Large-Scale Interlaboratory DI-FT-ICR MS Comparability Study Employing Various Systems.

Ultrahigh resolution mass spectrometry (UHR-MS) coupled with direct infusion (DI) electrospray ionization offers a fast solution for accurate untargeted profiling. Fourier transform ion cyclotron resonance (FT-ICR) mass spectrometers have been shown to produce a wealth of insights into complex chemical systems because they enable unambiguous molecular formula assignment even if the vast majority of signals is of unknown identity. Interlaboratory comparisons are required to apply this type of instrumentation in quality control (for food industry or pharmaceuticals), large-scale environmental studies, or clinical diagnostics. Extended comparisons employing different FT-ICR MS instruments with qualitative direct infusion analysis are scarce since the majority of detected compounds cannot be quantified. The extent to which observations can be reproduced by different laboratories remains unknown. We set up a preliminary study which encompassed a set of 17 laboratories around the globe, diverse in instrumental characteristics and applications, to analyze the same sets of extracts from commercially available standard human blood plasma and Standard Reference Material (SRM) for blood plasma (SRM1950), which were delivered at different dilutions or spiked with different concentrations of pesticides. The aim of this study was to assess the extent to which the outputs of differently tuned FT-ICR mass spectrometers, with different technical specifications, are comparable for setting the frames of a future DI-FT-ICR MS ring trial. We concluded that a cluster of five laboratories, with diverse instrumental characteristics, showed comparable and representative performance across all experiments, setting a reference to be used in a future ring trial on blood plasma.

Spatially Resolved Neuropeptide Characterization from Neuropathological Formalin-Fixed, Paraffin-Embedded Tissue Sections by a Combination of Imaging MALDI FT-ICR Mass Spectrometry Histochemistry and Liquid Extraction Surface Analysis-Trapped Ion Mobility Spectrometry-Tandem Mass Spectrometry.

To make the vast collections of well-documented human clinical samples archived in biobanks accessible for mass spectrometry imaging (MSI), recent developments have focused on the label-free top-down MS analysis of neuropeptides in sections of formalin-fixed, paraffin-embedded (FFPE) tissues. In analogy to immunohistochemistry (IHC), this variant of MSI has been designated MSHC (mass spectrometry histochemistry). Besides the detection and localization of neuropeptide and other biomolecular MS signals in these FFPE samples, there is great interest in their molecular identification and full characterization. We here used matrix assisted laser desorption ionization (MALDI) MSI employing ultrahigh-resolution FT-ICR MS on 2,5-dihydroxybenzoic acid (DHB) coated five-micron sections of human FFPE pituitary to demonstrate clear isotope patterns and elemental composition assignment of neuropeptides (with ∼1 ppm mass accuracy). Besides tandem MS fragmentation pattern analysis to deduce or confirm amino acid sequence information (Arg-vasopressin for the case presented here), there is a need for orthogonal primary structure characterization of the peptide-like MS signals of biomolecules desorbed directly off FFPE tissue sections. In the present work, we performed liquid extraction surface analysis (LESA) extractions on consecutive (uncoated) tissue slices. This enables the successful characterization by ion mobility MS of vasopressin present in FFPE material. Differences in sequence coverage are discussed on the basis of the mobility selected collision induced dissociation (CID), electron capture dissociation (ECD), and UV photodissociation (UVPD) MS/MS. Using Arg-vasopressin as model case (a peptide with a disulfide bridged ring structure), we illustrate the use of LESA in combination with a reduction agent for effective sequencing using mobility selected CID, ECD, and UVPD MS/MS.

Exploring structural signatures of the lanthipeptide prochlorosin 2.8 using tandem mass spectrometry and trapped ion mobility-mass spectrometry.

Lanthipeptides are a family of ribosomally synthesized and post-translationally modified peptides (RiPPs) characterized by intramolecular thioether cross-links formed between a dehydrated serine/threonine (dSer/dThr) and a cysteine residue. Prochlorosin 2.8 (Pcn2.8) is a class II lanthipeptide that exhibits a non-overlapping thioether ring pattern, for which no biological activity has been reported yet. The variant Pcn2.8[16RGD] has been shown to bind tightly to the αvß3 integrin receptor. In the present work, tandem mass spectrometry, using collision-induced dissociation (CID) and electron capture dissociation (ECD), and trapped ion mobility spectrometry-mass spectrometry (TIMS-MS) were used to investigate structural signatures for the non-overlapping thioether ring pattern of Pcn2.8. CID experiments on Pcn2.8 yielded bi and yj fragments between the thioether cross-links, evidencing the presence of a non-overlapping thioether ring pattern. ECD experiments of Pcn2.8 showed a significant increase of hydrogen migration events near the residues involved in the thioether rings with a more pronounced effect at the dehydrated residues as compared to the cysteine residues. The high-resolution mobility analysis, aided by site-directed mutagenesis ([P8A], [P11A], [P12A], [P8A/P11A], [P8A/P12A], [P11A/P12A], and [P8A/P11A/P12A] variants), demonstrated that Pcn2.8 adopts cis/trans-conformations at Pro8, Pro11, and Pro12 residues. These observations were complementary to recent NMR findings, for which only the Pro8 residue was evidenced to adopt cis/trans-orientations. This study highlights the analytical power of the TIMS-MS/MS workflow for the structural characterization of lanthipeptides and could be a useful tool in our understanding of the biologically important structural elements that drive the thioether cyclization process.

Physiologically Relevant Fluid-Induced Oscillatory Shear Stress Stimulation of Mesenchymal Stem Cells Enhances the Engineered Valve Matrix Phenotype.

Support of somatic growth is a fundamental requirement of tissue-engineered valves. However, efforts thus far have been unable to maintain this support long term. A key event that will determine the valve's long-term success is the extent to which healthy host tissue remodeling can occur on the valve soon after implantation. The construct's phenotypic-status plays a critical role in accelerating tissue remodeling and engineered valve integration with the host via chemotaxis. In the current study, human bone-marrow-derived mesenchymal stem cells were utilized to seed synthetic, biodegradable scaffolds for a period of 8 days in rotisserie culture. Subsequently, cell-seeded scaffolds were exposed to physiologically relevant oscillatory shear stresses (overall mean, time-averaged shear stress, ~7.9 dynes/cm2; overall mean, oscillatory shear index, ~0.18) for an additional 2 weeks. The constructs were found to exhibit relatively augmented endothelial cell expression (CD31; compared to static controls) but concomitantly served to restrict the level of the activated smooth muscle phenotype (α-SMA) and also produced very low stem cell secretion levels of fibronectin (p < 0.05 compared to static and rotisserie controls). These findings suggest that fluid-induced oscillatory shear stresses alone are important in regulating a healthy valve phenotype of the engineered tissue matrix. Moreover, as solid stresses could lead to increased α-SMA levels, they should be excluded from conditioning during the culture process owing to their associated potential risks with pathological tissue remodeling. In conclusion, engineered valve tissues derived from mesenchymal stem cells revealed both a relatively robust valvular phenotype after exposure to physiologically relevant scales of oscillatory shear stress and may thereby serve to accelerate healthy valve tissue remodeling in the host post-implantation.

Biochemical Basis of E. coli Topoisomerase I Relaxation Activity Reduction by Nonenzymatic Lysine Acetylation.

The relaxation activity of E. coli topoisomerase I is required for regulation of global and local DNA supercoiling. The in vivo topoisomerase I enzyme activity is sensitive to lysine acetylation⁻deacetylation and can affect DNA supercoiling and growth as a result. Nonenzymatic lysine acetylation by acetyl phosphate has been shown to reduce the relaxation activity of E. coli topoisomerase I. In this work, the biochemical consequence of topoisomerase I modification by acetyl phosphate with enzymatic assays was studied. Results showed that noncovalent binding to DNA and DNA cleavage by the enzyme were reduced as a result of the acetylation, with greater effect on DNA cleavage. Four lysine acetylation sites were identified using bottom-up proteomics: Lys13, Lys45, Lys346, and Lys488. The Lys13 residue modified by acetyl phosphate has not been reported previously as a lysine acetylation site for E. coli topoisomerase I. We discuss the potential biochemical consequence of lysine acetylation at this strictly conserved lysine and other lysine residues on the enzyme based on available genetic and structural information.

Publisher Correction: Novel detection of post-translational modifications in human monocyte-derived dendritic cells after chronic alcohol exposure: Role of inflammation regulator H4K12ac.

A correction to this article has been published and is linked from the HTML version of this paper. The error has not been fixed in the paper.

Novel detection of post-translational modifications in human monocyte-derived dendritic cells after chronic alcohol exposure: Role of inflammation regulator H4K12ac.

Previous reports on epigenetic mechanisms involved in alcohol abuse have focus on hepatic and neuronal regions, leaving the immune system and specifically monocyte-derived dendritic cells (MDDCs) understudied. Our lab has previously shown histone deacetylases are modulated in cells derived from alcohol users and after in vitro acute alcohol treatment of human MDDCs. In the current study, we developed a novel screening tool using matrix assisted laser desorption ionization-fourier transform-ion cyclotron resonance mass spectrometry (MALDI-FT-ICR MS) and single cell imaging flow cytometry to detect post-translational modifications (PTMs) in human MDDCs due to chronic alcohol exposure. Our results demonstrate, for the first time, in vitro chronic alcohol exposure of MDDCs modulates H3 and H4 and induces a significant increase in acetylation at H4K12 (H4K12ac). Moreover, the Tip60/HAT inhibitor, NU9056, was able to block EtOH-induced H4K12ac, enhancing the effect of EtOH on IL-15, RANTES, TGF-ß1, and TNF-α cytokines while restoring MCP-2 levels, suggesting that H4K12ac may be playing a major role during inflammation and may serve as an inflammation regulator or a cellular stress response mechanism under chronic alcohol conditions.

OH-Initiated Oxidation of m-Xylene on Black Carbon Aging.

Laboratory experiments are conducted to investigate aging of size-classified black carbon (BC) particles from OH-initiated oxidation of m-xylene. The variations in the particle size, mass, effective density, morphology, optical properties, hygroscopicity, and activation as cloud condensation nuclei (CCN) are simultaneously measured by a suite of aerosol instruments, when BC particles are exposed to the oxidation products of the OH-m-xylene reactions. The BC aging is governed by the coating thickness (Δrve), which is correlated to the reaction time and initial concentrations of m-xylene and NOx. For an initial diameter of 100 nm and Δrve = 44 nm, the particle size and mass increase by a factor of 1.5 and 10.4, respectively, and the effective density increases from 0.43 to 1.45 g cm(-3) due to organic coating and collapsing of the BC core. The BC particles are fully converted from a highly fractal to nearly spherical morphology for Δrve = 30 nm. The scattering, absorption, and single scattering albedo of BC particles are enhanced accordingly with organic coating. The critical supersaturation for CCN activation is reduced to 0.1% with Δrve = 44 nm. The results imply that the oxidation of m-xylene exhibits larger impacts in modifying the BC particle properties than those for the OH-initiated oxidation of isoprene and toluene.

Hygroscopic Characteristics of Alkylaminium Carboxylate Aerosols.

The hygroscopic growth factor (HGF) and cloud condensation nuclei (CCN) activity for a series of alkylaminium carboxylate aerosols have been measured using a hygroscopicity tandem differential mobility analyzer coupled to a condensation particle counter and a CCN counter. The particles, consisting of the mixtures of mono- (acetic, propanoic, p-toluic, and cis-pinonic acid) and dicarboxylic (oxalic, succinic, malic, adipic, and azelaic acid) acid with alkylamine (mono-, di-, and trimethylamines), represent those commonly found under diverse environmental conditions. The hygroscopicity parameter (κ) of the alkylaminium carboxylate aerosols was derived from the HGF and CCN results and theoretically calculated. The HGF at 90% RH is in the range of 1.3 to 1.8 for alkylaminium monocarboxylates and 1.1 to 2.2 for alkylaminium dicarboxylates, dependent on the molecular functionality (i.e., the carboxylic or OH functional group in organic acids and methyl substitution in alkylamines). The κ value for all alkylaminium carboxylates is in the range of 0.06-1.37 derived from the HGF measurements at 90% RH, 0.05-0.49 derived from the CCN measurements, and 0.22-0.66 theoretically calculated. The measured hygroscopicity of the alkylaminium carboxylates increases with decreasing acid to base ratio. The deliquescence point is apparent for several of the alkylaminium dicarboxylates but not for the alkylaminium monocarboxylates. Our results reveal that alkylaminium carboxylate aerosols exhibit distinct hygroscopic and deliquescent characteristics that are dependent on their molecular functionality, hence regulating their impacts on human health, air quality, and direct and indirect radiative forcing on climate.

Volatility of atmospherically relevant alkylaminium carboxylate salts.

Heterogeneous neutralization reactions of ammonia and alkylamines with sulfuric acid play an important role in aerosol formation and particle growth. However, little is known about the physical and chemical properties of alkylaminium salts of organic acids. In this work we studied the thermal stability and volatility of alkylaminium carboxylate salts of short aliphatic alkylamines with monocarboxylic and dicarboxylic acids. The enthalpy of vaporization and saturation vapor pressure at 298 K were derived using the kinetic model of evaporation and the Clausius-Clapeyron relation. The vapor pressure of alkylaminium dicarboxylate salts is ∼10(-6) Pa, and the vaporization enthalpy ranges from 73 to 134 kJ mol(-1). Alkylaminium monocarboxylate salts show high thermal stability, and their thermograms do not follow our evaporation model. Hence, we inferred their vapor pressure from their thermograms as comparable to that of ammonium sulfate (∼10(-9) Pa). Further characterization showed that alkylaminium monocarboxylates are room temperature protic ionic liquids (RTPILs) that are more hygroscopic than ammonium sulfate (AS). We suggest that the irregular thermograms result from an incomplete neutralization reaction leading to a mixture of ionic and nonionic compounds. We conclude that these salts are expected to contribute to new particle formation and particle growth under ambient conditions and can significantly enhance the CCN activity of mixed particles in areas where SO2 emissions are regulated.

Acid-catalyzed reactions of epoxides for atmospheric nanoparticle growth.

Although new particle formation accounts for about 50% of the global aerosol production in the troposphere, the chemical species and mechanism responsible for the growth of freshly nucleated nanoparticles remain largely uncertain. Here we show large size growth when sulfuric acid nanoparticles of 4-20 nm are exposed to epoxide vapors, dependent on the particle size and relative humidity. Composition analysis of the nanoparticles after epoxide exposure reveals the presence of high molecular weight organosulfates and polymers, indicating the occurrence of acid-catalyzed reactions of epoxides. Our results suggest that epoxides play an important role in the growth of atmospheric newly nucleated nanoparticles, considering their large formation yields from photochemical oxidation of biogenic volatile organic compounds.

Cánceres mamarios de buen pronóstico: presentación de una serie de 80 casos / Breast cancers of good prognosis: presentation of a series of 80 cases

INTRODUCCIÓN. Se conoce que el tipo histológico del cáncer de mama influye fuertemente en el pronóstico de la enfermedad y que existe una correlación directa entre este y los índices de supervivencia. El objetivo de este estudio fue evaluar las variedades histopatológicas que están asociadas a un buen pronóstico de la enfermedad. MÉTODOS. Se realizó un estudio descriptivo, longitudinal y retrospectivo de la influencia de las variedades histológicas sobre el pronóstico del cáncer mamario en pacientes operadas entre enero de 1976 y diciembre de 2007. De un total de 597 cánceres de mama atendidos en ese período, fueron tomados 80 casos con tipos histológicos de buen pronóstico. RESULTADOS. Se encontraron 23 cánceres de mama no invasivos, todos con un índice de supervivencia elevado. Se presentaron 14 carcinomas mucinosos con un 57 por ciento de metástasis ganglionar, que se evidenció en los tumores con más de 4 cm de diámetro. Se registraron 10 casos de carcinomas tubulares y cribiformes (1,8 por ciento), con un pronóstico excelente. Se estudiaron 16 carcinomas papilares invasores, donde a pesar del gran tamaño no se encontraron ganglios metastáticos en las 168 adenopatías analizadas. Fueron evaluados 17 carcinomas medulares mamarios, para una incidencia del 2,85 por ciento y un pronóstico relativamente favorable. CONCLUSIONES. Todas estas variedades histopatológicas, exceptuando las no invasivas, tuvieron caracteres invasores comunes, márgenes bien delimitados y un excelente pronóstico luego del tratamiento quirúrgico(AU)

INTRODUCTION. It is known that the histopathological type of breast cancer exerts a strong influence on the prognosis of the disease and that there exists a direct correlation between this and the survival rates. The objective of this study was to evaluate the histopathological varieties associated with a good prognosis of the disease. METHODS. A retrospective, longitudinal, and descriptive study on the influence of the histological varieties on the good prognosis of breast cancer in patients operated on at Dr. Mario Muñoz Monroy University Hospital of Colón, Matanzas Province, from January 1976 to December 2007, was conducted. Of a total of 597 breast cancers attended in that period, 80 cases with histological types of good prognosis were taken. RESULTS. We found 23 non-invasive breast cancers, all of them with an elevated survival rate. 14 mucinous carcinomas were detected with 57 percent of ganglionic metastasis, which was evidenced in the tumors over 4 cm of diameter. Ten cases of tubular and cribriform carcinomas (1.8 percent) with an excellent prognosis were reported. 16 invasive papillary carcinomas were studied. In spite of their great size, no metastatic ganglia were found in the 168 analyzed.adenopathies. 17 medullary breast carcinomas were evaluated for an incidence of 2.85 percent and a relatively favorable prognosis. CONCLUSIONS. All these histopathological varieties, excepting the non-invasive, had common invasive characters, well delimited margins and an excellent prognosis after the surgical treatment(AU)

Lesiones torácicas graves y el enfoque del control de daños / Severe thoracic lesions and the damage control approach

En los últimos años se han desarrollado nuevas estrategias para el tratamiento del trauma grave con lesiones exanguinantes o sin ellas, pero son estas últimas las que más requieren un cambio de la forma de actuar en aras de mejorar la supervivencia. Tales estrategias quirúrgicas se han denominado cirugía de control de daños, que en esencia evita complicaciones como la tríada letal de acidosis, hipotermia y coagulopatía. A diferencia del control de daños en el abdomen, existen lesiones torácicas que requieren una reparación inicial durante el acto quirúrgico, pero pueden hallarse otras cuya reparación puede ser secundaria. El método de control de daños en las lesiones torácicas debe llevarse a cabo con procedimientos que sean técnicamente rápidos y simples, para postergar el tratamiento definitivo de las lesiones que no requieran una reparación inmediata en pacientes in extremis(AU)

New strategies have been developed in the last years to treat severe trauma with exsanguinating lesions or without them. The latter demand more changes in the way of acting in order to improve survival. Such surgical strategies have been called damage control surgery that in essence prevent complications such as the lethal triad of acidosis, hypothermia and coagulopathy. Unlike the control of abdomen damage, there are thoracic lesions requiring an initial repair during surgery, but there may be found others, whose repair is secondary. The damage control method in the thoracic lesions should be conducted with technically fast and simple procedures to postpone the definitive treatment of the lesions that do not require an immediate repair in patients in extremis(AU)

La Tríada de la Muerte: acidosis, hipotermia y coagulopatías en pacientes con traumas / The Death Triad: acidosis, hypothermia and coagulopathies in traumatized patients

Las consecuencias fisiopatológicas y terapéuticas de los pacientes con trauma y con shock hemorrágico grave son causas de la alta mortalidad que muchas veces se escapan de nuestro control. Son la acidosis, la hipotermia y la coagulopatía las complicaciones que irremediablemente llevan a la muerte a los pacientes cuando no son previstas o prevenidas adecuadamente, y nos obligan a postergar el tratamiento quirúrgico definitivo con el objetivo de lograr una mayor supervivencia, mediante pasos consecutivos y ordenados basados en la tolerancia fisiológica del paciente, elemento este que hasta hace alrededor de una década no se tenía en cuenta en la reanimación del paciente con trauma grave. Estas estrategias han sido denominadas "cirugía de control de daños". En este trabajo nos propusimos realizar una revisión de las causas, consecuencias y tratamiento de los componentes de la tríada mortal para un mejor manejo del paciente traumatizado grave...

Fluidoterapia de reanimación en pacientes con trauma grave: ¿Necesita cambiarse? / Resuscitation fluid therapy in patients with severe trauma: Is a change necessary?

El acceso venoso en los pacientes politraumatizados ha sido tradicionalmente una medida de suma importancia que permite la administración de líquidos, analgésicos, anestésicos y drogas reanimadoras. Convencionalmente en un paciente exanguinado, la administración vigorosa de cristaloides o coloides estuvo encaminada a restablecer de forma ®empecinada¼ los valores de tensión arterial cercanos a la normalidad, en un intento por lograr la oxigenación tisular adecuada desde el preoperatorio. Sin embargo, se ha demostrado que tal estrategia de reanimación en este tipo de paciente aumenta la morbilidad y mortalidad de este debido a las graves anormalidades metabólicas que provoca, entre ellas la hipotermia, la acidosis, la coagulopatía y el resangrado de las lesiones vasculares previamente autocontroladas por los mecanismos fisiológicos de la coagulación. Hacemos una revisión de la literatura que refleja los relativamente nuevos puntos de vistas en la fluidoterapia de reanimación del paciente politraumatizado exanguinado(AU)

The veined access in the patient politraumatizados has been traditionally a measure of supreme importance that allows the administration of liquids, analgesic, anesthetics and drugs reanimadoras. Conventionally in a patient exanguinado, the vigorous administration of cristaloides or colloids it was guided to reestablish in way ®empecinada¼ the near values of arterial tension to the normality, in an intent to achieve the oxygenation appropriate tisular from the preoperatorio. However, it has been demonstrated that such a reanimación strategy in patient's type increases the morbilidad and mortality of this due to the serious metabolic abnormalities that it causes, among them the hypothermia, the acidosis, the coagulopatía and the resangrado of the vascular lesions previously autocontroladas for the physiologic mechanisms of the clotting. We make a revision of the literature that reflects the relatively new points of views in the fluidoterapia of reanimación of the patient politraumatizado exanguinado(AU)

Triada mortal en pacientes politraumatizados / Mortal triad in polytraumatized patients

La exanguinación es uno de los motivos fundamentales de fallecimiento en las primeras horas después de un trauma. Los mecanismos fisiopatológicos que contribuyen a la pérdida sanguínea traumática son complejos. Estos pacientes se presentan con severas anormalidades metabólicas, entre las cuales la más notable es el desencadenamiento de la llamada tríada mortal, constituida por: a) hipotermia, b) coagulopatía y c) acidosis. Si estas no pueden ser controladas adecuadamente, pueden llevar rápidamente al paciente a la muerte. Este enfoque ha permitido el surgimiento de la ®cirugía de control de daños¼, una técnica en tres etapas, que tiene como objetivo esencial la restauración de la fisiología normal por encima de la anatomía, en un intento de romper el círculo vicioso de la tríada. En este trabajo nos propusimos realizar una revisión de las causas, consecuencias y tratamiento de los componentes de la tríada mortal, para una mejor atención del paciente traumatizado grave exanguinado(AU)

The exanguinación is one of the fundamental reasons of death in the first hours after a trauma. The mechanisms fisiopatológicos that contribute to the traumatic sanguine loss are complex. These patients are presented with severe metabolic abnormalities, among which the most remarkable is the desencadenamiento of the call mortal triad, constituted for: to) hypothermia, b) coagulopatía and c) acidosis. If these they cannot be controlled appropriately, they can take to the patient quickly to the death. This focus has allowed the emergence of the ®cirugía of control of damages¼, a technique in three stages that he/she has as essential objective the restoration of the normal physiology above the anatomy, in an intent of breaking the vicious circle of the triad. In this work we intended to be carried out a revision of the causes, consequences and treatment of the components of the mortal triad, for the patient's traumatized serious exanguinado better attention(AU)

Carcinoma lobular in situ de la mama: presentación de casos / Breast lobular carcinoma in situ: presentation of a case

La denominación de Cáncer Lobular in Situ es un término engañoso, siendo más apropiado llamarle “neoplasia lobular”. Hasta 1993 se reportaban cerca de 1000 casos. Esta entidad identifica a mujeres que corren riesgo de desarrollar un cáncer invasor mamario. Realizamos un estudio lineal y retrospectivo de las pacientes ingresadas y operadas en el servicio de cirugía general del Hospital Universitario “Dr. Mario Muñoz” de Colón, Matanzas, con el diagnóstico de carcinoma mamario. De 495 pacientes operadas en el período entre enero/1976 a diciembre/2004, encontramos a 22 con un Carcinoma In Situ de la mama, de ellas 18 tenían un carcinoma ductal in situ y 4 un Carcinoma Lobular In Situ, constituyendo estas últimas nuestra muestra. La incidencia general del carcinoma in situ fue del 4,4 por ciento (22/495) mientras la del carcinoma Lobulillar In Situ fue del 0,81 por ciento (4/495), la edad promedio fue de 56 años, un caso resultó bilateral metacrónico, el 75 por ciento de la serie fue intervenida por presentar una tumoración mamaria, siéndoles realizada una cirugía radical al ser la biopsia por congelación positiva sin especificar tipo histológico “in situ”, el cual fue demostrado en el ulterior estudio biópsico por parafina, al 25 por ciento restante sin lesión palpable, se diagnosticó calcificaciones patológicas en estudios mamográficos, realizándose cirugía conservadora. El índice de supervivencia hasta la actualidad es del 100 por ciento. Solo el diagnóstico precoz del carcinoma mamario, específicamente refiriéndonos a los “in situ”, traerá como resultados un aumento global de la sobrevida y mejor pronóstico a las pacientes portadoras de esta devastadora patología...

Carcinoma agudo de la mama. Presentación de casos / Acute breast carcinoma

El Carcinoma Agudo de la Mama tiene una incidencia del 1 al 4 por ciento entre todos los tumores de la mama, en esta rara enfermedad la mama adopta características inflamatorias inespecíficas, teniendo el pronóstico más sombrío entre todos los estirpes histológicos del cáncer mamario. En el presente trabajo además de realizar una revisión bibliográfica sobre el tema, hacemos un estudio retrospectivo sobre la incidencia y manejo de esta enfermedad en el Hospital Universitario “Dr. Mario Muñoz Monroy”del municipio de Colón, Matanzas, mediante la revisión de los expedientes clínicos de 376 pacientes femeninas operadas de cáncer mamario en el período comprendido entre enero de 1983 hasta diciembre de 2004, ambos incluidos, encontrando cinco casos con el diagnóstico de carcinoma agudo de la mama. Se halló una incidencia del 1.33 por ciento, las edades oscilaron entre 30 y 60 años, la enfermedad fue bilateral y sincrónica en el 20 por ciento de las enfermas, al 60 por ciento se aplicó terapia neoadyuvante y cirugía, en el resto el tratamiento solo consistió en radioquimioterapia. Las metástasis más frecuente observadas en el período post tratamiento mediato fueron las óseas. Cuatro de las pacientes fallecieron antes del año de operadas y la última de la serie se encuentra en estado de coma por metástasis cerebral al haber cumplido el año de intervenida. El cáncer agudo de la mama es la expresión clínica de una invasión de la red linfática superficial prosiguiendo el desarrollo tumoral dentro de los vasos con el subsiguiente mal pronóstico clínico-terapéutico corroborado al comparar nuestros resultados con los reportados por la literatura...

Enfermedad de Paget: una forma especial de cáncer mamario / Paget disease: special type of bread cancer

La Enfermedad de Paget de la mama constituye una forma especial de cáncer mamario manifestándose como una dermatitis eczematosa y/o ulcerativa del complejo areola-pezón siendo muchas veces tratada ômedicamenteö al pasarse por alto su origen neoplásico. Realizamos un estudio lineal y retrospectivo de 5 pacientes que ingresaron consecutivamente en el servicio de cirugía general del Hospital Universitario ôDr. Mario Muñoz Monroyö de Colón Provincia de Matanzas con el diagnóstico de Enfermedad de Paget de la mama, en el período comprendido entre enero de 1974 a diciembre de 2002, nuestro propósito fundamental fue el estudio de algunas variables relacionadas con el manejo de esta patología en nuestro medio además de hacer una revisión exhaustiva de la literatura. Se comprobó que la incidencia de la Enfermedad de Paget fue del 1,03 por ciento entre 485 enfermas tratadas por cáncer de mama en dicho período, la edad promedio fue de 60 años, las pacientes con una masa palpable (60 por ciento) tuvieron una mayor incidencia de carcinoma ductal invasivo, ganglios linfáticos positivos y un promedio de supervivencia pobre para pacientes con dicha enfermedad. El tratamiento conservador de la mama resultó una alternativa factible para pacientes con dicha enfermedad y una extensión limitada del carcinoma mamario, mientras que para las pacientes con tumor adyacente, la mastectomía radical modificada con vaciamiento axilar constituyó el manejo más adecuado. Debe alertarse de tener siempre en cuenta el diagnóstico de Enfermedad de Paget en lesiones dermatológicas de la unidad areola-pezón para poder ofrecer el tratamiento adecuado en etapas tempranas y garantizar mejor sobrevida...

Cáncer de mama en el hombre: presentación de casos / Male Breast Cancer: presentation of cases

El cáncer de mama en el hombre ha sido considerado durante mucho tiempo como una curiosidad médica, éste ocupa el lugar 19 en la incidencia de cánceres que afectan al hombre en Cuba, su causa permanece oscura, siendo la presentación clínica, la patología y la historia natural similares a la mujer, no siendo así el pronóstico. En el presente trabajo analizamos el comportamiento clínico-histológico de ocho hombres diagnosticados con cáncer de mama en el Hospital Universitario ôDr Mario Muñoz Monroyö de Colón, Provincia Matanzas, en un período de 23 años, comprendido entre enero de 1980 a diciembre del 2002, siendo un estudio de diseño observacional, descriptivo, de corte transversal y retrospectivo, hacemos además una revisión de la literatura. Entre los resultados más relevantes tenemos que el cáncer de mama en el hombre tuvo una incidencia del 1,6 por ciento, la edad promedio del diagnóstico fue de 69 años, la localización más frecuente fue la subareolar, en 6 pacientes se hizo la confirmación histológica de un carcinoma ductal infiltrante, en un caso se diagnosticó un carcinoma escirroso y en el otro un carcinoma papilar. El 50 por ciento se encontraban en un Estadío II a, la Mastectomía Radical Modificada ha sustituido a la Mastectomía Radical en el tratamiento quirúrgico de los estadíos iniciales. Los resultados coinciden con los encontrados en la literatura revisada, siendo denominador común el precepto del peor pronóstico del cáncer mamario en el hombre fundamentado por una invasión linfática temprana y metástasis a distancias precoces...