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Neoadjuvant endocrine treatment (NET) has become a useful tool for the down-staging of luminal-like breast cancers in postmenopausal patients. It enables us to increase breast-conserving surgery (BCS) rates, provides an opportunity for us to assess in vivo NET effectiveness, and allows us to study any biological changes that may act as valid biomarkers. The purpose of this study was to evaluate the safety and effectiveness of NET, and to assess the role of Ki67 proliferation rate changes as an indicator of endocrine responsiveness. From 2016 to 2020, a single-institution cohort of patients, treated with NET and further surgery, was evaluated. In patients with Ki67 ≥ 10%, a second core biopsy was performed after four weeks. Information regarding histopathological and clinical changes was gathered. A total of 115 estrogen receptor-positive (ER+)/HER2-negative patients were included. The median treatment duration was 5.0 months (IQR: 2.0–6.0). The median maximum size in the surgical sample was 40% smaller than the pretreatment size measured by ultrasound (p < 0.0001). The median pretreatment Ki67 expression was 20.0% (IQR: 12.0–30.0), and was reduced to 5.0% (IQR: 1.8–10.0) after four weeks, and to 2.0% (IQR: 1.0–8.0) in the surgical sample (p < 0.0001). BCS was performed on 98 patients (85.2%). No pathological complete responses were recorded. A larger Ki67 fold change after four weeks was significantly related to a PEPI score of zero (p < 0.002). No differences were observed between luminal A-and B-like tumors, with regard to fold change and PEPI score. Conclusions: In our cohort, NET was proven to be effective for tumor size and Ki67 downstaging. This resulted in a higher rate of conservative surgery, aided in therapeutic decision making, provided prognostic information, and constituted a safe and well-tolerated approach, This research received no external funding

The role of vitamin D in mammographic density is still unclear. This study examines the association between serum 25-hydroxyvitamin D (25(OH)D) and mammographic density, overall and by specific women characteristics. DDM-Madrid is a cross-sectional study that recruited 1403 premenopausal women in a breast radiodiagnosis unit of Madrid City Council. Information was collected with a questionnaire and plasma 25(OH)D was measured by solid-phase extraction on-line coupled to liquid chromatography–tandem mass spectrometry. Percent mammographic density was assessed using a semi-automated computer tool (DM-Scan). Multivariable linear regression models were used to quantify the associations, categorizing 25(OH)D levels (nmol/L) into 3 groups according to the cut-offs established by the US Endocrine Society. Models were adjusted for age, education, body mass index, age at menarche, parity, previous breast biopsies, family history of breast cancer, physical activity, energy intake, use of corticoids, hypercholesterolemia and day of sample extraction. Mean serum 25(OH)D level was 49.4 + 18.9 nmol/L. Women with sufficient concentrations of 25(OH)D showed a slight decrease in mammographic density (β >75nmol/L=-3.40; p = 0.037). No differences were observed according to women characteristics except for parity, where the protective effect of 25(OH)D was only seen among nulliparous (β >75nmol/L=-13.00; p-heterogeneity = 0.006). In light of the protective effect of vitamin D on mammographic density and the high prevalence of vitamin D insufficiency in our population, improving these levels could be an effective measure for the prevention of health problems related to the lack of this essential vitamin.

To analyze the correlation between the state of health, knowledge, and social support of surgical patients' caregivers at home, with the intensity of nursing care and its consequences.A longitudinal observational study with follow-up at admission, discharge and 10 days following discharge at home, held in the surgical hospitalization unit at the Vic University Hospital, (Barcelona). A non-randomized and consecutive sample of 317 informal caregivers of surgical patients with abdominal surgery was included in the study. The characteristics of caregivers were studied using the Nursing Outcomes Classification indicators. The intensity of nursing care, consequences and impact on patient quality of life was evaluated through the validated ICUB97-R questionnaire.Most of the caregivers were women, with an average age of 52,9 ± 13,7years, with no previous experience as caregivers. The greatest intensity of care and impact was observed on caregivers who attended dependent and/or cancer diagnosed patients at home, dedicating the largest time to provide care (p0,005). Predictor variables for the occurrence of consequences during convalescence at home were emotional health satisfaction, routine activity disruption, fear, sleep pattern and being a dependent patient.Emotional health satisfaction, routine activity disruption, fear, sleep pattern and being a dependent patient before surgery are strong predictive variables for the occurrence of consequences on caregivers during convalescence at home. There is a significant negative correlation between punctuations in the ICUB97-R questionnaire and the Nursing Outcomes Classification indicators.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is frequently associated with coagulation impairment and perioperative blood transfusion. Our aim was to investigate the impact of each procedure step on hemostasis, as measured by rotational thromboelastometry™ (ROTEM), fibrinogen level and platelet count as a primary outcome, along with its relationship with transfusion needs.A prospective longitudinal study was performed. Hemoglobin level, fibrinogen level, platelet count and ROTEM parameters: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), α-angle (EXTEM, INTEM, FIBTEM) were measured before the procedure, at the end of cytoreductive surgery and after HIPEC. Appropriate statistical tests were used for comparison. A P.05 was considered as significant.Forty-one women, with median age 54 (range 34-76) were recruited. Cytoreductive surgery was followed by a reduction of hemoglobin level from 11,4±1,5g/dl to 10,6±1,6g/dl, a reduction of serum fibrinogen level from 269±69mg/dl to 230±48mg/dl (P.01) and MCF decline from 20±10 to 16±8mm (P.01), in the FIBTEM test. HIPEC was followed by no hemostatic impairment. The number of packed red blood cells administered during patients stay kept a mild significant relationship with both fibrinogen level (ρ = -0.5, P=.002), and MCF EXTEM values (ρ= -0.43, P=0.006), recorded after HIPEC.The mild observed hemostatic impairment appeared after cytoreductive surgery instead of HIPEC, involving surgical hemorrhage as the most likely responsible factor. Further studies are required to confirm a correlation between transfusion needs and postoperative hemostatic tests.

Objectives The aim of this study was to measure the level of preoperative anxiety in patients scheduled for cardiac surgery, identify any influencing clinical factors, and assess the relationship between anxiety and postoperative morbidity. Design A prospective and consecutive study. Setting A single university hospital. Participants The study comprised 200 patients scheduled for cardiac surgery. Interventions Each patient was asked to grade his or her preoperative anxiety level using the Visual Analogue Scale for Anxiety, Amsterdam Preoperative Anxiety and Information Scale, and set of specific anxiety-related questions. Demographic data (age, sex, body mass index) and anesthetic and surgical data (American Society of Anesthesiologists physical status, EuroSCORE surgical risk, preoperative length of stay, and previous anesthetic experience) were registered. Also, postoperative morbidity was assessed. Measurements and Main Results Twenty-eight percent of the patients developed high preoperative anxiety. The mean Amsterdam Preoperative Anxiety and Information Scale score was 11.4 ± 4.3, and the mean Visual Analogue Scale for Anxiety score was 48 ± 21. Patients scheduled for coronary artery bypass surgery, who had no previous anesthetic experience, and who were hospitalized before surgery, had higher anxiety scores. Coronary bypass surgery (odds ratio 3.026; 1.509-6.067; p = 0.002) was associated independently with preoperative high-level anxiety. Anxiety most commonly was caused by waiting for surgery, not knowing what is happening, fearing not being able to awaken from anesthesia, and being at the mercy of staff. Anxiety did not modify the postoperative course. Conclusions In patients waiting to undergo cardiac surgery, both fear of the unknown and lack of information, especially related to the surgery, are crucial factors in high levels of preoperative anxiety in cardiac surgery. Coronary bypass surgery is a determining factor for preoperative anxiety. The anxiety level did not modify the postoperative course in these patients.

Background: Established data confirm an increased incidence of skin cancer, mainly squamous cell carcinoma (SCC), in long-term kidney transplant recipients (KTRs). Objective: Our purpose was to investigate prospectively the type and frequency of neoplastic and preneoplastic skin lesions in KTRs during the first 3 years of immunosuppression, as well as the influence of potential risk factors. Methods: Eighty-one consecutive KTRs were examined every 6 months during the first 3 years after transplantation. All survival analyses were performed with the EGRET statistical software package. Results: After a median follow-up of 34 months, 25 skin cancers developed in 12 patients; the basal cell carcinoma (BCC)SCC ratio was 3.1:1. The cumulative risk of skin cancer developing after 3 years of graft survival was 18.1%. Only age at the time of transplantation ( p = 0.005) and occupational sun exposure ( p = 0.048) had statistical significance as risk factors. Conclusion: In carefully supervised KTRs, a high incidence of cutaneous malignancy, mainly BCC, exists in the early posttransplant period. Sun exposure and the patient's age at the time of transplantation seem to be the most important risk factors.

Capillary hemangiomas of the tracheobronchial tree are extremely rare in adults, with hemoptysis being one of the most serious forms of presentation. An operation has been the treatment of choice, although it does involve high rates of morbidity and mortality, especially in emergency situations such as massive hemoptysis, which has led to the search for other therapeutic alternatives. There is no experience with embolization by interventional radiology when the hemoptysis is tracheal in origin, caused partly because the infrequency of this pathology; however, the foundations for it have been laid with the development of embolization for bronchopulmonary pathology. We report a case of a tracheal capillary hemangioma in a 66-year-old woman diagnosed with idiopathic thrombopenic purpura, which began as a massive hemoptysis and was treated successfully with embolization by interventional radiology. There has been no recurrence of the bleeding after 1 year's follow-up, and the patient's control fibrobronchoscopy is normal.

Objective: To evaluate two different approaches used to perform fused fissures in lobectomies in terms of persistent air leak (PAL) and their impact on length of hospital stay. Methods: One hundred and nineteen patients underwent lobectomy or bilobectomy in our unit. We focused on patients with fused fissures (63 patients), all of whom were selected intraoperatively based on predefined criteria. These patients with incomplete fissures were randomly assigned to two groups: Group A patients who underwent a ‘traditional technique’ to approach fused fissures and Group B patients who underwent a ‘fissureless technique’. The latter technique avoids dissecting the lung parenchyma over the pulmonary artery, reducingthe chancesof air leak. Patients in both groupshad shown no significant difference in preoperative variables(p > 0.05).Results: The incidence of PAL was significantly higher among patients with incomplete or fused fissures (0 case vs 8 cases (Groups A and B), p < 0.005). Furthermore, the incidence of PAL was significantly higher in the Group A (traditional technique) (7 vs 1) (p < 0.05, OR = 3.1, CI 0.22—0.51). The probabilityforairleakcessationwassignificantlyhigherinpatientsofGroupB(fissurelesstechnique)(logrankp < 0.0001).Thelengthofhospital stay was higher in Group A (5.76 3.1) compared with Group B (4.9 1.7) (p < 0.05). No other variables were identified as risk factors for PAL in this series. Conclusions: The fissureless technique appears to be a superior approach for fused fissures in terms of both preventing persistent air leak and reducing the length of hospitalisation. This technique can be performed safely at no additional cost and without adverse consequences. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

To describe the clinicopathological characteristics of the scrotal bizarre leiomyoma in order to increase our understanding, and avoid the possibility of erroneous diagnosis and treatment.We report the case of a 43 year-old patient with a pendulous nodular scrotal tumour, which after microscopic study could be seen to be of smooth muscular origin, corresponding, because of its peculiar histological characteristics, to the rare variety called atypical or symplasmic bizarre leiomyoma.Although it is a form of leiomyoma which is extremely infrequently found in the scrotum, it is necessary to know it can occur and to know that we are dealing with a benign tumour that should be treated as such.

Primary non-lymphoid thymus tumors (PNLTT) are an uncommon though quite varied pathology. Our objective was to identify the clinical, therapeutic and histologic variables with a prognostic value in these neoplasms.We studied 58 PNLTT cases, corresponding to 52 epithelial neoplams (PTEN), 4 thymolipomas (7%) and 2 neuroendocrine tumors (3%). Commonest clinical manifestations were myasthenia gravis (41%) and dyspnea (21%). Three patients were symptom-free (24%). We used Kaplan-Meier survival curves and Cox regression model.All patients underwent surgery which consisted of thymectomy. Four patients underwent a biopsy procedure alone. Perioperative mortality was 3% (n = 2) and morbidity was 31% (n = 18), mainly because of respiratory and wound problems. 24 patients with PTEN, Masaoka degrees III and IV, and a patient with a lymphoepithelial carcinoma received adjuvant chemotherapy and/or radiotherapy. With a follow-up of 13 + 5 years, 12 PTEN patients and one patient with a neuroendrocrine tumor died as a consequence of the evolution of the disease. Cumulative survival was 80% at 5 years, 71% at 7 years and 63% at 10 years. There are currently two local relapses in two PTEN cases after 9 and 8 years of follow-up, respectively. Main prognostic factors are the histologic type and subtype and the clinical stage (p0.001).In PNLTT early diagnosis is crucial in order to administer a correct treatment before the clinical stage is more advanced. Main prognostic factors are the histologic type and subtype and the clinical stage.

Objective: The non-neoplastic mediastinal cysts (NNMCs) form a group of uncommon benign lesions of a congenital origin. The significant controversy regarding these cysts is whether to manage with observation or surgical resection. The aim of this study is to analyse the utility of thoracic computed axial tomography (CT) in imaging diagnosis of the NNMCs and the results of surgery in these lesions. Patients and methods: Twenty NNMCs underwent surgery between 1980 and 2000. The preoperative study of mediastinal cystic masses includes a complete blood test, chest radiography (CR) and, for the last 15 years, a thoracic CT and/or nuclear magnetic resonance. All the patients underwent surgery in our thoracic surgery department and were reviewed in outpatients at 1 month, 6 months, 1 year and biannually thereafter. The form of manifestation, clinical features, imaging techniques, surgical operation, morbidity, mortality and follow-up are analysed. Results: Ten corresponded to bronchogenic cysts, the most common symptom of which was chest pain. CR showed a mass in the anterior-superior mediastinum in nine cases, and CT (five cases) revealed a cystic tumour in the anterior mediastinum. All were removed surgically, with three patients presenting with mild complications. Seven corresponded to pleuro-pericardial cysts, four being asymptomatic. CR showed a right paracardial mediastinal tumour, which was confirmed by CT (four cases). All were removed surgically, with two patients presenting with mild complications. Three corresponded to enteric cysts. CR showed a tumour in the posterior mediastinum, with CT confirming its cystic nature (two cases). Excision of the cyst was done in all cases, which corresponded to duplication cysts: two oesophageal and one gastric. All the patients are asymptomatic and recurrence-free after a follow-up of 11 ^ 10 years. Conclusions: NNMCs are benign lesions in which the lesions in which the surgery can be done with a low morbidity and mortality rate, enables us to rule out malignancy and offers a definitive cure. Actually the thoracic CT permit a correct diagnosis pre-surgery in function of the radiologic characterisation and topography. q 2002 Elsevier Science B.V. All rights reserved.

Photodynamic therapy (PDT) is widely used to treat non-melanoma skin cancer. However, some patients affected with squamous cell carcinoma (SCC) do not respond adequately to PDT with methyl-δ-aminolevulinic acid (MAL-PDT) and the tumors acquire an infiltrative phenotype and became histologically more aggressive, less differentiated, and more fibroblastic. To search for potential factors implicated in SCC resistance to PDT, we have used the SCC-13 cell line (parental) and resistant SCC-13 cells obtained by repeated MAL-PDT treatments (5th and 10th PDT-resistant generations). Xenografts assays in immunodeficient mice showed that the tumors generated by resistant cells were bigger than those induced by parental cells. Comparative genomic hybridization array (aCGH) showed that the three cell types presented amplicons in 3p12.1 CADM2, 7p11.2 EFGR, and 11q13.3 CCND1 genes. The 5th and 10th PDT-resistant cells showed an amplicon in 5q11.2 MAP3K1, which was not present in parental cells. The changes detected by aCGH on CCND1, EFGR, and MAP3K1 were confirmed in extracts of SCC-13 cells by reverse-transcriptase PCR and by western blot, and by immunohistochemistry in human biopsies from persistent tumors after MAL-PDT. Our data suggest that genomic imbalances related to CCND1, EFGR, and particularly MAP3K1 seem to be involved in the development of the resistance of SCC to PDT. Fil: Gilaberte, Yolanda. Hospital de San Jorge de Huesca. Zaragoza; España Fil: Milla Sanabria, Laura Natalia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Río Cuarto. Facultad de Ciencias Exactas Fisicoquímicas y Naturales. Departamento de Biología Molecular; Argentina Fil: Salazar, Nerea. Universidad Autonoma de Madrid. Facultad de Ciencias. Departamento de Biología.; España Fil: Vera Alvarez, Jesus. Hospital de San Jorge de Huesca. Zaragoza; España Fil: Kourani, Omar. Universidad Autonoma de Madrid. Facultad de Ciencias. Departamento de Biología.; España Fil: Damian, Alejandra. Universidad Autonoma de Madrid. Facultad de Ciencias. Departamento de Biología.; España Fil: Rivarola, Viviana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Río Cuarto. Facultad de Ciencias Exactas Fisicoquímicas y Naturales. Departamento de Biología Molecular; Argentina Fil: Roca, Maria Jose. Hospital de San Jorge de Huesca. Zaragoza; España Fil: Espada, Jesus. Universidad Autonoma de Madrid. Facultad de Ciencias. Departamento de Biología.; España Fil: Gonzalez, Salvador. Memorial Sloan-Kettering Cancer Center. New York; Estados Unidos Fil: Juarranz, Angeles. Universidad Autonoma de Madrid. Facultad de Ciencias. Departamento de Biología.; España

The thymus is a principally lymphoid organ located in the anterosuperior mediastinum and one of the main elements of the immune system. Thymic disease is generally uncommon, and it can be quite varied. The most common thymic tumors are thymomas, but other types of tumors are located in the thymus, and making a differential diagnosis is important because treatment varies greatly from one type of disease to another.1 The fact that the thymus is a lymphoid organ makes it a site for lymphomatous tumor, although primary lymphomas of the thymus are uncommon.1 These lesions make up a heterogeneous group of lymphoproliferative neoplasms, and the distinction between Hodgkin disease and non-Hodgkin lymphoma must be made. Thymic lymphomas must always be considered among the diagnostic options, because the prognosis is strongly dependent on correct early treatment. We report 4 cases of Hodgkin disease of thymic origin and review the literature.