Axillary staging (pN) is considered one of the most important prognostic factors in breast cancer patients. However, the Z0011 study data drastically reduced the number of surgical axillary dissections in a selected group of patients, limiting the prognostic information relating to axillary involvement to the sentinel lymph node (SLN). It is known that there is a relationship between SLN total tumour load (TTL) and axillary involvement. The objective of this study is to analyse the relationship between the TTL and outcomes in patients with early stage breast cancer.clinicopathological and follow-up data were collected from 950 patients with breast cancer between 2009 and 2010 on whom SLN analysis was conducted by molecular methods (One Step Nucleic Acid Amplification, Sysmex, Kobe, Japan).TTL (defined as the total number of CK19 mRNA copies in all positive SLN) correlates with disease free survival (HR, 1.08; p = 0.000004), with local recurrence disease free survival (HR = 1.07; p = 0.0014) and overall survival (HR: 1.08, p = 0.0032), clearly defining a low-risk group (TTL <2.5 × 104 CK19 mRNA copies/μL) versus a high-risk group (>2.5 × 104 CK 19 mRNA copies/μL).SLN TTL permits the differentiation between two patient groups in terms of DFS and OS, independently of axillary staging (pN), age and tumour characteristics (size, grade, lymphovascular invasion). This new data confirms the clinical value of low axillary involvement and could partially replace the information that staging of the entire axilla provides in patients on whom no axillary lymph node dissection is performed.
espanolObjetivos: Analizar las caracteristicas descriptivas de los ingresos de Desintoxicacion por Alcoholismo u otras Toxicomanias en mujeres que requieren un ingreso hospitalario de desintoxicacion en nuestro medio. Diseno: Retrospectivo, incluyendo todas las mujeres ingresadas en la Unidad de Desintoxicacion de la Corporacio Sanitaria i Universitaria Parc Tauli de Sabadell (Barcelona) entre enero de 2010 y junio 2013. Utilizamos criterios diagnosticos DSM-IV-TR y una estadistica descriptiva. De forma secundaria, se compararon mujeres que habian requerido un ingreso por alcohol como sustancia principal de desintoxicacion (APD) y aquellas con alcohol como sustancia unica de desintoxicacion (AUD) en relacion al resto de la muestra. Resultados: Desde Enero de 2010 a Junio de 2013 se realizaron 360 ingresos en la Unidad de Desintoxicacion, de los cuales 82 fueron mujeres (22,7%). Se trataba de mujeres de edad media (43,3 anos) que ingresaron principalmente para la desintoxicacion de mas de una sustancia. El toxico principal fue el alcohol con 67,1% (n=55), seguido de las politoxicomanias que incluyeron casos con abuso de varias sustancias como motivo principal de desintoxicacion. A nivel de otra comorbilidad psiquiatrica, las mayoria de las mujeres no presentaban ningun diagnostico DSM-IV-TR (53,7%, n=44). Las mujeres AUD (n=33) fueron significativamente mayores de edad, utilizaron mas benzodiacepinas y tuvieron menos diagnosticos en el Eje II. Conclusiones: El principal motivo de desintoxicacion en mujeres de nuestro medio es el alcohol. Existen diferencias significativas entre las mujeres con desintoxicacion de alcohol y aquellas con consumos comorbidos de otras sustancias. EnglishObjectives: To analyze the characteristics of inpatient detoxification hospitalizations for alcoholism and other drug addictions in women from our area. Design: We use a retrospective design. The subjects were inpatient women hospitalized in the Detoxification Unit at the Corporacio Sanitaria i Universitaria Parc Tauli de Sabadell (Barcelona) between January 2010 and June 2013. Diagnoses were made by DSM-IV-TR criteria. The statistics were descriptive. In a secondary analysis, we compared women with alcohol as a principal reason of admission (APD) with women with alcohol as an isolated reason of admission (AUD) in relation with the rest of the sample. Results: From January 2010 to June 2013 there were 360 admissions in the Detoxification Unit, 82 of whom were women (22.7%). These were middle-aged women (43.3 years), who were mainly admitted for detoxification from more than one substance. The main drug involved in the abuse was alcohol (67.1%, n=55), followed by multiple drug abuse as a main reason for detoxification. Considering psychiatric comorbidity, most of the women did not display any DSM-IV-TR diagnosis criteria (53.7%, n=44). Women in AUD (n=33) were significantly older, used more benzodiazepines and had fewer Axis II diagnoses. Conclusions: The main reason for inpatient detoxification in women in our area is alcohol. There are significant differences between women with alcohol detoxifications and women with comorbid abuse of other substances.
Background: Establishing the etiology of community-acquired pneumonia (CAP) in children at admission is challenging. Most of the admitted children with CAP receive antibiotics. We aimed to build and validate a diagnostic tool combining clinical, analytical and radiographic features to differentiate viral from bacterial CAP, and among bacterial CAP, typical from atypical bacteria. Methods: Design—observational, multi-center, prospective cohort study was conducted in 2 phases. Settings: 24 secondary and tertiary hospitals in Spain. Patients—A total of 495 consecutive hospitalized children between 1 month and 16 years of age with CAP were enrolled. Interventions—A score with 2 sequential steps was built (training set, 70% patients, and validation set 30%). Step 1 differentiates between viral and bacterial CAP and step 2 between typical and atypical bacterial CAP. Optimal cutoff points were selected to maximize specificity setting a high sensitivity (80%). Weights of each variable were calculated with a multivariable logistic regression. Main outcome measures—Viral or bacterial etiology. Results: In total, 262 (53%) children (median age: 2 years, 52.3% male) had an etiologic diagnosis. In step 1, bacterial CAPs were classified with a sensitivity = 97%, a specificity = 48%, and a ROC’s area under the curve = 0.81. If a patient with CAP was classified as bacterial, he/she was assessed with step 2. Typical bacteria were classified with a sensitivity = 100%, a specificity = 64% and area under the curve = 0.90. We implemented the score into a mobile app named Pneumonia Etiology Predictor, freely available at usual app stores, that provides the probability of each etiology. Conclusions: This 2-steps tool can facilitate the physician’s decision to prescribe antibiotics without compromising patient safety.