Aberrant axillary breast tissue with pseudoangiomatous stromal hyperplasia in a man.

Diagnosing accessory breast tissue in a male patient is difficult when the condition is unilateral, and there is no areola or nipple. Pseudoangiomatous hyperplasia of the mammary stroma is an uncommon benign mesenchymal proliferation that may mimic low-grade angiosarcoma. We report herein an example of tumoriform pseudoangiomatous hyperplasia of the stroma arising in the accessory breast tissue of a 38-year-old man. The condition presented as a palpable tender axillary mass. Histopathologically, there were no changes of gynecomastia. Only two cases of pseudoangiomatous hyperplasia of the stroma have been previously reported in the accessory breast tissue of men showing unilateral or bilateral gynecomastia. Our case is the first report without associated gynecomastia. Radiologic imaging features are not sufficiently specific to enable a prospective diagnosis of pseudoangiomatous hyperplasia of the stroma. Microscopic examination of the lesion is indispensable in making a definitive diagnosis. Awareness of the condition can avoid difficulty in diagnosing it. Aberrant breast tissue with mass-forming pseudoangiomatous hyperplasia of the stroma, whilst rare, should be included among the benign proliferative mesenchymal lesions of the axilla. Keywords: aberrant breast tissue-accessory breast tissue-pseudoangiomatous stromal hyperplasia-gynecomastia-angiosarcoma-axilla.

Herramienta de alfabetización informacional dirigida a bibliotecarios de ciencias médicas en la provincia de Artemisa, Cuba / Informational alphabetization tool directed to people who work in the medical sciences libraries in Artemisa province, Cuba

Resumen El logro de este proceso informacional en la salud se encuentra centrado en el personal bibliotecario, por lo que resulta necesario fortalecer su desempeño en correspondencia con la identificación de sus necesidades de aprendizaje mediante la aplicación de una herramienta de alfabetización informacional en la provincia de Artemisa, Cuba durante el curso del período 2016-2017. Se realizó una investigación organizada por dos momentos y, con el empleo de métodos empíricos y teóricos, se propuso una herramienta de alfabetización informacional en soporte digital. La metodología utilizada se basó en un medio de enseñanza-aprendizaje de tipo software educativo. La herramienta contribuirá a la calidad en el desempeño del personal que labora en la red de bibliotecas médicas de la provincia de Artemisa.

Abstract The performance of librarians in the medical sciences is enhanced by identifying their training needs through the use of an information literacy tool. We performed this study between 2016 and 2017 with the staff of the medical libraries network at Artemisa province in Cuba. In the first stage of the study we assessed the initial state of the staff's information literacy, and in a second stage, we used empiri-cal and theoretical methods to propose an information literacy tool in digital format. The methodology used was based on educational software. The tool will contribute to enhancing the performance of librarians working in the network of medical libraries in the prov-ince of Artemisa, Cuba.

Merkel cell polyomavirus and human papilloma virus in proliferative skin lesions arising in patients treated with BRAF inhibitors.

The potential role of oncogenic viruses mediating development of proliferative skin lesions in patients treated with RAF inhibitors is poorly understood. The objective of this study was to investigate human papilloma virus (HPV) and Merkel cell polyomavirus (MCPyV) in skin lesions among patients treated with RAF inhibitors with the help of a case series describing prevalence of HPV, MCPyV, and RAS mutations in skin biopsies obtained from patients receiving RAF inhibitors and developing cutaneous lesions. HPV-DNA was amplified by PCR utilizing multiple nested primer systems designed for detection of a broad range of HPV types. MCPyV copy number determination with real time PCR technology was performed by a "Quantification of MCPyV, small t region" kit. Thirty-six patients were tested (squamous cell carcinoma (SCC) = 14; verruca vulgaris = 15; other = 11). Nine of 12 SCCs (75 %) and eight of 13 verruca vulgaris lesions (62 %) tested positive for MCPyV whereas none of the normal skin biopsies obtained from nine of these patients tested positive for MCPyV (p = 0.0007). HPV incidence in cutaneous SCCs was not different compared to normal skin (50 vs. 56 %, p = 0.86). The association between MCPyV and proliferative skin lesions after RAF inhibitor therapy merits further investigation.

[Impact of laparoscopic sacrocolpopexy on symptoms, health-related quality of life and sexuality: A 3-year prospective study]. / Impact de la promontofixation cœlioscopique sur les symptômes pelviens, la qualité de vie et la sexualité : résultats à 3ans d'une étude prospective.

OBJECTIVES: To evaluate the impact of laparoscopic sacrocolpopexy on symptoms, health-related quality of life and sexuality after a 36 month-follow-up. We also reported anatomical outcomes and reoperation rate. PATIENTS AND METHODS: A prospective monocentric study was carried out including 82 women with symptomatic Pelvic Organ Prolapse (POP) stage≥2 according to Pelvic Organ Prolapse Quantification classification. Symptoms were evaluated using the Pelvic Floor Distress Inventory (PFDI-20) and health-related quality of life by the Pelvic Floor Impact Questionnaire (PFIQ-7). Sexual function was evaluated using the Pelvic Incontinence Sexual Questionnaire (PISQ-12). Measurements were recorded at the preoperative examination, then at 3, 12 and 36 months after surgery. RESULTS: PFDI-20 scores were significantly improved at 3 months (91.9 vs. 31.8, P<0.05) and PFIQ-7 scores also (60.8 vs. 16, P<0.05). This scores improvement remained significant at 12 months. There was no significant difference between results obtained at 12 and 36 months for PFDI-20 (36.8 vs. 42.2, P>0.05) and for PFIQ-7 (18.4 vs. 24.7, P>0.05). PISQ-12 score remained significantly improved at 3, 12 and 36 months compared to baseline (34.8, 35.3, 38.5 and 38.5, respectively). Ten patients (12.8%) had anatomical recurrence at 36 months for posterior compartment, 4 (5.1%) for anterior compartment and 1 (1.2%) for medium compartment. Four patients (4.9%) required reintervention. CONCLUSION: Laparoscopic sacrocolpopexy improved early functional outcome that remained significant after at least a 36 months follow up. LEVEL OF EVIDENCE: 4.

Rapid and simultaneous detection of ricin, staphylococcal enterotoxin B and saxitoxin by chemiluminescence-based microarray immunoassay.

Simultaneous detection of small and large molecules on microarray immunoassays is a challenge that limits some applications in multiplex analysis. This is the case for biosecurity, where fast, cheap and reliable simultaneous detection of proteotoxins and small toxins is needed. Two highly relevant proteotoxins, ricin (60 kDa) and bacterial toxin staphylococcal enterotoxin B (SEB, 30 kDa) and the small phycotoxin saxitoxin (STX, 0.3 kDa) are potential biological warfare agents and require an analytical tool for simultaneous detection. Proteotoxins are successfully detected by sandwich immunoassays, whereas competitive immunoassays are more suitable for small toxins (<1 kDa). Based on this need, this work provides a novel and efficient solution based on anti-idiotypic antibodies for small molecules to combine both assay principles on one microarray. The biotoxin measurements are performed on a flow-through chemiluminescence microarray platform MCR3 in 18 minutes. The chemiluminescence signal was amplified by using a poly-horseradish peroxidase complex (polyHRP), resulting in low detection limits: 2.9 ± 3.1 µg L(-1) for ricin, 0.1 ± 0.1 µg L(-1) for SEB and 2.3 ± 1.7 µg L(-1) for STX. The developed multiplex system for the three biotoxins is completely novel, relevant in the context of biosecurity and establishes the basis for research on anti-idiotypic antibodies for microarray immunoassays.

Renal artery aneurysms.

A renal artery aneurysm is defined as a dilated segment of renal artery that exceeds twice the diameter of a normal renal artery. Although rare, the diagnosis and incidence of this entity have been steadily increasing due to the routine use of cross-sectional imaging. In certain cases, renal artery aneurysms may be clinically important and potentially lethal. However, knowledge of their occurrence, their natural history, and their prognosis with or without treatment is still limited. This article aims to review the recent literature concerning renal artery aneurysms, with special consideration given to physiopathology, indications for treatment, different technical options, post-procedure complications and treatment outcomes.

Endoscopic medial maxillectomy as a procedure of choice to treat inverted papillomas.

CONCLUSIONS: Endoscopic medial maxillectomy (EMM) is a safe, effective method for the treatment of inverted papillomas (IPs) of the paranasal sinuses. OBJECTIVE: To evaluate the efficacy of EMM as a surgical technique in the treatment of IP compared with non-endoscopic techniques. PATIENTS AND METHODS: This was a retrospective study of 52 patients with an IP diagnosed by biopsy from 1990 to 2004. EMM was performed in 34 patients (65.4%), whereas non-endoscopic techniques were used in 18 (34.6%). The mean duration of follow-up was 54.2 months. RESULTS: Recurrence occurred in 4 of the 34 patients who underwent EMM (11.8%; 95% confidence intervals (CI) = 39 at 26%) and in 8 of the 18 patients treated using non-endoscopic techniques (44.4%; 95% CI = 23.2 at 67.3%). There was a statistically significant difference (p < 0.05) between treatments, assessed by Kaplan-Meier estimator and log-rank testing. Of the 12 patients who suffered a recurrence, 6 (50%) were treated with endoscopic surgery, 4 (33%) with mediofacial degloving and 2 (17%) were merely followed up; no malignant degeneration occurred.

[Cross-cultural adaptation of a questionnaire for measuring the quality of life of patients taking oral anticoagulants]. / Adaptación transcultural de un cuestionario para medir la calidad de vida de los pacientes con anticoagulación oral.

OBJECTIVE: To adapt to Spanish culture and language a questionnaire developed to evaluate the quality of life of patients taking oral anticoagulation treatment (OAT) and to measure its validity. DESIGN: A descriptive observation study to validate an instrument to measure health-related quality of life. SETTING: Primary and specialist care. PARTICIPANTS: 225 patients, all the patients at our centre who were on OAT and a consecutive sample of patients on OAT from the referral hospital's haemotology service. MAIN MEASUREMENTS: Direct translation, back-translation, and pilot study. Factor analysis and item-dimension grouping, internal consistency analysis and analysis of the item-total correlation of the definitive version of the questionnaire in Spanish. RESULTS: Mean age was 65 (SD=13 years); 51% were women; 45.8% were monitored in PC. Validity study: factor analysis extracted 5 factors that explained 41.62% of total variance value and obtained a grouping different from the original; Cronbach's alpha was .82 overall and ran from .56 to .74 in the various dimensions; and item-total correlation analysis had statistically significant values, except for question 29. CONCLUSIONS: After adaptation to Spanish culture and language of a questionnaire developed to evaluate the quality of life of patients taking OAT, it was found to be a useful instrument, valid for use in our milieu.

[Is benign childhood paroxysmal eye deviation a non-epileptic disorder?]. / Desviación ocular paroxística benigna infantil: un trastorno no epiléptico?

INTRODUCTION: Benign childhood paroxysmal eye deviation (BCPED) is classified as a 'non-epileptic paroxysmal disorder'. CASE REPORTS: We report the cases of four patients aged between 6 months and 2 years, who suffered brief episodes of upward conjugate gaze deviation, with no clonic movements or associated cognitive deterioration. These episodes, which lasted several seconds, appeared in short repeated bouts that became worse with fatigue. Results of the neurological exploration, laboratory examinations, neuroimaging (CAT, MRI, brain ultrasonography) and a neurophysiological study, which included EEG-video monitoring and EEG performed during the waking state, were all normal. A nocturnal polysomnographic study was later conducted for 7-8 hours and EEG, EMG and EOG readings were recorded. The trace showed focal or generalised paroxysmal discharges during non-REM sleep in the form of polyspike-wave and spike-wave complexes. Sleep analysis (Reschstaffen and Kales) showed only a shortened REM sleep latency, with no clear clinical meaning. Several cases have been reported in the literature with identical symptoms and normal results in the diagnostic tests, including daytime polysomnography. CONCLUSIONS: The appearance of these epileptic anomalies in the nocturnal study makes it necessary to perform a complete nocturnal polysomnography. In spite of these findings, BCPED courses favourably and has a benign prognosis both with and without antiepileptic treatment. We therefore believe that BCPED should be classed within the group of 'benign idiopathic epilepsies of childhood'.

[Foreign language syndrome as a first sign of multiple sclerosis]. / Sindrome del acento extranjero como primera manifestación de esclerosis múltiple.

INTRODUCTION: Foreign accent syndrome (FAS) is a little known disorder affecting language which has been described in a few cases after acute strokes or traumatic brain injuries, but until now has not been reported in multiple sclerosis (MS). It is characterised by the appearance of what is perceived to be a foreign accent in the language of the patient. Although it could be included within the dysprosodias that accompany motor aphasias, it should be considered as an entity in its own right, since it may appear without the accompanying aphasia. Aphasia is an infrequent manifestation of MS and even less so when it appears as an initial symptom of the disease. When it does occur it usually accompanies large demyelinating lesions in the dominant hemisphere, and it is usually of a motor type. CASE REPORT: Patient, aged 38 years, who presented FAS that accompanied mild non fluent aphasia as the first manifestation of MS with pseudotumoral lesions. Initially the clinical features were interpreted as a somatoform disorder, which delayed diagnosis. CONCLUSIONS: Like aphasia, FAS can occur in MS as a manifestation of a cortical language disorder. It is important to recognise this in order to prevent mistaken diagnoses.

Short- and medium-term clinical efficacy of three endoscopic therapies for achalasia: a single-blinded prospective study.

OBJECTIVE: to compare the efficacy of three endoscopic therapies for achalasia and to identify predictors of response. DESIGN: prospective, single-blinded study at short and medium term. MATERIAL AND METHODS: 22 patients (9M/13 F; mean age: 47.45 +/- 21.01 years) with confirmed clinical and manometric achalasia were randomised in three groups: intrasphincteric injections of botulinum toxin (group 1: 10 patients ), injections of 1% polidocanol (group 2:6 patients), and a combined therapy with both of them (group 3: 6 patients). Clinical response was evaluated by a score (0-5) of tested symptoms (dysphagia, regurgitation and chest pain) at 1 and 24 weeks post-treatment. RESULTS: at 24 weeks post-treatment group 2 had the best complete response (CR) rate (33.33%), whereas CR in both the botulinum toxin and combined therapy groups was 10 and 0%, respectively. Groups 1 and 2 got an overall improvement in clinical score at 1 (p= 0.02) and 24 weeks (p= 0.04). Five patients (50%) in group 1, two patients (33.33%) in group 2, and three patients (50%) in group 3 needed other therapies (dilation or surgery) because of treatment failure. Separately, neither age nor sex, time from diagnosis or type of therapy could distinguish responders from non-responders in these three groups. However, absence of response within the first week, and an initial clinical score above 7 were predictive factors of poor response at six months. CONCLUSIONS: short- and medium-term clinical response to these endoscopic therapies was limited. The absence of response at seven days and a severe initial clinical score were predictive factors of poor medium-term response.

Kinetics and mechanism of the reaction of a nitroxide radical (tempol) with a phenolic antioxidant.

In the absence of redox-active transition metal ions, the removal of Tempol by Trolox occurs by a simple bimolecular reaction that, most probably, involves a hydrogen transfer from phenol to nitroxide. The specific rate constant of the process is small (0.1 M(-1) s(-1)). Metals can catalyze the process, as evidenced by the decrease in rate observed in the presence of diethylenetriaminepentaacetic acid (DTPA). Furthermore, addition of Fe(II) (20 microM ferrous sulfate and 40 microM EDTA) produces a noticeable increase in the rate of Tempol consumption.

Antibacterial activity of Rhizophora mangle bark.

The aqueous extract of Rhizophora mangle bark, also formulated to ensure physical and chemical stability, was found to inhibit the growth of seven bacteria frequent in infected wounds.

Antiinflammatory constituents from Heterotheca inuloides.

Three new compounds, cadalen-15-oic acid (1), 3,7-dihydroxy-3(4H)-isocadalen-4-one (2), and dicadalenol (3), were isolated from the aerial parts of Heterotheca inuloides (Mexican arnica), together with the known compounds 7-hydroxycadalene (4), 7-hydroxy-4alphaH-3,4-dihydrocadalene (5), 1alpha-hydroxy-1(4H)-isocadalen-4-one (6), 1alpha-hydroxy-4alphaH-1,2,3,4-tetrahydrocadalen-15-oic acid (7), 7-(3,3-dimethylallyloxy)coumarin, caryolan-1,9beta-diol, and quercetin. The structures of the new compounds were elucidated by spectroscopic methods. The antiinflammatory activities of the extracts and the isolated compounds were evaluated by determining the inhibition of TPA-induced mouse ear edema. The natural products 3, caryolan-1,9beta-diol, and quercetin were the most active substances tested and displayed dose-dependent activities.

Role of peroxynitrite in macrophage microbicidal mechanisms in vivo revealed by protein nitration and hydroxylation.

The cytotoxins produced by phagocytic cells lacking peroxidases such as macrophages remain elusive. To elucidate macrophage microbicidal mechanisms in vivo, we compared the lesion tissue responses of resistant (C57Bl/6) and susceptible (BALB/c) mice to Leishmania amazonensis infection. This comparison demonstrated that parasite control relied on lesion macrophage activation with inducible nitric oxide synthase expression (iNOS), nitric oxide synthesis, and extensive nitration of parasites inside macrophage phagolysosomes at an early infection stage. Nitration and iNOS expression were monitored by confocal microscopy; nitric oxide synthesis was monitored by EPR. The main macrophage nitrating agent was shown to be peroxynitrite derived because parasite nitration occurred in the virtual absence of polymorphonuclear cells (monitored as peroxidase activity) and was accompanied by protein hydroxylation (monitored as 3-hydroxytyrosine levels). In vitro studies confirmed that peroxynitrite is cytotoxic to parasites whereas nitric oxide is cytostatic. The results indicate that peroxynitrite is likely to be produced close to the parasites and most of it reacts with carbon dioxide to produce carbonate radical anion and nitrogen dioxide whose concerted action leads to parasite nitration. In parallel, some peroxynitrite decomposition to the hydroxyl radical should occur due to the detection of hydroxylated proteins in the healing tissues. Consequently, peroxynitrite and derived radicals are likely to be important macrophage-derived cytotoxins.

New modified eremophilanes from the roots of Psacalium radulifolium.

The investigation of the chemical constituents from the roots of Psacalium radulifolium, a member of the matarique complex of medicinal plants, which includes several members of the Asteraceae, resulted in the isolation of four new modified eremophilanes: radulifolin A (4), epi-radulifolin A (5), radulifolin B (6), and radulifolin C (7), together with the known natural substances cacalol, cacalone, epi-cacalone, O-methyl-1,2-dehydrocacalol, adenostin A, decompostin, and neoadenostylone. Antimicrobial evaluation of the extracts and the isolated compounds indicated that cacalol was the major active compound.