performed.ResultsWhen analyzing the cohort (884) excluding current or past anti osteoporotic medication (AOM), using our nominated thresholds, among the 621 (70.2%) women at low risk of fracture, 5.2% [CI95%: 3.4–7.6] sustained a fragility fracture; among the 99 at intermediate risk, 12.1% [6.4–20.2]; and among the 164 defined as high risk, 15.9% [10.6–24.2]. Sensitivity analysis against model risk stratification FRIDEX of FRAX Spain shows no significant difference. By including 206 women with AOM, the sensitivity analysis shows no difference in the group of intermediate and high risk and minimal differences in the low risk group.ConclusionsOur findings support and validate the use of FRIDEX thresholds of FRAX when discussing the risk of fracture and the initiation of therapy with patients

Clinical case of a patient undergoing radium-223 treatment following treatment with abiraterone acetate and enzalutamide

Objective: Over the last decade, significant advances have been made in the development of therapies for patients with metastatic castration-resistant prostate cancer. Abiraterone and enzalutamide were approved as treatments based on data supporting improved overall survival compared to placebo. Radium-223 became the first approved radiopharmaceutical which decreased skeletal-related events, palliated pain, and showed improved overall survival in symptomatic patients with castration-resistant prostate cancer and bone metastasis only. Materials and Methods: We present the case of an eighty-two year old man with metastatic castration-resistant prostate cancer who was treated with sequential therapy (abiraterone — enzalutamide — radium-223). The sequencing and treatment used for our patient was viable because of his clinical characteristics, which have allowed for longer survival time with an acceptable quality of life. These actions must be agreed on by the Multidisciplinary Tumour Board, in order to optimize the use of available courses of treatment. Results: The treatment of these patients is changing rapidly, but many questions remain regarding the optimal sequencing of the available drugs. Sequential or concomitant use of the next generation hormonal agents — abiraterone and enzalutamide — cannot currently be recommended. Data regarding the safety of concomitant abiraterone, enzalutamide or denosumab with radium-223 is reassuring and timely. However, we cannot advocate the general use of combined radium-223 therapy at this time, irrespective of prior therapy. Conclusion: A better understanding of active mechanisms, the genetic characteristics of each metastatic castration-resistant prostate cancer and the development of new prognostic and predictive biomarkers will help determine sequencing or different combination treatments for each individual patient. Key Words: castration-resistant prostate cancer, treatment sequence, abiraterone acetate, enzalutamide, radiopharmaceutic

Comparison in the aplication of the exploitation by optimal head model to hydroelectronic power station in run-of-the-river systems equipped with different types of turbines

n/