Multifocal-multicentric breast cancers: are they of worse prognosis?The malignant mammary pathology can be presented like unifocal or multifocal-multicentric tumors (MFMC). The influence of this factor as prognostic is controversial. Objective: Establish if the presence of MFMC breast cancer, in comparison to the unifocal breast cancer, is associated to worse prognosis. Patients and Method: Combined prospective-retrospective cohort, corresponding to the totality of patients treated by surgery of breast cancer at Hospital FACH between 1972 and 2007 that fulfilled the inclusion criteria, obtaining a total of 589 patients. The statistic analysis was done with Kolmogorov-Smirnov tests and T-student for quantitative variables, chi square for qualitative variables and Kaplan-Meier curves with log rank test for survival. Results: The 93.4% of the patients had unifocal breast cancer, while the rest (6.6%) had MFMC cancer. There were no significant statistical differences between ages of both groups (57.88 and 54.92 years for unifocal and MFMC, respectively). MFMC cancer group presented more bilateral cancer than unifocal cancer group (7.7% versus 1.6%; p = 0.04); also, the lymph node affectation was greater in MFMC group (4.06 versus 1.83 lymph nodes; p = 0.001). There were no statistical significant differences in 5 years survival when comparing unifocal and MFMC tumors (81.8% and 90.4%, respectively; p = 0.223). There were no differences on 5 years free metastasis survival between both groups (Unifocals 86.2%; MFMC 75%; p = 0.651). Discussion: MFMC breast cancer was associated to bad prognostic factors, nevertheless, there was not significant differences in 5 years metastasis free survival and global survival between both groups, reason why multifocality-multicentricity would not confer worse prognosis to the disease.Key words: Breast cancer, multifocality, multicentricity, survival, prognosis. ResumenLa patología mamaria maligna puede manifestarse como tumores unifocales o multifocalesmulticéntricos (MFMC). La influencia de este factor en el pronóstico es controversial. Objetivo: Establecer si la presencia de cáncer de mama MFMC se asocia a peor pronóstico. Pacientes y Método: Cohorte combinada prospectiva-retrospectiva de 589 pacientes sometidas a cirugía por cáncer de mama en el HospiRev.
Hydrocephalus is a common problem in Neurosurgery and Neurology. The usual treatment is the installation of a Ventricular Peritoneal Shunt (VPS). Infection is the most frequent and serious complication. With the aim to identify risk factors associated with infection in the post surgery of VPS in pediatric patients from Carlos Van Buren Hospital a case control study between 1998-2008 was done. Cases were patients with VPS infection reported to the Department of Nosocomial Infections. Results in contingency tables were analyzed to determine Odds Ratio. 264 surgical procedures were studied in 207 patients with 53 infections reported in 26 patients. Signifi cant risk factors were: history of prior ventriculitis, VPS dysfunction and prior external ventricular shunt, concurrent infections at the time of surgery and a neurosurgeon without the specialty of pediatric neurosurgery. We concluded that antibiotic prophylaxis was not an important factor in preventing infection and the neurosurgeon experience is relevant to the development of VPS infections.Key words: VPS, infection, risk factors, ventriculitis, shunt infections. Palabras clave: DVP, infección, factores de riesgo, ventriculitis, infección DVP.Universidad de Valparaíso, Valparaíso, Chile. Facultad de Medicina (APA, RSZ, RVF).Hospital Carlos Van Buren, Valparaíso, Chile. Servicio de Neurocirugía. (RRP, CSZ). Departamento de Control de infecciones (RHO).Los autores declaran no tener conflictos de interés. Fuente de financiamiento:Autónoma. Recibido: 21 de marzo de 2011Aceptado: 13 de octubre de 2011Correspondencia a:Introducción L a hidrocefalia es un problema común en neurología y neurocirugía pediátrica, cuya etiología es un desbalance entre la producción, circulación y reabsorción del líquido cefalorraquídeo (LCR)1 . El desarrollo de esta condición en la infancia es frecuente, siendo secundaria a un grupo variado de patologías cerebrales, entre las cuales destacan: cerebrales congénitas, traumáticas, tumorales, infecciosas y vasculares 2 . Una de las opciones para el tratamiento permanente de esta patología es la inserción de un catéter junto a una válvula que conecte el ventrículo cerebral con una cavidad serosa como el peritoneo 3 o derivativa ventrículo peritoneal (DVP) o con una vena profunda, donde el exceso de LCR pueda ser drenado.Se estima que entre 25 y 46% de las derivaciones tienen un mal funcionamiento durante el primer año después de haber sido instaladas 4,5 , siendo la obstrucción mecánica y las infecciones, las dos principales causas de disfunción valvular 6,7 . La tasa de infección post instalación de DVP en la población infantil se estima en 10% y fl uctúa entre 0 y 22% [8][9][10][11] , siendo una causa importante de morbimortalidad 12 . Las infecciones tempranas son causadas por la microbiota bacteriana introducida al momento de la cirugía, mientras que las tardías corresponden a contaminaciones posteriores 13 . Se han identifi cado diversos factores del paciente y de la atención asociados a una infección de DVP 14 . Entre los factores relac...
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