Sentinel node disection in the treatment of early stages of vulvar cancer.

OBJECTIVES: To assess the results of sentinel lymph node (SLN) detection in the initial stages of vulvar cancer and the recurrences that may appear. STUDY DESIGN: 76 patients with vulvar carcinoma, Stage I and II. Between 2000 and 2010, identification of the SLN was performed with a perilesional injection of Tc99m and vital dye. Ninety sentinel lymph nodes were found. They were removed separately, and lymphadenectomy was performed depending on the involved areas. Vulvar tumour was also removed. RESULTS: 76 patients were included in the study; 20 (22.22%) out of 90 SLNs presented metastases and 70 (77.77%) did not. There were no false negatives, and the sensitivity and negative predictive value reached 100%. Thirty-six months after treatment, one patient presented recurrence with a negative SLN, and two with positive SLNs. CONCLUSION: Biopsy of the SLN is a reasonable alternative to lymphadenectomy in patients with vulvar cancer Stage I and II.

Giant Isolated Omphalocele: Role of Prenatal Diagnosis in Prognostic Asessment and Perinatal Management.

Omphalocele is a congenital malformation of the abdominal wall consisting of a protrusion of the abdominal contents at the base of the umbilical cord. It has a high association with genetic and structural defects; however, if the latter is ruled out, its prognosis improves significantly. Prenatal diagnosis has a key role in this condition as omphalocele can be diagnosed by ultrasound in the first trimester scan, enabling a coordinated approach strategy to achieve the best perinatal results. We present a case report of a pregnant patient with a fetus having a giant omphalocele in which prenatal diagnosis played a decisive role, allowing the coordination of a multidisciplinary team, which was crucial in the immediate care of the newborn.

Randomized, double-blind clinical trial to evaluate the efficacy of topical tacalcitol and sunlight exposure in the treatment of adult nonsegmental vitiligo.

BACKGROUND: Vitiligo is a common skin disease which is difficult to treat. Approximately half of patients acquire the disease before the age of 20 years. This disease has a high stigmatizing impact but no ideal, aetiology-oriented, effective therapy has been found to date. Tacalcitol and other vitamin D analogues have been shown to have stimulating activity both on immunomodulatory mediators and on melanocytes in lesional skin. OBJECTIVE: To investigate the efficacy and safety of tacalcitol ointment plus sunlight exposure in the treatment of nonsegmental vitiligo. METHODS: A single-centre, randomized, double-blind, vehicle-controlled study including 80 patients with nonsegmental vitiligo was carried out in a specialized outpatient dermatology clinic within a tertiary care, university-affiliated hospital in Spain. Efficacy was assessed by quantification of the lesional repigmentation area at the end of the study compared with the baseline. Tacalcitol (n = 40) or matching placebo ointment (n = 40) was applied once a day at night. Daily exposure to sunlight for 30 min was performed. Treatment was continued for 4 months. The response of the lesions was clinically verified every 2 weeks by a blinded medical investigator. All adverse effects were recorded. RESULTS: Eighty adult patients with nonsegmental vitiligo were recruited. Over 16 weeks, 64 patients completed the study requirements. There was no significant difference in the repigmentation response at the 16-week time point between the vehicle + sunlight exposure and the tacalcitol + sunlight exposure groups. No reduction in the size of the lesions > 25% was observed in the tacalcitol-treated patients. No serious adverse effects were observed. CONCLUSION: The combination of tacalcitol with heliotherapy has no additional advantages compared with heliotherapy alone.

Prenatal diagnosis of right aortic arch: associated findings, pregnancy outcome, and clinical significance of vascular rings.

OBJECTIVES: To analyze the characteristics and clinical implications of right aortic arch (RAA) detected in fetal life. METHODS: Retrospective study of all cases of RAA diagnosed prenatally in high-risk patients who underwent fetal echocardiography between 2000 and 2007. RESULTS: There were 48 RAA; 18 had vascular ring (Group 1), including 15 RAA with aberrant left subclavian artery and 3 double aortic arch, and 30 had not vascular ring (Group 2), all RAA with mirror-image branching. The prenatal diagnosis was confirmed in 94%. In Group 1 most fetuses had normal heart (89%), and none had 22q11 deletion. There were 16 live births and all infants but one are asymptomatic (mean follow-up of 31 months). In Group 2 almost all fetuses had congenital heart defects (CHDs) (97%), and five were chromosomally abnormal (17%), including four 22q11 deleted. The 1-year survival rate was 69%, which was significantly higher in Group 1 (89% vs 57%, p < 0.05). CONCLUSIONS: RAA can be accurately diagnosed by fetal echocardiography. The outlook for these patients largely depends on the presence of associated defects, mainly CHDs, and their severity. If isolated, aortic arch anomalies are asymptomatic vascular variants in most cases. This information is important to assist parental counseling in pregnancy.

Patient and Physician Satisfaction with Calcipotriol and Betamethasone Dipropionate Aerosol Foam in the Treatment of Plaque Psoriasis on the Body. / Satisfacción del paciente y el médico con la espuma en aerosol de calcipotriol y dipropionato de betametasona para el tratamiento de la psoriasis vulgar en el cuerpo.

BACKGROUND AND OBJECTIVE: Calcipotriol and betamethasone dipropionate (Cal/BD) aerosol foam is more effective in the treatment of plaque psoriasis than earlier formulations incorporating this combination of active ingredients. The aim of this study was to evaluate patient and physician satisfaction with Cal/BD aerosol foam in the treatment of plaque psoriasis on the body. MATERIAL AND METHODS: Retrospective observational study of 446 patients with plaque psoriasis affecting no more than 30% of the body surface area who had received treatment with Cal/BD aerosol foam for 4 weeks. The patients rated their satisfaction with the treatment using the TSQM-9 (Treatment Satisfaction Questionnaire for Medication) and the physicians on a 5-point Likert scale. RESULTS: Patients were highly satisfied with Cal/BD aerosol in terms of its ability to treat their condition (84%), relieve their symptoms (84.4%), and act rapidly (82.8%). With respect to convenience, the patients gave high ratings to ease of use (91.8%), ease of planning (93.9%), and ease of following instructions (89.9%). Global satisfaction was also high, with 85% of patients expressing that they were satisfied, very satisfied, or extremely satisfied with the treatment. Of the physicians, 85.7% stated that they were quite or very satisfied with the treatment. CONCLUSION: Both patients and physicians expressed high satisfaction with the use of Cal/BD aerosol foam for the treatment of plaque psoriasis on the body.

Bortezomib-induced cutaneous lesions in multiple myeloma patients: a case report.

Proteasome inhibitors are emerging as a promising class of anti-cancer therapeutic agents. Bortezomib (PS341) is the first proteosome inhibitor with clinical significance. It acts by blocking vital functions of tumoral cells in myeloma, inducing apoptosis. Its toxicity is usually manageable. Gastrointestinal symptoms, peripheral neuropathy, neuropathic pain and thrombocytopenia are described as the most common side effects. We report on a case of cutaneous lesions induced by bortezomib in a patient with relapsed multiple myeloma (MM).

Does the chaperone heat shock protein hsp70 play a role in the control of developmental processes?

Expression of an hsp70 gene strictly inducible in somatic cells and constitutively expressed during oogenesis was investigated during embryogenesis of the amphibian Pleurodeles waltl. Results from Northern hybridization experiments and RNase protection assays provided evidence for the presence of inducible hsp70 mRNA under normal conditions at every embryonic stage. Immunoblotting of embryo proteins separated by 2D-electrophoresis provided evidence for the presence of a single polypeptide of about 74 kDa likely to be an HSP70-related protein, from unfertilized egg to tailbud stage. Immunocytological analysis showed that HSP70-related proteins were localized in the cytoplasm of all blastomeres. It also pointed out that nuclear transfer of the protein occurs in certain cells, precisely at the time of their invagination and subsequent internalization during normal Pleurodeles development. Such nuclear transfer involves involuting mesodermal cells in the blastopore region at the time of gastrulation. It also involves neurodermic cells at the time of neural tube closure. Interestingly, in exogastrulas nuclear transfer did not occur in cells which could no longer invaginate. Such behavior of HSP70-related proteins led us to suggest that they are involved in the control of nuclear activity associated with important developmental events such as cellular internalization processes. Such a role may be a direct consequence of HSP70-related protein functional properties as molecular chaperones.

Chromosomes of amphibian oocytes as a model for gene expression: significance of lampbrush loops.

Amphibian lampbrush chromosome loops exhibit morphological variability in their RNP matrix. The biological significance of such variability remains unknown. In order to approach this problem, the structural organization of each RNP matrix type was analyzed in relation to transcriptional and post-transcriptional processes. First, autoradiographic and transcription inhibition studies in conjunction with macromolecular spread analysis revealed a particular transcription pattern in the most typical loops, i.e. the globular loops. This pattern was characterized by asynchronous variations in RNA synthesis in the different transcription units present in a given loop. Second, morphological and experimental studies provided evidence that the typical morphologies of different RNP matrices were interconvertible and that the differences between the different RNP matrices resulted from various degrees of tightness in packaging of transcription products. In particular, analysis of thermic-shock-induced changes in the structure of lampbrush chromosomes enabled us to visualize the progressive disorganization of dense RNP matrices into globular, granular and normal matrices. Furthermore, these studies suggested that changes in post-transcriptional processes might play a determining role in the specific morphology of the loops. In particular, the kinetics of each of these different processes, related to one another and/or proteins specific to one or another of these processes, might determine the morphological appearance of the loops. The immunological approach revealed that specific nuclear proteins might therefore interfere with each of these processes. Third, the problem of a possible relationship between the specific morphologies of lateral loops and the expression of particular DNA sequences was approached at the molecular level.

[Prevalence of cardiovascular risk factors in Maghrebian immigrants in a semiurban area of Barcelona]. / Prevalencia de los factores de riesgo cardiovascular en inmigrantes magrebíes de un área semiurbana de Barcelona.

BACKGROUND: The cardiovascular risk factors present a high prevalence in our country, similar to other countries of the Mediterranean area. We don't know which is the distribution of these risk factors in the Maghrebian immigrant population. METHODS: There was designed a descriptive transverse study realized in 4 semiurban health center of Barcelona (Spain). 167 patients were included by means of consecutive sampling, between january 2005 and december 2006, major of age of a total population of 1127 Maghrebian assigned patients. There were studied the following cardiovascular risk factors: age, sex, smoking, hypercholesterolaemia, hypertriglyceridemia, high blood pressure and diabetes mellitus, and information was gathered as: time of stay in our country, weight, height, body mass index, the accomplishment of physical exercise, as well as precedents of isquemic cardiophaty. RESULTS: The middle ages were 36.79 years (SD 11.42) and 59,88% they were men. The average time of stay in our country was 4 years (P25-75, 2-6). The average IMC was of 26.96 (SD 5.21). 25.75% was smokers, 22.75% obesity, 19.76% hypercholesterolaemia, 15.57% hypertriglyceridemia, 10.78% diabetes mellitus, 10.78% hypertension and 1.2% CI's precedents. The prevalence of cardiovascular risk factors was higher in women, with a significant difference in obesity, 35.82% by 14% (P <0.002), men had a higher prevalence of smoking, 40% from 4.48% in women (P <0.001). CONCLUSIONS: In our study the North African immigrant population has a prevalence of cardiovascular risk factors different from that obtained in population studies in Morocco, with a clear tendency to resemble the Spanish population of the host.

Ziprasidone in the treatment of delusional parasitosis.

Delusional parasitosis is characterized by a patient's fixed false belief of being infested with parasites or small creatures. The first-line treatment options are typical antipsychotics such as pimozide. However, the accompanying extrapyramidal side effects might limit their use. We report on a patient with a good response to pimozide combined with ziprasidone. Ziprasidone is an atypical antipsychotic drug with a lower risk of extrapyramidal symptoms; thus, it might be considered a good first or second treatment option for delusional parasitosis.

[User satisfaction in the Virgen del Valle Geriatric Hospital, Toledo]. / Satisfacción del usuario en el Hospital Geriátrico Virgen del Valle de Toledo.

OBJECTIVE: Knowing the degree of satisfaction of inpatients at a geriatric hospital METHODS: Observational and descriptive study. Period 23/12/2008 to 02/24/2009. Scope Geriatric Hospital (acute unit and middle stay unit). Discharged patient population. SERVQUAL adapted questionnaire. Main outcomes (received attention, environment, attitude and care professionals, overall satisfaction) analyzed using frequencies and percentages. Comparison of variables with chi square. Suggestions section grouped by category, expressed as frequencies. RESULTS: 159 respondents surveyed. in 50.90% times the family answered. Care received was valued as good and very good in 92%. Environment rating good or very good 75.6%. Professional attitude always nearly always 82.9%. 89.30% would recommend the hospital and overall satisfaction level of 52.20% very satisfied. Suggestions section was completed in 63 questionnaires, we found 20 gratitudes. Respondents that expressed overall satisfaction quite satisfied and very pleased noted to feel trust and security nearly always and always (p =0.0009). CONCLUSIONS: Overall satisfaction levels have been high. Most value good or very good to all professionals. Regarding attitude and care professionals most satisfied or very satisfied. We must improve infrastructure.

Strict Anatomical Colocalization of Vitiligo and Elastolytic Granulomas.

Vitiligo is the most common depigmenting disorder, with a worldwide occurrence of 0.1-2% in the general population. Multiple conditions have been described colocalized in vitiligo patches, like psoriasis or lichen planus. However, actinic granuloma has not been described in association with vitiligo lesions so far.

Conjunctival Melanoma: A New Clinical and Therapeutical Approach.

Melanoma involving the conjunctiva is extremely rare. Graver prognosis has been reported with primary conjunctival melanoma than with their cutaneous counterparts [Collin et al.: Aust N Z J Ophthalmol 1986;14:29-34]. Among conjunctival melanomas, two significant risk factors for tumour-related death have been identified: (i) age older than 55 years and (ii) unfavourable tumour location (caruncle, cornea, fornix, palpebral conjunctiva) [Werschnik and Lommatzsch: Am J Clin Oncol 2002;25:248-255]. Here we present a rare case of lentigo maligna involving the palpebral, bulbar conjunctiva and the caruncle. We describe dermoscopic patterns observed and the use of a novel ocular melanoma therapy with topical imiquimod.

Clear cell sarcoma: a case mimicking primary cutaneous malignant melanoma.

Clear cell sarcoma (CCS) is a recently described variant of sarcoma characterized by prominent clear cells showing features similar to clear cell melanoma. This neoplasm was first described by Dr. Franz M. Erzinger. Primary CCS usually arises in deeper soft tissues, in association with fascia, tendons, or aponeuroses. Characteristic translocation t(12;22) (q13;q12) has been considered pathognomonic for CCS. Prognosis is related to tumor size. An early recognition and initial radical surgery is the key to a favourable outcome. We present a patient with an unusual neoplasm that resembled malignant melanoma.

[Prevalence of metabolic syndrome in the province of Albacete (Spain)]. / Prevalencia del síndrome metabólico en la provincia de Albacete.

OBJECTIVE: The primary objective of this study was to determine the prevalence of Metabolic Syndrome (MS) in people between 40-70 years of age in the province of Albacete (Spain). PATIENTS AND METHODS: A population-based, cross-sectional study was made of people between 40-70 years of age in three representative municipalities of the province of Albacete. A total of 425 subjects were included, with a mean age of 53.1 years (95% CI: 52.3-54). Women represented 50.4% of the series and males 49.6%. All participants were subjected to general laboratory testing, physical examination and the measurement of anthropometric parameters. MS was defined according to the ATP-III criteria. Prevalence of MS and its distribution according to the different epidemiological characteristics were calculated. RESULTS: Total prevalence of MS was 20.9% (88/421), with a mean age of 57 years (95% CI: 55.1-59). Prevalence was seen to increase with age, reaching up to one-third of all subjects over 60 years. Significant differences were observed in relationship to a background of ischemic heart disease, ultrasensitive C-reactive protein elevation and the detection of microalbuninuria in MS subjects. Arterial hypertension and abdominal obesity were the most prevalent criteria in MS subjects. CONCLUSIONS: Taking into consideration the important co-morbidity of MS, knowledge of the prevalence and characteristics of the syndrome in our setting and its early identification and intervention targeted to the different factors underlying MS will contribute to reduce the number of cardiovascular events associated with the syndrome.

Naevus lipomatosus cutaneous superficialis on the nose.

Naevus lipomatosus cutaneous superficialis (NLCS) is an uncommon hamartomatous lesion with an exceptional presentation on the face. We report the case of an elderly patient who presented with a classic type of NLCS on the right nasal orifice. This patient was taking inhaled steroids for his allergic rhinitis during 35 years.

Effects of in vivo heat treatment on lampbrush chromosome structure in amphibian oocytes.

When Pleurodeles (Amphibian, Urodele) females were subjected to high temperatures (32-35 degrees C) for varying periods of time (45 min to 7 days), lampbrush chromosome structure underwent striking modifications. These changes included a numerical reduction in normal loops and progressive disorganization of RNP matrices of various loops. The degree of such disorganization was a function of the intensity and duration of the stress. These modifications were completely reversible when females or oocytes were returned to a normal breeding temperature (20 degrees C). Results are discussed in comparison with previous studies on morphological changes induced by heat shock in lampbrush chromosomes carried out in vitro.