A. Martín

Adenomioepitelioma de mama: descripción de cuatro casos y revisión de la literatura

Adenomyoepitheliomas of the breast are infrequent tumors with a variable histological appearance, and they can mimic several epithelial, myoepithelial and biphasic lesions of the breast. We have reviewed four cases of adenomyoepithelioma of the breast diagnosed between 2005 and 2015 in our institution (Hospital Clínico San Carlos). Mean age was 57years. All lesions were solid irregular masses located in the upper quadrants (3 of them in the right breast and one in the left), with an average size of 13mm. Microscopically 2 of them were tubular and the remaining 2 were lobulated subtypes. Hyaline, myxoid and cystic areas, peripheral pseudoinfiltration and satellite nodules were occasionally seen. Myoepithelial cells were fusiform and immunohistochemically they were actin, calponin, p63, S100 and CD10 positive and CKAE1-AE3 negative, with variable CK23BE12 and CK5/6 staining. In all cases lumpectomy was curative, no recurrences or malignant degeneration were observed.

3. Vasovagal Syncope, Tilt Testing

Clinical presentation of patients with syncope: implications for therapy. Objectives To asses the clinical presentation of syncope and its impact on acute management. Methods Prospective observational study in 19 ED during Dec, 2003. Results 1428 patients included (prevalence: 1,21%), age 57±22 y., 51% females. Co-morbidity hypertension 25%, structural HD 16% (CAD 62%), arrhythmia 11% (AF 67%, Pacemaker 17%, AV block 5%, SSS 3%, VT 2%), neurological disease (Stroke 67%, epilepsy 13%). Previous syncope 92%. Presentation: triggers in 52% (pain 9%, orthostatism 7%, crowded/warm places 6%, emotion 5%, drugs 5%, micturition 3%, exercise 3%, defaecation 1,5%, hemorrhage 0,8%, change in posture 0,6%) and prodromal symptoms in 60% (malaise/nausea/sweating 50%, palpitation 3%, chest pain 2,3%, dyspnoea 1,7%). Physical findings confusion 5%, ↓ level consciousness 0,4%, murmurs 4,3% heart failure 1,4%; BP and HR normal (95%). Disposition: discharge 73% (21% outpatient clinic: cardiology 6,7%), ED observation 10%, admission 16%. The presence of SHD was associated with admission and derivation to outpatient clinic (p<0.001). Conclusions Patients with syncope usually arrive without physical findings but clinical criteria are helpful to differentiate from non-syncopal attacks. Structural heart disease is the strongest clinical determinant of management.

3. Vasovagal Syncope, Tilt Testing3.1 Clinical Presentation of Patients with Syncope: Implications for Management

Clinical presentation of patients with syncope: implications for therapy. Objectives To asses the clinical presentation of syncope and its impact on acute management. Methods Prospective observational study in 19 ED during Dec, 2003. Results 1428 patients included (prevalence: 1,21%), age 57±22 y., 51% females. Co-morbidity hypertension 25%, structural HD 16% (CAD 62%), arrhythmia 11% (AF 67%, Pacemaker 17%, AV block 5%, SSS 3%, VT 2%), neurological disease (Stroke 67%, epilepsy 13%). Previous syncope 92%. Presentation: triggers in 52% (pain 9%, orthostatism 7%, crowded/warm places 6%, emotion 5%, drugs 5%, micturition 3%, exercise 3%, defaecation 1,5%, hemorrhage 0,8%, change in posture 0,6%) and prodromal symptoms in 60% (malaise/nausea/sweating 50%, palpitation 3%, chest pain 2,3%, dyspnoea 1,7%). Physical findings confusion 5%, ↓ level consciousness 0,4%, murmurs 4,3% heart failure 1,4%; BP and HR normal (95%). Disposition: discharge 73% (21% outpatient clinic: cardiology 6,7%), ED observation 10%, admission 16%. The presence of SHD was associated with admission and derivation to outpatient clinic (p<0.001). Conclusions Patients with syncope usually arrive without physical findings but clinical criteria are helpful to differentiate from non-syncopal attacks. Structural heart disease is the strongest clinical determinant of management.

Clinical Presentation of Patients with Syncope: Implications for Management

Clinical presentation of patients with syncope: implications for therapy. Objectives To asses the clinical presentation of syncope and its impact on acute management. Methods Prospective observational study in 19 ED during Dec, 2003. Results 1428 patients included (prevalence: 1,21%), age 57±22 y., 51% females. Co-morbidity hypertension 25%, structural HD 16% (CAD 62%), arrhythmia 11% (AF 67%, Pacemaker 17%, AV block 5%, SSS 3%, VT 2%), neurological disease (Stroke 67%, epilepsy 13%). Previous syncope 92%. Presentation: triggers in 52% (pain 9%, orthostatism 7%, crowded/warm places 6%, emotion 5%, drugs 5%, micturition 3%, exercise 3%, defaecation 1,5%, hemorrhage 0,8%, change in posture 0,6%) and prodromal symptoms in 60% (malaise/nausea/sweating 50%, palpitation 3%, chest pain 2,3%, dyspnoea 1,7%). Physical findings confusion 5%, ↓ level consciousness 0,4%, murmurs 4,3% heart failure 1,4%; BP and HR normal (95%). Disposition: discharge 73% (21% outpatient clinic: cardiology 6,7%), ED observation 10%, admission 16%. The presence of SHD was associated with admission and derivation to outpatient clinic (p<0.001). Conclusions Patients with syncope usually arrive without physical findings but clinical criteria are helpful to differentiate from non-syncopal attacks. Structural heart disease is the strongest clinical determinant of management.

4. Syncope Evaluation & Syncope Unit

Background Previous studies suggest that the management of patients (pts) with syncope admitted to the emergency room (ER) is not standardized. Aims To perform a review of all ER visits in a period of three months, searching for syncope (Sync) and presyncope (Presync) consults, determining incidence, admission rates and diagnostic yield of pts admitted to the ER. Methods Systematic review of electronic charts from 4 academic hospitals. Admission and discharge diagnosis were recorded. A simple standardized diagnostic algorithm based on clinical presentation, previous history, physical examination and ancillary diagnostic tests were blindly reviewed by 3 of the investigators and compared with the admission and discharge diagnosis. Results Sync/presync was the primary diagnosis in 438: Sync 318 (72%) and Presync 120 (28%). Mean age of pts with Sync and Presync was 56±23.5 years, and 50% were females. Structural heart disease was present in 20% (CAD 69%). 123 pts (28%) with Sync/Presync were admitted, representing 0.51% of all ER. Average length of stay was 7.4±9.8 days. Average estimated cost in admitted pts was CAN

4. Syncope Evaluation & Syncope Unit4.1 ECG Performance and Interpretation in Patients Admitted to an Emergency Department because of Loss of Consciousness

4570.33±4700. Diagnosis at the ER visit, discharge and RESASTER diagnosis are summarized in the table: ![Graphic][1] Conclusions Application of a retrospective algorithmic diagnostic approach applied during ER assessment of pts with sync/presync increased diagnostic yield (15% to 77%), with vasovagal syncope accounting for more than half of the diagnosis. Simple clinical may reduce unnecessary testing, costs and hospital admissions in pts presenting with syncope to the ER. [1]: /embed/graphic-1.gif

ECG Performance and Interpretation in Patients Admitted to an Emergency Department because of Loss of Consciousness

Background Previous studies suggest that the management of patients (pts) with syncope admitted to the emergency room (ER) is not standardized. Aims To perform a review of all ER visits in a period of three months, searching for syncope (Sync) and presyncope (Presync) consults, determining incidence, admission rates and diagnostic yield of pts admitted to the ER. Methods Systematic review of electronic charts from 4 academic hospitals. Admission and discharge diagnosis were recorded. A simple standardized diagnostic algorithm based on clinical presentation, previous history, physical examination and ancillary diagnostic tests were blindly reviewed by 3 of the investigators and compared with the admission and discharge diagnosis. Results Sync/presync was the primary diagnosis in 438: Sync 318 (72%) and Presync 120 (28%). Mean age of pts with Sync and Presync was 56±23.5 years, and 50% were females. Structural heart disease was present in 20% (CAD 69%). 123 pts (28%) with Sync/Presync were admitted, representing 0.51% of all ER. Average length of stay was 7.4±9.8 days. Average estimated cost in admitted pts was CAN

Risk Stratification and Follow-Up in Patients Who Attended an Emergency Department Because of Loss of Consciousness

4570.33±4700. Diagnosis at the ER visit, discharge and RESASTER diagnosis are summarized in the table: ![Graphic][1] Conclusions Application of a retrospective algorithmic diagnostic approach applied during ER assessment of pts with sync/presync increased diagnostic yield (15% to 77%), with vasovagal syncope accounting for more than half of the diagnosis. Simple clinical may reduce unnecessary testing, costs and hospital admissions in pts presenting with syncope to the ER. [1]: /embed/graphic-1.gif

Neoplasias mucinosas papilares intraductales de páncreas: presentación de dos casos

Background Previous studies suggest that the management of patients (pts) with syncope admitted to the emergency room (ER) is not standardized. Aims To perform a review of all ER visits in a period of three months, searching for syncope (Sync) and presyncope (Presync) consults, determining incidence, admission rates and diagnostic yield of pts admitted to the ER. Methods Systematic review of electronic charts from 4 academic hospitals. Admission and discharge diagnosis were recorded. A simple standardized diagnostic algorithm based on clinical presentation, previous history, physical examination and ancillary diagnostic tests were blindly reviewed by 3 of the investigators and compared with the admission and discharge diagnosis. Results Sync/presync was the primary diagnosis in 438: Sync 318 (72%) and Presync 120 (28%). Mean age of pts with Sync and Presync was 56±23.5 years, and 50% were females. Structural heart disease was present in 20% (CAD 69%). 123 pts (28%) with Sync/Presync were admitted, representing 0.51% of all ER. Average length of stay was 7.4±9.8 days. Average estimated cost in admitted pts was CAN

P.2. Syncope, Pacemaker, CRT & ICD

4570.33±4700. Diagnosis at the ER visit, discharge and RESASTER diagnosis are summarized in the table: ![Graphic][1] Conclusions Application of a retrospective algorithmic diagnostic approach applied during ER assessment of pts with sync/presync increased diagnostic yield (15% to 77%), with vasovagal syncope accounting for more than half of the diagnosis. Simple clinical may reduce unnecessary testing, costs and hospital admissions in pts presenting with syncope to the ER. [1]: /embed/graphic-1.gif