Casuística del carcinoma intraductal de mama en el Hospital Universitario Son Dureta

Objective

To determine the incidence rates and clinical presentation of ductal carcinoma in situ of the breast, as well as its pathologic characteristics, the forms of treatment used, and outcomes.

Subjects and method

We performed a retrospective study with review of 83 consecutive patients with a histopathological diagnosis of ductal carcinoma in situ (DCIS) of the breast from January 1st, 1990 to December 31st, 2004 in the Son Dureta University Hospital in Palma, Majorca.

Results

Breast DCIS accounted for 3.5% of all breast carcinomas identified in our hospital in the previous 15 years. The most frequent age at diagnosis ranged from 50 to 64 years. Seventy-two percent of the lesions were detected by mammography. Total mastectomy was performed in 57% of the patients, and treatment with breast preservation was carried out in 37%. The recurrence rate was 4%, with an overall survival rate of 100%.

Conclusions

Screening mammography identifies very small cancers. Involvement of the surgical margins is a determining factor for local treatment of breast cancer and is an accurate predictor of risk of recurrence. Disease-free survival is almost 100% in patients undergoing mastectomy, although the preferred therapy in cases of DCIS is local treatment with breast conservation.     

Health related quality of life changes in somatising patients after individual versus group cognitive behavioural therapy: A randomized clinical trial

Objective

To assess changes in health related quality of life after a cognitive behavioural program for patients diagnosed with abridged somatization disorder in primary care.

Method

A multicentre, randomized, parallel group, controlled trial was designed. 168 patients were recruited from 29 primary health care centres in Spain and were randomly assigned to one of the three study arms: treatment as usual improved with Smith's norms, individual cognitive behavioural treatment, and group cognitive behavioural treatment. Health-related quality of life was assessed using SF-36 Health Survey.

Results

Individual cognitive behavioural treatment achieves greater changes in health related quality of life than group cognitive behavioural therapy and treatment as usual. Improvement in health related quality of life was fully observed at 12 month, and partially at 6 months. The modality of intervention interacts with time in all dimensions except for Physical functioning and Vitality. Patients who received individual cognitive behavioural therapy treatment had better scores in Physical and Mental health summary measures at 12 month follow-up.

Conclusions

Individual cognitive behavioural treatment is the most effective way to improve health related quality of life in abridged somatization disorder patients, and its effects are sustained over time. Also, regardless of the type of intervention, physical functioning improves compared with treatment as usual.     

Oscillatory resistance measured during noninvasive proportional assist ventilation.

Setting proportional assist ventilation (PAV) requires the measurement of patient resistance and elastance. To avoid patient sedation/paralysis or the use of an esophageal balloon, noninvasive PAV is indirectly set by the "runaway" method or in accordance with patient comfort. The aim of this study was to ascertain whether the forced oscillation technique (FOT) applied by the ventilator during noninvasive PAV is useful in assessing patient respiratory resistance. Nasal PAV was applied to 14 patients with severe chronic obstructive pulmonary disease. During PAV a modified ventilator applied a 5-Hz pressure oscillation to noninvasively assess FOT resistance (Rrs). Lung resistance (RL) was measured in seven of the patients by using an esophageal balloon. Moreover, measurements were also performed in five of the patients when PAV was applied through the mouth. Rrs was close to RL both during nasal (Rrs = 8.9 +/- 3.1, RL = 9.0 +/- 2.6; cm H(2)O x s/L; n = 7, p > 0.05) and mouth (Rrs = 5.6 +/- 2.1, RL = 5.8 +/- 1.4; cm H(2)O x s/L; n = 5, p > 0.05) breathing. Rrs was slightly greater than the maximum value of flow assistance applied during the setting of PAV (FAmax): 11.1 +/- 5.4 and 9.5 +/- 2.9 cm H(2)O x s/L, respectively (n = 14, p > 0.05), both variables being significantly correlated (r = 0.72, p < 0.05). FOT applied by the PAV ventilator allowed the assessment of patient resistance. These results suggest that FOT could be useful in setting PAV flow assistance and in automatically and continuously updating this setting in accordance with patient resistance.     

Neuropeptide Y and leptin in patients with obstructive sleep apnea syndrome: role of obesity

Neuropeptide Y (NPY) and leptin are two peptides involved in the regulation of body weight, energy balance, and sympathetic tone. This study investigates the independent role of apneas and obesity on NPY and leptin plasma levels in patients with obstructive sleep apnea syndrome (OSAS). To this end we compared their values in 23 obese (body mass index > 30 kg/m2) and 24 nonobese (body mass index < 27 kg/m2) patients with OSAS, and in 19 obese and 18 nonobese control subjects without OSAS. Patients who used continuous positive airway pressure for more than 4 hours/night were reexamined 3 and 12 months later. We found that NPY levels were increased (p < 0.01) in patients with OSAS independently of obesity. Leptin levels were also increased in OSAS but this was mostly associated to obesity. Continuous positive airway pressure treatment reduced NPY levels in all patients and leptin levels only in nonobese patients (p < 0.01). We concluded that NPY and leptin plasma levels are increased in patients with OSAS. Yet, whereas the former appear independent of obesity, the latter are mostly associated with obesity.     

Effects of pedunculopontine tegmental nucleus lesions on emotional reactivity and locomotion in rats

Bilateral damage to the pedunculopontine tegmental nucleus (PPTg) has been found to impair several learning tasks; however, it is not clear whether this effect could be at least partially attributable to changes in the rat emotional reactivity and/or spontaneous locomotion. Therefore, the present work has tested the effects of bilateral electrolytic lesions of the PPTg on the behaviour of rats in the elevated plus-maze and the open field test. Because the behaviour of rats in learning and emotional tasks can be sensitive to routine experimental manipulations, we also have tested the effects of brief pre-surgical handling procedures on anxiety-like behaviours and locomotion in both lesioned and control rats. Lesions of the pedunculopontine tegmental nucleus (1). did not have any effects on spontaneous locomotor activity and (2). did not increase emotional reactivity. In fact, there was a slight bias towards a reduction in anxiety-like behaviours in lesioned rats, as evidenced by a significant increase in the number of open arm entries. Pre-surgical handling induced a slight decrease of emotional reactivity and a slight increase of exploratory activity. We conclude that damage to the pedunculopontine tegmental nucleus is not accompanied by either an enhancement of emotional reactivity or by an altered spontaneous locomotion.