Ovarian metastasis in women with clinical stage I endometrial carcinoma

BACKGROUND: The incidence of ovarian metastasis in women with clinical stage I endometrial carcinoma is generally reported to be 5%, leading to the practice of removing the ovaries at surgery even in young patients. METHODS: A retrospective study of 84 patients with clinical stage I endometrial cancer was carried out. Patients were excluded if the pathologic study revealed any evidence of extrauterine, apart from adnexal, spread or if the peritoneal cytology was positive. Patients with serous papillary or clear cell tumor histology were also excluded. RESULTS: Sixty-seven patients fulfilled the inclusion criteria. Only three (4%) patients were found to be in surgical stage IIIA, all three had grade 3 tumors. Of these patients, two had uterine serosal involvement and one had a microscopic tumor implant in a fallopian tube; none had ovarian metastasis. CONCLUSIONS: The risk of ovarian metastasis in women with well to moderately differentiated endometrial cancer, myometrial invasion limited to less than one half of the myometrium, negative peritoneal cytology and no evidence of metastatic lymph node spread is negligible. Young patients with a preoperative histological diagnosis of well to moderately differentiated endometrial carcinoma may be surgically staged, leaving the final decision regarding removal of the ovaries pending a thorough pathological review of the surgical specimens.     

Pharyngitis due to Burkholderia cepacia. Person-to-person transmission

Burkholderia cepacia is a Gram-negative bacillus that is widely distributed in nature; it is isolated from the ground, water, plants and vegetables. Generally, it produces nosocomial infection due to contamination of disinfectants, medical equipment, prosthetic material and drugs, such as anesthetics or liquids used in urological irrigation. The most probable mechanism of transmission is through hospital material or through fomites among people after contact for several weeks or months. Recently, it has been considered as an important pathogen in immunocompromised patients, or in those with significant underlying diseases, such as chronic granulomastosis or cystic fibrosis. We present a case of pharyngitis due to B. cepacia and its transmission within a few days in two immunocompetent twin siblings without previous underlying diseases. The infection disappeared after specific treatment for this microorganism was started. We believe that samples should be taken from the pharynx and nasal pits in patients with acute upper respiratory tract processes that do not respond to empiric antibiotic treatment, before classifying them as viral infection without etiologic diagnosis.     

Calcium-supplemented daptomycin Etest strips for susceptibility testing on Iso-Sensitest agar

OBJECTIVE: Iso-Sensitest agar (ISA), which is recommended by the BSAC for routine susceptibility testing of staphylococci and enterococci, contains insufficient calcium for testing daptomycin. Isotonic agar supplemented with 50 mg/L calcium has been advocated, but is not routinely available in many laboratories. We evaluated a daptomycin Etest that incorporates a constant level of calcium throughout the daptomycin gradient, designed to give an appropriate concentration around the strip during testing, as an alternative for susceptibility testing on ISA. METHODS: Ninety-one isolates of Staphylococcus aureus (45 methicillin-susceptible, 46 methicillin-resistant) and 90 enterococci (47 Enterococcus faecalis, 43 Enterococcus faecium) were tested. Daptomycin Etest MICs were determined on ISA, whereas agar dilution MICs were determined in parallel on Isotonic agar supplemented with calcium to 50 mg/L as a control. RESULTS: The agar dilution and Etest MIC ranges of daptomycin for S. aureus were 0.25-1 mg/L (mode 0.5 mg/L), and 0.125-2 mg/L (mode 0.25 mg/L), respectively. The corresponding MIC values for enterococci were 0.25-4 mg/L (mode, 1 mg/L) and 0.125-4 mg/L (mode, 2 mg/L). For staphylococci, 86% of the Etest MIC results were within one dilution of the agar dilution values, and for enterococci, 90% of the Etest MIC results met these criteria. When results from the two methods were not identical, there was a tendency for the Etest MIC values to be lower than the agar dilution values. CONCLUSIONS: This study shows that calcium-supplemented daptomycin Etests on ISA are an accurate and convenient alternative to calcium-supplemented Isotonic agar.     

Evolution of the degrees of influenza vaccine (flu shot) coverage in Spain throughout the 1993-2001 period. Analysis by Autonomous Communities

BACKGROUND: Influenza (flu) is a disease involving a high morbidity which takes a high toll on healthcare costs for which there is an effective vaccine available. This study is aimed at evaluating the evolution of the different degrees of influenza vaccine (flu shot) coverage in Spain by Autonomous Communities during the 1993-2001 period. METHODS: A total of 42,123 cases from the National Health Survey (NHS) for the years 1993 (n=21,051) and 2001 (n=21,072) were analysed, all of which corresponded to non-institutionalised Spanish adults over 15 years of age. Both surveys are representative at the Autonomous Community level. RESULTS: For the total sample, a vaccine coverage of 17.94% (CI 95% 17.42-18.46) in 1993 and of 19.30% (18.77-19.83) en 2001 was estimated. In the logic regression model, adjusted by age, sex and related chronic disease, significant improvements were found in the degrees of coverage of individuals over 64 years of age (OR = 1.28 CI 95% 1.10-1.50) for Spain as a whole and for five of the seventeen Autonomous Communities between 1993 and 2001. However, no significant changes were found in the degrees of coverage for the group under age 65 with related chronic disease entailing an indication for being administered the vaccine. CONCLUSIONS: A slight yet insufficient improvement in the degrees of coverage among the high-risk groups studied were found to exist both nation-wide in Spain as a whole as well as in the majority of the Autonomous Communities between 1993 and 2001. Degrees of coverage varied greatly among Autonomous Communities. The individual under age 65 with related chronic diseases heightening the risks of suffering from flu-related complications have not improved their degrees of coverage regarding this vaccine during the period studied. The difficulty involved in improving the degrees of coverage among this type of patients might lead us to consider the alternative and potential benefit of lowering the age limit of the current influenza vaccine (flu shot) indication-related recommendations in Spain.     

Collecting duct carcinoma of the kidney: an immunohistochemical study of 11 cases

Background  

Collecting duct carcinoma (CDC) is a rare but very aggressive variant of kidney carcinoma that arises from the epithelium of Bellini's ducts, in the distal portion of the nephron. In order to gain an insight into the biology of this tumor we evaluated the expression of five genes involved in the development of renal cancer (FEZ1/LZTS1, FHIT, TP53, P27 ^kip1, and BCL2).